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0790 IYANNOUGH ROAD/RTE132 - HAZMAT
`7aD �{q-Rnuo 12cad-�*7,�*T INE►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 �EARMASS. EI.E.g! 200 Main Street• Hyannis, MA 02601 \A 039.p�0 'FDMP� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: I Date: Location/Mailing Address: C ` Contact Name/Phone: - 75 V Inventory Total Amount: �_ MSDS: C: 11 M 001 License#:-�q Tier II : Labelina: Spill Plan: Oil/Water Separator: Flojor Drains: k Emergency Numbers: UQk Storage Areas/Tanks: V� �� �� S Emergency/Containment Equipmen . WA ` A VAL k4iS Waste Generator ID: l ��d��� ,L1 Waste Product: Mi M Date&Amount of Last Shi ment/Fre uenc : a C� E@7! Licensed Waste Hauler&Destination: 1 � d Vi Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS na In NOTE: Under the provisions of Ch. 111, Section 31, of the eral Law04MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: �� INFORMATION/RECOMMENDATIONS: bb co AF Ats Viviv Inspe Facility Represe tative: AA It V WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty #1026 ................................................................................................................................. 790 Iyannough Road, Hyannis, IL Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 Bamstable Inspectional Services BARNSTABLE Public Health Division "`"rma .r•"''M ' 1 1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 862-4044 Fax: 508-790.6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE H A Z A T?11eVS!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)st—JUNE 30th), APPLICATION FEES CATEGORY 1 PERMIT 26-110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 O CATEGORY 3 PERMIT 500 or tngre Gallons: $150.00 1V;✓ni f( chK�t(p25�a" °A late charge ofS10.00 will be assessed if pa%ttlrnt is not received by July 1st. l_ --- r Cl 1. ASSESSOR'S MAP AND PARCEL NO. �� I 1 --� 2. IS THIS A PERMIT RENEWAL?_)�,YES__._NO. IF YES,-,KrP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIE;S-�((22,5 GALLONS)? _YES, NO. • 4. FULL NAME OF APPLICANT: U G-1 l 5. NAME OF ESTABLISHMENT: I )tTl-1 5. OF ESTABLISHMENT: -7q( 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 11 8. TELEPHONE NUMBER OF ESTABLIS:'..!ENT: -73 9. EMA,IL ADDRESS: .•Litvwty r,it: iiG it iiv,i:AT..E OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE 0 OF: C(A&ORAriii:Nftjvi: �WC' �l mE l ,. c�(; PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE N: COMPANY ADDRESS EMAIL: SIGNATURE OF APPC.I -'1-l,tt.,._:_,i}ATE 2,_/2_L1 Q,V4Vj1culat FarmAHU Met ApplI Deft 1rt201Q,Qocca.tt • Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --- ---------------------------------------------------------------------------------------------------------------------- -------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 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 4"..a Town of Barnstable -.M. Inspectional Services BARNS LE Public Health Division �-: WAAL A Thomas McKean,Director 200 IvEda Street,Hyannis,MA 02601 wr Office: 508-8624644 F= 508-790-6304 APPLICATION FOR PERMIT TO STO AND/OR UTILIZE HAZMWOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE CHAPTER HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES 3ULY 1st-IUATE 30th), ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS APP CATEGORY I PE LRMITTI26N FIEI0 Gallons: $50.00 CATEGORY 2 PERMIT I I I -499 Gallons: $125.00 QQ CATEGORY 3 PERMIT 500or More Gallons: $150.00 jguSl- 'Alate charge of 10.00 will be assessed i a ent is not received b Ja1 1st. Pd 0 L ASSESSOR'S MAP AND PARCEL NO. j Q '� . 2. IS THIS A PERMIT RENEWAL,? YES NO. IF YES,SKIP QUESTION 3. . 3. FOR ALL NEW PELT APPPLICATIONS,INDICATE WHETHER BUSYNESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: U � 5. NAME OF ESTABLISHMENT: b 6. ADDRESS OF ESTABLISHMENT: _ Q..._n P'ti 0�Q(� A � CA h n t C ... . �s 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: :l o g (e rn n a a e o 1 S. TELEPHONE NUMBER OF ESTABLISHMENT: r o u , L L top�C) Z U — , --- 9. EMAIL ADDRESS: Q \ I e U 10. SOLEOWNER: YES—NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS AND LEPH NE#OF: CORPORATION NAME PRESIDENT t _.. \ll l� 5 tC Q G TREASURER -� Q 4 Y O CLERK _ Z1 Q 12. IF PREPARED BY OUTSIDE PARTY: NAME: COMPANY ADDRESS TELEPHONE#: EMAIL: SIGNATURE OF APPLICANT, DATE ,/ Q 1Appilcuioa Fomu1H®z Mai App Revised 09-10-1 B dacx Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------- ------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 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 of B nslable �Von"glaatoryVmces Richard d V. Scah,Director QPublic Health Divisio BARNSTABLE' sexxsrnsr,�, �U.? . y $ Thomas McKean,Director K� r, °rFo r aim 200 Main Street,Hyannis,MA 02601 1639-2034 Office: 508-862-4644 �� APPLICATION FOR PERMIT TO STORE AND/OR UTIL Fax:UTILIZE H�508-790-6304a�a HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ e--*k CATEGORY 3 PERMIT 500 or more Gallons: $150.001/., *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. , ( o G 2. IS THIS A PERMIT RENEWAL?Y--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: U 5. NAME OF ESTABLISHMENT: \ 6. ADDRESS OF ESTABLISHMENT: .1, r\ rw i1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: l U 0 0 Oct S. TELEPHONE NUMBER OF ESTABLISHMENT:, hro `l � l0 0 U 9. EMAIL ADDRESS: A-e- ` 1 S - v ` CCJ rYl 10. SOLEOWNER:-Y—YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME U ( _ U v (� \� B 110 PRESIDENT � � � �O � TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME' TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:1Application Forms\HAZMAT APP 2017 REVISE —�j 1�b '' II r 1 Number Fee 1219 THE .COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL — Is Hereby Granted a License For: Storing or Handling.500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 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 wr0 of Unstable egulato ,rvlces t r Richard V. Scali,Director � Public Health Division BABSTABLE q EFRHSf.1CL•=HilFVlt •CONIi•11'N.;:IS 410' BARNSTABLE, - Thomas McKean) Director '"_'.'.3"' "'='" •'s` " MAS& y. -639-20-4 1 9`�pr16 39. e`er 200 Main Street, Hyannis,MA 02601 ao��-�oeg Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE i HAZARDOUS MATERIALS rnT ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 o V S *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. .3 A ICE - 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. ri 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: e 5. NAME OF ESTABLISHMENT: Vo'�a w2bj `Q a 6. ADDRESS OF ESTABLISHMENT: :z an !,:-()N Q�na - �--�� �CP ,C,OI 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:%O 7 o LL- . TELEPHONE NUMBER OF ESTABLISHMENT: ��`� ���� 9. EMAIL ADDRESS: 10. SOLEOWNER: ES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME k OCAD P e PRESIDENT TREASURER -%q CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 4 U Q:\Application Forms\HAZMAT APP 2017 REVIS x i Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS . $1so.00 Town of Barnstable Board of Health 4-� This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------ --------- -------------------------------- ----------------------------------------------------------------------- -------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services ti Richard V. Scali, Director ' BAR AS& Public Health Division :r57:,l ftl�Al 16gy. Thomas McKean,Director ,y 200 Main Street, Hyannis,MA 02601 Vy�%4l'q� Office: 508-862-4644 (b Fax: 508-790-6304 Q 1 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 Y15 A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: U M& d alon hs►iefics ¢-Ffa"Aee , T pzC. NAME OF ESTABLISHMENT:- k-6, ti-a kj:�j " ��OC`e A l Oaf ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): /22AtiMTM TELEPHONE NUMBER OF ESTABLISHMENT: (o3t�- o" '�$I��COrp• JP�-' 7 7��3� ��� EMAIL ADDRESS: Sire l ie ens�na @ Lc(fa .COrn SOLE OWNER: YES /NO IF NO,NAME'OF PARTNER: N14 FULL NAME,HOME ADDRESS,AND TEL PHONE#OF: CORPORATION NAME_U I'It1 dalon, CO3rn 7Cs d r-oc 1 nC• PRESIDENT ft(Ll b1 PA R TREASURE -I,U),e6 f' CLERK • IF PREPARED BY OUTSIDE PARTY: S N ft APPLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 `°FtTok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRMA�BLE.g! 200 Main Street• Hyannis, MA 02601 i6j9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT fF0 MA'S I Business Name: 'Me, Otgv+ Sfo,c,,e. 102-fo Date: 2 q Location/Mailing Address: D an�o� �- n►q, S a /; Contact Name/Phone: wtt �/ �o - '775-3 0�0 c� InventoryTotal Amount: IV O� 1�G lk, MSDS: /e S License Tier II : MIA Labelino: Ire-+4-1 ( Spill Plan:orc tom- fr'QIK1*1 Oil/Water Separator: tJ1A Floor Drains: Emergency Numbers: D Storage Areas/Tanks: AZT4-1 /,00< 4- s-,>Pp/y --OarAu., Emergency/Containment E ui ment: Waste Generator ID: AY& Waste Product: Date&Amount of Last Shipment/Frequency: ovK- re-t-Yn5 Licensed Waste Hauler&Destination: -1A ba.e- o SJ "c -f o l I ac.JS Other Waste Disposal Methods: 'J " "- 2 k LIST OF TOXIC AND HAZARDOUS MATERIALS cSSQ2 2Tt d� �✓�Of S " �C�2lQll b t / 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. t vl(vCv,.v,+�c� t nS Antifreeze Dry cleaning fluids -Qe�v�vCO� Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: et OVI, && dog dofA 2- -�—n ►` '� 1 ,1, v� I iLN�J 1�v'e�T 1 y1 O�1�1 -� B1lti . Inspector: a,A Facility Representative: V WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS —' Message Page 1 of 3 Lavelle, Timothy From: Hojnicki, Jeremy Uhojnicki@ulta.com] Sent: Thursday, March 24, 2016 12:01 PM To: Lavelle, Timothy Subject: RE: Ulta Beauty chemical classification form Tim, Attached is a revised Hazardous Materials Inventory Form for the Ulta Beauty store located in Hyannis, Massachusetts. I included estimated gallons of oxidizers/organic products and cleaners/solvents. Please advise if this is acceptable. If so, I can complete the Application for Permit to Store And/Or Utlize Hazardous Materials. I apologize for the delay in getting this information to you. I appreciate all of your assistance. Thank you, Jeremy JEREMY HOJNICKI MANAGER, COMPLIANCE Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.296.1552 jhojnicki(d�ulta.com ulta.com Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: Hojnicki, Jeremy Sent: Thursday, March 17, 2016 1:56 PM To: 'Lavelle, Timothy' Cc: Lentz, Christopher Subject: RE: Ulta Beauty chemical classification form Dear Tim, Thank you for speaking with me this morning. The clarification on the Town of Barnstable hazardous materials requirements that you provided was very helpful. Per your request, attached are two documents which should provide your office with the hazardous materials inventory information for the Ulta store located at 790 lyannough Road in Hyannis, MA. The first document is a list of products by SKU (store keeping units) and the associated hazardous materials classification. This information was provided to Ulta by Ulta's environmental vendor 3E. The second document is a chemical classification form which lists some of the types of products that are considered hazardous materials by volume, Ulta has provided this form to other jurisdictions. As you are probably aware, in the retail industry product lines and product numbers are ever changing and exact numbers of products and product volumes are difficult to accurately determine. Nevertheless, we hope this provides your office with the type of inventory information that you are looking for. Ulta will be completing the Application for Permit to Store and/or Utilize Hazardous Materials and we will send the form along with the application fees to your attention., Please feel free to contact me if you have any questions. Best regards, Jeremy ` JEREMY HOJNICKI MANAGER, COMPLIANCE 4/13/2016 E Message Page 2 of 3 Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.296.1552 jhoinickita'�ulta.com ulta.com j Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.rm From: Lavelle,Timothy [mailto:Timothy.Lavelle@town.barnstable.ma.us] Sent: Thursday, March 10, 2016 9:36 AM To: Hojnicki, Jeremy Subject: RE: Ulta Beauty chemical classification form Hi Jeremy, Thanks for contacting me. I am usually only in the office for phone calls between 8:30 and about 10:00 AM EST, then out in field doing inspections. Please call any day when you're available, except Mondays. Thanks. Timothy Lavelle Hazardous Materials Specialist Town of Barnstable Public Health Division 200 Main St, Hyannis, MA 02601 508-862-4645 tim.lavelle(a)town.barnstable.ma.us -----Original Message----- From: Hojnicki, Jeremy [mailto:ihojnicki@ulta.com] Sent: Wednesday, March 09, 2016 10:34 AM To: Lavelle, Timothy Subject: RE: Ulta Beauty chemical classification form Dear Tim, I was given your contact information from Ulta's Loss Prevention Department. I understand that you have some follow up questions from your visit to the Ulta store located at 790 lyannough Road. I think I might be better equipped to provide you the information that you are looking for. I was also given a copy of the Town of Barnstable Application for Permit To Store And/Or Utlize Hazardous Materials. I would like to make sure that you and your office have all the information that you need for Ulta to complete the application. Are available for a quick phone call today to discuss what you are looking for from Ulta? I am available today between 11am and 2pm, between 3-4pm and also at 5pm (times in EST). Please let me if any of those times work for you or, if not, when you might be available for a call tomorrow or Friday. Thank you, Jeremy JEREMY HOJNICKI MANAGER, COMPLIANCE Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.296.1552 jhojnicki(cDulta.com j ulta.com Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.7M 4/13/2016 ULTA BEAUTY HAZARDOUS MATERIALS INVENTORY COMMON CHEMICAL QUANT LOCATION NAME NAME FORM STORED (storage&use) JUSTIFICATION ACETONE NAIL POLISH REMOVER ACETONE LIQ. 3 GAL. SALES FLOOR MSDS NON-ACETONE NAIL POLISH ETHYL ACETATE LIQ. 3 GAL. SALES FLOOR MSDS REMOVER BUTYL ACETATE LIQ. NAIL POLISH TOULENE LIQ. 14 GAL. SALES FLOOR MSDS ETHYL ACETATE LIQ. SALES FLOOR 90% FRAGRANCE ETHYL LIQ. 54 GAL. STOCKROOM MSDS ALCOHOL 10% SALES FLOOR 90% AEROSAL HAIRSPRAY ETHYL AER SAL N/A STOCKROOM MSDS ALCOHOL 2� 2 4 /b L4a A l 10% OXIDIZERS&ORGANIC PRODUCTS HYDROGEN PEROXIDE LIQ 5 GAL. STOCKROOM 50% MSDS SALES FLOOR 50% CLEANERS& SOLVENTS CORRISVE ACID LIQ. 3 GAL. STOCKROOM MSDS CORRISVE BASES ad Company Name: ULTA BEAUTY# 1026 Company Address: 790 lyannough Road Pagel 1 ,Hyannis, MA 02601 I L� l of L WT,-,Lw vk1T ll-rl' t zo = p Ir 4 l -t- t v k 2 = I SS �9 GlcrVL-�vow�, �Jvoa tf7Dk 3- CL �I Message Page 1 of 4 Lavelle, Timothy To: 1026,Store Subject: RE: From Ulta beauty- Fw: 1026 Fw:`Ulta Beauty chemical classification form -----Original Message----- From: 1026,St-Dre [mailto:Store1026@ulta.com] Sent: Thursday, February 25, 2016 10:14 AM To: Lavelle,Timothy Subject: From Ulta beauty - Fw: 1026 Fw: Ulta Beauty chemical classification form Importance: High STORE 1026 HYANNIS, MA -CAPE TOWN PLAZA CUIta Beauty 00 R on Blvd. Suite 120 o ingbrook, IL 60440 W 508,775.3840 store 1026 a)ulta.com I ulta.com I Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.TM From: Francies, Bayyinah --�� C����fi� �B�'t' 3I� Ib� S�L� 1�� �� �►�t- +0UC' Sent: Friday, February 12, 2016 3:51 PM w To: 1026,Store;,Egan,Joseph; Covington, Donna /A, pp d Subject: RE: 1026 Fw: Ulta Beauty chemical classification form y IV�Ge� �Sfta�l",o►1= — III ie. -fit ►► '►"`�1��� 5 `P Hi Jen- 11 e-evt5-� I spoke to Tracey Anzar she advised that we should use the attached hopefully this will suffice. Thanks, Bay BAYYINAH FRANCIES RISK CLAIMS SPECIALIST Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.378.7178 C 708.261.2661 bfrancies@ulta.coml ulta.com l Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: 1026,Store 3/4/2016 I� ' Message Page 2 of 4 Sent: Wednesday, February 10, 2016 10:09 AM To: Francies, Bayyinah; Egan, Joseph; Covington, Donna Subject: 1026 Fw: Ulta Beauty chemical classification form Hi Bay- Joe Egan suggested I email you for help with the information the town of Barnstable is asking for. I am not sure if we have documentation for these products. Please advise and,Thank you in advance. Jen - GM STORE 1026 HYANNIS, MA -CAPE TOWN PLAZA Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 508.775.3840 store 1026 a(� ulta.com I ulta.com I Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.TM From: Lavelle,Timothy<Timothy.Lavelle@town.barnstable.ma.us> Sent:Wednesday, February 10, 2016 9:48 AM To: 1026,Store Subject: RE: Ulta Beauty chemical classification form Thanks, Jen. This is a good start. Don't you sell a lot of cosmetics though?Also, hair coloring would be a big category. Are you in all this week? I'll stop by when I get a chance. Thanks again, Tim -----Original Message----- From: 1026,Store [ma i Ito:Store 1026@ulta.com], Sent: Tuesday, February 09, 2016 3:35 PM To: Lavelle, Timothy Subject: Ulta Beauty chemical classification form Hi Tim - Attached, please find a chemical classification form. This is what they sent me when I inquired - if it's not the correct info -just let me know and we can do a count. Thanks so much - Jen GM STORE 1026 HYANNIS, MA - CAPE TOWN PLAZA 3 3/4/2016 ' -'Message Page 3 of 4 Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 508.775.3840 store 1026Co-,ulta.com ulta.com Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: Egan,Joseph Sent:Thursday, February 4, 2016 8:57 PM To: 1026,Store Cc:Covington, Donna Subject: RE: 1026 board of health question Hi Jen Attached is what I believe the inspector is looking for. Please share this with him. Let me know if there are any other requests. Thanks Joe JOE EGAN AREA LOSS PREVENTION MANAGER Ulta Beauty 1000 Remington Blvd Bolingbrook, IL 60446 C 508-930-8975 JEcianOWlta.Com I ulta.com Ulta Salon, Cosmetics & Fragrance, Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: 1026,Store Sent: Thursday, February 04, 2016 12:04 PM To: Egan, Joseph Subject: 1026 board of health question Hi Joe - Tim Lavelle the town of Barnstable health inspector was here today- he was inquiring about toxic materials on hand. He was wondering if ULTA has some sort of list of items and estimated quantities on hand. If we don't he would need to do.a walk through and estimate amounts of flammables, combustibles, corrosives and toxics. I am not sure where to begin - so I figured you could lead me in the right direction! 3/4/2016 r-Message Page 4 of 4 Thanks - Jen STORE 1026 HYANNIS, MA -CAPE TOWN PLAZA Ulta Beauty 1000 Remington Blvd, Suite 120 Bolingbrook, IL 60440 W 508.775.3840 store1026()ulta.com I ulta.com I Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM 3/4/2016 CHEMICAL CLASSIFICATION FORM ,F- COMMON CHEMICAL % QUANT QUANT IN LOCATION HAZ NAME NAME COMP CAS# FORM STORED USE(opeiciosed) (stomge&use) CLASSES JUSTIFICATION ACETONE NAIL POLISH REMOVER ACETONE 99% 67-64-1 LIQ. 3 GAL. 0 SALES FLOOR FLIB,IRR,OHH MSDS NON-ACETONE NAIL POLISH ETHYL ACETATE 45% 141-78-6 LIQ. 3 GAL. 0 SALES FLOOR FLIB,IRR,OHH MSDS REMOVER BUTYL ACETATE 35% 123-86-4 LIQ. FLIB,IRR NAIL POLISH TOULENE 20% 108-88-3 LIQ. 14 GAL. 0 SALES FLOOR SENS MSDS ETHYL ACETATE 15% 141-78-6 LIQ. FLIB,IRR,OHH SALES FLOOR 90% FLIB, FRAGRANCE ETHYL 25%to 64-17-5 LIQ. 54 GAL. 0 STOCKROOM IRR, MSDS ALCOHOL 92% 10% OHH SALES FLOOR 90% LEVEL 2&3 AEROSAL HAIRSPRAY ETHYL 22% 64-17-5 AEROSAL 1117 LBS 0 STOCKROOM IRR,OHH MSDS ALCOHOL /4_ 10% Company Name: ULTA BEAUTY STORE#1026 CAPE TOWN PLAZA Company Address: 790 IYANNOUGH ROAD Pagel of 1 HYANNIS,MA 02601 pFTHETph Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMBT�RLE.9` 200 Main Street• Hyannis, MA 02601 i639.MP'�p`000 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT TFD Business Name: 014,5. Beam Date: Location/Mailing Address: 7qO onft() 1000 kmih. " n B 61a "iMe 120 Contact Name/Phone: 630 -a 10 a 9$1q Inventory Total Amount: J ICI MSDS: Lkes License#: 214 Tier II AID Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Aid Emergency Numbers: Storage Areas/Tanks: da Emergency/Containment E ui m t: Qwc(�� Waste Generator ID: AA A A 6005 11 HSl Waste Product: Date&Amount of Last Shipment/Frequency: 111241 a0a O 15 (At S Licensed Waste Hauler&Destination: U liG Eny.5NSk,/+iS 1 P!'0✓lr,yn CP. Ri Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS iNOTE: 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 4 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: AO iTW7-1qWAAd09( 4 AiS Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. MASS. fir. 200 Main Street• Hyannis, MA 02601 'OTEDMP+a,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: o I Date: Location/Mailing Address: 000 ReA,,11440A ` Contact Name/Phone: Inventory Total Amount: ��� MSDS: L— ` License#: 4 Tier II : Labeling: Aes Spill Plan: �Q Oil/Water Separator: VA Floor Drains: Emergency Numbers: c ] Storage Areas/Tanks: ` Emergency/Containment Equipment: 4 aste Generator ID: M.kp Waste-Product: Date&Amount of Last Shi ment/Fre uen : t� 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 �r Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: ak Ins or: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 eA M�`E 200 Main Street• Hyannis, MA 02601 0lE0Mn+a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Q Date: Q14/ Location/Mailing Address: AD P, ziyyJL11V10 loco D & 17, Contact Name/Phone: 6 — 4314 Inventory Total Amount: SDS: t C..a License#: �� �"3 Tier II : Un Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Emer enc Numbers: Storage Area � e, cnw�nws �( Emergency/Containment Equipment: ` Waste Generator ID: M�wj-16%4® Waste Product: (t4i)1-n,5 Date&Amount of Last Shi ment/Fre uenc . Licensed Waste Hauler&Destination: ►C. YiJ6L6 Other Waste Disposal Methods: A-04a Iy l 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) ---------�indshield wash Motor oils V 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 V Miscellaneous Combustible aint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: J=rt'_comM 48,1 (MS Qi iS el,`✓ )e Inspector: —A6 Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°F�►+E rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' MA.q ' 200 Main Street• Hyannis, MA 02601 prFDMP'�a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: V 14", 19,9q.0� =0--/0 2 G Date: z Location/Mailing Address: 7 O y 0, V1 t-, a n t i Contact Name/Phone: - '7'7 -3F3 D bb ; - a t+," W4 Inventory Total mount: 0 a 1 S�DS: �6- C,4)y, License#: a o �ak 3 Tier II : La eb lin : lct-A&,1- tJ�e--7 9?0 Spill Plan: ON<,-t 'r4-1K-1 Oil/WaterSeparator: Floor Drains: Emergency Numbers: OY� l Storage Areas/Tanks: VLUAM \01" Q4t<Ak6 Emergency/Containment Equipment: 5 0r V�t.k t t- s 1 mv\- 5 4 -e, Waste Generator ID: J D°b,1-5 D Waste Product: AthL M Y Date&Amount of Last Shi ment/Fre uenc : 2 110 3 4 "1 ve,,<�,e-e-1 -3 E Qco owe Licensed Waste Hauler&Destination: 1 v\ '5 oc-Yti.1�w� Other Waste Disposal Methods: Vo Ira.m :5 <J-zQ S YKOA� LIST OF TOXIC AND HAZARDOUS MATERIALS N 0 v.n w o-< \,A NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of M"A, hazardous materia 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 �M�ie' Hydraulic fluid (including brake fluid) 45 Windshield wash �G�e� �s� �'y' e }� Motor oils Miscellaneous Corrosives Q�oor 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/RECOMM NDATIONS: MLIP- viuvti oA, IbS e.v� W 0.JGN ado\2 0� v�._ �a c, �Ge�S . Inspector:—l' L`LV^e-lIl`-e— Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I ��1�,..v,� ,ry�1.C,��' ` ,fir.�tx '�' • �� S Co I� • ' `°F�►�r°,�� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARN STABLE. 200 Main Street• Hyannis, MA 02601 ,b,q. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MP'�a Business Name: ` 16,-1"--) Date: 3 7 r 1 Location/Mailing Address: -7610 3.�. wv.o.�ail.� yav�haS Contact Name/Phone: Sow -7 10 _ 4- 19 8 B. ybv 0.�� InventoryTotal Amount: S SDS: - k ay �bl e. License#: �. Tier II : o La eb lin �e�o 1 wo taa5�e G<2A Spill Plan: M I p 1A Oil/WaterSeparator: Floor Drains: o Emergency Numbers: 0 il Storage AreaslTanks: ct,q A,, 9 a l G„�,�4-a�ti.�,lg „ti }��� G1-eA-, 0 S� Emergency/Containment E ui me t: .e�a�� +�`r�� ..ham a 41^ h. �wk- s� o.1ICt s Waste Generator ID: (IA `�0'�'` �`S �a4 5c<-\I, ?� 1 as e Product: s r,n Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: C ,,aw e.,n m,r- LIST OF TOXIC AND HAZARDOUS ATERIALSc vk&W a'(e.5 V., 5 0v1 a.Re. � 5 wv s5 ,e � oe,c,. 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 Xro. r4%%Ct14 Fertilizers Floor&furniture strippers o�� k r� PCB's Metal polishes �' Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" C05 c5 Z fi 3 (including chloroform, formaldehyde, ,nay I 01�Sh. I -6�+' 1 hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: C VK F.25 1L e,7__CvwiyV.. 1A ati.ZIV Gees 5 0 5 < OSIA A I k,e D - u. (�V k,� -�-C¢�'�.aL4t o vw Qov� dQo�..M-dQ�©-'vl • ��' ,PY�� E-a V a-,-!y 5 au v ct vt,'�`� Inspector: 1 , biy4J lei (g 11�'ateyt�e 1�I Facility Representative: C t lxx_ 1 Vt V�►v� Tv )4¢Ll l`^- � - -m+ _,(— WHITE 1 COPY-HEALTH DEPP RTMENT/CANARY CO Y-B SINESS .>,G✓�[L�5 ���� - � �¢�� X• �PteS kA �Qtbecaw�5 45 1u6+Je ,C, � r+�Z0/41. A °FI��o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 sne A�LE. ' 200 Main Street• Hyannis, MA 02601 ArFOMP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: --Ive. ae-1 OLZ Date: Location/Mailing Address: -7 t4y4kp4ts Contact Name/Phone: Slog - 7 - L I�, e k. JX( r K61y Coivie,5 Inventory Total Am unt�5ls> MSDS: N° qe-«55 License#:T'g\�) Tier II : Labelina: Spill Plan: 1a Oil/WaterSeparator: Floor Drains: 90 Emergency Numbers: Storage Areas/Tanks: 9w Imo/ © 4--Ii)e-- 0-d%&ka\\A.� e Co5vw -,gS Aa.� �01�5�� VeyvAvve-S: Q � Emergency/Containment E i ment: Waste Generator ID: tQ1 v Waste Product: M% t- a,AJ o , i- Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: C�Cc Zan v k�� v V,,e CcaS`.. 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" (including chloroform, formaldehyde, `Ma Qw�oJv�SlCova�ue�c� oq etD�j _��L`5� hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION RECOM MEN DATI NS: VA-AA9 k— C I v �CA\vL\rJ, I C f R��Cbwlwt� � � a.,� Inspector L Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �y °Ft►+E►ok Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ena A�LE.$ 200 Main Street• Hyannis, MA 02601 ArFOMA+A,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: IV o') Date: 1 Location/Mailing Address: 51v av&vLo fin, Z Contact Name/Phone: C n o 7 Inventory Total Amount: << q C, MSDS: 'AA1 0`04A1i,,.., License#: /J Tier II : NIN Labeling: — Spill Plan: — Oil/WaterSeparat r: NIA Floor Drains: — Emergency Numbers: Storage Areasi7anks: — Emergency/Containment Equipment: Waste Generator ID: tQ A - M q< 6.x Waste Product: Date&Amount of Last hipmen 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" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: CCOJk /5,,7p0b-0 ,u<}S < eA 5 L, C',evtwv-- e-r -PA1$c- C,O S►Ad.L�C�e-S 4 5 9A I ¢'Jv)AO'- t -s 010 2 19er,44,1,14, - o 44.I Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS • Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify tha Ulta Beauty 790Iyannough Road, Hyannis, IL Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, an and expires 06/30/2016 unless sooner suspended or revoke ------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 04/11/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health 1 a loan Town of Barnstable ' o+<T KIE� Regulatory.Services Richard V. Scah, Director i ' MASS. ' ' Public Health Division D k,4S- ABLE �. 6>0.Y5-P31E-CC 051RV.E•E- iT--rti':AI$ �^ ZB39• 10 MMF095 M:LS•GSTER�`.LLE•WEST 3A:Ji5TABLE F� Thomas McKean Director '6'9_Z°1° - � fag � 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 lob W 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 July 1st. ASSESSORS MAP AND PARCEL NO. 3 ) ®q DATE t J )6 FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: V I A 'S Q A y�j ADDRESS OF ESTABLISHMENT: 'jq0 13 dj NrN&US , R043 , O y a r%i S (')A O�6 o I MAILING ADDRESS (IF DIFFERENT): S,0-- 111> � o�k L 6Q�tjU TELEPHONE NUMBER OF ESTABLISHMENT: 3'�' q J O " y� 14 EMAIL ADDRESS: `\ ►"�� n� J 1 y SOLE OWNER: V YES_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME o� PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SI ATU IE APPLICANT Name: Wal Company Address Telephone#: Email: Q:\Application Fonns\ IAZZAPP Rev I6.docx Page 1 of 2 r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department aivarn Public Health Division !!! rnss Thomas A.McKean,CHO 200 Main Street, Hyannis,MA 02601 Payment Receipt 'Hazardous Materials Payment received: $125.00 (Check) on 4/11/2016 jCheck number: 580592 Check amount: $125.00 Name on check: Ulta Salon, Cosmetics, &Fragrance Inc. :'Business: Ulta Beauty Owner: CAPE HARBOR ASSOCIATES Address: 790 IYANNOUGH ROAD/RTE132, Hyannis i ;Note: Category II Permit Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- --------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health —.t,_..,....�......, .,..,�.,..��wo....a Fay Iw.au is uU I tcwtvt:u uy JUIy lU,LVAJ. • Please feel free to view the above Code,Chapter 108:Hazardous Materials on the Town Website,www.lown.barnstable.ma us,which.is located under the E-Code section if you should have any questions or concerns. Q:\Hvm AMaz Mat Permit 1,ata.DOC Town of Barnstable Regulatory Services Richard V.Scali,Director "'R'F`A01Y.f Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Offim 508-862-4644 - Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS Al"AND PARCEL NO. DATE lY�l�j ``.f t APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OH RAL.ARRD11OUS MATERIALS FULL NAME OF APPLICANT W NAME OF ESTABLISHMENT ADDRESS OF ESTABLISE A/E�N�TK.�7��/�1(.A, �7I I LAr a. tjt-t-;ni C Jo t1 AV- ( VA i Ht Y d S V01Z TELEPHONE NUMIER SOLE OWNER: YESVNO. IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNER: See.. a� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0 Z-C'✓b� STATE OF INCORPORATION ,NCI FULL NAME AND HOME ADDRESS OF: PRESIDF,NT TREASURER CLERIC . �' Tax Analyst GNATURE OF APPLICANT RESTRICTIONS: I I o A u A D D R E s s 1 5 3 3 3, Pc L 82-1134, No-Wwao- D+& 7 HOME TELEPHONE# -`73`J�l CA—h Wempomy Intamm F8es101.XD7\h1AZA1'P kw2015110C T/T'd S6£2982Lb8T6:01 WM906L80ST 1-l'U3H iSMUe:wnJd 8£:10 ST02-eT-NM ELECTED OFFICERS OF KMART CORPORATION • FEIN 38-0729500 3333 BEVERLY ROAD HOFFMAN ESTATES, IL 60179 847-286-2500 NAME TITLE 0 0 Lawrence J Meerschaert VP Tax, Asst Treasurer& Secretary Scott E Huckins Vice President & Treasurer • �T Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department • BMAR rN rna �- Public Health Division Mom ! Thomas A. McKean,CHO 6 q. . �►r�'b�a. 200 Main Street, Hyannis, MA 02601 r Payment Receipt 'Hazardous Materials Payment received: 1$ 00.00 (Check) on 6/30/2015 ICheck number: 130186890 Check amount: $100.00 Name on check: Sears Holding Management Corporation s Business: KMart Corporation Address: 768 Iyannough Road , Hyannis • Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768Iyannough Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r Town of Barnstable °ptHE Tpy� Regulatory Services Richard V. Scali, Director B" MASS.LE, Public Health Division '°rfa 39. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN II I GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C1'� NAME OF ESTABLISHMENT K K 7 ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER: YES_NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION. Is FULL NAME AND HOME.ADDRESS OF: PRESIDENT eDt.o A►'Z7 TREASURER CLERK �lTGNA�TUIWOVAPPLICANT S/, RESTRICTIONS: HOME ADDRESS U• d� (� a' HOME TELEPHONE# 77 Y Q:\AppGcation Fonns\ AZAPP.DOC Town of Barnstable P��F4HE Tti Regulatory Services <r. Q b 4 Richard V. Scali, Director } BARNSTABLS, f 4� . ��� Public Health Division 1659. pTfo Mai°` Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J. Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stared,:transported, utilized, and/or disposed of at a particular site. STEPS 1 — 2 - 3: 1. Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on.or before June.30, 2014. A late charge of$10.00 will be assessed if payment is not received by July 30, 2014. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town WebSite, www.town.barnstable.ma.us , which is located under the E-Code section if you should have any questions or concerns. Q:\Hazmat\Haz Mat Permit Letter.DDC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q\Appiication Forms\HAZAPP.DOC I Appendix B — Hazardous Waste Chart (example j I Haardous W"8,te Sepgaflon. Chart, �Fxp'i835CLN'.4$SlC4`ASS- }.p.,yy,..ayzy..?i MOP(liff ,� �,."; �,,,,, � 1. �i.reca rlcfrckixcar'�tts�rrtsaw-1 �*c.�§rarY car• s�'tnn=+�'rix't� � � .� '4'S�"ast� (�c�tgt&�'�7 �`rlcrui6ic,� iar ct� �'clrunai cultxcnra ' evarec: i i2c qry$w npfc: it irib6 k Yc �.d V`•[2G'i'r'k�A'4�4 7f'd'f8a7F.V.i'irR 5.:.,xt rg° ".1N) ue<=t'li aw o a mole=ta;t cin (I mear rr wYtt§a ara ^tL1 ti' rly td:rs�r; pruthw-kEf in toteir ' r,l rtrrru :r$dt9c i i. pFockwt in owtiv,lhL7,fur, wnc;Cibdd ab-,ofbenr,,wa &al�r(:in:.A"r ag x "rr'1 4rf :i effm 1 tX"'Ylri �,'�• 4 $pilt I� ,��� t ,. i4 (4l".•uw6w-v+t kklxv,.�' ctvJ JQ milal �ak-d in,as%ar b;L vaxtN c�sr�Yr ¢,3 or tlrYrx is t m i vraa,"'M Mid put iMO ttM Wta lWkt trucks ttu ca'ac ry af iepmrlurctha.war.cleuieclup- ra"'4t i 5, I t�rta5 ,&cif .t9v ;(rr rattm'r, tl; s t��,�r s ac r' rr 1w, MRMt lv 1 T 4rv.a,r Am*,rw l srrm, r,;,:tsr cntch A r l 1-6WENT-SCARS AM .Karah,a;rttowntd Affisim wO �* � � � .c�x;�lo14 rttc d�rermirsaei� , Sc lid on rv*v and Romwely 63 L"" t asaanr-af�rac'c«�E•fur,arcirev;- `.: whrx, t€a� ha,�a; �3�rrt.a�r�fFitre-ci':"scree vsara.� ��Ct[:rPt ix: " l Isarral In dw r otr.: r S. if a low i tx�,+rr,nt file,or it a 1*7 r.a�x rat p`r1l W",Sm ax gr;nr'rak*rd Onch w;:t pallet aat.a"Airm.gmterar ,,,�,•", tcra.o ter.xv`re�:l,�elrase tzk�t.;�r, n�rirrarnt�l�:ftw tt�rrrrr x'�r ,��•t axttllec;t-:�Ct' •1E:':'�ta�,�iftElfiLIFC"�". C 'Am star A.t'm YMI WW%4 1�e-'epamired 1 --- 44( sg ct v fix r fn;arr,Wvfm r Cymc pry l anal I.)cram,.. •.hMM #tp. ffi' SYt f9A+ 3adl%i TOPIC TAB PAGE REVISED DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 12 of 14 06/20/14 INDEFINITE STORAGE AND DISPOSAL Appendix A — Hazardous Waste Accumulation Area Set-up HAZARDOUS WASTE ACCUMULATION AREA Typical Setup Using Racks/Shelves Hazardous Waste Yellow Tape or Paint Accumulation Area Sign Hazardous 5 s yr` Waste a� Segregation w -w � Chart `° CD F RBRC A vs Box a M fT r XF F CD Y c� Waste fin... s T Aerosols ater�� 3 feet"No Merchandise" Yellow Tape or Paint Continued on next page TOPIC TAB PAGE REVISED DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 8 of 14 06/20/14 INDEFINITE STORAGE AND DISPOSAL Hazardous Materials/Environmental - EAP Version: 3/15/2012 Page 1 of 2 Hazardous Materials Hazardous materials are chemical substances, which if released or misused can pose a threat to the environment or human health. Examples of hazardous materials include flammable liquids (gasoline, paint thinners, and solvents), corrosives (deck wash, muriatic acid, and concrete cleaner), oxidizers (potassium permanganate, iron out) and gases (propane, MAPP gas). The SHC Environmental Helpline provides 24 hour service on Hazardous Material issues. There a is no direct cost to the unit for these services. C e SHC Environmental Helpline - Poison Control Assistance or MSDS Assistance 1. Call1-888-368-7327 2. Select the appropriate option listed below based on your needs. Select 1 -Spill and environmental emergencies 2 - MSDS/ Poison Control `m 3 -Asbestos, paint, mold, indoor air quality 4 - In-ground hydraulic lifts 5 - Permits, Inspections o 6 -Waste pickup, oil water separators, gasoline pick ups MSDS A Material Safety Data Sheet (MSDS) is a document that is intended to indicate what the hazards of the product are; how to use, store and handle the product safely; what to expect if the recommendations are not followed, what to do if accidents occur; how to recognize symptoms of overexposure and what to do if such incidents occur. MSDS - Requests • MSDS are available online from the Environmental Affairs intranet website at http://law.intra.sears.com/sites/environmental affairs/. • Once at the environmental site, the MSDS links can be found in the "Toolbox" on the left. • If you cannot locate the MSDS online, call the Helpline. The Helpline will fax the MSDS to the unit. • Units need to verify local jurisdictional requirements of having a hard copy "binder"of all MSDS on site. Follow all local jurisdictional requirements. • Customers can request MSDS information by calling 1-866-463-9210. Poison Control SHC Environmental Helpline provides 24 hour service to assist Associates on responding to potential poisoning and appropriate emergency treatment. If you have a poisoning emergency, call the SHC Environmental Helpline. If the victim has collapsed or is not breathing, call 911 for emergency services first. Contact with Hazardous Materials If you come in contact with anything considered hazardous materials, do the following; • If splashed into eyes, flush eyes with cold water for 15 continuous minutes • If in contact with skin, wash skin thoroughly with soap and water • If clothes become contaminated, change clothes • Review the product label or the MSDS for additional first-aid measures • If in doubt, seek medical attention immediately Hazardous Waste Hazardous wastes are hazardous materials that are no longer usable and need to be disposed. http://srscdc00siis204:84/Docs/3/3-4p.aspx 6/23/2014 hazardous Materials/Environmental - EAP Version: 3/15/2012 Page 2 of 2 Hazardous wastes can damage the environment and create a risk to human or animal health if not managed properly. Hazardous waste cannot be placed into regular trash and must be handled by special procedures. Spills / Leaks/Clean-up Depending on whether spills or leaks of hazardous materials come from known or unknown sources, it can still present a health or fire hazard. If the spill or leak can be identified and is not a harmful, trained Associates may clean up the spill/leak using the appropriate items within their c Hazardous Material Spill Kit. 0 c W If the spill is large or cannot be safely cleaned by onsite Associates, contact the Environmental Affairs Helpline and select option 1 for assistance. Associates must always seek assistance if a +o spill or leak occurs from an unknown source. a Always Call for Help If... • there is a doubt about the hazard of the spill c ors • the spill is from an unknown source • enters a drain, or is a large spill • the spill occurs outside of the facility If Associates can safely clean-up the spill, refer to the Spill Cleanup Guide on the SHC Environmental Affairs Webpage for guidance: • http:Maw.intra.sears.com/practice areas/environmental affairs/index.htm • Once at the Environmental Webpage, the Spill Guide links are in the "Toolbox" Section Hazardous Material Spill Kit • Each location must have at least one (1) readily accessible Hazardous Material Spill Kit. Additional HazMat Spill Kits can be ordered through POWS. (Item # Swarz 10076). • The following Associates must receive training on environmental operations (which includes hazardous materials spill response procedures): • ASM, Operations a Paint and Hardware Associates • Unit Manager ° Shipping and Receiving Associates • Loss Prevention Associates 0 Logistics • Cosmetic Associates http://srscdc00siis204:84/Docs/3/3-4p.aspx 6/23/2014 Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS 100.0o Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health JUN-26-2014 09:00 Frorn:BRRNST HEALTH 15027906304 To:912472364635 P.�/,4 ` � 1 Town of ]Barnstable pa Ck- `WHE Regulatory Services rckz .Sew Richard V. Scali,Director ➢MAS&LE. " Public Health Division Tbom.as McKean, Director 200 Main Street, Hy Innis, iN&� 02601 Office: 308-862-464 4 Fax: 503-790-6304 Application Fee: $100.00 ASSESSORS 'A/LAP AND PARCEL:NO. DATF APPLICATION FOR PERM1TI TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS y FULL NAME OF APPLICANT LcLa c� NAME OF ESTABLISHMENT 1�1�Y1�-� � SCLAV ADDRESS OF F.STABLIST ENT � zc- fC) TFT,.F_PHONF NUMBER Off' �( I ' CI 97ZP ' C7 SOLE OWNER: YES /NO ..n -- 1F APPLICANT IS A PA-2TNERSHiP,FULL NA NIE AND 11.0MF ADDRESS OF L � :Coo* w r— PA1ZTN Elk S: ,o M 1N A.PPI.,ICA.NT IS A. CORPORATION: STATE OF INCORPORATION FULL NAME AND HOME ADDRESS Ol+: � l'121i;S)1)t�NT a TREASURER CLERK TaxAnalpt sic;lvn � 'or•nrNr,rc:�v�' RFSTRT(TIONS: HOAIE ADDIZESS 3 3 �ce,�1. _ 62-11��, � HOME TELEPHONE#�17 2�r„ ScX n g E S+1 � Q\AppLcaum f omisAHAZAPVj)(?(' ELECTED OFFICERS OF WART CORPORATION FEIN 38-0729500 3333 BEVERLY ROAD HOFFMAN ESTATES, IL 60179 847-286-2500 NAME TITLE Ronalid D Biore President 0 0 Lawrence J Meerschaert VP Tax, Asst Treasurer& Secretary Scott E Huckins Vice President & Treasurer i Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services Thomas F. Geiler,Director BA MASS. ' Public Health Division .9 MASS. 1639. �0 '0'Eanw�A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. I �.i DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ma d C c � I-C on NAME OF ESTABLISHMENT �rk r� �)L4 o ADDRESS OF ESTABLISHMENT lunnouaVk TELEPHONE NUMBER SOLE OWNER: YES_NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: # 3o Q 3 11 82-1 13AX �� . IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ✓9' 2250 U STATE OF INCORPORATION i FULL NAME AND HOME�ADDRESS OF: PRESIDENT TREASURER CLERK I�Wl� 1h Gjbr�qa&' TaXAnalyst SIGN OF APPLICANT RESTRICTIONS: HOME ADDRESS Bel FS4; �L HOME TELEPHONE # 2 ton 79 Number Fee O 169 THE COMMONWEALTH OF MASSACHUSETTS $100.00 0 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2009 unless sooner suspended or revoked. --------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health fl 1� Town of Barnstable Barnstable W Teti Regulatory Services Department uatuv srnst.e. Public Health Division 1 = �0� 200 Main Street, Hyannis MA 02601 163 9. 2007 Office: 508462-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT SOAkS 401-01 A2 GJ- 000- , NAME OF ESTABLISHMENT K- M ko.T ADDRESS OF ESTABLISHMENT -7 -q Au o I,t Cv w- Ro A r:> TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. --7 , 00 1 STATE OF INCORPORATION r FULL NAME A DI) OF: = ma►�a9 er TREASURER CLERK r- SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS So--' -+ t3�z..r ��.n►� 03So$ HOME TELEPHONE# Z.o-i Q:\Hazmat\Haz Mat Application2008.DOC Town of Barnstable THE Tkyjftrg Regulatory Services Barnstable do Thomas F. Geiler,Director A"muicaCity Public Health Division BARNSTABLE. I I Mass. Thomas McKean, Director 2��� 1639. A`0 200 Main Street FD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular arti lar site. STEPS 1 — 2 - 3: 1. Please complete the attached application form. 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on or before June 30, 2008. A late charge of$10.00 will be assessed if payment is not received by July 1, 2008. Upon receipt of the fee and a completed application form, an inspection will be performed by the Hazardous Materials Specialist to complete the Hazardous Materials On-Site Inventory. A permit will be issued once the inspection is completed and has passed. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town.barnstable.ma.us , which is located under the E-Code section if you should have any questions or concerns. r TO: ALL STORE COACHING TEAMS STORE USE Coach's Initials FROM: STORE OPERATIONS ADMINISTRATION (kl) Date Reviewed RE: Bulletin MCC #4413 "Hazardous Waste Identification, Storage and Disposal" (Connecticut, Illinois, Indiana, New York, Massachusetts, Minnesota, Stores Only) Expectation Every associate is responsible under the Code of Conduct to comply with environmental laws. Store coaches must ensure that all store associates are knowledgeable and understand the difference between "Hazardous Material" and "Hazardous Waste." Certain merchandise and supplies may contain hazardous chemicals or components, such as batteries in a toy or alcohol in a perfume. The presence of hazardous chemicals or components makes the merchandise or supplies a"Hazardous Material"that must be properly handled, regardless of whether the item is damaged, defective, or an undamaged return. Refer to Bulletin MCC#02 "MCC Area Standardization"for additional information on Hazardous Materials. Each store is required to properly determine if a damaged, defective, or returned Hazardous Material item is still usable. Definition of a usable item is "if it can be marked down and sold, used by the store (store use), or donated". Under no circumstances can non-usable items(such as leaking containers or aerosol cans) be donated. Once a Hazardous Material has been determined to no longer be usable, that item is now considered to be "Hazardous Waste" and must be stored in the store's Hazardous Waste Accumulation Area. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 1 of 14 03105/08 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued Policy Points Associates who may come into contact with Hazardous Materials and Hazardous Waste must complete Environmental Hazardous Waste Training and Right to Know Training. Basic principles regarding how to handle Hazardous Waste are taught in these courses. Any associate who has not been properly trained will be prohibited from handling Hazardous Waste. Associates who need to take the courses or a refresher must contact the People Coach or a member of the Store Coaching team for assistance. It is imperative that store associates understand the difference between Hazardous Materials and Hazardous Waste. Hazardous Materials refer to chemical containing items that may be discontinued or aesthetically defective or damaged, but still in usable condition (i.e. not leaking, pumping activator still intact, etc.). These items can be shipped back to vendors following Department of Transportation rules. However, there are restrictions on sending Hazardous Materials to the Return Goods Center(RGC). Refer to Bulletin MCC#02 "MCC Area Standardization" for additional information. Hazardous Waste refers to items that are not usable(i.e., non-sellable, non- donatable expired, cannot use in stores, etc.). These items cannot be shipped anywhere and must be properly stored in the Hazardous Waste Accumulation Area. A waste vendor will pick up Hazardous Waste items on a quarterly basis, as set forth herein. The MC&C Associate, the Loss Prevention Coach and the Store Coach will inspect the Hazardous Waste Accumulation Area on a weekly basis to ensure there are no leaks or spills, labels are correct, etc. The MC&C Associate will be responsible for filling out a Weekly Hazardous Waste Container Inspection Log. The weekly log must be completed regardless of whether product is in the totes. The Store Coach and the Loss Prevention Coach are responsible for ensuring the completion of the weekly log. It is important to remember that these weekly logs will be asked for by inspectors. Policy violations identified during inspections MUST be corrected IMMEDIATELY. Please contact Environmental Affairs if you need assistance (1-888-ENV-SEARS)or if an inspector has been at your store. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 2 of 14 03105108 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued Hazardous Each store must have a Hazardous Waste Accumulation Area for hazardous Waste items that are no longer considered usable(Hazardous Waste). Appendix A Accumulation has a diagram and several sample pictures of a typical store layout. Area Set Up In most cases, an environmental vendor will set up the Hazardous Waste Accumulation Area. The Store Coach and Coaching Team will be asked to provide assistance with placement of the area and to provide available racking for tote storage. A normal set up is as follows: Containers must be properly labeled and legible, the following must be on each container: • Hazardous waste • Type of hazard (i.e. Flammable, Toxic, etc) • Name and Address of the store • Accumulation Start Date—when a hazardous waste container is emptied by a vendor, a new date must go on the container the first day you start refilling the container with more waste. 1) Eleven (11) 18-gallon industrial strength storage totes(16"w x 24"1 x18"h)with covers will be initially used for waste storage, by category of waste. In some cases, the size or number of the waste storage totes may have to be adjusted depending on waste volume generated by the store—contact Environmental Affairs for assistance if this seems necessary. Other Hazardous Waste containers may also be stored in this area, such as the used fluorescent light bulb box, as well as the Hazardous Waste Spill Kit. The totes are labeled for the following types of Hazardous Waste items. Appendix B has an example for details. A. Flammable liquids/solids—oil-based paint, Goo Gone, fingernail polish, Pine Sol, butane lighters, and other flammable items that are not in aerosol cans or compressed gas cylinders (two totes provided) B. Corrosive Basic— Drano crystals, ammonia, pool chemicals (pH increasers), etc. (one tote provided) C. Corrosive Acidic—CLR, muratic acid, Easy Off, pool chemicals (pH decreasers), etc. (one tote provided) D. Oxidizing —Tilex, Comet, bleach, pool chlorine, etc. (two totes provided) (two totes provided) E. Toxic— herbicides and insecticides, latex paint, detergents, pool chemicals(algaecides), etc. (two totes provided) F. Flammable gas— propane, MAPP gas, etc. (one tote provided) G. Flammable aerosols—spray paint, oven cleaner, Fix-a-Flat, etc. (two totes provided) Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 3 oaf 03105101 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued Hazardous 2) The totes must be set on sturdy, secure, metal racking. Shelves must Waste be set with enough clearance so that waste items can be bagged and Accumulation put into the totes. Area Set-Up 3) The totes must be lined up with side labels facing the same direction. Some categories have multiple totes. Totes labeled "C" and "D" must always be at least a tote width away from tote"A." 4) The area may be set against facade or building walls, although if the area is against an exterior building wall, the totes and other containers must be at least one (1)foot from the exterior wall itself. The area may also be arranged in the middle of a floor, although stockroom pathway minimums and exit locations need to be taken into consideration. Do not use a mezzanine or basement location. The area must be readily accessible to an inspector or a waste vendor. Do not set up in a locked location. 5) The Hazardous Waste Accumulation Area totes and any other Hazardous Waste containers must be at least five (5)feet from sources of high heat(such as a space heater) and electricity (electrical panels, etc.), and must have reasonable air circulation (no closed closet areas). The Hazardous Waste Accumulation Area must also be at least five(5)feet from all food items, and cannot interfere with any exit doors or traffic ways. 6) The totes and any other Hazardous Waste containers must be separated from all new products and store supplies by at least a three foot width space (non-food items)on all non-wall sides. This open area must be marked off with durable, non-slick yellow tape. Only Hazardous Waste containers can be placed into this area. No other items, including ladders, stools and other store supplies or merchandise are allowed inside of the tape line. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 4 oaf 03105108 INDEFINITE STORAGE AND DISPOSAL • - • - -• Hazardous Waste Identification, Storage and Disposal, continued Hazardous 7) The Hazardous Waste Accumulation Area can have NO DRAINS. Waste Accumulation 8) A copy of this bulletin must be printed out and posted in the Area Set-Up Hazardous Waste Accumulation Area. 9) A copy of Bulletin SAF #10 "Spill Response" must be printed out and posted in the Hazardous Waste Accumulation Area. 10) The yellow environmental records folder must be stored on a shelf in the Hazardous Waste Accumulation Area. See Appendix A below for a diagram and pictures of a typical set up. Program Each store must have a Hazardous Waste Accumulation Area with special Tools hazardous waste bags and totes set up to handle the storage of Hazardous Waste items. The waste vendor must post a Hazardous Waste Wall Chart with detailed procedures to help the MC&C Associate properly segregate the various types of Hazardous Waste. The Chart explains how to use the special plastic hazardous waste bags to seal items before placement into the proper waste totes. See Appendix B for an example of a Hazardous Waste Wall Chart. Hazardous waste bags may be ordered from KIN in two (2) different sizes: • Regular—0-91358111-2 • Large—0-91362211-4 Once each week, the MC&C Associate must inspect the Hazardous Waste Accumulation Area, using the Inspection Log in Appendix C as a checklist to verify compliance. Any items found to be incorrect must be corrected and noted on the log. Completed log sheets must be verified by the Store Coach or Loss Prevention Coach before filing the log sheet with other environmental records in yellow environmental records folder. The yellow environmental records folder, KIN 0-86521211-2, must be used to store all environmental records. The folder must be located on a shelf in the Hazardous Waste Accumulation Area. The Weekly Hazardous Waste Container Inspection log must be retained for 3 years. To dispose of these logs that must have a date greater then 3 years and they can be thrown away. Refer to Bulletin MCC#02"MCC Area Standardization" for additional information. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 5 of 14 03/05108 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued General The MC&C Associate must take the following steps for handling Hazardous Procedure Waste: 1) All Hazardous Materials that are placed in the MC&C area must be reviewed by the MC&C Associate to verify whether or not the item is usable. A usable Hazardous Material is one that can be used for its intended purpose in its present form. Example: A slightly dented, non-leaking bottle of bleach is not considered Hazardous Waste (it may be sold at a discount). However, an aerosol can that does not have an applicator tip would not be considered usable, and must therefore be handled as Hazardous Waste. 2) Usable Hazardous Materials that cannot be sold under normal pricing must be aggressively marked down for clearance (follow the progressive markdown guidelines in Bulletin MCC#8"Pantry Merchandise Defective/Damaged/Outdated"). 3) If these items do not sell, any Hazardous Materials that can be used by the store must be transferred into store supply use. It is important that stores do not keep excessive amounts of supplies that will never get used. Store supply containers must be so labeled by writing "Store Use" on the container in black permanent marker. Follow the store use procedures in Bulletin GSO#03 "Store Use Merchandise"for taking correct markdowns and the marking of the merchandise. 4) If any usable Hazardous Materials can be donated under a Kmart donation policy, those items must be stored in the MC&C office, and not in the Hazardous Waste Accumulation Area. Remember that you cannot donate non-usable, broken or leaking hazardous items—these items are considered Hazardous Waste. Also, aerosol cans must never be donated. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 6 oaf 03105/01 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued General 5) If a Hazardous Material is determined to be non-usable and is Procedure therefore now Hazardous Waste, the MC&C Associate must use the Hazardous Waste Wall Chart(see Appendix B for a typical example) to determine into which Hazardous Waste accumulation tote the item must be placed. Each item must be individually bagged, sealed, and put into a tote as directed on the Hazardous Waste Wall Chart. Follow the steps below to account for and ensure inventory integrity of Hazardous Waste before placing the items in the tote: • All Hazardous Waste must be processed as a Type 41 620 claim prior to merchandise removal by a Hazardous Waste vendor. If the claim indicates to wait for vendor approval, take the UPC label off of the item and place the label on the waiting approval shelf in the MC&C room. Send merchandise to the Hazardous Waste Accumulation Area. • If no credit is given on the claim then the merchandise must be marked down to zero. • Under no circumstances can Hazardous Waste remain stored in the MC&C process area; this merchandise must be moved to the Hazardous Waste Accumulation Area. 3) Personal Protective Equipment(PPE) must be used when handling Hazardous Waste. Refer to the Right to Know Safety Guidelines for details on use of PPE. To locate the (PPE) information you can log into Internet Explorer/Store Mgmt under myKmart.com. Key in (PPE) under Document Search this will pull up the Right to Know Safety Guidelines with the information. This is also located under LP & Safety in the Kmart Safety/Safety Guidelines. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 7 oaf 03/05/08 INDEFINITE STORAGE AND DISPOSAL i Hazardous Waste Identification, Storage and Disposal, continued Special Certain Hazardous Waste requires special procedures: Hazardous Waste A. Rechargeable Battery Recycling Corporation (RBRC). RBRC provides Processes a free box for recycling Universal Waste (a type of Hazardous Waste). One box is normally placed on the electronics counter for customer recycling, and another box is placed in the Hazardous Waste Accumulation Area. If you do not have a box, contact Environmental Affairs(1-888-ENV-SEARS). The boxes are self-sealing. When one box is full, it can be returned to RBRC via common carrier using the pre-paid shipping label on the box itself. The box must be dated when the first of any of the following items is placed inside. Boxes must be returned to RBRC not later than one (1)year from the date the first item is placed in the box. 1) Rechargeable batteries—Any returned or damaged waste rechargeable batteries from toys, tools, etc. must go into the RBRC box as Universal Waste. 2) Sealed lead acid batteries—Small sealed lead acid batteries(less than two pounds in weight) must be placed into the RBRC box as Universal Waste. Larger sealed lead acid batteries (over two pounds) must be handled in the same manner as automotive batteries (see Bulletin HRD #01 "Automotive Batteries"). 3) Cell phones— Cell phones must be placed into the RBRC box as Universal Waste. The battery does not need to be removed. B. Veolia. Veolia provides recycling for fluorescent light bulbs, and certain electronics. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 8 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL f Hazardous Waste Identification, Storage and Disposal, continued Special 1) Fluorescent light bulbs —These bulbs include 8-foot, 4-foot, U-tube, Hazardous "twisty," HID and other mercury-containing lights, and "green-cap" Waste fluorescent light bulbs. These bulbs must be disposed of in a Veolia Processes container. If you do not already have containers for old fluorescent (continued) bulb storage, contact Veolia at 800-478-6055. Veolia containers can be shipped via common carrier using the pre-paid shipping label on the box itself. Light bulb containers must be stored in the Hazardous Waste Accumulation Area. Large broken bulbs(such as 8 ft bulbs) may also go into the Veolia container. Powder and other small debris from broken bulbs must be handled as a small spill (bagged and put into the Veolia container). The container must be dated as soon as the first bulb is placed inside. Bulbs can be stored for up to one(1) year before the container must be sent to Veolia. 2) Electronics—Cathode-ray tube devices (such as older computer monitors and televisions), LCD and plasma screen devices, and other computer equipment cannot be thrown away. a. For customer returned un-repairable televisions and other similar electronics contact your appliance haulaway company for proper disposal. b. For old store electronic equipment, contact IT Support for disposition information, or refer to Bulletin SYS#02A "Computer Equipment Repair Replacement Information." Waste electronics must also be stored in the Hazardous Waste Accumulation Area. Questions If you have any Hazardous Waste Identification, Storage and Disposal questions, send a Help Ticket to Category — Loss Prevention and Sub Category Environment Health and Safety, or call Environmental Affairs at 1- 888-E NV-S EARS. For software or hardware system problems contact Support Central at 1-700- 321-1040. Continued on next page TOPIC TABLof DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 03/05101 INDEFINITE STORAGE AND DISPOSAL Appendix A — Hazardous Waste Accumulation Area Set-up HAZARDOUS WASTE ACCUMULATION AREA DIAGRAM Typal 5 dup U&g R cl h Ives YellowTapeorP6t ,�tti�u�lt,�a Hazardous Wash w t77 w a a Yy'y/y ep#ya nChart < ,� � k -•t, tqy �'• � '� za� ,� Sb `�rl Mniv, BY N .� ;N�M� ♦ E+y. � }7 ',} t1t1 Y.Y111 Y11t11 7Y/t11YW7Wt'Y'VMtt 2 `l F 112 ""'"»M"'rS �rx exraxn.e�n�xgxxnr Al�� i§nny� ii�A + q - Y 4£ - TeT Y3 t Sr yq p S i 1 v sus mot¢ .� �L a� �t;; •'a ��s� . fte Gas 1 �a 89 1 T H , art'• � `i 18t83181 /// �r 77, SOIKit 5�'C t c, .- •a.,)r.x`, .,..... .�s ,nq.+.+his; t feet"No%c se" Yellow Tape or hit 1 I TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 10 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Accumulation Area Set-up (Store example) r ti N�. T e 4 � G �r 0 TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 11 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL •' To,' -0 Hazardous Waste Accumulation Area Set-up (Store example) / 3txs � f £ A � / �/�/%ram✓//iir//fr/rl"�°' Q �, - � �4�Y' A -_ �f �s� �zar�l�/ ��tirv/ %vim✓ ?may F �� y a� ��, �a `f`' � i � x TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 12 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Accumulation Area Set-up (Store example r +s P� J q F `ate s J� w ar � 1 � r � d f /y��� < :.�, � �'� 3 '.b5 `✓ : �� ^, y� lea TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 13 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL Appendix B - Hazardous Waste Chart (example "`", ,u.s Wa sto . . ;;if a rt rrTs.�s��sata`. i..e r."thretch cultawn vA W«.. t�:�,a^✓r v::vs c>. :2'... h�;'�'gr;.TF 'xraAt,�a•::;a::e,„C'aPaT 4;c�x,xtrTr[r,: %�;aiE».k.E#w 4'4w4*«aEr AS Y.ls�al-v'rr t-sr € vxraal�k wat*x An W). bra>iv T='<«.x ,�-r."Jmta in Owia as wrc. m :'s, �a�:r@:#�sr-rf;nx§aiiHft�&sv-�'�rtxa 1'taaMx$t4'E'l:�xEa: rera;lea . s`` Flax Ti `� 4 aw e la.�^k`rxT�°rc 3t x d f ,,,,•�„�„ seiW,a4�Lc._f_<Ew.�s w_`,.wri`�Lira"ttf'C5 YT.Sa.K Si.L..ET 1«c.*c.S.4��'-SR<\<4S • .ram. ��, Tar fi.�;.rtl3:tt+s.".sx.x°3Lraa'w.3-ab�'.r, tuarrzK.:fts �o�nt..+rvatCsacxx: ,5. T� ,'�xr%aay�,«r$t;diatgwr Jfesr=ltavz =�4 t;!3a�xxa aaa, E"• ,.:«�: ;ea�.rrr,<:r;$flfsc. ...�`•".` :4-$a l.:a'^t m).V S axr. C;,,r Et asreas..a�eL9 MQ4m will eq+:r.�'.•_�. <-, .,•`..'°°� �:� �.,.x,�_sFs .,�a.�a :;r£r.T tt;2���re.�r3€t�a r�.r`ss:. w:xa:,a F.rM a,s�.e aiti.ta�a„,�.Tr r,a,�^:"x'^=:aakm e��sxas<. perara�:,ax t. r». ka��•bx.. ,fig ..e-...�- �,. }fr:.R FeE3:Gz �"wr-."^%O8 YY1$,�afY��'�^:sy'3q:$1�5'v'},.;%,`i'em y'rsfl.1E¢'aH� •'°"•••","• EFa�zs...��tea'f�.aalf:F�t�l�x't:l?.trsv-=pFn'�,^sras�xas s x�Y3"',a�s�:lae- z ..�a,r-h s,ffir�rrM 9, V a...e,t e ram. A t .z: 3xaa�T z?y..ata::w t� >l»,;a x s.•;.3'3rTa :w"d T)rors;" [..U'll'"9•. TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 14 of 14 03/05108 INDEFINITE STORAGE AND DISPOSAL Appendix C — Weekly Hazardous Waste Container Inspection Log Weekly Hazardous Waste Container Inspection Log Print this out each week to perform the required weekly inspection of your Hazardous Waste Accumulation Area. Retain completed forms in your Yellow Environmental Records Folder for 3 years. Store# City State Logged by Title Clock Number Date Signature Verification of weekly inspection by Management: Name Title Signature Date Inspection Items Yes No If no,explain deficiency and correction actions taken Date fixed Is the Hazardous Waste Accumulation Area accessible and separated from and free of merchandise,debris and supplies? You must be able to easily get at waste containers,and nothing but hazardous waste can be stored in this area. Are all hazardous waste containers properly closed? All waste containers must be kept closed except when items are being added or removed. Is there one Accumulation Start Date clearly marked on every container? When a hazardous waste container is emptied by a vendor,a new date must go on the container the first day you start refilling the container with more waste. Are containers properly labeled,and are the labels legible and complete? The following must be on each container label: 1. "Hazardous Waste" 2. Type of hazard(i.e.Flammable, Toxic, etc.) 3. Name and Address of the Store 4. Accumulation Start Date Is the area clear of any spills or leaks? Any spills or leaks must be immediately addressed. Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that K-Mart(GeneralStore) 768-Iyannough Rd., MA 02601 — Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 31, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 5/31/2007 PAULJ. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services °s Thomas F. Geiler,Director STABM NAn ' Public Health Division '°r�aru•� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE _ �7 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT S(?aCS 4011f)_g NAME OF ESTABLISHMENT KArRT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER '�(� " '7 0 0 l o SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: I IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION ( a FULL;NAME AND HOME ADDRE S OF: - -J/ PRESIDENT 'fiI/fir?/i'J 1: ,tWI S 33.3 f�e�,- �a rL �t /79CPY1 C�S'�CC �S TREASURER CLERK L SIGI ATURE OF APPLICANT r RESTRICTIONS: HOME ADDRESS HOME TELEPHONE 9 AZV 72fCY24 5 r� ALL DIRECTORS OF STORE OPERATIONS ALL DISTRICT MANAGERS ALL STORE MANAGERS/DIRECTORS ALL HUMAN RESOURCES MANAGERS --SPILL CLEAN UP PROCEDURES- -STORES- The Right To Know Law requires that each facility maintain a written set of instructions for cleaning up chemical spills.- The Operations Manager and Department Managers shall have the responsibility of coordinating the clean up of chemical spills. All Kmart associates trained in these clean up procedures are able to assist in the clean up of chemical spills. The Human Resources Manager is to discuss the following guidelines with the designated clean up people and insure that these people are trained on proper clean up procedures. -INFORM ALL ASSOCIATES THAT THEY SHOULD NOT DISPOSE OF HAZARDOUS PRODUCTS IN A COMPACTOR,A BALER,DOWN A DRAIN, OR IN THE DUMPSTER, ETC. (THIS INCLUDES AEROSOL CANS, POOL CHEMICALS, PAINT PRODUCTS, AUTOMOTIVE PRODUCTS, MAINTENANCE PRODUCTS AND GARDEN CENTER PRODUCTS.) IF A HAZARDOUS PRODUCT NEEDS TO BE DISPOSED OF, CONTACT THE ENVIRONMENTAL DEPARTMENT AT 810/637-6544. The best defense against chemical spills. is to prevent the spill from occurring. First keep emergency supplies handy. Supplies should consist of the following: Rubber Gloves Kitty Litter Overshoes(if needed) Broom Shovel Durable Bag and Plastic Container Second assess the Lawn & Garden Center and rearrange products that could produce potential hazards. All garden merchandise in glass bottles should be stored near the bottom shelves with guards surrounding the products. Shelves should be checked to insure that the brackets are strong enough to y; hold the weight of garden chemicals. Take ail of the products off the shelves when bracing the shelves with brackets. x Attached is infohon that will PI pareyou inthe event oran emergency chemical spill. Review these step your associates Frame these instructions and ost themlma�promme areaifoi uick <K p 9 reference ' ,� -� z, A w rn. `�;, � �� ��r � ��� O�Mr=Richard�McLonls �q' i�;, �;•� - 13 AM .� � Director'of Corporate`Safe 4 e 14 ' Code'38=0=930103-1 6 F ergency spill of garden chemicals does occur, immediately take these steps to control the be aware that some people may become ill. These people should be removed to fresh air. If pill occurs, please notify the KIH Environmental immediately at 810/637-6544. If a spill or more bottles of a product,contact: INFOTRAC 800/535-5053 OR CHEVRON CHEMICAL COMPANY CALL DAY OR NIGHT AT 415/233-3737 i 11. ISOLATE THE AREA. Keep people away. 2• VENTILATE THE AREA. Do not.breathe vapors Open doors and windows. Set up portable fans. Close return grilles on air conditioners. 3. KEEP FIRE SOURCE AWAY. Keep away from all heat sources and do not allow anyone to smoke near a spill. 4. PUT ON RUBBER GLOVES AND OVERSunt:c nrT 'Ornor E INVOLVED IN THE CLEAN UP. Avoid contact with skin or clothing. If contact occurs with skin, wash affected area thoroughly with soap and water. If contact occurs with clothing, remove contaminated clothing, wash skin thoroughly with soap and water. Wash contaminated clothing in strong detergent before being worn again. I _ 5. READY FIRE FIGHTING EQUIPMENT. 6. IF A LIQUID,USE KITTY LITTER AND ABSORB UNTIL DRY. 7. CAREFULLY PLACE ABSORBENT OR SPILLED DRY PRODUCT IN DISPOSABLE CONTAINERS. 8. SCRUB SPILLED AREA WITH CONCENTRATED DETERGENT USING BROOM. 9. BEFORE DISPOSAL OF SWEEPINGS AND/OR BROKEN PRODUCT CONTAINERS AND OTHER CONTAMINATED WASTE IN ACCORDANCE WITH RECOMMENDATIONS OF =LOCAL HEALTH AUTHORITIES NOTIFY THE KIH ENVIRONMENTAL'AT 810/637-6544 FOR FURTHER INSTRUCTIONS 10 WASH GLOVES OV ERSHOES AND SHOVEL-WITH STRONG DETERGENT SOLUTION: "CLEAN SUP" PERSON NEV; HOULD' CHANGE CLOTIIING RAND 'WASH SKI1V THOROUGHLY i; � a �WITH"DETERGENT _ Code 38-0-930103-114 Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that K-Mart(GeneralStore) ?q e 768 IyannougkRd., MA' 02601 Is Hereby Granted a License STORING OR HANDLING 111 GALLONS OR MORE HAZARDOUS MATERIALS. FOR: ------------- - ---- ---------------------------------------------------------------------- =- -- ,-:-----:-------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 imless`sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 15, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable 00 1 j616(o Pd � °F'THE l Regulatory Services °. Thomas F. Geiler,Director / G I 1 * BA ASS.MAS3.LE. * Public Health Division 9 •i679 ArEO 39 A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT Mar+ 30 go ADDRESS OF ESTABLISHMENT I&F J: � W)IS 61 TELEPHONE NUMBER SOLE OWNER: YES NO .fir IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF PARTNERS: in M n IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.. STATE OF INCORPORATION �('p U . Y 11►C � FULL NAME HOME A DRESS OF: PRESIDENT !S TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Application Fomis\HAZAPP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below.. Also include a copy of your Of contingency plan (to handle hazardous waste spills, etc). Iri addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing.'Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the,address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q Upplication Fonns\HAZAPP.DOC i Town of Barnstable °FtHE Tp�, Regulatory Services Thomas F. Geiler,Director s" MASS. ` Public Health Division Qj .s6gq �0 AlF1639 A Thomas McKean, Director W 200 Main"Street;-Hyannis; MA 0260`1 Office: 508-862-4644 y Wayne Miller,M.D. Fax: 508-790-6304 Sumner Kaufman,M.S.P.H. Paul J. Canniff,D.M.D. NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials,.a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials ate stored, transported, utilized, and/or disposed of at-a particular site. Please complete the attached application form and submit it along with the required fee of$100.00 to this office on or before June 30, 2006. A late charge of$10.00 will be assessed if payment.is.-not received.:by July 1, 2006. Checks should be made payable to the: Town of Barnstable. Upon receipt of the fee and a completed application form, an inspection will be performed by the Hazardous Materials Specialist to complete the Hazardous Materials On-Site Inventory. A permit will be issued once the inspection is completed and has passed. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website,'www.town.bamstable.ma.us , which is located under the E=Code section if you should have any questions or concerns. Q:\Hazmat\Haz Mat Permit Letter.DOC i No...... FEE..... ...5..00.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T own...... o F.......Barns table ...... ..........................................................•-----------•-- Appliration for Uigpn.sFal Works Tonstrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: Route 132, Hyannis, MA 02601 -•-• ........._........_.............. ..... ...................... -•.............--•-•-----•-••-•-•-••-----•-•-••---•--•.........._..-•---•.............-•--•------• o ion- dr s or No. Hyannis Moteavi fanner Route 132, Hyannis, �A 02601 ......................_........................ ...... ............................................ ......-•••-----------.....---------•---------•--•.....-•-•-•-•---•------...............-----....-- W A & B Cessp ool enrvice 128 Bishops Terrace TfTf annis, MA 02601 .............. ................ ----......... q. Installer Address UType of Building Size Lot----------------------------S feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ). Other—Type of Building No. of persons............................ Showers a yP g ---------------------•------ P ( )..— Cafeteria ( ) Otherfixtures -----------------------------------------------------------------•----------•-•---•-------•.........••------------- ------ W Design Flow............................................gallons per person per day. Total daily.flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter....-.--.-.--.-. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--.-..-_--_-_-._.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z . Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-__-_._..-.--.--------. •-- - •----........_....... ---...--•-•---....-- ODescription of Soil and- ----------------- ---------------------- -----....._._..------•-•-----•-------- --------------•.... -----•---------------•--•----•-•----•-•---....._....-•---•--....-------•--....----------------------------........-----....-----------------------.....---------••----- x w UNature of Repairs or Alterations—Answer when applicable.. nstallati on___of-a__1 000-__gallon•-pzre-cast, ............ __-.Repla�cing_acaye-in.-_.- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 5 of the State Sanitary Code—The undersigned further agrees no to place the system in operation until a Certificate of Compliance has been iss4eZf by tfie boa lth. R Signed-- .... ••-------------= 3/15 82 Application Approved By.................... _..! .>.. .... . ---................... ......... A5` ==2-e-------------- Date Application Disapproved for the following reasons----------------•--...........---------------------------------------------------•--•-----•------••-..........._ -----------------•------•-••-•••-------••--------•-------------------------------•••-------•-----------------------•---.--- •-•--•----- Date Permit No...........8 2--•-....-•••---•--•----•--------•...... Issued..3�15/82 Date No..... i2.-.1-2-.0 FEB....Yt....5_.00..... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•--......_..'POW!_...............OF......parrs table. ... Appliration for Ramat Works Tunstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: --........Route 132:...I?yanntsl...".4 C??..Fnl. .......... ..•--••-----------. ...........-----•----- ------.....---.......----........ -o ation-iVyanni s *,Otel/DaV ddrM anner . Rout. .....--••--.................. wner W A e. R C. ool ervice 12 ' 'Bishops Terrace;dd�Vann_16, A 02601 a . (� Installer ......----•--•--------------•----......-----Address...----....._._._............-•----._..... UType of Building Size Lot............................Sq. feet -� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building g ---------------•--•-----•--- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' \ pSand--------------------- ---------- - ------- ---- ----•---....-•-----............-•------------•--•-•-•--------------...----•-••-----------•------•----- .. Description of Soil----------- --...... ••------------------------------ -... ---------------•-------------------------------------- •------- ------------------•-----------------------------.. W .-•----------------------------------------------------------------------------•------......--------------------------------------------------------•------••-••-••-•--•----••----•------•--••-•----•-. U Nature of Repairs or Alterations—Answer when applicable_ rs�allati.on.-of-_a. ... gallon pz�e-cast, stone-.packed--lack-•Dit---(overflow _._-_.Replacing•-a••cave-in. • . ----------••......••................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T T':' . 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board gf a alth. SignedG%{ > _. - __. _ < 3/15/82 •.............. Application Approved By.............,, __:.....4A..:.�✓�� .... 3/15 •----� j - -•----^---•--•-- ...-----•---•-•-•---Date.............. Application Disapproved for the following reasons:_...----•-•.....• •-----------••----•--•---•----••--•------------•-------•---•--•---••-•-•---•---••••-..-•--•- --------------------------•--•------•-----.....---------......-------•--•---------------------•-----•---.••---------........•-•-----•-•-----•-•....-••-•--------•-------------••-•--------•--.....•-•--- Date a Permit No......................................................... Issued..3••�5-82 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........:..........Tew.n..........oF.......Darnsta)le ...................................................... Trrtifiratr of Toutpliana THIS IS TO CERTIFY, That the Jpdividual Sewage Di s osal S stem con trl� d ( ) or Repaired (X ) A & F Cesspool Service, 12^ Bishops TerracE. Hyinni.s,_ °'l by.............:......................................•--•--........._........•-•-----•••-•-••--•-------•--•--------•-•••-•--•-----•----.............--••----•.......•--••-..............--••--....._. at_.._____Hyanni_s hotel, Route 132, ilyannis, iXall-02601 - David Banner has been installed in accordance with the provisions of T 5 of The State Sanitary C g / q cribed in the application for Disposal Works Construction Permit No._ �L'�................... dated_.-.._�i.l�l---...._._...____............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......3//S/p2. Ins ector-•-rn---.. ..'. . ........• ..................--•................_..•••. P Il�'�"•------------•------------•---------------•--------------•--•------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF.............�'arnstaole $ 5.00 T awn No...........2., .� FEE........................ Disposal Workv %TAantrnrtivi - rrmit Permission is hereby granted_....A-_& T. Cesspool Service, 128 B shops Ter., Hyannis 02601 ............................................----•-••. ....-•-••---•--••--....•-•---.....••---•.....-•.............••.-•-•- to Construct ( ) or Repair (X) a Individual Sewage Di s System. at No....HyannisMl otel , Route 1n32, Hyannis, I (� �%l - David Fanner Street 3/ 5/ as shown on the application for Disposal Works Construction Perm it No....................- Date ._.._............�2.................. ' o DATE.................3/1.�./P2.............................................. Boa f! ealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No.8 :. Z '`r� .:',S.x.Q.�............. THE COMMONWEALTH OF MASSACHUSETTS \` BOARD OF HEALTH ..............T.own-.................OF....... ........................................................ Appliration for 1 spoii al Works Tonotrur#iun panfit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: ....Hyannis,Motel..= Route..1,�2,...HY-4x?bs,..MA... 026Q�,_•--------•--...----„ ----- •--•----•.........................•----•--•-•--••................. Location-Address or Lot No. ....David Banner Route 7,�2,.. Xs �11a.7,s.,.._NL�.._Q �2Q�................. Owner Address W A & B Cesspool Service 128 Bishops„Texrece-,-,Hyannis,,,,MA••--•02601-,•-•.- a .................•-- Installer Address UType of Building Size Lot............................S........ q. feet �-, Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .......----•-----••......-••--••--•-•-••---•-- ---------------------------- -------------- •---------------------------- W Design Flow_•-•........................................gallons per person per day. Total daily flow..............._............................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......... ...........-------------------------- -•.--•--------..--••- Date........................................ W .a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-----------•---_----. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......--...............: P+ ............. ------------------------ ••-•--•••--------------•......•-----•---•..-•-••------•......--•......................................................... 0 Description of Soil._Sand........................................................--•-••-••---. V ......................................................................................................................................................................................................... W ------------------••-------------•----•••--•------••••-••-----•----•-•--••-••--•--------••--•••--•----••-•--•••-------------------•--•-----•-•••--•••------•--•----••----•--------•----•----•-•----•••. U Nature of Repairs or Alterations—Answer when applicable....inaCalla tiara...Qf..2...--.l,.QQQ-.ga7ls�n,_. ....cast:---ston....Packed:,leach_•pits...Coverf Iwo)........•-----•-•------•--------•----••---•-----•-•-------•-•-•-•--•-•--••-••-•.............••. . Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i9sued by the: he 1th. Signe"��.....e.=.............---•----••. -•-- - -. .......... �8 _ ,!✓� D t Application Approved By•••-•-••-•---• /y8T�=18-'•.-•--- Date ----------------- Application Disapproved for the following reasons:-------•------------------------------------•--------------•--------------------------------------...........••. ••-•--•..............••••----•••••----•••••-----••••-----•-•------••--•---...----•-----.........._.....••-------•-----••-----•-••••-••--•-••----••-•--••••-•-•--••-••••--•----•------------••-•--------- / Date Permit No....81- ..................................................... Issued-....8.[_..4Aj81 Date NO.-8�,...._..._..----- .... .00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................f`Own.................O F.,.....BI,Z"Mtabler. .------------.......--•------*...................... Appliratinn for Disposal Works Tonstrurtuan Prratit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal system at --... Hannis-Notgl --,Route..l ,..Hyannisa..r1A 02601. - - - ------------ ._... Location-Address or Lot No. ......................ad Fanner Route 132,...!yannis, M.................................................... 00 -------------------------------------•----•-••---•............---........ ---- Owner Address a A & B Cesspool Service 128 Bishops Terrace, 1.4yannis, INA0.26.01 Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a 1 Other—T e of Buildin a yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W ;Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W ' x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---•------••-------•-••---••--•---------------•--•--•------•--•••-------...-••--•---.......-•••------•-•--•---•----......--------•......_.._........... 0 Description of Soil--Sand---------------•-•---.............------------......-----------•-•------------------------•--•---•------•------•-- x U ----•---•----------••------------------------------••--...-•-•------------........----•--••-•------....----------•---•------•••------••-••--••-----•-•--••--------•----------------•-------------------- W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- U Nature of Repairs or Alterations—Answer when a lira le-...installation of_ 2 — 1 000 gallons pre— �p --------- ------- --- cast, :-tone hacked leach pits �overows . •-------------------------•---------•-•-------•-•--------•-•--------------------..........---•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the b I doh lth. Signe 8 4 81 ........................•---------...A .......................... te Application Approved By------------------••-•---•-•-------•1 -�� t 4•/81 Date -- Application Disapproved for the following reasons:............... ..........................•-----.._._...----•-----•-------....----------•-------......------------------.--------•--•-•--------•--•-----•-••----•---•••-------••-••-----•---•---•••--------••-----.-•--- Permit No 81. .....-•••--------••-•--•----...----•••....... Issued......B/.4-/81 ...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........I...........`'own.........O F............Parns table ............................................................... Trrtif iratr of Tuntplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by -ACesspool... ervice._..128_.Bishors__TerraCe1_Hyannis,.__MA...02601 ...................... ----•--- • - Installer at.........Route 1321 Hyannis, MA 02601 - Hyannis_P�otel-__---David •Banner-------- has been installed in accordance with the provisions of TIT — `�fL'he State Sanitary Col��sd�;�ribed in the application for Disposal Works Construction Permit No..........................�'..—..._....... dated................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.---------•-8/•••-/91.................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ,Y. BOARD OF HEALTH Town.....OF.._.__.__ Barnstable ................... .... ................-••••-•--.................................... No.........--•............. FEE.. ..5.,00....... Disposal Works Tlanstrnrtion rrntit Permission is hereby granted......A & B Cesspool Service --------------------•---•-------......------•-••--•--•--..........................•----- to Construct ( or Repair X � an In "dual Sewage Disposal System Route 1�32, Hyannis, vIA 02901 — Hyannis Motel — David Banner at No................................................................................................................................................................... Street as shown on the application for Disposal Works Construction No.81.-.._..... to . .........8/..4�81 y i Boar Health DATE......--•------a/S'/81-•••••---------•••-•-•----•----•.............. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 82- 37 3 -r> No.........--••--.... .. = Fps$... .A 0............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T own..............OF........Barn st abld ................................................................... , pphrFatiou for Biipusal ?darks Tvaagtrurfiott amit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: Hyannis Motel, Iyanouth Rd. , Hyannis, MA 02601 ................_--.............................................................................. •..............._....---•-----•--.........----••...._.......-----...........................------ David Banner Location-Aaaress Iyanouth Rd. , Hyannis, MA 02601 ......................---............................,........................................... ..........--...................................................................................... Owner Add e W A & B Cesspool Service 128 Bishop Terrace, V�ss annis, MA 02601 Ins tall.er Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................................. _Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ---------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter...._............... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...............................--•---•------------------•---------------- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••----•----------------------------------•----------------------....-••--........•-----•-•-----............•--•..._...._..------•----...----•......--....-- ODescription of Soil.............5.aJA................................................................................................................................................. x U ---------------•-----------•-----------------.......................................................................................................................................................... W ..................................................-............................................................----------------------------•--------------•------...------•----•--••--•---...------••-- UNature of Repairs or Alterations—Answer when applicable--inSt_allati Qn_.9-La_lie.aY_V... on stone_.Packed--loch-.P t...0 -•...............•---- -•---------------------------------------....------------------•-•----------------•...-•-•--•-•--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the revisions of TiTT,i", p 5 of the State Sanitary Code—The undersigned further agrees n to place the system in operation until a Certificate of Compliance has been issued by --- thb r -f health. Signed r. 6 2 Ste -------- -leA.>---• - ••' .. Date Application Approved BY r. � ................................. 6/2s82.............. Date Application Disapproved for the following reasons-----------------------------•----•----------------------------...--------------•-----------••---•---------•..... .....................•----------••----------•-----•--------------•--------------------.............._..--I---------------•-------•------------------------------•-----._...-----•----- ------------------ Date Permit No.........82----.......--•- -- Issued....-----•6/29/82 ................ Date 82- 337 �.. No......................... FEE$...5.00............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town............................oF...-...Barnatabld..... -----------------------........................... Appliratinn for Disposal Works Tonstrurtuan rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: Hyannis ?Rotel, Iyanoutti Rd. , H�rannis,.. ... 02601------------•------------------------------••------••---.............-------•---•_-•---• ...............................at ......................................uhRd ...... Location-Address or Lot No. David Banner Iyanough Rd., H�ra.nnis, IAA 02601 •-..................._........................................................................ ......................................... ............._....... W A & B Cesspool Service er 128 Bishop Terrace;d�Apniss., FA 02601 Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Ga Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—. Liquid'capacity......_..._.gallons Length._.............. Width................ Diameter................ Depth................ \ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x 3 Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area_...............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. I............:...minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------------------------------------------------------•---•......-•--•-......................................................... O Description of Soil-----------54Xd---------------------------------------------------------- x W -----••----•-------------------•--•----••--•----••------------------------------•------•---•---------------------------------------------------•-------------------••--•------------------••-•---•-•-•-- U Nature of Repairs or Alterations—Answer when applicable-installation_-of_-a--heavy duty-1100Q_-gallon stone Wicked lach__Pi (overflow). ----------------------------------•----•-------------------------------------••--•-•--_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL,;=. 5 of the State Sanitary Code— The undersigned further agrees nQt to place the system in operation until a Certificate of Compliance has en issued_by the b rd-of health. Signe� 6 2$ 82 Application Approved BY -v ._ �r�, '----------------------------------- ...--.-6..2$ Date Application Disapproved for the following reasons:-----•----------------------------------------------•---------•------------------------------...-----.....••••-- ............................•----------------•----•----------------------......_.........---------.....-----------------•-------•-----------•----•----------•--------•---•-------------------•--•---•--- 2................Date Permit No -82 _ Issued. 6/29/8.. ---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town..........o Fr Barnstable Ba�natable...................................................... Tnrtifiratr of Tuutplittnrr T II&S V-TO CER�IgY That thf�j,*i o Se y e s osal S-ste con tru 8t d ( ) or Repaired (X ) esspoo 4_ ce, i ps rac�9 Hya Mss, Mx �2601 bY.................................................................................................................................................................................................... Iyamouj,h Rd. , Hyannis, 1,1A 026011nst=°efiyannis 14otel - David Banner at............................................................................................................................................................................................... has been installed in accordance with the provisions of TIT L�R 2 5 of The State Sanitary Code g� gsg Ted in the application for Disposal Works Construction Permit No--------------- _ ,, ........ dated....______..._._...--_--_//__-____................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM 1Al L F NCTION SATISFACTORY. �� / DATE................2.......2...--... Inspector....� ` i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town o F Barnstable £? ....................... No.............2--- = .� FEE.......$_5...00... Disposal Works Tnnutrttrtion "motif A & B Cesspool Service Permission is hereby granted............................-----------------------------------------------------••---...---------------........-----.................. to Construct ( , or r u Sewa e D> sa S st yazuTis NRo 'e� �Iyane agh c�. Hymn s, MA 02601 - David Banner atNo.............•--•----•--•...-•---•--------•.........-----•----------------.......................----------- --------------------•---.........--------------...------............... Street as shown on the application for Disposal Works Construction Per mit No..................... Dated..K-.. 6/29/�2 6/29/82 Board ealth DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS LOCATION /�jv' SEWAGE PERMIT EMIT NO. VI.LLAG INSTALLER'S AME D ADDRESS �VC ® U I L D E R OR OWNER DATE PERMIT ISSUED �� 7 DATE COMPLIANCE ISSUED . ����.�, a� . ��a Y \ ., ` � p .y �'1 �3 ____-�, �+�sa� . �1 10,/ LOCATION f3� SEWAGE PERMIT NO. VILLAG KoWl5 IN T A ll R'S` N ME i ,ADDRESS e U 1 L D E R , R: `01IN ER 7;� DATE PERMIT., ISSUED DATE COMPLIANCE ISSUED two A Lt)CATIZ SEVAGE PERMIT NO. Ulf— VILLAGE INSTALLER'S NAME & ADDFWS d4,6 oo<--,x7 yezlx� BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �f�a � i NeW� c. P /000 RA &,37 LO CAT I N SEWAGE PERMIT NO. VILLAGE IN T ER'S NA E i ADDRESS 5S Poo BUILDER OR OwN_ER- &Va a"s H U� DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �1 � � t o . , w 20 LOCATION SEWAGE PERMIT NO. VILLAGE Y-, R� r s INSTALLER'S NA i ADDRESS SUILDER OR VNER DATE PERMIT ISSUED _ �� 8� DAT E COMPLIANCE ISSUED _14 _ez w D peo � Q ' le � G LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S /J NAME A ADDRESS y ® U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ®o ASKS MAP N0: �.. y PARCEL NO: Fps......ZLQ.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH L_.Q w.• ................OF... .w...u.S - -�-e-- Apptiration for Bhipoii al Vorkti Tomitrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at• �. 5 �... �G7 J- c�•1o�a �cQ 32T r— ... d do s CMocati�,_ p 5 " act c� . rr1 t f e '15 �o Owner � Address ...-Y Installe Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Pq Other—Type of Building ............................ No. of persons..................---------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ----------------------------•-•. - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by:............................-........------------------------------•-•-•- Date........................................ 04 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t� -------------------------------------•-.......----- -----------.......................^--------••--•----------.:_... O Desc ' n of Soil n... • .• •o�c� CSC-t�SG- tru (�ek _ l l 1� + !o rj2_ .ems e `' =•` -'`2�e�c u M �`�-.. J C ...... U -� w S $_ e S '.. - -'?-o-� ---�'-----�'-- --- -------'!............................................. 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 iITI 5 of the State Sanitary Code—The undersigned further rees not to place the system in operation until a Certificate of Compliance by the It. Sign 'I Sg Date Application Approved By............. ---.ts-.,�.�....."„� ------------•----------------- ---------- ^ '- D ate Application Disapproved for the following reasons:................................................................................................................ .............•-•-----•--•------------......_......-•••-•-•-•......-•-••-•-------•...-----....••••--•--•---••-------•••-•-••-•-------•--••--•----••------ Date PermitNo........... ......................... Issued....................................................... Date - e \S No.... .:..3..4? } Fims.....43L( .(......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1................ --- .......OF............::....`...' , �' t I '- Apphr atinn for Dispoii al Works Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Systemat..._.. .. ... - - .............. - ....._ ! .-T- ......---- .....! ......-•-• `' ------ ..... Location-Address - or Lot No: ..........-•--•-...-----------------....---•--•---•-•-•---•-----......----...........-•---....... ...------............................. ............................... Owner Address a -------------------------------=---------•------.....------•------- ---..------------------ ---------------- ._.......:: .._.... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___.•.......................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures -----------------------------------------•-•-- W Design Flow............................................gallons per person per day. Total daily flow----...................-....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-------......... Depth................ x Disposal Trench—No..................•.. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �-' Percolation Test Results Performed by---••---•---...--••--•--------•--.....-•--------••-------•------••••_._. Date....................................... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------------------------....._..................••---------------.._...---------------------------------------------------------------------------- 0 Description of Soil...........----.....-.........------------�..---................._........................-----......------`-`--'-- ---`-- -----...........-•=........... ---- ...........................................-.................................... ........................................................................... 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 TIT .; p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign_5-----�.-.-:-:--- - __° --------------------------------- Application to Approved By........ ...... ..U----------...-- �...�.� .....1 L..- 3---te � .......... - Date Application Disapproved for the following reasons-........................................----- -----------------------............. -------------------•------- .........................................I..._....•-•-••---------•---•----••---•-•-----•--- Ff- 3 Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............I............................OF..................................................................................... C15rdifirFatr of ToutpliFanrr THI& 6 CE1 4 h -the Individual Sewage Disposal System constructed ( ) or Repairek( ) ...... -------- hJ t�- ( 7 ns al r ,!'� at............................................................................................ .............................-•--•••-------•---•-------••-...•--------•�-Z+,................... has been installed in accordance with the provisions of T j of The.......... e State Sanitary Code as described in the application for Disposal Works Construction Permit No. -----•--.. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS k GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................a,._—.... '..��d---...•....------. Inspector............... -- ....��----------•--------•----_--_--------•-•--- THE COMMONWEALTH OF MASSACHUSETTS BOAR/R OF H-tE{/jA,, (T/, H - No...............•-------.. ..................... OF......................•---•....................._..... ......................... Fix . ....:�......... Ww at�. nr o Tondrndion "unfit �� Permissionis hereby g a ted................................................••••--•••••-•---••-••----••------•-•-••••---•---•-•-•----•--....-•---•...............-•-•-•-- to Const�&(7) of �it .,,t�n�I dividtial S&e ,age(f ispo�s—S�s t��m2 �`� � atNo.•----•-•••-••---•.............. ...........•---- U............................................. ---------- ................................ ..... ....._... Street as shown on the application for Disposal Works Construction Permi N . .......... Dated.......................................... G - G---'-�- -3 3- — 'j - Q K' Board of Health DATE............-................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS raw �✓ No. 9 .......... \ • FEB.....a e...l.............. THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH ' ------- -- -----..............--.....OF................................:.:... Appliratiou for Bispnoal lforkg Tnnstrurtinn Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ,) an Individual Sewage Disposal System at: ......... ...A.:. ....__•-•••••.j�ajj......=..7.vs<4..... 11:1-•-••- -••-------------------•------••--•-----•--- I Locat�n-Addr s or Lot No. �J i!1+�x;�-------------L'_� f'.. Owner a, f Address .... .. .. { . :...�-fir.... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms,,,, Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----•------------------•------•-------------•--------------------------------------------------------------_------•-----------_----------•-•--•---- W Design Flow.....A21�'V.........................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length..._................ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. I...........:....minutes per inch Depth of Test Pit.................... Depth to ground water.....................__. 44 Test Pit No. 2................minutes-per inch Depth.of Test. Pit-------------------- Depth to. ground water........................ O Description of Soil.......................................................................................................................................... --------------------------------------------------------------------------------------------------------------------------------------------••-- ! U Nature of Repairs or Alterations—Answ r when applicable !.= __.____ Ss -- ,�;4, ���•.._-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code The unde •gned further agrees not to place the system in operation until a Certificate of Compliance has be n ss by the and of health. 1 Signed......... ----4- --- --------------••-=----------- .............I.................. Date Application Approved By.............. -------- c Date Application Disapproved for the following reasons----------------------------•-•---••------------------------••--------------------------------•-•--•--........--- -•----•-----•-•••-•---.._.....•••••••-••••....--•--------•-•••---------------•---•---•........-----••••--••••••••--•--•..._...----•-------•-••-••----------•-•-•--•------••----• ....................... Date PermitNo......................................................... Issued....................................................... Date ♦•-•••••s•-•se•e•••••ss••••••••.•••••s••ee•e•••se�see�e••+s�•�s�aa�••�►s�•••eeeeee•eeeee••eee•••••ee�••�••a•••••ae••re-.-•�s� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................................................... ..................... Ae Tn#ifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------- ......,frr..P.c ...........................................-------------------•------- --•-••---...---------•--•----•------- Install......---- .. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .............. dated_-...__-._-._-_-___----__.................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE._.......--•------•-----------------------------•--------•-••-•••----...-••-_... Inspector.................................................................................... No......... Fps............. v- THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ........................ .......OF......... ......... ................................ AppliraTion for Disposal Works,�tv4strnrfiun rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ; ) an Individual Sewage Disposal System at: . (t 1./ 4 2"'t, /-3-� . ...:....- .J. .... ...............•.....-•-------•-•---.......--•••-••--.....•--•-• -- Location-AI f or Lot No. Address a .....--••••-----------•-••---•---------------------•---...................•....................... ......------............- Installer Address Type of Buildirrig Size Lot----------------------------Sq. feet Dwelling No. of Bedroom, ,.L------------------•_--_----__-__-Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building .............. No. of persons............................ Showers ( ) — Cafeteria ( ) a YP g -------------- P If 0 9 'tures - --------------------------------------.-•------------------------------------------------------------•--------•-•----........-•-•----- W Design Flow..........................................:.gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid'.capacity-----..____-gallons Length................ Width..............._ Diameter---............. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total,leaching area....................sq. ft. Seepage Pit No_,-,---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......`:................. (� Test Pit No. 2................minutes per inch Depth of Test Pit...._............... Depth to ground water-------................. ... .............................................. .......................................... Descriptionof Soil _ -------- ................. --- _........-............ ............. ........................................................ :. V -==-------------•- ---••---- W ......................------------------------------------------------- -----------------...............-............................ ? U Nature of R airs or ten tions—Answer when applicable_____-. %� ! ___.._. �i�G1 �....__.._ .................`.. ._.. ---------------� --..��-----•-----------------------•---......------------•----------------------------------•-----------------------•------. ---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Samtar od �- The urhersigned further agrees not to place the system in operation until a Certificate of Compliance has ee i ed by t oard of health. Signed..... G"" '�t""i-. Date Application Approved BY-----------. y i ................................. Date Application Disapproved for the following reasons--------------------••---------------...--------------- .................................. .................•--•------------•---•--...-------••--------------=--•------ ......................................... 0 r Date - PermitNo......................................................... ISSU61....... _ { Date THE COMMONWEALTH OF MASSACHUSETTS - BOARDS OF HEALTH , f$ OF..............a..............:3...............................:....................... Trrtifiratr l f Tuntplianrr THIS IS`-T0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -tom: ----------------••-------•------------•--- Installer at------------------ -• has been installed in accordance with the provisions of TITLE 5 of The State:Sanitary Code as^desdribed in the application for Disposal Works Construction Permit No.. z .._.... ' dated.........................:��;`.._......___._. • ;�y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT-THE SYSTEM WILL FUNCTI@N' SATISFACTORY. DATE........................................................... ...........:.: Inspector.......................... THE COMMONW 'ALTH OF MASSACHUSETTS r BOARD OF HEALTH ............................OF............................... Disposal Works ITPOnstrudion Vprrmit Permission is hereby granted............. ......... to Construct ( ) or\Repair ( ) an Individual Sewage Disposal System atNo.. .._.........fj ;.... .,z,t -- ---------------------------•------------------:.............. ' � Street � gas shown on the application for Disposal Works Construction Permit,No.__--_••_- _-__._-- Dated................... } .......•-•............ DATEy I oard of Health ---------••--------------------------•------------•�.....:....... .....:.. FORM Fi255 A. M. SULKIN, INC., BOSTOW%+: r ; i No.40?,L3 V a THE COMMONWEALTH OF MASSACHUSETTS BOARD 'e HE LTH �� .---......OF.......:................................. ...._.. Aptiration for Uiipla ial Works Tonstrnrtion Vrrmit Application is ereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal ' - System at: .....--••-------. .`...... .,� .. ---_�. .................................. ........•-- ... - .......... ......... -Locati -Address or Nro�. ....------. .. ....... �...1 .' -. I..................•-- �• Ovyner /// _ •�-- •Address ( ................................................................................................................ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 14 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures -----••-•------------------------------------- ---- ------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow_._._________________________.._._......_.__gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-_---------------------•-------.... ................. _......... --•--•- Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit____._-__________... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------------------------•-------......_....._._....-•----_............................................................ 0 Description of Soil---..................................................................................................................................................................... x V •-•----•---------•-•--------•------- --------•--•--- ...--- W _ U N ure of epairs or Iterations nswer whgn appl' blew_..____ .: ........... ....��._._.__.__._.__ _.- Agreement: The undersigned agrees to install the aforedescr ed Individual- isposal System in accordance with the provisions of TITLE 5 of the State Sanitary Cod The undersigned f th ;� rees not to place the system in operation until a Certificate of Compliance has been ' sue by the b and of e Sig --_...- •------•-_... ......- -----• •-•---•-------------•• -- � Date ApplicationApproved By.......................•------------•-.............................. ---------•---........•-•- Date Application Disapproved for the f ollowi re ns:..................................-•......................................................................... --•---------=--------•----_..._.....-•---.._..._.....-•-----_.....__.....---•--------........•----....-----------------••-----••---•-----•--•-----•-------•---••••-•--•-•--•--•---•-••----•••--••------- Date PermitNo......................................................... Issued....................................................... Date -c �THE�COOM^O�N®ACTH OFUACS,SA;MASSACHUSETTS >j BOARD rl G. L 1 I7..................... ....................0 F...............--....-...:.:.......__....--.-............................................ Appliratiaau for Elispaaaittl Warks Taatt3truru ott Frrutit Application is ereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ....._........... - ................................................................... Locati :Address 0fij N, .............:...; ;__.. .._... --_:-- •-••------ ..........• - --•- - .................... W d2"ner ......... .................... YY tr.Q._._.... .....: ....... Installer Address Type of Building Size Lot............................Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type T e of Building No. of ersons____________________________ Showers C4 YP g ---------------------•------ P ( ) — Cafeteria ( ) Q' Other fixtures _____________________ d -----------------•-----------•--—--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..........................._.............................................. Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Tit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ - i ---•--------------------------------------•---------------•--••--•---------•-•-••-••--••-••-------- -------------•-•-•----•------------•-•------------•----- : 0 Descriptil Soil_________________ U --------•••......................•-••----------f---....---------------------------...----•-----•-••--•-•------------I_.. ..--•------••--------.....---------- ;- ............................... UW •-•--•-----•--------------------------••---••-••-•-•---•-•-•-------••---•------•-••--------------••----•--•-•--- ----------- N ure of gg-a' or Iterations nswer w n appl blew____._ --- ___.......................... Agreement: The undersigned agrees to install the aforedescr ed Individual S isposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Cod The undersigned f th rees not to place the system in operation until a Certificate of Compliance has been sue by the b and of Date ApplicationApproved By...................--- ....................................................................... Date Application Disapproved for the f ollowi re ons:--•--•-••------•-•-------•-•----••-----••----••--•-•-••-------•-------•---•-----•...........................•-•- .....................•---------------.._--•---•---------._.....-••--------•-----•--...------------...--•-------------------------•--------•--------.................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y�..►/� J/d ..............................•--.........OF...-...... :+.fla.".:•r/.7•':-:r..: :................._.............._... (Intifiratr aaf Taautpliattrr THIS IS TO CERTIFY, at the Individual Sewage Disposal System constructed ( ) or Repaired by - .--...... ------------------------•--- -- -------- -•••-----.......-••-•••---.....•--•..................._....•-----......•- Ipstaller at.._...__.._ - .- ......... has been installed in accordance with the provisions ofT� 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .-el___SY>____________ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 7 /Z DATE...................... .................................. Inspector..--•-- ` �r� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NreO.............. FEE---••.................. Disposal Works Tonstr tiatt rrutit Permission is hereby granted---------- ------ •• -'........ ::... . '---------------------------------•----------......-------............-•---.... to Construct ( ) or Repair ( an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction It No...................__�D�aed.......................................... Bo��of` Health DATE............. - ��f��.............................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y� THE Tp No.-----z -- y`� O FICE OF THE BOARD OF HEALTH % BARNSTABLE o OF THE MASS. I 9�'ArFp 39 k�e� TOWN OF BARNSTABLE, M4S§. p — - .-- ---- ------ 19 d n SEW E DISPOSAL PERMIT _ ____ o construct � � Permission is granted to�� --r- - - a-- t 4 - �.• - "' ------- 10 ,Up the Premises of f Sketch __________ _____ ___________ In the. village of T 100 or more feet from any sour of water supply' , 20 feet from building 10 feet from property line ««�- 1' Health Officer. 7 LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A,4 LER'S NAME & ADDRESS "o . I-1-Ae2z I c!!!6 �5S 0 UILDE R OR OWNER DATE PERMIT ISSUED i�; 2 31,*/ DATE COMPLIANCE ISSUED d Q 8 a � -o s -7� /�' CAA ou TOWN�F BA NSTABLE LOCATION S — SEWAGE # VILLAGE L — ASSESSOR'S MAP Cz LOT INSTALLER'S NAME PHONE NO. / A & B CANCO 175-6264 SEPTIC TANK CAPACITY o e ,O,(s ax V lie. Pr- LEACHING FACILITY:(type) AL1-e-Z--5- (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER -�2�,L� DATE PERMIT ISSUED: - ^-4y _ DATE COMPLIANCE ISSUED: p - Z 3-S T VARIANCE GRANTED: Yes No rye/$L lit SAW, Vz n fia v x o �L THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: Lae.. Z3 4r-& BUSINESS LOCATION: I (A a yu 0,.,k 4 MAILING ADDRESS: f' ' INVENTORY TOTAL AMOUNT: TELEPHONE NUMBER: 50 9 —77/—SQ06 CONTACT PERSON: A.�7a_�e?a i . C,4&e4 Cr��i,r�eel r7� en c EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: /fit/ SOS- FIDE 0(57IGT OTHER INFORMATION: exi.42a. s G J C,9A / INC9, eon M S AS oh 5if� " Waste Transp ation: 7AJo 14az__ waste Name of Hauler: IV� Destination: Waste Product: Licensed?. Yes No NIA 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners .NEW USED Cesspool cleaners Automatic transmission fluid '-7 aak Disinfectants ; _ A— Engine and radiator flushes _6� Road Salt (Halite)�Scc-/a'! - y" Hydraulic fluid (including brake fluid) �/,aaCRefrigerants Motor oils Pesticides '1aat NEW USED (insecticides, herbicides, rodenticides) Gsatine, Jet-Fuel ir�se�r Photochemicals (Fixers) DieseG fuel, kerosene, #2 heating oil NEW USED 2 Other p troleum products: grease, Photochemicals (Developer) lubricants, gear oil , NEW USED , �L Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) t Battery acid (electrolyte) 1-(0 aqA Swimming pool chlorine Rustproofers Lye or caustic soda .2 57 h detergents Jewelry cleaners ) Car wages 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 ._ Paint brush cleaners �4,Any other products with "poison" I;bels (including chloroform,formald-�nyde, Floor &furniture strippers hydrochloric acid, other aci(as) Metal polishes Laundry soil &stain removers Other products not listecJ which you feel (including bleach) may be toxic or hazardous (please list): $ k Spot removers & cleaning fluids Misc.: W /a a�l � Other cleaning solvents _ C. a,L _ Bug and tar removers Z S V\12k V I l + J1,A.14.2004 2:52PM BARNSTABLE BOARD OF HEALTH 80 � 1� 2/3 Town. of Barnstable Regulatory Services / Thomas F.Geiler,Director +� Public Health Divisio Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Me: 509-962-4644 Fox 408.790.6304 �! '�O y Application Fee:�100.00 `g• ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT.TO STORE AND/OR UTILIZE MORE THAN I11.GALW-NS OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT ZZal) Y-O NAME OF ESTABLISHMENT �- ADDRESS OF ESTABLISHMENT �2t24/J�2 TELEPHONE NUMBER SOLE OWNER: YRSNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.. ;y STATE OF INCORPORATION y,!!a,!:m bho FULL NAME AND HOME ADD RE 3 OF: , r ' PRESIDENT GU ' ` 3 3 s TREASURER CLE SIGNATURE OF AAMICAn RESTRICTIONS: ROME ADDRESS /�/ tr1�ryooa . .00ftu HOME TELEPHONE#_ 5 n,9— IiabdooPo�/q _ ' - o .3 t �; T BLE UL " k • S -s - 1� .4+ + j'i �S r 7 "`' .p ti .. a t '� Y. ra t y 4' Number F -0h.; r R. 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't r*� � �- r'1'-�.rt r �' 1't..�; .�-":TM3, ,7 far;.. 7'i tT r'� �'�} ,`a. '�S s. t �'SE+ :7�, ,.� $�fi JY,. r;. a rt� i '�: ♦ J�° ':k � J 'J' ; c a`, c� r� �`.t _ •','.F F.L ,?+ x ,. 'CF yx x r `1 p -, A' . TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM' NAME OF BUSINESS: �"c�_.�.�5 /7t�lc C� �7���°� Mail To: BUSINESS LOCATION: Board of Health Town of Barnstable MAULING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: 7i�� ' EMERGENCY CONTACT TELEPHONE UMBER: 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 twMotor 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) _ 9 Rust roofers / Swimming pool chlorine P 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 Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business • • i ' ' iCOMPLIANCE: CLASS: 1. 0rine,Gas Stattions,Rep • • • ' • ' • �♦ �° Auto Body Shops 4.Manufacturers • 5.Retail Stores 6.Fuel• �� � Suppliers7.Miscellaneous off • Case lots Drums Above Tanks Underground Tanks,,", MENNEN NEMIN I 'go 1.020WIR- A, I MEN M NE11011M 1001011M In MENOMONEE on MENEM �� . . _ IiLL'J►i L./, 0 fflyffln.� rdNa Name of Hauler Destination Waste Product Licensed? TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS:. `7G2 Town of Barnstable TELEPHONE NUMBER: `7 7 / - yo i z P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quan (ties totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES V NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: V 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 L,� 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 P-) 5� 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 --y Metal polishes (including chloroform, formaldehyde, Ve 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 • _ J kBLE 1 Ousehold Hazardous Waste Collections, 1991 - 1994 ape Cod, Massachusetts Date Held 7191 Waste Collected 1992 1991 1991 3rn$table 1991 1942 1993 199t no O1D No� No cmucctlma 25ann _ ou me Iro won rJb 2a-1u1 - - 3.mo Fol rewster - 97s to sas 1•Jd sy 2-May S-alar 7-b"T 1.175 2.6m 2A10 1.640 hatham 7-Sep 27 ennis Noaoo�,t 11 � I•� 1-125 1.815 smao 'B No amnacbm 4-A;w!I S-Om No a gkcom No amawcoo 18 No aoaedfao almaulh 1 - 1.100 _ =- 28- S A s.lo5 2.986 2im Ji rwl ch a.71ts �-Oci �17et 22-May/6-Nor 29-Jvt 1.550 2.105 1.655 ss pee 20,.1W No coaamam No rieans 30• ' 'g 1.070 I.Z?S -- sat FALm X Ah roYlnCetOSR La a-M+7 17-Sep 1.592 1aAamm, .180 1.41a , 5 2&4 andwich 5- 13-Now I-0cY 2.noo27-Jut 22-Aus 31.h so.Ail 400 rur0 No dub 1.FaZ0 3.140 SAas 13-Jar 7-ldW/1-0id g� e l l t I e e t I A48 lso/1.906 31-Oct 13-Nov T 1Asf11-Oei g,tp arrnouth 7� SzTVUM saeTt no 22Jua 27�hsn 26Jun 25�� I AM 1.825 2a36 2 SW otals 1 XIS 37.765 21A20 a1 J54S too 011ed by Cape Cod domisaton,daft-WPLId by Tb, rite Collected Is in galimn 's 1963 tad J oo�Lectbat���m''�'��for Tc> ro/We3itleei, 199Q. � t mHe At>Moetawra and Trs:ro 2��m and Wejjticet nc 1993 and 1984.ftLmoutb mod)tom unt of rrastt 0"bl for Trutn f WeWkvI 1198.3.19"mnd ftLnouthjmaahpce(19"Is In bout eas=s aanibiried data from the two to.vsas, l 99-4. the tawas of C5tltam,Dennt,,Falmouth,Or4m�ts,p� saetowrn.Truro, and hmidass wraite in adriftSan to she gaLIOnage sh wrn abovm- collected 2.TZ3.4 pa�ida d aon-lLquW Ltousehold ')=Fatlasazcd data � I f Z '348 e59 776 Receipt for �. Certified Mail No Insurance Coverage Provided 1pUTED STIIrt Do not use for International Mail POST1LL SEhICE (See Reverse) OQf Sent to r, r - , ,t Streei.and No. !//� State and ZIP CoddJ p� O A co Posta e M E Certified Fee O LL Special Delivery Fee Rg�SF�gdiQ;��e,y f `Y,7 ;fiU%p ff�gCe P c5;P. .. to Whom&Date D i Return Receipt Sh t Date,and Address e s a TOTAL Postage &Fees Postmark or Date 09Z STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want tltis•recei" p' t postmarked,stick the gummed stub to the right of the return address leaving the receip�t,`�ttach'ed antl:'present the article at a post office service window or hand it to your rural�rGfer�no�xtr�a chargel.J^S� � 2. If you do not,want this receipt postmarked,stick the gummed stub to the right of the return Cl) address of the article,date, rA tdetachiand retain the receipt,and mail the article. ✓ \ L 3. If you want a�eturnreceipt,write the certified mail number and your name and address on a return receipt"corrd,Fmm'3811,avid attach it to the front of the article by means of the gummed ends if space permits:p�theiwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent t—o the number. OC co 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If li p� return receipt is requested,check the applicable blocks in item 1 of Form 3811. a I 6. Save this receipt and present it if you make inquiry. 105603-93-13-0216 1• SENDER: o ■Complete items 1 and/or 2 for additional services. I also Wish t0 receive the �.y ■Complete items 3,4a,and 4b. following services(for an y ■Print your name and address on the reverse of this form so that we can return this extra fee): .. card to you. ai ■Attach this form to the front of the mail piece,or on the back if ace does not d e p p 1. ❑ Addressee's Address permit. •Z d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery, r ■The Return Receipt will show to whom the article was delivered and the date C delivered. Consult postmaster for fee. c a 3.article Addressed to: 4a.Article Number m �d Mr. ASP Tr -Ycr► Z 3�f 8 (o59 � 7 `E y� 4b.Service Type I U k'- 1 r /c r-- ❑ Registered Certified c co l I W � / 40 ���Q j ❑ Express Mail ❑ Insured 3 (O c(u�. H I IM C MA ❑ Return Receipt for Merchandise ❑ COD owvl 1 S 0� 7 ate of livery C ;� •- Z �V ; APR � �d/�6 1:3 5.Received By: (Print Name) 3 Addressee's Address(Only if requested c I¢ 9c a/nd fee is paid) t g 6.Sig : Addressee or Agent) v J 10 j-w I Ps Form 3811, December iss Domestic Return Receipt +I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 s Print your name, address, and ZIP Code in this box• w i Board of Health Town of Bamstable P 0.Box 534 Hyannis,Nlassachuaetts 02601 I I Town of Barnstable Health Department } """ 367 Main Street, Hyannis, MA 02601 Office 508-79"265 Thomas A. McKean FAX 508-775-3344 Director of Public Health April 25, 1996 Mr. Art Triveri K-Mart , 768 Iyanough Road Hyannis, MA 02601 Dear Mr. Triveri, You are required to appear at the Board of Health hearing scheduled on May 21, 1996 at 7:00 p.m. Thd meeting will be held in the Second Floor Hearing Room of the Town Hall. At this meeting you or your representative will be asked to explain why you have not complied with the order letter dated December 4, 1995 in regards to the State's Underground Injection Control Program( 310 CMR 27.00). If you should have any questions please telephone me at (508) 790-6265. Sincerely yours, omas A. McKean Director of Public Health I Date f/ � Dear-- -- - You are required to appear at the Board of Health hearing schedulij on at, 7:00 p.m. The meeting will' be held in the Second Floor Hearing Room f Town Hall. At this meeting you or your representative wi 1 be aske� to explain why you have not complied with the order letter dated a R% regards to the State's Underground Injection Control Program (310 CMR 27.00) . If you should have any questions please telephone me at (508) 790-6265. Sincerely yours, Thomas A. McKean Director of Public Health JUN 7196^ 18 : 26 FIR K—MP LEGAL DEPT . 810 643 10 TO 915087753344 P . 01 Peter Palmer Kmart Corporation Vice President International HtaC,Jorters labor Relations 3100 West Bic Beaver Rood Assistant General Counsel, Troy MJ 48O 4.363 81 0 643 1682 Jeffrey J.Reitmyer $10 643 5619 Shavan Giffen Sherry L-McMillan 810 643 1846 Employment Law& Louis Zednik 810 637 65dd Environmental Richard L.Kalcjian 810 643 1144 Caw Counsel Michael J.Lane 810 6a3 5499 810 643 1631 'I ELEFAX J'RANSMI I"�AL DATE: TO: "�. TELEFAX NUMBER: FROM: LOUIS ZEDNIK SENDING A TOTAL OF 4—PAGES,INCLUDING THIS COVER PAGE. IF YOU ISO NOT RECEIVE ALL PAGES, OR ARE EXPERIENCING OTHER PROBLEMS IN TRANSMISSION,PLEASE CALL THE SENDER AT (313) 637-6544. THANK YOU. Our telefax machine telephone number is: (313)643.2514. COMMENTS: CONFIDENTIAUTY NOTICE: The pages constituting this f rc contain confidential information ' which is legally privileged and intended only for the use of the recipient named above. If you are not the intended recipient,you are hereby notified that any disclosure,copying,distribution or taking of action in reliance on the contents hereof,except direct delivery to the intended recipient named above, is strictly prohibited. If you have received this fax in error,please call immediately to arrange for return to us. JUN 7 ' 96 18 : 27 FR K—MART LEGAL DEPT . 810 643 1054 TO 915087753344 P102 Pater Palmer Kmart Corporation Vice President International Headquarters Labor Relations& 3100 Wes►Big Beaver Road Assistant General Counsel Troy Mt 48084.3163 810 643 1682 Louis Zednik 810 637 6544 Shavan Giifen Matthew J.Home] 810 643 5619 Employment Law& Janet M. Crockett 810 614 1385 Environmental Law Counsel Richard L.lCplojian $10 643 1144 Janet C.Wlosinski 810 643-5499 $10 643 1631 June 7, 1996 Mr. Thomas A. McKean Director of Public Health 4. Department of Health, Safety and Environmental Services Public Health Division P.O. Box 534 Hyannis, MA 02601 Re: Penske Auto Centers 768 Iyanough Rd,Hyannis, MA Kmart#3040 Dear Mr. McKean: This letter will follow-up my telephone message left with your office today. Based on the reasons more frilly discussed below, I am requesting that that you provide Kmart Corporation("Kmart')additional time in which to respond to your late May 1996 letter. I also request that you remove the above-referenced matter from the Health Board's June and July 1996 agendas until Kmart's Landlord has responded to Kmart's enclosed June 7, 1996 demand letter. As indicated in the enclosed formal notice of default letter,Kmart has directed Cape Harbor Associates, the Landlord at the above-referenced location,to comply with the Landlord's responsibility forgovernmental compliance under Article 17 of the parties' lease. Pursuant to Article 17, Cape Harbor Associates is responsible for the auto service center floor drain connection upgrade compliance requirements under the Massachusetts Underground Injection Control ("LIC") Program and Plumbing Code. Given the nature of this environmental compliance issue,Kmart is proceeding in good faith by seeking waiver of the thirty(30)day period under the Subordination,Non- Disturbance and Attornment Agreement with American Saving Bank,FSB to correct or remedy the Landlord's default. Further, in the event that Cape Harbor Associates fails to cure its default, Kmart will undertake the work required to bring the auto service center drainage system into compliance with the Massachusetts UIC and Plumbing Code regulations. JUN 7 ' 96 18 * 27 FR K-MART LEGAL DEPT . 810 643 1054 TO 915087753344 P- 03 Mr. Thomas A. McKean June 7, 1996 _page 2- In light of Kmart's obligations to the Mortgagee and Kmart's commitment to regain compliance should the Landlord fail to cure its default, Kmart requires an additional 30 days in which to obtain(a)either the Mortgagee's waiver or allow for the cure of the Landlord's default and(b)written confirmation of Cape Harbor.Associates' intent to cure the default. Upon my receipt of the Landlord's response, I will advise you as soon as possible, but no later than July 15, 1996. Should you have any questions regarding this matter,please feel free to call me at (810) 637-6544. Thank you for your cooperation. Sincerely, Louis Zednik Environmental Law Attorney Encl. cc: John Walsh,Esq., RIH (w/encl.) Cape Harbor Associates (w/encl.) c/o Trammell Crow Realty Advisors 3500 Trammell Crow Ctr. 2001 Ross Ave. Dallas,TX 75201-2997 VIA FAX AND MAIL (508)775-3344 JUN 7196 18 : 27 FR K—MART LEGAL DEPT . 810 643 1054 TO 915087753344 P.. 04 Kmart Corporation Inteenationol Heodquorters 3100 West Big Beaver Rood Troy MI 48084-3163 June 7, 1996 Cape Harbor Associates c%Trammell Crow Realty Advisors 3500 Trammell Crow Center 2001 Ross Ave. Dallas, TX 75201-2997 Attention: David W. Campbell Re: Kmart#3040 Hyannis, MA Gentlemen: This letter constitutes former notice to you, as Landlord,on the above captioned property as to a default under Article 17 of the Lease("Lease")dated June 29, 1972,as amended. (Article 17 states that Kmart is responsible for compliance with governmental regulations, including non- structural changes insofar as they are due to Tenant's occupancy;however, all structural ehmmes, or non-structural changes if they are required irrespective of the nature of the tenancy, shall be complied with by Landlord at its sole expense. The type of work the Town is requiring here is considered to be stnictural in nature, and as such,Landlord's respon- sibility to perform). During an inspection of the premises by a representative of the Town of Barnstable, it was - observed that the floor drains in the automotive service center were tied directly into the septic drainage field via an oil/water separator system, which type of setup is a violation of the Federal.Safe Drinking Water Act(a copy of the Town's notice to Kmart is enclosed for your reference). Under the State Plumbing Code,oNNmers/opemtors of facilities with floor drains tied to injection wells(which the septic field is classified as)have three(3)options: 1. Seal the floor drains 2. Connect the floor drain to a holding tank 3. Convect the floor drain to a municipal sewer system, if available Option #1 is not viable, as it requires that all previous discharges to the drain be eliminated;as Penske operates this space as an automotive service center,fluids and potential contaminates will continue to be used. Further, we have investigated connecting the floor drains to a municipal sewer system, however,there is no sewer he within a reasonable distance, so Option 43 also does not appear to be viable. It is therefore recommended that Landlord pursue Option#2 to bring the automotive drainage system into compliance with governmental regulations. It should also be noted that, if in the course of performing the outlined corrective action, contatrwiation of the septic field is discovered,then remediation of same will be necessary. JUN 7 ' 96 18: 28 FR K-MART LEGAL DEPT . 810 643 1054 TO 915087753344 P.. 05 l Cape Harbor Associates June 7, 1996 Page 2 In the event of Landlord's failure to cure such default, IGnart Corporation,as Tenant,will have no alternative but to undertake such work and request reimbursement from Landlord. If such reim- bursement is not forthcoming, Kmart will offset the expense of such work from future rentals as provided in Article 29 of the Lease. By copy of this letter,we request American Savings Bank,FSB to waive the thirty(30)day period provided under the Subordination,Non-Disturbance and Attornment Agreement to correct or remedy such default. If Mortgagee does waive such period,Kmart will act to cure Landlord's default upon receipt of waiver,but not sooner than seven(7)days after Landlord's receipt of this notice. Sincerely, KMART CORPORATION By. J t John F.Walsh, Resident Counse JFWf MP/ar Enclosure cc. Cape Harbor Associates c/o RIS Enterprises, Inc. 1303 South Frontage Road, Suite 13 Hastings, MN 55033 cc: American Savings Bank, FSB 1133 Avenue of the Americas New York,NY 10019 D. VanLoo P. A. Gawel L. Zednik D. R. Guthrie-Pittsburgh Construction Office J. Dewar-Albany Construction Oice CERTIFIED MAIL RETURN RECEIPT REQUESTED 1 �' ;.:.. .... x O(A ^t 17 —tali Ckw or lc �` a Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 ba Office 308-790.6265 Thomas A.McKean >; FAX 508-775-3344 Dit f 6f Mile Health h i April 25, 1996 ' s f Mr. Art Triveri K-Mart 768 Iyanough Road Hyannis, MA 02601 Dear Mr. Triveri, You are required to appear at the Board of Health hearing scheduled on May 2191996 at 7:00 p.m. The meeting will be held in the Second Floor Hearing Room of the Town Hall. At this meeting you or your representative will be asked to explain why you h6v6 hot' complied with the order letter dated December 4, 1995 in regards to the State's Underground Injection Control Program( 310 CMR 27.00). ' If you should have any questions please telephone me at(508) 790-6265. Sincerely yours, �jJ! r. omas A. McKean Director of Public Health t RA t x �• 7 4 f y � +i 6 Date 1 B - Dear-- y:du are required to appear at the Board of Health hearing schedulJon at- 7:00 p.m. The meeting will be held in the Second Floor Hearing Room f Town Hall. At this meeting you or your representative wi 1 be ask� to explain why you have not complied with the order letter dated /`Q Nin regards to the State's Underground Injection Control Program (310 CMR 27.00) . .If you should have any questions please telephone me at (508) 790-6265. Sincerely yours,; 3x Thomas A. McKean Director of Public Health l'r "y S. I' - ® SENDER: 0 ■Complete Items t and/or 2 for additional services. I also wish to receive the ■Complete Items 3,4a,and 4b. following services(for an a► ■Pdnl your name and address on the reverse of this form so that we can return this card to you. extra fee): > ■Attach this form to the front of the mallpleoe,or on the back if space does not . ❑ Addressee's Address o •Wl rite'Refum Recelpf Requested'on the mailpleoe below the article number. fs •The Return Receipt will show to whom the article was delivered and the date 2. Restricted Delivery C delivered. C Consult postmaster for fee. V y3.A.P111cle Addressf ed to- 4a.Article Number bar I ' Ir, ArP Trk'✓er►' Z 3Y 8 1059 —7 7 4, cc E f/, 4b.Service Type R — ' I 1 c r� ❑ Registered Certlfled �g arl O O ❑ c Express Mail ❑ Insured y M A Return Receipt for Merdtandise ❑ COD °a N an n I S fy�A Dog ate of Poilvery 5.Received By:(Print Name) _ A dressee's Address(Onty if requested m Q a d fee Is pa/d) am g 6.Sig : Addressee or Agent) —_ 0 1' PS Form 3811, December 19 N _ Domestic Return Receipt a ..... Z'348 '659 776 Receipt for Certified Mail No Insurance Coverage Provided UIYTEDC4f� `o not use for International Mail OOSr45FYVICF (See Reverse) Sent to r, r T Scree and No. lk1ex P. .,State and ZIP Cod oa 0 Posts e . � Certified Fee ' D Special Delivery Fee '' ,icted Defiveiy;,aF e"'" -R1urn'Aecelpr'SV —�to Whom&bat Return Receipt SDate,and Addrea (/) TOTAL Postage ^ &Fees Postmark or Date �9Z ' P j% P . 496 564- Receipt for Certified Mail .� No Insurance Coverage Provided Do not use for International Mail (See Reverse) Sen o ^ v street andblo.1:21,0 �. n-r) /6 P .,State and ZIP C de Posta e i Certified Fee / /C/ Special Delivery Fee Restricted Delivery Fee Return Receipt Showing O) to Whom&Date Delivered Return Receipt ShovYjgg'tQ'Wt r- Date,and Addre 9;s� d[e§S iY TOTAL Posta + ,� C &Fees Cry ec -7 0 Postmark CV16Je M E % o W a ..:rear STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(we front). y 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address � leaving the receipt attachbd and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return �. address of the article,date,detach and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Ftprm 3811,and attach it to the front of the article by means of the gummed ends 9 space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent•to the number. O " O 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E o" 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. a 6. Save this receipt and present it if you make inquiry. 102595-93-z-0478 0 SENDER: rn Complete items 1 and/or 2 for additional services. I also wish to receive the • Complete items 3,and 4a&b. following services (for an extra Gii Print your name and address on the reverse of this form so that we can feel: > 4) return this card to you. d • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address y does not permit. t • Write"Return Receipt Requested"on the mailpiece below the article number. .. � 2. ❑ Restricted Delivery •d • The Return Receipt will show to whom the article was delivered and the date c delivered. _ Consult postmaster for fee. 0 3. Article Addressed to: -' 4a. Article Number 0c m r, A(4- j(, ve r l' c _ r� 4b. Service Type ; � G. ❑ R Istered ❑ Insured v � W �/ j c/a an (� Certified El COD Euyi (� -F—7 iK�/ ❑ Express Mail ❑ Return Receipt for W Merchandise G L/U {�1) ! S/ f 1� �C0 7. Date of Deliv ry a /2— '0 5. Signature (Addressee) 8. Addressee's Address(Only if requested,Y and fee is paid) c H r ` Uj ge 6. S' a re 1 ~ I ; H PS Form 381 , Dec.WnberJ 1991 *u.s.G 0•1ee3-452 DOMESTIC RETURN RECEIPT i UNITED STATES POSTAL SERVI� �N. 9 P fl/ 47 Official Business m ' 0 E C A PENQLTa<�-@R -Rl TE - USE TO YM ' /99C� POSTAG , Print your name, address and ZIP Code here Heaitb Dope 1 Town of Bam W$ P.O.Box 534 <" f11«It1,1j1�,t1„���4I If,1., _I fit Illtl ttill it iI1a11 4 Town of Barnstable Department of Health,Safety,and Environmental Services ■ MSTABLB, ' MASS. Public Health Division 039. &` 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health December 4, 1995 Mr. Art Triveri K-Mart 768 Iyanough Road Hyannis,MA 02601 Dear Mr. Triveri, RE: Penske Auto Centers,768 Iyanough Rd.,Hyannis On December 1, 1995,Donna M.iorandi,Health Inspector for the Town of Barnstable observed floor drains connected to an MDC trap and then to a leach pit,which is considered an Injection Well. As mandated under the Federal Safe Drinking Water Act,the state Underground Injection Control(UIC) regulations prohibit potentially polluting discharge to injection wells. Vehicle maintenance operations commonly use unauthorized injection wells,such as floor drains leading to a septic sytem,dry well, or oil/water separator which leads to any subsurface leaching structure. Under the State Plumbing Code(248 CMR 2.09(1)(c)(3),owners/operators of facilities with floor drains tied to injection wells(or discharging to any surface point)have three options: 1. Seal the floor drain. Contact your local plumbing inspector for the appropriate filing form. If choosing this option,all previous discharges to the drain must be eliminated at theri source. For example,cars should no longer be washed and floors should no longer be hosed down. 2. Connect the floor drain to a holding tank. The tank will need DEP approval. The DEP approves two types of holding tanks for this waste: new installations and conversions of existing structures (e.g. oil/water separators). These tanks are for non-hazardous, industrial wastewater. If solvents, antifreeze,oil and other fluids are washed down the drain,the waste is likely to be hazardous. 3. Connect the floor drain to a municipal sewer system,if available. An oil/water separator is required to be installed under this option. This requires a permit from DEP and the Town of Barnstable Department of Public Works along with the sewer connection application. The amount of discharge shall not exceed ten parts per million(10 ppm). In all cases,the owner must file a UIC NOTIFICATION FORM with DEP. You are directed to comply with the state's UNDERGROUND INJECTION CONTROL regulations (310 CMR 27.00)by informing this department in writing of your intentions within ten(10)days of receipt of this notice and completing the work within thirty(30)days. PER ORDER OF THE BOARD OF HEALTH / �, "Thatfias A. McKean Director of Public Health Enc. Industrial Floor Drains cc: Ed Jenkins,Town of Barnstable Plumbing Inspector Town of Barnstable Department of Health, Safety, and Environmental Services �► MAN. Public Health Division � MAN. Eo+ � 367 Main Street, Hyannis MA 02601 Office: 308-790 6263 Thomas A McKean FAX: 508-775-3344 Director of Public Health 'Deca 1�1k® Afi�'r -rkI V6ki (g J AMOUG4 no i Dear 0 ��l�l/E2% Hlvpvlv/v sW As mandated un er thTOW deral Safe Drinking Water Act, the state Underground Injection Control (UIC) regulations prohibit potentially polluting discharge to injection wells. Vehicle maintenance operations commonly use unauthorized injection wells, such as floor drains leading to a septic sytem, dry well, or oil/water separator which leads to any subsurface leaching structure. Under the State Plumbing Code (248 CMR 2.09 (1) (c) (3), facilities with floor drains tied to injection wells (or discharging to any surface point) have three options: 1. Seal the floor drain. Contact your local plumbing inspector for the appropriate filing form. If choosing this option, all previous discharges to the drain must be eliminated at theri source. For example, cars should no longer be washed and floors should no longer be hosed down. 2. Connect the floor drain to a holding tank. The tank will need DEP approval. The DEP approves two types of holding tanks for this waste: new installations and conversions of existing structures (e.g. oil/water se par These tanks are for non-hazardous, industrial wastewater. If solvent antif eese` it and other fluids are washed down the drain, the waste is likely to be hazardous. 3. Connect the floor drain to a municipal sewer system, if available. An oil/water separator is required to be installed under this option. This requires a permit from DEP and the Town of Barnstable Department of Public Works along with the sewer connection application. The amount of discharge shall not exceed ten parts per million (10 ppm). In all cases, the owner must file a UIC NOTIFICATION FORM with DEP. �owlv of otss6f✓6p na,r` .D2N%NS C01W6Cr640 -7-0 Al /MC T,efi F �IVD 7��N To N t,64C-M Pi l, W� iC#1 iS CO/IASlb626�o ,Q!✓ Si�ti E /D/t� We L)(- You are directed to comply with the state's UNDERGROUND INJECTION CONTROL regulations (310 CMR 27.00) by informing this department in writing of your intentions within ten (10) days of receipt of this notice and completing the work within thirty (30) days. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Cc 0 ic�u o ou> OFF n PLVM811 lovcp6corcc, Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 Office 509-790-6265 Thomas A. McKean FAX 308-775-3344 Director of Public Health April 25, 1996 Mr. Art Triveri K-Mart 768 Iyanough Road Hyannis, MA 02601 Dear Mr. Triveri, You are required to appear at the Board of Health hearing scheduled on May 21, 1996 at 7:00 p.m. The meeting will be held in the Second Floor Hearing Room of the Town Hall. At this meeting you or your representative will be asked to explain why you have not complied with the order letter dated December 4, 1995 in regards to the State's Underground Injection Control Program ( 310 CMR 27.00). If you should have any questions please telephone me at (508) 790-6265. Sincerely yours, omas A. McKean Director of Public Health