HomeMy WebLinkAbout0030 PERSEVERANCE WAY UNIT UNIT 1 - Health er
30 P everance,Wy (TJnit 1) �.
Barnstable
A=295-007-OOA
r �f
CID Py
Date: lv o
TOXIC AND HAZARDOUS MATERIALS ON-SITE INV TOY
NAMEOFBUSINESS:
BUSINESS LOCATION: 3 d i.Q �/ �1 � eGt�Gay
MAILINGADDRESS: " ti 1NV NTORY
TELEPHONE NUMBER: S o g -- -7`7/ �T S�S- IOTA M
CONTACT PERSON: U �r.0 ICI i'l o✓r. ,s�-I(o. 2 5"c�st,�
EMERGENCY CONTACT TELEPHONE NUMBER: 1=li�E p(51C '
TYPEOFBUSINESS: ham_
0 HER INFORMATION: lea
3 a-roL;
C-�ru'.wa.� �Gi�e. G--�-O y, a.�-.►ta1,�c.�-,'o� er�clos�l,. ' (�( ,�2-
Waste Transportatica:
Name of Hauler: Destination:
Waste Product: _ Soa�t-�i,'�s Licensed? a No
LIST OF TOXIC AND 'HAZARDOU4 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
.5`sIEW BUSED Cesspool cleaners
L Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt(Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
2-44%5—NEW USED (insecticides, herbicides, rodenticides)
Ggsoline, Jet Fuel Photochemicals (Fixers)
•Diesel fuel, kerosene, #2 heating oil NEW USED
-257 Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
?� Degreasers for driveways&garages Wood preservatives (creosote)
/Battery acid (electrolyte), (Oa:, ,;e-s Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt& roofing tar Fertilizers
Paints, varnishes,`stains, dyes PCB's f
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED. (inc. carbon tetrachloride)-
Paint&varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners
Floor&furniture strippers (including chloroform,formaldehyde,
Metal polishes hydrochloric acid, other acids)
Laundry soil &stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers &cleaning fluids Misc.: _,( (h0i'.'4U•e.,fae yu?," c(2 cam{
(dry cleaners)
Other cleaning solvents G-ea c aix
Bug and tar removers �—
Town of Barnstable-Health Department Page 1
# (HAZARDOUS MATERIALS INVENTORY SITE VISITS
DBA: Je Bacon Auto Service Fax: _
_ -._ __.. _........ _ _...
Corp Name: Mailing Address
_. -"f
Location: 30 Perseverance Way,Hyannis Street: 30 Perseverance Way
_. _.. . ...... - .. .._
mappar: City: Hyannis
f ontact: Jeff Bacon State: Ma
Tele one: 508-771-9515 Zip: 02601
Emerge cy: Person Interviewed`.
............................._...
....
Busines Contact Letter Date: 5/28/2004 -07
Category. Miscellaneous Inventory Site Visit Date:
Type: Follow Up/Inspection Date:
W publ' water ❑ indoor floor drains ❑ outdoor surface drains W license required
77 ❑ pr- ate water ❑ indoor holding tank mdc , ❑ outdoor holding tank mdc ❑d currently licensed
own sewage V indoor catch basin/drywell ❑ outdoor catch basin/drywell expir -- -- -
� on-site sewage El indoor on-site syste El outdoor outdoor onsite system --- --•-6/26/2-- --0
------04---
5/31/2002-Oil waste burner.Parts cleaner serviced by Cyclesolve, compliance:
Cranston RI. Sand used for small spills. Disposal rags used. Oil filter Satisfactory
cutter-used for filters. Tires recycled with Town Fair.Anti Freeze-WE
Environmental Smithfield RI EPA#MV5087719515
Z)� 8/21/2002- W.O.heater ecyc a tifreaze to be used. a ' S
Cycle Solv parts washer. terstate does batteries. oyne sti rags �cJ�Q•�I
service. Tag bucket w/cover pres a moved. wn fair
ire,R.I.trades tires MV 5087719515.
4h r
�s • �
, � �_ N
VO
41
i_
<J 47 a M
ti
r
Page 2
Town of Barnstable-Health Department
HAZARDOUS MATERIALS INVENTORY
Chemicals: ❑ zero Toxic Waste Materials
❑d gty's>25 Ibs dry or 50 gals liquid but less than 111 gals
❑ gty's 111 gals or more
desc`ription:. ° qty unit.of measure . ,
antifreeze(for gasoline or coolant systems) 55;gallon
__.__._.._..._._._ ..................
propane __�_ _._.___..._.........__._...._.....__
propane 30 cases
_.._.___
paint,varnishes,stains,dyes 5'drums
motor oil 13 cases
............._._._.......__._.._..___._.......___...........__....._.__._._......._.__...........___........_..._.._....._. ...__.-___......n___.___.__._.__.._._W.___..........
.............
gear oil 5gallons
motor oil 220 gallons
waste oil 775gallons
waste antifreeze _______._.__._._._...._..:____...:._._......_._._. .. _.__. .... ons
hydraulic fluids(including break fluid) 1cases
Batteries 10units
Waste Transporter: Fire District:
Last HW Shipment Date: Waste Hauler Licensed: No
_.............. ..........................................__................
._.__...__.._......_.
f
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
David g. Koicomg %iumting & flea�tiny Mail d o
NAME OF BUSINESS: Board of Health
MAILING ADDRESS: 30 i e4zeve2ance Oay Hy¢nniz 02601 Town of Barnstable
TELEPHONE NUMBER: 790-0007 P.O. Box 534
CONTACT PERSON: David Ko.Lcomt 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 quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO X
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-whe _ id
Vol - _ �` �' Please put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners '
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants .
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE OMPL/ANCE: CLASS: 1. Marine,Gas Stations, Repair
satisfactory 2. Printers
BOARD OF HEALTH 3.Auto Body Shops
Q unsatisfactory- 4.Manufacturers
COMPANY!iffi RACc k__- v (see"Orders") 5. Retail Stores
y 6. Fuel Suppliers
ADDRESS K(Class: 7. Miscellaneous
RA QUANTITIES AND STORAGE I (IN= indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above'.Tanks Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) x.
new motor oil (C) x
r:
transmission/hydraulic
Synthetic Organics:
degreasers
1
Miscellaneous:
L�A-,Rwo
C4_e� C)I*
1-d
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply m� r)gz.—
Town Sewer Public
O On-site OPrivate
3. Indoor Floor Drains YES NO,4. i Ste,
O Holding tank:MDC
O Catch basin/Dry well 0 i � �z Fri Ikl S
O On-site system Vr
4. Outdoor Surface drains:YES N0X— ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter �V 1
Name of Hauler Destination Waste Product
1. It(64A4,10 S NO
2.
(XA Q 0j—
P rson(s) Interviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
`(see"Orders") 5.Retail Stores
COMPANY - ` u �d 6.Fuel Suppliers
ADDRESS = , `? Class' G 7.Miscellaneous
QUA*ITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATE L LS
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
t��� 7
1
Heavy Oils:
C)
n
nsmission/hydraulic
Synthetic Organics:
�4.easers
Miscella a s:
IVA
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply ,
>Ifown Sewer ublic
O On-site OPrivate
C /
3. Indoor Floor Drains YES N0_1--'
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDE
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination
1. ��� - � � �✓��� �A` ,�i� YES NO I�
2. 117 l V .
Person (s) I rviewed -spector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations, ep
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body shops
unsatisfactory- 4.Manufacturers
COMPANY — P a�-Co+� O (see"Orders") 5.Retail Stores
` 6.Fuel Suppliers
ADDRESS 36 Class: 7.Miscellaneous
r' *�Qv TITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALSUndergi
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels,
solin Jet Fuel (A)
Diesel, Kerosene, #2(B)
Heavy Oils: '
waste motor oil(C) zZS ➢�
new motor oil (C)
ransmissio ydraulic
Synthetic Organics:
degreasers
Miscellaneous: 1 q LS X
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply '" 2:A . I?a-Q'C 6d t-"4 W- Y<::'
KTown Sewer Public Ikevim« C (e. So .0 wet) �
O On-site OPrivate
3. Indoor Floor Drains YES N0
O Holding tank:MDC_ '� '�� �'`� rj d7
O Catch basin/Dry well IdL w�.rw a7-4, rair" '7;-;-t. 12
O On-site system A V SZ071 9S.-
4. Outdoor Surface drains:YES N0 ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
VIP
� �
YES INO
1.
2.
r - _ r
erson(s) Interviewed Insp et tor D aig
\J i
TOWN OF BARNSTABLE COMPLIANCE: w CLASS: 1.,VIa}ine,Gas Stations,Repair
BOARD NOF HEALTH satisfactory 2.Printers
3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY 13�c'bra ?? (see"Orders") >. 5.Retail Stores `
� ., pp
BSS: = 7 Miscellaneous ' +.L
ADDRESS -� ��-�<� G.. .-- ...r.
QUANTITIES AND STORAGE, (IN= indoors;OUT=outdoors) t
MAJOR MATERIALS Drums Above Tanks Underground
IN OUT IIVc OUT IN OUT #&gallons Age Test
1'14
Fuels: -
Gasoline,Jet Fuel (A) ;
.y 9
Diesel, Kerosene, U (B) .
Heavy Oils: v�
waste motor oil (C) ( "
new motor oil(C)
c -
!
transmission/hydraulic 1 U '
Synthetic Organics:
degreasers
s.
k _ i
iscellaneous:
l�
D� a
DISPOSAURECLAMATION REMARKS:-
1: Sanitary Sewage 2.Water Supply P Ot &V �
Town Sewerublic1 t(
p On-site / QPrivate r s
3: Indoor Floor Drains YES N0
O Holding tank:MDC �4 1 Lo
O Catch basin/Dry wells
O On-site system 6,n
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC J l LJ l .S I u
Catch basin/Dry well ,
O On-site system ( '
5.Waste Transporter .
DestinationName of Hauler
j YES NO
2.
, '
� t
PeFson (s) Interviewed Inspector Date
-
HAZARDOUS MATERIALS REGISTRATION FORM
:........__.........................................................__....__............................._.._............................_......................- ....................._...................
DBA: :Bacon,Jeff-Auto Service fax:
................................................................. ....................................................................................
corp name: Mail Addr
..........................................................................................................._.........................................................................._ .............................. ................
location: €30 Perseverance Way street 30 Perseverance Way
.....
mappar: city ;Hyannis
.............................................................................................................. .....................................................................................
contact: 'Jeff Bacon state: 'Ma
.......................................................................................................................................................................: .............
telephone: 771-9515 zip: 02601;
emergency: p
g y ya�_ Ob C lJ�,ll ers n interviewed:
.... .... ..........
Business:
- - inspection date 1 6/26/95
category: Vehicle Maintenance ...............
inspection date 2
type: .......... ................
.......................... ........................._............................................ inspection date 3
Q public wate indoor floor drain 1X7 outdoor surface drain license required
Q. private wate Q indoor holding tank and ❑ outdoor holding tank and 17, currently licensed
17 town sewag 17 indoor catch basin/drywel Q outdoor catch basin/drywel expir -- ------------------
Q on-site sewag 17 indoor on-site syste Q outdoor onsite syste date:
.........................
notes:
WASTE OIL GOES NEXT DOOR TO NED BENNETT. RECYCLES compliance:
BATTERIES WITH INTERSTATE. DRAINS(PUNCTURES)OIL FILTERS. - incomplete
........ . ........
TRASH. 1 HYDRAULIC/ELECTRIC LIFT. METAL CAN FOR RAGS.
DZM ALSO 4 CASES BRAK CLEANER,4 CASES CARB CLEANER,
SAFETY CLEAN SOLVENT. 55 GALLONS WASTE ANTIFREEZE
Chemicals' Q gty's > 25 Ibs dry or 50 gals liquid
description: unit of measure
antifreeze (for gasoline or coolant systems) 12 Gallons
automatic transmission fluid 12 Gallons
hydraulic fluids(including break fluid) 10 Gallons
motor oil 12 Gallons
other petroleum products : grease, lubricants 10 Gallons
car waxes and polishes 1 Gallons
paint, varnishes, stains, dyes 1 Gallons
paint&lacquer thinners 3 Gallons
paint&varnish removers, deglossers 1 Gallons
household cleaners 1 Gallons
toilet cleaners 1 Gallons
waste transporter �C.oyne
waste transporter Safety Kleen
...............................................................................................................................................................
I
/') v
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: YjalQ4COAlAu I t Mail To:
BUSINESS LOCATION: Board of Health
Town of Barnstable
MAILING ADDRESS: r 1V _ O t P.O. Box 534
TELEPHONE NUMBER:."1�i �SSi�� Hyannis, MA 02601
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER:
Does your firms 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
� s Antifreeze (for gasoline or coolant systems) Drain cleaners
s Automatic transmission fluid 1(,4tl Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
ILf Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,:
o I35 Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages. Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
02 s' Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
r lys. Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
�4L 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) t Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners) rZ_rjq E-i2
+i Other cleaning solvents (_/61_S -C4r,4Nb d1
Bug and tar removers E�rti-ScN�
ICUL. Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
I ..
. Body Shops
unsatisfactory- 4.Manufacturers
"Orders")
Suppliers
7.Miscellaneous
...MM11111 . ...
1 Case lots Drums Above Tanks Underground Tanks
i
.new .
. 0 11 Ll rj� MENEM
0001001M
MEN 11011M
1011001ME
:.+►� ,/ rN 104v MENEEMEM
•� 1 Pffui��
MENINSIM
.�1 r Aso I t� Ff-orm ,I:..
1 • 1A 9 1 1j No N ti
..
REMO
/...1"
• ... , ,► • 1 . 1
Name of Hauler Destination Waste Product Licensed?
d ®®
TOWN OF BARNSTABLE ,COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY �%��{/ !`1�� O (see"Orders") 5.Retail Stores
` 6.Fuel Suppliers
ADDRESS ti��'�'2���i�i v Class: � 7•Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors).
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks V
IN OUT IN OUT IN OUT #&gallons Age Test
ram. -
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C) ��
transmission/hydraulic %j/
Synthetic Organics: `r
degreasers
117
4_1
tscell neous:
/Z.
� ..Zz -
�--
r
34
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply z �
O Town Sewer Public ........f' J
10n-site OPrivate10
3. Indoor Floor Drains YES NO /
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES ENO OR) S.
Q.11olding tank:MDC �� 71
t
Catch basin/Dry well
O On-site system T �-
5. Waste Transporter
Na
� � d?me of Hauler 1 •
V 1.' " c >. /u� �d3►/ � � '���✓ ' gyp. YES NO
2.
Per. n(s) Interviewed Inspector 47 Date
TOWN VV 1V OF BARN STABLE COMPLJANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY Je 4 (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 36.E4 Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR TERIALS ,
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: .�
waste motor oil(C) (j
new motor oil (C) r
transmission/hydraulic-,
Synthetic Organics:
degreasers
Miscellaneous:
ti
DISPOSALfR.ECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply l/ c
&Town Sewer *ublic
O On-site OPrivate
3. Indoor Floor Drains YES N0—Zl _
O Holding tank:MDC_
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES LNO O RS:
O Holding tank:MDC
_9Catch basin/Dry well
On-site system
5.Waste Transporter
Name of Hauler Destination W
asteProduct
2.
C;_
2
P son(s) Interviewed In pector Date
TOWN OF BARNSTABLE OMPLIANCE CLASS: 1.Marine,Gas Stations,Repa
satisfactory 2.Printers
BOARD OF HEALTH *V_ 3.Auto Body shops
unsatisfactory- 4.Manufacturers
COMPANY 1V (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS -_F6 _ - f Class: 7•Miscellaneous
o QUAN'1'1TIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR �MATERIALS ,
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil(C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
t
DISPOSAURECLAMATION REMARKS:
1,§#tary Sewage 12.Water Supply
Town Sewer Public
O On-site OPrivate
t�c�e
3.Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well 06 5
O On-site system
4. Outdoor Surface drains:YES NO ORDER : "
Q Holding tank:MDC
O Catch basin/Dry well
O On-site system
5. Waste Transporter
Name of Hauler Destination asUiVrbillict Licensed?
YES NO
2.
�-
MIA I I A
f
Person(s Interviewed Inspector Date
LO /9 y
TOXICiAND HAZARDOUS MATERIALS REGISTRATION FORM
Mai I To:
NAME OF BUSINESS: d¢& A07-72 aSpCpw� Board of Health
MAILING ADDRESS: 1(-1 ' Feag-e*u61— Town of Barnstable
TELEPHONE NUMBER: I%0, JEFLO P.O. Box 534
CONTACT PERSON: lj ww
Hyannis, MA 02601
Does our firm store an of the toxic or hazardous materials listed below, either for sale or for
Y Y
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
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:
.Antifreeze (for gasoline or coolant systems) Drain cleaners
V Automatic transmission fluid , Toilet cleaners
Engine and radiator flushes Cesspool cleaners
/-,,Hydraulic fluid (including brake fluid) Disinfectants
V Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, r
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
U` Car waxes and polishes Jewelry cleaners
i` 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
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2. Printers
3.Auto Body Shops
O unsatisfactory- 4. Manufacturers
COMPANY (� I �. (see"Orders") 5. Retail Stores
o ' o� 6. Fuel Suppliers
ADDRESS T r �2 Class: 7. Miscellaneous
QUAN TIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
xj
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
O Town Sewer �ublic
)(On-site OPrivate
3. Indoor Floor Drains YES NO-7y—
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains: YES NO—�Y,_ ORDERS:
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
5. Waste Transporter
DestinationName of Hauler
�S -Ng__
Person (s) nterviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 7.Miscellaneous
/ aUANTITIE AND STORAGE (IN=indoors;OUT-outdoors)
MAJOR MATEPLS Case lots
an
Pfiderk &Vks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil(C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. ater Supply > ;&_0fx/
O Town Sewer Public
O On-site OPrivate
3.Indoor Floor Drains YES NO r ��
O Holding tank:MDC_ -
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORD S:
O Holding tank:MDC -
O Catch basin/Dry well
O On-site system
5.Waste Transporter
1
'Nanie of Hauler Di?stination,
1 1Licensed?
1• ��� I'� YES NO
ewed -Inspector Date
No.. Fs$ ... •�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
AJj
Applutt#uan for Disposal Works Tonstrudion Famit
Application is hereby mad for a Perrrtt ,tA Construct ( ) or Repair_ -(\,:�F an Individual Sewage Disposal
System at: N
--------•----•-------..._............---•-----
Location-Address or Lot No.
............ _ .. _..._s! AATA� . ....... ------------------ ---- --------- •---- •. ---...
Owner Address
Installer Address
dType of Building Size Lot--------------------------..Sq. feet
aDwelling—No. of Bedrooms.....................................:......Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria-( )
a' Other fixtures -----•--------------------------------------------------••-•••••••-••----•-••-•-•---•---••------------•-=--•-••----...-----•---...---•--......----•-.
d
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. 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........................
..........----------------••----•-•----------------------------••-------------....-•------------•••---.........--------._......•---•-•-•--•-•••••-----.....--
Description of Soil Z SU Y ��F'� C'g� `' ----------
x
U Nature of Repairs or Alterations—Answer when.applicable_—'.._.✓?f Ptr�c ........
...... .........t`u-�'1'-L.....------.E Q ......... �� "r 2 ......... �-'-------------•--....----......---•-_.. . w�
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance ha been issue by the board of health.
. ��Signed--------- --- - ------------------ -- ---.----'--------------------------- ------�> --��---�-�-----
to
Application Approved By ------- -mow- - .. 1E K-W-ll--�?
to
Application Disapproved for the following reasons- --------------------------------- ---=----------------------- -------------------------------------------------------------------
-----------------------------------------------------=---------------- ----------------------------------------------------- ----------------------------------------------------------------------- ----------------------------------------
Date
PermitNo- -------------------------------------------------------------------- Issued ----------------------------------.................................
Date
No:•..11� ' �Fimis .)...
THE COMMONWEALTH OF MASSACHUSETTS '
BOARD OF HEALTH
TOWN OF BARNSTABLE
a �-Appliratiou for Disposal nrk� C�l�ri�tr�rttrrn. rruttt
Applition is hereby made for a Permit Construct ( ) or Repair ( an Individual Sewage Disposal
_ System at: .-� ��t�,�.-��. � �+� �"C�,c���`:�w�^- c-�-�� .
....A ...�r 4..... •................... .. ..• ........................ ..•......... .... ......•...............................................
Location-Address For`t No.
..
......- -•----••-•- ••-------------- .------.-•- -.--•- ---•-----------.------.-
^ Owner a� Address;
,...
�.._-i Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............a :............... ....•Expansion Attic ( ) Garbage Grinder ( ) a
t4 Other—Type T e of Building .............. No. of ersons....___._._.........._....._ Showers — Cafeteria
a YP g -------------- P ( ) ( )
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 ( )
a Percolation Test Results Performed bY.......................................................................... Date........................................
R
A Test Pit No. I................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........................
•--••••••-••••••-•---•---•-----••-••----•-••-•-•-•-•--•..._......•--•-•.........••.••---
9
Description of Soil......d- ...........30 L................. .. y----••.. CfA ---C's0........... -------•---------•-•-------------
U -------------------------------
--------
..-•-------•--
.....
UW •--•--•------------- --- --•---•-----------. • . ----------•---•--••-•------------• .--- .. .....••...
Nature of Repairs or Alteration Answer wheeen�Iapplicable � � -( f FSSfA -i--
�'.-.�--•---'�'•---r'•' '^••'-".- ---•-....r.v.'___._,.._�.............. ...y crw,-<......-----..i'•_...----------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Comp'1 ance`ha bep is ed by the board of health.
.. rr
Signed.-------- r .....-......... ..,. Lr..-'- lC. � ...
�J / Dare� - -_-•• >:_Application Approved B '..: t-..... .... N... "-------------------------------------------------------------------- -------1. 14re2
`.
•_,-• Application Disapproved for the following reasons: ....................... .
------------------------------- ----------------------------------------------------------------------------------------- ------..................................................................... ......-............--------------------
Dare
PermitNo- ................................................................... Issued .............................................................--------
Date
THE COMMONWEALTH OF MASSACHUSETTS 1�
BOARD OF HEALTH �y
TOWN OF BARNSTABLE
&rtifira e of Compliance
HIS.rS�TOq CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
i�- o v, ..d=='.. ► .c ..�s,- . -�--... �------------- -------------------- --- -
bY == ------
_ Installer , y f
at ------- 1----------------------------- -----.: .i...., ,�`, .. .. .. .a*
r
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. n..- ........... dated ---!�'�A-� Qn._................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUES A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1/- 13 -90
DATE - Inspector ... �---------------- ' { - .........
v �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� TOWN OF BARNSTABLE
J
No..�.......:T :S. FEE...` ............
Disposal orks-C�uustrudion Vrrmit
Permission is hereby granted._.?�)L-......................................+ a� !dr- .�^ ----•-••-•..................••--._.............--•........................-----...........
to Construct ( ).or Repair ( ) an Individual Sewage Disposal System
atNo.. .......................•-•---- .........--•--........•-•.--•--- . -----•---•----....,...................._._..
*,_Street - /
as shown on the application for Disposal Works Construction Permit No.9 S j j. Dated... �Jl� `...
f �� I Board of Health
DATE----1•- /•-----,
----------•----------....---......••--•-..........••-•••.........
FORM 36508 HOBBS Ei WARREN.INC..PUBLISHERS
C\,
`�' s-iv�P�e��
Town of BarnstableCHEALTHEpT.
ssF
Regulatory Services
A ,,
° Thomas F. Geilr�i;I` rector
B" KAS&'� Public Health Division
9� 1639. ���
'�Eenn�11 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. 9-7 D 7 DO A DATE
APPLICATION FOR PERMIT TO.'STORE AND/OR 'UTILIZE MORE.THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT L . dJ ee
l�
NAME OF ESTABLISHMENT BAeoAj hu-16 tS(A ,C,r
ADDRESS OF ESTABLISHMENT' _3LQ P&P5LEYERI C-6- LXJ� T
TELEPHONE NUMBER ' 7 71 7 5 s
SOLE OWNER: V .YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAM_E AND HOME-ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
SIGNATURE OF APiP//LICANT
RESTRICTIONS: HOME ADDRESS !oO
HOME TELEPHONE# �/l� e 1,114
Haz.doc/wp/q 2 6 �"
,. . Town of Barnstable
• P�°FINE�Q�� Regulatory Services
Thomas F. Geiler,Director
'" MAM.'E ' Public Health. Division
i639. ♦�
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. oZ4S-D a'1 -0DA DATE
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT JE�F,e� V �. � ea"V
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT 3y, f FA'.561 '6�e6 _L�
TELEPHONE NUMBER SAS—
SOLE OWNER: 1/ 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
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS /o 1c&6 F 2, 1A Ay,//s 44
HOME TELEPHONE# -t
Haz.doc/wp/q
TOWN OF BARNSTABLE
LOCATION 30 Dr- SEWAGE # /® 's
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.`-/,' �CP✓ �orsC'�� ��,c T7/--///-;19
SEPTIC TANK CAPACITY ✓ mil
LEACHING FACILITY:(type) Pp, C,,A (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER &rke ai
DATE PERMIT ISSUED: /3 — `>6
DATE COZIPLIANCE ISSUED:
VARIANCE GRANTED: Yes _4 "No ,
lC��/SKr _
1��Pc+I T c.,
��• ��,
'1 �
��
�5,
.3'g�
�'
I
A-0
LOCATION SEWAGE PERMIT NO.
40 T A -1 /eA<fffV e2,AAbc--- LjA 71 -- 6_3
VILLAGE �r5
INSTA LLER'S NAME i . ADORES
�. oC) �o D
e U I l D E_R OR OWN ER
/vl ccAn/�/
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
I
r�edAl�o
7�
�k
L .
THS;k:.OMMONWEAL'i H OF'UASSACHUSETTS
_ BOARD OF HEALTH ..
...:DVj ...........OF .. ..L... :. .f.. ...............................
Appliration for Di"oii al lUorkii Tomitxnrtiun Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.....� cao:ic......Wa ........I� ------------------� EA --I --
--------------------------------•-------------
Loc tiq�-Addre � '
l �
Owner r+ �d ess
Installer Address (,` V
dType of Building Size ....Sq. feet
U
Dwelling—No. of Bedrooms ...... ................ Expansion Attic ( < .) Garbage Grinder ( )
p-4 Other rType of Building .... ._..� persons..__.__-................. Showers ( ) — Cafeteria ( )
a O er fixtures ..................... .
d _ t0;
D.S ....�... ons er erson er day. Total daily flow.._...._3..l -....................... Ions.
W Design Flow. ---.-�.�1. P P P Y Y 1
WSeptic Tank A 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 ( ) - U 1p. /'C 4 ' /�
Percolation Test Results Performed by------- ___ ----------------------------- Date.--_,k-._-.,(_,4 2Y�............
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--____--.._.___-..-____-
Ix ------------------------•.--. _ ..............-................---- ---
116... y` `'
U -•-•---••--•••-••-•-----••--•-......-----•-•-----••••-•---••--••-••••-----.....•••...-•••-••••••--••••••-•--••••-••-----.....-•••-•-••••-••-••-••••••••--•••••-••--•-•........................�
W ---------------------------:.....-••--•--••••----••-••--------••-••••-••---•-•----•-•--•----•••----••....•----•-•----------...•••-••...•-•••-••••••••-•••-••------•--.........•-••--••-••--_-6G.! /
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 TITTIE 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 boa:rd of health.
Sined . . --- ..................... ................................
Datee4
Application Approved By......... .... ---'Z- -7-.-f
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------•---•
---------------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------------.........--
Date
Permit No......................................................... Issued-------------��...r�
------------------•-- .................
Date
GR0-41
No.......... ..............................
r THECOMMONWEALTH OF MASSACHUSET$
$`BOAR ff`� O 'HEALTH
r7.. �»! ..........O .F.....l. _: 0_ '..............................
N
App ira#ion for Dwvoiia1 Marks ji4oniitrurtiou ramit
Application is hereby made for a Permit to Construct ( ) Ior Repair ( ) an. Individual Sewage Disposal
Y _
S stein at
Lo ti Add
- ...............
Owner .r
a .. ssd
• ...................................................
.
Installer Addressj"
Type of Building Size Lot_-/-' .�2p__Q.....Sq. feet
U Dwellig—No. of Bedroo _.Expansion Attic ( ) Garbage Grinder ( )
a � o. o ersons-------`:--------------- - Showers — Cafeteria
P4 Other'—Tie of Building ......... ............... p ( ) ( )
d er fiat ur SS ; �t -►
W Design Flow ..-- - - .ga Ions 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.
g
SeeP a e Pit No Diameter........... Depth below i t_._n. ..__: G Te�ll
r leaching area..................sq. ft.
11, .
Other Distribution box.( ) Dosin tank ) ' ' 79
. M7
Percolation Test Results Performed by.. ................................ ...................•....__..-_Date.........................................
4 Test Pit=-No. I....._ _.,_.,minutes per�,inch Depth of Test Pit ................: Depth to ground w ......................
Test Pit No 2.__2.......___minutes per inch Depth of Test Pit................•... Depth to ground water........................
:..........................
`
O Description of Soil_t4 :"- Gt 5---.....___.30...•.. f._.. . $ + --- --
V .....................................................................------_.:--------------------=--------------------------•--••-•--•------------•--= ................................................
-------=------=-----------•--•-=-- ------------------- -•---------••••--•--•-------•----•-••---••...-••-•-......-•--•-------•....•..... .
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 iITL is 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.
Sne .....................•-•--••-•••-•-- ..........--••-••----•••.
.0 _ t '
Application Approved By........ •.....----• . ........ �
Application Disapproved for the following reasons----------------------------------------------------------------------------------------•-------•--------------•-
......-----•-•-•-••--•--•••••••-•--••--•-••--•----- •••.... .. -----•---------------------------------------------------------------------- -----------------••--••--•-•---
Date
PermitNo..........................................------•---••-• Issued--------- ---l•...-
Date —
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............I... .{l4 .M........OF. .j�: �..t... . ..I ........................
fit
muntifiratr of Toutpli atta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by........� � - .. .--••-•-•-•- . ...................................•-.
�ti. Instal "
at...... �.._. '._ . ,... n»d4l,.:4. w �tp ` , .....................................
has been installed in accordance with the provisions of T 5 0 tate�Sanitary.�/oedescr�btd n the
application for Disposal Works Construction Permit No... .......... . dated.__l__ ......_._._-..
THE ISSUANCE OF THIS CERTIFICATE 'SHALL NOT-.BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
� � _ / �
DATE.: .:..............•---•--•--..._.......!�..................� -......... Inspector... -------•--•• -----•---•- ---- ...................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7y
........... .'. .. .`.....®F.....�- ...s . .1v... FEE ..
No..... ............. .....--.. ......
i �raor 1 rk Tnntrnr$uan amit
Permission is hereby granted ! -- :...:
to Construct .( o Re it ( man Individual Sewage Disposal System �+
at No.---k5.1.T- ._:._.__ :yca �4!. =...:_ ? ! f f `"
_ .. -,. y 9
as shown on the application for Disposal Works Construction�� 4.-
.......... ed--------- - --- -- -------••--_.....
C Board of Health
DATE 1 ... ••.•--•• ••.........
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ,_
°FIME Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARMs 200 Main Street• Hyannis, MA 02601
1
6
S9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT } S
CFO MPS s
Business Name: Te 2caK- t ,+0 5e^r\h G2 Date:
Location/Mailing Address: 30 er t czWe: e 'I
Contact Name/Phone::12-eQ gax-&o - 5'08- "7?1- 9S15-
Inventory Total Amount: A� 1 L 00 w1 MSDS:,9kc-mAm,g4wP -vwt 5q License#: `2
Tier II : tJa Labelina:0K\&10-1,nLwwad}ee1� Spill Plan: OW
Oil/WaterSeparator: Floor Drains: PJo Emergency Numbers: oxlc,
Storage Areas/Tanks: 1.-a1Sha l nnA 2S0 ga l -k7&t e-o•k A 5 ,Q�S a4 0,A� o.l a wash-e- a,<«&c
Emergency/Containment E ui ment: . ti�•�r o ,,2— caw5��
Waste Generator ID: Waste Produ t: e5 o �anbc s
Date&Amount of Last Shipment/Frequency: o%I bv<y A-tL ow 5 t k-p-
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods: �aC��le-¢-���'1��5 oo�kc,�ko-k<&yL4jcrl! A-,,�-e_
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
Antifreeze r %VA^k& 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 ,4 wm0t,3-awu•5 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: 62W-t_ 5-
Inspector: A' Lam-1��
Facility Representative: !
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS
Number Fee
162 THE COMMONWEALTH OF MASSACHUSETTS $150.00791
Town of Barnstable
Board of Health W
This is to Certify that Jeff Bacon Auto Service Center
30 Preseverance Way Unit#1, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
------------------------------------------------------------------------------------------------------------ ---------------------------------------------------
------------------------------------------------------------------------------------ --------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and.
and expires 06/30/2017 unless sooner suspended or revoked.
-------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
07/01/2016 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN,R.S.,CHO
Director of Public Health
Town of Barnstable
Regulatory Services
Richard V. Scali, Director
�wA BARNSTABLE CA
Health Division �
16-3.9. `0$
�fD MIA p
1639-2014
Thomas McKean, Director
200 Main Street, Hyannis,MA 02601 Q .
Office: 508-862-4644 ` �� Fax: 508-790-6304 tV
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
ANNUAL PERMIT(RUNS HOUSEHOLD
OUSE st �HOE DOQj QUANTITIES ARE REQUIRED TO OBTAIN AN
N
APPLICATION FEES
CATEGORY 1 PERMIT -26- 110 Gallons: $ 50.00 0
CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 1I,S
• A late charge of$10.00 will be assessed if payment is not received by rJuly 1st.
ASSESSORS MAP AND PARCEL NO.,295r00?4L0 DATE 7-14
FULL NAME OF APPLICANT: J�EF erg
NAME OF ESTABLISHMENT: :�e0r 41--k
ADDRESS OF ESTABLISHMENT: 27
�E10 /7�'E Gv /fit /ems'
MAILING ADDRESS(IF DIFFERENT):
TELEPHONE NUMBER OF ESTABLISHMENT:• ' 4V- 77/-9!S 45" .
EMAIL ADDRESS: N
SOLE OWNER: "S, 'NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME -
PRESIDENT
TREASURER
CLERK
.• IF PREPARED BY OUTSIDE PARTY:
SI�ATREO ICAN Name:
Company Address
Telephone#:
Email:
Q:\Application Forms\HAZZAPP Rev I6.docx Page 1 of 2
f
OF THE*off Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARN STABLE.`E ' 200 Main Street• Hyannis, MA 02601
�'O�EDMA+A`e� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: e-To'lt' 0.eovI- Date: 16 1
Location/Mailing Address: 30 �� vela e-li.�ay v\A+I , gQin&!�7 Aok4e-
Contact Name/Phone: -:5W� 6a.cov—
Inventory Total Amount: A--l 4 0 010 MSDS: m kt`v-- License#: (�2
Tier II : tJ o Labeling: OK Spill Plan: DK
Oil/WaterSeparator: Floor Drains: N)I0 Emergency Numbers: 90
Storage Areas/Tanks: -1 S ,l x -1 So a l 4\0-wmolc o, kSS a1 c�r�s �.a codl�Gt Jaste. rl� ��ee��t
Emergency/Containment Equipment: 5���1 1� �5 w�'t1n, Oc�d� t boov ala.l�lole�
Waste Generator ID: Waste Product: Ayt��nc«��
Date&Amount of Last Shi ment/Fre uenc : na& A--Ix ,S` el
Licensed Waste Hauler&Destination: W-v., 4-,el CoOr% tee .& "6,nj
Other Waste Disposal Methods: QU6c t-
LIST OF TOXIC AND HAZARDOUS MATERIALS I o VA-�10,( �►1�v� it g�KG�1k' ' ►�t5 'aK
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous m terial use, 02 I n(I
storage end 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) V Windshield wash
Motor oils Miscellaneous Corrosives
f Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts
J 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: v
Inspector: ---v—, L'-�V�1'e®
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Date:
TOWN OF BARNSTABLE 11 �
TOXIC AND HAZARDOUS MATERIALS N FORM
NAME OF BUSINESS: v � �,c,�
BUSINESS LOCATION: -3D <<5,2�1�ra✓tC.e� bt'ay, t),,, ' I 64rngMaIdNVENTORY
MAILING ADDRESS: Sa+ TOTAL AMOUNT:
TELEPHONE NUMBER: -SD - 771 ollons
CONTACT PERSON: —Je,(k �Q ca►ti.
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: 4'v-+'o (-c!pct,-r -, f-ot.. )1e,5
INFORMATION / RECOMMENDATIONS: Ale 6f, , / e5 Fire District:
.�,�� s ,ow . eca►-►�,�c
f e-FJvt+1 J, e T r -t, .y g ) g �GG
all Coy%-+ ,ivLJ 5 GaJp�1.�.w n YL yse.
Waste Transportation: /Va'1' `IYarigpol�.4, as Last shipment of hazardous waste:
Name of Hauler: �'Q k; Kci.e-rt, Destination: `�Yah3parfe�Qs ('P,Cyc�edIble.,
Waste Product: 046fe VAIV Licensed? Yes No
b\)CK.S -S,t -011 ,%-,- Dv,.61 SQac� c"ion
NOTE: Under the provisions o h. '111, Se1, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
3 Anti eeze (for gass line or coolant systems) Miscellaneous Corrosive
19 NEWBD Q USED SS Cesspool cleaners
ZO Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils �,4 z�90< Pesticides
� /� k / '-' Insecticides, herbicides, rodenticides
l 12 Cd3NsW 4�Q U�ED 00 1 X�So R (� )
Gasoline, JlNuel,Aviation gas
Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives(creosote)
Caulk/Grout Swimming pool chlorine
,2s Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison"labels
(including chloroform,formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
S� Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous(please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
!00 Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials I V
I
VKWU-
E M E A
KEEPING YOU ORGANIZED
No. 10334
2453L
MADE W USA
GET ORGANIZED AT SMEAD.COM
t0 P OF FOI*!DATI oN
° a CCNCeFETE rpV&4'S
A .ii 117J3TJll'- 7TT_7/j /ai
CAT IRON 12"MAX w 12°MPX'
a POPE OR �}"GQIINuEQU1ZGltO�EQUn/.)
MijIV,)- MIN. PIPE- MIN, LEACH �)
"s PITCW I/4„PER.Fr �— PITCH I/4 PER.Fr PIT PeCCRST / I
--- -.
L6ACHJNU'
INV
� -INVE(?r
.A EC, 47;77, RT -INVE12r a P IT, o/L
n'. S6PT"I . TANK . 3q DIST E� 47.0/ s EQUf1/
a
.A INVE27 /moo NV
A F1 47•SL GAS _J I 4 T I INVERT o, w�►
�' 8 ��? w *ZL A5 Eli
to STONE
/
A
PICOF-ILL ()F clzv�N� WA7 rAs>.> j I
515WAGE DISPOSAL EM
No SCALE .�OFM�ss I
0
� E H
90�FG/STEP 6\�� vo
FSS�ONAI a
TaTh ,, C,yT/MH7eS`1? f"-GOGu '
THOMAS E.KELLEY CO. v
WM46 hMrvS O SAS L<o VA>:l D .
�NC,ITIEERS—SURVEYORS
346 LONG POND DRIVE
DA-46AJTH YARMOUTH,MABd. � ' I
026"
� A
v
/25 /S'
.4 gip. lot-
t Ali
t�41 a _
ao � �,b � I � I I ► �
/
0
a ! � / I i � .:.JC!/LTi//•/� ( Soso
+P' I /8 000 54p, C77
4ZeV4 a ro.v ✓.wvi
7�7c,�� a O O / •• G /�-
arm
4h �+G C�S"c a z-•��.� �C^ � Acll.
AT 1 .
4q,+ r s., i
r
Ell
n
' 0/G .. 6 AfR/STi•.0G �I. 7-
Ry
J�kwL HvlL� 13v.�-r�s� cG.�/Er>r-T�/
77;�ny1s a ,c/zt.Z,,,l�
D '
TZ=T Alot-C Z
r ,P, a17
S✓6-_o r S�3-Soi t
Ycvl� G/ZAv[4
�¢ PRELIMINARY
r Rey.
GXiDE-
„Z' wig C- P.eop� D�'vG
+d^Tti D
1
/�Lexr°. ,eq-j�_t �/��.�,.. .S"Jac/i.v'e<� .L>"vG!�S 7'' �v �f 7 � .SC'..9G.� / "= •�o '
No wAr� �i✓covNr�xtZ� , &VISED se.pr- 14 >y7�
I
tIF
Ems. So-O ��tiSTi��G Gi,?s��6 '
1
1