Loading...
HomeMy WebLinkAbout0072 THORNTON DRIVE UNIT BLDG A UNIT 5 - Health �C-2 Thornton-Drive;Ba'rpstable—( ---X---l� A= moll J C i I e k TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Re it BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops ram, O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS � Class: 7.Miscellaneous 7 ?---j 17,r1?iI,;? ANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS ,• - IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Ga oline Jet Fuel (A) ` Diesel, Kerosene #2.(;), Heavy Oils: 1 / waste motor oil (C) Y new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers r Mis llan us• 11,14 DISPOSAL(RECLAMATION REMARKS: / 1. itary Sewage 2.W ter Supply. > Town Sewer Public , c i O On-site OPrivate - r 3. Indoor Floor Drains YES NOJZFV O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO O ERS° O Holding tank:MDC / Z O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Desti nation j Licensed? 7=77 Pf.�' Zo YES NO 2. Person s) Interview d rispector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2.3nters .Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY �� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 1 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATE�2IALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) P4 Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) 0 new motor oil (C) � transmission/hydraulic 1,444 Synthetic Organics: de easers Mcel n-e us: , L= '01 DISPOSAL/RECI AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 1114 " O Town Sewer Public XOn-site OPrivate 3. Indoor Floor Drains YES NO H O Holding tank:MDC �/� O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDER : O Holding tank:MDC O Catch basin/Dry well O On-site system zw 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. p- Pers n (s) Intervie ed Ihspector Date J J Date: OL Id TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: Sa,(P- BUSINESS LOCATION: 1 Od 4246,,P1 MAILING ADDRESS: J Mail To: Board of Health TELEPHONE NUMBER: � 1� � Town of Barnstable CONTACT PERSON: � P.O. Box 534 EMERGENCY CONTACT Td1EPHONENUMBER: l- q6q Hyannis, MA02601 TYPE OF BUSINESS: M 4d Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES _ NO e 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. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(forgasoline or coolant systems) Drain cleaners n,� NEW USED Cesspool cleaners _� Automatic transmission fluid 1.66 tb Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants ,45 4r Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED 104rl- 'Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers An other products with " Paint brush cleaners y p poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) da Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS rf" TONOF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops .� unsatisfactory- 4.Manufacturers COMPANYta*z ui ,SaAL (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 2�tal&v. �DkLs- Class: 7.Miscellaneous` h Y QUANTITIES AND STORAGE (IN_ indoors;OUT- outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN JOUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: t waste motor oil(C) SS new motor oil(C) I transmission/hydraulic 1 = Synthetic Organics: degreasers Miscellaneous: U-4g Gat �r h� u� V_ 14 DISPOSAL/R.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC ' O Catch basin/Dry well o!r O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC dn O. O Catch basin/Dry well O On-site system `"` 5.Waste Transporter l � Name of Hauler Destination Waste ProAuct YES NO � 2. OE Person (s) Interviewed Inspector / Date TCIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 6IA60-GENCi( Ay T 0 (16PAi2 0 Ay'10 SALE Mail To: BUSINESS LOCATION: IQ '<rN O R N40e-) 'Do ) tXAQV15 -AA Board of Health Town of Barnstable MAILING ADDRESS: (N.NlC P.O. Box 534 TELEPHONE NUMBER: C .50 7 7 -40 12 Hyannis, MA 02601 CONTACT PERSON: A1.Ex .S R t-jDQ0 TA -5ilLUA EMERGENCY CONTACT TELEPHONE NUMBER: _90 9 1-45 9 .509 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 50 6z Antifreeze (for gasoline or coolant systems) — Drain cleaners 50 Ci Automatic transmission fluid Toilet cleaners --- Engine and radiator flushes Cesspool cleaners 30 GZ 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 fI `.,.��•.�vti h� g a. U�.U`. t '�`TTaa.r � � 9• -'r...,...,tn.�.d-`T' :�vY'.:ir•..n.'h " 4�+-.f„'Y r"ita . -TO- .,ND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: E MER&E NC,.t AO T o 0 6 PAIR 0 W'10 SA ZE Mail To: BUSINESS10CAT.ION: IQ 4R 0 2 N40�) Ta N4AQV%5 AA Board of Health Town of Barnstable MAILING ADDRESS: 5 A K cP.O. Box 534 TELEPHONE•NUMBER: 5o -4 Hyannis, M A 02 1 � � S O I � 60 CONTACT PERSON: AlE x S A 0DQ0 P. 1D A S►L L A EMERGENCY CONTACT TELEPHONE NUMBER: _�0 2 1-45 a S O al I Does your firm store anpo th'e toxic or hazardous materials listed below, either for sale or for your own use, in qu ntitiegs totalPi g, at anytime, more than 50 gallons liquid volume or 25 pounds dry weight? YES N.( �,P 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: j 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 ;r .5 0 Gt Antifreeze (for gasoline or coolant systems) -- Drain cleaners 50 Gt Automatic transmission fluid Toilet cleaners . 1 Engine and radiator flushes Cesspool cleaners 0:G Hydraulic fluid (including brake fluid) Disinfectants O Gt/Motor oils/waste oils — Road Salt (Halite) g' Gasoline, Jet fuel — Refrigerants Diesel fuel, kerosene, #2 heating oil --� Pe'"sticides (insecticides, herbicides 1 -- Other petroleum products: rease .lubr n � ' p p g c is odenticides -- Degreasers for engines and metalPlhotochemicals (fixers e developers) develo ) Degreasers for driveways,& garages! Printing ink Battery acid (electrolyte) -- Wood preservatives (creosote) Rustproofers — i Swimming pool chlorine I , r -- Car wash detergents. — Lye or caustic soda Car waxes and polishes -=- Jewelry.cleaners — Asphalt & roofing tar Leather dyes 't — Paints, varnishes, stains, dyes % Fe`rtilizers.(if stored outdoors) -- Paint & lacquer thinners -- i PCB's Paint & varnish removers, deglossers f Other chlorinated hydrocarbons, Paint brush cleaners j (inc. carbon tetrachloride) -- Floor & furniture strippers — ? Any other products with "'Poison" labels -- Metal polishes I (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) I (including bleach) !1 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 r White Copy- Health Department/ Canary.Copy-Business Iv _ � l — �� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: E1AE26EaC�( Aj 4o 61CPAtf1 A ✓-DAKO SWE Mail To: BUSINESS LOCATION: 1;2 T No R N i ON 202 t J I ZY N A, jk Board of Health Town of Barnstable MAILING ADDRESS: SA x- P.O. Box 534 TELEPHONE NUMBER: 11 ( -10 1a2 Hyannis, MA 02601 CONTACT PERSON: _f AQ10S AA6 00 ARAM k�,0 EMERGENCY CONTACT TELEPHONE NUMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for our own use, in quantities totalling, at any time, more than all n liquid volume or 2 pounds dry Y weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) '" Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, .al Paint brush cleaners (inc. carbon tetrachloride) ;I 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): r i (dry cleaners) ' Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business 60 �,►�1� 2. � �� � 9yo eor G�f osL6� rro. DATE wwaree 1 : �P, MA88. FEE � <� 1639. D� � ti Town of Barnstable REC. BY " ° � Board of Health G � 67 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan 0.Rask,R.S. FAX: 508-775-3344 �' Ralph A.Murphy,M.D. VARIANCE REQUEST FORM All variance requests must be submitted at least[iltun 51 days prior to the scheduled Board of health meeting. Trustees of Thornton NAME OF APPLICANT Drive Commercial CondominiuI EL.NO. 362-6873 (lawyer) Trust ADDRESS OF APPLICANT 78, 80, 82, 84 and 86 Thornton Drive NAME OF OWNER OF PROPERTY nine rondnTninium nni tc with vo., 000=��=g listed on reverse SUBDIVISION NAME NSA DATE APPROVED N/A ASSESSOR'S MAP AND PARCEL NUMBER 269/12.OOA thru 12.001 78, 80,, 82, 84 and 86 Thornton Drive LOCATION OF REQUEST SIZE OF LOT 20,985 SQ.FT WETLANDS WITHIN 200 FT.YES NO x VARIANCE FROM REGULATION (List Regulation) Extension From Connecting to Town Sewer REASON FOR VARIANCE(May attach if more space is needed) The condominium was created in 1984, and the initial trustee was supposed to call a meeting to elect a successor board of trustees after 80% of the units were sold. The initial trustee never called the meeting, eaving the condominium effectively without management.or the ability to PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED Susan G. Rask, R.S., Chairman NOT APPROVED Brian R. Grady, R.S. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. impose or collect common charges. The unit owners have scheduled a meeting to rectify the situation for November 24, 1997. i ..fin ZA T \ Unit Number Thornton Drive Street Number Unit Owner Name 'J 9 M 70 James Driscoll 8 72 Carl os'Arauj o 7 74 Steve Aiken 6 76 Rick Miller 5 78 Jeffrey Luff 4 80 Susan Morrison 3 82 it 2 84 Len Soares l 86 " PETER A.•SUNDELIIV ATTORNEY AT LAW' TELEPHONE:(508)362-6873 990 ROUTE 6A,BOX 771 WEST BARNSTABLE,MASSACHUSETTS 02668 FAX:(508)362-5438' •E-MAIL:SUNDELIN@CAPECOD.NET November 13, 1997 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: Thornton Drive Commercial Condominiums 70 through 86 Thornton Drive, Hyannis " Dear Sirs : I enclose herewith a completed Variance .Request` Form for an extension for connecting°to town sewer, together with a check for the $65 : 00- filing fee. Please place this matter on the` agenda for the meeting on tecember 2, 1997 . ' Thank you. Sincerely, Peter A. Sundelin C:\WP51\LTR\BARNBOH.01 Y � Tii .,$ 5J017/2110 PETER A. SUNDELIN 11/94 41 2005 990 RT. 6-A 508-362-6873 ZZ 47 WEST BARNSTABLE, MA 02668 /J 19_J! Pay to a o derof - 1�-7 � Dollars ems.... � CITIZEN� S BANK r Massachusetts For — ': 2LLO ?O0Si: LLOL904LL61120L 2005 Oparke Amerkan W. e-7� No. / / 1 Fee ��'��� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migogal *p5tem (Cold truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. `� / p t"A-f aA ✓J 'i Owner's Name,Address and Tel.No. Assessor's.Map/Parce A Installer'�Name,Address,and Tel.No. �5�5` Designer's Name,Address and Tel.No. Z— e�rc� Type of Building: 1 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by th Boqof Health. �l Signed Date Application Approved b Date Application Disapproved for the following reasons Permit No. A' Date Issued No. �"' / . _ Fee ' — .,°"THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Zl,, '. Yes PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for DigPogar 6pgtem ion truction permit Application for a Permit to Construct( )Repair( )Upgrade( ),Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. `2 / p ('r"lam d✓'i Owner's Name,Address and Tel.No. ,( Assessor's Map/Parcel A / Y4� Installer's Name,Address,and Tel.No. 7 O n-5 S�r' Designer's Name,Address and Tel.No. L Per y Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow. gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) .Y Date last inspected: Agreement: - `The.undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system_ in operation until a Certifi- cate of Compliance has�been issued by tho Bo of Health. Signed y, Date Application Approved b Efa1 Date .`�^—.�,���? Application Disapproved for the following reasons i , .1 Permit No. Date Issued f ... THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS T CERT Y,th t the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( �— 'e C>- at 7 / O '� /'. N do Yt t� has been constructed in accordance with the provisio s of Ti le 5 and the for Disposal System Construction Permit No. / � dated Installer M 1 r le or Designer The issuance of this permit s all not be constjed-as a guarantee that the system will Lunction as designed. Date ..- " 1 Inspector a— � No.— /'�-���———————————————— -------Fee THE COMMONWEALTH OF MASSACHUSETTS �f q PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Xigpogar 6pgt4 Congtruction Permit Permission is hereby granted to Construct( '?A)=12epai , )Upgrade( )Abandon System located at ,J and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi it. r� Date: `" Approved b " Y THE TOWN OF BARNSTABLE r�� e�P��♦� OFFICE OF »ST,33L i BOARD OF HEALTH MAIM. 1639. `{� 367 MAIN STREET r HYANNIS, MASS.02601 December 4, 1997 Peter A. Sundelin; Esquire. Attorney at Law 990 Route 6A West Barnstable, MA 02668 RE: 70,72,74,76,78,80,82,84, & Thornton Drive Dear Mr. Sundelin: You are granted an extension, on behalf of your clients, the trustees of Thornton Drive Commercial Condominium Trust, concerning the connection of the building located at 70,72,74,76,78,80,82,84 and 86 Thornton Drive, Barnstable, Massachusetts, to town sewer. The extension is granted for six months. Therefore, the above-referenced building shall be connected to town sewer before Junel, 1998. This extension is granted because the initial trustee of this condominium, which was created in 1984, failed to properly manage or collect funds to fund a sewer connection project at that time. An additional six months would be sufficient time to fund the project, according to the applicant. Sincerely yours, O�dI ZY.�lilc, (/t�r�L Susan G. Mask R.S. Chairman Board of Health Town of Barnstable SGR/bcs sundelin s Date: 7 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Ra, A�-oryto{'�v2_ BUSINESS LOCATION: _7:Z—I I rv%-A-ov.-9roje_. , O%j4v►K,s INVENTORY MAILING ADDRESS: �S'�IeA<�pG- � .�er�.soe, TOTAL AMOUNT: TELEPHONE NUMBER: �roS - 3�,+ - 8880 CONTACT PERSON: eyi w. ,Shoce_.� EMERGENCY CONTACT TELEPHONE NUMBER: — MSDS ON SITE? TYPE OF BUSINESS: ao o r'�- a, .(, Ala(�!D INFORMATION / REC1^OMM(��ENNDA IONS: '� 1 Rt a a. Cr a Fire District: o r' Li fL ✓"l .� 1n ►r4 lnro , o i vt ✓use (�ya►�v�,s 16e,e.,0 ©K,s s-hs Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Kew cw-}rac - w4t,6&+ake,Destination: Waste Product: as-1'� o�( �►�f��'<ee Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive l(NtiEW y O"USED I Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides C(NEW 6 Ud USEDO( (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) ( Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes � ( ✓ n +t /U D ��ryt�'�" C'2.9 ut���X- • 1 J 4�uJafo�e, I s Laundry soil &stain removers (including bleach) �a���-� . y ►11�t�sorb�, ace �� �, Spot removers&cleaning fluids (dry cleaners) JV`An,,�I ((�� I abK2 Safe 1 sk.e.ts are. vp-, Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials 77F� ,v - YOU WISH TO,OPEN A BUSINESS? For Your Information ::•:Busi.ness certificates(cost$40 OOfor 4 years). A business certificate'ONLY REGISTERS YOUR'NAME in'town(which you must do by M.G.L:-it does.not.give you permission to operate) You must first.obtain::the'necessary signatures on this forni at 200 Main St.,:Hyann s` Take the completed4orm to the Town Clerk's Office; 1 st Fl., 367 Main St., Hyannis;.MA 02661 (Town Hall) and get the Business Certificate that is required bylaw. r V DATE: — h. Fill in please: �� . .APPLICANT'S YOUR NAME/S: 1 BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Teleph ne Number NAME OF CORPORATION: NAME OF-NEW BUSINESS TYPE,OF BUSINESS WSJ - IS - ARDAESS OF BUSINESS ` Ft .11; MAP/PARC�LJV MBER .[Assessm9J... :,W,h nstarting a new business here.are several things you rr usvd,o in order to be in.compli6hee with the rules and,regulat~;idhdOof the Town of ' a .Berristable. This form is intendedito=assist you in obtainin tFre inFormation you may need You'1VIUST._GO TO 200 Nlaart sty t corner of Yarmouth Y 9 , Y Y [ Rd :&Main Street) to make-scare you-have the appropriate permits and licenses required-to r:legallyoperate you busin�es5'in this town. `- `� c ,-1 BUILDING CO MISS10 ER.'S OF. CE , 1 This indivi al e n:i d f.a y r iG requ_;.ements that pertain-to this.type Ofl U sil ess. `� ut on ed.'Srg..-purre** .. COMMENTS: 2. BOARD OF HEALTH This individual ha e i pe it requirements that pertain to this type of business. Authorized Si to * ,��-i;�\� F1\rV COMMENTS: �aN1 n�S 3. CONSUMER AFFAIRS[ I EN ING AUTHORITY This individua as be n ' fo d f t li n i e�uw a ents that pertain.to this type of business. Auth rized ignat COMMENTS: Date: . / 20/ 13 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: lS A-U WC)TI E BUSINESS LOCATION: _72- 1J'`'( �� �At\ltJ INVENTORY MAILING ADDRESS: -76 -TRL-L-7,V 1 A V)-D e ),wSV62T TOTAL AMOUNT: TELEPHONE NUMBER: - ,E (IbI4- 9PSM C/// kl CONTACT PERSON: 1 EMERGENCY CONTACT TELEPHONE NUMBER. - MSDS ON SITE? TYPE OF BUSINESS: AUTQKk0-1\1�--- TEWV, INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: eerti Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: 1454.& o l/ Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111.gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners �►S Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED \ Miscellaneous petroleum products: grease, Photochemicals (Developer) V lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap cant's Signature aff's Initials q�_of - � � ®® SMEA KEEPING YOU ORGANIZED No. 10334 2453L MADE IN USA GET ORGANIZED AT SMEAD.COM