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0217 THORNTON DRIVE - Health
217 ThorAton'Drive 1•� . c G A= 297—028 L , a �I e o v < f e a k LOCATION SEVR1 (CC4 1 L zo VILLAGE INSTA LLER'S� NAME & ADDRESS tI G U I L D E R OR OWNER GATE PERMIT ISSUED _ s^ �l DAT E COMPLIANCE ISSUED 41.19 TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: -� BUSINESS LOCATION: 017 fl2af �F4 Z7M2 [M T /d 2 k-L. INVENTORY MAILING ADDRESS: It i� T T- TELEPHONE NUMBER: l•' 110 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Adze _tr V C, : INFORMATION/RECOMMENDATIONS: 0 Fi a District: Waste Transportation: /1ld1 Last shipment of hazardous.waste: Name of Hauler: Destination: s Waste Product: _ Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials 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) __ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. 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 Misc. 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 (inc. carbon tetrachloride) NEW USED F Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): 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 Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Oceanside Fax. Corp Name: Mailing Address Location: 217 Thornton Drive,Hyannis Street: 217 Thornton Drive mappar: City: Hyannis Contact: `Richard W.Clark State: Ma Telephone: 771-3110 Zip: 02601 Emergency: Person Interviewed: ............................................................................... Business Contact Letter.Date: ......, ......... Category: Miscellaneous Inventory Site Visit Date: 9/28/2005 Type: Follow Up/Inspection Date: public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑ town sewage W indoor catch basin/drywell ❑ outdoor catch basin/drywell expir ❑�/ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: ................................................................... REMARKS: 1999-Building with the natural gas.Use speedy dry for oil compliance: spils. ORDER:Cement Floor Satisfactory Drain. 9/28/2005 alp recommend storage of empty drums indoors to prevent further rusting. M I i _ 7 Pa Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials W gty's>25 lbs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more " � clescngtion .- Wk'qtyre.- Misc.Corrosive 45 gallons .. ..__��...._......._-..�.._.�...__.. -...__. -..___� .. ... __......__•. .._ Fungicide 4 gallons Misc.Flammable i 34gallons acquer thinners ( 4 gallons Waste Transporter: Fire District: 'Barnstable Last HW Shipment Date: Waste Hauler Licensed: No ._._.. .... ........................ t l Town of Barnstable OF114E t Regulatory Services Thomas F. Geiler,Director Public Health Division BARNSTABLE, Thomas McKean,Director 9� 69' � 200 Main Street, Hyannis,MA 02601 ArFD MA'1 A Phone: 508-862-4644 Email: health@town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 May 8,2006 Mr. Richard W. Clark Oceanside 217 Thornton Dr. Hyannis,MA 02601 Dear Mr. Clark: A site visit was performed at Oceanside on 217 Thornton Dr. in the rear of the building in September 2005. At that time you were not responsible to purchase a Hazardous Materials Permit for Oceanside located at 217 Thornton Dr. If you have not added any products to your supply count,then you will not be required to obtain the permit. When inspections take place on Thornton Drive,I may stop by just to do a walk thru with you to update your file and determine any permitting needs. Thank you for your quick response to the application. If you have any questions or need further assistance,please do not hesitate to contact me. Thank you for your patience in this matter. Sincerely, ,/ *' � � " Alisha L. Parker Hazardous Materials Specialist i MAY-04-2006 15:58 Oceanside Inc. 508 775 2848 P.01/01 T `"` Town of Barnstable j P Regulatory Services Thomas F. Geiler,Director `Zoa G ' G Public Health Division Thomas McKean D irector 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 . Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. Lk""- DATE f �� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 0Ge0.0- .Pe .Q, :,.. NAME OF ESTABLISHMENT t �+ ADDRESS OF ESTABLISHMENT " Z A, rz TELEPHONE NUMBER -SOLE OWNER: YES NO - r Y vl IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALf- =' PARTNERS: :Vt IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 6 STATE OF INCORPORATION 4 FULL NAME AN HOME ADD S OF: PRESIDENT TREASURER fI CLERK I t SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE 4 Haz.doa'wp!G V tom- �3'w�9✓�� t�� l� A re�r� o� Tz%-� '5� 1 7-c /P Ic a.4-f- cc.� '�f Y a TOTAL P.01 I _ r 1 Commonwealth of Massachusetts o29� ba$ @ Title 5 official Inspection Form le Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner T> Owner's Name �-�: information is r required for tagnis $oy.14 Ma 02601 2-27-19 01 every page. City/Town State Zip Code Date of Inspection �ssr I Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. Inspector Information S( 13(�$�-- forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o. Box 145 Company Address *LA Centerville Ma 02632 Cityrrown State Zip Code 508-420-4534 Sf 4297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails �L 2-27-19 I Inspecto,pO§ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board t. of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to I the buyer, if applicable, and the approving authority. i Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.i 7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: At time of inspection this system met all minimum passing requirements. This report can not predict the future performance under the same or increased usage. This report is not to be used to determine design flow. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i I i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): The system required Ely equ red pumping more than 4 times a-year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: I i I 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•'rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form �= F Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'u 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ! El ® tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] i ® The system is a cesspool serving a facility with a design flow of 2000 gpd- El 10,000 g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The j system owner should contact the Board of Health to determine what will be necessary to correct the failure. 4 5) Large Systems: To be considered a large system the system must serve a facility with a i design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes or"no"to each of the following, in addition to the questions in Section CA. Yes No I ❑ ❑ the system is within 400 feet of a surface drinking water supply I ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area Interim Wellhead Protection El El Area—IWPA)or a mapped Zone II of a public water supply well F t5insp.doc 1 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 .2 27-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, ' dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with. information on the proper maintenance of subsurface sewage disposal systems? The-size and location of the Soil Absorption System(SAS)on the site has I been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. f ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: i Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes El No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No i Last date of occupancy: Date I i t5insp.dbc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 i j c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L; 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: office/commercial Design flow(based on 310 CMR 15.203): unknownGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ® No Water treatment unit present? ❑ Yes ® No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: Last date of occupancy/use: currently occupied Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No l. If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Fora I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Tank and pit were found no D-box Approximate age of all components, date installed (if known)and source of information: Appear to be original Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grader feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 4 I cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: appears to be 1500gall 10'6" long Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): f Tank is pumped every 2 yrs per new owner. I i t5insp.doc-rev.7r26r2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i I i Commonwealth of Massachusetts Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 217 Thornton Dr I Property Address i Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27=19 everylpage. City/Town State Zip Code Date of Inspection D. System Information (cont.) i 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): j { 1 , I Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle I Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): r i r 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): I Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): f ff( Dimensions: I Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I nLI Commonwealth of Massachusetts Title 5 Official Inspection Form j. la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): I I f "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: i i i I i Type: f ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5in Ip.doc-rev.7/26/2018 Title 5 Official Inspection form.Subsurface Sewage Disposal System-Page 13 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 217 Thornton Dr Property Address Paula Clark Owner Owners Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pit was functioning properly at time of inspection 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form P' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 217 Thornton Dr I Property Address Paula Clark Owner Owner's Name information is required for Hyannis Ma 02601 2-27-19 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i i I i i I i i I i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 I i cam, Commonwealth of Massachusetts Title 5 Official Inspection Form I- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 217 Thornton Dr Property Address Paula Clark Owner Owner's Name information is requited for Hyannis Ma 02601 2 27-19 every'page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: f ❑ hand-sketch in the area below ® drawing attached separately i i I . i i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 i cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .u � 217 Thornton Dr t Property Address Paula Clark Owner Owners Name information is required for Hyannis Ma 02601 2-27-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont..) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain:- ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database'-explain: You must describe how you established the high ground water elevation: Property is at the top of hill on Thornton Dr I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 i c Commonwealth of Massachusetts p Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 217 Thornton Dr Property Address Paula Clark Owner Owners Name information is required for Hyannis Ma 02601 2-27-19 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f for* 3- �w Town of Barnstable - Assessing Division- Page 1 of 3 12 Share Tweet Shares -� — Custom Search Property Display 297/- 278/-=Use Code: 31 000wner Information �► Map/Block/Lot: 297/028/ Property Address 217 THORNTON DRIVE Village: Barnstable Town Sewer At Address: Yes GIS Zoning Value: IND Owner Name as of 1/1/18: CLARK, S PAULA TOBEY TR 65 ACRE HILL ROAD BARNSTABLE, MA. 02630 Co-Owner Name R & P REALTY TRUST Assessed Values v Tax Information v Sales History v r Photos y i Sketches v r https://townofbamstable.us/Departments/Assessing/Property_V alues/Property-Display.asp... 2/27/2019 � I THE COMMONWE TH OF M S USETTS BOARD OF HEALTH NOTICE TO ABATE AMP ACE ' 19 ' you are hereby notified to reme , the conditions named below within 24 hours of the service of this notice, according to Massachusetts General Laws, Chapter I11, Section 123: _ . did 4 {{1 f If at the expiration of time allowed these conditions have not been remedied, such further action will be taken as the law requires and a fine of$20.00 per day may be charged. By Order of the Board of Health �f Inspector FORM 600 HOBBS&WARREN,INC. REVISED 1979 r. � N. 1_ ..Y.rz�=.�.. - G_ Fps....... .............. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ' ........ OF........... 6_ •............................ �! Appliraation for Disposal Works Tonstrnrtion fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..t.-- - oc do - ddress r Lot No. ner Address Y .. - • ---•................ Installer Address �s� •�- Type of Building Size Lot_____.f .....Sq. feet Dwelling--No. of Bedrooms____________...............................Expansion Attic Garbage Grinder pa, Other—Type of Building f persons____________________________ Showers Cafeteria (,—�- P� Other fixtures ..-- •---••••-•--•-•-•--••-•••-••-•-••- �►..�`,� W Design Flow....... ............................gallons per person per day. Total daily flow................I"__._.._______.____gallons. WSeptic Tank—Liquid capacityfgM.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-----=�-•fir•- ( � --- -------•--.._._ Date....... -•-- -- ------•-------- Test Pit No. 1....... minutes per inch Depth of Test Pit.... _______.. Depth to ground water..... f3, Test Pit No. 2....... _minutes per inch Depth of Test Pit....ZZ Depth to ground water..... _____.___- �� _ ---------------- o _ I C. .. . _. .._ ------------- Descrlption of Soil. %% .....1. I�•/y?u� _ ...__. V -_•- G.•G- -9 y �� ..•-•-•--•--••.. - o -----•-• ........... W ••---•-•-•••. ----------•-•-• -----•-••••-••••••••••••••-••-•••_••-••••--•----•••-••-•-----•--•-••-/02.......Z_8-----•�d �� i�� -........... V Nature of R a' s or Iterations nswer when applicable............................................................................................... --•-••• =------------•--.....••-•-•---.....---------------------------------------•---------._.._...--••••••-•-•-••-_•--•--........ Agreement: ikp The undersigned agrees to install the aforedescribed Individual Sewage Disposal-System in accprdance with the provisions of TITi L 5 of the State Sanitary Code—The undersigned further agrees not to place the.-,�ystem in operation until a Certificate of Compliance hr4rZ d b oard of health. G/Signe •-•--- g --�•---- ---•••-•••-••--- ✓ �� 1 ...._ rf to Application Approved By_,...� _ s:/ �___ ... . . . ___ ..._............................ - Date Application Disapproved for the following reasons____________________________________•____..._.._._.____...._____________________...________....________-__--__... --•------------------•------.....----•--......__......---.....-----------..._.._...-_------•---....•-•----••••••••-••-••-•-•••••-••-•-••••-•••••-••-------•-•••-•••-••-•••............................. Date PermitNo......................................................... Issued....................................................... Date FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS - - BOARD OF HEALTH .cJ................OF............ -----_--_--._-_-----..-_-_-- Appliration for Disposal Works Tonstrurtiun Frrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ..- /�,r�70A.)PP....--------------•---------- ' oc io - dress r Lot No. .... 't ---- ---..1. .._'� ------------------------------------ ------�•/1'�..0;f ..x_!.j[� ..--,�.�e...�,�1,�f*wi Owner Address a -•-------•.............................'---------._..._.._........_------..........•.............. ......--•-------••---•------•-----.._......-----------.._......................................... Installer Address ��jj Type of Building Size Lot..... Ite w_`"..Sq. feet Dwelling—No. of Bedrooms............. -Expansion Attic (�...) Garbage Grinder pP-4 Other—Type of Building!� /. �! �/lof persons___________ ________________ Showers ( `" — Cafeteria (-w. G" Other fixtures ----••......••----•-•--•-------- . W Design Flow......._.'. ............................gallons per person per day. Total daily flow____...... ..........................gallons. WSeptic Tank—Liquid capacity/.0%-gallons Length................ Width-----------:.... Diameter................ Depth................ x Disposal Trench—No.•--------- ----_- Width.................... Total Length_.._...... .,f.._._ Total leaching:area ......sq. ft. Seepage Pit No.......�.--------- Diameter.... Depth below inlet___..'.'.46.......... Total leaching area, sq. ft. Z Other Distribution box ( Dosing tank (`•" ) Percolation Test Results Performed by....... [.��- : ...................... Date_ ...�.`S , ,4 Test Pit No. 1...... minutes per inch .Depth of Test Pit_____ _...... Depth to ground water.i...t.�!�`_.......... (s, Test Pit No. 2........ per inch Depth of Test Pit..... ..... Depth to ground water------/0.......... a � / - - / - --- O Description of Soil....... `' �e� G4►�!!Y1 v�.................... / x -••--••-••••----------------••---•••-•••-•--•-.------------------------......----------------------------------------------.4QSl"�8....... .... -- . ! .. f� V 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in. operation until a Certificate of•Compliance has b d iss ed b e. oard of health. ' s � • Sig' i ne ------ . �r •._...-• ......................... to Application Approved .._....__. esGP/ .w e Applicatioli Disapproved for the following reasons: -----------------------------------•------......--------:....••--- .....................•----..........---•--•----......._...--•---------.......-----------•-----------......-----•--•--•--••--------------------------------------------------------------... ........ Date f PermitNo......................................................... Issued....................................................... Date a ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............1...,�t'!• .............O F.... .: may,. k ......................................... Trtifirate of Tuutpfiana THIS IS TO CERTIFY, That the)n��iv>dual . Disposal System constructed ( ) or Repaired ( ) by ------------------------------------•---------;� s........ ..' Install ' at �2. ......A.i...---..... ---- --- - has been installed in accordance with the provisions of TIT of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__ ................ dated__..._._-_._.--___-_-___.___.__--_-_-_-_-- THE ISSUANCE OFT IS CERTIFICATE SHALT. NOT BE CONSTRII ® A C�BJA ANTEE THAT THE SYSTEM WILL F C SATISFACTORY. DATE......... _.a2.. �0------•------------•-------------------- Inspector..--• ----- .... ................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ....... No. �!� ��- . � FEE.... .................. Mavollat n k� C n trudivit ami# Permission is-hereby granted...-- to Construct ( or Re air ( ) an ndividual Sewage Disposal Svstem at No.............. ,/6 .......... 11441. ..---• .JD.,- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ------------------------------------------- 77/ .-•.•................• of Health DATE----..�.:A .Y.:.-�-�-----------•---•-------•---- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ��}�� ,y�r, aIL►�stp:, c.a�M:i' wK? ai �q .'� �ZC'��s' i. S,,$ L g r!,i •S+ D4 a;".tr >v-:r, :'"s. fl .y d ±.,,7+i gry �y r�� �' �C�17 i2 p �` { , Yh I Y��°3't i) !a f •I',� A M'Rlr f+. � 1,"Ri,:`r l}':�!sv NS.p�is�'�' k * ,`3 Y '� �� •� ,- �}� - 4{ 1 1 �h` t.,�yi�.JB '+�'f� yi �'�'�t tM1k.:F'r ki' '�A 'a;.- I'��.. •t1°. • '�:. ' f�` fak k t 5 r t ,('s �i� �/ o -� �,,;,/ :n•`° '' p,y 4ry,d'+�,"i�L�.kf��,Qj,".t � �;t9,r't s rr,+^t!+ ,p`r Yr; •.{�'`a"3, we �k�:r s ah� + � •,:� ;,1 r ,y; e � "�'_,� �'�.R}. ;3e.7,. t.`� rr r. �. 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I r%n'y �'��'. �/ '.Ti. + t,r, i IN W. t SAP ����i*80ARD. ;OF; HEALTH f `, � t,�' 3 r � Y,`T 1 .9•t A.0 i t, t ._ r � ''AGE T x..' r 1 *r b SCA•lE DATE.:F�t��il�� F `° C� £N`GINEER,I G;CO. dN n �- � { � ClIENT1�� �- I`'.CERTIFY' ''.THAT' °THE PROPOS1 ,r� ''Rf " r iEGIS` ERE , . ;�pg d'?FiOG `�' " BUILDING 'SHO:W N ON ` 'THIS .Pl ANC r° Ail CONFORMS: Td' THE .ZONING LAWS�`r S" r DR Elf a �fGIN�E^E SUFtYEYdR � OF BA�RNSTABLE ' MASS. f w� r„ - � Y �.. ^. - < E " N ST STD j �9 Y �t�yTH, MASS' H ANNISX MASS SHEEN r ! / f REG. LAND SURVEYOR' •0 DATE' 4- �va W P7' /4//v. wrz-'O_PV - 7`7 `AF?,W- -A e,�q -7 -,f CO P 'o O/A A;j W A? 7, 4 4:; &,F,13 R 0 06 Al 7r 7 0 4 'PIP !01V'� C40 ST VR CO1VC#RE7.E A7 1.oV. -Al 7 j co Jo Y� ,7 s ATA AD 4 A ------ -7-77— "A/ A CA- '7 418 4f CA S;r M� -I'�. 'I u R40 N Azy p /00-0 _I CA 4C. It ' 1� - �* 0 r' r 1, -_�' 5 0 1 ;;!�/C' jAA/ t' N "L 'A9 f3 0 Or- 9'.. E)r 46 L?_A=,Z;'7,A-/ • A.5qE _.t• 4�• L w- as i L :, a :', +1 r +: ,.n :il. .J•i .» - - t !.. • O c r . .• • • • �'► o: r _ �" . - 3i „^. Te LA '7- _14 /A/ z E VA r/,OV 4 IV - 7041D I A (.4TlON r1C r Fr. oU71-4:77•S 7-/.C_7A N /57 c 40' -/?/454/;r/O/V CIOX 4a_C6rZ ON 40OX ir7 .157R J;r/ SE4"GE 4?15 X-5 9 5; t L EA C HI IV C, 1�1K A 7 A/'i.?Im51v ,SCALE 6 IV R 1A -N.5 0-",. 4s',o TI zlmaER OF qm� Z_o R CA 5 3:4 4/,v 7�1 -0 7-A C Zf,"A� q jo L. __7'PA j�f�. 5 77% -7 _,VUM9,fA- AC7A 7 -SO A H54 _A 40 0 T TOM 2—=A C r A-le 9 0-17 • 7. O Af 4� -TO 7# A A 2-4 i:o zX1 .0 R,7 !� 'g� - _a ip4, f t k� &.4 7:7 Iv % fir. Y A:— -:r gs ?TPYMVV� �s T11 oF ik V' 1 1.4 • ;r'Z' ' __�A wn A- k� JR. i�- 74 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r_ C k1..........OF.....1. .. ..5..�.... .. ........................... App iration for Bispoti al Works Tilmitrnr#iun rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �d1 V� , ............ c��:....................•--------..--- l..l: ....... ._.._.......... Location-Ad Lot No . - . ' . � r, .. ,� ........ - ---. 0,1,,r Address a ...%j_.6_ -RX.....Q.u. ---------------------------•----------•- �i .t --------...Mat _ 1.�-4---- Installer Address p UType of Building Size Lot_-T-7--lka.....Sq. feet R Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—Type T e of Buildin 1 pi yp g��(��_..�,a�L��atr Jb`�persons____________________________ Showers ( ) — Cafeteria ( ) Q'' Other fixtures -----------------------------------------•_.... W Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank I Liquid capacity./M.gallons Length................ Width____......_..... Diameter__._--__-____._- Depth................ x Disposal Trench—No.--__--_-----_--- Width........... �otal Length.................... Total leaching area....................sq. ft. Sj /........_.. Diameter.l 0, pth belo inlet.... . ............ Total lea�ng area...................'i ft. Seepage Pit No __. n Z Other Distribution box ( ) Dosing tank ( ) S l !/av4C /�.z'N yrP - /-5A 7cr-. Percolation Test Resul Performed .................................... Date../._=.V.-.7k.-............. Test Pit No. l_. ...2.......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........................ 9 -----------•--- •----•••••--•--------------•-••-•••••••---••••--•-•-------...................--....................------•-----..................----... Description of Soil = �� to-R �f® f-mod- �� — -2L. ..-----•---------------------------- U W I 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 iITIE 5 of the State Sajbeen The undersigned further agrees not to place the system in operation until a Certificate of Compliance by the boar eaSign `�? -•--.•.-.�...... ................ � ate Application Approved By......`.... -7� Date Application Disapproved for the following reasons:--•-•------------------------------•----•-------------------------------------------....------•-•-•.......------ /� r� Date Permit No............... ---.... Issued �_..._� _`r---.C�:........... ._.._... ^___.__- Date No.----................. . EFs .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7rOWh 13 AAIV T .................. . ......OF....................................149.� Allpfiraffull for Bigpviial IRldrks Tomitrurtion ramit P Application is hereby made for a Permit to ConstructI or Repair an Individual Sewage Disposal System at: ...y1mil.. ............ LA. ....r ................ L....t....... . ..... .......... ...... ../ ""-I.'t N......... ... ......... o. ..........# P fA ALI ffov' — o .. .......... . ..... u.ao. ................................................ .. .. Installer Address Type of Building Size Lot.,.V21.14.0......Sq. feet Dwelling—No. of Bedrooms .......*.................................Expansion Attic Garbage Grinder ( ) P4 Other—Type of Building lk�-.1...CVPAt.-:A&14 persons............................ Showers Cafeteria ( ) Otherfixtures ------------------------------------------------------------------------------------------------------------------------------------------------------ Design Flow............................................gallons per person per day. Total daily flow..............j.............................gallons. * Septic Tank—Liquid capacity............gallons Length................ Width.__............. Diameter________-___--_- Depth......_.._..._.. * Disposal Trench—No. .................... Width............._._.... Total Lengt�................... Total leaching area..........*..........sq. f t. Seepage Pit No..................... Diameter.................... Depth belo inlet Total leaching area..... sq. ft. P.4-IV,$ Z Other Distribution box Dosing tank Percolation Test Res I Performed by .................................... Date..1.:!.fA-..7X................ Test Pit No. I -Z�-------minutes per inch Depth of Test Pit.................... Depth to ground water....:-.._............__., Test Pit No. 2................minutes per inch Depth of Test Pit..............I..... Depth to ground water.___._._......_........_ P4 ......................... ........................................................... -------------------------------------------------- ..................... 0 Description of Soil.......4........4.0 V7 ----------------------------------------------- ....... ---/ .....................................ji....... 04 -1`7 ...........4�411......../....................... J_ .... .......................... ............................................ U -------------------------------------- ---------------------------------------------------------*-------------- -----------------------------------------------------------*------------------------------ ti 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 TITiE 5 of the State Sanitary Co The undersigned further agrees not to place the system in as b operation until a Certificate of Compliance h bee Co by the boa Sign d... � ............. . late Application Approved,By..... .... .. �/ _LA ....Z.-, /, 7 Date Application Disapproved for the following reasons:.............................................................................__.............................. ......................................................................................................................................................................................................... Date PermitNo........................ ................................ Issued........................................................ Date THE'COMMONWEALTH OF MASSACHUSETTS BOARQ.,,OF HEALTH -e #�j .........................................0 1..........A.....TL....... A, Trrtifiratr of Toutpliatta Tliu Is TO CERTIFY, That&I individual Sewage Disposal System constructed or Repaired by........ V-0-A .................................................................................................................................. .......... istaller T-Hu DQ P- at..... ...... ......... ...... ... .......................................... ------------------ has been installed in accordance with the provisipiks' of r 5 of The State Sanitary Code a�described in the application for Disposal Works Construction Permit NC.. ....././-.a L................... dated--4--A4--?� -................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GPARANTEE THAT THE SYSTEM V! IIA FUNCTION SATISFACTORY. 7A Inspector_.. .............3 sr�....... .......................................... DATE......... ................................................ THE COMMONWEALTH 01. MASSACHUSETTS BOA HEALTH ................................AJ ..........'OF..--- ....... .......................... 2S. No......................... FEE........................ Permission is hereby granted...........q C ............................................................................................................ to Constfjct (,-) or,Rep �an k..Wividual_ ,Tage Diposal System A# atNo..... ..................-.1...........................................I............................ St t 4;.. P ....................................... as shown on the application for Disposal Works Construct ion gm]x No.,-., Dated. ..........Z Board of Health DATE.................... ...............................*................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS . r 11,E 0 LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LER'S NAME & ADDRESS /5�irJPs Aa O L/51 S? e-- A� 0 U I LD�E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED C9 r r rVry II,✓s1 e,�/ No.........1�- ..... ...................... THE COMMONWEALTH OF MASSACHUSETTS BOA �-iEALTH �W.V --......OF......1-�.. .. .2.1�11...��..�� / Lea .... ............... ...... Appliration for UispvM Works Tonstrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... -------•-------------------- ................ . .:v:7-.1�:.. .. Tv catio ress or Lot,a�o i .�t_I_ er... --•- ---•�-- ---T�:�o +!..1 !�....1�iw -•----A jug 1,�: Owner ddress wID : . ................................................... ..... _ Installer r Address Q LL j Type of Building Size Lot_T2__.YZ.0._._Sq. feet U Dwelling—No. of Bedrooms___________________________ .____Expansion Attic ( ) Garbage Grinder ( ) ------------ — pW-, Other—Type of Building �'SaI_._` ii4i t�7o. of persons........... ____________ Showers ( ) Cafeteria ( ) Q' Other fixtures . -----------------•---------•--•-••-•-•-•----•-----____-------•-----•-•-----•--- W Design Flow__.r!!?f1 ..............................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 -nlet___ __ °____._._._:_4otal lea1ching area..................sq. ft. z Other Distribution box ( ) Dosin talk ( ) ON. — �a ,�' �'�-77 y r Percolation Test Results Performed by-_ CO1�/, ___________ Date '...___. aTest Pit No. I...L0......minutes per inch Depth of Test Pit____________________ Depth to ground water:......................... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p a ... v--------------- -•-------------••-----------------•••••--•------ Description of Soil......�--....�.U..�4__1tY1...................Z�..-•-----s�id.�--�-Q-I--•�-------------------....._.....-----------...-•---.......------------• cx� -----------------------•.-•••••••••••.laf..... VE-I-................................................................................. ---------------•-••---------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable._______________________________________________________________________________________________ E --------------------•------------------------------•---•---- ......_......................................--------------------------------•-------•------------------------......----_..._. s Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1: 5 of the State Sanitary Code—The undersigned further agrees not to,place the system in 44 operation until a Certificate-of.Compliance has been issued by the board of health:. - fSi ed• ................................... •-•-•-•••---- ............. Date . Application Approved By--••- ;y- (�_ G�(/1/L.. ................ .3....�li__- --------- Date Application Disapproved for the following reasons---- ----------------------------•--------------------------------------------------------------._._..._---•---- -----••-------•--•-..................................................................................................... ... Date Permit No........... --- ---: Issued....................................................... c: Date r C�,. f v,,. •- ,� Fes$...............�.�..;w� No.........1!:�...... ............... THE COMMONWEALTH OF MASSACHUSETTS BOA OF HEALTH Appliration for Disposal Works Tunstrnrtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem .........TH�AYTO _ru..............?...... .................................1-6...................................................... or C• 1�C C n NY I' `o ra�SR s" I'laouTt)'vlat� ._ ..---- Owner ddress Instailer Address Type of Building Size Lot. S feet U YP g -:�---- - - ---... q. Dwelling—No. of Bedrooms .........................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building __.: _...._: filo. of persons.............- ( ) ( ) �+ *� _____________ Showers — Cafeteria Q' Other fixtures ________________________________ W Design Flow...IPP/..............................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............... .„�ota lea hin area..................sq. ft. Z Other Distribution box ( ) Dosin t k ( ), ` ✓�t �� '-' Percolation Test Results Performed by_ i�"�A.cb-Cc ... ! �i..t UJO........._.. Dater r_. ./+._ .+ ........ aTest Pit No. I--- ___-__minutesperinch Depth of Test Pit.................... Depth to gro nd water_-___-__________---_-__. Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ ---- --------------•--••---... �.-•-- .......................................................... Description of Soil..._. .A. J"� t V ----------------•---•------------ -; .... W --------••--------------------------------•--------•---------------------•-•----------•-•••-•----------••-•---------..-. --------•----------•-----•---•--------------------------------...........:_. UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ •-•-•---•----------------------------•-•-•-•-----•••----••-•-------------------------.....--•.......------•-----------••--------•-----••------•-----••--•------------------•••...---•----•-•---.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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 board of health:-,-.... Signed------•- = ---------•-----------------------------------------------•--------- ---- --------------•--•.._.... Date Application Approved 3Y r E:` r �+ r.. = '" �r f....----•-. Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------•----•---•-••-----•- ....-•----•-••-•-•--•-----•..............•---•---•-------•--...........--•-------•-•-•......•-----•-----•--.......--------------•--•-----••---•---•------•---------------•---------------------••-•••--- Date Permit No. Issued --------------- - Date THE COMMONWEALTH OF MASSACHUSETTS BO ,. OF HEALTH � f........................... %furr#ifiratr of f omplianrr TFIS I TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ct.....�.n..l......---..a-)IL '• er I /jM .-... Install at. t•.lC._.. l-{.7 �"._.. _�. AI....... f .....................................................been installed in accordance with the Iprovisions of „ _' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No --_-.../-_.,?---_----.-_----. da.ted_.,:ft../4 4_.. ................. THE,ISSUANCE OF THIS CERYIFICAT .:'SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFi6fdRY. DATE................................................................................. Inspec tor.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ulg-, .........• . . ,,,,.•�-^........ BQ � . HEALTH fr.. ....... lt/ .........oF...... ...... - .--. ' ..A............ ,................ No. ..-3..... .... Disposal Narks 0-Faantrndion rrmit Permissionl��e is hereby granted... _ /Z- ...........tl .................................................................,.,................... to Constr'ict-L or Re air ) an Individual wa e Di osal S stern at N ...IT.. Street as shown on the application for Disposal Works Construction eln>t No..... ............ Dated.??'"f r '+:.........:. a - �r oar o DATE--- . •--•-----•------•----•-•..... -.----• ----------- f th ._.FORM 125! HOB�BS & WARREN, INC.. PUBLISHERS- .r ' '1.�:. •.:`5... ..: ,; 17' t .., «,aT•.x' 'a"';(. ?,�.. •.�• ! .4A' ' t ,a+w 3:,.. `w `t"_ wvlkw a •a:..k.4 r , OR 2 c Ak .,. a.rtgB xr*ad `' - rn; `., ;' 3y 'Z°a i^ °u +►, + "'" '�.,n'•. .` _•ti jd`., a..�: + r.;LS'r w` '.,h :�'�:d, ✓�K'; /—u/yA/�7 IS'L�'y � PW "9 � 'h.,�:,wY r r. ET.In@ CON-GsPET.��/�♦� v :; � r,b•�n' a - y a �' • -T. "TO',6RA 17E !`�!✓ E�t"'!'IE'A .; v ~Yap fit# z v« «• s z s., p GzGI/ER SH.QL'L.13�aC/ � `e LOAF �CQv�RS ;,yam :+►,8 � 3 4 iL F°+ O_ ' a:' acj. 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's, ' . _{..t 4 p ?' �Epr i g4 ,�;+'' ,p't ,s h .+fa t4 i; ° r f.. n !� xyw w•F ' MO 14. 44 1 `JS /t9009r1 tYlOt3 y yi.,F t - S.`�� - 'e r< F� t Y ,f J��A� � I•I� � �J �� r 1 x � ' � '! Cf` X '.j� � r � � r '�'•r r -���� � 1� � S` 'aLyy# ti t *#�"y, �, /�CC'',,�- -- e t8 �l "' �u'! •S �rx if � 1' `" !S`1 e 2"A � � t`ta�.�,K ?�YI t.. �� r r. 4r�t s LF}VE p tP a'`vaR & 2 �EX19.T'II�G '°SPOTf Ei.' i/A.T10 CXO; ��a CERT�FI:ED tE, >��LOT E 41. IItitfl�- CONTOUR"-= f " '=- 3 r :'ft� '1 ISI°ilD� SPOT; EL1lATnlQ ` �^ ry } FINiEQA CdNTOU — 4r tN $T s P �iOVED BOARD OF irAL s1`.`' t r p .f r �/r 1J• r1 F a ipL•td °a' ti- (i - y - y �� `' { i 1 A �� • f� � ,� '' .„t.•�'� 4 .` �" E' £ ��a .r 7! 3 i c° `f v z. !� p. t* tt ;, '� r � v �'. �gff,�'C Ytv �gr'�--•i - -i. }• , y n� r i.l. F� 'yF'F s �a pq.:.. r t;I� �/ `�� CY $m A ,EYs'_•t� n i fk. '.'�.M.: -}1 R.;n` r � Fsi A?LG� pg9�bV":6}}�.�I�.1i.. .4? *. � y } 1PE�$ta5IG/NER1IVQ /V. LI Tre.l s r �:w ,:,w" f4 ---�.�- a —� — .; .SCE' t �!. ,TP AT Y T.H z P•.f POrt t�Din ( Ptj0W , Q;N THi �- k � �� L VAN f t oNFI :: IDSTd r' S'UR�VEY4 et DI7�8�$Y P � — OF' BAFyt�07ABlmE , •ASS � f h4 � rs f*4 F7fj ` $,f � t��i; �//�� 4�� b.4�.�/G. •M' ��{r�/ ` YHp Q �# s°3 }'---�t:++�A'�4 --, �,.''f ^r+ �, a`,:,i ddi�l� / '�.. n a. �. � ��.. ,r 'A .�.a,,i'`.�.,, =;rw�• : SHEI �. ',o�, ,,,.:.�_ tbAT E�` k� Eri, .,{y RING.�+�i:A N 0��,�'U,,�Y �`� i• ... •� st d+Jr.,e b•: 'rI, Rt a `•.( ! r R , •4' h in 1 s8 ay' {., ,R"„ .. .,.. A 7 l it ,,'.`. s,.♦ y.A' .,>,l:%. '�'��i ro ��/r �.a., s k '.e.���"i141 e( of>' R as;.. `8, i:fi"' eta h,Y �r .v LOCATIO.." SEWAGE PERMIT NO. w / / o r'iY i 0 VILLAGE 0 I N S T A LLER'S NAME & . ADDRESS er BUILDER OR. OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 1::�Poly7 0l- � ,vi� �.y _ s TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM HOME, INC. Q) / � NAME OF FIRM: Cd/b/a SERVICEMASTER OF CAPE Co.. �� �U MAILING ADDRESS: 217 THORNTON DRIVE —� TELEPHONE NUMBER: HYANNIS, MA 02601 (617) 771-3374 CONTACT PERSON: Does your_ firm store any of-the toxic or hazardous- materials lstedbel:bw, 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 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: P Y Antifreeze (for gasline or coolant systems)w Refrigerants Automatic transmission fluid Pesticides (ins-ecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives / Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda [/ Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) . Car wash detergents 'PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar Paints, varnishes, stains, dyes carbons! (inc.carL�n Paint and lacquer thinners tetrachloride) Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform formaldehyde, Y , Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluids C E 6 V E toxic or hazardous please (dry cleaners) HEALTH DEPT. list)= Other cleaning solvents TOWN OF BARNSTABLE Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners ti Cesspool cleaners MAY 1 4 1981 Disinfectants Road Salt (Halite) TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: WtANSIDE, INC. MAILING ADDRESS: 217 THORNTON DRIVE HYANNIS, MA 02601 TELEPHONE NUMBER: (617) 771-3110 CONTACT PERSON: e. r921< Does your .firm .store -any._of .-the .toxic _or hazardous--.mat-ex als -listed- bel-ow., _ either for sale or for your own use, in quantities totall`i-ng, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO O T s g c.s 07 vc�,e,4 I- wr_r, 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 gasline or coolant systems)w Refrigerants Automatic transmission fluid Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink � Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluirds, � ' � E D toxic or hazardous(please (dry cleaners) HEALTH DEPT. list)1 Other cleaning solvents TOWN Of BARNSTASLE Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners MAY 1 4 1981 Disinfectants Road Salt (Halite) I �' y~ TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM --� �e spun%Ce ) a+e r- ADDRESS Major types of materials: 1) My Jd yr �i; �[ea 2) _I' I. Description of material(s) use: eQ a 1-K CaVt II. Storage (denote product by number listel above) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels .aboveground tanks i 0 underground tanks , bags,boxes U 5 open,loose,uncovered inadequate labelling B. Storage Facility ✓or # Remarks/RecommenL�'Aons 1. Indoor a) separate, contained room i , b) stored in general work area i) inadequate ventilation ii) floor drains iii) inadequate fire protection 2. Outdoor a) uncovered, exposed to weather b) pervious surface/catch basins III. Disposal A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system 3. Separate holding, tank C. Off-site disposal 1. hauled by own firm 2, hired hauler a) name of hauler b) address or disposal site JPersozl(s) Interviewed — — — — — — Inspector— — !-� 1 Date - - -(—_ 7- -- - - 6 30 81 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repai satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops _ unsatisfactory- 4.Manufacturers COMPANYO T �� (see"Orders") 5.Retail Stores a y 6.Fuel Suppliers ADDRESS �� 1� ✓2--t1claSS: 7.Miscellaneous �� UANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MAT IALS oveUnderground IN OUT IN OUT IN OUT #&gallons Age Test Fuelse z Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers xle.*V - z iscellaneous: ` . o a DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply 4z,o8r�_ O Town Sewer Public AOn-site OPrivate 3. Indoor Floor Drains YES____jNO k1 O Holding tank:MDC ! O Catch basin/Dry well O On-site system , 4. Outdoor Surface drains:YES NO ORDERS: �'` O Holding tank:MDC AVCatch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination WastelProdu: lct •d YES NO 2. Person(s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIAL REGISTRATION FORM Mail To: NAME OF BUSINESS: Z Board of Health MAILING ADDRESS: s RVICEiViASTER OF CAPE COIT Town of Barnstable TELEPHONE NUMBER: HYANNIs° ` s; -3374 5 Q26e1 P.O. Box 534 _49/� CONTACT PERSON: 94&kA-+Z1 r-r 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 NOS 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 v Please put a check beside each product that you store: f Antifreeze (for gasoline or coolant systems) Drain cleaners / I Automatic transmission fluid r/ Toilet cleaners Engine and radiator flushes /Cesspool cleaners Hydraulic fluid (including brake fluid) c/ Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants t/ 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 :]-�/ aints, 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 t 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 11 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: C-rpu�V ��c�wry �Lr �2S� C Mail To: BUSINESS LOCATION: 211 7hawz� J�/du✓� Board of Health Town of Barnstable MAILING ADDRESS: .0 30X_9 kI5 IVA 01 P.O. Box 534 TELEPHONE NUMBER: 65:Q2),,3G 2_ -7o90 Hyannis, MA 02601 CONTACT PERSON: Susgni cot s( = EMERGENCY CONTACT TELEPHONE NUMBER: �5a8� 7�1 -Zc�0 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalli , at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the;Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids �Q be t xic�or hazardous (please list)- (dry cleaners) �l _' ' ����e� ®mII®�r Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business r � U.yS 'DEPARTMENT OF LABOR 1'o�m ��Nu����'•� •� OMI1 No. 4.1•I11ill? i Occupatiori�,! Safety and Health Administration T E R I At. SRFETY BATA SIKET Required under USD,.�Safelj and Health Regulations for Ship Repairing, I Shipbuilding, a:rt6Shilihmakinq (29 CFR 1915, 1910, 1917) _ SECTION MWUFACTURER'SNAME tME11GENCVTCL4'PIIUhL' NO. ignal Div. 696-7575 Anscott Chei���pal Ind'. Tnc. AO►R ESS(Number,Street,City,State,and ZIP C,,dr•J -— - 26 11anes Drive, Wayne, flew Jersey 07470 � CHEIICALNAME AND SYNONYMS TRAD NAME QN NUNYMS CHE CnL AMI _ gigna�. Altaline Boiler Com ound`'.�ormulat on Mum I SECT10.'411 HAZARDOUS INGREDIENTS PAINTSPRESERVATIVES,&SOLVENTS % TLV nits)_ ALLOYS AND METALLIC COATINGS (lT1`�ts) PIGMENTS N/A BASE METAL 1 I. CATALYST I ALLOYS VEHICLE METALLIC COATINGS I SOLVENTS FILLER METAL . PLUS COATINt. OR CORE FLUX AOUITIVES OTHERS -� OTHERS HAZARDOUS MIXTURS.s:9F OTHER LIQUIDS,SOLIDS, OR OASES TLV y, Sodium H 3roxide 5 iI(sue I ray SECTION III • .PHYSICAL DATA BOILING POINT(°P,) SPECIFIC GRAVITY(H30■1) • VAPOR PRESSURE(mm Hq,) PERCENT,VOLATILE BY VOLUML VAPOR DENSITY(AIR01) EVAPOkATION RATE SOLUBILITY IN WATER Irif lriit I APPEARANCE ANOODOR L1 rht browrj_ Solution*. slight odor I SECTION IV •- FIRE AND EXPLOSION HAZARD DATA FLASH POINT (Method uted) ter' �` �FLAMtW9LE LIMITS Lel Val None _ _ _ EXTINGUISHING MEDIA SPECIAL FIRE FIGHTING PROCEDURES -'— UNUSUAL FIRE AND EX--OSIOON HAZAROSV,'i!t SECTION V - HEALTH HAZARD DATA THwr_S►iOLD LIMIT VALUE +— . EFfLCTSOF OVEREXPOSURE EMERI.ENCY AND FIRST AID PROCEDURES _ Flush with water;_treat as al�t �4urns.. SECTION VI - REACTIV;TY DATA STAULITV UNSTABLE CONDITIONS TO Ayo10 ry; y_F STABLE X INCDIPATABILITY (Alatt/IaIJ to avoid) HAZAIOOUS DECOMPOSITION PRODUCTS CdNDIY UNS TO AVOID HAZAR)OUS MAY r)CCUR POLYIARIZATION X WILL NOT OCCUR SECTION Vil SPILL OR LEAX PROCEDURES I STFr; TOtIF. TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED Ilas ylL_Qf 92-12-- 5 flush with w +ter: t?so nrc�innx!w preca"i-iuns :(or_.�lkaline spills. 7,77 r WASTE DISPOSAL METHOD SECTION VIII • SPECIAL PROTECTION INFORMATION RESPIRATORY PROTECTION (Specify rYl)tl VENTILATION LOCAL EXHAUST SPECIAL MECHANICAL(Gent►aIj OTHER PROTECTIVE GLOVES EVE PrY'O7ECTION es � Yes _ OTHER PROTECTIVE EQUIPMENT SECTION IX SPECIAL PR,,ECAUTIONS PRECAUTION TOPE TAKE IN HAN I O AND STOR id Avoid freezing - Take normaNO recaLyions for handling: _ alkaline solutions. _ OTHER PRECAUTIONS PAGE (2) Form OSIIA•2c Oro 930.040 Rev.M•v7: TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH O 3.Auto Body Shops rhW 0unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ass: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALSUnderground 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: DISPOSAL/R.ECLAMATION REMARKS: 1. anitary Sewage 2, ater Supply l9r Town Sewer 9Public O On-site Private 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler 1 Product YES NO 1. 2. /�` ✓�� l erson (s) Int•erviewed Inspec or !Atel r 4 � TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH O 3.Auto Body Shops %01,01V -�/ �" f(/(� Ounsatisfactory- 4.Manufacturers COMPANY ( .(�f' 1 W_ (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS f1 r",. 0 S' s . i4; Ic till- `-C1aSs: 7.Miscellaneous tQUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS __--caselots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) =" Diesel, Kerosene, #2 (E.) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: tb DISPOSAIJRECLAMATION REMARKS: ( , 1. Sanitary Sewage 2.Water Supply ►r� (, ,.Town Sewer `®Public Q On-site lQPrivate \ — 3. Indoor Floor Drains YES NO ON v �� 1 r i�i 1 O Holding tank: MDC I /. O Catch basin/Dry well �+ k O On-site system ` 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste ' duct Licensed? YES NO 1. 2. Person (s) Interviewed Inspector Date i h.. �� Date: TOWN OF BARNSTABLE pea4er-OL— TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTO Y NAME OF BUSINESS: &4W BUSINESS LOCATION: 0Loin INVENTORY MAILING ADDRESS: �� TOTAL AMOUNT. TELEPHONE NUMBER: Ap jLdLcm CONTACT PERSON. EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: ht4h1Ajj4:2 h., INFORMATION/RECOMMENDATION V b A� L Fire District: Waste Transportation: Z Last shipment of hazardous waste: Name of Hauler: Destination: " Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials 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) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. 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 Misc. 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 (inc, carbon tetrachloride) NEW USED Any other products with "poison"labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers s (including bleach) cin Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i V Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Golden Crown Cleaners Inc Fax: Corp Name: Mailing Address Location: 217 Thornton Drive,Hyannis Street: ...... _..._.._ mappar: City: Barnstable Contact: 'Paul Ferzoco State: Ma Telephone: 508-790-1370 Zip: 02630 Emergency: Person Interviewed: _._..._......................... .............. Business Contact Letter.Date: _ _ ...._......._ ...... .......... Category: Dry Cleaner/Laundry Inventory.Site Visit Date: 9/7/2005 Type: Follow.Up/Inspection Date: ❑ public water ❑ indoor floor drains ❑ outdoor surface drains license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir -- -- - - - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: 4 GALLONS BOILER COMPOUND SEE MSDS SHEET 9/7/2005 alp-No compliance: dry cleaning done,just laundry and pressing,no smoking near incomplete oxidizers outside,clean up property-dispose of battery outside,dispose of empty drums of the hydrogen peroxide. No permit ever obtained. Needs permit. 1 f Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑d gty's 111 gals or more <d descnptrgn .x ., qt', r„ ,unitaOf:lTt2aS,Ur�'' ' Detergent I 9 gallons ___.____._._.......__.._._...._..__...__.__._..._._.---._..._...._............_..........__........ ____.._._.._..___.___........_.._._........._..__._.........__ Misc.Corrosive 105 gallons Hydrogen Peroxide 50 gallons �� Waste Transporter: Fire District: 'Barnstable Last HW Shipment Date: Waste Hauler.Licensed: No { %ty Town. of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division b ib`s� � 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 ?,IV L __j I L-270C10 NAME OF ESTABLISHMENT 1 �0Cb AC -A- LL ADDRESS OF ESTABLISHMENT pA i' t S` TELEPHONE NUMBER f� ��® f 3 7 0 Q SOLE OWNER• /YES NO �,s IF APPLICANT-IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF AlIj _ PARTNERS: - `_ C7 C11:3 !'S 3 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION 00 3 9(y �2-3 FULL NAME AND HOME ADDRESS OF: PRESIDENT 'PAy A7QZhCt) 54 QCZ5e 1t_ S- ffiItq / �C 9 62E 9 TREASURER SKME CLERK l L i 4� SIG URE OF APPLICANT 4 RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# 5 -L/77°'S17-2 0 Haz doc/wp/q t y /%3 LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED s 1 a { f k of 0 . Orimm1 � o Robert J. Canning ' Board of Health (5 8)240 37 00 ° ext.450 Town Hall Orleans, Massachusetts 02653 Fax(508)240-3388 April 11 , 1995 Mr. Steve Jenney Service-Master of Cape Cod 217 Thornton Drive Hyannis , MA 02601 RE: April 7 , 1995 Old Colony Condominium Orleans Dear Mr. Jenney, I am contacting you about the following incident because a van was identified with the "Service-Master Cleaning" logo and the telephone number 1-800-734-8701 . ' The only "Service-Master" office listed in the local phone book is at the above address and the phone number reported to- the Orleans - Health Department . The property manager at Old Colony Condominium also indicated this incident was discussed with a representative of your office and reported the service was provided by the Hyannis office . On April 7 , 1995 the Orleans Health Department received a report of a "Service-Master" carpet cleaning truck emptying liquid into a drain in front of the Old Colony Condominiums on Old Colony .Way, Orleans.. The .report also stated it "smelled like chemicals" . An agent of the Orleans Board of .Health conducted a site-visit on April 7 , 1995 at approximately 3 PM . Also present was Mr. Paul_ Connell , Assistant Property Manager of Old Colony Condominiums . At this time a catch basin in front of building Hancock 4 ( located at the corner of Old Colony Way and the Hancock 4 parking lot ) was observed to be -full with suds or a sudsy liquid. Grey sudsy liquid was also noted on the pavement surface adjacent to the catch basin. Mr. Connell stated a Service-Master van had been cleaning rugs at Unit 7 , Hancock 4 . The Orleans Health Department recommended that the property manager for the condominium association contact Service Master to determine what-was in'the wastewater discharged and then arrange- to have the catch basin pumped and to arrange disposal at the appropriate waste disposal facility. I informed Mr. Connell they could check with Service-Master Carpet. Cleaning Old Colony Condos . - April 11 , 1995 Page 2 the Orleans Brewster Eastham Groundwater Protection District Treatment plant regarding disposal . However, the nature of the wastewater would be to be identified. According to the guidance provided to the Orleans Health Department by Mr. Rick Rondeau of the Massachusetts Department of Environmental Protection, Division of Water Pollution Control Southeast Regional Office , this activity is in violation of 314 .CMR 5 and 314 CMR 6 The Groundwater Discharge Permit Program. 1 ) It is my understanding from the conversation I had with Mr. Rondeau that all discharges -into leaching drywells are regulated by 314 CMR 5 and 6 .- If a drainage system discharges to a water course 310 CMR 4 also applies . For guidance relative to these regulatory requirements I strongly suggest you contact the Massachusetts Department of Environmental Protection Division of Water Pollution Control The contact person in the Southeast regional office is Mr. Frank Mezzacappa ( telephone : 508-946-2700 ) . 2 ) I also strongly suggest you discuss disposal of the wastewater from the carpet cleaning business with the health agent in the town where the business is based. 3 ) The Orleans Health Department is concerned that all future disposal of wastewater from your -carpet cleaning business in the Town of Orleans is handled in a manner consistant with the applicable regulations . Please contact me upon receipt of this letter so we may discuss the matter. A written response is also requested. The best time to reach me in is between -the-hours of 8i'30 - 10 : 00 AM at 508-240-3700 ext 450 . Sincerely, Patricia J . Ballo Assistant Health Agent CERTIFIED MAIL: RETURN RECEIPT REQUESTED enclosure : 310 CMR 15 : 004 cc : David McGrath-TAD Inc . 629 Mass Avenue Cambridge , MA 02139 ATTN: Joseph Alfonso Property Manager, Hancock 4 , Unit 7 Service Master Carpet Cleaning ti Old Colony. Condos - April 11 , 1995 Page 3 f Barnstable Health Department P.O. Box 534 Hyannis , MA 02601 Massachusetts Department of Environmental Protection Division of Water Pollution Control , Southeast Lakeville , MA 02347 ATTN: Mr. Frank Mezzacappa Old Colony Condominium Association c/o Mr Paul Connell Property Management Office 42 Old Colony- Way Orleans, MA 02653 Wayne McDonald Orleans Brewster Eastham Groundwater Protection District P.O. Box 273 Orleans , MA 02653 Disc 114: Serviceast r li.6--2E-- 007 10:35 Oceanside Inc. 508 775 2848 P.01/01 Town of Barnstable ��q p Regulatory Services Thomas F. Geiler,Director i Hr1RNSTAELE. Public Health Division " 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 III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT OCEANSIDE,INC 217 THORNTON DRIVE NAME OF ESTABLISHMENT HYANNIS,MA 02601 ADDRESS OF ESTABLISHMENT l TELEPHONE NUMBER J -D 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. STAVE OF INCORPORATION S FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICAN RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# TOTAL P.01 I TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers -� 3.Auto Body Shops , r�� ,�j ZA,f- O unsatisfactory- 4.Manufacturers COMPANY26,9 t�c'r �Oeu.� �1 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS _�17 s7�t-%ffB,e�d�c.�' Class: 7rMiscellaneous b�yoo_ls M'4 QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) pies 9> #2 (B) � l� Heavy Oils: waste_motor'oil- ) new motor oil (C) transFrrissiorr/fYydi�lic Synthetic Organi^s: degreasers Miscellaneous: <1 DISPOSAL'RECLAMATION REMARKS: 1.,?,��itary Sewage 2,Water Supply 6 3 f - /P Town Sewer Public .' . Q On-site OPrivate 3. Indoor Floor Drains YES NO 6' O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO O ER O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product, a� YES NO 2. lp, r n (s) terviewed Inspector Date �,� Jtrc;ea oclo i TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: � ���� ' �s � '��s Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER:` P.O. Box 534 CONTACT PERSON: Hyannis, MA 0260t� �Gs�-�- � � 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 characteristics and must be registered when stored in quantities totalling more than 50,aallons liquid volume or 25 pounds dry weight. , t a check beside each product that you store: . !v/ w- Antifreeze (for gasoline nt 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 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M /A�G,�� F DATA 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 Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION 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 On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5. Waste Transporter =M1 1, 04 � 1. 2. Person (s) Interviewed Inspector TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY A �T " d-A•sbe"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Yl '�'d 2944� Class: 7.Miscellaneous QUANTITIES ANDS ORAGE. (IN=indoors;OUT=outdoors) MAJOR MATERMLS Case lots Drums Xbove Tanks Undergi-ound 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) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer ublic /wOn-site OPrivate 3. Indoor Floor Drains YES r NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste od r YES NO 1. 2. rson(s) Interviewed Inspecto Date I r.�shk°rvv�,;k::-a•,.',. ..., .:. � emu:,._..:. - ._ �..�—....: _..,—�.,._.__ _.:_.__�.__ .___ - - __ _ - � — — _�.... - — 'ealCiiWBMr_......��.ew� i • ak�i �. Number Fee 1052 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Oceanside Inc. .---------------------------------------------------------- ----------------------------------------------------------------•.... 217 Thornton Dr., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. .................................................................................................................................................................... Restrictions: ....................................................... ............................................................................................... •---...----. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable. Inspectional Services BARNSTABLE �'t� PiJtY.Tea c•tEMEtVIL1E_teNrt•nr< ts .'4tiSilNIS N'LS_Oa�0.ViLtc•1✓'.51 B?PoVSIriBIE Public Health Division ff639-2014 1 1 Thomas McKean,Director * �''°lfDMpls`� 200 Main Street, Hyannis,MA 02601 ' IIyYrNJ Office: 508-862-4644 Fax 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE' HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26 110 Gallons. $ 50.00 ❑C?A:T:EGORY_.2.1'ERMIT_ I U. ,,,A99 Gallons: ..__ _.$125.00_ - A•,,, CATEGORY 3 PERMIT 500 or more Gallons: $_150.00El *A late charge of$10 00 will be assessed if payment is not received'by July 1st. 20 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? ✓ YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER'THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: . �✓e�1 I cn/1�y 5. NAME OF ESTABLISHMENT: ® Ge_u.✓1 S t,c�_•e 6. ADDRESS OF ESTABLISHMENT:' /? _f�oV-0. Z t D✓t y,e- 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: � c✓e- ^ .®G�cxr1 l��tdlc. mCc�v�1� 10. SOLEOWNER: ✓YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ® ✓t.! e�C ,V'C-• PRESIDENT S'-}-�✓e✓t c�n -� TREASURER CLERK . 12. IF.PREPARED BY OUTSIDE PARTY: .7 r o 31 (a NAME:- cwt-i ::::j�_i►/►Qy TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q\Application FormsWaz Mat Appli Draft Jan201 .do Number Fee 1052 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Oceanside Inc. A 217 Thornton Dr., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ----------------------------------------------------- ----------------------------------------------------------------- ------------------------------------ -------------------------- ------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. " ------------ ------------ ----------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable , Inspectional Services BARNSTABI,E �TNE Tn.- � .. nnnuTnn_e•ae, :.imi.conirt..annr ~O Public Health Division ��" °'�'_°9°z014'' "E ! BARNSTABLE, ` a U � Thomas McKean, Director 0 39. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Ems!, APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ; HAZARDOUS MATERIALSu i IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, E HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS I JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2`PERMIT- 111 —499 Gallons: $125.00In V5 j CATEGORY 3 PERMIT 500 or more Gallons: $150.00 P. *A late charl4e of$10.00 will be assessed if payment is not received by July 1st. 1 1. ASSESSOR'S MAP AND PARCEL NO. a97 oa8 GlSr� C'o�E' ,3��0 I i 2. IS THIS A PERMIT RENEWAL? VIYES_NO. IF YES,SKIP QUESTION 3. 4 r 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS i ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD.QUANTITIES (25 GALLONS)? YES NO. I 4. FULL NAME OF APPLICANT: � GyLw way I 5. NAME OF ESTABLISHMENT: . nezowsrl-& 6. ADDRESS OF ESTABLISHMENT: 2,(7 -rt�r'n4n v-,V-E_' 4Ja.nettS 6ZC-0) 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: *✓e_��� dGest-�d'c�ti/1C� Cam 10: SOLEOWNER: ✓YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: Y CORPORATION NAME CMG e-knS,0(j, 5 Fr - Y6-Z-G PRESIDENT S vz cT ie e TREASURER CLERK --f-(rvlae ti 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Forms\Haz Mat App Revised 09-10 cx Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"RM�LE.� 200 Main Street• Hyannis, MA 02601 OM9.+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 0 I 6 cold ` (fbsS% Date: �6 q Location/Mailing Address " Contact Name/Phone: Vt ItI1100 - Inventory Total Amount: SDS: S License#: �aJ � Tier II : Kf D Labeling: Le_ Spill Plan: Oil/WaterSeparator: Floor Drains: u , Emergency Numbers: Storage Areas/Tanks: SWIVK Emergency/Containment Equipment: S ►` o 0 aste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: icensed Waste Hauler&Destination: retn i'wi (�vru�O�► Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. I Antifreeze Dry cleaning fluids Automatic transmission fluid 0 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil aO�— 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 _1 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 �c Other chlorinated hydrocarbons \� Laundry soil &stain removers Ail (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: S S 51MA. S' i Inspector: Facility Representativ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS P`pF THE Ip�� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAN,% $ 200 Main Street• Hyannis, MA 02601 039. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: De2Av1 S► Sko��.kti®v�. Date: Location/Mailing Address: Contact Name/Phone: 0 -7 - l l y�I I, InventoryTotal mount: �`' o0 CIA SDS: Y ow t<���-5 License#: Z- Tier II : i) Labeling: 0 K Spill Plan: AV 05+- Oil/Water Separator: Floor Drains: 1) Emergency Numbers: Storage Areas/Tanks: N 7 Ar AV, Emergency/Containment ui ment: Waste Generator ID: 0 A Waste Product: ON.1 tJk L 16 Date&Amount of Last Shipment/Frequency: o k- 10 Licensed Waste Hauler&Destination: o�-- Other Waste Disposal Methods: A 5 �0b !�o d, 50 y S eel 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 JMotor oils Miscellaneous Corrosives gagglae,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Z Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: JCaulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: aV -� Facility Representativ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °PIKE ' Z Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B`RM�`E ' 200 Main Street• Hyannis, MA 02601 Eo 9. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 0--5 i 4, kqe-0+6tcu�-�o� Date: Location/Mailin Address Contact Name/Phone: —Inventory Total,Amo nt:'4-9••'10 4&� Wagkc, MSDS: License# . �- Tier II : N o ` Labeling: OK �a�x- ,Fvw-- Spill Plan: DK Oil/WaterSeparator: NIAFloor Drains: NO Emer enc Numbers: DK Storage Areas/Tanks: o , t 1-1 b-CA e,�S Emergency/Containment E ui ment: S P i I.I pa °� a,1 a1bl - Waste Generator ID: Waste Product: Date&Amount of Last Shipment/FrequencX: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: Cyl aln,) c,ntic �ow- owv�5 ����I d(��wy �„, 5 Baer �o a vF, &5z 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. 3 A tifreeze � Dry cleaning fluids utomatic 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 1 5' Cesspool cleaners Di-es—el fuel, kerosene, #2 heating oil (00 Disinfectants S�tG�ec�2eT.c�{5/c�escKetS Miscellaneous petroleum products: Road salts .I-5, grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout/1'12A .5tve5 2St30 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 LA Paints, varnishes, stains, dyes 1,12 -'30 x�w'� Lye or caustic soda Lacquer thinners ,M°\ XA" 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, �2�2 hydrochloric acid, other acids) VIOLATIONS: ORDERS: A o V-41 IV- INFORMATION/RECOMMENDATIONS: s--)wl v1 Z rA Inspector: l Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FTC*o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 • BARMAS11. ,� 200 Main Street• Hyannis, MA 02601 eoMP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: vt3ro�- t$ occ� };o w- Date: Location/Mailing Address: 2-I ^1�noty� o.ti �r�v� avl�� S Contact Name/Phone: Inventory Total Amount: t MSDS: 5 License#: Tier II : 00 J Labeling: Spill Plan: Oil/WaterSeparator: IQ1A Floor Drains: 0 Emergency Numbers: 0fl' Storage Areas/Tanks: c, 0 1 ��a G��J• Emergency/Containment Eq foment: 5 1 dw Waste Generator ID: 0 ik Waste Product: o Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: ,0<c 6LZW[0kZ- Cv 1e*-,0K,tjet 'e-,( a ovtr 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 JEngine 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/f gkl .s.�.c t, 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/ ECOMMENDATIONS: Q-<,Ac - 0- koLtJ- e- Inspector: v-�-)`-e, Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date: / 7 / /3 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: (/G�RVl6 7 ��SIDr iov� BUSINESS LOCATION: _2_t-T a�-w}-o,� D c��/� , 1-� ���ri S INVENTORY MAILING ADDRESS: SavK-ems TOTAL AMOUNT: TELEPHONE NUMBER: ..So - -7 71 - ,3 i p ", CONTACT PERSON: 14r e Z t�464e-�nvujz 11,19 te12 " EMERGENCY CONTACT TELEPHONE NUMBER: �SDS ON SITE? TYPE OF BUSINESS: yes INFORMATION / RECOMMENDATIONS: m&tee- s �ure- .I0 covt�a,ncrs Fire District: Ctre, Ca 0 Ledah cos h l ✓Io-f"im et— Z� ri'-ec•- 154rrt5f41!Q- L t; f ,*,K NL Z �AV# Gt 11 41 t .c.x 441vt v 15 Lt, r,/i o�r- ��G A Q• b0 0 a Uh y5a 14 2 O rI Waste Transportation: Last shipment of haza dous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS 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 Antifreeze (for gasoline or coolant systems) 13 Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) gj Caulk/Grout-r AeR44s1vr-s Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Z., Ger�a&h detergents (V&o tL- +) Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's 3 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 3 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 1052 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Oceanside Inc. 217 Thornton Dr., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------ ------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 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 VoewgtUoryf B nsxable ervices Richard V. Scali, Director I �I Public Health Division NS BA� TABI,E t Y IM�RSTOpSe LSROS'I�Fav�Bit •8 ugsraelE ASS. Thomas McKean,Director MASS. � 1639-2014 'Ar1659. ,�a`e 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 ` Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES ' - -CATEGORY-1-PERMIT. 26 110_Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 x v.S. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. d9 / /Do� 2. IS THIS A PERMIT RENEWAL? V 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: c,u ept J e n� 7 5. NAME OF ESTABLISHMENT: oceA.,s't-Lz, 6. ADDRESS OF ESTABLISHMENT: 41'1 l n�v�-Ioh vt✓ �-I., �,�;S 2 c�e9� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT. S- 2 (-31 to 9. EMAIL ADDRESS: -��ve-e T �' 0Ce-g17S/de/17C, Cara 10. SOLEOWNER: AYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAMEe�ta.si�C PRESIDENT e.0 �e,14!4 TREASURER csevr�r �v�y CLERK_ C.a 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: iCOMPANY ADDRESS EMAIL: SIGNATURE OF APPLICA DATE Q:\Application Forms\I-IAZMAT APP 2017 REVIS Number Fee 1052 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Oceanside Inc. 217 Thornton Dr.., Hyannis, MA Is Hereby Granted a License,; For: Storing or Handling 111 - 499 gallons of Hazardous Materials. =- ------- -------- ------- ----------- ----- --- --- -------- ------ ------- -------- ----- ------- ------- -------- ------- ------- - ------- -------- ------- - ---- -------- ---- --- ------- ---- ------ -------- ------- -------- ----- ---- ------- This license is granted in conformity with the Statutes and ordinances relating there to,and - and expires W30/2018 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 Scales & Clark Inc. Containerized Rubbish Removal J I 1 800-734-8701 pow o of hnstable Regulatoervices cV!- Richard V:.Scah,Director. v VKWE Public .Health Division BARNSTABLE t f r t:. r, e • 6 V.A—.ENTL1VIlLE COTUrt NYati'I:IS A Punsrw.SFs e39-20e vsrea nsraolt • 3 _CAB . • Thomas McKean,Director, 1639-20_4 i v�AjED 200 Main Street,Hyarnis,-MA 02601 s 575 Office: 508-862-4644 9 ` 'Q2 {U Y r,Fax: 508-790-6304 t . APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE' Y HAZARDOUS MATERIALS E f IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER108, HAZARDOUSMATERIALS,ALL BUSINESSES,THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN,AN 7 ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). - } =APPLICATION FEES,, `V CATEGORY I PERMIT '.26-J 10 Gallons: $``50.00 0 • a j CATEGORY 2 PERMIT,-111 —499 Gallons: $125.00 'Q U 5` 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 lst. 1. ASSESSOR'S MAP AND PARCEL NO:(n)4_P, a97'�. �.." P cQ,I *, 9q j 2. IS THIS A PERMIT RENEWAL? V,YESC 'J NO. ;IF YES, SKIP QUESTION'3., ' r F 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: - -�/�►'(= 1Q ev►✓+2C{, 4 � r > 5. NAME OF ESTABLISHMENT: �. 6. ADDRESS OF ESTABLISHMENT: o'Zl 7 � - llr" V�1Q 1 1 / ►'175�,�'1') :O�j�p� l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE N . 8. TELEPHONE NUMBER OF ESTABLISHMENTS� 7 9. EMAIL ADDRESS: 7'��A , . ©C2&yv6u e Lh.Lr -ev 10. SOLEOWNER: YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF •°; CORPORATION NAME PRESIDENT _ Q. �Ct,►'1 TREASURER CLERK12. IF PREPARED BY OUTSIDE=PARTY: NAME: i TELEPHONE#• COMPANY ADDRESS EMAIL: . .SIGNATURE OF APPLICAN DATE Q:\Application.Fonns\IAZMAT APP 2017 REVISED.do , Number _. Fee 1052 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Oceanside Inc. 217 Thornton Dr., Hyannis, MA Is Hereby Granted a License For: Storing.or Handling 111 - 499 gallons of Hazardous Materials. ---------------------------------.-------------------------------------------------------------------------------------------------------------- ---------------- ------------------------------------------'--------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable �'THE Regulatory Services • f °� Richard V. Scali,Director .�! - BAR11�"B`E ` Public Health Division BAST E 039. �0� n SKaLC,nis�os�x COw�rewma fn ° Thomas McKean,Director 1639-2014 200 Main Street,Hyannis,MA 02601 /,,✓ �.• Office: 508-862-4644 /p d d4 ; /,, Fax: 508-7 6304 I/ 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$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE lY FULL NAME OF APPLICANT:(I-f e V evq ^ Ten n!--y NAME OF ESTABLISHMENT: , e G ADDRESS OF ESTABLISHMENT: 1 �") D-/�Id /'0 �.,,—D r MAILING ADDRESS (IF DIFFERENT): } TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: �. �� ✓e J e,- O C `Pay1 S ►J-e� t 1l' � Ca lA SOLE OWNER YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: 3 4a1,GAJI f CORPORATION Fare_PRESIDENTZlv�;ncg-cunsld•e- car?e E TREASURER ve r1lhe w � . CLERK e✓e emi$ i- f IF PREPARED BY OUTSIDE PARTY: ! SI TURE OF APPLICANT Name: Company Address Telephone#: p _ -,Email: Q:\Application Forms\HAZZAPP Rev16.docx Page 1 of 2 .z-,7..,,'. � 'fit ,.:, . .. ,.. , .. .. _. "'c.: • .. Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Golden .Crown Cleaners 217 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. Restrictions: .................................................................................................................................................................•-. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f�l� Town of BarnstableAl nA� Inspectional_Services BARNSTABLE f.7` • MY MBLE Rn'tE W1U_CONK tyAK 15 - Public Health Division "atm"`"� 6539 1639--]2r0�14 - �L�cJ BARNsrnsM s Thoxnas,McKean, Director `j, ED�Ap/s� 200,Main"Street, Hyannis,MA 02601 Office:, 508-862-4644 Fax: 508 790 k6304 " APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN,ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons $ 50 00 } CTf 1MT,. lI`-449 Gallons - $1-?5 0� .— CATEGORY.3 PERMIT, 500 or more Gallons: $150.00 ❑, a-"� *A late charge of$10 00 will be assessed if payment is not received by July Ist. P01. $ ,�:M 1. ASSESSOR'S MAP.AND PARCEL NO : 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS S ORAG /USE OF GREATER THAN HOUSEHOLD QUANTITIESy(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT:. AU •� 5. NAME OF ESTABLISHMENT: ICA CR n� 6. ADDRESS OF ESTABLISHMENT: p O� A n°s 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: S vn 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS:' ." ® �° Z Q 10. SOLEOWNER: YES_NO IF NO,NAME OF PARTNER: :. 41: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NA PRESIDENT TREASURER ri CLERK te4 12. IF PREPARED BY OUTSIDE PARTY: - NAME. , -TELEPHONE#: COMPANY'ADDRESS ' EMAIL• SIGNATURE OF APPLICANT DATE QAApplication_Forms\Haz Mat Appli Draft Jan20l9.docx j Number Fee 810 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, Hyannis, MA I Is Hereby Granted a License - For:.Storing or Handling 111 -499 gallons of Hazardous Materials. -------------------------- ------------------------------------------ ------------------ ----------------------------------------------------------------------- --------------------------------------------- --------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN R. DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health I CIS - Town of Barnstable , ta Inspectional Services BASTABLE i SHE TpV_ - RN5CTAB=•ce•.r.n,i•wi nnms T FS�!U NtJS•CS'EFY:LLE Public Health Division 2014 312 at, BA"STABLE, Thomas McKean, Director KAM 1659. �0 Ar fo 200 Main Street, Hyannis,MA 02601 t Office: 508-862-4644 Fax: 508-790-6304 �3 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL,ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $.50.00 ❑ CATEGORY 2 PERMIT .111 —499 Gallons: $'125.00 . V� CATEGORY 3TERMIT 500 or more Gallons: $150:00 ❑ �d I� *A late charize of$10.00.will be assessed if payment is not received by July 1st. f 1. ASSESSOR'S MAP AND PARCEL NO. j 2. IS THIS A PERMIT RENEWAL? v YES NO. IF YES,SKIP QUESTION 3. l 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS- ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: , ! 6. ADDRESS OF ESTABLISHMENT: QA 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER`OF'ESTABLISHMENT: ' J O'� 9. EMAIL ADDRESS: (tD 1. LM C tDWr% 10. SOLEOWNER: y YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK W►(� 12. IYPREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 1 Q:Application Forms\Haz Mat App Revised 09-10-18.docx 1 41ofro✓ v`°Ft roy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMA.BR 200 Main Street• Hyannis, MA 02601 039. �preD M 1 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: &011 ,en Crown rleA &- Date: 3GI!4 Location/Mailing Address: aJ7�f1'1+DiQ Dr Contact Name/Phone: 5DZ-36o —6M Inventory Total Amount: l61 SDS: LACS License#: 8� Tier II : d Labeling: Iff Spill Plan: QPd Oil/WaterSeparator: Nd Floor Drai s: *0 Emergency Numbers: UeS Storage Areas/Tanks: rfaAQ Emergency/Containment Equipment: ih S Wt Waste Generator ID: J Waste Product: r� Date&Amount of Last Shipment/Frequency: / Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes ug 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 etroledm-fi roducts: Road salts grease, lubricants, gea poil Refrigerants Degreasers for engines&}garages Pesticides: Caulk/Grout C;a 4;� insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents T 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 Ho (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/REC M NDATIONS: /10 Inspector'. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS .r .F `pF(HE 1p�'1• Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. Y MASS. �. 200 Main Street• Hyannis, MA 02601 FO59.M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: &01ceeK GsowvL C,��av�.��5 Date: 6 �8 Location/Mailing Address: 2 t-f 'T!�o�w�a w r��2 ( $a ins 0.10 e, Contact Name/Phone: A34LU I �7e!Z-vGo 5"De- "71 - 1 310 .� Inventory Total Amount: SDS: d License#: S70 S�"'�� Tier II : Labeling: OK Spill Plan: C9K Oil/Water Separator: J A Floor Drains: Me Emergency Numbers: — Storage Areas/Tanks: 417 I Emergency/Containment E ui me : Waste Generator ID: NJ k Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: NO xlb504-5 <5 Inspector: , VGvi- b�e Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 1HE rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BAaM.1u; . 200 Main Street• Hyannis, MA 02601 1bM A��0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 17 MAC TED ,; , - P, Business Name: �o�d�+-�-- �- Dater ({` T Location/Mailin Address: 2 t 1 �w�c o�- c vie , y4 K,rt 1 S f�l n5�"4,b12. ED Contact Name/Phone: Ma--,I te,,c- Sob-79o- j 70 Invento Total mount: ^"'-70 SDS:Ye�5 License#: Tier II : Labelina: 09 Spill Plan: Oil/WaterSeparator: N 10 Floor Drains: tj a Emergency Numbers: C7-K — Storage Areas/Tanks: I q 6-\ Ay 4 ul.L wtG�rjC, <a&A W _V—"rS Emergency/Containment Equipment: kt Waste Generator ID: k) N Waste Product: rJ Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS /Kv�4orl kr,0 �,Qvt_ cAvCj ak 1 �t Z-e-VL � NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: 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 VMetal 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: ,&W m L n , �Ovk- A 0 t)6yf-b Or 4-,vim, Inspectofr 1 . 1 ei Facility Representative: \II n n n WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS stHE rop Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 RnRMASS. 200 Main Street• Hyannis, MA 02601 foMA+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 6-016 .r.- Croww C avi.c. Date: Location/Mailing Address: 21-1 nri,s K S-f"I Contact Name/Phone: 4.y k E-e<.Anc o - 08 790--13'ID Inventory Total Amount: ! y MSDS: � e, License#: �1 Tier II : 00 Labeling: A oa Spill Plan: OK Oil/WaterSeparator: Floor Drains: o Emergency Numbers: e 7 Storage Areas/Tanks: 4� e-&w3 ) Emergency/Containment E i ment: OK Waste Generator ID: A Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 5g — 11 f 1y ►tti5 k, rnn,Sc�! 41,P--5 4 Aaw"'9 c NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, y�'-�`t- storage and disposal of 111 gallons or more requires a license from the Public Health Division. OW 5`k�' Antifreeze Dry cleaning fluids 10 Automatic transmission fluid u Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 3 5kta*amm Gasoline,jet fuel, aviation gas Cesspool cleaners .�y 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 yr7 Laundry soil&.stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" So k�y� l� (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMME ATIONS: Q-`7 tiL- o5-k4.tS �, Cm uc S �� a i Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKE►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 • BARMT,q. .A 200 Main Street• Hyannis, MA 02601 A�FOMP+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 6-v I A-v- (f v,,ex-s Date: Location/Mailin Addres �torw'�o�- ���� a�►��S Contact Name/Phone: av2s i✓v Lo j OS-?90-I 7D Inventory Total Amount: "�i 3 MSDS:&N- tvAtVJk&- A&Vt 410r-e—s License#: N Tier II : IJ o Labeling: CI—Plan: bk os� Oil/Water Separator: OJA _ Floor Drains: N-0)-wwskevlwkcc Emergency Numbers: Storage Areas/Tanks: t i S ubock--,-t5 c ovi Emergency/Containment Equipment: Waste Generator ID: Waste Product: sec Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: Voe 4 whAltg-,046 P..C� +i/424 �A c o05 LZaSfe, collec* o vt.. 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 3 Laundry soil &stain removers 104r 60 rsw (including carbon tetrachloride) (including bleach) z<-r-At?+9 Any other products with "poison labels" 4 (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS:_ Ct crQou5 Kq:- Er.e k,- ,A._c�k%M� a-\ A0'{- g ja-1 l ab 1o. RDE�RS: f �J �, �(' al,.\5 c A �1." /O5 +'�'\n g 1 btyt� VW g\at, . 1Avl..� 0.W($L Yv�S S 1" Ct 'e44 15 tc, IINFORMATION/RECOMMENDAeTIONS: oX1 ►t2IUG sUalCam'' "v awl-Canc,'' x�AAA+ 1 l aL ar vcr.o�s ,Q c��r2�.��K,4 3�a►rc.fc,n..o�f�,r.S. � �aV�I Inspector: Facility Representati e: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE BAR-W 4 933 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg. # Village/State/Zip Business Name am/pm, on 20_ Business Address V- !"7 �.' Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense , l: ram. `� „� �,�, � , , � ,� ; r!�� t �: L►ra+t>x �r Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD)REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE R BAR-Wt' ' r Ordinance or Regulation `Y WARNING NOTICE Name- of Offender/Manager i u ` s ;fir•! ' a a q Address, of Offender MV/MB Rego:# Village/State/Zip Business Name '=�,� _,� �' y.,._ t ,, ., 'am`/pm, ,.on 20 Business Address Signature of E=nforcing Officer, t A Village/State/Zip , .,4,,c�� Location of Offense "t-1.F t } Enforcing Dept/Division Offense, '� }y {r,,,; .� /14 (` .{ � }✓: !' tj ? .,:� k'r,_ ,syr Facts t,tt , ffI" ;t._ - This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance" of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will' result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GCLD-ENFORCING DEPT. , Date: 7 / 22-/ /3 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS R N FORM NAME OF BUSINESS: o 0e4v t f6 BUSINESS LOCATION: 2 �'7 I cx,,.,�ow �c-�v� . earl✓I IS INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: .19 9-11 D - 1370 /Z o CONTACT PERSON: f>ay 1 Fc<--eoLa EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: avvt r INFORMATION / RECOMMEND A IONS: C� ccx,�- 1,u�� I%e K Is 1—Q Fire District: 2 D�f a l o. &bS Pro ve,+ and,kew ekt 611 te- V R t et-v".-c K�e c&,recsf ble— ' eeX µ/ IfI�IoJS�� �'891Ieg� Y►LN�IO"1 y �lvwt5 �,owt, �.el-y�-�lydOxl� t�� � Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS 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 Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda . Rustpryoofrers Miscellaneous Combustible GarIainras��i detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health . ' This is to Certify that Golden Crown Cleaners • 217 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------_-------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------ This license is granted in conformity with the Statutes and ordinances~relating there to,and • and expires 06/30/2019 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 Vowegulatoryof B nsxable � I_Services Richard V. Scali, Director of THE►pN. Public Health Division BARNSTABLE f -STO A2LE•C&REAVILLE•COiUfT•4YMTi15 BARNBrABM = Thomas McKean, Director ""u'°"�""�i„"_o;" --200 Nlami-Strdet,-.I-Iyarinis-1VIA 02601-- -- ------ Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ' HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons; $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 f CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? V YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALYSTORAGEIUSE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? V YES NO. 4. FULL NAME OF APPLICANT: PRUL J— 5. NAME OF ESTABLISHMENT: 6bu m CPbwrl 6. ADDRESS OF ESTABLISHMENT: L-�I ( rim 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:8. TELEPHONE NUMBER OF ESTABLISHMENT: 3�2 0 12�)T O 9. EMAIL ADDRESS: GbcJjo't La x MOO r. C61-n 10. SOLEOWNER: AS NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS AND TELEPHONE#OF: CORPORATION NAME t PRESIDENT (. Z TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT/ DATE GS Q:\App(ication Forms\I-IAZMAT APP 2017 REVISED.docx I Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------I--------------------------------------------------------------------------------------------------I-------- ------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and o and expires 06/3012018 unless sooner suspended or revoked. ---------------------------------------- ZZ PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/0112017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ` 4x_• Towg Unstable er. Of ` � a� 0 �e ulatoervices . Richard V. Scah, Director " Public Health Division BARNSTABLE � i BANNSfA°tE•CENLERYILLE•[tlNR•HYMNIS w4aNSCABLE. r Thomas McKean Director NARSRk:°NWS•OSiFAVLLE.WSf°""�" MASS. p ) 1639-2014 ArE%3.�a`0 200 Main Street, Hyannis,MA 02601 575 Office: 508-862-4644 p?(J/ Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE i 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 3 0th). APPLICATION FEES �L CATEGORY 1 PERMIT 26— 110 Gallons.: $ 50:00 tQ'� 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. f 1. ASSESSOR'S MAP AND PARCEL NO. r 2. IS THIS A PERMIT RENEWAL?4/YES—NO. IF YES,SKIP QUESTION 3.` 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIAL�S�TORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25•GALLONS)? V YES NO. • 4. FULL NAME OF APPLICANT: �� 5. NAME OF ESTABLISHMENT: �pLb tK, C-9—b �A � 6. ADDRESS OF ESTABLISHMENT: U AAN 3rT 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: ?0 13-X) �� 36 to . 9. EMAIL ADDRESS: G0 LV)� Q-Vou-M 2-1 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION Q—Z A Q, PRESIDENT TL AVl, TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE �w p I , Q:\Application Fonns\HAZMAT APP 2017 REVISE .d c Number Fee 870, :THE COMMONWEALTH OF MASSACHSETTS $125.00 5 Town of Barnstable Board• of Health This is to Certify that ` Golden Crown„Cleaners - 217 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017 unless sooner suspended or revoked.---------------------------------------- . } WAYNE MILLER,M.D:,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health �z' /-J1JZV 3JJ- Town of Barnstable / • �s Tw,ti Regulatory Services Richard V. Scali, Director L ' '"�r,,�s"AP�m ` Public Health Division BARNSTABLE - . i659 anrs' n y �fC►A°'�' Thomas McKean Director 200 Main Street Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 }' a?/ -7- 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 THATHANDLE OR,STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNgwLY-Ist=Ji1NE-3Uth) 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. 'DATE FULL NAME OF APPLICANT: l �a�� �1 QZ=7 NAME OF ESTABLISHMENT:'! l,[j AAt—_Z'5 ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (II+DIFFERENT)c TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: SOLE OWNER:ZYES NO, IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAMEnC PRESIDENT TREASURER .'r CLERK IF PREPARED BY OUTSIDE PARTY: - TURE OF APPLICANT - •` Name:P .,f A Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev 16.docz " Page 1 of 2 �` `' fly. A Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, 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 6/30/2013 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ,A own Of Barnstable.- Regulat®ry Services Thomas F. Geiler,Director Public Health Divisi®n. 4 a r� ThomaiMcKean, Director,, _ l 200 Main Street, Hyannis, MA 02601 ' Office: 508-862-4644 Fax:�508-790-6304 Application Fee: $100.00 r ' ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS 1YIATERLUS FULL NAME OF APPLICANT ( NAME OF ESTABLISHMENTGQ?_OCs� � ADDRESS OF ESTABLISHMENT Z 1 TELEPHONE NUMBER -.r.[_6, 13 90 � ~ S O L 6 y63 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: w T,) IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.62-(4 4L 8-2 STATE OF INCORPORATION FULL NAMEANA HOME ADDRESS OF: U PRESIDENT L � 7 TREASURER CLERK 4 7* - v SIGNATURE F APPLICANT i RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# I Haz.doc/wp/q i i Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Y Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, 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 �1� s� Town of Barnstable °FINE>� Regulatory Services Richard V. Scali, Director &4M AS& Public Health Division �FDMo'lA Thomas McKean, Director TM� 200 Main Street, Hyannis, MA 02601 c a7 Office: 508-862-4644 Fax: 5f,R&790-6304 FX-) Application Fee: $100.00 '� ASSESSORS MAP AND PARCEL NO. oG� / �009 DATE V-0' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT %jL NAME OF ESTABLISHMENTS ® � ADDRESS OF ESTABLISHMENT 4 TELEPHONE NUMBER 07796 1'3'7 0 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ®q`":!?4(Wa 3) STATE OF INCORPORATION FULL NAME AND HOME DRESS OF: PRESIDENT 1 2 0 14. TREASURER CLERK S1rGN-AYURE OF APPLICANT • RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP Rev20I5.D0C i} Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, Hyannis,MA 02601 — Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. G ------ ------- ------- --=- - ------ ------- ------ -------- -------- - --- ------- -------- - --- ---------- --------- --- -------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2012 unless sooner suspended or revoked. ------------------------------ ----- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M:D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable �TNE Tpy, Regulatory Services ti Thomas F. Geiler, Director B" MASS. ` Public Health Division y MASS. g' 16g9. �0 i°rEo►�+" 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 6,0 Q ,Q,A C?z LA>M CU76A ADDRESS OF ESTABLISHMENT 7►t dT04 TELEPHONE NUMBER 50 Y ""I 6 0 1371) SOLE OWNER:AYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: 1 a 7.g APPLICANT-IS A CORPORATION: FEDERAL IDENTIFICATION NO. t-STATE OF INCORPORATION— FULL NAME AND ADD S OF: PRESIDENT )V/4UL &22= TREASURER CLERK SIGNA&tM OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q sA MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee amount. Make check payable to: Town of Barnstable. 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. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. t For further assistance on any item above, call (508) 862-4644 Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, Hyannis,MA 02601 'Is Hereby Granted a'License FOR: . STORING OR HANDLING 111 GALLONS OR•MORE OF HAZARDOUS MATERIALS. --- -- ----------- ------- -- -- ---- --------- -------- --- --- ---- ------- ------------ r --------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2011 unless'sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J. CANNIFF,D.M.D. ` .6/30/2010 JUNICHI SAWAYANAGI ,. THOMAS.A. MCKEAN, R.S.,CHO Director-of Public Health Town of Barnstable °f�HE rti Regulatory Services Thomas F. Geiler, Director * BARMASS. LE, ' Public Health DivisionAtASS. a i639 ATFnrnA�"' 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 7" 3 O( APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANTl, NAME OF ESTABLISHMENT ,Q" Cn A �.L e. ADDRESS OF ESTABLISHMENT all TitO&= TELEPHONE NUMBER ..,p SO 9—„ _ _ 50 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOMEADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HI YE ADD S OF:', '- PRESIDENT �d;. .(l� TREASURER. CLERKS Z c' SIGNATURE OF APPLICANT RESTRICTIONS:° HOME ADDRESS dect Flew JRV W& HOME TELEPHONE # 04 l f— � Haz.docAvp!q Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, Hyannis,MA 02601 Is Hereby Granted a License l FOR:, STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. . o ----- ----- -------- -------- -------- ------ --- -- - --- -- --- --- ------- - ------ ------- --- - ---- -------- --- This license is granted.in conformity with the Statutes and ordinances relating there to,`and Q� and expires 6/30/2010 unless sooner suspended or revoked. ----------------------------------------- WAYNE MILLER,'M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D.' 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director.of Public Health, f Town ®f Barnstable . Barnstable Regulatory Services Department ��, i1)9-Americattily # Ag Public Health Division RARNSTM MAM 200 Main Street, Hyannis MA 02601 m 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE y . APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT1 NAME OF ESTABLISHMENT Cb L!U • ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER` g . `.� b 0 j 3 7 SOLE OWNER: YES • NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: 0 �t F p co IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. rn STATE OF INCORPORATION FULL NAME AND HOME ADD S OF: PRESIDENT T)A-Ut+ �b TREASURER CLERK (A-)t U a nil= Zb Cf7 • SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS Sa Ut7F.�rjt, jn M HOME TELEPHONE# 5jp t08j—qqq(,2 Q:\Hazmat\Haz Mat Application2008.DOC 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 time 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, I please fax us a copy of your contingency plan (to handle hazardous waste spills, etc.) In • addition, please mail the required fee of$100. Please.make the check'payable to: Town of Barnstable. The check must.be mailed to the address listed above. Allow time for in= - house processing. For further assistance on any item above,,call (508) 862-4644 Back to Main Public Health Division Page QAFIazmat\Haz Mat Application2008.DOC Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, 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 thereto, 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 ��- Town of Barnstable Barnstable Regulatory Services Department o ;ericaC i Public Health Division ""MAC • ' 1639. � 200 Main Street, Hyannis MA 02601 �lfD �Y A 2007 Office: 508-862-4644 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 Q-O-C C I ," NAME OF ESTABLISHMENT Gt2Lk QM ADDRESS OF ESTABLISHMENT o� ee cn; 60 TELEPHONE NU R w SOLE OWNER: YES NO FW- cn IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRES1 OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION VV( FULL NAME AND HOM ADDRESS OF: a PRESIDENT F Sryd' TREASURER z CLERK SIG*TUAOF AkRLWANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# 'd� Q:\Hazmat\Haz Mat Application2008.DOC 16 Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive, 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 ✓w Town of Barnstable zti Regulatory Services Thomas F. Geiler,Director STABLE, Public Health Division 9� 1639, 10 '°TeaMs•�" 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 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN I II GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANTS��1 ® NAME OF ESTABLISHMENT C�O L } A (' jZQWN Q160rm ADDRESS OF ESTABLISHMENT o'�1-7 I P10aCA 0 4-AM I , M/A 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-6 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT `ll L Q J a Oc c,� 1 f�L� �F� M)4 SHW 4 J9 07 TREASURER CLERK . .. GNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Number Fee 870 THE COMMONWEALTH OF MASSACHUSETTS $100.0o Town of Barnstable Board of Health This is to Certify that Golden Crown Cleaners 217 Thornton Drive;Mai` 02601 Is Hereby :Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUSWATERIALS. ------------------;-------------- - ------------------------------ - . - 1 *4 ---------------------------------------------------- ------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 9, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health o-s Town of Barnstable OFtHE ram, Regulatory Services P� o Thomas F. Geiler, Director * .BA MASS.LE, r Public Health Division ���fob 16 9 '°TFn 39 a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00. ASSESSORS MAP AND PARCEL NO. DATE , APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �(Z2oeo ►�C NAME OF ESTABLISHMENT__�o C JZM C _0 LU A- l L 11M ADDRESS OF ESTABLISHMENT o� O TELEPHONE NUMBER SOLE OWNER:- YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: . 1 cr, IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT [It a fcZ?10(` `i 'Qy a u �Q S' I/1�1AS�1 �P`01 KI TREASURER CLERK 'SIGNATUE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# b$ y y 220 Q:\Application FormsUTAZAPP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency to handle hazardous wastes ills etc). In addition lease include the required g YPlan ( spills, ) > P q 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 4 1 Q:\Application Fonns\HAZAPP.DOC fNAMEOF OFFENDER D A D �J Gt < D C.0 D„n 4 15 TOWN OF ADDRESS OF OFFENDER ` { f I t,<'Ut,A.�K- Cle,at��:r t ~M1arvJ4,'L �c•,a�, BARNSTABLE CITY,STATE,ZIP CODE DATE rCM, MV REGISTRATION NUMBER f � qr uiMAlOFFENSE i 'QH�ArXATAR I�.Y.Vp n S. CL .ayv' LLJ <I�E� + �(fr�� 9 !/`U�1-C �.�V iil. i�4`� �+C�V')d'�..+ } NOTICE OF TIME AN DATG,IOLATAt / M, ON ! t"i 2D g LOCATION OF W ii(( r "U� "tJvJ W- �-t4 L'f,C"r� J SIGNATURE OF ORCING 0 � J �) ,VIOLATION J6 . - `J* `" ' ✓ ENFORCIN DEPT. BADGE NO. rW _ lCD OF TOWN I H REBY ACKNOWI PKE RECEIPT OF CITATION X a., ORDINANCE Unable to obtain Ig ature of offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS $ "7 W Date mailed LCL 0R YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, LLI before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. Il (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BBARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNS ABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and erclose payment in the amount of$ Signature A7 `rharnton Drive, Hyannis Richard Clark = 217- T ornton r. , yanrds R1cYiard Clark TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME OQ22-75 yx 11 G ,a-Vv dy(i Ct)0 Ih- ADDRES3��7 �/� aYytaYL ,t ye VILLAGE KV"� LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: pp ® OR CHEMICAL era �` eat D 4 rs (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: '5 ~' TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS �T��' (9 b ' ��� 7 D j � '�"RuK ko TOWN OF BARNSTABLE e b UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME (C /q/2-/Ic ADDRESS 5P Z 7 VILLAGE N� LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: / OR CHEMICAL [—O T l y /L/��170✓ ���- / G U U (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4.' DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS APPROVED Barnstablo Conservation Commission Signed Date i e 'lot\ �Ff,. ��I�P (�i1tltIltDltlUpMlt�' D� . �tB��1��1t�Pf�S` , _ r DEPARTMENT OF PUBLIC SAFETY.—DIVISION OF FIRE 'PREVENTION ' _ 1010 COMMONWEALTH AVENUE. B05TON 1, 1981 Barnstable r June 29 '(City or,Town) (Date) ;re -LIC E E In accordance with the provisions of Chapter 143 of the General Laws, a license is hereby granted to use.the land lierein described for the.l,. use of the building-... or other structure.... which is/are pr:is,/are to be situated thereon, d g and as described on the,plot plan filed with the A,pplication for this license. of land •,217 Thornton Drive Barnstable Road Location ....Nearest cross street ...................... . ....... ...... ... ..:............... ;(St re t &Number) Owner of land ....Ric...... W,.. C�4r;{....... .. ................._Address :: 33...Pin.ewogd.:;?a . :We$t...Yarm4uth-.... Number of buildings or other structures to «I h this license applies ....... 1 Occupancy or use of such buildings ...':.:. :.of f l.c.e/wax.ehous.e... .........................................:.. :........ . : ........ Total capacity of tanlcs,in gallons:=Aboveground......... .... Under'ground 4,p00 in one tank Kind of fluid to be stored iii tanks ........: . .........9asoline (not for resale). c Restrictions-=If any airman, Board of Selectmen .. (Signature of licensing autbority) , Town of'.',Barnstabl( THIS LICENSE OR A PHOTOSTATIC OR CERTIFIED COPY THEREOF MUST BE CONSPICUOUSLY" y POSTED IN:A PROTECTED PLACE ON THE LAND FOR .WHICH iT IS GRANTED-77777 '` ' X. 1 th c clbove time and i dare in the iizac� (1i the Town Clerk, Town of ° i "tr1 �3rnstable MaS�,�dluS(�tts in r Book z - —' Page =� t I A True: Copy Attest s r TTwn Clerk l 21.7 Thornton Drive, Hyannis Oceanside Construction 13 o D-E, 4kiAry%� MMM i x smrA KEEPING YOU ORGANIZED No.10334 2453L UMMUSA CET ORGMIZEED AT SD.COM