The URL can be used to link to this page

Home My WebLink About0061 CONNERS ROAD - Health 61 Conners Road Centerville A = 251 029 par 1521/3 ORA 10% P2 TO ALL NEW BUSINESS OWNERS DATE:4tt,u,x�A boob Fill in please: 0 No �f APPLICANT'S . YOUR NAME:M%61 '4 x sit ha vf( BUSINESS YOUR HOME ADDRESS: eowll� O 506•3W0• ►quo cf► 02.co Z TELEPHONE Tele hone Number Home o -a� footo NAME OF NEW BUSINESS ft C NVE "10%49. %A3pah TYPE OF BUSINESS, 0%4.1C w NIIIN . IS THIS A HOME OCCUPATION? YES NOLLLI Have you been given approval from the_building division? YES=NO ADDRESS OF BUSINESS I Co, n s MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be incompliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. —(corner of Yarmouth Rd.-& Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S FFICE This individual has been informed fjanyrpermit requirements that pertain to this type of business. Authoded Signature" FOLLOW HOME COMMENTS: CDrrUPATTON RITLES 2. BOARD OF HEALTH This individual d o the permit requirements that pertain to this type of business. uthorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) _ This individual hms,,been informed of IkWnsi, requirements that pertain to this type of business. Authorized Signature" COMMENTS: _ Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME.In the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. a.P* "SIGNIFIES APPROVAL. FOR A BUSINESS CERTIFICATE ONLY. Date:O4 /26 /o(o TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: A%� CARE k'�0%Ast WPtSt"� BUSINESS LOCATION: Mrjbi Ve_ INVENTORY MAILING ADDRESS: Cek C000xes TOTAL AMOUNT: TELEPHONE NUMBER: - 50S- 3 60 - O 1 V CONTACT PERSON: W)N! kAA k 311140Cl EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 0b4_T&_ W ASS, INFORMATION/RECOMMENDATIONS: Fire District: Was 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 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 GA% oo �1QAc� (including bleach) S'�OP� O�.l 'CR�►GK Spot removers & cleaning fluids ��Rcs� PIS N,�;�►R�► (dry cleaners) Other cleaning solvents Bug and tar removers . ��,.... Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS C a '7' TOWN OF BARNSTABLE LOCATION SEWAGE # �)7 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO.,�Sw�4/`—yG�� SEPTIC TANK CAPACITY �i LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL O UBLIC WATER BUILDER OR el NE '�1� ''. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: YesUl CNo Yl�Q h Ns ya. t '`l 1s �i4PPROVEDY/ THE COMMONWEALTH OF MASSACHUSETTS e Bar 8 rt8t b e Conservation Opartment BOARD OF. HEALTH � TOWN OF BARNSTABLE C� SA e� Data Applirativ,t for Di1ipininl Wi urlig C omitrnrtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (py an Individual Sewage Disposal System at: 61 .................JJ._._L._._._._.._......_._._._._._._.._._._ .... `-__..c..-._.._.[__S__t ..._r_t_vs____....._.................C..�...V... ....................................................u�C /............................................' 1. or /vo� .__ >1.__...-_._._._____ ........... ................. /.............................Il K....._. .„........ o ddress Installer Add ess Type of Building Size Lot......................:.....Sq. feet U .., Dwelling—No. of Bedrooms----------------S-----------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons------.---_-_-____-_---_-- Showers ( ) — Cafeteria ( ) Q' Other fixtur d ----------------------------------------------------------- ----------------------------------------•-----------.-------- --------------- ----- -- -- W Design Flow...........................................gallons per person per day. Total daily flow.._.__..._ ..._................gallons. tx Septic Tank—Liquid capacityfQQa_---gallons Length---------------- Width................ Diameter ...... Depth................ Disposal Trench--No. ------/__......... Width.._..�7.. ........ Total Length._...=;43..'.... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth,below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......---................................................................ Date........................................ aTest Pit No. I................lninutes per inch Depth of Test Pit.................... Depth to ground water_--_--.-.-___._-----_--- f.T4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 -----------------------------------------------•----------•------------•------.._...-----•-----••-•......................................................... 0 Description of Soil........................................................................................................................................................................ V -----------------------•-••...---------••-•----•-•••-•-•-•-•---•--•---------•----------•--•••••-----•-----•-•------•--•-•-•------•-••---•------------------------•---------------------•---•----•-••--•. W .-•---------------------- ..................................................----------------•-------------------------------....--------...--------------------------- ............................... U Nature of Repairs or Alterations nswer when applicable..z%u- w 4 ._1 ...... '2j �.es'%= ,�1 f----------------------�.^-� c-?�1.4:� aS-----t"� ._ -? ...-...� . ? .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s en i ue by t oard of health. Signed .......... ...................... ................ .. ................ .... ........:..... Date Application Approved By .......-`� -- .. ....... ... ....... eb?..." Application Disapproved for the following reasons: .. ........... ........................... ....... . . .. ............... .......................... ...............................7........................... .......................... .......................-- . Dare Permit No. 7L /..`..../........................................ Issued ..........-.......... . .............-..---....-..... Date No. THE COMMONWEALTH OF MASSACHUSETTS rl/ " BOARD OF HEALTH YTOWN OF BARNSTABLE Applirativit for Diripwial ail ork,6 C owitrnrtinn rrrnnit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: ------------------------------------------------------------------------------••----------........ --•--••-----------••-•---•--------•--•--------------:=------•--•-.....--------------------------•- Location-Address or Lot No. O�cncr � � ddress - W �l6 U ��7 ,1� ?-5 = 3� �` t ..: /INI�__:._✓t/1-l(C 5.... Installer Address d Type of Building Size Lot____________________ Sq. feet �.. Dwelling—No. of Bedrooms------------------S-----------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) al Other fixtures _______________________________ _ W Design Flow............................................gallons per person per day. Total daily flow-.--__-___� �._.__.__._.___._.___gallons. WSeptic Tank—Liquid capacityAQq----gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench-- No- ------l._..__..___ Width_____7_I----_-. Total Length.___:.':a_.`__._ Total leaching area....................sq. ft. 3 Seepage Pit No-.-__.-__--___..... Diameter-------------------- Depth below inlet-----------_........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit-_.___-_____________ Depth to ground water........................ A+' -------------------------------•---•------......-----•---•-----•---•----••••....._...__..._...---•--......................................................... 0 Description of Soil..................•--•-••---------------------...---•--•------•-••-----•-....--------------------r--•••-...------•-•---•----•--•------••-•••---•-•••--•-._....•--•••-••- x W ••................................--................................................................................................................................................................... U Nature of Repairs or Alterations-Answer whenapplicable---;7U4_��_l-_�- A__._./ u4?.•s_�_�!___ {�7/�.-7/1-rJ1—' , •' !s% ------- ..............••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo�ard�o�f-health. i /,�-�,,-� /gin- Dace Application Approved By ------- �.. .;.::.R:, - ... 1._......f. Dace Application Disapproved for the following reasons: ............................. ................ .............. ... . ............-- . ........................ . ............. . ............------------..._........---------- ------------------------------------- qq` `•"` Dare PermitNo. ......../....�.` .....�.... ................. Issued ......................................................... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C11Er#ifirate of Q-Toxaylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ................ - ...................... . ......V': r..o c n ........... r1.. . ..... ..fi ...---- --- .._.__...-' Installer — -.___ at ._...... _. .. C:'.l� U>aG.(G„5-------------.... ........._.C.....C... \ .......`... - ......... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....__./...tj(.-...�...r...._....... dated .......... THE ISSUANCE OF THIS CERTIFICATE SHAH NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ .....t.'.._�.. ...`.....1.-.. Inspector ..- - ... ...... _._...._......_..............-- THE COMMONWEALTH OF MASSACHUSETTS ' OQ _ BOARD OF HEALTH Cp� TOWN OF BARNSTABLE No... FEE__........................ Dispnmttl' arks Tonotrurtilan "rrnnit Permission is hereby granted-------------------Z. /f .4.... '.._......�.._...._.-�_�'N S�`�L v C`. ge D to Construct ( ) or Repair (�") an Individual Sewage System atNo...........................................................l"-/-----•� O��J!v G ------ ........................... .......... Street as shown on the application for Disposal Works Construction Permit No._. •.�'_16_.__ Dated........................................... ................................... ....................................................... r � Board of Health DATE.................. ^ �� - •-------------...................... FORM 36508 HOBBS R WARREN.INC..PUBLISHERS G, � d T-�4I TOWN OF BARNSTABLE LOCATIONW� --� / SEWAGE # VILLAGE ASSESSOR'S MAP & LOTS INSTALLER'S NAME & PHONE NO.,yalc -a-zyl1-w eAA-i- SEPTIC TANK CAPACITY 110a LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL O UBLIC WATER BUILDER OR NE �� DATE PERMIT ISSUED: / /7y DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No G -� A 50 yr' 3e- sl o Na