HomeMy WebLinkAbout1550 FALMOUTH ROAD/RTE 28 - Health (2) i
1550 Falmouth Rd
209-015 Centerville
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No. 4210 1/3 ORA
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you.
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this format 200 Main St., Hyannis,
Take the completed form to the Town Clerk's Office,.Ist FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE• . Fill in please:.
2, _APPLICANT'S YOUR NAME%S: ���1� C�1���
(Tir! x o thfi,l,a o�e�, ... '•' � BUSINESS YOUR HOME ADDRESS:
�r
r �f ^�FiTI TELEPHONE # Home Telephone Number {{��
.c:::W J 81•li Ar±±Bu'J ' _a ` � � V. � ..
NAME`OF CORPDRATION`. r, , ;:
NAME:OF NEW BUSINESS•; TYPEOF:BUSINESS: Ci
IS THIS:A HOME OCCUPATIOIV?
1
l
'MAP/PARCEL NUMBER:
-ADDRESS.-OF.:BI]SINESS.: t : - .(Assessing]`
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. &Main Street) to make.sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMI SID R'S OFFI
This individualhas n 1`—or f y rm �requireme�s that pertain to this type of business: .
Au ri d Sign t re*
COMMENTS: /
2. BOARD OF HEALTH
This individual has be n infjjVV Ai;the permit requirements that pertain to this type of business.
Authorized lSignature*
(rt y l
COMMENTS:
B. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which.
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367
Main Street, Hyannis, MA 02601 (Town Ball)
DATE: Ali Fill.in please:
?n APPLICANT'S YOUR NAME/S: q�
BUSINESS YOUR HOME ADDRESS:
TELEPHONE # Home Telephone Number ��/
NAME OF CORPORATION:
NAME OF NEW BUSINES /. •. '�" a «Y' - TYPE OF BUSINESS /r
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESSJ_- 'J MAP/PARCEL NUMBER % �J�s (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 2®0 Main St. -.(corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIR'S OFFICE
This individ infeiz, of n per it requirements that pertain to this type of business.
J AA
Authorized Signatu
COMMENTS:
2. BOARD OF HEALTH
This individual h b an infor e of th permi requir ents that pertain to this type of business.
Authorized Si azure*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORI )
This individual h s en infor of the li e si equirements that pertain to this type of business:
Authorized Signature*
COMMENTS:
t
fib U
YOU WISH TO OPEN A BUSINESS? 6V, V
For Your Information: Business Certificates cost$30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in
town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town
Clerk's Office, 1st FL:, 367 Main Street, Hyannis, MA 02601 (Town Hall).
DATE: . 21N �hC c� �'flS QIpI�
Fill in please:
APPLICANT'S YOUR NAME:
, tµ BUSINESS YOUR HOME ADDRESS: 5-
6(Ok) CIPvtkVIruc« ✓vvlr 2
TELEPHONE # Home Telephone Number:
..:.I.�..._.....T...FII_:S.................A.n.,....-...I"....I:Gr r..IVI..E........r..O.......:..C...,r...�:rrI.r(:.l.��...l.�....'IOr I�.?:. ..................r..r.:I:.�.r Ir._..r...r.r..a...... : :::.. .. r.!::i..
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When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business
in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature*"
COMMENTS:
2. BOARD OF HEALTH
This individual has b info W ermit requirements that pertain to this type of business.
A thorized Si nature**
COMMENTS: \jS Pq,,,&,,,-o 4n .DgA /Jlj / Z ;4w7--
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements.that pertain to this type of business.
Authorized Signature**
COMMENTS:
Date: 5
TOWN OF BARNSTABLE :
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
by \"
BUSINESS LOCATION: `—a v Sual6§�,kIrvu ANVENTORY
MAILING ADDRESS:15V TOTAL AMOUNT:
`
TELEPHONE NUMBER: aDSO 0406
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NU BER: bf-0 e'(\o,l� ��t� MSDS ON SITE?
TYPE OF BUSINESS: A10_6 Cv -r :t�
INFORMATION/RECOMMENDATIONS: 15+ QA" Fire District:
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 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
i I ypr NEW USED Cesspool cleaners
f ' 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 A Z
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
r
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you.permission to operate.) Business Certificates are available at the Town Cleric's Office, 1•`FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
DATE:/ Fill in please:
x APPLICANT'S YOUR NAME/S: ✓/ G=
YOUR UPME ADDRESS:
At
TELEPHONE # Home Telephone Number 0
n.
NAME OF CORPORATBON: C�,4Pef-/s� 49 -`_ oO
NAME OF NEW BUSINESS -,00'r aSl C� TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS MAP/PARCEL NUMBER ��.��(Assessing)
When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 2®O Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COM ISSI NER'S OFFICE
This individu I h s en inf 96-81 an, permit requirements that pertain to this type of business.
uthorized Sign ur
COMMENTS: U bi4Kk6e
2. BOARD OF HEALTH
This individual has. en informe e 4rmit r uirem that pertain to this type of business.
Authorized Sign re*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY
This individual h en infor d of the lic in requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
BAXTER & NYE, INC.
Registered Land Surveyors and Civil Engineers
7 Parker Road/Osterville, Massachusetts 02655/Tel. (617)428-9131
W LLIAM C.NYE,A.L.S.-President
RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering
March 9, 1987
Town of Barnstable Board of Health
P.O. Box 534
Hyannis, MA 02601
RE: Lot 15 Falmouth Road, Centerville
Center Plaza
Installer: K. Hickey
Permit: 86-1212
Dear Board:
In accordance with your request, I have inspected the installation
of the above referenced septic system. The system has been installed
as per the approved plan with respect to components, location and grades.
Very truly yours,
Peter Sullivan, P.E.
Baxter & Nye, Inc.
PS/bc OF
M9ss9 .
PETER
SULLIVAN
No. 29733
PO,.�FG's-rSIt
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS .
r +
FEB'
THE COMMONWEALTH OF MASSACHUSETTS ^ !�
_ BOARD OF HEALTH 4�V U
............ v'` .................O F�tt.'jz Z G.._...-----------................
Appliration for Bispoii al Works Tnnitrnr#inn Vamit
Application is hereby made.for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
.. ."d \ . .Z ..........................................
�Locatio -Address �—� •----••-• --•.•-.•-.--•-------.--•.-.or Lot No.
Owner Address
W
Installer Address
U Type of Building Size Lot._A., ....Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type e of Building — '
a yp g _QF!�=l�C�.___._.. No. of persons____________________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures -----------------------------------------
W Design Flow.)Z� x?J�, _` allons per person per day. Total daily flow-----,. ........___________dons.
WSeptic Tank—Liquid capacity .gallons Length_t,_':!S ". Width.la'-4"._ Diameter__- Depth.--•�A...
x Disposal Trench—No.• .......... Width.................... Total Length.........._......... Total leaching area............_._.....sq. ft.
Seepage Pit No.____...� _.__.. Diameter.....14!......... Depth below inlet...&._._...._._. Total leaching areae,36....sq. ft.
Z Other Distribution box (� Dosin tank (dC? �a 1
'-' Percolation Test Results Performed ......................
aTest Pit No. 1...4.2:_----minutes per inch Depth of Test Pit...v _75!... Depth to ground water_. T�-�►��� ���
f= Test Pit No. 2-_/-Z.....minutes per inch Depth of Test Pit.....1Q!10..... Depth to ground water----!_1.............
0` 1.c ^�1r�3 ,_sm_. �2.,�5_ lt'-.��Za_3=1•y + ll)..._._.
Description of Soil............ Z,�.__�_-2�...?�-�? .. ►t_............................." .....................
x
W
VNature 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 TITTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance ha i y i of health.
ined•............ ........................ --•----•-•--------------------
Date
Application Approved By................ r....-- ••• . ................_................. -,1• 1.2-104?----••-•-•.
Date
Application Disapproved for the following reasons----------------------------••--•----------------------------•--------------------------.._.........------......_
-------------------------------------•---....._..-•-----•-----•----•-•••-.....-•---------...•••---•-----.----•-•-•---•--••--------•---------•---------•-••------•------•------•---•-------••----...-----
Date
Permit No.........
�-Z Issued
Date
No...._.. _.._.... Fss... ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1.... ...r. .......... OF.....�.�...AQ�S--- s��.. Z................................
for Uhipuuttl Works Tuustrudivit ramit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
��crrngy .. lLr�nl_ t�fintRy,►t�; - `- .....- --.......
... -
Locatio -Address or Lot No.
-- - . e -----•------- -------------- Address
-- ..
...........
••.• Owner Address
W
Installer Address
Type of Building Size Lot______A,1 3_..Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther Other—Type of Building ...0�A�C_�,...._... No. of persons............................ Showers ( ) — Cafeteria fixtures t1l . ---------------------------------------------------------------------
•••-•-••...------------------
Design Flow..�.7j .�"-c'r?=�,�sx �.8� a11ons per person per day. Total daily flow...... (� ....................gallons.
WSeptic Tank—Liquid capacity_Z gallons Length__- Diameter________________ Depth...Z.1.A
x Disposal Trench—No. ......... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----------Z------ Diameter......14--------- Depth below inlet....Z�........... Total leaching area._e!>_"..(Q..sq. ft.
Z Other Distribution box Dosing-tank (!�.�
'-' Percolation Test Results Performed by
'.._�`atx .�t__l `ls __�........:.... _..
a =
Test Pit No. 1--_1-.'--._.minutes per inch Depth of Test Pit.... Depth to ground water___ ��v�ca�Lcy
44 Test Pit No. 2...e-.-:Z_....minutes per inch Depth of Test Pit......lQ_C)_._. Depth to ground water----!."...............'
Description of Soil.............:D.A _f_ = A.wt- ................................................U1S ,. 1l ?• 1�t,tL,��
x
W
x •-•--•-----•----------------••-••-------------•-••••---••------------•--•-----------•-•-••••-•-•---•---••--•--••-----------•••-••----•-------•-•••••••-•••-•••----••••-•----•-............--••-••.-•---•
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
------------------------------------------------------------------------------------•----------....-----••----------------------------------------------------------------------------------•••-••-••---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has y r of health.
Slgne -- *•� .:....................................... ..........................
Date
-
Application Approved By_ . /r .�? ...
Date
Application Disapproved for the following seasons-------------------------------------------------------------•-----------------------------------------------....
.....................................................---------------------------------------------------------------------•---------------------•--------
Date
Permit No......... ................. - Z:. Issued•....-----•--------------------------------••-••-•-•-...
. Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD -"HEALTH
........OF................. 4
...............................................
C9rdifiraIr of Toutplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by------------------------------------------------------------------------------------------- ------------........... ................................................
I taller
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code described in the
application for Disposal Works Construction Permit No..... ..;XLZ dated_-- ----f.'_ _!.'��__�Zp_._...____.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..... ................. ............................. Inspector...----...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No........................ FEE......... .:
Rapusal urk �uu #rr#iun rani
Permission s hereby granted
.....................•....................
to Construct ( or Repair ) an Individual Sewa g Disposal • em
at No.. :..... �.. __! � ... c:c
Street
as shown on the application for Disposal Works Construction Permit N�5r'.':1?J.? Dated.....:_1_ �. _ ........
�ard of Health
DATE..........JJ IIJJ---------------•-----....-•----............----
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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cis
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LOCATION SEWAGE # (.�
VILLAGE ASS.ESSOR'S MAP & LOT
L _
INSTALLER'S NAME 6i PHONE NO. ev
SEPTIC TANK CAPACITY 'XIS 0 U G:rx
9^
_LEACHING FACILITY:(type) o (size) \®pp
30. OF BEDROOMS PRIVATE WELL OI ''PUBLIC WATER
BUILDER OR OWNER Ne)L_cL\, cr Lr-
DATE PERMIT ISSUED:
DATE . COMPLIANCE ISSUED--. _ S` 10
VARIANCE GRANTED: Yes No
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LOCATION �
— ®s \Z?� SEWAGE #
VILLAGE
ASSESSORS MAP. LOT
INSTALLER'S NAME`& PHONE NO.
SEPTIC TANK CAPACITY c "
�4 LEACHING FACILITY:(type) o , (size) \QoC� C-c
O. OF BEDROOMS PRIVATE WELL Oi�r"PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED,
VARIANCE GRANTED: Yes .
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