HomeMy WebLinkAbout0370 LUMBERT MILL ROAD - Health mmomw[
370 LUMBERT MILL ROAD
Centerville
A= 169-067
S M EAD®
KEEPING YOU ORGANIZED
No. IM4
2-15UR
ow
anm e�rso MIS
ummum I
GETORGANIZEDATSMEADMII
TOWN OF BARNSTABLE
LOCAT ION 3?0 L1,ro Aerf A-1/• V SEWAGE# _
VILLAGE Leifer'J! e- ASSESSOR'S MAP&PARCEL /0 -®67
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY 1606 6c4 l
LEACHING FACILITY:(type) 1606 P"4— (size)
NO. OF BEDROOMS 3
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) c J
Feet
FURNISHED BYh�t�✓rl -`Flody �eO�6 C soars- a�/s
Bo,
go,.Ck.
A �G ra L
C
2C
D �2
A /96" 8-6- 7 '
-0- �3� ��
Y
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 form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE 0 - 10 \f ill i please:
APPLICANT'S YOUR NAME/S: V N 1vS a
BUSINESS YOUR HOME ADDRESS: h"vAtki
TELEPHONE # Home Telephone Number
'�'
NAME OF CORPORATION: O Af <
NAME OF NEW BUSINESS ULIFV ' TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO ]
ADDRESS OF BUSINESS 3 f 10 V w V rl 7`i MAP/PARCEL NUMBER ��a �I� �(o`7 (Assessing)
O�3 -
When starting a new business there are several things you must do in order�o 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 COMNh' '
'S OFFIC
This individunf r�e a p mit it meet that pertain to this type of businkr 4.ST COMPLY WITH HOME OCCUPA►iON
RULES AND REGULATIONS, FAILURE TO
Si nature** COMPLY MAY RESULT IN FINES.
M ENT GZt
2. BOARD OF ALTH
MUST COMPLY WITH ALL
This individual has been informed of t e mit r �'��ertain to this type of business. HAZARDOUS MATERIALS REGULATIONS.
Authorized Signature
COMMENTS:
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:03/ �� /�/6
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF'BUSINESS: PauF
Le) . /j r
BUSINESS LOCATION: 'INVENTORY
MAILING ADDRESS: TOTAL AM IJNT:
TELEPHONE NUMBER:
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: �� ` j '�, j�- MSDS ON SITE?
TYPE OF BUSINESS: f�,J 0 Y-
INFORMATION / RECOMMENDATION : Fire District:
r, VVeff
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
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
ah
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS p ant's Signature Staff's Initials VD