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Home My WebLink About0045 SOUTHWINDS CIRCLE - Health 45 South-winds Circle Centerville A=226-164 No.2453LOR UPC 12534 smead.ccm • Made In USA cER,u�en �c�w orrr��c�ws�.;ra SGURCiNG �iYii�/�yryyYlvW Hxxazannrdou0s Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines,thinner to clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature -.understand what is listed and noted Staff Initial -any questions, know who to ask 41 f Z Vehicle Washing/Rinsing? -give a vehicle washing-policy and / explain it (( � r QN,-I°rl� fl!XI v/ Attach the Business:Certificate with our . ign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? X� For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS 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, 15t FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. - Fill in please: Date: I > /o G %©9 APPLICANT'S NAME: C E 10 / A YOUR HOME ADDRESS: Ll-� � n v + if Y /U O �5 C I . ..r. CE rV t F f—i i I BUSINESS TELEPHONE # HOME TELELPHONE #: NAME OF CORPORATION:- NAME.OF NEW BUSINESS CO_U G 6. f U TYPE OF BUSINESS (`y G 1C y IS THIS`A"HOME OCCUPATION? NO , ADDRESS.OF BUSINESS 5 �c �-I. ,) ( /1j�,i� C i.(�2 .CeR{��2U, f e:v`� MAP/PARCEL.NUMBER :22 `M' (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO, 00 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 town. 1. BUILDING COMMISSIONER'S OFFICE. This individual has been informed of any permit requirements that pertain to this type of business. . �XCOMMENTS: Authorized Signature** 2. BOARD OF HEALTH MUST COMPLY WITH ALL This individual as b form f t it requirements that pertain 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: r TOWN OF BARNSTABLE Dated0 / o 6 l d 1 TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS:2 CO U S I A S C OMS IL) c- 1 O^/ BUSINESS LOCATION: Lj 5 S pU tH l/I N P 5 t� JAR 026 1-9 INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: ��SS q EMERGENCY CONTACT TELEPHONE NUMBER: 53 J —J _r� / MSDS ON SITE? TYPE OF BUSINESS: CON S T I'3l/ C TI Qn/ INFORMATION/RECOMMENDATIONS: 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 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 (including bleach) Spot removers & cleaning fluids e g (dry cleaners) • Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS •: /A- TOWN OF BARNSTABLE LbCATION _ "tj v l N (X) SEWAGE # /L1 ¢VILLAGE 66A ASSESSOR'S MAP & LOT a INSTALLER'S NAME & PHONE NO. e ! SEPTIC TANK CAPACITY 1S6 LEACHING FACILITY:(type) Ste' L/ (size) NO. OF BEDROOMS �/ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER )G ,S (5 2 1 )-,i A/L- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No /� .� '� S�� .��1 � I s• � 9�. �9St �' � ..,�._,.�s. �� . ,,,o`d-� � � � � No.f. .....'/.. (� Fxs.....,3.. 00...... THE COMMONWEALTHOF MASSACHUSETTS BOAR® OF HEALTH I OWN OF BARNSTABLE t zt Di-gPos l Works Tonotrnrmin ranfit Application is hereby made for a Permit t Cons r t ( .I ) or Repair (x ) an Individual Sewage Disposal System at: 45/47 Sout_hwinds Duplex ................_... .............................................. ------•-----........-------------•---•--------•---...........-----...----.......------........-•-- •-•-•--•--Bill Sh ----••Location•Address or Lot No. .-- o_rtmar.............•-----••-•-------------•-••------......--- W W.E. Robinson Septic Service P.O. 1089 Centerville a ........................•-------••---------•----••----•----•---------•--....._......--------•--•-- ......_..---------------------•-•-•-•---------•-•--...._...---......--•-------•--•---.....-•---... Installer Address U Type of Building 4 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—T e of Building a yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W - Design Flow............................................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..............._____... ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ PLO Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water..................... M ...._-•----------------------------------------------------•--------•----------....----••------••...--------•-•-----------••--•--........... ---------------- O Description of Soil...............sa11d.................................................... U -------------------------------------•----•--------...-------------•-------------•---------••--------------------------•--------------------- ......................................................... W x ---------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when ap licable_.i n s t a 11 a 1 , 5 0 0 0 q a 1 tank pump station and leaching fiel Pump and fill old cesspools . •.•.------•--•. ------- •• •. •.•••.----•-. -------- •----------------------------•-----------------------------------------••••--•----------- 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 under 'gn further rees not to place the system in operation until a Certificate of Compliance has obessuv4 o d 9f heal C� �//,s—� Signed ........ . ...... ..... Date Application Approved BY .----------------------------------------------------------------- .... Application Disapproved for the following reason ------------------------ -------------------------------------- ------------------- ------------------------ ............................. --.--------- ----......----............-- .---....................---- ----------------.-..... Permit No. ....--�..3- � Issued Date Date No.fa----7 F�$3� .�� ► � , THE COMMONWEALTHYOF MASSACHUSETTS BOARD OF HEALTH IL7 /G _9�T,OWN OF BARNSTABLE ppliration fur Disposal Works Tonstrnrtinn Permit- Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: ......4..5.../4-7__.S--o-ut..h..winds Dunlex-- . _....._._.. .A ...........------------ -- Location-Address otNo.- .....-------._................_. ....Sh n;r n, - ----------•-------------------------•---------- -•-----•------------•--------------------- ......................................-..... Owner a --••W.E. Robinson Septic Sezva ae P 0 1 QSq ('� irQr�� g11 a ......................... -------------------•----------- Installer Address Type of Building Size Lot............................Sq. feet D-I Dwelling—No. of Bedrooms.....4_------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..................:......... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------------------------••------------------.-••------••-••--- W 1 Design Flow............................................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. 3 Seepage Pit No..................... Diameter......--............ Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) HI Percolation Test Results Performed by.......................................................................... Date........................................ 4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ . 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------------•---_-•--•. a ----•--•---------------------••-••------•-------•--•-------...-•--•----••---•---....-•-•••-----••--•......................................................... 0 Description of Soil---------------r ....................................................---------------- -----•---- - W ----------------------•-----------------•----- ..------------•---------------------------------•---------------------------------------------------------- ----•-•---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------•--------•--- U Nature of Repairs or Alterations—Answer when applicable-.i n t a l-i....a---1—5 f f m•.C+ra 1...tank.__._•............... ----puma_station__and......k axla _f al�d-r----- Puz _ra__.al� x1, 1 .r ± �c�l = 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 under igned further agrees not to place the system in operation until a Certificate of Compliance has b e issue• by�t—e- o rd of health. J r_n' . / `7 Signed // D .......:....... ............................................ '........................................ i- v Dare Application Approved BY ....... 4` �`----------------------------------------------------------------- --- . ED).t r 3 Application Disapproved for the following reasons- ----------------------------------------------------------------- ------------------------------_-------------------------------- ---------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ------- ---------------------- -----------------------........... qq p Date Permit No. l -3 -r- ------------------- Issued . - ................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (9er#iftrate of (gnntplianre f� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by W- .. Robinson S nti.o ..�.�r�t�.cQ ---------------------------------------------x...... 45/47 Southwinds DuP lex . Installer, at --------------- ------ -------- ---Vd-- ---HVa nn i so rt ` has been installed iri accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....7_',_�_---.-.-- ..-- dated ...................._------._._...._-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -17 Inspector --------- THE COMMONWEALTH OF MASSACHUSETTS { BOARD OF HEALTH 33-yz g TOWN OF BARNSTABLE S, Disposal Works Tuns#rnr#iun Vrermi# Permission is hereby anted__tri9 ,- un ......• ...............•----•--••-._--- to Construct ( ) or Repair ( x) an Individual VSewage Disposal System at No..4 _�[1 7 C�t,i k�F4 xa S TWinI"I" r.� uRa a.,r,1 ..,n --------------- ------------- -_. .... ------------------- street as shown on the application for Disposal Works Construction Permit o.-,--:--.�.`_-----°.- Dated.... K_'J4-•:....::............. 1 / �� Board of Health, DATE -... CO .................................................. FORM 36508 HOBBS A WARREN.INC..PUBLISHERS I ASSESSOR'S MAP NO. PARCEL .L T ION SEWAGE PERMIT NO. =ys' Sow " ,,� � a�� - i� IAGE -Y vf �� I N S T A LLER'S NAME a ADDRESS d U 1 L D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �d ILOr-� ASSESSOR'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. L1 So 677r v QLl VILLAGE INSTALLER'S NAME A ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUE )d / ! THE COMMONWEALTH OF MA SACHUSETTS BOARD(�OF HEALTH 9UD,. (S -._qC oW�'i........... OF.....VS. ...UL........................................................ Appliratiou for Diipa ial Works.Tonstrnrtiun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( .) an Individual Sewage Disposal System at: �a �(IAl - _r 5SA.W.i)&A..�t4t� �.. xi �f 5��t�........ .....•----•-••-----------.......-•----•-•------•--................................---............. cation-Address or Lot No. S► o2Tm j}ty '-..►. ................................................ - s-y? ...................................................... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..................4......................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria P4Other fixtures -------------------------------•------------------------------------------------------------._.._.._..........._.......-•-----------•._....•--....... W Design Flow............................................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.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY---------------------------------------•---------............---------.... Date_:.......---------..............••...... W ' Test Pit No. I................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........................ --••---------------------------------•----••----••--------•----......-------------•-••-...................................................................... Descriptionof Soil.................................................................................................................................------•----•----------•---•---•-•----- W T U Nature of Re irs o Alterations—Answer when applicable,__ _____ t__t__ 1 u_s�� "66 grs.r-.. .=.. i s -- s 1l.. �.s�.n --- r ...aeml d �.e v Agreement: 2v The undersigned agrees to install the aforedescribed ndivi ual Sewage Disposal System in accordance with the provisions of TIT L4 5 of the State Sanitary Code—.The u dersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the oard of healt . ............ ._ •. -•--- ............................. ....�..3- at Application Approved BY---- '....... Application Disapproved for the following reasons:............................................................................•._••------------•---............. ..-•-•...............•--•-•••-•--•.....---•-••--•••------------••---••.....----•----•-••-••-•--------••-----------------•-------••--------------•------•----•----------- ............................... _ 1Date Permit No.................. ---• ( Issued_ Date No... / L 'P `" FEE`/¢? �'„,— THE COMMONWEALTH OF M SSACHUSETTS 1F / -Vt ,(•\ BOARD OF EALTH �y- t .�, `_T-�J 4� Tower:....... oF.................... .... .. ... .....................•----•-•---•-----....-•-••-•-•-- # : * Appliration for Disposal Yorks TI-Ustrurtion Vrrmit •`Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: .y 5.:y.11»».�.�.o e 41 iA Ci ree; C'e 'e rut :e:-••--•--- -•-----------------------------------•----....................._....................------.....--- Location-Address or Lot No. 5N402TMl.rl ��,=t "l5" ......................» ..,. ........ . ............................._._.............. . ........` ................_.......... ..»........_................................. W Owner Address a ••.....................................................................•---..............---••- ----........_..,.__...---------------.........---......---•-----•-----........................_. Installer Address Type of Building Size Lot................ S feet �.� Dwelling—No. of Bedrooms.................4...:....................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building No. of ersons____________________________ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) Q Other fixtures ------------------------------------------------ -----•----------------- ---------- -------•-•-----__........ . Design Flow........................:...................gallons per person per day. Total daily flow............................................gallons. Septic 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.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ''" Percolation Test Results Performed by.......................................................................... Date........................................ a � Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ------------------------------------------ ••-•••-••••--------------•-. -------••----------- •....... ___--__.......-___........... ___._.._...•••..........•••- 0 Description of Soil........................................................................................................................................................................ W U ........................ ........................................-----------------------------•------------------------- ............... -------------.. W --••••••••••-------•---•----••-•••-•--•-•...•-•••-•-•--••••--•-•-•-•-••-..._..-•-•-••-•-----•-•--•-•---.....-•-•-----•---•-• --•-••-......--••••-_- U �i�LC'Cnt.Ca rencoue- i t jQP- S'--_ Nature of ReRairs r Alterations—Answer when applicable__________________ _A._______._._.. -.__......: ._Q......!t s`ors - -2Gt C R L c(� _ 5 to-x e, 1^2 - ---•__________ ___ ________________I---•-----Sz--.-.----------sS ar-S___--•--------•-•---•---------_ ___-•---• ---------__________--•-------• --____-___-___. - 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 u dersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bythe board of heal h. 1 �" ----"..'` ` .......................... 7tN 38�` ..... APPlication Approved BY • - -:.......-•............................-, ....._.. te............. Application Disapproved for the following reasons:............................................................................................................ .......---•---••---•-••--•..................... ..................................•»`----•••••-------•----•-------...._..._.............._.........•-•-.............•-•••-- _ .....-----» Date e PermitNo... ------------ --- --- Issued-....................................................... Date t THE COMMONWEALTH OF MASSACHUSETTS (� BOARD OF..��HEALTH f ............I oWn...............OF....!?Gr.A5;Icoe ............................................................................... (Inrtif iratr of Toniplianrr THIS IS T ,,L TIFY, That+the Individual Sewage Disposal System constructed ( ) or Repaired �) by ................... .. -...................._....... ---• -----•_---� ----- ----_...... -_-----------__..__.......-------------- ._.... .»...._.... has been installed in accordance with the provisions of T.1Z.1Z 5 The State Sanitary Co as described in the application for Disposal Works Construction Permit No .__ .... dated_.... _ .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANTEE THAT THE SYSTE I UNCTION SATISFACTORY. DATE.. / ---------•- ---------------•--- •------ Inspector...l ..... ....... --- ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / 1 o to 1 ! '� d' ��.. .................... OF��ti" ._......--_..._ ._.... NF .......... Disposal Works Tonotrnrtion frrniit Permission is hereby granted......... to Construct or Repair ( )_,ap I�ndmiduak, Sewage ispo�xl Sy em atNo........_ .... --.....--•• .................... �._W................................... ---•-- --••-•................ Street as shown on the application for Disposal Works Construction Permit-10y_.n-::1&_r;_5. Dated.. .g.t0................ ..............................................................__...__ DATE... 4n......................... _ Board of Health ,.^x .._...._..........» D -•- •• _ � FORM 1255 A. M. SULKIN, INC.,*`BOSTON '*.,.