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HomeMy WebLinkAbout0732 PHINNEY'S LANE - Health 732 PHINNEYS LANE CENTERVILLE A = 251 120 UPC 12534 No.2-153LOR HASTINGS, MN YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cosr�4Q.00` for 4 y�ar�,. 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, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE: - 7— l Fill in please: APPLICANT'S YOUR NAME/S: ` BUSINESS g YOUR HOME ADDRESS: �� �'h l nv1e--tS L�H OoL�3a �Pc�-F�rV•�(e uri t...- �:.. 1 ''`' `JTELEPHONE # Home Telephone Number Y t S �1 vi�134v:d wr;;,rti.......... ........... E-MAIL: O(`G 2r -�c•: vv�a/t.{ 7 jai '� . GO-vN NAME OF CORPORATION: oei a , c� c^-d e y NAME OF-NEW BUSINESS v TYPE OF BUSINESS Poo I Sic V I)C IS THIS A HOME OCCUPATION? u YES NO ADDRESS.OF BUSINESS. (�60me`( MAP/PARCEL NUMBER _/ A26 (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 COM SIO R'S OFFICE MUST COMPLY WITH HOME OCCUPAT tON This individual hd b inf e an p mit requi emerits that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO --z�� COMPLY MAY RESULT IN FINES. Auto d igpat' \. OMMENT 1 ✓� 60 t 2. BOARD O EALTH This individual has been informed of per it requirements that pertain to this type of business. MUST COMPLY WITH AL L, HAZARDOUS MATERIALS REGULATONS.. Authorized Signatu * 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.jjl-/ - TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Lsy C1 C) �A�Z 1 BUSINESS LOCATION: 71a 2kinti5g.i(s Lc„r- CeAlsr U,'S1e- INVENTORY MAILING ADDRESS: ? 3P ;Vkylyl� L-4 v AA& TOTA ;AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: L"S Lovv,- Q rclo' EMERGENCY CONTAC TELEPHONE NUMBER: , t:�08- 5Sl c� Ll I MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECO MENDATIONS: 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 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 d; 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 r (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, x Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages ;,x Wood preservatives (creosote) Caulk/Grout ;W CI) Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda X Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes fX 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 X 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 60lica 's ignature Staff's Initials No. o V J l C1 Fee 0 d THE COMMONWEALTH Oi MASSACHUSETTS Entered in computer:_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPliration for Disposal bpstem Const urtion J)errnit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Vividual Components and Tel No Location Address or Lot No. Owner's Name,Address, . 73Z A / Assessor's Map/Parcel (i Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H h. Si Date Application Approved by Date v Application Disapproved by Date for the following reasons Permit No. I o/y — 3 yp Date Issued No. ( U Fee THE COMMONWEALTH OPMASSACHUSETTS Entered in computer: . PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Misposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System �dividual Components Location Address or Lot No. O Z ��Iirl�lcp /w^ner's Name,Address,and Tel.No. /�` Assessor's Map/Parcel �' 1? G �N��/ 1? Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title r Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4/ q za cif se 7.,� ram ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Head It Si d I `� -__ Date/ �d Application Approved by . S Date Application Disapproved by Date for the following reasons Permit No. 0o/v — 3 Date Issued ------------------------------------------------------ --------------- ---------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired(✓/ Upgraded ( ) Abandoned( )by /h �/j�• '7,r at 1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. U O -3 V0 dated Q / .� d Installer Designer , #bedrooms Approved design flow �/'f�- gpd The issuance of this p it shall not be construed as a guarantee that the system will ftiJ as desi ned. Date D J Inspector No. U/0 - 3�t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal �&pstrm Construction hermit Permission is hereby granted to Construct( ) Repair( ✓}� Upgrade( ) Abandon( ) System located at Z S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date by lei 1 - New Page 1 hfttp://www.town.bamstabie.ma.us/assessing/2010/HMdisplay.asp?... P 1r �' �E LOCATION /i�-3-31 i�_a� /���+r r- _ SEWAGE#402---W VILLAGE�S't� f ASSESSOR'S MAP&LOT '" C INSTALLER'S NAME&PHONE NO._42 J.o SEPTIC TANK CAPACITY l S-e o LEACHING FACILITY: (type) /.2/_�/7/Li l�u,�s' (size NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: C7 C7 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) Feet Furnished by i G � .4 0 a 4 A l-.L-4 DI%!o 4 2/ !�ZIP A 3 13311 I oft 8/11/20102:38 PM ^T OF,BE T E LOCATION 3-� PP` j S. SEWAGE # 000 VILLAGE �� �ll�a ASSESSOR'S MAP & LOT '*' o INSTALLER'S NAME&PHONE NO. % �f/_ Z�_ 7 JL r. SEPTIC TANK CAPACITY lc re e o LEACHING FACILITY: (type) (size}/ NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 6-0- '"COMPLIANCE DATE: oci r , W Separation Distance Between the: t 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) Feet Furnished by i� G i 1/ 43 - �3� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for 0i 0 at *potem Con!5truction Permit Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) Womplete System ❑Individual Components Location Address or Lot No.73 1 �/,�/y�s Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1-1 Inst s e,Address,an e.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �SlJ gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t /�?�n G�TfL�'fio4�i c Type of S.A.S. c.I Zp,XL,_ G `7i'f Description of Soil Nature of\Repairs or Alteratio s(Answer when applicable) v � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has his Board ih. Signed Date Application Approved by Date lZ—/l —� ,_.• Application Disapproved for the following reason Permit No. 7 ZZ Date Issued P�t9T {� F BA l�l'tT E - , i LOCATION 1 SEWAGE # 000 VILLAGE ( R [.9 ASSESSOR'S MAP & LOT r INSTALLER'S NAME&PHONE NO. oe4 7 h c�w��_C�. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ��l /7IC/9 ,9L�_ (size)�l NO.OF BEDROOMS BUILDER OR OWNER /�, , PERMITDATE: v e� 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 I" on`site ar.within 200 feerof leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ir � z� n No Fee e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1._.. 01pphration for ;Dt��)Upgrade aY *pOtem Construction Permit y Application for a Permit to Construct( )Repair ( )Abandon( ) )KComplete System ❑Individual Components Location Address or Lot No.73,-3L p wns lqcz Owner's Name, ddress and Tel.No. ` Assessor's Map/Parcel Inst s e✓Address,any el.No�f Designer's Name,Address and Tel.No. ? Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank�1 1C W Type of S.A.S. fiizRzog e ' -Lom.,4r Description of Soil Nature of Repairs or Alterations(Answer when applicable) �vL S7N `l�i.��J's� ),""I ( To Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance-with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has�heen.issuedly.this Board o ealth. Signed I Application Approved by, Date /�—�i —Zd3►?� Application Disapproved for the following reason Permit No.'��I7/Z) 7 Z E Date Issued Z _Z_V� ---------------------------------------- I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (compliance THIS IS TO CER that e/On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded((/� Abandoned( )by at c� 'C©sv�� has been constructed in accordance with the provisions of Title 5 and the or Disposal ystem Construction Permit No.`� ' dated I Z—// Z=.>LaZ6 Installer Designer t - r The issuance of this peirt shj,'ll not be construed as a guarantee that the sl�ssttem will-function as designed. . 4111 ` r Date . / t Inspector ll �� (y '� &'. _____ No.�� / � --------------------Fee y " , v w' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH! DIVISION - BARNSTABLE, MASSACHUSETTS Mt! po5ar *potem Construction Permit Permission is hereby granted to Construct( )Rep 'r( Upgra e( )Abandon System located at 3.Z �t.`wit S � 692, .f.4 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructionust be completed within three years of the date of this rmit. Date: /Z/ ;/ Approved by a j 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PE MIT (WITHOUT DESIGNED PLANS) I, % VG ' , hereby certify that the application for disposal works construction permit signed by me dated 1 Z -1 I-Cb , concerning the property located at I ZRlfont(jS meets all of the K�uso I Le following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business / uses associated with the dwelling. •/ The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system 9 There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed ,e"' There are no variances requested or needed. e The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground SurfaElevation(using GIS information) 46., - B) G.W. Elevation 1�+the MAX.High G.W. Adjustment. = 33 t�- DIFF NCE BETWEEN A and B 35 :4 SIGNED : `I� DATE: k_I [Please SkeA proposed p an of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �,aV I o0 0 �J 7�