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HomeMy WebLinkAbout0067 PINE CREST ROAD - Health 67 Pine Crest Road Centerville A= 247 — 125 — 004 SMEAC? No.2-153LOR UPC 12'534 amead.com • Made In USA rQ). Hazardous Materials Inventory Sheet Checklist IS Date c..._-------Physical Street Address-Check database to ensure it exists —"Working Phone Number �G---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 Vehicle Washing/Rinsing? -give a vehicle washing policy and l explain it !/ Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doina. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? f, 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,.I st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 7J IV3 15 Fill in plepse: 4tca+sg +� + ar '� °ids APPLICANT'S YOUR NAME/S: C-p E tZ L !ft-rfl�f� - Pic ��' BUSINESS YOUR HOME ADDRESS: 6 7 PINE G ear 6 . der re_:xt�ci �.:� 503-3160-6.3r7 CLNTc� VrLLL,M<1 k.iF'h,k r{ TELEPHONE # Home Telephone Number s - 3 00 ­3 7 7 +.tx NAME OF CORPORATION. TYPE OF.BUSINESS t�, .�ii;.. t rn �ti'... NAME OF.NEW BUSINESS .� l 1�.r✓�. t .M.Pfit�v�M��vT;' ��'�% 10 �iN:?i i'�1 IS;THIS,A HOME OCCUPATIONS YES NOI.�:. .: ADDRESS OF BUSINESS �^ r`: i. G S:f �E -Cc�.h�c v vi l'� ,rGl� `C1.JEj� MAP/PARCEL NUMBER2�'� 15 �0 (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 leg ally'=operate your business in this town. .UST COMPLY WITH HOME OCCUPATION 1. BUILDING CO ISSIO ER'S OF CE RULES AND REC.UI<.AnONS, FAILURE TO This individ al h s e inf d or'an per it requirements that pertain to this type of busirtePLv MAY fEULT IN FINES. Au on Si rm C MMENT I / "� I I �1/I 2. BOARD F H TH .� m�v This individual h b inf orrjied oft rmit, uireme at pertain to this type of business. ' Must COMPLY 4TH•TALL Authorized Sitnature** HAZARDOUS MATEaIgLS REGULATIEIS 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: 4f Date:/-2/-& //3`-- TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: j 7!1 110M L i AA P k 0 UC nA5-IUT BUSINESS LOCATION: 6 7 P/A) CAL S r X5 KI1417W 052 3.2 INVENTORY MAILING ADDRESS: 5 .4A4 e �` TOTAL AMOUNT: TELEPHONE NUMBER: -_5-0? 3 b o 6 2 7-1 CONTACT PERSON: C D r f I- - T,-7;9Q A EMERGENCY CONTACT TELEPHONE NUMBER: Sd_3 3 G 0 b3"7 7 MSDS ON SITE? TYPE OF BUSINESS: 1.-)o:�V1 j!yt 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 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 " WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staffs Initials`�2ii►/ r, 7sY,����OWN OF BARNSTABLE LOCATION �©7' 9' ` SEWAGE # �?O VILLAGE - ASSESSOR'S MAP &LOT2 t 7/Z ®� 5 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 400 Zl' (size) NO.OF BEDROOMS 3 \ BUILDER OR OWNER Xo✓iti 3A w,.lr C71;11:z o� PERMIT DATE: L 9-95Y COMPLIANCE DATE:J6 .� Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leachingfacili ) Feet Furnished by of A yf. FT��/ ems' 2 u z7& 3Z' 3s y� a " of ' 3 'j-Y N F r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ` .........................OF. ApplirFatiun for Uiipustal Works Tunstrurtiun ramit Application is hereby made for a Permit to Construct ( or, Repair ( ) an Ipdividual Sewage Disposal System at: U!l ��PI .. x ............. _.._....._.... ..... -------------------- --•--- ... . Location- dr s or Lot No. n/12.� IV �.1 S C l� G�� 6 L L� -•-•----------------- __... ............. ---•-- -- Owner /LAddress `r . .'..— � . ...................... ......... 14 14 Installer Address Type of Buildin Size Lot...13 4:3 _ ...... feet �-, Dwelling=No. of Bedrooms............................................Expansion Attic (-,9) Garbage Grinder (ILL) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures es__________________'. per person per day. Total daily flow_:._....................0...............__..gallons. 6 to W Design Flow........... gallonsP P P n Y• Y;. it WSeptic Tank—Liquid capacity. gallons Length......_...... W>dth.¢�......._... Diameter:............... Depti-K.4....... x Disposal Trench—No................ Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No-------------I....... Diameter....a'.----------- Depth below inlet..3:5.......... Total leaching area... b'.....sq. ft. Z Other Distribution box Percolation Test Results ' Performed by... ;a .-t t ._..1'X X...... Date - $• 5 .a Test Pit No. L.4- ......minutes per inch Depth of Test Pit....i.�........ Depth to ground water*;_W� A .)_. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------......... •................. ...... k ----...I....-----------------------------,-7-�... O Description of Soil--- .....................................Sv - Z L ................. = Y ! .._......... x W ••-•••-•---•---------•------•-........-••-------•-•----•------------------------•--•---••-••---._... . fb.� U Nature of s or Alteration — swer when applicabrle.__ ,. :iG a ,� `^ __. .��c����re�i ..iuIUST SUPER111- 1. -------------------••-••------....fVSTA [.A�rtL fi�� Gti�TIFY IN .......... Agreement: THE SYSTEM WAS INSTAI LF WRITING The undersigned agrees to install the aforedescrib�d"I'i�di •i ,'liC6e%gSoQsgposal`5'ypst�i i Ta°ae�i�clance with the provisions of TITIL4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bep-- utby the board of heal h.Si ed-----•- --••••-- Application Approved By.................. ......•••............ . �....................-•-- L- D ate Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------------•-- -•......-••---••-••----•-••-•-••••----•--•--••••---•-•--......-••--•-•--•-•••-•-•-----.......•••••-•-•---•-•••--••------•-•--•••-•--•--•--•............................................................ Date Permit No...... Issued....................................................... 9 y "7--)-- Date s \ r r N FEBE-a THE COMMONWEALTH OF MASSACHUSETTS —�z w� BOARD OF HEALTH \..."...... .....................OF......... .!...`....�":: ...1 A .L Appliru#ion for Disposal Works Tonutrurtinn rprutit Application is hereby made for a Permit to Construct ( 4 or Repair ( ) an Individual Sewage Disposal System at: ....... l! �` �-(��-� K 0 G(!AI L u 1 L LL _ kJ, �-�►'► �+11 S / 0 ► ............ .................... .---.......----------......_..._....... .......---••----•-----•--......--------------•-------...----------••- ....._......... ( (" Location-A dress M 1 N .. Y..tc tc CC-Al 6..V.i L--zL- : tic�torK,Q W. 1+y4wrV)>���, Owner ,' Address a L........1 ) LL_ ............... �1 ' IL(. S .--•.............••------...•••.............---••-••-•-------•-••------......._.. Installer Address Type of Building 3 Size Lot-----3f4 U__ Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (P� Garbage Grinder (N9 aOther—Type of Building ............................ No. of persons............................ Showers =O Y. Cafeteria Other fixtures .. ( ) ..;, :. .a � --------- : W Design Flow...............5_ .......................gallons per person per day. Total daily flow......... V..._...._......._....gallons. WSeptic Tank—Liquid capacity.t�Dgalions Length...�.�.6.��.. Width..�_.I.°..... Diameter................ Depths...If.� _.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............_..__._.sq. ft. Seepage Pit No------------- ------ Diameter.._..6_...._..... Depth below inlet...3!-5-.__..... Total leaching area..__..�A....sq. ft. Z Other Distribution box ( 1) Dosing tank ( ) Percolation Test Results Performed by.....Q.:_. L_�. .......................i�X 4 S a --•-------------• °...-Date........................................ ,.a Test Pit No. 1...� ._._minutes per inch Depth of Test Pit...._�. _,. Depth to ground water..__�`?r-°L.13�. 44 Test Pit No. 2................minutes per inch Depth of Test Pit............gr_"'.� Depth to ground water........................ a ............................................. ........Z...••...---••• .....-_.... ---•.... Description of Soil-----b."`. •----LV(�rrY� SU 3 ,��_L.... j3..__.i CYO-= - x - V -•-•------•----•----•--•••••-•••-------•-•-•-----•---•---•-•-•-•-•••----------•-•••••---------•--•••--••--•---•-•------•---•--•-•••------•••---------•------••••••••-••-•-------•-•......---•----••----- ------------------------•-----------•------•------------•--------...------..._.....-•-----•••_.._...- U Nature of i s or A to ation —A swer when applicable._.__-:--- t .f0_._......L� ��+•��?-----( .... Agreement: The undersigned agrees to install the aforedescribed Inda&ridual Sewage D.aisposal System in accordance with T „ w•.._�«�W.-"'yam,. the provisions of m I I.LE 5 of the State Sanitary Code—The undersigried�fux.+.thR er agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. U,',, � I.M. APPlicati6nr,APProved BY----•-------•------ ----� '�''•-- ----••--------• = .............................. - - - --------- .------ APplication Disapproved for the following reasons:..................................................._........................................................... ate..�— �w�� o ________________ Permit,No.--. .......... ,Issued....................................................... M� may, ... Date TFECOMMONWEALT OF MASSACFiAl7✓ ��yN.a BOARD-4 F,,H,.EALTH 3 ` , ............. ....................OF..........1........ Trr#ifirat r of Tonip ft - THIS�S TO CERTIE That the Individual Sewage Disposal System constructed ( or Repaired L 1- Li L•-.L--L If bY--------•------••-- ----- •. • •........--•-••--•................. .. ... ..� L UT 4 f'" �h L�r Install V"(J • cr�i G V -- . L at..............................................................-------------••---•----------------- has been installed in accordance with the provisions of -1E 5 ooff-The State Sanitary Cod-51 as e•cr'bed in the application for Disposal Works Construction Permit No (;�:r�_". =- •.. dated... ----(>. - THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUAR NTE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OFHEALTH �� t r (J t►..�........... FEE._ �yc+ .........................................OF........... N ••--... Disposal Works Cnunutritrtinn Uprrutit Permission is hereby granted ' -----:.... ......... to Construct ( 'v j or Repai ) an Indi 'dual Seur e Di y at No. �--6 I 4' , ,.1 C.�I JvT fZ.( �-M �-!�(_ W j F{>✓!N /�(�l '" ------------------------------------------•.-••-•--•---------•---•--•-•.....---•----•-••......----- -•-•-•. .......... Street as shown on the application for Disposal Works Construction P�e=it_No�1 ���•-�^''Dated-•__•__---- ...4. ..... �P- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 %L or- '^tea+�C�e_a•.� _3 x 1tb X = 33d C rip i r Sr1GraG: 3k 110 Y. 150r0 = •495Cz� �-o use Coco G-�A�t_.o1..t`�,�►:�� plr�c� G¢��r' Qv� Grp t 6,k-/I LJ-6 W A.U- AIZms. -6 '�t t1GCt�f: 15•� �2,5 = 385 C�r"D - �MVA ' 15q S F G4PA,CRY: 15A(?- 1.p = 15 G,e"i7 ; 3S Cam, , OF m� �E5�64Ki IVAN �.� (# No.29733 ti < E3AXTirR � " r1.10.211043 S SVPER�IISE •� p>` ``��,Q. `�c',7���° ��� G ENGINEER MT f" IN WSTfk%GS � CER iN STF1 o �ESIGNINT101`► AS INSTA�E� T8e S p�NC T Pam' Accoa 4d.... 40• , - NY u.! NV �fl►.�K t N`� IELZ ISI S b raw I 19 14' TEC1•FIM--bT Goa CsaurJ�..��� �� i -scout 5'L�cL� III= dt U. �3 •�.:=��,�o yy,�,,� ice- _A� '�.��r�c.�, (�rzupost PL ►31L. G >=Tz-rlTr`( `T't{AT 7iks �t��Zz✓a� �M�L�tS �!1-t�-4•-tt�� •6���Ll N� �u� -3Rx�-z-� v E 1►� � � t GK (��QU1��l�lE'�T'�j OF`C'k�ETa'vc[1-1, �C-Z15'C�'Q�='t7n St�2�11=`(02.5 es Ir l--r+Va v`�-aAl ��v+►.,_� ►"Lol:$ MxznI� Ti2AYwtce__ L�-'��' �• ��S��t l lS t.?,Ot'}�.5�>2?U�1kfJ,tfl.Si�'-°IS t1 Mom"--r.j.Z\,f� r-4nn'S 'S�{kkV I 'N C N1`eFCM SttCx4L-0 N►CYr-E5M Us p-t-p IC. I ow I 42 lLo ��, 3a 3z 3r d � 44` knot \l o • • ��L � IJIV 1 70 ul RICH R ,• z2* Ya c c � .,� � r c F3AXTER INO. BAXTER & NYE, iNC. Professional Land Surveyors and Civil Engineers 812 Main Street a Osterville, Massachusetts 02655 Tel. (508) 428-9131 FAX(508)428-3750 WILLIAM C.NYE, P.L.S.-President PETER SULLIVAN,P.E.-Vice President-Engineering RICHARD A.BAXTER, P.L.S.-Vice President October 25, 1996 Mr. Ed Barry Town of Barnstable Board of Health P.O. Box 534 Hyannis, Ma., 02601 Re: Lot 4 Pinecrest Dear Ed: At the requests of Kevin Shearer and John Aalto we have checked the locations and elevations of the septic system installed at Lot 4 (House#67)Pine Crest Road, Hyannis. The system has been installed in the location shown on our plot plan dated April 25, 1986 (Rev. April 7, 1995). - Very truly yours, Baxter&Nye Inc. Richard A. Baxter, P.L.S. Vice President cc: Martin Traywick MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS