The URL can be used to link to this page

Home My WebLink About0031 SOUTH EAST LANE - Health 31 South East Lane { Centerville .A = 189 - 148 No. 4210 1/3 ORA rendat'"lexe 1000 0 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates. cost $40.00 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 format 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL.,,367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: ed -Lu v l ' APPLICANT'S NAME: > >C E! (,a - - r YOUR HOME ADDRESS: 3 iay-7-:r `P.�-r c► , BUSINESS TELEPHONE # -� HOME TELEPHONE #: NAME OF;CORPORATION: 'S FID'# NAME OF`NEW BUSINESS TYPE OF BUSINESS TRJCC<��vtcr 19 THIS A HOME OCCUPATION? YES NO oo ,,rk A-s-, L ry , '. . � fl��3� MAP/PARCEL NUMBER � `(Assessing) ADDRESS OF BUSINESS ' L. —� 4 , / � L�g �.�� 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 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 town. 1. BUILDING MMIS ONER'S OFFICE This indi 'dual ern�i !rre- of qny permit requirements that pertain to this type of business. Au rize igrn re** MUST COMPLY WITH HOME OCCUPAI ION OMMENT RULES AND REGULATIONS. FAILURE TO 1 t i A COMPLY MAY RESULT IN FINES. QbIl- 2. BOARD OF EALTH MUST DAMPLY WITH ALL This individual has bee nformed of the permit requirements that pertain to this type of business. K11ZARDOUS 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: � D )�, TOWN OF BARNSTABLE ate: j I!1 12 0 TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 1V t.—IK' S E'2V 1(_ BUSINESS LOCATION: E7AS rJ Czwct�p t N z. INVENTORY MAILING ADDRESS: -3 l So.,-m `.As r L,- -i\ M -- TOTAL AMOUNT: TELEPHONE NUMBER: _�U S -3 6.q - 6� S CONTACT PERSON: D a v j�,to u3 ti rV EMERGENCY CONTACT TELEPHONE NUM ER: og -S-1 S-o h-7o MSDS ON SITE? TYPE OF BUSINESS: -T-�Ec A Q INFORMATION/RECOMMENDATIONS: Fire District: 0 ��► `C'�Iti� N� �� (\-.tip ) S1 VQ - C 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, I 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 P WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initial �CTOWN OFF�BARNSTABLE LOCATIONZ � ` ' �`N SEWAGE # VILLAGC�A ASSESSOR'S MAP & LOT JV n INSTALLER'S NAME&PHONE NO.C, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 5X3(:)+\5x go NO.OF BEDROOMS BUILDER OR WNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility JA- Feet Private Water Supply Well and Leaching Facility (If any wells exist ,�� 11 on site or within 200 feet of leaching facility) vv A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CL- 1 O C � �� 4 0 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZppYication for ]Di9;po!6a1 *p6tem Construction i3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addre s or Lo o. wner's Name,Address and Tel.N� �-17 Z Assessor's Map/Parcel Installer's Name Address,an Tel.No. Designer's Name,Address and Tel.No. Type of Building: -sq 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 6 Size of Septic Tank Type of S.A.S. Description of Soil Nature Repairs or Alterations Answer when applicable) r a 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 bee sued this Bo Signed Date Application Approved by Date Application Disapproved for the ollow g reasons —Permit No. —�� 9 �� Date Issued --- - TOWN OFF�BARNSTABLE f'�ATION 12� ��1 SEWAGE # VILLAG ASSESSOR'S MAP & LOT n INSTALLER'S NAME&PHONE NO.2- (D 0l SEPTIC TANK CAPACITY L bW (A'i-L LEACHING FACILITY: (type) 4} ,� s� � (size) �k `# °� U NO.OF BEDROOMS BUILDER OR WNER 'Prt .Z v� PERMIIDATE: 7jVCOMPLIANCE DATE: 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ' " Feet Furnished by 1 to 40IlArt a 0 �- ^ 77 No. Fee �d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migpogar *pgtem Congtruction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System. ❑Individual Components Location Ads�or LoyAio, r-^ � r ` n�'s Name,Addles Tel`No• {17� � Z� Assessor's Map/Parcel Installer's N e ddress,and Tel.No. Designer's Name,Address and Tel.No. 5CSI "77 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) L-t-- .J 91�C '`�'�1�C 0 'r 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 bee sued this Bo Signed Date "t Application Approved by Date Application Disapproved for the ollow g reasons J Permit No. 77 , / Date Issued THE COMMONWEALTH.OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO FY, that - ' Sewage Disposal System Constructed ( )Repaired (A----/)Upgraded( ) Abandoned( at l Vt has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. t Date , '1 Inspector _ f —y------- ------ --- ----------- ----- ^,.—,— No. 27 1 Fee (l THE COMMONWEALTH OF MASSACHUSETTS j PUBLIC HEALTH DIVISION.- BARNSTABLE, MASSACHUSETTS Migpogal *pgtem Cdn5truction Vermit Permission is hereby ranted to Csnstruct Re air Upgrade Abandon System located at ( .'fz�,S�i 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:Construction must be completed within three years of the date of this permit. Date: / - 1- 7 Approved by 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 PERMIT (WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated f �� 7 , concerning the property located at I � - 0� meets all of the following criteria: o- • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIG DATE: C 9 7 LI TIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j xert C� c _ ssef e 40 O