The URL can be used to link to this page

Home My WebLink About0079 ARBOR WAY - Health 0 MAA.9ORy6'+ 'Y, IYANNIS:_ - _ ° ° ° TOWN OF BARNSTABLE °e LOCATION D� W G; SEWAGE # ✓)-0 8'0 VILLAGE 014 ASSESSOR'S MAP & LOT '--- f INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Cif LEACHING FACIUN: (type) 'i X/ (size) �. NO. OF BEDROOMS BUII.,DER OR OWNER PERMIT DATE: �' f ' 6 COMPLIANCE DATE: `+ D 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 4 , within 300 feet of leaching facility) Feet Furnished by A 1� r `�V zt YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which - you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) 1M4 WCm DATE: =109fmty Fill in please: r APPLICANT'S YOUR NAME: A�L?,OS +® BUSINESS YOUR HOME ADDRESS: -�%9 422,02 WAY _`';`�- �60 9�D- 4�V�4A),j 5 - Mir " KMIM TELEPHONE # Home felephone Number '5d;- 3V0o- 9:+0-2- NAME OF'NEW BUSINESS. M';'C"° IAJ i44. �� jTYPE;OF$USINESS' Ct�SIOM; CL1 -E 2f.D 7•.,a "{ "'�. ai ,fit x''=! zr #.:,z r ° r;:. "ry?..f�5q, i+X IS THIS'A HOME OCCUPATION. YES��>?<;. NO. � .. .. ax ,� �, -- .-.. ,• •y y:. .. 1 Jp¢. r'P k "5; .•ui,- 4irjs. ,.; ,7p ,,. Have. ou:been ivenla royal from.the`buildin division:*YES F:tr ADDRESS OF BUSINESS �� _ k�V 9 ,N A)'I r� ;;�,��_! - M MAP/PARCELNUMBER� 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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has b informed of the mit r rements that pertain to this type of business. MUST COMPLY WITH ALL uthorized Signatur * COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b n ' formed o e lice sing requirements that pertain to this type of business. Authorized Sig ature** , COMMENTS: r' Hazardous Materials�hvento'ry Sheet Checklist Date ` = Physical Street Address-Check database to ensure it exists • orking Phone Number - Actual Amounts-(le.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information If none,note that. -location of storage,how long is storage for? Disposal Information-where and who?If none,note that. Applicant Signature-understand what is listed and noted j Staff Initial-any questions,know who to ask !I Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain It-note that it was given L/ 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 doUig. Notes need to be left to explain what you discussed with them. Date: 7/ � 102 - TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: M G 1 In)I/i WAJt ) (1 vzpEA 1qy BUSINESS LOCATION: J ! INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: Y00 -11-4-02- MSDS ON SITE? TYPE OF BUSINESS: r140M C"j2C�+44 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) (10f� Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash �� 2l�lp WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS No. Feet THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migpogal *pgtem Construction Vertu Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -7 9 /9 Owner's Name,Address and Tel.No. ' Assessor's Map/Parcel ��TN Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /V-t e C eCef`� Type of Building: Dwelling No.of Bedrooms 3 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) f 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 been issued y this 'oard alth. Signed Date (.//9 —l O O Application Approved byfA Date Application Disapproved f r the following reaso Permit No. Date Issued No.... Fee THE COMMONWEALTH OF MASSACHUSETTS nterfd in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZfppYication for Xigpogar bpgtem Congtruction Permit Application for a Permit to Construct( )Repair(µ',.)Upgrade( )Abandon( ) El Complete System ❑Individual Components i Location Address or Lot No. Ct ,k� Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0 J L �Z c 7Y Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. F Type of Building: Dwelling No.of Bedrooms 2 , Lot Size sq.ft. Garbage GrinderR( ) 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 t Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) f 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 been issued y this oard alth. / Signed Date .. Application Approved by k Date Application Disapproved for the following reasops� _ Uu Permit No. 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 /SK t � e L *-- r L f at 9 2�j O ►� 4 y has beewconstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ted Installer Designer II V The issuance of this pe t sfc, 11 no be construed as a guarantee that the system-villl f•,urnctio�n as d�gned,/7 Date I/) ® Inspector . No. ----�---_; 7------------------,'------Fee]/�.�� THE COMMONWEALTH OF MASSACHUSETTS y PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal �pgte Congtructibn Permit Permission is hereby granted to Construct( )Re air( )Upgrade System located at ? 6 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 leted withi thr a ye. s of the date of t ' pe `: Date: c _ — Approved by TOWN OF BARNSTABLE LOCATION r D W. SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. I ancr i SEPTIC TANK CAPACITY !�� LEACHING FACILITY: (type) I/�/Ft (size) I ) _ 1 NO.OF BEDROOMS BUILDER OR OWNER I iA^ y PERMIT DATE: �� ` V COMPLIANCE DATE: C 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 FL—J. G. t r, 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 PERMIT (WITHOUT DESIGNED PLANS) c L Eck>1 y , hereby certify that the application for disposal works h construction permit signed by me dated "O O , concerning the; property located at 7 l !C n/J o r cJ Q c,i meets all of the 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 • 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 • There are no variances requested or needed. • 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: lyA) Top of Ground Surface Elevation(using GIS information) ' B) G.W.Elevation +the MAX.High G.W.Adjustment. DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sket h proposed plan of system on a ]. 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 .. � ,,` � s � � �.� .� � + `� 0 ,_-. ,L. .: �. -� ., —� ', .S _ ; �_ R , n�{ IoV J