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HomeMy WebLinkAbout0159 ARROWHEAD DRIVE - Health 159 Arrowhead:Drive Hyannis - --- - — -- - -- ' A—'270-185 v o O o � 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 opera e. 'ness Certificates are available at the Town Clerk's Office, 1 s`FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Fill in please: APPLICANT'S YOUR NAME/S: A G S C AlOE BUSINESS YOUR tk IgME ADDRESS: I S9 l l Number TELEPHONE # Home Telephone s ffis S Xhx i:YS��it NAME OF CORPORATION: NAME OF NEWBUSINESS CxSTYPE OF BUSINESS '7 IS THIS A HOME OCCUPATION? Y NO ADDRESS OF BUSINESS v I .•+,v!S MAP/PARCEL NUMBER (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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. `Authorized Signature* OMMENTS: 2. BOARD OF HEALTH ��`_,.:..' MUST COMPLY WITH ALL This individual has be informed oft permit r irements that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS Authorized Signature* COMMENTS: Ge— G - 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: you discussed with them. Hazardou Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists orking Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) t/ 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 V hicle Washing/Rinsing? -give a vehicle washing policy and 'explain it Attach the Business Certificate with your sign off and comments wentory form should explain what the business consists of and the procedures ping. Notes need to be left to explain what you discussed with them. . h Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: M Pr269 "1✓ 4 2-7 22 UAe -.lc i _ / / OkOiNVENTORY MAILING ADDRESS: Q TOTAL AMOUNT- TELEPHONE NUMBE �f - S f7 CZ I CONTACT PERSON: A ti (� SCE Y /✓�f_ EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS:, INFORMATION/RECOMMENDATIONS: Fire District: o� LGo ,4 T I �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 materials use, i 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 (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE LOCATION f S-E A RR O W N eAd Dk SEWAGE # 1 4 VILLAGE A/V A /IZIS ASSESSOR'S MAP& LOT-176, l�v INSTALLER'S NAME&PHONE`NO: —. n� ��.,s�.y��© SEPTIC TANK CAPACITY "I LEACHING FACII,TTY: (type) (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: & COMPLIANCE DATE: P ,-.31 'I 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 leaching facility) Feet Furnished by I �� � � o\ ' \ � 1 \ \ C ' .. �\ i ., . � i�� i _——._ No.......... ... F�$.. ....3.�.-.�0.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di!jpw3al Worko Tomitrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or 1Zep.t1rX6(X) an Individual Sewage Disposal System at: ....1.59...Arrowhead... riye..H ?n3�.s .............................................................. Location-Address or Lot No. ...Effie.Dal rymp l e•---•......--•.............. 0"ner Address W J.P.Macomber Jr. Installer Address PQ UType of Building Size Lot............................Sq. feet ., DwellingX-- No. of Bedrooms.....---.3--------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ---------------------------- No. of persons----- ------.---.---------- Showers ( ) — Cafeteria ( ) a' 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....................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........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit......-------.------ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.-.------..--------. Depth to ground water..--.....--............. ODescription of Soil------------------------------------•-----------------------------------------------------------....-----------------------------------------------------------••.•-•--• v •----................Sand---&---Grave1----------------------------------------...------------.....------. v Nature on etank rAlterations.—Answer when applicable -1.00f)l x ... .. . .......... ....... r.....-- -- -- ------. ---- -- -- .--.... ----••• •------- ga...lon- leach.-.P--lt........... .............. 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n iss b e board o e th. Signed .... ../ A.�.. ... ... ............................... ..9....9.5.................:...... Dace Application.Approved By . .......... .................... ... .... .. .......... {..... . ........ ....................... ........................................ Date Application Disapproved for the following reason : .................................. ..:............................................................................................. ...... ...................... .................... ................... .............................. ...................... Dare ....... Permit No. ...�.......................­................ ...... Issued ........ /..... ................................ Ua t TOWN OF BARNSTABLE LOCATION f,S`-P A 2 p v ui P e Act /ape SEWAGE # VII.LAGE_T A /VA//S ASSESSOR'S MAP & LOT a-76- f 8 5 INSTALLER'S NAME&PHONE NO. _ --. nn�@ i�a-�9 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) _ NO:OF BEDROOMS 3 BUILDER OR OWNER 6L �-►� PERMITDATE: 3 ^ ��' 15J COMPLIANCE DATE: / -a I -7 2 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 leaching facility) Feet Furnished by O �4 i� o 30.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFatioat for Di�apwi al Wor1w Tomitrurt"ton Permit i Application is hereby made for a Permit to Construct ( ) or RepairX(XX) an Individual Sewage Disposal System at: 1.59...Arrowhead...Drive_..Hyannis----------------- --•----•------•--•••------••-••-••------••••••-••----••----••••-••••-•--•-•-••-•---............... Location.Address or Lot No. Effie Dalrymple -------- --------------------------------------•---------------.....-•----......-•-••-•-•••-.......--...... Owner Address W J.P.Macomber Jr. Installer Address Type of Building Size Lot...........................Sq. feet DwellingX- No. of Bedrooms._--_-----3--------------------------------Expansion Attic ( ) Garbage Grinder ( ) PQ aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d g Other fixtures •---•----------- ----------- •--- ---------- -.....••- ------------------- .-- ---••--•---:..----------------------------------�------. W Design Flow................ . ... . . gallons per person per day. Total dailyflow............................................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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LT. Test Pit No..2................minutes per inch Depth of Test Pit.................... Depth to ground water,....................... ---•----------------------------------------•----_----------------------•-----------------.----••-------------•-------------•-•-----------------------.----- ODescription of Soil----------- ---------------------------------•----------------------------------------------------------...------------.........--------------- ••-----•-•---- U -6.......---••-•Sand...&-.,Graver--------••--••-•-•----•-•---------•--------------------....................................................................................... W UNatu of Repairs or Alt rations—Answer when applicable.--...-.Omit---C----S Aoo 1 s- --Install- •..1-•-1.0 0.0. ] . gaelon �ank, 1 -distribution box and 1 -1000 gallon leach pit•- 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 undersigned further agrees not to place the •system in operation until a Certificate of Compliance has been issue/-d b e board o 'e th. Signed .... ..... ..... . .... .... ... ... .................3�.9.�9.5......:..........:...... Dare APPlicalion.Approved By .................... ... ..... .. ,.o....... . . . ........................ . ........ ..................'....... ........................................ Date Application Disapproved for the following reaso .................................... .............................::. ............................i........................ ..................... ........... ...---.....-----............................................ ........... ................ Dare Permit No. ...... _0........ Issued �.�.. . ..................................... .................... — ----- -----'- -.-- THE COMMONWEALTH OF MASSACHUSETTS .BOARD OF HEALTH TOWN OF BARNSTABLE 01Qr'ifirate of Tuamplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedX(XX ) by .................. ...P...Macomber....Zr............................................................................................................................................................................. �nst:dier at ..................1.59 Arrol�head---Drive....Hyann .s.......................................................... ........................................................ .......... has been installed in accordance with the provisions of TITLE 5 The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........QSTRUEaq ..." dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �DATE................................. . ...,1. ..�........�-. .... ..... ................ Inspector .............. �11 ....... ... .................................................... _--- -•_ -_-_-__---_ ___-�� -------_ _-_ -,_---- _.-_-----_--- THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH TOWN OF BARNSTABLE 30 00 No........... FEE. $................... Biopoottl WorhD Tonotrurtion "permit Permission is hereby granted.----J.P.Macomber._J '...---••-••----------------------•••-••-•------•••----------•--•--._...._..---...........•••- to Construct ( ) or Repair ;kX) an Individual Sewage Disposal System at No.. ...159 Arro ead Drive H -annis •.----- ---•--••-••-11--•••---------•---•-•--•-• ••X Street ' as shown on the applicatio for Disposal Works Constructio er it No.. �_.. _ ed_ �-_--_----. �� y -•-•---••.......--••-_...... Board of ealth DATE.................... -- FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION /S_R A R P o W P eAd �2& SEWAGE # Xif- �- VILLAGE A/VA NW/S ASSESSOR'S MAP& LOTS- 4 f _1 INSTALLER'S NAME&PHONE NO. �. nn����Yt_t SEPTIC TANK CAPACITY qz� LEACHING FACIL TY: (type) - h :`'t` (size) cr NO:OF BEDROOMS 3 g' BUILDER OR OWNER PERMUDATE: f i5 COMPLIANCE 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 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 L 6O 1 http://issgl2/intranet/propdata/prebuilt:aspx?mappar=270185&seq=1 3/8/2013