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HomeMy WebLinkAbout0402 BEARSE'S WAY - Health 406- -Bearse's Way ' - Hyannis' 292 160 , I I I v y I I I I n d li I u I n' N 1 II k 'I 'I P II II II 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, 11 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) 1 . DATE:^? Fill in please:" z APPLICANT'S YOUR NAME: 0Cdb_ (A4 .ia..i c.rw ':a €'" • BUSINESS YOUR HOME ADDRES TELEPHONE # Home phon umber ^ - —iD NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YE NO . Have you been given approval fro the buld division? YES NO D 01 ADDRESS OF BUSINESSA40q AP/PARCEL NUMBER 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 COMMISSIONyir MUST COMPLY WITH HOME OCCUPATION OFFICE RULES AND REGULATIONS. FAILURE TO This individual has bee of any requirements that pertain to this type of business COMPLY MAY RESULT IN I^INP_ Authorized Si n ture* COMM TS: L 2. BOARD OF HEALTH This individual h s een inf rmed bf the rmit quirements that pertain to this type of business. IIIIU,�sliA R ZO RDOU_10TER040461 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: N J TOWN OF BARNSTABLE Dater /29/ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS-.( BUSINESS LOCATION: Z R �NVENTORY MAILING ADDRESS: tI OITOTAL AMOUNT: TELEPHONE NUMBER: v -3(� -l'� 0 1�95 CONTACT PERSON: &by Cam-- �11 EMERGENCY CONTACT TEL HONE NUMBER: MS901 N SITE? TYPE OF BUSINESS: I_ 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) Photochemicals (Fixers) Gasoline, Jet fuel,Aviation gas 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 1&� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applica 's Signature Staff's Initials T0Vv 16 L:ARN STABLE 2� L'JCr"1.O1�I rG WA SEWAGE #vtOc�y i 3 L 2_f6c j'fFA/NI S-- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ArCk r Q1V 7'7,5- 136 SEPTIC TANK CAPACITY ? LEACHING FACILITY: (type) 00 C / $ (size)NO.OF BEDROOMS BUILDER OR OWNER 1'r5 E9,V IFC, AAC/ PERMITDATE: � 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 � Q o �► �} C4 �� i No. I • Fee THE COMMONWEALTH OF MASSACHUSETTSS Entered in computer: Ye—t/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for ;Mi!�pog;al i6p5tem Con5tructidn Permit 64A ZA, Application for a Permit to nstruct(Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot o - Owner's Name,Address and Tel.No. Assessor's Map/Par I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. i9Rei-j Lod 57 Co CAa I"A I gy S'o 7 S /3 o? 5e' 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. 641 �.1 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 Certifi- cate of Compliance has been iss d by this Board ealth. Signe A Date - Application Approved by _ Date Application Disapproved for th o lowing reasons Permit No. 7 cSb,� f�� Date Issued -716 No. `app s. � / ' ". .t . p Fee J� THE` Entered MASSACHUSETTS ` Entered in computer: ' - - i Yes PUB IC HEALTH DIVUSION -TOWN'OF BARNSTABLE, MASSACHUSETTS : , f 01ppYtcahon for 30iipozaf *pgtem Cott!truction Permit Application for a Permit to -onstmct( Rep ' ( )Upgrade Abandon( ) ❑Complete System Individual Components t Location Add ss or Lot o 0 r 7 to Owner's Name,Address and Tel.No. -- j ��.901SE s �A y �r .2 Si E'.✓ F c `f A 2� ' Assessor's Map/Parcel 02 / Installer's Name,Address,//and Tel.N ll�. Designer's Name,Address a%Te),No. C 4 o? t$7 F 4v �f Aq SOS � � s /.3ez 0 '754::� Type of Building: Dwelling No.of Bedrooms i Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures 7 Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title a Size of Septic Tank 3-W Type of S.A.S. 3 P° y:iu-1 M rS 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) ID -cy. 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 by.this Board-of Health/ Signed C� Date Application Approved by '� �- Date �7 — r Application Disapproved for th following reasons Permit No. D Vu Date Issued 7 U S —————————————--------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate Of (Compliance I THIS_ IS TO CERTIFY, that the On-site Sewaee Disposal System Constructed( )Repaired(x )Upgraded Ub Abandoned( )by llv dz } at �,)_" `�%`— �' S z=s has been construe a in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. u�S 3 ated 7/01 Installer 12 Designer(—"9,- .g � The issuan6e thist rmit shal of b!e c nstrued as a guarantee that the }_stem will 1,f/unction s designed Date `` -_ , [�� Inspector ----- ---------_--------------- ————— - - �- No. .2 U U- 1 Fee Mu � THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mgozaf *pztem Con!5truction Permit Permission is hereby granted to Co struct( )Repair Upgrade( )Abandon( ) System located at /'� t A SE S rig S - -C 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 ears of the date of th�ye`rm)it /J Date: Approved by 1 / /l J` TOWN OF BARNSTABLE LOCATION y(3'l �'Qta b l-AC5 rg WAY SEWAGE.#,!:Z-a05 VILLAGE UY�1 S4* ASSESSOR'S MAP & LOT 2-4 6 INSTALLER'S NAME&PHONE NO. ArC C oly 7-74 116 i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) C (size) oL"" NO.OF BEDROOMS BUILDER OR OWNER tr 5 Ar01 PERMTTDATE: 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 U 0 1 c c L � J0s� Aff71 Citizen Web Request Page 1 of 3 r !_ WN" „As: Citizen Request Management Frid2y, f�ic7u TOVdN`;0connelt Route to Users Search RegUC-StS Create Requests Changes saved Request Information Request ID: 31867 Created: 8/19/2010 2:53:42 PM Status: Closed Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard: Routine work: No Estimate: No Date scheduled: Estimated 9/2/2010 Change Estimated Aug September 2010 Oct Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 117, 18 19 20 1 21 1 22 23 24 25 26 27 28i 29 30 1 2 3 4 5 6 7 8 9 " Created By: O'Connell, Timothy Priority: Medium Health Office Citation Numbers: Requestor Information Requestor Hyannis, Ma 02601 Request Parcel Number 1HE" Asbestos Material within utility Map: 292 Block: 62 Lot: 01 Room Parcel Lookup Email: http://issgl2/intemalwrs/WRequest.aspx?ID=31867 8/20/2010 Citizen Web Request Page 2 of 3 Track Request Progress Request Work History: Internal Note History: Entered on 8/19/2010 3:06:39 PM System entry on 8/19/2010 2:53:42 PM: by O'Connell, Timothy Assigned to O'Connell,Timothy On 8-19-10 talked with tenant and has set up an appointment for 8-20-10. System entry on 8/20/2010 10:52:23 AM: Entered on 8/19/2010 3:32:09 PM Request Closed by oconnelt by O'Connell, Timothy On 8-19-10 talked with National Grid. The rep. did state a technician had been to property on Aug.17,2010 and did refuse to light a boiler due to asbestos. - Entered on 8/20/2010 10:52:23 AM by O'Connell, Timothy On 8-20-10 went to said property and met with ` ....'owner. Owner produced invoice that stated asbestos •problem had been abated. See file. Enter work progress: Enter internal note: (Viewed by everybody) I (Viewed internally only) i j i ( I I i i Spell Check I Spell Check i Add document or image link: Brc��se . You can also type in a folder name to see everything in the folder Current Links: http://issgl2/intemalwrs/WRequest.aspx?ID=31867 8/20/2010 Citizen Web Request Page 3 of 3 Time worked on request: FT. Response time: 0.10 J, Time entries are in hours. Examples of time entries: 1,25, 0.5, 0.75, 1, 3.5, 0,25, 0.10 Response time: Measured from the creation date to your first actions on the request. Do not include nights, weekends, and holidays in response time for most departments, C-. Reopen i 0 Reopen and notify citizen Reopen T ' Public Use: Printer Friendly Version Internal Use: Printer Friendly Version http://issgl2/intemalwrs/VYRequest.aspx?ID=31867 8/20/2010 ��j ALII}10RIZED;.' ' Work order number OM-1 ALER508-775-3083 /~ ROBIES Tel 800 698-4522 ® Heating—Cooling— Refrigeration Fax 508-534-1272 Date: Turn to the Experts. 279 Yarmouth Rd., Hyannis, MA 02601 info@robies.com Contact: w ww.robies.com Qty. Part No. Material Description Amount Service Phone: Address: :OF y� Phone: v-,f ❑ Job No. Billing: �-�,� /Service Call. <1T 4 A U`G� ❑ Preventative Maintenance ��j /J�/J CG�d�� �� �Ux � y ❑ Warranty Service �t�//,� ❑ Overtime Service, Equipment Info Service Needed: 4".7 Description of Work- �^ )•--, Service CallOr7 / minimum Service Technician Travel ON JOB Date start end Labor27 Materials Sales Follow Up Tax Work: Total /j 0 �7 Customer Signature: ROBIES'S REFRIGERATION INC.TERMS: Net 15 Days A FINANCE CHARGE Payment by: OF 1 1/2% PER MONTH (18% PER ANNUM)WILL BE CHARGED TO PAST DUE BALANCES OVER 30 DAYS. Robie Charge ❑ Cash ❑ X The customer agrees to pay all collection costs and attorney fees in the event if becomes necessary. Credit Card 13 Check Ili Work order number 508-775-3083 DEALER ROBIES Tel 800 698-4522 ® Heating-Cooling-Refrigeration Fax 508-534-1272 Date: Turn to the Experts... 279 Yarmouth Rd., Hyannis, MA 02601 info@ro6ies.com Contact��,� www.robies.com Phone: r-Service Qty. Part No. Material Description Amount Address: Phone: �j U�3 �/'��/% ens"i f �� Y�7�y�/`/i S ❑ Job No. Billing: �^ / Service Call Adoll"O. 'eo ❑ Preventative Maintenance AV coley-leoe � •---: p Warranty Service '• � y ❑ Overtime.Service 1 Equipment Info Service Needed: / �/ JiJ�J1O S �f'f 4VE�f Description of Work- r ` IT, Service Callminimum Service ON JOB �SS/U SL`L Date Technician Travel Labor start end MO/�"�U/����� s��C 1/✓/ Gr�� �sS�// -- �,/3� ��' 1 a l,c/,�-�°E�GL�S� �CG�1C�� /�/�'E.i9• a , L Eli�sj�✓i�r3��J sL.r^ A�c Materials ---� Sales G 7 7 Tax Follow Up Work: Total /�o G7 'Customer Signature: ROBIES'S REFRIGERATION INC.TERMS: Net 15 Days A FINANCE CHARGE Payment by: OF 1 1/2% PER MONTH (18% PER ANNUM)WILL BE CHARGED TO PAST Robie Charge ❑ Cash ❑ DUE BALANCES OVER'30 DAYS. X Credit Card ❑ Check The customer agrees to pay all collection costs and attorney fees in the event if becomes necessary. Notes: Refrigerant Tracking: Recovery operation: ❑ Type recovered; Quantity lb i Recharged: New ❑ 'Existing ❑ Both ❑ Quantity lb. 4 Purchase Orders: Date: P.O. # Vendor: Item: Date: P.O. # Vendor: Item: Credit Card Info: Card # Exp. Date / Visa ❑ M/C ❑ 9/16/03 Notice: This Form Is To-Be Used For the Repair Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM 1, (Aev_i ONJ �Y ,hereby certify that the engineered plan signed by me dated 4 110,5 concerning the property located at 40 3t, 404 -1_ -A c S W A y 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. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests at-the site without a health agent present. • 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-be located no less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the. Frimptor method when applicable) Please complete the following: A) Top of Ground Surface Elevation(using GIS information). 5,_�.QQ B) G.W.Elevation qJ .+adjustment for high G.W.rQ. p . = 4a : I C) DIFFERENCE BETWEEN A and B , 4 e.G Q SIGNED DATE: tJ 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. 9.1Septrc\percex=M.doc Permit Number: Date: Completed by: HIGH GROUNDWATER BEVEL COMPUTATION Site Location: 440'3t AD e} p-��Cs�;�P, �,�� � � N`.�� Lot No. Owner: L-,5A �c'Llc�c- Address: �'�' S - (0 Contractor: �v�cx31._ �t��9. �vCS Address: Notes: STEP i Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date _,3L2S 6-S AA� month/da /year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: _ OA .Appropriate index well..I..................................... o23Q OBWater-level range zone ................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... � �• . mo th/year STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), andvater•level zone (STEP 28) determine water-level adjustment ..............................................:........................................... . STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............... Ir Figure 13.—Reproducible computation form. 15 �, Town of Barnstable �W .o Regulatory Services Thomas F. Geiler,Director BARNSTABLE, • 'S. �0� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 4/13/05 Designer: Shay Environmental Services, Inc. Installer: ARCH Construction . Address: P.O. Box 627 East Falmouth Address: PO BOX 914 MA 02536 Hyannis, MA On 4/08/05 ARCH CONSTRUCTION was issued a permit to install a (date) (installer) L� ®G septic system at 402 &404 Bearses Way, Hyannis, MA_based on a design drawn by (address) Shay Environmental Services, Inc. dated 04/01/05 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF iygsSq o`er CARMEN cy� (Installer's Signature) o� E. 0 SHAY No. 1181 r o 01STF esigner's Signature) (Affix D p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form LCj.CATt10N SEWAGE PERMIT NO. l= I N S T A LLEAS NAME i 4.ADDRESS S U I L D E R OR OWNER/ t-1 u M a£ A-(ZAS TR 0S T DATE PERMIT ISSUED f DAT E QC0MPLIVN- E ISSUED � 0- 31 - S5 4 t1 t7(Z�VEwR� - H- as Lot1�rN� © ay�