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Home My WebLink About0030 CEDAR STREET - Health FHyaannis dar Street (formerly#30) - 022 Ha�ardo s Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines,thinner to clean brushes all count as hazardous materials-no blanks) ySttorage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. i 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 explain it At__Ltach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. 1- L Date:t I I I TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS{'1T ON-SITE INVENTORY NAME OF BUSINESS: "h aW �T SF_RAC L-,-G BUSINESS LOCATION: S—F ' INVENTORY MAILING ADDRESS: _�O TOTAL AMOUNT: TELEPHONE NUMBER: , CONTACT PERSON: L- (K EMERGENCY CONTACT TELEPHO E NUMBER: MSDS ON SITE? TYPE OF BUSINESS:CLVm.)I - 0,;7P CE - plasi A,-- 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 j 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 1 Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes S Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) t Any other products with "poison" labels ❑ NEW ❑ USED (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): jMetal 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 Staff's Initials 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 form at 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: APPLICANT'S NAME: C✓ C! (- C\oQ R�, , YOUR HOME ADDRESS: 70yi I� 4�NN�AS VAA 0 LO l ' BUSINESS TELEPHONE # 5-sc-?-3e14 S Ut HOME TELELPHONE #: ��j • q�(�-f �� NAME OF CORPORATION: FN A'21J G\0 IGCS FID # NAME OF NEW BUSINESS E — 1� kGt D C- N IC-�TYPE OF BUSINESS IS THIS A HOME OCCUPATION? NO cL- IV4<!�r ADDRESS OF BUSINESS? CEDAR- S, ouJ MAP/PARCEL NUMBS -Vdoh -(Assessing) T6 Ole l 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 COMMISSIONER'S OFFICE This individual has.been informed of any permit requirements that pertain to this type of business. 3� Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has beerF,'nfor ed of Me per it requirements that pertain to this type of business. Authorize\ Signature** COMMENTS: �" MUST TH ALL "AZARDOUS MATMIAI S REG n „Tie is 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** / h LOCATION SEWAGE PERMIT NO. VILLAGE' INST R'S NAME & ADDRESS ® U I L D E R OR OWNER DATE PERMIT ISSUED i DATE C 0 M P L I A N C E ISSUED 1 Idoe o - i i i LO CAT IOb S I V A G E PERVIT p0• -- --" dILLAGE " I H S T PIS NALIE b ADDRESS 0 U I L 0 E 0 OR _Ot7nER -- DATE PERMIT ISSUED DATE COMPLIANCE . ISSUED _ _ ` /` �Q W .a. ry y '� — � e r^ �� G I � �a FBE THE COMMONWEALTH.OF MASSACHUSETTS BOARD 0 HEALTH .......OF.......... ..... ----------------------- p)-m Ajip iraftvn for 11isposal Works Tonstrurtion ramit S-f "'TO ��4 Applicatioh is'hVfby made for a Permit to Construct or.,Repair an Individual Sewage Disposal —System at- * e'- jr -------------- ------------------------*......................................................................... ------------------- ------- ......L.c d ess or Lot No. ....... .... ... ... . ................................................................................................. Owner Aid cress ............. .. .... ............................. ........................... ........K..t................................................ Installer Address Type of Building Size Lot............................Sq. feet .......... Dwelling No. of Bedrooms................. ---Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons................._...._.._.. Showers Cafeteria Other fixtures ................................................................................... ................................ --------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacity............gallons Length................ Width....._.._._..... Diameter._._.._..__..__. Depth.............._. Disposal Trench—No..................... Width.........._.._._.... Total Length.....................Total leaching area....................sq. f t. Seepage Pit No--------------------- Diameter..........._.__._... Depth below inlet.................... Total leaching area..................sq. f t. 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_.__.................__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit..._........_..._... Depth to ground water........__........_____. P4 ...*-----------------------------------------------------------*------------*.....*--------------------*"'*"*--------------*-------------------------------- 0 Description of Soil........................................................................................................................................................................ ----------------------*---------------------------------------------------------------------------------------------------------------*--------------*--------------------*------ .................................................. ...................................................... --/----------------------------------------------------- xz__U Nature of Repairs or Alterations—Answer when applicable.-____ ... ;f.- ....................................................................................................................................rt............................................................... Agreement: The undersigned agrees to install the aforedescribed Ind* i ual wage Disposal System in accordance with - I ual the provisions of TL IT�U 5 of the State Sanitary Cod The ndersi ed further agrees not to place the system in Compliance 'le operation until a Certificate of Compliance has ssued UPt 'e bo a� oaf health. ....................... ......................... ................................ .831ned. ---------------- Date Application Approved By............. ... ... ..... . ..&P'l............... / Date Application Disapproved for the following reasons:............................................................................................................... .................................................................................................................................................................................................... Date Permit No.............................. Issued_ ....................... Date Nof�f_ ;?_7kl. nr T FEs THE COMMONWEALTH OF MASSACHUSETTS ,BOA R D O �-I E A T I-I '1.......OF........ .................... Appiira#ion for llhiplls ai Workii Tonotrnr#ion-rnmit Application is hereby made for a Permit,,.to Construct ( )-or,Repair ( ) an Individual Se age Disposal System s7,11". at: - �...........................� ' ............................................... - -'--- --------••--•-------- ..... -_ . on- d ess or Lot No .._... -• -..._.._.. - -- --•- --•-- . . 1 WOwner Address airh�r------•-•-• .C-�- �'��'ir�-.;..t---`�'' � .............................................. Installer Address UType of Buildings Size Lot............................Sq. feet d I-� Dwelling No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder O pa-I Other-Type, of,,Buildi ig,I........................_... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .........................----------•-•----------------------•-----------------------------------•--------•-•------•---------:_.....-••••--......---• W ,'! Design Flow...........:................................gallons per person per day. Total daily flow..............................._............gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length---,........_........ Total leaching area....................sq. ft. "`;Seepage.Pit No..........>_---------= Diameter____________________ Depth rUelow.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------------------------ 44 Test Pit No. 2.............___minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •... •------------------------------------------------------- •------------•-•-•-----------•-----•••-------------------------------------------- ---------------- 0 Description of Soil....................................................................................................---------------•--------------------------------•------------------ x ------------------------------------------ --------------------------- --------- --- -- ----------- x --------------------._...------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable.._____'�t }_ '-_._ �"�'�f�_ ________. ----------------------------•------------------------------------------------------•--------•-_._...-•-----••------------------ ............................................................... Agreement: The undersigned agrees to install the aforedescribed Ind' 1 ual wage Disposal System in accordance with the provisions of TIT?.i� 5 of the State Sanitary Cod The ndersi ed further agrees not to place the system in < operation until a Certificate of Compliance has Lek. sued bo pf health. Bi ed._ - ........................ to r-� Application Approved By.........` ,ti±(o l�l:_.... ...... ! ................... Date Application Disapproved for.the following reasons--------------------------------------------------------•--------------------•--•--------------------....._-•••-- .................................••••-------._._.... -••------•-•-•-•----------- ---------------------------------------••----................................................... �^ Date Permit No................................... ......................... Issued....1�'_:`_�!J` .. . .. = - - - - Date I THE COMM':ONWEALTH OF MASSACHUSETTS •'"'BOARD EALT 4/2 ax .... .... .... ...:....OF . . ... ...... . ......:. . .. Trrtifirtt#r of TompliFana THI' IS &.0 FY at the Individual Sewage Disposal System constructed ( ) or paired by = �' ---- In1 _; i ---- _ -;.-`'�---- --- .-- ` has been installed in cordance with the ovisions of " j, 5 of The State Sa. ry Cgde as described in the application for.Disposal Works Construction Permit No--�----�'--r�-------......... date ...... -.--.--••._ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WILL .FUNCTION SATISFACTORY. DATE.............[ .............--.............. Inspector.---- '----�---.........-�l�:._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . EALTH .._.. No.......__°�.7 .... FEE...: Ul svoo o . ion #r ion rruti Permission is hereby grante ---"' -- _1 - ' "'- •----A------------•-------------•-••-•--•---------------•-•........................................ to Construct ) or Repair ,.-an ividual Sewage D' p os Syst a at No._'`� Street as shown on the application for Disposal 7orks Construction PeruaiiVNo.._ Dated D -- Q Board of Health ATE----- " FORM 1255 HOBBS & WARREN- INC., PUBLISHERS - - -