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Home My WebLink About0041 COMPASS CIRCLE - Health �I -Compass-Circle Hyannis k•r 444 s y G A Y fi 1 k . r YOU WISH.TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 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.) 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, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: I aOl a Fill in please: APPLICANT'S YOUR NAME/ ;►'Sim . �. J71aEr1�7 ,4-is Kii�-�c BUSINESS YOUR HOME ADDRESS: LI I C "1e)"n a5S �7. � TELEPHONE # Home Telephone Number - r NAME OF CORPORATION: NAME OF NEW BUSINESS V5 TYPE OF BUSINESS L- _MPro��►clpn�s IS THIS A HOME OCCUPATION? ✓ YES NO ADDRESS OF BUSINESS i-I 'C S �V_ I-c 7�auaon , - MAP/PARCEL NUMBER `l q (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 ua-n E_�225_�_' 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 been; ormnof the`permit requirements that pertain to this type of business. MUST%;OMPLYWITH ALL �V RVARDOUS MATERIALS REGULATIONS Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS CENSIN AUTHORITY) .. This individual ha n infor d of the licensing requirements that pertain to this type of business. 474uthorized Signature* COMMENTS: l s , Date eo TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: ; ,:.l'y Cc�n�-rac' s'S BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: 6 � s EMERGENCY CONTACT TELEPHONE N M ER: �g-t MSDS ON SITE? TYPE OF BUSINESS: ,. 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 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 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS pli is na a Staff's Initials Ar Date:� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: Z11 INVENTORY MAILING ADDRESS: a5_9 TOTAL AMOUNT: TELEPHONE NUMBER: �� CONTACT PERSON: 4:�k4 415 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Your 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 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 betoxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents , I Bug and tar removers Windshield wash' WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Appli nt's gnaGre Staff's Initials 9" l '4 AT10 SEWAGE P 7� IT N0Z6!:(:� e- KC-LC VILLAGE h/'X/J r INST LLER'S NAM b "To BUILDER OR OWNE12 DATE PERMIT ISSUED 3 _ _ 7517 DATE COMPLIANCE ISSUED I Z � 0 w Irs l a n No..-•-.---./ .�...... ----.-.... �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ,� r'........................oF...... ....... .---------- .._... 'RRGEL.7 Z Alip ira#ion for 3 wpaoul Mirkii Tnn,itrurtinn Errant Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ....P`:.o f ... ...L4%G ..................... ....................•---•---...--•--.........-----------••----•--.........-•------................ cati -Add or No. caner ---------------------------------Address Installer Address - Type of Building Size Lot-------/9' 3.`f.......Sq. feet U Dwelling—No. of Bedrooms_ _._6................................Expansion Attic ( ) Garbage Grinder ( ) --_•--.__----- No. of ersons.........(a......_.. Other—Type of Building �� p ..._. Showers Cafeteria ( ) a' Other fixtures ................................... d ------------------------- --- ------------- ----------------- ------ -30 W Design Flow.... S______________________________gallons per person per day. Total daily flow......._. ..__ -----------------gallons. o� __ . ._ Width.............. Diameter.` b.' p---... Depth W Septic Tank—Liquid capacity-�_....._..gallons Length_ __ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....cz - ..---.sq. ft. Seepage Pit No.----------I-------- Diameter....._........ Depth below inlet..........: ..... Total leaching area....2.-0_.4sq. ft. Z Other Distribution box (l� Dosing tank ( ) 10fPercolation Test Results Performed by..__ 6 rxc_.._ �1l �xr -,.__________________ Date._..__ . __.._________._.. aTest 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........................ r _ .............................................---------------------------- : --.---------.......... O Description of Soil... -- •---•--••----••----•..... ............... --•---------------••-••-----•----•----........_.................-- ---•----------.............-••-..- .........................=----------------------------------.---------.---------------:.---- UW UNature of Repairs or Alterations—Answer when applicable............................................................._.........._......._.._....._..__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITi.;.., 5 of the State Sanitary Code—The*undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by th and of health. � _ z ate Signed.. ------------•--- -•-- •........- 7--..... Application Approved B f� :.. / 7 PP PP Y------- Date Application Disapproved for the following reasons--------------------------•----------------••-------:=....-•---------------•-•--........................... ..................................•-•-------•----------...---------------...--------.._..--•--............__. Date - Permit No......................................................... Issued--- ��(`- - Date 1. • ',\ :No...•_•--•--/-.......... Fss... 7 .....J....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � — --------------------OF...... ... .. ................ Appliration for Disposal Works Tonstra rtiinn rtrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: �' 2 �' .� ,; --L catio�n�-Address.A // �r or,�Lot�No. y L.... O,�!,'�fef.f .....e�._:� f�........................................• Owner ..... Address ................................. �. ............................ d........................................... L Installer Address Type of Building Size Lot.......A:.'e!C....Sq. feet Dwelling—No. of Bedrooms.._..._. .. .._.......Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building % :Z............ No, of persons.........Viz............... Showers Cafeteria ( ) a' Other fixtures -----•-•--•---••-•-•-••-•-••-••. . W Design Flow....`.....................................gallons per person per day. Total daily flow____._...=...=...........................gallons. WSeptic Tank—Liquid capacity.....f_?_.gallons Length._:.-... _.._.. Width................ Diameter.b..!_...._. Depth................ x Disposal Trench—No. .................... Width.................... Total Length...........,.._.r_._.... Total leaching area.... .....sq. ft. Seepage Pit No-_-------I-------- Diameter........ ....... Depth below inlet........�r_:_....... Total leaching area....2.0.4sq. ft. Z Other Distribution box (4*1 Dosing tank ( ) Percolation Test Results .Performed by... ..... --••---------•---- Date...... 17 r= •E Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT,, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .,:._.... .......... =•---•-�----- -----•- -•--•------- •-•------ D Description of Soil.... '"- " :!��J� v _, - - e �/ . .. ,> v ...................................................... ...................................... �.-----••-•-•----•-••••••---.__..--�'--".......--------- ------ W -•------------------- -----------------------------------•----•••••-••----•-----•-- Nature of Repairs or Alterations--Answer.when applicable........... •-------------------------------------•--------------------•--------•---•--•--------------------....---..........-•--------------------••--------------•--------------------------------------.......... Agreement: The undersigned agrees to'install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT`. y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the�board of health. Application Approved By � DTate`+ Application Disapproved for the following reasons:.................. .................•------...-•--•-------------------------------•---......--------------•------•----------.._...---•----..._..----•-------...•----...----------------------•--••------•-••--••---•-....... Date Permit No....:..................... Issued....-----........_.._.....-- =�,-�_ � ... ,. Date--- - -----• THE:COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !`. ....... ...OF.... . d ..'.. : `Trrtifiratr of Toutph astir THIS IS TO CERTIFY/That e Individual Sewage Disposal' System constructed ('�<or Repaired ( ) by....�� ? �..- H -� ....................................................... stalled / s_ has been installed in accordance with the provisions of..,T j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.: _.___...14.4............. dated......i�." .-7_.f ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE'CONSTRflq AS A GU RANTEE THAT THE SYSTEM WILL F 4CTION SATISFACTORY. e DATE--------- ------ -•--g2�d`..z� Inspector ---•--•-- ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH C79/�jj {' ././� .............. ................. .. No......................... -'--FEE.. .i.....-- .�✓,;� .... �t��tn�tt�t. nr�,� ��an�#r�r#inn .rrnti� `} Permission is hereby granted.. ��... .of± %'. ......................•-............................_................-•---•--- '- to Construct (`?` or Repair ) an�Individual,Sewag Disposal-Systerq, atNo..__z ...... Y✓� ..... 11 ..••-•••••-••••--••.............•-•-••......--••••.............-•-- •;y: Permit/t/. eet 'k* as shown on the application for Disposal Works Construction lrDated 1`.... ...... ..... .................. ___. _ _"_ _ ._.�.y.^.. ............................ DATE....... ��.�^.--�--��--"--------------•----......._.._...-•---••--- Board of Health FORM 1255 HOBBS & WARREN. 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