HomeMy WebLinkAbout0362 OLD STRAWBERRY HILL ROAD - Health 362 OLD.STRAWBERRY HILL ROAD
Hyannis
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4
YOU WISH TO OPEN 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.
1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is '
Take th.e completed form to the Town Clerk's Office,
required by law.
DATE:_Q Fill in please:
r -.,.,;,y,-., Y.,., ;,,,T•��:�.trr;:.': r.� _••,:��;:Iit' �; `.I APPLICANT'S YOUR NAME�
S:
Yi „�.,.a::4!:',i ?1L) `., ' :.•.I BUSINESS YOUR HOME ADDRESS—,
d'�9' ` ►L' 1l �;r- TELEPHONE # Home Telephone Number
W.'.• „•_w;t.�4t:J•.uti�;r,•,ri;i';:i? OR E I N #• 1 'L 1 Jr E-MA L:
-
NAME OF CORPORATION: — ' .
NAME OF NEW BUSINESS TYPE OF BUSINESS —
IS THIS A HOME OCCUPATION? YE NO -�
ADDRESS OF BUSINESS. :�6 _ n' MAP/PARCEL NUMBER ' c) 4 (Assessing)
When starting a new business these 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 ITcenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'1S OFFICE "
This individual has been of . rfed of an ,p , It requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPAT.10N
�- UL.ES AND REGULATIONS. FAILLME To
Authorize Sign ture* COMPLY MAY KSULT .IN FIIN��;
COMMENTS: '�. �/ �' C% Cc 61C
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2• BOARD OF HEALTH t� OMPLY WITH ALL
This individual has been informed fMthp&/_ re uir .- ents that ei,tain to this e of business. M` _ P type FfA'^•ROU -MTFRtALS RGULRTt15 .
Authorized Signat re
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
E. Authorized Signature** u`
`COMMENTS: .
TOWN OF BARNSTABLE Dater 1P1q
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: 41-1 u "s lyoi .Affl1 :�Ipyi t<-.
BUSINESS LOCATION: 3&a V�ft� 1�{ INVENTORY
MAILING ADDRESS: ? kA,01o�vt TOTAL AMOUNT.
TELEPHONE NUMBER: LA -1ia
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: Ai MSDS ON SITE?
TYPE OF BUSINESS: LAV�kcA oe-
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 re uires 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 0 USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ;J USED (insecticides, herbicides, rodenticides)
Gasoline Jet fuel Aviation as Photochemicals (Fixers)
, 9
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 None,
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash ,c
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A plica is Signature Staff's Initials
AT ION SEWAGE PERMIT NO.
V I L-MG E _ � a 9
INSTA LLER'S NAME & ADDRESt n
B U It DE R OR OWN ER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � 0� - 7;7
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THE cowmomWsAc,:�xopwAssAoHussrrs
BOARD r HEA),
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Application is bercbv-oadefo« u Permit to Construct or Repair ( ) an Individual Sewage~ Disposal
System at
go or Lot No
Owner Address
'
' ---'�—'---- ----'----------''-------------'------ |
^��u� ^° Address
Type ofBu�d�e S��
Dwelling of Bcdr000�s-------�����---.-Exouos�o Attic ( ) Garbage Grinder (1n�� `
Other--Type of Building ----.----.- No. ofyersous---------- Sbonccm ( ) Cafeteria
(}tbcr6 ----''---------_---' ------------------------------------------------------------------------------------------
Dco�p Flow----~~&-C�- per person per day. Total daily flow.--*2:����-------gJloo,. '
Septic Tnok--L�n@cupac6v.^��J.��Douo Length-__-_ �V�hb----_ D�m�er-----. Dqx|`---.—'
DisposalTrench--I�o.-----_-' VV�H�'-----. Tota --_--- Iota area------.sq. 6.
| � �� Seepage Pit I�u------- D�oetcc---.---. Depth b� - I uuzacc'------sq. ft.
�� Other D�t�bot�mbox ( ) Dosing tank ( ) �� �2-' �'��v���- ^ �'-��^-^'��
~~ Percolation �[cotDcodto Pe�oco�edbv_-------_-'--.-'`'----------- Do1�---------.---'
. TestPit No. L-_---..minutes per inch Depth of Test PiL.-.----. Depth to ground water.-.------- `
(X4 Test Pit No. 2.---_-.miou1 spec inch Depth of Test Pit-.---.--. Doydb to ground water----- --------------
----------- `
0 ' `
r. _��* -----------------------------
-'=°="�=-'��'=-'-.-="..=�.-=°=-�=-----_--
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
� U Nature of Repairs or Alterations—Answerwhen ---_-'''''_-'-__---.------'--_-- �
�
--'--''--'''-''-----'--'''---''---''--------'---------------------------'--
egrccozcot:
, The undersigned agrees to install the uforedcocribed Individual Sewage Disposal System in accordance with
de provisio ns of Article XIof the State Sanitary Code—De undersigned further agrees not m place the system in
f.
Date
operation until a Certificate of Compliance h b.een issued b the board of health.
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__
Date
Date
7P J f�+
No.......................... Flm ✓:.. .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD H T
OF.......... ... .. ...... .. ...................
u
n
Applirutiuri -fur Uttip uttl Works Turifitrurtion Vrrulit
Application is hereby made for. a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at �
-
"tio. A or Lot No-•--••••-••.-•---•--•-- ---•. .l . ...
-
wner Address
a ••----•-••---------------- ......•••.................•••• ......•••-••....--••--•-•----•--•-........_.......••••....... ._...... ...•••••••••••••----
Installer Address
U Type of Building Size Lot..r`•��t.#.Vr .Sq. feet
.-� Dwelling—No. of Bedrooms - .-._..Expansion Attic ( ) Garbage Grinder
a4 Other—Type of Building ;Y--.-. ---:--____-._::- No: of persons. ......: ---------_...... Showers ( ) Cafeteria ( )
Q' Other fi ures ----------------------
Design Flow............ __________________ _gallons per person per day. Total daily flow___..__�+t•..... ..._..._.gallons
WSeptic Tank—Liquid capacity__: Ilons 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. 1________________minutes per inch Depth of Test Pit.. __...._....._.... Depth to ground water...___..._____.__.._..
f� Test Pit No. 2----------------minutes per inch Depth of Test Pit....................... Depth to ground water--------------
-------- -------- ------e
O Descrion o ---tif y
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W
UNature of Repairs or Alterations—Answer when applicable... __-:.............._-_-_- :.:r:'_
Agreement
The undersigned agrees to install the aforedesc-gibed Individual''Sewage Disposal }5.ystem in accordance with
the provisions of Article LI of the State,Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance h been issued b the'.board of health
S. �,,,,F,k-- * ,R�l'r
i
. ate
A lication Approved B -+ ! ---- * , �.'" `
PP PP
Application Disapproved.for the following reasons:........................... ..____ h. ......: ...... ............... ....:_____._.Date
._._..........
........................•--•-•-----•-•-••----•--•---••--------------•--...--•-------...----.....----------------•------------------:.....-----•---•-- --------------------------------_.................
Date
PermitNo........................-•-•••......----•-•••••-•--•-.. Issued....................- -------
F Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD : .. F HEALTH
. -.".'!`."`OF........ :..... .................................
�rrtif ir�tr �f 'f�um�liurirr�
T IS IS TO C TI hat the Individual Sewage Disposal System constructed ( ) or Repaire ( )
by. + • ----•-- ... --- - - - --- -
i_
,. 7r�•
ai............... ______ ____ ___ _ ------ - -.L --1IICr. .:_ __•_______•_ __ w .___!�'•�---:< _. _ /.
at----• V " � ...
has been installed in accordance with the provisions of Ar I h State_Sanitary C `e as desscci bed in the
application-for Disposal Works Construction Permit .lo____ _________ _____________________ dated ..�jd,.: /t .. :/�.__........
THE ISSUANCE OP `THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS_A GUARANTEE,THAT THE
SYSTEM .VVI'LL FUNCT9ON SATISFACTORY.
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DATE.............................---------------------------........................ Inspector.........................................................................
THE COMMONWEALTH OF MASSACHUSETTS,....,,
a,sf
BOARD t6f , HEALTH ¢;
OF..... .......... ............................... .......
Ro � ......... FEE
RitiVuii Nor trurtiuri Vamit
Permission i reby granted ----------- -----------------
to Coirsfr t •or R r Individual stemOf
at No: - ... •• . •• a
e ff /,, �-�
as shown on the application for Disposal #; orks Construction Pe• rt o. ._ ated__j,�� v .. ............•-••-
r_ --•- -
OCJ S` Board of Health "' -- ------..
DATE.._......---•--------- _...-----.��-............................. , r
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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