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HomeMy WebLinkAbout0115 PINE AVENUE - Health 115 Pine Ave Hyanni -EWE s A= 308 - 21.1 o a i 0 4 4 G 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 fv 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 gei:the Business Certificate that is required by law. DATE: Fill in please: APPLICANT'S YOUR NAME/S: , � fq BUSINESS~ J YOUR HOME ADDRESS: At WA UM,'` "' ` TELEPHONE # Home Telephone Number oSDir (� D / �17;j'u + _rx+� { t+ NAME OF CORPORATION: NAME OF NEW BUSINESS` vr>' U ' ®' TYPE OF BUSINESSt Is'THIS A.HOME OCCUPATIONS ADDRESS OF BUSINESS. N �' . � 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 r 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 bee nformed of the permit requirements that pertain to this type of business.' MUST�;OMRLY'WITH ALL .t-'Aoli y l RAZARDOUS MATERIALS REGO ATVV,!c. 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: v'. Date:12/ l`l/ v TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE NAME OF BUSINESS: ►�tl Ss C. Y✓,c ovi BUSINESS LOCATION: yl K MIA— -INVENTORY MAILING ADDRESS: 4. 14&A TOTAL AMOUNT- TELEPHONE NUMBER: czU`r; ,'7,2j— 32 12_ CONTACT PERSON: ��_� n rw /A9" S EMERGENCY CONTACT TELEPHONE NUMBER: Sc�I (c j�s .(Qo�l MSDS ON SITE? TYPE OF BUSINESS: &eAeep ( Cry-too 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 0 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) .y 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) "EW ❑ 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 1 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS APPIi s Signatu Staff's Initials LOCATION SEWAGE PERMIT NO. W- Pi h e J -?g-2z-2, VILLAGE INSTALLER'S N� MIE & ADDRESS _- OR 0 NER / c c DATE PERMIT ISSUED DATE COMPLIANCE ISSUED -�, �© v c-� A �. r� o �� � �' `� � G�` J 2. 0 P � Fps....... .... No... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .� .u a... ..................OF... ............................... ................-......................... Appliratiun for Uhiprnual Workg Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �l -� oti Lt s t Location-Address or Lot No. :....... ........ — r.._.... Address .tw ...----------------------- --------------------- .--.-----.------------._._........._..._..- Installer Address Type of Buildi g Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—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. 1________________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....................... a4 --------------=-----------------•----•-----------------------------------......................................................... O Description of Soil__________________ V -------•----------------•--------------._....------•--------•------------------•------------....----------------------------------------•------------•--------•----------------------------••---•------ ----------------------------------------•-----______------------•---------------------•------------------------------------------------------------ --------- -----......................... U Nature of Repairs or Alterations nswer when applicable.----------- i_E,_�_ .._ -,,------- +�--------- . ....................... ---- ----------•-•---------------- Agreement: .. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T` y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been iss ed by the board of health. Slgne - ------- -- - � . Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:------------------------------------------------------------- --------------------------------------------- ..-------•-----------------------------------------•---------------------------•-•----.......------ `� Date Permit No......................................................... Issued_....`. ..... 1........................................ Date ` l =i�-•`" - _.. 1- - � �, rr may, No.-••-••••-- .2 v Fps.......�—�'r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..'..........`...'. ....................OF......��....... ..`....?":......I_------------------------------------------------- Appliration for Uhipoii al Works Tonstrurtiaat Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 9 -------------------------------------------------------=-------------------•---.......-----....... .••••---------------------•••-----.....----- Location-Address or Lot No. W ........ • .................. .... ............................................ _.._...._...._......._..._......_.............._...................._............................. Own r Address �f 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 ( ) Q' 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...................... . (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•------------------------••-••-••-----------------...--••-•------------•---••-•••----............................................................... 0 Description of Soil--................... - t '....................................................................................................................... �., ----- ----------------------------------------------------------------------------------•--------------------------------------------------------------•••--•••--•-•-••--•-- U Nature of Repairs or Alterations when applicable.____--.,,✓ 2 .......... ..---•--... - --------------------------------•--- ----------- -•--• -------- ---•---- ... ............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT y g g p y of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is d by the board of health. ` Signed''_ .� --•----•-----•-•----- - Date ApplicationApproved By.................................................................................................. ..------------------------------------ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ...................•--------------•--------•--------------------•---•----••-----•-------------------•---•----•-••••-•...------.--•--- --••••---------------•-------•-••---•--•••-------•--•-•------- Date PermitNo......................................................... Issued_...._\5--................................................._ ® Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................O F.... '' '"'" ................................................. (Intif iratr of Tompliaata THIS IS T ERTIFY, Tha t e In idual Sewage e Disposal System constructed ( ':); or'Repaired • �.� �? 0 //I staller `4 n at............... ---- •-- •----•--•--•--•--••-•--•-•• ••... •. has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the- application for Disposal Works.Construction Permit No......................................... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-- "-......................................................... Inspector............... �� ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w .Z de No......................... FEE._. ................. Disposal, IV"�k���aB #r permit Permission is hereby gran�ted�.•• --• •.-• ..�J� (`> ........................................................... to Constr ct.L. ) or Repair lam) an Indivi. l Sewage Disposal System Street y� as shown on the application for Disposal Works Construction Per-r No._... 62/arof ___ ated----- ".�. `..�+�.....ealth ----------- DATE-----.�...�'.�_.�.� FORM 1255 HOBBS & WARREN. INC., PUBLISHERS