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HomeMy WebLinkAbout0014 SUMMERSIDE LANE - Health 14 Sizmmers_ide Lane f Iyannis - - --- — A= 367 -07$: I e I 0 o a T YOU WISH TO OPEN A BUSINESS? _ 3 , . 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, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE: I Fill in please: isi;4<''• „_;L7,j,j; ,;a,,, .. :) YOUR NAME S: ( m '(YL •'"' °`'' '�'' APPLICANT'S / �j,, �IM�(� I(�ti C "` BUSINESS YOUR HOME ADDRESS: 14 5u TELEPHONE # Home Telephone Nfumber i ) 53l3— 4 a3�- -- '3-0 h� J' G�,„.:or,,.!u: ;�tt5c•e,ej•.. ,) E-MAIL: t'r /Yl NAME OF CORPORATION: C f Uc orJ NAME OF-NEW BUSINESS TYPE OF BUSINESS +i� IS THIS A HOME OCCUPATION?_ _YES NO ADDRESS OF BUSINESS ? um rs��r v�N MAP/PARCEL NUMBER �� I (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 operateour business in this town. UST.COMPLY WITH HOME OCCUPATION 1. BUILDING COMMISSIONER'S O ICE RULES AND REGULATIONS. FAILURE TO This individual has been jo r ed a mit requirements that pertain to this type business. COMPLY MAY RESULT IN FINES, ut oriz ignature** („ G COMMENTS: 2. BOARD OF HEALTH This individual has be i formed of the r it requ' a nts that pertain to this type of business. �' I t� rQMpLY INtTH'ALL ut orized Signature ** W.-RWQ iiktERIALS REGQ ATIONS 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: I Date:)/ /;i p TOWN OF BARNSTABLE t TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 1,Q.� I" NGOs, C-emsI U c;�-(*0 /y BUSINESS LOCATION: m INVENTORY MAILING ADDRESS: i S 0,96 8 TOTAL UNT- . TELEPHONE NUMBER: CONTACT PERSON: •2 r'�+m Cz. t rt EMERGENCY CONTACT TELEPHON NUMBER: �xa8� �l5-9� �� MSDS ON SITE? -�- TYPE OF BUSINESS: Ca �p� ( V 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 81, 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) i Other cleaning solvents Bug and tar removers h t' Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applic s Sig na u Staff's Initials= e t0 CAT ION- SEWAGE PERMIT NO. VILLAGE , .INSTA LLER'S `f NAME i ADDRESS U I L D E R OR OWNER DATE PERMIT ISSUED • t DATE COMPLIANCE ISSUED �- , �e .. / � \ : . � �, r � ; � � � 1. . r �` �� ::/� . � .` . _� N /� h • �.::s ` 0 .d :� --=—� ty �7i?'7 F ......................... No................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH LAWA.)...........OF...... .45rW. ........................... Appliration for llhiposal Works Tonstrurtion rrr*mit Application is hereby made for a Permit to Construct or Repair (e an Individual Sewage Disposal System at: - - j ///-- -------------------------------------------------------------------------------------------------- ion-Ajddress or--- Lot No. e..........i�� 4*fWX&e(-------------------------------- -------- ........------ --------------------....................................... 0 owner Address jot....&/ ess '11:00e ......... ... ... .. ... . ..... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling Building of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons_...._._..__................ Showers Cafeteria 04 Other fixtures ...................................................................................................................................................... Design Flow......................................_.___..gallons per person per day. Total daily flow-------------------------7-------------------gallons. 9 Septic Tank—'Liquid'capacity............gallons Length................ Width....___......... Diameter_.______........ Depth................ Disposal Trench' No..................... Width.................... Total Length.................... Total.leaching area....................sq. ft. 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. 1................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......._._....._..._.__. ----------------�0--------------------------a/........ ---------------------------------------------------------------------- 0 - -1 e �4 Description of Soil..............-1.41110 Alek.................................!!..... ........................................................................................ U ......................................................................................................................................................................................................... W .......................................................................................................................... �ri U Nature of Repairs or Alterations—Answer when applicable..........z� ....................................................................................................................................:.......................... ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beey issued by k%e bo of health. 00' oe Signe ....... .... V, Date ApplicationApproved By......... =IL---------------------------------------------------------------------------- ........................ ............... Date Application Disapproved forte following reasons:................................................................................................................. ......................................................................................................................................................................................................... Date Permit No....... . ........................................ Issued....................................................... Date ------------I------------------------------ 'No................ ......c% Fns..,r` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH . ........ Prf.� '✓..............OF..... t"g '�e' y'i",5cr pfirFattun for DiupuuFal Works Tonutrnrtuan Frrmit Application.'is hereby made.for a Permit to Construct ( ) or Repair (y-j an Individual Sewage Disposal System at: .,/�1 . .....................................•----.. ........-•------..........---•-----...... rv.l• o�ation-Address or Lot No. ........yj. /JsCf .........fl...t�.'9Jr w.l. /�;.11�y................................ ..............•................................................................................... � J Omer 1 Address •---...--- --..:--•--1.4•--•.••-.:....-�-i-•`.-- t�..................3::.:....:r�a*'P✓'G---•------------...----...----•------...........------------......_......•••••..............--- Installer Address Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion. Attic ( ) Garbage Grinder ( ) aP4 Other—T e of Building .. No. of persons........................... Showers YP g -------...--•---•--------- P - ( ) — Cafeteria ( ) Otherfixtures -...........--------------------------------------------------------------------------- -------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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. I................minutes per inch Depth of Test Pit.--..............--. Depth to ground water..--.................--. f3� Test Pit No. 2................minutes per inch Depth of Test Pit.....:.............. Depth to ground water......---............... .. ....:... .......... /'�✓... ----------------------------------------------------------------------01 --- -----------Description of Soil.. ..r .: :2:_ - -p............. x ----------------------------------------------------•------------------- c.� •••-•••--•-•-••••••-•••-•-•••-•••••••......•-•-••••-•--••--••••-•--........-••-•-•••--•.......•-•---....._-•--•-••••••......--•-••......-•----•-•••-•••..•... W . .....................••---•-----•-•••---•------••-----•••-----••--••--••••••-••-•---•-••••••••••••-••-•-•--••----•............. t �I�,��-�.�+--------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable........./w..i.Le .:.. ................................................. --- --------------------------•--------------------------------------------------------.....--,•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by zthe boar,, of health. Signe& � Date - ---- ----....- ------- Da........................................ Application Approved By-------- Date Application Disapproved forte following reasons-.............................................=..................................................................... ............................................................................................................................................................................... Date PermitNo.••••-•......::... d.�............................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ /�. d . .........:.......\. OF.. . .� Tr . (Irtfirate of Tuntpltttnr THIS I)�TO. RTIFY, ThaVthe Individual Sew ge Disposal 5istem constructed ( ) or Repaired r • .•.bY-----fix -----�=� i9a� f e' `� 0 ....,,` _�z '4 g::::'Y all , ............................. has been installed in accordance with the provisions of TF 5 The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......i%........... 0.............. 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 f -s ............. el 7cC .........OF.....- es, l ! l�l. No......................... _ J FEE..� s .. �tu�uuttl Turku �unutrnt~tiun- rrm't ._ Permission is hereby granted,.... ...t ........................................--�� to Construct ( ) off,Repair (4.)'an Indivadua. Sewage D* Sal•S stem't 44- Street as shown on the application for Disposal Works Construction Permit No'.......... :..-- Dated.._ --.(�..p-�•,............... w "= -----•------------- --•-•---------- -f.............. / ... ------ DATE.......P••........ `r ............................... oard of Health r...1 • FORM 1255 A. M. SULKIN, INC., BOSTON - a TOWN OF BARNSTABLE V ; LOCATION �t//�'/ � ' �� SEWAGE # ,/ Y 1 3 VILLAGE ®���� _� . ASSESSOR'S MAP 6z LOTS ,INSTALLER'S NAME 6a PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY CZ4 Z LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PU . . BUILDER OR OWNER'� -� DATE PERMIT ISSUED: r 1 DATE COMPLIANCE ISSUED! VARIANCE GRANTED: Yes No / �j •O • P�RAw} O I I e�©I No...9.��.�._� /FR13.......... APPROVED THE COMMONWEALTH OF MASSACHUSETTS earr�stabl®D0' "�U0f1 Deparan�t BOARD OF HEALTH �-'-" TOWN OF BARNSTABLE Si ed Date Applirativit for Diripa iial Walrkii Ta tititrnrtinn j1erntit Application is hereby made for a Permit to Construct ( ) or Repair (&- ran Individual Sewage Disposal Syst at ... .......... ... �.YYI.t? 1: ..Ctp-t Y4�1 .. .......................................... ocatinn :\ddrrss o Lot No. t ...... ` ... a..�.... ....... :.-----dew....y ....------ y� Oa•ncr _ � A r s ,/ -t- ►� � �C sso------.mg&t A•----- �: ............................................. Installer Address UType of Building Size Lot...........................S q. feet ... Dwelling—No. of Bedrooms.............43---------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water................... GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....:._._._............. P+' ------------------------------------------------------------------------•-------•---...:....................................---•-..............--------.•-•-- ODescription of Soil.....................................................................----•-------........--------------...-------------------•--------------------------....-----.----- x U ------------------------------•-..........-------------------------•---------------------------------•----------------------------------------------------------------------------...-•----.....-----•-- W ------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- x U Nature of Repairs or Alterati ns—Answer hen applicable.__.i.n1.s� .%�.........I..._ ,/QDQ....... ........SP, -l.".l�.....cdnn.e.c e�clat-1v`� ec - - 1.e�zc P Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha ee issue by the board of health. Signed ................ ........ ............................. ...... Dare Application Approved By ............ -± 1.....1�. 1...-....�...3...-.9 LIB v d Dare Application Disapproved for the following reasons: ........................................................................................................................................ ................................................................................................................................................................................................................ ........................................ D. PermitNo. ...........eJ. -t-1.......1.,3............................. Issued ................................................................... Dace 'ib - F> c — - ........ THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD' OF HEALTH ` ' �`���s `� TOWN OF BARNSTABLE Appliration for Dio.pooal Work,i Tonotrnrtion r'rmit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: ---- ---------------- I 1�ocation/ \ddress l ' 1 I -'- _f `SoLot No: Q........................................y r t ���O icr Address �..�......... ...................... ......................................... . Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms-------------�----.__---:---_.___.__._.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ......................................__.........••••-_._ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 7 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. 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........................ 0 ..................................................................................................................................•---•.........•••......-•-- 0 Description of Soil----------------------------------------------------------------------------------------------------------------- --------------------------------------------•......... W U •••••-•••••-•••--•••••-••••••••--•--......-••••-••......•••-••-•--....•••--•--••-•-•-•-•••-•----•••••-•--••-•-••••••••••----••••-•••--------•.........-•--••-•-.......•--........-•••---•............... W x ••• -------------------------------•----•••••••••-••••••...._..••••••-••••••••-------••-•-•••••.........•----•......•......... U Nature of Repairs or Alterations—Answer when applicable...__..L),5-f ..._...._I..........evo....q.:��........SPp... 7f}atJLc r�� ►� � +� ex ✓C fCC S-f" �Qs<t.� !? D.!............................................. ----------- -----I......... .. t Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has;bee •issoul y the board of health. Signed ................. 0_.,CL.44,e . .................................. ......I..-.�.t.e:..�1... Application Approved By ............ j....1 .t>. -4, .. ...................................................................... .....I ..../......� �/.L� Dare Application Disapproved for the following reasons: ........................................................................................................................................ ................................................................................................................................................................................................................ ........................I............... Dare PermitNo. ..........��..-Y......./_3............................. Issued .................................................................... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE TErtifi ate of Co ttplianre, THIS IS 0 CERT FY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ........./fit..................... at ........................ ......5;.......:.............../#.f'.V—............................. / ...................... has been installed in accordance with the provisions of TITLE 5 offThe State Environmental 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................................. .....--/.... ...:.91 ........................... Inspector ............................... ..\ ............................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p TOWN OF BARNSTABLE �� y No../..�/.- FEE.----- ............. �io�osttlnnorko �u�otr�trtion �rrYnit Permission is hereby granted - !�7.... ..----••••- ��n---------------- .. to Construct ( )_or Repair (✓�an Individual Sewage Disposal System atNo....)--------- -- -------=<�' e..............11-1 p................... ....... ........................................... Street p as shown on the application for Disposal Works Construction.Permit No., :Y.7/_3_.. Dated......... ------.-- ...---•--......--••-••--•.--. •-, .............................................. Q• Board of Health DATE.._..: ; ....1.. +_.`_..1.�� -••-•- I FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS