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HomeMy WebLinkAbout0379 WEST MAIN STREET UNIT UNIT 3 - Health 379 WWEST MAIN,,ST-REET>',"d . W Iy161S Al, A = 269 100 ='OOCf. ,�, . Ha ar j s Materials Inventory Sheet Checklist of 2�l � Date X Physical Street Address-Check database to ensure it exists �C Working Phone Number /7—Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) x Storage Information -location of storage, how long is storage for? If none, note that. �G Disposal Information -where and who? If none, note that. Applicant Signature -understand what is listed and noted ,49 Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach 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. t G►�r�� �fi��is ac�lcl rc�S �S d� .� �n ��� YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 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.) Business Certificates are available at the Town Clerk's Office, 1'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: lr''C "ie y p Fill in lease: APPLICANT'S YOUR NAME. n BUSINESS YOUR HOME ADDRESS: kk l D 1_- v k✓-Q- _n� err^� �• TELEPHONE # Home Telephone Number 43 -Cc��- f 3� NAME OF NEW BUSINESS ICE TYPE OF BUSINESS F) IS THIS A HOME OCCUPATION? YES NO \/ Have you been given approval from the building division? YES NO ���� ADDRESS OF BUSINESS U ESr -� S « c . ,A- MAP/PARCEL NUMBER 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' FFICE This individual has been i r of any per equirements that pertain to this type of business. 40-6h-orVed Sigrla ure** J , COM ENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. ¢e Signature** COMMENTS: S ( i VJ S;!2 a'f_�_C4j VIP AeatA 0-1 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: D�THe t Barnstable Town of Barnstable A&AmedcaCft WAS& `� � Board of Health i639• ��� '°rem ram+" 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Public and Environmental Health Program Policies,Procedures, and Guidelines 4. Tight Tanks at'.Beauty Salons and Barber Shops No. 2010=06 [The State Environmental Code, Title 5, 310 CMR 15.000, prohibits the discharge of beauty salon/barber shop industrial waste into an onsite sewage disposal system and requires that this waste be discharged into a holding tank. This policy only applies to beauty salons and barber shops which are connected to onsite sewage disposal systems.] On June 8, 2010 the Board of Health voted to issue the following policy relating to hair salons and barber shops: 1) Every owner of: • any new hair salon or barber shop,or • any existing hair salon or barber shop which is seeking approval to install additional seats, or • any salon or barber shop where the onsite sewage disposal system fails a sanitary inspection, or • any salon or barber shop that has a change in ownership, or • any salon or barber shop operation that has a change in licensure. and which is connected to an onsite sewage disposal system shall submit plans for an industrial waste holding tank. The plans shall be submitted prior to opening for business, installing additional seats, or upon discovery of a failed onsite sewage disposal system, change in ownership, or change in licensure. The plans shall be prepared by a professional engineer, designed in accordance with 314 CMR 18.00, and shall be submitted to the Department of Environmental Protection and to the Public Health Division Office,at 200 Main Street Hyannis Massachusetts. 2) All hair salon and barber shop holding tanks shall be installed in accordance with the approved plans prior to opening for business, prior to installing any additional seats, or upon discovery of a failed onsite sewage disposal system, change in ownership-or change in licensure. Q:Policies\TightTanlcsatBeautySalonsand Barbershops Revised 6/12/2010 3) Any sink, which is connected to the approved holding tank, shall be designated as a hazardous materials/chemical discharge sink. Clearly visible, permanent signs shall be posted at the designated sinks indicating that any and all potentially hazardous materials and chemicals shall be disposed of into this sink Signage at other sinks, at the same facility, shall also be posted clearly indicating that no employee(s) shall discharge any potentially hazardous materials or chemicals into these sinks. Each sink shall be posted separately. Wayne Miller,M.D. Junichi Sawayangi Paul Canniff,DMD Q:Policies\TightTanlcsatBeautysalonsand BarberShops Revised 6/12/2010 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 Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law: DATE: a o / Fill in please: APPLICANT'S YOUR NAME BUSINESS YOUR HOME ADDRESS: 7 d �d -44%•L—1--,1P —,1 42^ T € i i i i stl /S't�T� !✓i I Y� �'Z Gi Cj Z.0 -- O : TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS�I r�� Ct�Gi�`G- h�� F` �zs� R2 TYPE OF BUSINESS 4 C.r`s?' IS THIS A HOME OCCUPATION? YES NO ESS °1MADDRESS OF BUSIN f ) AP/PARCEL NUMBER Z(A I Ob 00 (Assessir g) 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 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 orVed of the its that pertain to this type of business. MUST COMPLY WITH ALL Ka,r I VIe perm requirements HAZARDOUS MATERIALS REGULATIOhlq 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: YOU WISH TO OPEN A BUSINESS? For Your. Information: Business Certificates cost $30.00 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 R signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1s' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. , XMt NFill in please: Date: I APPLICANT'S NAME:. s;, r YOUR HOME ADDRES p T� ,��, - 9-2 °r, `' s HOME T BUSINESS TELEPHONE ELELPHONE #: t NAME OF CORPORATION: FID # NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NOS ADDRESS OF BUSINESS MAP/PARCEL NUMBER (Assessing)- 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. Authorized Signature" COMMENTS: 2. BOARD OF HEALTH MUST COMPLY WITH ALL This individual has be informed of the permit requirements that pertain to this type of business. HAZARDOUS MATERIALS REGU�AT!rIWq (� ry I VI 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: 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, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and-get the-Business Certificate that is required by law. DATE)Lko-10 2, 1Z Fill in please: APPLICANT'S YOUR NAME/S: 1 SCE Cot (()CC-( Bp Y �N S),_4C'I YOUR HOME ADDRESS: Q 2, lam. l l i1 �-G C9 TELEPHONE # HOme Telephone Number 1 IU NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS ' 0 IS THIS A HOME OCCUPATION? YES O tA, U Z_(00 I ADDRESS OF BUSINESS Ai Lj--,-1144 tt)4_MAP/PARGEL NUMBER Aaq- 100 -00G (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 tovun. 1. BUILDING COMMISSIONER'S OFFICE 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 he beets farr4a� of the permit requirements that pertain.to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has P+n i o d of the licensing requirements that-pertain to this type of business. Authorized Signature** ° COMMENTS: © LlJC,61'v L9 LA S(✓)e3 alJ" TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory s,Printers dy Shops unsatisfactory- 4.Manufacturers COMPANYG Lt �5 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS q�_n �L= �AVNM ST• Class: 7.Miscellaneous N I�NN� . QUANTITIES ANDS R.OAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS AboyetaAs uMs _ IN OUT IN OUT IN JOUTI#&gallonslAge ITest Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) -.I new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: dbu O9 _ c S 0 vvu a (� DI OSAL/RECLAMATION REMARKS: 1. S�itary Sewage ter Supply Town Sewer ubl-c O On-site OPri to 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC - O Catch basin/Dry well O On-site system 5.Waste Transporter Name o •d YES NO 1. I 2. P son s) n ewed Inspector Dat TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 611- AbegAvmw Mail To: BUSINESS LOCATION: , . Board of Health MAILING ADDRESS: 5,9 � 1 � Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: Y"21� EMERGENCY CONTACT TELEPHONE NUMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalliinngrat any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes / Cesspool cleaners Hydraulic fluid (including brake fluid) y Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) - . Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers �r hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents A?Wn/eA,' Bug and tar removers v Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business : ,41111111110 TOWN OF BARNSTABLE Dater J TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: /141 V1 I� i TOTAL AMOUNT: TELEPHONE NUMBER: CO CONTACT PERSON: W h EMERGENCY CONTACT TELEPHON NUM R: MSDS ON SITE? TYPE OF BUSINESS: 4AL S 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) rn � S I UM Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash V\11;j lot, 30 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINES A pIicant' S're Staff's Initials Dater XIC AND HAZARDOUS MATERIALS REGISTRATION FOR NAMEOFBUSINESS: h• Y �'. ��'� _BUSINESS LOCATION:,�T MAILINGADDRESS: 3 m-eyl e— Mail To: TELEPHONE NUMBER: _�50? 7 7/_,3;?9 S"_ Board of Health CONTACT PERSON: Town of Barnstable P.O. Box 534 EMERGENCY CONTACT TELEPHONEAA// �NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: dye- 'Salo" Does your firm store a of the toxic o hazardous materials listed below, either for sale or for you own use? YES t/ NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) 1 Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids F--Wh^ -Sot V*Ctl s0 u-n-c�j (dry cleaners) jv-f,0,, r Other cleaning solvents kt. �� 9 - 49� uz Bug and tar removers � �� v If 1Oh WHITE COPY-HEALTH DEPARTMENT/CANARY COPY`BPSINES 1� i fJ '77/- 39� TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory BOARD OF HEALTH 2.Printers3.Auto Body Shops R unsatisfactory- 4.Manufacturers COMPANY � ��Cf� ' c O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ass• "d .s 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT-outdoors) MAJOR MATERIALS Case lots 1 Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 91 r1al�l o DISPOSAL RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer Public O On-site OPrivate � 3. Indoor Floor Drains YES NO O Holding tank:MDC t O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_>� NO ORDERS: O Holding tank:MDC .Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler 1 ' o' ct YES NO 1. 2. Person (s Int &wed Inspector Date