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HomeMy WebLinkAbout0091 FALMOUTH ROAD/RTE 28 - Health 91 Falmouth Rd. Hyannis rgmAntu-Repay, r NI I i 1 VV� I i O YOU WIS14 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 fi rst obtain the necessary signatures on this form at 200 Main St., Hyann is. 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: G� �J Fill in please: APPLICANT'S YOUR NAME/S: U BUSINESS YOUR HOMADDRESS: TELEPHONE # Home Telephone Number r r iv,i4,Uth7ul�t PJ OR E I N #: E-MAIL: iw1y r b iG NAME OF CORPORATION: ' NAME OF-NEW BUSINESS ✓^ /{ TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS. u./ v�j— MAP/PARCEL NUMBER ,- 1' 1 6-1 c!— (Assessing) When starting a new business there are several things you must do in order to be in compliance with the ruies 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 COM SSION R'S OFFICE This individu I hsA i or'm y rmit roq 'r is th pertain to this type of business. Af Al CAC ut riz Signature COMMENTS: 2. BOARD OF HEALTH This individual has been in r a e eq 'rements that pertain to this type of business. AuthDPiZW Gtffnature** COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This Individual has been informed of the licensing requirements that pertain to this 1 type of business. Authorized Signature* COMMENTS: ' I auto salvage ymd op ul I It d d—peep 72 5 t/2 it / stub tied - in `°pud Aug 12 04 a I1ap Parcel 4tf 311 - 72 / f P 4� / JP 1 coDDed 6. 4 at 5 It deepp y� ^1 y r do� drop of 5 1/4 It dceo / pe•/ / at 2 1/ It dceo J r� s d t F O � Jf 4 JM1 v drop clew-awe 3 3/4 It decD Oif P .ant 55 ft _, try" aye 6 !t°It de.eep;, 91 Falmouth Road , Hyanni5 4 .6 reducer eccentric Date: 1(/ Zl / to, TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: XPA A BUSINESS LOCATION: get,, PkUA.0(jk-(- &6. , 4AAAAtkiJ1A INVENTORY MAILING ADDRESS: [.��cS ci.�- TOTAL AMOUNT: TELEPHONE NUMBER: (,008'� �-�S - 31 I CONTACT PERSON: �! kck Wr P. an S U EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: USG• m 2 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 ❑ 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 /v (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A licant's i natu Staff's Initials 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 the Town (WHICH YOU MUST DO according to .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, 15' Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is requited by law. DATE Fill in please: ��nis )2l N A -ks APPLICANT'S YOUR NAME/CORPORATE NAME t o as i An ti BUSINESS TYPE: 1/SE7 &, SQtes BUSINESS YOUR HOME ADDRESS: �a . 38 norii C�rst'� Crnkcr��11G TELEPHONE Home Tele hone Number mail Address e- a• r..- NAME OF NEW BUSINESS Y �., �+`G Have you tieen`given approval i om thecbuildin,'g division? YES �/. NO• ADDRESS>_OF,B,USINESSl 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'COM S 10 R'S OFFIC This individ I inforrpe oNaopmit re" e�ntss at pertain to this type of business. Aut orized Sign ture** COMMENTS: an - c.Ccl .JL ( u 12 OSQ-� 2. BOARD OF HEALTH Mun OMPEY WIITH ALL This individual has been informed of the it re uirements at pertain this type of business. �WRDOUS MATERIALS REGULATIONS Authorized Signature*` COMMENTS: 3. CONSUMER AFFAI *eSnakira" UT TY) This individual.hf e sin requirements that pertain to this type of,business. COMMENTS it ti I YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 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 signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15f FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. - - Fill in please: Date: 07�huA 2o f Z APPLICANT'S NAME: `v-��v `�-n l� -ziiz '5668K TBONVAN T ¢ YOUR HOME ADDRESS: 3L4 P0LcAd0c-K \N0,`f aF h-1CAS �� Ne �, "1 �a .LLc4 i - yZcl z ' ' BUSINESS TELEPHONE # 508._ -7 7 j - ����� HOME TELELPHONE EIN NAME OF CORPORATION: . VAC-Uu M mq FEE b A FID # NAME OF NEW BUSINESS F1 rU s L1eG h U I Ux TYPE OF BUSINESS VACUU M -SAL. IS THIS A HOME OCCUPATION? YES ✓ NO ADDRESS OF BIJSiNESSI FQI "Kyt I�1Q MAP/PARCEL NUMBER (Assessing) 4q AI\S0r5 o1 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. R 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 This individual ha een info ed f the eLmit re it ments that pertain to this type of business. Authorized Si ature** COMMENTS: MUST�;OMPLYWITH ALL M-ATERIALS REGULATION'S 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** 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 to you must do by M.G.L.-it does not give you permission to operate.) - Business Cert"ificates are available at the Town Clerk's Office, 1=town (which 367 Main Street, Hyannis, MA 02601 (Town Hall) L., 367 SZA DATE:Z� APPLICANT'S YOUR NAME/S: L 1 Fill in please: BUSINESS YOUR HOME ADDRESS: /� j :fits a. ax�;s ; ,r� _2r?/ d U TELEPHONE # Ge e� zip : 3x Home Telephone Number---:-- - NAME"OF CORPORATION: NAME OF NEW.BUSINESS /7'Sri��N,'Corae�/o1v ,yrya 1S TH15 A HOME OCCUPATION �� TYPE OF.BUSINESS ADDRESS .OF BUSINESS._ �:. YES NO _ FL - /✓�G/3/� s�/�jL l� MAP/PARCEL;NUMBER tJ /� (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 This form is intended to assist 9 Town of 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. I. 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 i � f the permit requirements that pertain to this type of business. e� Via•. .... ..__.�__,._ .. ......, yl( ATc011�lYwtnlAM Authorized Signature** 'MZ4RW&S MATERIALS REGULATIONS 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' Date:/d /2q/ 10 -� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: _11yelyc' ei GG✓ "09a -0 /2 %/37-//t-' BUSINESS LOCATION: 9/ ,2y^�Iyu�Jrfi4�f✓�°/ INVENTORY MAILING ADDRESS: S!q/'Ie- ,A/d,00 c—' TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: /-1/'6yi9�L�/�Hf�y EMERGENCY CONTACT TELEPHONE NUMBER: _J 7 Y ',P-2?�)-./ MSDS ON SITE? TYPE OF BUSINESS: � &ro /�&/A 0/LIec///9ryle_, LO.�Gy � 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 tAntifreeze (for gasoline or coolant systems) /,/�rG Miscellaneous Corrosive ANEW ❑ USED Cesspool cleaners GAG. Automatic transmission fluid Disinfectants ® e Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) o Refrigerants 0Q1_MMo/tor Oils Pesticides t{Se o o B NEW ❑ USED (insecticides, herbicides, rodenticides) Photochemicals (Fixers) Gasoline, Jet fuel,Aviation gas No,,, Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 10Q, lubricants, gear oil ❑ NEW ❑ USED �/�i✓2 Degreasers for engines and metal „/�_a Printing ink �,. Degreasers for driveways &garages / Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine t ; Battery acid (electrolyte)/Batteries Lye or caustic soda t ( Rustproofers l Miscellaneous Combustible f Car wash detergents . k Leather dyes Car waxes and polishes , Fertilizers o Asphalt& roofing tar t PCB's t Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) Any other products with "poison" labels ❑ NEW ❑ USED - - (including chloroform, formaldehyde, t 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): Iva< Metal polishes Laundry soil &stain removers ` (including bleach) Spot removers &cleaning fluids ' (dry cleaners) Other cleaning solvents ` Bug and tar removers 644, Windshield wash / WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A plicant's i n re Staff's Initials Date: 5� -OV TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: P BUSINESS LOCATION: I 's a MAILING ADDRESS: INVENTORY AMOUNT: TELEPHONE NUMBER: SOg--2-7 5--3//.S CONTACTPERSON: "CAKUop I—}a�.rY► i�/lLu� /�p. a� oc�s EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: Y� Fi�E t�ts7IcT� OTHER INFORMATION: Ptect�. 'ta�b�{ �.rt w ,d v r M 5 0,5 ors 51 Waste Transportation: C " �'���� w"'�G�'''�s, 40ve-4--S Name of Hauler: e-ev- Destination: Waste Product: icensed? Yes No 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners ,9-t_gfLA.NEW FUSED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants c/' Motor oils Pesticides `7 NEW 5�USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diese!fuel, kerosene, ##2 heating oil NEW USED j� '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) 26 9v`. Battery acid (electrolyte)) 6rx�e�6-2_ Swimming pool chlorine Rustpro ofers Lye or caustic c soda Car wash detergents Jewelry cleaners Car wanes 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 Misc.: A (dry cleaners) '1� i,�:P/1 ana.t Other cleaning solvents Bug and tar removers I n p / TO ALL NEW BUSINESS OWNERS: Fill in below: _� f r �r,� U NAME OF NEW BSINE SS: b 0� 5 � rQ insotri-�n TYPE OF BUSINESS i_)1 (Wealz) IS THIS A HOME OCCUPATION? ZVd r� ADDRESS OF BUSINESS 1115 MAP PARCEL NUMBER a If you are starting a new business there are quite a few things you need to do in order to be in compliance with all rules and retulations of the Town of Barnstable. Once you have been checked off on this sheet you may apply for a business certificate at the Town Clerk's office(Ist floor-Town Hall). GO T BUILDING I ECTOR'S OFFICE(4TH FLOOR TOWN HALL) This in ' ' ual is in co pli nce s been explained the procedures needed to start a busi ss Building Inspec 's Sign u 2. GO TO BOARD OF HEALTH(3RD FLOOR TOWN HALL) This individual has p7n informed of any permit requirements that pertain to this type of business. �Healthlnspector's Signature 3. GO TO CONSUMER AFFAIRS(LICENSING AUTHORITY)-(3RD FL SCHOOL ADMINISTRATION BUILDING This individual has been informed of any licensing requirements that will pertain to this type of business Licensing Authority Signature After being checked off by all of the above-remember to return to the Town Clerk's office to actually obtain your business certificate. .f Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: 17s (! &A. a.. g,4 BUSINESS LOCATION:. (mo MAILINGADDRESS: 3 " Mail To: TELEPHONE NUMB Board of Health ER � �"` Town of Barnstable CONTACT PERSON: 8 - Q r 61 s & °e_ P.O. Box 534 EMERGENCY CONTACT TELEPHONE N MBER: qW Hyannis, MA 02601 TYPE OF BUSINESS: Cc . Does your firm store a of the toxic or hazardous materials listed below, either for sale or for you own use? 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: T�jF'b'Lrja-a-r46Ln n I S TELEPHONE: !� C5_�L/,;% 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) 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 2 aQ ✓ Paints varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers o.Q ✓ r-�Paint brush cleaners /H rivI eera,1 sP� . Any other products with "poison" labels (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 (dry cleaners) Other cleaning solvents Bug and tar removers `` WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable °Fs►+E„�,,, Regulatory Services ti °s Thomas F. Geiler,Director /((�)• 9'" '�' . Public Health Division ' Q16 ' 9. 61 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT A/ NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT / �ti ,f/�'LAv al-1-1 n,D: z6y����� TELEPHONE NUMBER SOLE OWNER: A YES NO c IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF5LL M PARTNERS: vs o Go rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: . PRESIDENT /'�V ��i9/t�'►.�}r�l�� /�``/ f��L1� �/3 D�i�, �✓,/���ti,✓ i9c3<(1 TREASURER 'CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# `�Lf- �, Ck 2 Haz.doc/wp/q Town of Barnstable Regulatory Services !� • o� Thomas F.Geiler,Director MANSTABM Public Health Division 4i'OrEn3 9. a'�"�� Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. DATE / =�8 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT _66"Cl< Ate �'0VY1x NAME OF ESTABLISHMENT Y/ji"��/.l f® 116N ,61a ro Rez'A lyt ADDRESS OF ESTABLISHMENT )ZO%/L Z-2 /°7BYL.j AR, • TELEPHONE NUMBER :7 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK 14. IGNA E OF APPLICANT RESTRICTIONS: HOME ADDRESS y fit,t3efA,,,W • HOME TELEPHONE# y2-2-1A 1/> Haz.doc/wp/q l 1 " MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan(to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7)working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street \ Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. • For further assistance on any item above, call (508) 862-4644 • A' Town of Barnstable Regulatory Services Thomas F. Geiler, Director BAMffMM MAM 9�ArE .0� Public Health Division Thomas McKean, Director 200 Main St, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 28, 2003 Robert F. Lorange -Allen Fuller 135 West Main Street Hyannis, MA 02601 IMPORTANT NOTICE RE: Map & Parcel 311- 072 Dear Addressee: You a re d irected to connect your b uilding located at 91 Falmouth�Road, Hyannis Massachusetts, to public sewer on or before August 29, 2003. -- -- — `-� The Department of Public Works, Engineering Division, has notified us that your property abutts recently installed vacuum sewer lines. The lines were extended because of the density, and the size of the lots in the area, and the potential for serious health problems. Failure to comply with this order will result in a complaint against you, in a court of law, due to your failure to comply with a Board of Health Order. If you should have any questions, please telephone me at 862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. CHO Health Agent for: TOWN OF BARNSTABLE BOARD OF HEALTH Wayne Miller, M.D., Chairperson Susan G. Rask, RS. Sumner Kaufman, M.S.P.H. Return receipt requested Cc: Barbara Childs, Water Pollution Control Mark Giordano, Engineering Q:Sewerorder.doc { ............ V/000, -�- .f TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: L e Q f- Mail To: BUSINESS LOCATION: v Board of Health rv�� Town of Barnstable MAILING ADDRESS: SCL P.O. Box 534 TELEPHONE NUMBER: 77 5--- 25- 9- Hyannis, MA 02601 CONTACT PERSON: Z • ,r, 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 totalling, at 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) 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 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) _� i'N �Ci e—W Other cleaning solvents 12 1'A C . Bug and tar removers ` Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business T s V Nick Harmansky HYANNIS FOREIGN AUTO REPAIR Fuel Injection Experts F i 1 Major & Minor Repairs ^ Diagnostic Service 1=800-640-3115 *IIFOREIGNNIS -• UT DO REPAIR 77S-3nS 91 rear :. Folmoulh rd. I Servicing Foreign Cars Since 1975 TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY /, a s "Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS J/ 4 ; Class: 7.Miscellaneous y. QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) � MAJOR RIALS Case lots 1)rurnl, ove",Tank's Underground Tanks' 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 Misce lan A b o Vf- Li DISPOSALIRECLAMATION REMARKS: / 1. Sanitary Sewage 2.Water Supply ,tP4 O Town Sewer Public 4f Yon-site Private 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: .y y" Q Holding tank:MDC 1Ci i L/ O Catch basin/Dry well 7 O On-site system 5.Waste Transporter Name of"auler Destination Waste Product 1. 1 2. jg�Pe o s In ew rispector Date )-5-- 311 S�- 4 TOWN OF BARL ABLE OMPLIANCE: CLasS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HLTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS lass• 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS 1urn 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) 1J transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: I S Q44 DTSPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.WpLter Supply to, ��� U O Town Sewer ublic �RcOn-site OPrivate tic 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_X O ERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler1 • ' � �uct se' YES NO 1. 2. r © i / / o I wed Inspector Date - i fi! j' HAZARDOUS MATERIALS REGISTRATION FORM DBA: :Hyannis Foreign Auto Repair fax: .. ........ corp name: 91 Rear Falmouth Road Mail Addr ....... ............ ......... location: street '91 Rear Falmouth Road mappar. city ;Hyannis .. ........: contact: Nick Harmansky state: Me telephone: ';775 3115 zip: 02601' .......... emergency: 428-6547 -- erson interviewed Nick Harmansky Business: - inspection date 1 category: Vehicle Maintenance - - inspection date 2 type; ......... inspection date 3 F public wate F indoor floor drain 17, outdoor surface drain- license required 17. private wate r7 indoor holding tank and 17 outdoor holding tank and 17 currently licensed r7 town sewag M indoor catch basin/drywel 17 outdoor catch basin/drywel expir on-site sewag 177, indoor on-site syste 1777. outdoor onsite syste date: notes: Manifests and MSDS sheets on site. Parts Unit-30 g&Parts Cleaner. compliance: Satisfactory ......... Chemicals: X gty's > 25 Ibs dry or 50 gals liquid description: t : unit of measure antifreeze (for gasoline or coolant systems) 6 cases motor oil 150 gallons antifreeze (for gasoline or coolant systems) 55 gallons waste ...... ............. waste transporter Safety Kleen waste transporter w `TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH NC satisfactory 2.Printers 3.Auto Body Shops ,,r a O unsatisfactory- 4.Manufacturers COMPANY IV Q041 ee"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS I V Rao n Class: 7.Miscellaneous W WS QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) He waste motor ON new motor oil - I M Itransmiss' . y draulic I j Synthetic Organics: degreasers Miscellaneous: 0"61(:5- o DISPOSALIRECLAMATION REMARKS: AM 1. Sanitary Sewage 2.jVater Supply ffil$0S S fl's_ O Town Sewer Public On-site ()Private DA K ff t4A C 3. Indoor Floor Drains YES NO _4 O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: () Holding tank: MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product ' I YES NO 1. P e ill L� l� �f s 2. Perso ,0, 414V63 ' y Inspect Da OCI� PA TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: /YA.�Ii✓al /Lea°o� a;ro fts /�ilr� Mail To: BUSINESS LOCATION: of ( O&AIx- L/"lou ram/ -��/yi�,.►,,,a Board of Health MAILING ADDRESS: Are 1J,&f3o j1-e Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: 7 7S�°3y/Jw Hyannis, MA 02601 CONTACT PERSON: �a�l/'C �/��r�l�r✓I�% EMERGENCY CONTACT TELEPHONE NUMBER: > J-1/2 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, ° - 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 C 5_ Antifreeze (for gasoline or coolant systems) Drain cleaners �. Automatic transmission fluid ® Toilet cleaners 0 Engine and radiator flushes ® Cesspool cleaners 2 Gg Hydraulic fluid (including brake fluid) Disinfectants o 0 r oils/waste oils _� Road Salt (Halite) Gasoline, Jet fuel D Refrigerants G/t1.- Diesel fuel, kerosene, #2 heating oil 0 Pesticides (insecticides, herbicides, t" ` � Other petroleum products: grease, lubricants rodenticides) pAafS gGNL &Degreasers for engines and metal 0 Photochemicals (fixers and developers) D Degreasers for driveways & garages 0 Printing ink 0 Battery acid (electrolyte) Wood preservatives (creosote) Q Rustproofers p Swimming pool chlorine L Z 13, Car wash detergents ® Lye or caustic soda `S0 o-4,Car waxes and polishes _D Jewelry cleaners —fF) Asphalt & roofing tar 0 Leather dyes © Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's 0 Paint & varnish removers, deglossers Other chlorinated hydrocarbons, _) Paint brush cleaners (inc. carbon tetrachloride) 1 Floor & furniture strippers Any other products with "Poison" labels _n Metal polishes (including chloroform, formaldehyde, 0 Laundry soil & stain removers 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 Bug and tar removers Household cleansers, oven cleaners i I White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMMANCE: CLASS: 1.Marine,Gas Stations,Repair, satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY . (see"Orders") 5.Retail Stores ,�,s� 6.Fuel Suppliers ADDRESS lG'. 7- 9 Class: 7.Miscellaneous 141V,�1!�r QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS 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: V r I� DISPOSAIJR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply l /Y y 0 Town Sewer Public Yon-site OPrivate 3. Indoor Floor Drains YES NO 6' 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES L NO ORDERS: O Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination WasteProduct Licensed? YES NO 1. 2. Pers s Interviewed Inspector Date TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1. Marine,Gas Stations, Repair BOARD OF HEALTH -satisfactory 2. Printers 3.Auto Body Shops unsatisfactory- 4. Manufacturers COMPANY C�,'1(lt r i�l'�%Ah O (see"Orders") 5. Retail Stores �7 6. Fuel Suppliers S ::Tl �1�� Class: 7. Miscellaneous MAT�1��S QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) IALSUnderground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: ' 5-- waste motor oil (C) its new motor oil(C) �---� S ra mns issio draulic §Ynthetic Organics: degreasers �W4 1 Miscellai eous: gs-u'll , , l DISPOSALIRE(:LAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply '� (,41�1 �L � 1S qfyuf 1red L � town Sewer Public ,— ` • S On-site �9,Private .Q, — 3. Indoor Floor Drains YES_NO_ O Holding tank:MDC - O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NOS ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product r (n ti1�S YES, NO 2. : G AilL-- ers erviewed Inlgpectok Date r ' Town of Barnstable �yt r Regulatory Services ' Thomas,F.Geiler Director 71 Public Health Division sA><txsrn�F * _-. Thomas McKean,Director -- ,y, MASS ;>.'. ,�, � ♦�, 200 Main Street, Hyannis;MA 02601 ki-yo ,Phone- -508-862-4644 Email:: heaith(a�town:baritstable:ma.us Office`Hours: ,M-13"8 00_-5:00 Hyannis Foreign Auto Repair Attention:Nick Harmansky,Manager June 24,2004 91 (rear)Falmouth Road Hyannis,MA 02601 RE: Hazardous Materials License Required and OVERDUE ; Dear Mr.Harmansky: The Toxic and Hazardous Materials Inventory conducted on May 20,2004 shows that you have approximately 216.5 gallons of toxic and hazardous materials being used/stored/generated/disposed of at your place of business(Please refer to your copy of the Toxic and Hazardous Materials Onsite Inventory). The Town of Barnstable Board of Health has determined that using, storing, generating and/or disposing of over 111 gallons of hazardous materials per month requires businesses in the Town of Barnstable to obtain an annual Hazardous Materials Permit. Please obtain your permit. You have 14 days to comply. After this time,you may be issued a warning or non-criminal ticket citation in the amount of$75.00 for the first violation and $25.00 for each additional violation. Each day's failure to comply with an order shall constitute a separate violation. Please refer to Article 39: Control of Toxic and Hazardous Materials,Section 13,and Section 14-1,14-2, 14-3, and 14-4 (copy enclosed). Passing your Hazardous Materials Inspection and obtaining your license will keep your business compliant,prevent contamination of Barnstable's existing and future drinking water supply, prevent environmental contamination which can bankrupt site owners,lead to future regulatory, and possibly,legal problems, lower or destroy land values, drive out residents and industry, depress local economies and endanger public health. You will receive your Hazardous Materials License certificate after you have passed your inspection and paid the license fee. Your continued cooperation is greatly appreciated. If you have any questions or need further information,please do not hesitate to contact the Public Health Division. Thank you, Thomas A.McKean,RS,CHO Director of Public Health enc. Hazmat license application Article 39,Sect.13,14 j ' 1. • 1 Nick Hari-ansky HYANNI5 - FOREIGN AUTO REPAIR Fuel Injection Experts Major & Minor Repairs ` . ,,._....,.. Diagnostic Service 1-800-640-311 HYANNIS 911 FOREIGN' RUT : REPAIR ns-ans 91 rear F IrnoJih rd. Servicing Foreign Cars Since 1975 f Date: Sid -09(, . n 1'7 04 TOXIC AND HAZARDOUS MATERIALS ON SITE INVENTORY NAMEOFBUSINESS: BUSINESS LOCATION: � ' 's MAILING ADDRESS: " INVENT Y,�•`�J'`� TOTAL AMOUN1tc, TELEPHONE NUMBER: 50$-275-vim// CONTACT PERSON: /U o J- �cr»�y»�/k-tom ( �/�p• ,ate' dA0"S EMERGENCY CONTACT TELEPHONE NUMBER: - 17WE pf s7 RICT TYPEOFBUSINESS: t^�- . OTHER INFORMATION: �(ect _ � � �.r.L wa--�-� p�idaa s - .M 5D5 oe) �rf� o rrwr► c� c p�. Waste Transportation: Name of Hauler: S Destination: Waste Product: icensed2 Yes No P 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners :Z-c_*.NEW FUSED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants c/i Motor oils ° Pesticides -76 cCa NEW 49?zgoUSED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Dieso!fuel, kerosene, k 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) 26. 2* Battery acid•(electrolyte)� (�xke�•e-i Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car wakes 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 Floor&furniture strippers (including chloroform, formaldehyde,- Metal polishes hydrochloric acid, other acids) Laundry soil &stain removers ✓ Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids MiSC.: C=Ja,46W-77aAV­i� J a _ (dry cleaners) Wirlp 4_41r. eA at. �a>t. �•5 Other cleaning solvents � ,� ��-/vex Bug and tar removers r Town of Barnstable-Health Department Page 1 / a f HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Hyannis Foreign Auto Repair Fax: — _ i Corp Name: 91 Rear Falmouth Road Mailing Address Location: L91 Falmouth Rd.Hyannis Street: 91 Rear Falmouth Road mappar: City: Hyannis Contact: ',Nick Harmansky State: Ma Telephone: .775-3115 Zip: 02601 Emergency: 428-6547 Person Interviewed: Nick Harmansky Business Contact Letter Date: Category: ',VehicleMaintenance Inventory Site Visit Date: 5— —6)�{ Type: Follow Up/Inspection Date: ❑d public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ curreontlylicensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir --❑J on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date:Manifests and MSDS sheets on site. Parts Unit-30 &Parts Cleaner.g compliance:Remarks: 7/1/97 2 electric-hydraulic lifts,MSDS sheets on site,Spills- SatisfactorySpedi dry,Rags in can with cover. Note: 7/1197 See 97 inspection for current list of chem.on site. j Z�,) ���• ,z2�• mac.( R C _ Z �- 7 J2�� LAI Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials 0*1 gty's>25 Ibs dry or 50 gals liquid but less than 111 gals N—gty's 111 gals or more descnptior 'city'; unit of measure antifreeze(for gasoline or coolant systems) ? 6cases .......-_.__...__......................... - ......_____._.... _.._....__......................._..........._..............._......._................._;............_..._..._...:...._.._......_............._....................................._...._...,..... motor oil 150gallons ..� _ ._._.._... _...,.._. .... ._. ._... ...._._....__._...... _._..... antifreeze(for gasoline or coolant systems) ; 55 gallons waste Waste Transporter: Safety Kleen Fire District Last HW Shipment Date Waste Hauler Licensed: U /, r, Hazardous Materials On-Site Inventory/Inspection For ALL Shops and Businesses: DBA: --}ti��x.�2�r i 5 �rsze.�t414-, Location: / 4a.- )QA Date: S-Z,::) -o y Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): 2. Waste storage areas: 1 � 3. Satellite accumulation points throughout: 4. HazMat stored outdoors - CHECK OUTSIDE: 5. Shipping and receiving areas: JJ VV 1� 6. Run down of shop activities: L� 7. Housekeeping practices: e �� `1 9 4 HazMat On-Site Inventory/Inspection: Records to Review for SQGs and CESQGs DBA: G� azR�' Location: Q' 1 1�r�� • �� Site visit date: S— ZQ • Hazardous Waste Manifests: • Employee training documentation (if required): • Hazardous substances ill control and contingency Ian: p 9 Y p L"/ • MSDS on site? (� • HazMat Inventory records (if applicable): • HazMat Waste Shipping documentation: • Spill records (if applicable): /�y THE COMMONWEAL OF MASS US TTS Entered c RNSTABLE PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Q ZIppYication for 30k;p5ar bpotem oiUtru'ct o $rn�it zs o� Application for a Permit to Construct( )Repair( )Upgrade( )Abandon.(_ ) 0 Complete System ❑Individual Components A� �/� it 7 1 1 P 1' V' i P N o Location Address or Lot No. Owner's Name,Address and 1t� �! Assessor's Map/Parcel - / ©^7 � tjW%6 O69 Installer's Name,Address,and Tel.No. _Q ` Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ...(D bl/1114 j im� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance ee rigned o 0 e Application Approved by Date t�l Application Disapproved for the following reasons Permit No. _y y --I Date Issued S, a O t_1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage isposal System Constructed ( ) Repaired ( )Upgraded( ) Abandoned( by at G� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer !4"Qt.� rt AiI Designer The issua e of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ----------N o.=—®---- ---- ---- --------_--.. --_—Fee----------- -,q L4 � �5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS lwigozat *pgtem Cori.5tructiou Mtt Permission is hereby grantQdAo Construct( ) pit( )Upgrade( )Abandon(✓) System located ate and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be co pleted within three years of the to of this p Date:_ ' _ Approve No. ��"' 47 Ll Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS f rJ, ZppYication for bigoogar 6parm. Conkrusction, petrmit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( )'. D Complete System El Individual Components Location Address or Lot No. Ow er's Name,Address and TeL No ` I } Assessor's Map/Parcel -3 / / 07 ' Installer's Name,Address,and Tel.Nod Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. r Garbage Grinder( ) s -Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fiktures Design Flow gallons per day. Calculated daily flow gallons. -Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. t �"•� # r Description of Soil Nature of Repairs or Alterations(Answer when applicable) _ L ,. - a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- ii* cate of ComplianceCamed s ee s ed • t our �th--_� b �p ate Z5 k, ►j 0 q, Application Approved by Date Application Disapproved for the following reasons Permit No. Li `- y U I Date Issued s, R = ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C RTIFY, that the n-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abando,>,tei( �by U db'-YIC l at �� W. has been constructed in accordance with the provisions of Title 5 and the forDisposal System Construction Permit No. dated 'i Installer G r tt Designer. The issuaae of this permit.shall not be construed'as arguarantee that the system will function as designed. Date j r:. I t t° Inspector t --------------------------- No. ----- oy y Fee 5 I1 � ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpogal 6pgtem Congtruction Pffmit Permission is hereby granted-to Construct( ) ePair( )Upgrade( )Abandon System located at ti and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to .t comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be� co Ipleted within three years of the date of this p t.Clt- t PP - Date: � �' A roved - 1. 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 format 200. Main St.; Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 67Main St.; Hyannis, MA.02601 (Town Hall) and get the Business Certificate that is required by law. j' DATE: � z0, Fill in please: APPLICANT'S YOUR NAME. S: �� r S Y,¢✓Zu�yG'TGl BUSINESS YOUR HOME ADDRESS: 2 Ctl-PT III 08 -7 5-3(I S J n zdti n4u'f`J� — ' il'{'j :;tP� TELEPHONE # Home Telephone Number' I� Yl�C� R��11� Rlht'T���[r " Email Address: NAME.OF'CORPORATION: S ��L'` NAME OF NEW'BUSIIVESS ,t/�i,4.i/tii s ho-rz c!v /�v J-o s c�YPE OF BUSINESS (%S e ��� CS IS THIS A HOME aCCUPATION? Y NO_� �j � � �(Assessing) ADDRESS OF BUSINESS ,G O' o/ 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 COMM 10 S OFFICE This individual as b R' rm foe an rmi equirements that pertain to this type of business. iz d+Signa re V D {+ t MENTS: '2. BOA. OF HEALT This individual has bee armed of the pe r requir nts that pertain to this type of business 4 dry? �Ca uthorized Signature** I�(IuMbMPLYAI'>`FI ALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Date: V 1 ;tOV-2&S TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: '�I glaiUNeS F-,vuz.!;;-L(t„\,f> -,>4-t—Z5; BUSINESS LOCATION FA LPti QC �► 2`1, fL , INVENTORY MAILING ADDRESS: L',041VN°,5 8// 02642 ' TOT I AMOUNT: TELEPHONE NUMBER: 5-0..9 7 `7 S_ 3 1 I CONTACT PERSON: is [� t4i i� l-•s EMERGENCY CONTACT TELEPHONE NUMBER: 5�� 'Z�i2 `7 �� T MSDS ON SITE? TYPE OF BUSINESS: 05 C d, Cam- n INFORMATION / RECOMMENDATIONS: Fire District: ,V 0 u3 �- G-p- 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 ❑ 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 .5 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS App ican�gnature Staff's Initials