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HomeMy WebLinkAbout0242 OLD YARMOUTH ROAD - Health 242 Old Yarmouth Road Hyannis Map/parcel344-024 t � I ° } i d YOU WISH TO OPEN A BUSINESS? s ' For Your Information: Business Certificates cost $30.00 for 4 years. A Business C rtificate NLY R GISTERS HE 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, 1st FL., 367,.Main Street, tC Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required,by law. Fill in please: Date: , I -1 - F `u � APPLICANT'S NAME: U ►� a(i+� 41, YOUR HOME ADDRESS: � B'USIN5SS TELEPHONE # HOME TELELPHONE #: .NAME OF CORPORATION: u, FID.# NAME OF NEW BUSINESS TYPE OF BUSINESS � I&THIS A HOME OCCUPATION? YE S NO _ ADDRESS_OF BUSINESS 2 I f a MAP/PARCEL O "1 ARCEL NUMBER I Z (Assessing) g). 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 s form is to assist you in obtaining the information you may need.. You MUST GO TO 200 Main St. (corner Y 9 Y Y ( ne 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 MI TONER'S OFFICE t This indi id a ,bee Qif m d o any permit requirements that pertain to this-type of business. A thorizeq Si ture** COMMENTS: 2. BOARD OF HEALTH This individual has been iyTgrmed of the r it re ements that pertain to this type of business. Aut rized Signature** - HAZARDOUS 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: � �, z (�c�� � 0-s`, qua �-�C'� cJa�,-�o-�1��tj,� 2�' _ � iu �9l JI v :� Hazadous Materials Inventory Sheet Checklist Date f — L,-*'--Physical Street Address-Check database to ensure it exists Working Phone Number --sue Actual Amounts -( ie. gas being used to fuel machines,thinner to clean brushes all count as hazardous materials-no blanks) (—"--'storage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature -understand what is listed and noted -7�—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. TOWN OF BARNSTABLE Dater l /X/ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: h Pj BUSINESS LOCATION: INVENTORY MAILING ADDRESS: ' 0 QLd TOTAL AMOUNT: TELEPHONE NUMBER: b - CONTACT PERSON: __ _,;��_ �a, EMERGENCY CONTACT TELEPHONE NUMBER- MSDS ON SITE? TYPE OF BUSINESS: V INFORMATION/RECOMMENDATIONS: =, L Fire District: L 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) Any other products with "poison" labels ❑ NEW ❑ USED (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 Windshield wash Lb,49L LL A�Vcl� 4L. Ar WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS VP licant's Signature Staff's Initials LOCATION° SEWAGE PERMIT NO. L)-4-ha�d VILLAGE I N S T A LLER'S NAME i ADDRESS i G.UILDE R OR OWNED DATE PERMIT ISSUED �9- �� DATE COMPLIANCE ISSUED � I © .. � �� _ � � ,�, ' + � � S � � �° �,/ o �/ � � /� �� L...... FRs... ...5.00........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........... ...........T.own......OFPasnstable....---••------------------------------------------ Appliration for Bisposal Works Tonstrurtioaa Vamit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 242 03A.laxinm tki..Rd...,...Hyannist--bA.....02b01..... .................................................................................................. Location.Address or Lot No. Mx x..R..... l�zaent ------------ -------------------------------------•------.--- 24.2..01d.-Yarn Owner Address aA... ... ..e� 41 exY .�e.--•-•---------------------------------••-----.. 12 ..Hishaps..T_ersace,..H,yannis,.._MA.----02FiD1---- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------3--_-----._----------------Expansion Attic ( ) Garbage Grinder ( ) �a Other—Type e of Building No. of ersons......2------------------- Showers YP g -•-•--•-----------•-•------• P ( ) — Cafeteria ( ) dOther 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. 1................minutes per inch Depth of Test Pit._------_-_-_.-.-_- Depth to ground water----.--..............--. (_, Test Pit No. '2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...................................................-......................................................................................................... 0 Description of Soil..........S and...............................................................................-...........-......---------------------------------••--------•-•--- W UNature of Repairs or Alteratio s—Answ when applicable.installation of a 1,000 gallon pre-cast, stone packed leach pit roverflczaI . ---------------------------•------------------------------•------------------------•--------------------•----------------------------------------------------------------------•---••-••-•---......•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of SIT p 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 the and o health. _ Signe =. ----•- -•-- 29 81 - Date ApplicationApproved By•••-------.................................................................................................... ............�2901......•----- Date Application Disapproved for the following reasons:............................................................................................................... .........-•---•-••------•---••-----•-•---••-------------•----•---.............-•-----•-------•--------------•-----------------------•-••----•---•--....._----------......------ ...-----••---•......... Date Permit No.8!.................................................. Issued_..........5/29/83.............................. Date ......;P Fizii.1.5.too..........7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T .......oFBarnstabl ..: Appliration for Di-4pnaal Works Tomitrurtion trntit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 242... .....02601 ..... ------------------------------------............................................................. Location-Address or Lot No. MMA... .,...0.1amen.ts............................................................... 242...Old_Ia outh .....02601-. Owner Address aA -¢ B des,e 4ol.se e ................................................ 12.8..,Biahop&.TezmcsL,...Hy.amnis,...MA....A26ju..... Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms.............3............................Expansion Attic ( ) Garbage Grinder ( ) ___-_--___- Showers —p., Other—Type of Building ____________________________ No. of persons_.... ____._: ( ) Cafeteria ( ) 0.1 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------_............ �Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------------------------------------------------------------------......................................................... Descriptionof Soil...................and..................................................................................................................................................... x W x Nature of Re airs or Alt e ti ns—Answer when applicable_ nstallation c� a 1,000 gallon pre-cast, v stone packe� leach pint k overflcw). -...................................................-.............................................................................---------------------------------------------------------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of�TTI.E p 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 the hoard of health. ` SignedG? � :.1 P ------------r ............ / D to ApplicationApproved By--••-••--•-••----•--•-••••-•-•••....•---------•--••••••••-•----•----••........................... -----------V�97 ----- ----- Date Application Disapproved for the following reasons:---•------------•-----------------------•------------.......................................................... ----------------------------------------------------------------------------------------------•-•••••- Date Permit No 47:.................................................. Issued----------51-?91 51?91%------_-------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................`s'Q M.......OF......B�.1.'tSt��?. ................................................... Trrtif iratr of Tnntpliana JTJS I TO CERT FY, That 1� I 'iv'dual S wa e Disposal.System construct d ( ) or Repaired ( x) by._A & B esspool Service, 5.z8 % sWops 'e race, Hyannis, MA 02�01 --------------------•---............------------....................----........ 242 Old Yarmouth Rd„ Hyannis, FA _026bi11 Mrs. E, Clements at --•-••-•---••• has been installed in accordance with the provisions of TITLE j of The State Sanitary C`.de aa described in the application for Disposal Works Construction Permit No.............ta..�'+___-- - .. _-___- da.ted_._.5/-`"9181 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................................�.Q.�.l .................. Inspector................ = -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............I.Tfin..........O F..............Barnstable 7 ....................... ..................... No......................... FEE--$..5.0o0 ...... . Raposal antic Permission is hereby granted..A & B Cesspool Service, 128 Bishops Terrace, Hnp?jis, MA 02601 to Cons t ( ) r Re air ( x) an Individual Sewage Disposal System t�u9w Old � ammo Rd., Hyannis - Mrs. E. Clements at No.......................................---------------------------------------------------------•----•----------•- Street as shown on the application for Disposal Works Construction Permit No$1................ D�ted........5/29V81 ----------------------------------------- DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS