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Home My WebLink About0720 PITCHER'S WAY - Health 720 PITCHERS WA A= tHE?q r i v I r TOWN OF BARNSTABLE o LOCATION ,�� ' /� �CGJc.-�Sy G✓C SEWAGE # /J- VILLAGE �/<,�ti%,r ASSESSOR'S MAP & LOT * J INSTALLER'S NAME & PHONE NO. , 4GG%rt,5�! f.Sch 1f� SEPTIC TANK CAPACITY r -, LEACHING FACILITY:(type) T (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER. cv— DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 9n VARIANCE GRANTED: Yes No i f v � / _ s r II POD` 0 � � — 0 00 No.. ?� ��.3 Fps... ....3.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apli iration for Dispoiial Works Tow5trnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 753 Pitchers Way Hyannis ,Mass . ............................ ............. ................................................. --•-•-....-••----•-•••--...---...............•----.......---••--•----........•---............----• Location-Address or Lot No. DaSilva ......................_.......................................................................... ......................................................... W J.P.Macor-aber Jr.Owner Address Installer Address'-•-------------------•----------------••- d Type of Building Size Lot............................Sq. feet Dwelling I No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------------------------•--••-•-------------•--••-------••--•--••••...--------------------------------••-•---••_.. 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................._.-_--. (s, Test Pit No. 2................minutes per inch Depth of.Test Pit--------_........... Depth to ground water..--................---. ...-----•----------------------------------------•-------------.....-----------....--------•--........................................... 0 Description of Soil............... WHanel--8c.Graze I ------------•------------------------------------------•---------------------••-•-•------._.....---_--•-- v --------------------------•-----•--------••------------------••-•---•-•-----------••------------•--------•------••---------•---•-•-•-••-------- W Z --------------Q---......--------------------------------------------------------------------------------------------------------------...--------------------------...---------------•-••-•---------.---- U NatureUfJ epairjy nit�eion l—.nswpeyvIien applicable............................................................................................... •----------------------------•------------...----•--•-------------•---•-----------••----•--•-•---------------------••-•...........---• 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 been i/,,ued by the boar of healith. Signed . ---` ,-.............. � .6.��2---------- Date Application Approved By ........ ------------------------------------------------- ...... Date Application Disapproved for the following reasons: ............................................................................................. .................................... ---------------- --------------------- -- ---- - -------------------- ------------------------- qG Date PermitNo. --../...�o.- o-� ................................ Issued ....... --.................----- Date .UoT Cll+rr� �y � -��- 18 -- 30.00 No.- a.:: .1?3 5 Fps...�....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE. Appliration for Disposal Works Tonstrnr#iun Prrmit -- Application is hereby made for a Permit to Construct ( ) 'or Repair (X ) an Individual Sewage Disposal System at: 753 Pitchers Way Hyannis ,Mass . ................--..................•-•---•-------..............---••--••-•.......----•-••-••--• --••....._...--••-•-•----..........-•-•-•------•--•--•.............•--•-•---•..................... Location-Address or Lot No. Da`S i lva Owner Address w J.P._Macomber Jr. Installer Address UType of Buildi Size Lot............................Sq. feet Dwelling—No.,of Bedrooms....:........3..............................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building a YP g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures-...................................................................................................................................................... w Design Flow.......................... ...............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gatlons 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........................ G4 .............................•-••••-•................---•--....-----•-•--•-......_.--•-••......-•---......................................................... ODescription of Soil................Sand---�---�"rave 3------------------------------------------------------------------------------------------------------------------- U .......................................................... w - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nanof Repair or Alterations—Answer when applicable -------------------"."..____-___---"""---__"________---__----_---."•-----._"----.__. i -1000 gallon leacning pit. ---••--••.....................• ------•-----------••-----•----••-•-............••------.._........-••..._....------•••----•-•---••....._.---..._............-•-•--••••................_................. 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 i system in operation until a Certificate of Compliance has been issued by the boar of he .th. Signed -- ....2/26/92.------- Date Application Approved,BY --- ' - - ----------------------------------------------- -----a--o.... D-- � Date Application Disapproved for the following reasons: ............... .............................................................. .... ....................................... .....-- ------------- -------------- ......---- qG Date PermitNo. ----- ..- o_ ---------------------------------- Issued .............................................. ----........------ Date THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH TOWN OF BARNSTABLE Q`TXrttft.ca#P of TAImpliartce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by J.P.Macomber Jr. ------------------------------------------------------------------------ Insmlle, at ---753- Pitshers Way Hyannis ,Mass --------------------------------------------------------------------------- -- - ------- -- ---- -- -----------------=----- ---------- has been installed in accordance with the provisions of TITLE 5 of The 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. q DATE - l ...... .... Inspector ---- ..` ✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No GQ2 FEE.TOWN OF BARNSTABLE ... ... 30,00. 7a.— ....[1_^� ... ...... .... Disposal Work, T' onstrudiatt pamit J P Macomber Jr. Permission is hereby granted ----`----- -• --------------------------------------------------------------------- to Const uct ) or Repair. (X ) an Individual Sewage Disposal System at No..(.5�.3 ay Hyannis Plass....._itcher w -"""-.._...•-•----------•.......--- •-•..............•-----•...---•-••----------....•--•-•-•..........---...............-----•-•-•----•••........._........... Street as shown on the application for Disposal Works Construction Permit No..: _. Dated.......................................... ...r --""-"""""----------""""--"--..."-""-"--"-"""-.... LJ Board of Health DATE.................----"•"o-"'"-""-"-...... ................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS f��TOWN�OF BARNSTABLE LOCATION �0 �.ClC: -o GJ�u.� SEWAGE# 14LLAGE ASSESSOR'S MAP&PARCEL,V7/O4'l—CV INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY N 07 ZVI I� I Cq LEACHING FACILITY. (type) (size) NO.OF BEDROOMS OWNER - d PERMIT DATE: COMPLIANCE DA E: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY J Date: CJ1 Zf oe TOWN OF BARNSTABLE Rai TOXIC AND HAZARDOUS MATERIALS ON-SITE NAME OF BUSINESS:_T5 PA4006 BUSINESS LOCATION: O I P,CS fiUffl*rD3h , Wl NUIIS.MAi od6oi INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: 502 - a10 55 4-6 CONTACT PERSON: �1 A N6S SA SI LVA EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 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 wt« Are- to ► y InC4, b� Laundry soil &stain removers (including bleach) S a Y%k buy r - saicclf �T Spot removers &cleaning fluids (dry cleaners) � - F kob o k Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS App icant's Signatu Staff's Initials L � �� nI Delete A ❑01922 7/21/2006 I 001 I A260727 I 1J p Challo nge Activity N Basic 1 State Incident Date Station Incident Number Exposure - Check this box to indicate that the address for this incident is provided on the Wildfire Location Module in Section B'Alternative Location pecifigatien".Use only for wildland s. Census Tract 60 ° ❑ Street Address ❑ Intersection �II u SOUTH STREET ; ST U ❑ In front Of Number/Milepost Prefix Street or Highway r trees Type Suffix ® Rear of J Hyannis MA I 02601 ❑ Adjacent to Apt./Suite/Room City C! State Zip Code ❑ Directions ocean st. docks behind the old teen center ❑ Cross street or directions,as applicable C Incident Type E1 Dates &Times Midnight is0000 E2 Shifts&Alarms 411 (Gasoline or other I Local Option Incident Type flammable liquid spill Check boxes if Month Day Year Hour Min dates are the LB Still U D Aid Given—Received same as Alarm ALARMahvaysrequired 1 Date. Shift Alarm 07 2111 20061 107:341 p�oon No OfAlarmDisfict 1 ❑ Mutual aid received II II I I ARRIVAL required,unless canceled or did not arrive 2 ❑ Automatic aid recV. u U Ind ® Arrival 07 21 2006 07:41 E3 Special Studies 3 ❑ Mutual aid given TheirFDlD Their ) ) A Local Option. 4 ❑lAutomatic aid given I --'y/) CONTROLLED optional,except forwildlandfires 5 ❑ Other al given ® Controlled 07 21 2006 -N ® None The1r Incident Number Last Unit LAST UNIT CLEARED,required except wildland fire Special Special ® Cleared 07 21 2006 10:16 Study ID# Study Value E Actions Taken G1 Resources G2 Estimated Dollar Losses&Values Check this box and skip this section if an LOSSES: Required for all fires if known. Optional for non fires. 1 45 Remove hazard I ❑ Apparatus or Personnel form is used. NonePrimary Action Taken(1) Apparatus Personnel Property I I ❑ 12 1 I Salvage&overhaul I Suppression 0 �0 Contents I I ❑ .Additional Acton Taken(2) EMS 0 �0 PRE-INCIDENT VALUE: optional 70 (Assistance,other I Other 3 4 Property I I ❑ Additional Action Taken(3) Check box if resource counts include aid ❑ received resources. Contents I I ❑ Completed Modules H1 Casualties ® None H3 Hazardous Materials Release I Mixed Use Property Deaths Injuries N❑ None ❑Fire-2 Fire . NNE] Not mixed ❑Structure-3 Service I 0 I I 0 I 1 ❑ Natural gas:slow leak,no evacuation or HazMat actions 10 11 Assembly Use 2 ❑ Propane Pro as: <21 lb.tank(as in home BBQ grill) 20 ❑ Education Use ❑Civilian Fire Cas.-4 p g 33 ❑ Medical use Civilian $ Gasoline:vehicle fuel tank or portable container ❑Fire Serv. Casualty- I n I ® 40 ❑ Residential use El EMS-6 L1 11 4 ❑ Kerosene:fuel burning equipment or portable storage 51 ❑ Row of stores ❑HazMat-7 Detector 5 Diesel fuel/fuel oil:vehicle fuel tank or portable storag( 53❑ ❑ Enclosed mall ❑.Wildland Fire-8 2 Required for confirmed fires. 6 ❑ Household solvents:Homefoffice spill,cleanup only 58 ❑ Business&residential El Apparatus-9 �7 [1 Motor El use Motor oil:from engine or portable container . 1 ❑ Detector alerted occupants 8 Paint:from paint totaling<55 gallons 60 ❑ Industrial use []Personnel-10. t ❑ p g g 63 ❑ Military use 2❑:Detector did not alert them 0 ❑ Other:special HazMat actions required or spill>55 gal., 65 ❑ Farm use U®I Unknown Please complete the HazMat form 00 ® Other mixed use Property Use Structures 341 ❑ Clinic,Clinic Type infirmary 539 ❑ Household goods,sales,repairs 34 ❑ Doctor/dentist office 579 ❑ Motor vehicle/boat sales/repairs 131 ❑ Church,place of worship 3 [1161 Restaurant or cafeteria Prison or jail,not juvenile 571 ❑ Gas or service station 162 ❑ an or nightclub 419 ❑ 1-or 2-family dwelling 599 ❑ Business office ❑ 429 ❑ Multi-family dwelling 615 ❑ Electric generating plant 213 Elementary school or kindergart. 215 ❑ High school or junior high 439 ❑ Rooming/boarding house 629 [1Laboratory/science lab 241 ❑ College,adult ed. 449 ❑ Commercial hotel or motel 700 ❑ Manufacturing plant 311 0 Care facility for the aged 4459 ❑ Residential,board and care 819 ❑ Livestock/poultry storage(barn) [1 Dorm itory/barracks 882 ❑ Non-residential parking garage 331 Hospital 519 ❑ Food and beverage sales 891 ❑ Warehouse Outside 936 ❑ Vacant lot 981 ❑ Construction site 124 Playground or park 55 ❑ Crops or orchard 938 ❑ Graded/cared for plot of land 984 ❑ Industrial plant yard 655 ❑ Forest(timberland) 946 ❑ Lake,river,stream ❑ 951 ❑ Railroad right of way 807 ❑ Outdoor storage area 960 919 ❑ Dump or sanitary landfill 961 ❑ Other street Look rt and enter a Property Use 940 [1 Highway/divided highway Property Use code onl . 931 Open land or field you have NOT checkey if d a ❑ 962 ❑ Residential street/driveway Property Use box: I Water area,other I NFIRS1Rev-0V11M A260727 - EXP 0, 712112006 - PAGE 1 OF 2 HYANNIS FIRE DEPARTMENT- MFIRS REPORT K1 Person/Entity Involved Local Option ' I Business name(if applicable) I I Phone Number same address as I I I I U I same address as u incident location. Mr.,Ms.,Mrs. First Name MI Last Name Suffix Then skip the three t• duplicate address I lines. LI IJ U IJ Number/Milepost Prefix Street or Highway Street Type Suffix IJ I Post Office Box Apt./Suite/Room City State Zip Code ❑More people Involved? Check this box and attach Supplemental Forms(NFIRS-1S)as necessary. Owner ❑Same as person involved? Then check this box and skip Local Option the rest of this section. Business name applicable) I I Phone Number I. Check this box if same address as I1 incident location. Mr.,Ms.,Mrs. First Name MI last Name I I I Suffix Then skip the three duplicate address lines. Number/Milepost Prefix Street or Highway Street Type Suffix Post Office Box Apt./Suite/Room City State Zip Code LRemarks: Local Option ITEMS WITH A MUST ALWAYS BE COMPLETED! ® More remarks?Check this box and attach Supplemental Forms i (NFIRS-IS)as necessary. M Authorization 7201 ICraig E Farrenkopf C. I I Captain /EMT I Suppression 07 21 2006 Officer in charge ID Signature Position or rank Assignment Month Day ,Year Check box if same aS - - ..Officer in charge. 7201 ICraig E Farrenkopf C. I I Captain /EMT I Suppressionj L07J2111 2006 i Member making report ID Signature Position or rank Assignment Month Day Year a A260727 EXP 0, 712112006 - LY - - page 2 of 2 HYANNIS FIRE DEPARTMENT- MFIRS REPORT 01922 11 � AI 1 7/21/2006 1 001 1 A260727 I 0 ❑ Delete NFIRS - 1S 11l. State incident Date station Incident Number Exposure El Change Supplemental K2 Remarks - SOUTH STREET a? / Q�� -- C)0,y �d3i BARNSTABLE ASSISTANCE HARBOR MASTER MART [508-790-6327] CALLED REPORTING HE WAS NOTIFIED BY A MR. DAN DWYER [A BOAT OWNER] THAT TWO [2] BOATS WERE SUNK DOCK SIDE BEHIND THE FORMER TEEN CENTER. MARTY CHECKED THIS REPORT OUT AND FOUND A INBOARD/OUTBOARD MOTOR VESSEL LEAKING FUEL. MARTY REQUESTED OUR PRESENTS THERE. ARRIVING ON SCENE [BEHIND THE FORMER TEEN CENTER OFF SOUTH STREET] WE FOUND A TWENTY [20'] INBOARD/OUTBOARD MOTOR BOAT STILL TIED TO THE DOCK WITH THREE QUARTERS [3/4] OF IT UNDER WATER. THERE WAS A DOCK 3/4 " WASH HOSE RUNNING IN IT. ON THE OTHER FINGER PIER THERE WAS A TWENTY-FOUR [24'] SAILING VESSEL WITH A GARDEN HOSE RUNNING INTO IT THREE QUARTERS [3/4] FULL OF WATER ALMOST SUNK. THE .M; MOTOR BOAT WAS LEAKING GASOLINE AND OWNER STATED IT HAS A FORTY [40] GALLON: IS TANK ALMOST FULL. INVESTIGATING WITH A CREW, 800,AND COAST GUARD TRAILER WE DEPLOYED THIRTY SIX [36'] OF ABSORBENT BOOM AROUND THIS LEAKING VESSEL AND TEN [10] ABSORBENT PADS. WE ASSISTED THE HARBOR MASTERS OFFICE [ERIC AND JOE] WITH DEPLOYING PUMPS AND REMOVING WATER FROM THIS STILL SINKING SAIL BOAT. THE OWNER OF THE "DOCTOR DIAL TONE" TWENTY FOOT MOTOR BOAT WAS THERE EARLY INTO THIS INCIDENT.AND MADE ARRANGEMENT WITH A LOCAL SALVAGE COMPANY TO RISE THIS VESSEL AND PUMP IT OFF. THE OWNER OF THE SAILING VESSEL"SEA SHELL"WAS NOTIFIED AND AS OF TEN O'CLOCK HAD "NOT"ARRIVED. 3. INVESTIGATING FURTHER THE COAST GUARD WAS CONTENT WITH THESE SALVAGE 6PERATIONS AND PLANS ON REMAINING THERE UNTIL BOTH VESSEL ARE PROPERLY OFF WATERED AND SECURED. BARNSTABLE HARBOR MATERS OFFICE IS ALSO GOING TO REMAIN ON SITE. CAUSE: VANDALISM, GARDEN HOSES. FIRST VESSEL: 20' INBOARD/OUTBOARD FORTY,[40] GALLON FUEL TANK MS 7293KA NAME: DOCTOR DIAL TONE OWNER: MR. EDWARD CORR 42 CEDAR STREET, HYANNIS, MA. LIC; S26442833 D. O. B. 12/08/1944 508-775-6829. - SECOND VESSEL: 24' SAIL BOAT WITH A SMALL OUTBOARD [NO FUEL LEAK] MS 5042 LG NAME: SEA SHELL OWNER:�- LEONARD GOBEIL [NOTIFIED VIA PHONE HARBOR MASTER]. REPORTING PARTY: MR. DAN DWYER 508-428-5108. DAN REMOVED HOSES FROM OTHER w BOATS THE NIGHT BEFORE AND REPORTED IT TO THE DOCK MASTERS OFFICE. SALVAGE: MR. SKIP GALLAGHER ANCHOR BUOY COMPANY HYANNIS. AGENCY NOTIFIED AND INVOLVED: HARBOR MASTER - .BARNSTABLE POLICE r U. S. COAST GUARD MST 1 MR., BOB BAPTISTE M. S. O. OFFICE C. I. O. COUNTY [PHOTO'S] DEPUTY r BOARD OF HEALTH r WEATHER CONDITION: CLEARING, HUMID, WIND OUT OF THE NORTHWEST ABOUT 4 MPH, T 78" F. x• I _ FARRENKOPF, C. CAPT. 07/21/06. __... .._- z.: A2'60727 - EXP 0, 712112006 HYANNIS FIRE DEPARTMENT MFIRS REPORT PAGE 1 l—_ u { 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 FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. ri DATE: (7 Fill in please: APPLICANT'S YOUR NAME/S: S L1/A- r'- �gBUSINESS YOUR HOME ADDRESS: S 3 55 �-yA N N 1 S � 'AAA . 6—ei604. TELEPHONE # Home Telephone Number 3a" Ss'it NAME'OF CORPORATION: NAME OF NEW BUSINESS. TYPE OF BUSINESS —C" IS T.HIS AHOME OCCUPATION? YES .ADDRESS.O.F BUSINESS � � MAP/PARCEL NUMBER ��/ �� Asses sing) 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 CO ISSI NER'S O FICE This individ al h enrinf=46ny ermit requi ements that pertain to this type of business. A -hor=-At . ture, * COMME T IV 2. BOARD OF HEALTH This individual ha� beefs'(J�f_grM, --1 of the permit requirements that pertain to this type of business. � Y V SNouyi 03H SIVW31bW Sf10awz\f j Authorized Signature** 11V HIIMAldffl^ ism 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: 7131,E 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) aan�tt�:cxxni NMpA C#��••" �. ov.'TE•/Q V Fill in ple ; sin APPLIGANT'S YOUR NAME: f�T�GLja/U �rL (v�}- +' BUSINESS YOUR HOME ADDRESS: •3-2-,0 41iTCl-rz�;r S �Sg MA 6� . TELEPHONE # Home Telephone Number so=i Flo - NAME OF NEW BUSINESS• P>=S �T� ��C7aziCii9iV C TYPE O.F BUSINESS: 1S THIS A HOME OCCUPATION? YES NO . v ou been ..iv&h a ro �...: .. . rL ADDRESS OF BUSINESS srr1 e o�7� �` 7 O6 :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 POO Main St. - (corner of Yarmiouth Rd. &Main Street). to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO,M NER'S oFFlc MUST COMPLY WITH HOME OCCUP This indiviu I his errinfo ed• y permit requirements that pertain to,this type of business.RULES AND REGULATIONS. FAILURE TOTIO AILURTO N ti l `Authpriz Si n ure COMPLY MAY RESULT IN.FINES. MMENT v 2. BOARD OF HEALTH This individual h been infor e f t e perrequire ens t that pertain to this type of business. Authorized Sig ture** MUST COMMENTS: . COMPLYWITMALL GULATI 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: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: _ C%w, BUSINESS LOCATION: MAILINGADDRESS: Mail To: TELEPHONE NUMBER: 0� �'� �� Board of Health CONTACT PERSON: Ir1?r�� Town of Barnstable 1 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMB R: Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store any of the toxic or zardous 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: 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 %6--6Z 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 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 (dry cleaners) Z(,PD7-- Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: / TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: j MAILINGADDRESS: Mail To: Board of Health TELEPHONE NUMBER: 7 �` 9 Town of Barnstable it CONTACT PERSON: P.O. Box 534 o �,� �. 1 B EMERGENCY CONTACT TELEPHONE NUMBER: S� f_ Hyannis, MA 02601 r TYPEOFBUSINESS: h Does your firm store any of the toxic or hazardous materials list1d below, either for sale or for you own use? YES N II 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: f 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 I you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity , Quantity t 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) i 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 Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) r i 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 (dry cleaners) L° Other cleaning solvents Bug and tar removers - %fWHITE COPY-HEALTH DEPARTMENT./CANARY COPY-BUSINESS