HomeMy WebLinkAbout0006 SETH GOODSPEED'S WAY - Health 6 Seth Goods peed's Way '
Ostervi l l e
A = 1.46 — 054 .
Date
Physical Street Address-Check database to ensure it exists
-� orking Phone Number
AYtual 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
U 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.
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 JD
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, 'I"FL, 367
Main Street, Hyannis, MA 02001 (Town Hall)
;� DATE: -�� I Fill in please:
tit 1 � �c�;o � � APPLICANT'S YOUR NAME/S: � e 1ti (ems ��j1N
f BUSINESS YOUR HOME ADDRESS: ej4k
PM .„� TELEPHONE # Home Telephone Number 0 "13 '
! Firs
NAME OF CORPORATION:
NAME OF NEW BUSINESS vp✓Icei c ¢:�'1 TYPE OF BUSINESS Co n5IIk
IS THIS A HOME OCCUPATION? YE2' (J NO
ADDRESS OF BUSINESS W u OS' t�E MAP/PARCEL NUMBER l �60 6:5 (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
r
COMMENTS:
2. BOARD OF HEALTH MUST ►OMPLY WITH ALL
This individual has been ipfeqmed.of the permit requirements that pertain to this type of business. r-� n0!n0!lS A ► 7lnq �±
L . riyvlV� -
Authorized Signature* MUST'r..OMPt.YWITH ALL
COMMENTS: vRFA1"fDO I^mAxcIAI S_R.FCl-11=/XIM19—
3. CONSUMER AFFAIRS (LICENSIN AUTHORITY)
This individual.has b infor e licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Dater
TOWN OF BARNSTABLE
TOXIC AND K&CAU6-f&
HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: v� Q
BUSINESS LOCATION: aJ V,el a INVENTORY
MAILING ADDRESS: (p SG �', TOTAL AMOUNT:
TELEPHONE NUMBER: ,�D$-a 90. 0 0(2G,
CONTACT PERSON: �tZG Se �e--N—
EMERGENCY CONTACT TELEPHONE NUMBER: 67_Of!r- O-(�9 a. MSDS ON SITE?
TYPE OF BUSINESS: CC}/1Sd-ruc Ham (S1utdrki
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed' es 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
**60 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
gQ 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
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staffs Initials
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA�J��
T_;v jZ,�..........OF......... kIV-5.7VI ................. 141P /V� -OSK
Application is hereby made for a Permit to Construct V.,�®r Repair an Individual Sewage Disposal
Systerp at:
Location-Address
or Lot No.
Owner I
Installer
Address
Type of Building Size Lot--./,?,, feet
Other Distribution box Dosing tank
'-----------------------'----'---------..-------------'—'---'-----------
ugccoozcoz:
The undersigned agrees to install the uforedesoibed Individual Sewage Disposal System in accordance with
� the provisions of Article II of the State Sanitary Code-- The undersigned further agrees not to place the system in
operation until a Certificate ofCompliance has been issued by the board of health.
' '�������-- --/�� -- ...... --'-�r--''
Application Approved 8y---n-' y � ' —_..-_-.- -''��..�°� .�.
16� Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................--------------------------------------------------'--'---
u"te
Permit ___
Date
----------'''''—'
R
No. -� •----•--- Flnc.���................._
THE COMMONWEALTH OF MASSACHUSETTS
T
BOARD OF HEALTH
`� /G�✓. /.........OF..........T� !./. . /._� /fr3�. -1...............................
AVVlirtttiun -fur Uhiputtl Works Tomitrurtiun Vrrutit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: I ry 4-
Location-Address i 1 or Lot No.
t e U, ' 'I
p �.>P 1, �'f {/ c� i�J Rl 1
..-•-------••--•-•----------•.............•---------•-------------•--------••--------••-•-------•- ......----•-........... .....................................tj Owner � A dre s
-----------------------------------
� Installer � Address r � -��Sq. feet
UType of Building Size Lot... j_...,_.. ..
., Dwelling—No. of Bedrooms---------; ..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( .) — Cafeteria ( )
a' Other fixtures .....44-41_C::...............
w Design Flow.__.____: ___ ...........................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacit. gallons Length................ Width................ Diameter---------------- Depth.___---__..._-
x Disposal Trench—No_ ____________________�W�Width.................... T,ptal Length--_______-___-__.-/Total 1• Ching area....................sq. ft.
Seepage Pit No..fl-��_-`Dig'mct�r. "�—-------:-••DejAh*e-ov{-"inkt; ota eaching area------- ----------sq. ft.
Z Other Distribution box ( -9� Dosing tank ( ) p N _ _7
aPercolation Test Results Performed by---•----------------------------........................................... Date -•-.-_-.----.---.---.------------...
Test Pit No. I----------------minutes per inch Depth of "Pest Pit--.--__-____-___._.: Depth to ground water...-_-_-_-_--.---_------
fs Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.-.._--__-_._-____----
x -- -- ---- --a-r-•------------•-----�- --�------„
p Description of Soil------------- J ------
U --------------------------------------------------------------------------------------------------------------------------------------�---�-----•---•--------.--.-.-_-.-_-.--.-�.---_--.-j-- --------------------------------
-------------w
VNature of Repairs or Alterations—Answer when applicable............................................................................................._
---------------------------------------------- ---------------------------------•------------------------------------•--------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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 board of health. /
'j /�� r Date
Application Approved BY / U� 1t!�
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
...-----••------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ...................
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
C _ BOARD OF HEALTH /�
..........7 -4��_e ....o F........
1
01trrftfirttte of Contpliourr
THIS ISTO CERTIFY, That�te Individual Sewage Disposal System constructed ( or Repaired ( )
byN! U/ c°` I ` y ---------- - -----------•-•---------------------------•-------- -
-� Installe t
at............................•--- �',e- -•�.C�U__ , 1/a P FC :�'1..C,: I "f _.
- -{ -1.. ._._....
has been installed in accordance with the provisions of A ticcl XI ofThe State Sanitary Code as described in the
application for Disposal Works Construction Permit No._7G.__.._�,l(_�_______________ dated-..._q-_�.:_.? ..._____..._.__.._.
THE ISSUANCE OF THIS CERTIFICATE SHALE. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION
SATISFACTORY.
DATE----------/�-�...-` `T ........................................ Inspector-------------_------ --- -- --------------........................
THE COMMONWEALTH OF MASSACHUSETTS
0-76, BOARD OF HEALTH /
f !.. ..................OF........ ,�� r ..�.!'� ............2- .................
No......................... FEE...
i� u�ttl// urk.q C11omitrttrt�utt Vamit
Permission is hereby granted______.___--1 1..f_Z/z&_•__-____ ��... -- ...........
to Construct or Repair ( ) an Individual`Sewage Disposal §ystem
at No. -----
42---------- / ... ��........ ---. '�/��-----------
: Street
as shown on the application for Disposal Works Construction Pit
No� ........... -_ Dated--------
, ................
DATE................................................ ---------------------------
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FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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