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HomeMy WebLinkAbout0171 ABLE WAY - Health (2) 74 BOSUN'S WAY ,MARSTONS MILLS A = 046 113 1 1 YOU WISH TO OPEN A BUSINESS? F r Your Information: Business certificates [cost$30.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME 'u must do by M.G.L.-it doesnot give you permission to ope.rate.j business Certificates are availaf;le at the Town Clerk's Office, 10 FL,�367hain Street, Hyannis, MA:02601 [Town Hall) suiRl9 VIM Yam^""' ppn, in r Fill Igasa, GATE: . 'A'A •`u5tig',�idlwVf 8dLt19 _ tt .t . - - APPLIGANT`S YOUR NAME: SeAAl ,"4•C•Ay f BUSIN S YOUR HOME ADDRESS: s Svfj'---3C7 -05% mA olyS aSy/V'J !AAA TELEPHONE # � mks 0-;i "'' Home Tele hone Number S o NAME OF NEW BLJSF ESS D G 15 THIS A HOME OCGUPLITIOIV?, YES Np. `� TYPE D.F BUSINESS_ C.L okA/)A ADDRESS bF BUSI'NES. 00 wL W/A :MAP/PARCEL NUMBE When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.information you Cray need. You MUST GO TO 200 Main St. - (corner of Yarmouth � Rd. & Main Street).to make sure you have the appropriate permits and licenses-required to legally operate your business in this town. t 1. BUILDING COM SIO ER'S OF�IC �= u This individu I h s b6i n i )�d• a' permit requiremen at pertain to,this type of buMUST COMPLY WITH HOME OCCUPATION ;L NTEN AND REGULATIONS. FAILURE TO ut pri d igodture � COMPLY MAY RESULT IN FINES.. C LAMENT 2. BOARD OF HEALTH This individual has be informe the p i eq i ements ertain to this type of business. Auth i d Signature*** MUST COMPLY NTH g ALL COMMENTS: . \D HIAZARDOU$MATERIpLSREGULATIONS 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:"( /qS / o� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: SeM MG Ui � �5 GLem), SeXy,�e.S BUSINESS LOCATION: �C,s�NS vVAy iW)�'S7dt/S N1�f,4S /'V�ASS INVENTORY MAILINGADDRESS: .O13ex �oa- iNAySTdVStM;t<LS MA5 a',r*Li TOTAL AMOUNT: TELEPHONE NUMBER: 50�-3C7 -05-jo CONTACT PERSON: Se14� M SA�i Yr-e� EMERGENCY CONTACT TELEPHONE NUMBER: SOT-3`7 'd scl o MSDS ON SITE? TYPE OF BUSINESS: CL-�I11 NG1 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 materials 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) Misc. 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 Misc. 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 Misc. 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 (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers ,�� (including bleach) 11�AR1e Spot removers &cleaning fluids 1 c,\ 6A,�, D C aA, / (dry cleaners) o n a C.t C Other cleaning solvents Bug and tar removers Windshield wash v ' WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Dater C TOWN OF B.ARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: '�'~� M GNU I ;1`e J� C L:�ewi A,') �.#�V,'-e BUSINESS LOCATION: y 60LL 5 WAY Lti'If2+ yiCA6 n �� �-5 MAAS INVENTORY MAILING ADDRESS: O c X (�c �- W►�✓ST�,N S VYt dN1A5S Oa6�! TOTAL AMOUNT: TELEPHONE NUMBER: SU� IC-7 CONTACT PERSON: 5eMl M SAUl� LCL EMERGENCY CONTACT TELEPHONE NUMBER: �G� 3G% —G 5`� MSDS ON SITE? i 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 materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. x 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) Misc. 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 Misc. 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 Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's v Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED . Any other.products with=°poi_son',aabe_Is, _-. . _ - Paint&varnish removers,_ deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) - Floor & furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) u w C k S ` ,\ ',k e Spot removers & cleaning fluids 0 \ \\u �' \\o L ` L (dry cleaners) c Other cleaning solvents Bug and tar removers Windshield wash y J WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS LL 55 TOWN OF BARNSTABLE 0 LOCATION 'Y SEWAGE # C9,WQ VILLAGE ASSESSOR'S MAP & LOTW 4 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �1� Ot�('bAr- � (size` { NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: ab"P�)-2-0�I 6b COMPLIANCE DATE: 00 i 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 -D , �. �� TOWN OF BARNSTABLE � Mtj LOCATION SEWAGE # I VILLAGE ASSESSOR'S MAP & LOTIJ �. INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)l Al- (size` ,. -5 1 NO. OF BEDROOMS s BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: (7 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 i Ai Q ,yam �0i1 �� 046 1 l C� LUG l2. Fee A No. THE COMMONWEALTH'OaF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mi5pool *pgtem Cow5truction Vermit Application for a Permit to Construct( )Repair( V,/Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� Owner's Name,Add s and Tel.No. M - 'N� l.i� c kk�_L Fri , Assessor's Map/Parcel © 1 o Le`\-Z 74 1:1 1^A -0 )LLS lqstqler�s i/awe. dr s �Io. 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 *hSp applicable) l CvU 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 o e 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue b h oard o Signed Date Application Approved by de Date Application Disapproved for the following reasons Permit No. -���/ Date Issued � A Lo V [2. No. ��' 1/� IF THE COMMONWEALI MF MASSACHUSETTS Entered in computer: Yes r. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 1 Zlpprication for IBi.5poe ar 6pgtem Construction Permit Application for a Permit to Construct( )Repair( V<Ulppgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� Owner's Name,Add s and Tel.No. An . U`S LI90 CNU`I_[ FFF_ Assessor's Map/Parcel 0 —,110 L.6; `-Z 114 nU j W f\` M n M I LL S le6s N`are, s` �Io. ` \ 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 vyhen applicable) A7 G� R� %C ` E�4S Date last inspected: ,Agreement: The undersigned agrees to ensure the construction andirzaintenance of the afore described on-site sewage disposal system in accordance with the provisions ofLitLe 5 df tl a Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue b hi d o ? Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. _7-0?1V—111 ` Date Issued ------------------------------------THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS V Certificate of Compliance . THIS IS TO C TIFY, that the - ite Sewage Disposal System Constructed( )Rep red( -)Upgraded( ) 1 Abandoned( by \ Q 3��� at ?u O�iA 11u� U�1`(�-�. N�. 1M 1 t L has been constructed in accordance with the isions of Title iandthe for Disposal System Construction Permit No. -Z4M -#/ dated Installer\ Tc�r�� Designer ,C A _ The issuance of this permit shall t be construed as a guarantee that the systemwill functiion as desigriedy�J Date Inspector / �' �� d. � �I N I i ---�-I----------------------------------�j-- No. _V&V— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 30i5pogaf *pgtem Construction Permit Permission is hereby granted to Cons ( )Repair( v}'Upgrade( )Abandon( ) System located at 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 completed within three years of the date of this ptrrrut. < Date: Z/Z �� Approvedby ,t 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) �<-14lereby certify that the application for disposal works construction permit signed by me dated p2 1 ':10p n , concerning the property located at MA\US P Teets all of the foilowing criteria: r • This failed system is connected to a residential dwelling only. There are no commercial or business ' uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W.Adjustment. / _ 6 DIFF BETWEEN A and B � SIGNED' DATE: 2 /� [Please Sketc proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �'.�. .�.— c..• �� � / . �C� ���� 3�S r �� } � _ . . �� _------ No................_1....... Fss..............�... THE COMMONWEALTH OF MASSACHUSETTS jw BOARD OF HEA TH . ._-----�. -->. ...........OF..... 12a 1 Y1.. ..' �'�' / ................. Appliration for Disposal Works Tontrnrtion rprutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at• / f7 .........e .. .A dress or Lot No`, ------•. tvt. G... -.:��lv��E'. .!✓ ---�------Th l owner %�'Y• ess W .............. Ql .. .......---...-•-------•-•-•.........------------ .. ........ ................ nstaller Address Q Type of Building Size Lot..074.4.../_--•Sq. feet 0-4 Dwelling—No. of Bedrooms___- .._.__.....•..•.................Expansion Attic Garbage Grinder 04 Other—Type T e of Building .............. No. of ersons......_...__......_..__.____ Showers — Cafeteria G4 YP g •------------- P ( ) ( ) a' Other fixture ____________________________ Q --- ---- ----- --- ---•••• ------ Design Flow............. ...................gallons per person per day. Total daily flow........__._.��:1�.__._..__...___.___._..gallons. WSeptic Tank—Liquid capacity/P0®.gallons Length.e- `!�_•• Width---4.......... Diameter______________ Depth 4_........._. x Disposal Trench—N9. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. -: Seepage Pit No..................... Diameter... _.--....... Deptl below inlet...�...-........ Total leaching area..9 q-�-...sq. ft. Z Other Distribution box (/ ) Dosing tank W) Percolation Test Results Performed by.___ ................................................. Date__. _�..�� �-j r � 04 Test Pit No. 1.. --------minutes per inch Depth of Test Pit.................... Depth to ground water.!_�-o___--_I-____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •-------......................................................... O Description of Soil........•••--� ._�.... ....... ve1..� '- V ------------------ •------------------------- ------- •------------------------------------------------ ----•------------------•-------------------- •----------------•-----------------------------•-- ---------------------•-----------------•------------------------------...---------------------------------------•--------•--••-••--•-•....._..._..... U Nature 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 TITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Abeissued by t of health. Signed hei = -•-----------•--..._.....•• E2..f. .. ..Date ApplicationApproved By••••••-•••••--•................... .._... .....•••-•-•......-••-•••............--••- Date Application Disapproved for the following reasons:.......................................................................I....................................... -----•---•-• .......... .------- ------------------------------------------------------------------------- 2� Date Permit No......................................................... Issued_................ ....................................... Date Ni .................. .... FEs.............. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD , OF HEA TH na N Applira#inn for Disposal Works Tonstrur#iun Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Syste ©S AA+A! S Lddress or Lot N G ' piwe %% Owner Address f 17 S W Installer Address 7� / Type of Building Size Lot________ ------------------Sq. fee U Dwelling—No. of Bedrooms...........................................Expansion Attic Garbage Grinder 610 aOther—Type of Building __.......................... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfi:tures •••••-•••--•------------•-----•-•------•--•••-•-...-••.••---•--••-----•---•--•-----•-••--••. ---- Design Flow...........a....0....____ _________gallons per person per.d Total �ai _ flow..__._._.__:.�� .__..._______... lons. WSeptic Tank—Liquid capacity.�d_.gallons Length_ .`4 _ Width__0......_.._ Diameter................ Dept.................. - x Disposal Trench—N _ ___________________ Widt __.�__.____._______ Total Length....... ...0...... Total leaching area...... ._____:.....sq. ft. Seepage Pit NO--------------------- Diameter____________________ Deptl below inlet_._ .__________. Total leaching area........ .f_:_sq. ft. z Other Distribution box (f ) Dosing nk ) Percolation Test Results Performed by _ �''/..___ __�'�___'______.__. 0 , a •--••• Date •- ----•- minutes per' inch Depth of Test Pit________________ Depth to ground water_________._._ _..:.__. Test Pit No. l._a---------- -•-_ q ►� 44 Test Pit No. 2................minutes-per inch Depth of Test Pit.................... Depth to ground water........................ __ _ -•-.............. .......................................................................................... Description Hof Soil..................................................' ..� ... P J U ---•--••------------------------------•--•-----------------------------------------------•----------•----- W U Nature 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 TITLE 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 board of health. Signed...................................................................................... .......................... Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons-..........................=-------••-•----•-•---------------....---------------------••-••--•••--•--•--••---- ••...............•--•--•....•••--....-•--••••-••....------••--•-••••-...-••----------•••••-••-------...••'•----••--•--•-•--•-•-•-•-------•-------- .............................. Date PermitNo....................................................... Issued-..... -------- --•-•.........._...•-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH en .....<.... ........-OF............ - .,.w............................................... Tntifiratr TuntpliFatur TH T ERTIFY,,That the Individual Sewage Disposal System constructed or Repaired ( ) b Instal / --------------- -•-•----•-- ......... eo.. ........... has been installed in accordance with the provisions of T_ 5 of The State Sanitary Code a� described in the application for Disposal Works Construction Permit No.. .......... dated_--5 "! .._�..____: f '_____________ THEASSUANCE OF THIS CERTIFICATE: SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL"FUNCTION"SATISFACTORY; DATE............. ........ .................................. Inspector.........••-•-----------------------------" ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ara. .......... C•? ?...:.......OF._.... .-..- ............................................... _ ,NO......................... FEE......,................. Dispos a or Tunu#rttr#iun rrnti# Permission s ereb anted_.... '.. fs' --------------------------- Y 1 to Construct or Rep ' ( ) an roidual w Dis al Syst at No. r� , Street as shown on the application for Disposal WOTks.Construction Permit o.____._ Dated... s ." � ' -- f '' _ '...................................— y ----- , --• Board.of th DATE-.--•7`.''2p -' � `- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �`� w! /i Cy R d, ,Ok •Z 7J . ZZ a vc o 1� 66'k1 ,5 f� 6le / ,2. 0 r' 1.:5'/4 YE AVAIL Y s/ .5 10� 0 % /f'e fc i�e� oar s r'f-ce r• / to 9 jr 0/v 1J #,e o o o.�70'vee n O p / "�► � S/ f/a}Nr �• ��.��o��N=3yT� Av�x.G jay"//o iO,/040 v\ . Me V ta _ • ... �. Qe clv,* r-n G'_ ✓ram,,C4,4 le v h 15 'A L'.e�LZI !c ft . r Inv, t/ / ,s •. . � �/Vic. •_ . � � . - -- _ � • y � . _- . .- a/V �3 �/5� � �- "�� � ���,.cK a F MA�y f� .���7F �sN h �' P FRANK FRANK t9 y o CONtRY o COMERY d, + .. ;•� ,_ f ,'"Q� .. - ,: Ka 6573 4. N( .'6232 O �.� w G CI8TE��r Q- o z P LA a of LAND 4a� MCI IN 0 MASS At rl - FRANC COMERY S TRENTOW ST. g� 7,z "-1#4 SSG: , _ � _ 1 � - r w¢G�6T�R¢D EAICit�CSLSA a L.I�ND liURME�'O°R. , • SwF /o /o G. /�+ y�`a / !a fia sly ,� �_ - t;, •,. _. : r ' ,s. C/r ��!'��.T` / .P3,�i ;dY'7. '�/k�f�� ///�luC'p="�t7;1 /:. '!1`trr'fi'f/• *I- r "� y . ♦ f 'Y,