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Home My WebLink About0077 CHUCKLES WAY - Health 177-Chuckles Way Marstons Mills II.,% C Hazardous Materials Inventory Sheet Checklist 4 Date- L_ Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines., thinner to clean brushes all count as hazardous materials-no blanks) /I/ 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 —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 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. DATE: ' °�'U 5 Fill in lease .. APPLICANT'S. YOUR NAME/S: Hi il-I'q c (:j'aT-)k)iq r E f-P j a, �-' BUSINESS YOUR HOME ADDRESS-J- C L L S k. TELEPHONE # Home Telephone Number Jn fi �28 Lt, Ad NAME OF CORPORATION: NAME OF NEW BUSINESS c r<t~T r r\-i G L E a tj i V TYPE OF BUSINESS C LL-�9 N f G IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS I-±, CJ40C C 5 LjA Y - /J. r'I ILL - M,-1 MAP/PARCEL NUMBER � � � � (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 COM IIS_510 ER'S OFF E This individu l h s a infor e e y per it re uire ents that pertain to this type of busin idST` COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO ut on gflatuf ** �. OMMENT : . - (_:OMPI.Y MAY RESULT IN FINE` v' 2. BOARD OF ALTH This Individual has.kleen inform �df th permi equip nts that pertain to this type of business, r. Authorized Si ature** CiNIAP 1�thm&L COMMENTS: -k4ZARWW MATERUtLS REWAPONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed ofthe licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: 03/ ,Z0/W 4 5 TOWN OF BARNSTABLE -*O\ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: (,A ` aA K-ET O �CL-tFA//I'IU C,� BUSINESS LOCATION: 34. CCt+vG(<LFS `J67 - H •MILLS - 119 INVENTORY MAILING ADDRESS: C4 Jc<C S �,J q y - M• M i L i_5 - M4 TOTAL AMOUNT- TELEPHONE NUMBER: 5C 8 - Ll Z,?- L4 X 5 Lf CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: ,5 o f- Ze-'l Z S 14 MSDS ON SITE? TYPE OF BUSINESS: C LEIr1 f rj G 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 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 Staff's Initials ot,4k TOWN OF BARNSTABLE G LOCATION LC,,+ /�, C H U C-k- IF -, bj,; SEWAGE VILLAGE ASSESSOR'S MAP & LOT '-'/3 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY L_Qc)o cif i6LEACHING FACILITY:(type) (size) /(300 rraf�. �NO. OF BEDROOMS ,3 PRIVATE WELL OR PUBLIC WATER r , BUILDER OR OWNER �l.l�S i�sG �?30� ICI,i q Cnrn DATE PERMIT ISSUED: I CT-9 / DATE COMPLIANCE ISSUED: / --?- f— Z?r VARIANCE GRANTED: Yes No f �l Fss.. NO� ...... ..........._.... .-. THE COMMONWEALTH OF MASSACHUSETTS BOAR® QF HEALTH ................ .........OF.............. T ...................................... Appliraation for Diipnsaal Works Tomitrnr#iun frrmff Application is hereby made for a Permit to Construct (✓S or Repair ( ) an Individual Sewage Disposal ". System at .y � cr ... -N1 f � ........................... ocatio�,}-Address o t . .......... /_.-.......................................... •.... . ......... ..--- • .. Owner j/fA 1,; /JW..- Address r� _-- ....... .. ...--------••-••------------------•--- r Installer Address j dType of Building Size Lot----- ----Sq. feet aDwelling—No. of Bedrooms............... Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No: of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ................ ................ W Design Flow.....................J ..............gallons per person per day. Total daily flow......................... ........gallons. WSeptic Tank—Liquid capacityAW.gallons Length................ Width................ Diameter.............--. Depth................ x Disposal Trench—No. ---_--. •.---_- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I-------- Diameter............1?.-- Depth below inlet.......4(p........ Total leaching area.- q..��?...s ft. Z Other Distribution box ( ✓) Dosin ank ( ) Percolation Test Results Performed by.. ._ M,.-f...N 6............................. Date--...`/:rW.'1 ........ aTest Pit No. 1.....Z-.-minutes per inch Depth of Test Pit--------[M---- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' •--•-•••--••-•-•••----------••--•-••--•-•--••-••-••----•-----•--•-•-•--•----•-----•-------•..._...••......................................................... 0 Description of Soil............. --•----••- -_.....---- •----•---------------•••-•-••••• .......................................................... U __4�......a---- 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 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 issued b the b d of ea Signed ------------. ..--- �Z- I v --....... . --- -- ----- ------- - s� Date Application Approved By - � -- :. ! ------ iF-�..' ''� 1.5 ---- ---------- ------------------------------_----------....--- Dace Application Disapproved for the following reasons: ................................: -------------------------------------------------------------------------------------------------------------------------------------------------------------................................................... ------------------------------- ---- e Permit No. -----9 ---``------ -------------- Issued ........ �A---- �r . � a............ N,o 41 THE COMMONWEALTH OF MASSACHUSETTS BOAR® + F`( HEALTH ...............j..... .(sl.!�.........OF.............. 1� l7 'fl 1J i-� -------------- Ap iratiou fnr Disposal orks Tomitrur#iun Prrutit Application is hereby made for a Permit to Construct (1/5" or Repair ( ) an Individual Sewage Disposal System at t.. 1 .� kl I� ................_.._........._........... ._.. .......... .......... ...................................._........................_.._.............................. ocatio -Address r o Lot No. Owner Address W .............................. ..•-.... ..------- .7......... ---•----...._............... Installer Address Type of Building Size Lot ..... ,. v....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a � g ......................... Other fixtures�;;;....f-------g-------------•-----..,_._......-----.......-•--•-----•----•----------------•----•-------•----••--•-.....:-•---•-------...........-- W Desi n Flow...................5........_ .--•---. allons per person per day. Total daily flow............._......_....-��........gallons. WSeptic Tank—Liquid capacity..AW.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........L______' Diameter...._....._.'•-... Depth below inlet_.......-:?........ Total leaching area..S; ...sq. ft. Z Other Distribution box Dosing-tank ( ) ! ~' Percolation Test Results Performed by........... �� _.. ..... �M�............................ Date...._�................. U........ Test Pit No. 1.......?-^'---minutes per inch Depth of Test Pit .... Depth,to ground water........................ (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---------------------------------------- -............ . ...........------•--------------------------------- •.........................:.....................-- O Description of Soil............... ..................... ..._.. .. %.. V /-- 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 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 issued by the board of health. Signed ........... ' --- - - f� Dace Application Approved By -- -z�, ":..�.. �- -- ---;r'rl,�*i^ ................... Application Disapproved for the following reasons: ................................. ... -------------------------------------------------------------------------------------- ...................................................--------------------------...--------...........------.................................._......----.......-----------------------------.. ......--------.Dace ................ Permit No. " "� -a�-------------- Issued ........10?.'2- O. ..-,fP . ............... f Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH lJ t U-- ------------ OF ....."� 1h 1J!J ve_'e- fJ Te rtifirate of (Euntylianr e S L� TO CER LFY, That the Individual Sewage Disposal System constructed ( i/ ) or Repaired ( ) by -- �/` --------------------------------------------............................... --------------------------------------------------------------------.......................................... Installer J a �. :'.............. ... at - �� .. :... --�� .....- - ... 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. *�.:}., n .....� dated . ...-u^�.� .. . Pp P � � - ��---- � , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - /r` 7.q � ....... -------------- ---- Inspector ....----- --...........:_....�� • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I t.G OF......... �..r7J ST:�` l ........................................ ....._...---•-------------•••-•••.............. f. No..,r�i: ':-sue.._ Disposal alat_r(:�o. ns i>an rrntit Permission is herebyranted_. ... g ------ to Constr ct (t✓ or Re� it ( ) an Individual Sewn ee jDis�psa l Sys em . Street gg as shown on the application for Disposal Works Construction Permit NN ated.... ------------------•-•--••---•-•---------•------------•--------...--•---•-------••••••....-••••.....----- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS L. balt_�{ Ft_ow = Ito .c 3 t �3o G.P.U. !� a 33o- F�l a % * 5 cS.Ft D. USA l00c�, GAL-. vt , .... 1�ISPoSAt_ PtT USE. t000 GA.t_• ,,� ` 8w7TOAA jg.. i'EXi'• iT sue. ,� • 1 .o ��`., . � . /r , . TOT,&L 'fl ESIGti1 r 425 •�TQ L vat t_�f FlewT� -2CblaTlo�J 2�TE : �tttt.l 2�VSiu 0¢.LESS. 60 - aRD G�c, Pc TERAL " , _ - _ � M � � •. Rr-H SULI_IVAN 10 SAXTER -WAL LAW YD TEST' P-7loG t ToP Fu n's 75 7 K Svc iG "Poe loot lwv. A �Z 4 pp� DiST. i w.TG,o 7/A♦ f 7/,6 LA14Z loop `j Sc�-tC tu ( x v i�►v. 6aL. / 7/SL STo►JE _ � t .�...� CEQT F Lo`r- Przo��try - !2' L bC11 T I o tom! 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DATE: 6 / /d Fill in please: APPLICANT'S YOUR NAME/S:_ �'��i z izih.rt 2 BUSINESS YOUR HOME ADDRESS: �- cl,4.1 �Es `, { ', �ry TELEPHONE # Home Telephone NumberC NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS G/F IS THIS A HOME OCCUPATION? 3cn _YES NO ADDRESS OF BUSINESS :i- e4 �G/ MAP/PARCEL NUMBER /�9 (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** COMMENTS: 2. BOARD OF HEALTH This individual ha e n infor f pheper it requirements that pertain to this type of business. Authorized Si nature 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: i i i