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HomeMy WebLinkAbout0040 ROSA LANE - Health 40 Rosa VLane' 000-004.001 Marstons Mills YOU WISH TO OPEN A BUSINESS? FFoYour Information: Business Certificates COST $30.Ofl for 4 years. A Business Certificate ICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first 0 Main St., Hyannis. Take the completed form to the Tovvn Clerk's Office ;� ONLY REGISTERS YOUR NAME in the Town usiness Certificate that is required by law, obtain the necessary signatures on this form Fl., 367 Main St., Hyannis, MA 0260�1(Town Hall) and get Fill in please: DATE: ��—�� d. APPLICANT'S �— r M YOUR NAME: .c.f/IS BUSINESS YOUR HOME A RESS: S TELEPHONE NAME OF # Home Telephone Number: �R gUSINESS�7;/�, —' IS THIS A HOME OCCUPATION? S LLCryPE OF BUSINESS given a ----YES � NO Have you been � g approval fro the building division? ADDRESS OF BUSINESS No c S. MAP/PARCEL NUMBER When starting a new business there are several things you must do in r s Barnstable. This form is intended to assist you in obtaining the information you may need. Y order to be in compliance with the rules and regulations of the Town of Yarmouth Rd. &� Main Street) to make sure you have the appropriate permits and licenses ou MUST GO TO 200 Main St. — (corner of town. required to legally operate your business in this 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of busines s. COMMENTS: Authorized Signature** 2. BOARD OF HEALTH This individual has be infor ed o the er i requirements that pertain to this type of business. uthorl ed Signature"* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha en informe of the licensing requirements that pertain to this type of business. COMMENTS: Authorized Signature** TOWN OF BARNSTABLE Date: �//5//) TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: �' Y)S L LC BUSINESS LOCATION: INVENTORY MAILING ADDRESS: Pd, IQK JaQ W2rS7'nr)S Wj JIS J�d P TOTAL AMOUNT: TELEPHONE NUMBER: JV 'q36— IS7o� a e CONTACT PERSON: G V_11h S EMERGENCY CONTACT TELEPHONE NUMBER: ���� ��D � MSDS ON SITE? TYPE OF BUSINESS: an('yd-fncaL , INFORMATION/RECOMMENDATIONS: S 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. UST 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) Spot removers &cleaning fluids _ (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Hazardous Materials Inventory Sheet Checklist Date /Physical Street Address-Check database to ensure it exists ./ Working Phone Number Actual Amounts—(i.e.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) d — 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?—provide a vehicle washing policy and /explain it—note that it was given. 1/ 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 Date: -7 /a9/69 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERI LS ON-S TE INVENTORY NAME OF BUSINESS: n. •LIP BUSINESS LOCATION: IN MAILING ADDRESS: 1q r , m TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON hld EMERGENCY CONT T TELEPHONE MBER: ��`7 •�I ?J Q� MSDS ON SITE? TYPE OF BUSINESS: ll( 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 removersQ Ir J � � Is (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE 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, Vt FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: APPLICANT'S NAME: t')S 6 S1-� Q YOUR HOME ADDRESS: QoD q '-# t t BUSINESS TELEPHONE # 5(0- '�'o0"15r HOME TELELPHONE #: � -Lf —���j�a NAME OF CORPORATION: " NAME OF NEW BUSINESS j° �'/ /�Y1 _ TYPE OF BUSINESS' © _ IS THIS A HOME OCCUPATION? YES NO 'n ADDRESS OF BUSINESS P,0, X l�q , GlrS�1'1S � ftt 5 IMP MAP/PARCEL.NUMBER (Assessing) 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 form is 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 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 h en informed of the er it req ents that pertain to this type of business. IMMIMMMIRALL Authorized Signature*" !iA?A OM NI�ALS 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: ; �r t 1A c� LOCATION SEWAGE -PERMIT NO.. !1 D eS�R kAMC, VILLAGE y, 1-NSTA LLER'S NAME R A0DItES`S �o fdel��1 �'JA1?i� Il AA s/ON ® U I L D E R OR OWNER: DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED c30- Y3 i a .. . � �N��+�► S.do olC vsc • R . . ,. � � .. .. b . o X .y e 5 V" LOCATION SEWAGE PClftlIT M0• lcS� Vic- - 7d VILLAGE I N S T A LL-EIS S RAISE & ADDRESS 4 . G'UILDE R OR OWNER l ` DALE PERMIT ISSUED DAT E` COMPLIANCE ISSUED r � �� i 6��` ;� Q d `x � �N ZOP _. IVo. .... ..... Fss.. 5.................. ` THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..... .............:......OF....... GJrI= Annliration for Diinniittl Works Tomitrurtion amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at h., L cati n-Address or Lot No. �d - r 1 / Owner _ Address Installer Address ^ d Type of Building Size Lot._A�=,4r_—Cr Sq. feet U Dwelling—No. of Bedrooms____..... -__•.Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons........ __________________ Showers Cafeteria a' Other fixtures ---------------------------------- d W Design Flow_//O.. s.Pf...t __ ._gallons per person per day. Total daily flow.......�So.....................:....gallons. WSeptic Tank—Liquid capacity,f ...gallons Length..._?........ Width.Y.Kt..._ 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.......................................................................................................................................... - x UW ----••...-••-------•------------------------------•----•------------------------------.............•----•.......m---------------------••---••........_...---•••---......_..._--•--•......-•----•----•••- 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 TI'i 1Z- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in =y h'operation until a Certificate of Compliance has been issued by t board of lth. Application Approved By--- ••-- ....... ------f� l°r--� ---- Date Application Disapprove f or a following reasons:.............: .. - Date PermitNo........................................................ Issued_....................................................... Date go') ....7 . F.Rs..Ij................. •�' THE COMMONWEALTH 'OF MASSACHUSETTS BOARD OF HEALTH 4. � , _ --------------......OF....... . l-= Applira#ion for Disposal Work, �onstr trtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ._ ...l........ ✓:5....... ..�. !hed ::.... / .......... A 6 l .................................................. Lofat' ' •Address or Lot No. Wll Owne r I� Address a W .5 XR.h......'---:T-4/ni"k...--�'z........................... Installer Address d Type of Building Size Lot...±?$.-. 1CA'_C___Sq. feet U Dwelling—No. of Bedrooms......... ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ......4rt.?.............. No. of persons......­Z................. Showers ( ) — Cafeteria ( ) dOther fixturesQ----�---------------------------•------••-------••. -•-•--------------------••----•---------•-••......-----------------------•.......---------------- Design Flow.,�M.- .-trf-..... .gallons per person per day. Total daily flow.__.....sM!................... W -� P P P y' Yt -------gallons. WSeptic Tank—Liquid capacity.r M..gallons Length..... Width..9' l!-•.... Diameter__._____-___-- Depth.."--_-_-_-- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-.-.I------------- Diameter,,....6✓'__........ Depth below inlet...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) J Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... GT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0+ ---------•----------••-•--•..................••-----•------......---------...............•--•--....................----....------••--•-•-------------•----•-- 0 Description of Soil........................................................................................................................................................................ x V ......------•--------------•--•-----------•----------------------------------•-----•-----------------------•----------------------•----------...---•--....•----------------------•......-•----------•--- W UNature 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 TILL LE 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 th, board of h lth. /Silel; -- 'f-•/ e . Da .. Application Approved By..... --------------------------------------•--------...----------------- `.j='......................... � Y Date Application Disapprovedfor a following reasons:.............................................................................................-.................. ..................•-••--•.........••----.....---...---•------...----••--•-------......--•--•--••-•------.-----•--....-•-•-----•-------------•---------•---------------••------------------•-------...... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ,,..- BOARD, OF HEA !x' L.� :....................OF.... ........ ........:.. .. .......... ...................................... Tntifirtttr of Tome itturr 7`HIcS IS T CERTIFY, That the Individual Sewage Disposal System constructed ( Repaired ( ) by 'r ........... ------------------- ------------------------------------------------ •............. •---•------------------------•._.......----------- i Installer ........................... ........... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Codes described in the application for Disposal Works Construction Permit No---9.'9.._.7A__3............... dated_-.1�Izel`��____......_.__:. THE IS50J N E OF THIS CERTIFICATE SHALT. NOT BE CONST AS A C:IJARANTEE THAT THE SYSTEM W1 gqNCTION SATISFACTORY. DATE---3 ...�. ....1---•---=-------------------------•-------------------. Inspector... THE COMMONWEALTH OF MASSACHUSETTS t.....-�.-�~-.." BOATOF HEA T .g ................ NO. i ."..!.U. ... FEE... .................. Dtopollat o ko (1-11ono#rudion rrutit Permissionis hereby granted----•-�_ ...............................------------------------------•--------------........----..................---.... to Construct ( repair (� an Ind'vi. 1 Sewage Disposal System as shown on the application for Disposal Works Construction Permit tNo.. ._ ated.ff'r . . .. {....... //ard of Health DATE................................1. !.... F FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 10' 20'. 22' 24' 2fi' 26' _ ti v ' ' y r- e .. r r, rr ? � < Q r 2 VV —1 - ,: nn i -' + ,. .. rr J --_ - r r W Q • -:10' 1 .. ... .. N fCli ! .12 : • 0 , DESTGN-STU 10 641 Main Street oC a We Yarmouth,MA 02673 z , r.. 16; .r. ...: .._ _ .. ♦ . � . . �IlVE LL �OOD CABM"' TRY _ • z p" i. 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No. `' r i z� AROU140 WATE ) IM/ERT PI 5Z,90 / 1 'a I c�bY o I No GARSA F- GR11,11?SR R/ - 20/M!N � 5EPTlc Sy5TEM CONSTQL)alnON t?�S�cani cantn�T,a�I o,�5 SHALL CONFORM - o -THE HE MAS6. � • is/� cs-�--B--3 SV( RONMENTAL CODE TIfLEy RE D5� 4 of 14fAL:r 4 UAj)orJS 1Cahf PL0V4 ° - .�, LEACH iN6; RAT5, s Ge Ss ,z Mlvlly SEPTSG'fANK, O15Tf21 B�TlON 1 r — AV LX.ACMlkd PIT TO 139 of ';+��wv�`� REQ1O. LEAC.W. CAPACITY 330 G.1lP. REl tJFoRC-4z,ty Got�tCRT"E. :MitWf4FE SFlVRO My PROQ45aV LEA414 CAPACY S3" P�IN � — 20000 H 10 LDA of r CA PRIVE-WAY NOt' Tv 8E LOC MP ,O CRAG I7E5t GZN LOAE711�C7 (.tra�O RirAG+iC\ At,L P1 P To Oo WA'f gUi 1N'i" ,�fl z74ss ti , Tb t36 �( �I� elo►�� f�f •�����. ..— — — OARM50 Rer, 9669SP 'C5�`� W-ir LR� oR Pt>:-CA5'f ,a�3►18 ' -- �: OF a nay: oC •9az , # —,-3�� ENGINEERING CuRn DESIGNING BUILDING HeAL4 HORT AaF-r4V AFMOVAL- INC. MASS. DENNIS, 38531