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Home My WebLink About0276 TREE TOP CIRCLE - Health 276 TREE TOP CIRCLE MARSTONS MILLS 150-041 YOU WISH TO OPEN A BUSINESS? a For Your InformEG ion Business certificates (cost$30.00 for 4-years). A business certificate ONLY REGISTERS YOUR NAME in town which You must do by .L-it does not give you permission•toope.rate.) Business Certificates are ava-iilable at the Town Clerk's Office, 1' FL.[367 Main Street, Hynis, MA.02601 [Town Hall) ;taW romat eoyua,B4p9a p .' GATE• `/ n—,. kil Fill in laase: v .wr a /iP!'UGANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS: Z& TG TELEPHONE # Home Telephone Number NAME OF NEW—EW61-Njt Ss i� T'YPP OF Bt1SINE5S: G�ti�� p/dr 15 THIS A NDME DDDCIP�XTC(�IV YES Np ADDRESS-OF :MAP/PARCEL'NUMBER LSC� C I When starting a new business there are several things you must do in order-to be in compliance with the rules and regulations bf the Town of Barnstable. This form is intended to assist you-in-obtaining the information you [nay need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street), to make sure you have the appropriate permits and Iicenses.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. Authprized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has n inf rmed f ermit r uirements that pertain to this type of.busiriess. A orized Signature. * MUST COMPLY WITKALL COMMENTS: . Uiti 1kN Z. rn W-•r-1 HAZARDOUS MATERIALS REGULATIONS �-fit. 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: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: 27-/- Zlke A ,2 4i� INVENTORY MAILING ADDRESS:,r e2op/-:5;�-5 G1��`�LS TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERS0N:.OLeZ 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 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 Lau y �. (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS .. t� _..Y,... ,. ,.- "`ti,Y,-�^.�.r "'+."^"^.'",y:...^�+r.i+r'..�r..-..�'vs.,,.r+.:: --{«..�.!�'"y��- .ti,r• _ - - - �`` Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: '` BUSINESS LOCATION: 7� T.�c2 �`c✓' INVENTORY MAILING ADDRESS: ��%u�5�` ��j' ,�5 TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: u � `v, 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 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 ICar 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._,._.._ U.SE.Q. __ .. _ s_ _. Any.othe:r�products with:':p-oison'--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 t7A41 (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ASSESSOR'S MAP NO. /� —0 PARCEL LOCATION " SEWAGE PERMIT NO. a--7(Q ` C2.-e --lno Q Lti\r-c-)\-e� VIIIAGE INSTA LLER'S NAME i ADDRESS s UILD�E--R—� OIR OWNER DATE PERMIT ISSUED � `�_ � DAT E COMPLIANCE ISSUED 'ExiiVili ZM\lX CEss foo l— o�v arc K � 75� /s-o No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... .... .'`'....OF..............1�.. ..�^ s` ..�..��... Appliratiun for 11spuuttl luorks Tonstrur#tun f rrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: Location��ress """"'"'"""'" or Lot No. --..... _ .Y.. _....-•-•-•..t.�.C�I/k ...................... 1........------••-• -nr--- .1 `- .... ....................... Owner' Add .......ress -........... ,Wa - ..............:..e. - .:," ----------•--••-----------------•- .......................... L.i�.f -c'. ... .fT Installer - Type of Building Address SizeLot............................Sq. feet U� Dwelling—No. of Bedrooms...........�3- --------------Ex Expansion Attic-------••-- P ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) .< Other fixture ..................................... -•....................•............. ... -- -- . Design Flow............... . allons er person per day. Total dail flow.............. .gallons. W G. g P P P Y Y .... 1 -.. W Septic Tank—Liquid*ca.pacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.... Total Length.............. _... Total leaching area....................sq. ft. 3 Seepage Pit No........I............ Diameter-----1%.D....... Depth below inlet............... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by....................................... ---------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.--................. Depth to ground water.........--..........--. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------------------- -.......... ------- •--------------- •----------- .------- •---•....................... ----- • *...... •.... ••............ 0 Description of Soil........................................................................................................................................................................ ......•............_.._..•--• V ------------------------------------------------------ ---------------------------- ----------------- •------------------------------- •--•------------------------- W =----------------------------•----------------------------------------------- --------------------•------------------------ U Nature of Repairs or?lterations—Answer when applicable---------An'ra.......`�.��.....�1�......� ...........: ,} -----�.. , .. y.-kv........................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'i LF, 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 bogrd of h Signed. ............ P .. Application Approved By....................................... ....--•-•-----...................... =/ e-,��... Da Application Disapproved for the following reasons:.................................................. ..................................-.......................... - ....--•••--•--•---•-----••--......••••--•-•-•-••---•----•--•-----•------•-•--•-•-------•--•----•-•.......... .......-•--•-. Date PermitNo................................... ........ Issued ....................................................... No.....---•--....._....... © M�f�-G'`c' Fps. THE COMMONWEALTH OF MASSACHUSETTS � BOARD OF HEALTH --�- ......_1.... ....OF............... Appliration for Disposal Vorks Tonotrurtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair (`5 an Individual Sewage Disposal System at: I . _ Location-Address or Lot No. ....... 5��? .... .1....------.s �. `�—`� l �'f` P� ................ ................ ... Owner Address ° r' 5-----... ..... `�c �7 z... ..t'1:. �. r �.t :r? Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms.........��--------------------------Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------ ........................................................... W Design Flow................-... ..................gallons per person per day. Total daily flow.............. .62...........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........I........ _1. Diameter.... -__- Depth below inlet......1..... Total leaching area..................sq. ft.' Z Other Distribution box ( ' ) Dosing tank ( ) Percolation Test;Results Performed by.......................................................................... Date........................................ i Test Pit No. 1................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......................... Rr ..--•----------------------------------------------•---••-----......------.........----------------.............------........----•-•-----..............---- 0 Description of Soil......................................................................................................................................................................... W V --------------------------------- .--•---------------------- .----------------- ---------------- •---------------------------------------- •------------ •------------------ -----.......... W U Nature of Repairs or Alterations—Answer when applicable.......... _0.0._..___q ................mooK!=z D.i--y G' �f_!TLk--�1 -----------------_XI.t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 11. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in p Compliance has been issuedfb he bo.rd of liealth.o erarion until a Certificate of Comt ^ - ---------•-- ----\ ' Signed Application Approved BY - ............................................................' ?./ / Date �___, D_te . Da Application Disapproved for the following reasons-----------------------------•--------------------........-----•................................................ ........:.........................................................----....----------......------•..........-•---...---•-------------.....----------------=---•----•----------...-------•------•--•--•- Date s` PermitNo.................................................. Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......OF..... .. ............................. Trrtifirab of Tontplinurr THIS IS TO.�_E TIFY, That he Individual Sewage Disposal System constructed ( ) or Repaired (�)/ .�._ .�.-- �installer by................................... , -----------------------------•..-- has been installed in accordance with the provisions of m j"�_ Hof The State Sanitary Code as described in the application for Disposal Works Construction Permit No......_ �� _� dated_._.._.�'�ai_2_��C%9----...- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... !. �-- Inspector_. lI------------------------------------- �c--------------------•------••--------------------.----------•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ....�6.UV.�......OF...... ..cti r C''..5. f , ,' No....................... FEE Disposal Work T notrttr#ion �rrntit Permission is hereby granted............... ----------i. -� P.__' �:...................... to Construct ( ) or Repair (�-- an Individual Sewage Disposal System atNo................................. fir...... f7 �`'� � "-'r�.......��-�.-�. I-Y--------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No-----c.-_ _(_. ..Sa .__...._.... � , -./ O t�s' - Board of Health DATE. ...........!