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HomeMy WebLinkAbout0076 WOODSIDE ROAD - Health �(Y1�5�ons (�1115 r YOU WISH TO OPEN,A BUSINESS? +►'� For Your Information: Business certificates (cost$30.00 for.4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which a; You must do by M.G.L. - it does not give you pQrmission to operate.) Business Certificates are available at the Town Clerk's Office, 1" FL., 367 Main Street, Hyannis,.MA 02601 (Town Hall) DATE: Fill in please:, x APPLICANT'S YOUR NAME/S: `�l�\'1 3 ,-011br& ME, ile �� � BUSINESS ` � YOUR HOME ADDRESS: -1 s � TELEPHONE # Home Telephone Number Sow Ha.-C>— cj NAME:OF CORPORATION: . NAME OF.NEW BUSINESS SS TYPE.OF BUSINE Gt� -1� c_�_.C:=j—i 1S THIS A HOME OCCUPATION? :YES_'' NO. ADDRESS OF BLISINES9S�'l.o - 6-ae .1 ��? at ,: �P S-� (��i;/ . REEL 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 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 ,.�Qb n infor f tF}e permit requirements that pertain to this type of business. Authorized Siy nature** i COMMENTS: 3. CONSUMER AFFAIRS;7iNn S G AUTHORITY) This individual has rm f the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: U-•2-' QKEIS�116bLf . I1WENT a CORY MAILING ADDRESS: LO U �131C�f QJ �� ��m ��-?� OTOTAL AMOUNT- TELEPHONE NUMBER: �� CONTACT PERSON: �rL .� �b�, EMERGENCY CONTACT TELEPHONE NUMBER: GDS5 MSDS ON SITE? TYPE OF BUSINESS: �r 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) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I I I _6/ 1 SEWAGE PERMIT NO. V` E L AG E ASSESSORS MAP NO: T A ELEVS ' A ME 3► ADDRESS 11 � iyr� 5 U I t D E R OR aYM ER DAJE PERMIT ISSUED BATE CGMPEIAHCE ISSUEE� r e__Slp -�r 0 r� (/^ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......OF....... ��,.0 S C :YJ� ........................................ .�l �r�irtttilan for Di_qvosal Works Tonstrnrtion Permit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal., System at: )ff ..... - Location- ddr s- or Lot No. QAWer t Address _✓AV d L .................•.......................... --••-•-•-•--..............................• Address nstaller dType cf Building Size Lot___ Q.....Sq. feet U Dwelling—No. of Bedrooms..............3.........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Other fixtures --------•----------------------•-'b - W Design Flow..........1 person XQ........................gallons per per day. Total daily ow..... ..........................gallond G: Septic Tank—Liquid capacity.t gallons Length_$._..___._ Width.* .... Diameter________________ De th-. -..):___ W Disposal Trench—No. .......I........... Width-----g............ Total Length_--. ....... Total leaching area.. 6. ...o.......sq. ft. x Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. .z Other Distribution box (x) Dosing tank Percolation Test Results Performed by. _. � .-i.�- }-m- -�? 11 _ Date_-lat ....61 gtW v*5 4 Test Pit No. 1...&,.?S......minutes per inch Depth of Test Pit.................... Depth to ground water.......... _.. _. (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water. J�CC �Y�� ` ...--.--• -•--...... O Description of Soil.... M•--•-lxtt.--- .. ._..... Q.. ..... -------'t-\ UT-- ------•--------------------- ------------------------------- ......CQw��c .. W ••••...•--•-----------------•....•---------------••••--------•--------•-•-••••-••------............._----•- ---••----•-....M- U Nature'of ReRairs or Alterations—Answer when a plicable.--. ... ................................................ .........__. 670 R -----•••• Y •. r�+c DA-iR n(= cry�Ti-� --r�i s yS r M ►s d N s �;��� n� Agreement: t"2,C_T e�GcO"RDR4vC;E: tr-> "rliE T'he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wit the provisions of TLIT= 5 of the State Sanitary Code— The undersigned further agree lace the syste o)eration until a C/ertificate of Compliance has b issued y the oa d of healtS I g!x(d]...J... = + ` APPlic ion Approved BY -=. ........-•--••-•••----- ----• l• ... �. - - Date Application Disapproved for the following reasons:-----•-----------•-----------------------•----•---------------•-----------------•----------••......--........._ -•....................................•-.........-••.._.........----•-------------------.....----------...----------........--------------...----•----•••---•-----•--•-•-•-•-•••--•......•-••............ Date PermitNo......................................................... Issued_....................................................... Date NO..T . •g� Fss................. .... .. r . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............0F..... �`v.1Sf . . . Appligation for Disposal Works Tonstrur#ion Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at- .......V a .. .. ....................................•- --.....--.� .. 3............ ..........-----••---.............:....... .. .-.... ...........•- --L at' Address or Lot o. . .........................•--... . .. Owr �................................ .....................•......................Address a I l�!/t'S Per cC� .7Z y Installer Address Type of Building Size Lot. Q.......Sq. feet �., Dwelling—No. of Bedrooms.............3...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ....... No. of persons............................ Showers a YP g ..................... p ( ) — Cafeteria ( ) a' Other fixtures -----•--•---------------------•- �Dr�•�o01^k W Design Flow..........�X0..........................gallons per per m_ er day. Total daily flow.......33.0.........................g' .lons. WSeptic Tank—Liquid capacity-AD d ons Length...--� _ Width..�_(Q -- Diameter----•--•-•--_--. Depth5--.' f•--- x Disposal Trench—No. ........_1........ Width.................... Total Length......1!;�....... Total leaching area....5.4.Q....s . ft.q Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. .Z Other Distribution box ()Q Dosing to ( ) ''" Percolation Test Results Performed b _. .... &:SMM ...14 3� ,-a Test Pit No. 1..... . ..minutes per inch Depth of Test Pit.................... Depth to ground water...._.._.-i.-.....yy._._".�.�. W Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water�?_CY 4►l��A,.17!!\lvJ O Description of Soil....... ......- �..............�__... t���....Y_�4T. w . ................................................ x ---- --••---- -•-- ---•---- ----- ----- -----------• ••----•_. ...••-- U Nature of Repairs or Iterations—Answer whe a licable OE_s16tt� f ...B -- Thu ............................................................JI/ Ar�oIIT A Np cr'Ir�y '!V �'�? �p-z: C..T .. Agreement: 1*1M DA of-- H PRL:r'H �`I� t� I ri,5;Ti4 e.4�� I N �C�c��ZCARnaG -I -hsc LA1V The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wit the provisions of TITL1 5 of the State Sanitary Code—.The undersigned.further agr to lace th yste o eration until a Certificate of Compliance has b ern issued b the oard:of health. Sl ... .... D to Appli ion Approved By..... "` .. ... ........ .t.....: 1 --- •--�................. .....- �_.... .... Date Application Disapproved for the following reasons:------•---•-•--::......................•------------.............•--.....-----------•......•..............:_- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF .MASSACHUSETTS /BOARD OF 9A HLTH .......... ! .......OF............ i .? c - c.................................. (Irrtifutttr of Tomplianrr THIS IS TO CERTIFY That t e Individual Sewage Disposal System constructed ( or Repaired ( ) bY....................... ---••-•-------.t...............:.�--- -'........ - -.....:...... .'..... .� °U. .!4.K....................._..._ t --- • at---•-•--•-�-`��--- �� 1 •�� -�,.' --`--------••----------------------------------•--•----------•-•---.-----....... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... .r' -_. _d._t.....__. dated.............. ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT,I0N SATISFACTORY. --OFF// DATE.. .L. -••-•-•--------•-•-----•-----------------•---.----- Inspector.../ --------•-------------------•----•-----................----••---....... THE COMMONWEALTH OF MASSACHUSETTS +V SfNC Re BOARD OF HEALTH J:aUR..1NC,-�N" -rA4.c..�-r/00V �} ..�,! ...OF... n:,,l�c-sc C I$�V► No � ._C Fit o tt f~ Disposal arks Ton #.rnrtion rrmi s "' # Permission is hereby granted.. ` -_ ........................................� 4 ................... � .0 ly 1v - 1. {c t- � 'Pt tot No........ � � a e Disposal System Constructcs,.. or I2 ndivl Sew r ---•--•VAt7i----------•--.-... .......................:...... PP P _ �Dated.. Y14I ........... as shown on the application for Disposal Works Construction Permit No ........... .............................. .� , ` `Sosrt! of Health is DATE.. !'` �..-------••------------------- } FORM 1255 A. M. SUL IN, INC.. BOSTON i r .. 362-4541 926 main street yarmouth y mass. 02675 down cape earineering civil engineers&land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site planning sewage system designs Town of Barnstable Board of Health inspections South Street Hyannis, MA 02601 permits Gentlemen: This is to certify that the sewage system on lot 53 Woodside Road has been installed in accordance with our Flans and as required by the Board of Health. The construction was checked on 7/30 & 7/31 1986. The approved plan has been followed exactly, except for the position of the septic tank. A plan is attached showing the location of the system as installed. Very truly yours, Arne; H. Ojala, P.E., R.L.S. 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