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HomeMy WebLinkAbout0067 HARTFORD AVENUE - Health 67 HARTFORD AVEn 0 e- MARSTONS MILLS A = 103 067 --- - - �I Date: 6/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: C /?-t'C Cc 17 C- 0 ff i� L S'FA t X I CIN BUSINESS LOCATION: ( �? i� �l =^c Ave- INVENTORY r ' MAILING ADDRESS: 44 r'l'I s TOTAL AMOUNT: �a TELEPHONE NUMBER: _ G-9� 7 41 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: Ja - `0 7 O-M MSDS ON SITE? TYPE OF BUSINESS: -5'M cdl Ac m e le i?0-,1 ,- INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: 90 L)!,A e J Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? a 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 re uires 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) 4�6'p,.�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 Ap�pfyicant's Signature Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367. Main St., Hyannis, MA 02601 (Town Hall) and.get the Business Certificate that is required by law. 6, < < ,20/ `? DATE: � Fill in please: APPLICANT'S YOUR NAME/S: �T�S��h IV �`rlr BUSINESS YOUR HOME ADDRESS: O a n S c2 C R E�s o 1/771 14 wn TELEPHONE # Home Telephone Number moo$ �-'7y 5/6 4/S Z'0 9 3-yd g 8 NAME OF CORPORATION NAME OF NEW BUSINESS f'f� 0 R/ L S' ✓ ESTYPE OF BUSINESS o n c C '✓I IS THIS A HOME OCCUPATIONS YES NO AD,DRESS:OF BUSINESS: ✓C' GarSt4nS'IC 1.I,: 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 busin hi t �� NI ll93d AbW AldW00 Ol 38miv=i 'SN0dv-in!D38 (INV S31nH 1. BUILDING COMMISSIONER'S OFFICE N011ddf1000 3WOH H.LIM A1dVN001Sf1W This individual has bee of d of any p t re uirements that pertain to this type of siness. Authorized Sign ture** COMMENTS: 2. BOARD OF HEALTH MUST COMPLY'WITH ALL This individual has been informec'of-.-thy permit requirements that pertain to this type of business. H.AZARDOUS MATERIALS REGULATIONS, Autho iat3/d' ignaty�� --� well ** , J COMMENTS: IJ .✓1Q. /?M /�'1... a (�r ' 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; TOWN OF BARNSTABLE LOCATION 47 ���t�o�1 /��� SEWAGE # 2041- �Z VILLAGE ls/�� <<�i A-V A/S ASSESSOR'S MAP & LOVE J �:�Z INSTALLER'S NAME&PHONE NO. �✓DR�� / ��� -7 7�= � SEPTIC TANK CAPACITY /S�o GAL LEACHING FACILITY: (type),r.,—/, (size) %B X 30'>G2 NO.OF BEDROOMS 3 BUILDER 0 WNER Af PERMITDATE: COMPLIANCE DATE: 10 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -s� 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 box t_ { dig a0 3 o a$ 0 t: � 3s �rsprrfir/ Viq!' 3a No. ZOO) _O Zz Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Dizpozal *patent Conztrurtion Permit Application for a Permit to Construct( )Repair(000)Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel I faf Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. 71-INY Type of-Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ® Other Type of Building ) eVee No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ,�� gallons per day. Calculated daily flow c�,' gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank © 4 Type of S.A.S. A9 3"Z �i l Description of Soil Cwrc��y Nature of Repairs or Alterations(Answer when applicable) 7-)?-, e �2'���'' 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 of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued hi Bo o ealth. Signed - Date Application Approved by � S Date I a C3 l Application Disapproved for the following reasons Permit No.7 CD I -02Z Date Issued 12 C7 I TOWN OF BARNSTABLE LOCATION 7 //�Jri�Dd �(/� SEWAGE # OG�/' VILLAGE_ ASSESSOR'S MAP & LOT16 3 �LS INSTALLER'S NAME&PHONE NO.�l�R rDJj Cor�ST` 7 7/ �� SEPTIC TANK CAPACITY /pvo GqL I LEACHING.FACILITY: (type) (size) 30 :2 NO. OF BEDROOMS- BUILDER O WNER PERMITDATE: COMPLIANCE DATE: 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 oc within 200-feet of leaching facility) Feet 'Edge of Wedand and Leaching Facility(If any wetlands exist i within 300 feet of leaching facility) Feet L s Furrushed by.. � I Qi 0 .. 0 g� o {DZ" '$ I No.o.` 2 Cam! -D Z Z Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS :E 2pprication for Migpogal *pgtem Construction Permit Application for a Permit to Construct( )Repair( �)Upgrade( )Abandon( ) 1:Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Teel`.No. Designer's Name,Address and Tel.No. 6©l to� � 70 /y Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( d Other Type of Building eet e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow 3 3w gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ©/� ye Type of S.A.S. ��/ii' 3U�►'Z Description of Soil Natire of Repairs or Alterations(Answer when applicable) A 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 of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is�ojar, of ealth. Signed 4'% '� z4ow � Date Application Approved by (�t:c�- SCE - Date Application Disapproved for the following reasons Permit No. 20D I -027- Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of lCompliance THIS IS TO CERTIFY,that the/O_n-site,Sewage Disposal System Constructed( )Repaired(Upgraded( ) Abandoned( )by Dr�G' /,Y/ at q/ � I* —A-yeolQ ile _A /5has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2CV1-U Z Z- dated I 2 O Installer Designer The issuance of this permit,shall not/be construed as a guarantee that they es m will function a designed.v s Date Inspector �f E i��l (__ J 1 P - L" r 1 --------------------------------------- No. Z_ 0/ '0 Z?_ M 3 < Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Migpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Rep 'r(t/�U grade( )Abandon( ) System located at tilQr,� mays -�ii s 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 permit. Date: 1 �2 o) Approved by I L lalg NOTICE: This Forma Is To Betsed for the Repair Of Failed Se -tic Systems.Only. _ CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION_PERMIT(WITHOUT DESIGNED PLANS) hereby certifythat the a J pplic arson for disposal works construction permit signed by me dated concerning the property located.at 6 7 r�-,�ora�Q meets all of the following criteria:. V she:ailed system,is connezted to a residential dwe;ling aniv. There are n es ass=.ated with the dweiIing, o commercial or business V i ne i 9� sail s c.assuiea as CLASS I and the rorcaiation nt_P s i.. M=or equai :o 4 ztinutes nc:u - - �_ Vim• ne:a are no wedpmds within Ioo:mt of to proposed=dc syste:n � ,i ne:e are no or.'vme wt s within __;o :-ee,of the proposed s=ic e:a is no incrse.n flow and/or c:tange in se proxSea ore are no s�sewt. varanc�.repuemed or neeaea 4/The bottom of the proposed leaching - .P g la�.lfty will not be located ltis titan uve feet above the maximum adjusted groundwate.-table elevation. [Adjust theoundwater.able using the:rimptor /ethod when applicable]. if S.4.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 mp-,dm utt adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface EIevation(using GIS information) 3) G.W.Elevation L/ 7+the MAX FIigh G.W.Adjv=ent D rl'�c'NCE BETWE N A and B 33 . 7 SIGNID :--44 -- DATE: A Z//of. [Sk=h proposed plan of system on back]. cphaft&kkr.«rt J 10 0 .. a s