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Home My WebLink About0154 LAKE SHORE DRIVE - Health 154 LAKE SHORE DRIVE Marstons Mills A= 030 - 027 / C i a I' p i f Y Hazardous Materials Inventory Sheet Checklist ZpJf Date Physical Street Address-Check database to ensure it exists _ -Working Phone Number 1A -Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? t f none, note that. k--J - 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 plain 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 I:jy M.G.L.- it,hoes not give you permission to operate.) You must first obtain the necessary SigrIatures on this form at: 200 Main St., Hyannis. fake [lie comph'-�ted form to the -[*own Clerk's Officer, 1 sl FI., 367 Main St., Hyannis, MA 02601 (.Town Hall) and fret the Business Certificate that is required by law. DATE: Fill in please: APPLICANT'S YOUR NAME/S: KC v r v� >r\ s ag BUSINESS YOUR HOME ADDRESS: 1 4 (_d R S l .� ,d TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINES SD tJ TYPE OF BUSINESS o k) q1 /r) IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS C' C MAP/PARCEL NUMBER �� .J O '— �-� (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 bus ness in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has bjaqn informed of ey permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION Aughorized Signature* RULES AND REGULATIONS. FAILURE TO COMMENTS: e2 C,v cz-4 A277- e8Mr P ' 2. BOARD OF HEALTH This individual has e infor e th m i t r q ir� t- at pertain to this type of business. A horize Sig a ure**. COMMENTS: i�.'�3 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) . �s,. d -� This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: s r 1.ei / twC err •,� • �- x Date: � //7 / 2tSrI� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 4b-lowe4 BUSINESS LOCATION: *,jr IfJs INVENTORY MAILING ADDRESS: 3S VV4 TOTAL AMOUNT: TELEPHONE NUMBER: 7`7 W' 9 6 �j 13 S/ �- CONTACT PERSON: Revin T)uv1N EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: U + INFORMATION / RECOMM NDATIONS: 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 Cat d 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 J� Ether products not listed which you feel Floor&furniture strippers ay be toxic or hazardous (please list): �6 1y1nq c� Ake e� - Metal polishes 04'i 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 Applican s Signature Sta s nitials TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ,1/S ASSESSOR'S MAP & LOT0J0_ ba 7 r . INSTALLER'S NAME & PHONE NO. �. +�--.� SEPTIC TANK CAPACITY ,C'e. LEACHING FACILITY:(type) I' i (size) (k NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: L VARIANCE GRANTED: Yes No r T I r� � ti� �._�' � . � � � � �-� �� . �� 3� � �_�=�� ,�� -�i a . I q w ASSESSORS MAP No: PARCEL NO: THE COMMONWEALTH OF MASSACHUSETTS > BOAR® OF HEALTH TOWN OF BARNSTABLE App iration for Dioposa1 Works Tonotrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stW at: . .-y_-�----- e_ - ............................. ............. -•-•- •• ............................ Location-Address ` or t No. ..... ----------•----•--------- -- Own .......................... �. __..__�,/. .t 17�._.. ...A ... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-_-____. _.............................Expansion Attic ( ) Garbage Grinder ,(�-^`4 Other—Type of Building No. of persons,........................... Showers — Cafeteria dOther fixtures -----•--------------------------•---------------------------------------------------------------------------------------------........_........_..._. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid ca.pacityAP -__gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.......... ......... Width_.____._._.____._._ Total Length._�_r_._..____._ Total leaching area....................sq. ft. Seepage Pit No______ _____________ Diameter......6........... Depth below inlet. .____........._. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ R+ - ----------------- . ODescription of Soil----�- ----------- ----•-••-----•-•------------------------------------------- -----------•--------.......-•------ x W ---------------------------------------------------------------------------------------------------- U re otpa or Alterations—AnAwer en �l�pli le___R.V I _ l / = e�s �r �r - �r 9 trim.—S.. A-11-----V�- /°9-°--- 4L.------- & --- --- Ah--- ..... �1 0�( :P�.�tcl._..A... 7�6_./e�4(,�.. J � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage To sal System in accordance with the provisions of TITLE 5 of the State Environ tal Code—Thy nders ed further agrees not to place the system in operation until a Certificate of Compli e has been iss y the and of health. Signed .. -- ------- - -- ---------------- .. Application Approved By ------------------ U ...--------------------- ----------------_--- te ~.... -=� . a.3._...9°� Application Disapproved for the following reasons- ...........................-------------------------------------------------------------------------- ------------------------------ ------------................................................. ....................................------'-----------._..__....---....-----'--.........__...................-- -- ----'-- -- ' ------- --.......----.._....--.. /g Permit No. .... Dare /( '` - ------------ Issued ---------------------------------------------------- Date [ / THECOMMONWEALTH OF HAS S\ BOARD Of-' HEALTH TOWN OF BARNSTABLE Apphration for Disposal Works Tonstradiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ') an Individual Sewage Disposal Syst m at: _ _ .... .._._.. --J�ALV1 t ddress.......... ...................... ....... .. ��5 V �.. 0 sd z e— �Owne ..._.............__ rt ------•------- I............--. ..... ..---- .................. . - � M Installer Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............ :............................Expansion Attic ( ) Garbage Grinder ^ Other—Type of Building -------------- No. of persons............................ Showers — Cafeteria 04 Other fixtures -----•---------------------------------------- W Design Flow-------------------------------------------- per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity-/ ...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width_..f--------------- Total Length........,........... Total leaching area--------------------sq. ft. Seepage Pit No....... Diameter......A........... Depth below inletl............... Total leaching area..................sq. ft. Z Other Distribution box (4--)® Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,�• Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1--1 ._..._..R_______________'-_...._....--------------------------------------------------------------- ----------------------------------------------- ---------- O t Description of Soil....-�-c- ............ _n a.,....1r.1C..-•----•--•--•-•-- Y U ......................•------------------------•------------------....................----._....-•--.__._..----------------------------------------------------------•----------..-..-------------------- UNature of-Repairs or Alterations—Answer when applicalSle_....t�� t�.l�:'�'...... -..�.! _ ...........#,---:�DO.a._ ,...0 � _ t�"-�--"�-`�r--........ `� -/w�n�( ^..T_1� ._�P�t I, < 2$ 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 Compliancehas been, ue'issy the board of health. gSi ned �.... - ---- ------------ ---------------.---...... - Date Application Approved By - ti......:- ------------------------------------------------------------- ----------- 3 Application Disapproved for the fo lowing reasons- ----------------------------------------------------------------------------------------------------------�----------......... - - ---------------------------------- -- ------------------------ ------- --------------......----------------....---------........------------------------------------------------------------ ....------------------------------------ G'�� Da[e PermitNo. ---------- 1 L, rJ ---------------- Issued -----------------------.....e--------------------........--------.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of Cent liaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ► ) by - .......... 5..- _p ..:�� =�sL - - Installer at ......- 1------ i: :; - ... Ti - -.............................................................- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Codel as described in the application for Disposal Works Construction Permit No. -. lg._... ./2 j......�--- dated _� .................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B� CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE �) (�..-... ------ Inspector �'��.'�.=- ..... v� ------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9�2 f TOWN OF BARNSTABLE ispnoa1 nrk Tons#rnr#inn Vvrrmit Permission is hereby granted......_, _` :._...._7 �, .....�'�....................., . to Construct ( ) or RepairO an Individual Sewage Disposal System ' rye ' •-.�. atNo.. ... = ... = ` ............................................................. Street as shown on the application for Disposal Works Construction Permit Not.v :Dated.......................................... Ili I� board'of Health DATE............. = ••------------------------------------- `J FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS