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Home My WebLink About0353 WILLOW STREET - Health 353 Willow Street West Barnstable A= 131-032 i L_ YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G,L, -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fi ll in please: -e APPLICANT'S YOUR NAME/S: -3 exys e- BUSINESS YOUR HOME ADDRESS: 3 TELEPHONE # Home Telephone Number 70 9 36 f5k L 0 ly NAME OF CORPORATION. NAME OF�NEW BUSINE8S:T�,_w-,,k S::v TYPE OF BUSINESS: IS THIS A HOME OCCUPATION? PATION?-------C,YES —NO ADDRESS.OF BUSINESS--,3.5-3 W,1(ow S-t- MAP/PARCEL NUMBER. I L 6 AL (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST,60 TO 200 Main St. - (corner of Yarmouth Rd, & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUIILDIN�GfM SICO R'S OFFJCE MUST COMPLY WITH HOME OCCUPATION 'd This in ivi u�I!h"=—�En g�IiI 6�Pr it requirements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO PtVMAY RESULT IN FINES d j oriz e** MENT ,, S�- f_,_,Au_t)A W, 11 j aEV�1_1� dy-) SS ii& k )o 7ZFA=S GtiL �r7 I V (j J 2. BOARD OFQEALTH Z41 This individual hAsrbeen informed f the permit requirements that pertain to this type of business. P\A� 110-L TH-ALL Author ed Signatur R,1j&$AGULA 9 COMMENTS:. LLS QAA 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 REGISTRATION FORM NAME OF BUSINESS: �_-ose vt C �D;nCevt av��QSLa��t BUSINESS LOCATION: 35.1 W E2- 026 6 INVENTORY MAILING ADDRESS: �s� U) II o� SF. Itl(. �. - �z TOTAL AMOUNT: TELEPHONE NUMBER: 0 CONTACT PERSON: �� ;,,�,� o � . ; i c.e EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: J-cuik-ce--ktje- S.ev-�^ <.e INFORMATION / RECOMMENDATIONS: Fire District: iUft-� 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 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 k y e vv-a 4 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`'plicant's Sig a`u-rre Staff's Initials TOWN OF BARNSTABLE LO k TION �3 �Z&Afe-49f,40— SEWAGE # (d� VILLAGET ASSESSOR'S MAP 6i LOT n INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) - /�dO . � p (size) NO. OF BEDROOMS— PRIVATE WELL OR PUBLIC WATER OR OWNER DATE PERMIT ISSUED: = - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: "No- r� 54 '79 r a.6 � r L,..OppCATION,42,.� �_. SEWAGE PERMIT NO. VILLAGE 632. INSTA LLER'S NAME R ADDRESS 0 U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 4 6 OVAL THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................:............OF......I................................................................................. Appliration for Dhipwial Works Tantitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal ystem at: . ................................................................................................... Location-Address ............ ...... .......... .............. ..................... ....... TA., ......... --- wner Aire.s 6- _A "t... ......... _9..t J- ,7 �� _N ........ ............ .. . ...... ... ... .... ....... ..................... . ..... .... taller Address Type , Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___------ ..............................Expansion Attic ( ) Garbage Grinder ( P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( Otherfixtures ......................... ............................................................................................................................ Design Flow.........110........................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacityl-r-SM..gallons Lengthl!........... Width...__._...__4-.#........ Diameter................ Depth................ Disposal Trench—No. .................... Width Total Length__.................. Total leaching area....................sq. f t. ---- ---- -- th below inlet____________________ Total leaching area..................sq. ft. Seepage Pit No."' Diameter/jt�Oi.-__ ep Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 04 Test Pit No. 1................minutes per inch Depth of Test Pit.................__. Depth to ground water------------------------- 14 44 Test Pit No. 2................minutes per inch Depth of Test Pit___................. Depth to ground water--_________-____---____. R'+ ,--------------------------------I................................................................................................. 0 Description of Soil........................................................................................................................................................................ x ......................................................................................................................................................................................................... ...................................................................................................... :4�.,��. ....C......................... Nature of Repairs or Alterations—Answer when applicabie. 001-------4. .. ............................ U .. .. _Vnc-----------........................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of THL HE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of, h alth, Signed... .... ........ ....................... .............. .. ............ ................................ Date Application Approved By............... - --------------------------- ------- Date Application Disapproved for the following re ons:.............................................................................................. .................................................................................................................................................4....................................................... Date Permit No........?'!L=...Zaa.................... Issued_....................................................... Datt '- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...---- ..... ................OF........------.....-----................------------------....__.._.._....- Appliration for Uhipasal Mlarks Tamitrurtiutt rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .._: :.............. � _. �.......` ::../ ---------------------- •---.. .... . ---------.._... ----- Location-Address r . caner A r s --- ••• ---......- staller Address Q Type-. Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms........q..............................Expansion Attic ( ) Garbage Grinder ( ) pl Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----•-----------------------------------------••--- . W Design Flow.........U.0........................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/n ..gallons Length_/!........... Width...._._._... Diameter................ Depth................ x Disposal Trench—No. .................... Width___._.. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.___. .._ : Diameterl.��.�1'/_. �Depth below inlet____________________ Total leaching area..................sq. it. z Other Distribution box (r) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ -----•----••----------------••-•--•-•-•---•--••--•---••------•-••-•-------------•---•••..................................................................... 0 Description of Soil........................................................................................................................................................................ x V ----------------------------------------------- --------------------------------- ---------------- ------- --•------------------- ------------------------ ------------------ -------------- ---•------..---- W - ----------------- -•----------------•--•-...•-•-----•-•-•-------••---••••----•••--•---------•----------------•-•••. -- —i - ----- ------ ------------------------- 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:TTi.is p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee i;ssued by t e board of h alth. Signed ; ...... ........... ....... _. Date Application Approved By...............11". ��__. = •---------------•--------- ------./.X ... it k... Date Application Disapproved for the following re ons:-------•-••----•--......•---•--•---•-----•••-----••••----•------------------•••----•-----•---••---....._.._._._ ---------------------------------•-••---.............---------------------------••---------•---......-----•---------------------------••----•----•------------------•-••-•-••-----------•••-•----....._. Date Permit No............. '""--=--7. _—)--------------------- Issued....................................................... Da._- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF............. . ......!..vtrc�.:�r��!N................................... Trdif iratr of MautpliFattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired '} by................. = ............ .-----•----•--•----------------•-------- ------------....------......---..................------------....--------. .. - Inst4l1l / has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-___-__. .__�.7 PP. P ..-�---. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ .f._l.a.- ` .................................. Inspector.............. ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF......... t�.g.......................................... NO... ,.... / �................ FEE.., ........... BisposFal Work.5 Tlaatstrltrtuaat firrutit Permission is hereby granted .......t la. ••----•--•-------------•••----• .............................................. to Construct or Repair ( ) an Individual Sera e Dispo-sil System at ......................................-.......................... street p as shown on the application for Disposal Works Construction Permit Dated........................•................. ........................................-- ,C,Moard of Health DATE............................................................................... FORM 1255 HOBBS & -WARREN, INC., PUBLISHERS