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HomeMy WebLinkAbout2700 MAIN ST./RTE 6A(BARN.) - Health 2700, Main Street/Rte 6A Barnstable A = 258 - 023 - r Hazardous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists ji-- ' Working Phone Number jfctual Amounts - ( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) -Storage Information - location of storage, how long is storage for? ° If none, note that. /;-�isposal Information -where and who? If none, note that. �-Applicant Signature - understand what is listed and noted Staff Initial -'any questions, know who to ask ti Vehicle Washing/Rinsing? - provide a vehicle washing policy and explain it - note that it was given 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. r:JlaN 9016 A 3:00 - YOU_WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to opera e. ou must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st Fl:;367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. ' DATE: 9ho --73 >Fill in please: APPLICANT'S YOUR NAME/S: �s BUSINESS YOUR HOME`ADDRESS kJ29' 1tl e�:�J ie?s'��:•I TEEPHONE # - :Home Telephone Number L - ' . tqft =� i NAME OF CORPORATION: s o NAME OF-NEW BUSINESS � l G!L (]I TYPE OF BUSINESS IS THIS A HOME OCCUPATION? - YES NO ADDRESS OF BUSINES �C-��'� � �� SLlgl , MAP/PARCEL NUMBER ��"�a (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (cornea of Yarmouth `Rd.&Main Street) to make sure you have the appropriate permits and licenses required to.legally operate your business in this town. 1.,„BUILDING COM SIONE 'S OFFICE MUST COMPLY'WITH HOME OCCUPATION This individu has nf6T'rr a p rmit equirements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO uth riz i at COMPLY MAY RE-$ULT KFIN110: MMENTon- J)3 r b kjr 2. BOARD F E LTH This indivi ual h e inforn r f e p r it�re �i nts that pertain to this type of business. Authorized Si t&e** � COMMENTS: 1kfATARDOUS`MAt1ER1AtS.FGUtJikiS:. k 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: - TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �� -tp-1GA-1 l�v/GDs BUSINESS LOCATION: Sl'�uI�D��.�S IV, ,641 INVENTORY MAILING ADDRESS: TO , 9 0x TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: s EMERGENCY CONTACT TELEPHONE NUMBER: Svc 776 /oS o MSDS ON SITE? TYPE OF BUSINESS: �D n/S'fi�JLf7`1 o N 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 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 prod not I'sted which you feel Floor&furniture strippers may be t i or h rdous (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 Applicant's Signature Staff's Initials 1 1 �' TOWN OF BARNSTABLE L:0CATIO SEWAGE # VILLAGE _ ASSESSOR'S MAP & LOT eo2� INSTALLER'S NAME PHONE NO._�,C SEPTIC TANK CAPACITY 11 TOO as'7— — LEACHING FACILITYAtype) .I, y Kv C.4110 _ size) NO. OF BEDROOMS J PRIVATE WELL OR PUBLIC WATER Ju�li� BUILDER OR OWNER_ LEA p•+31' rr �, DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes _—No_ r1 X N � qQ i C..fl o s Grp��s r No....-- Fxs......3°...._.. ._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /C70 /4Q,,,?�—T'OWN OF BARNSTABLE Appliration for Di-epos l Works Consul ion Prrutit PApplication is hereby made for a Permit to Construct ( ) or Repair ( &-)�'an Individual Sewage Disposal yslem at: .............. .................................. ........................ - ................ ovation-Address or Lot No. .�f......------•----------•----------------•------------- ... (.e�G.. �) Owner Address .... ---------------------------------------- Installer Address � feet Type of Building Size Lot___________________________S q. U Dwelling—No. of Bedrooms................a---------__--_--___-____Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ......................................... d ----------------------------------------------------------------------------•---------------------- W Design Flow............../l..Q.....................gallons per person per day. Total daily flow..................67_C�?..............gallons. WSeptic Tank—Liquid capacity-4'rop..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit------:------------- Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil---------------------------------------------------------•--•--•----......-----------------•---------------------------•--•-----•-----••---•--•-----•---••-•---------- x W -•--•-••----•---------------•---------•-•----------------•-•--------•--------------------•--•-------------•-•----------•---------------------- ...................................................... U Nature of Repairs or Alterations—Answer when applicable----C-2 Sti.,.i�___.1-v_fl_.:C.sT... lex.�___pvzt.....�...A_d�i.�.q Y._-.... y.-./c. �:.,� ... �tl s .t�zo ..Q,�_s��l '.r ._E t d s.....-----•-•--------------------•-•----•---......-- �l 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 Compliance has been issued by the toard of health. Signed - ---------------------- --- -f 2 Date .�.. ' Dace Application Approved B `3----: .°.-��L---- PP PP Y Date Application Disapproved for the following reasons: -- -------------------------------------------------------------------------------------- -------- --------------------- --- .......................................................... ---- ----- --------------------------------------------------------- ----- ------------............................................---------- ................................... Date Permit No. -----------{/,....-- .f 1--0------------------------- Issued .........................................................---------- _l__!_J_r/Z Fics...... °....©o No..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratilan for Dispntittl Works Tons rn.rtuan ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ,,)fan Individual Sewage Disposal System at: r �j Location-Address 4 or Lot No. w �j l «r:.. ��1G� ........................................................... --=�L .. m�C.. ..ri . air / .r 1 lAf� ✓S j_ �;_-[ ..... p Owner n Adddress /9d.ha_J 1,0 L-75TVA16 tAA01)4 a .Installer ,--•-----------^-•------ ---- ------- ------------ -Address 1-------------------• � -.Type of Building Size Lot____________________ ______S q. feet ap.l Other—Type Type of Building ms.................�_.__. No. of persons Expansion Attic ( ) Garbage Grinder ( ) Dwelling— ` ---•---- ............................ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures ---------------------------------------------•-•-• . W Design Flow............../1__D•..............•--•••gallons per person per day. Total daily flow..................i r --------------- WSeptic Tank'�Liquid capacity.LS o..gallons Length................ Width................ Diameter-----------------Depth--_ -_.__---_-. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching,area...................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. ' Z Other Distribution box ( ) Dosing tank ( ) 4 Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water......................... I LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__-_-_---_...__..______- 1:4 --•-•••--•••---•-••-•••••-•-•••••-•-••-•---•......-••-•.....•-•--•--•-•-----••..................••--.: Descriptionof Soil........................---------------------------------------------------------------------------------------------....----•---------------------------------------•- x W ••••-••••-••.......-----•---••-••• •-•••--•----•-•••---••-•--------•---•---•-----•----.....••••-•••---•---•----•---------------•••••-••••--•--•----•••-•-•--••--•-•••••-•.........•••••._.............. UNature of Repairs or Alterations—Answer when applicable____1:..,I_t .......ssa_sX__ 5T__•. ......---_,qa, s.�..rc- -1^..)J yJ.��..... 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 Compliance has been issued by the Loard, of health. Slgned _A. �L .�� -� '� ------__----- -�'' "�12 H g-/- --- ---- ---- -- -- --- Dare Application Approved By -------------- � � . v ............. - -' �-... �� .......................................... Uace Application Disapproved for the following reasons- ..................................---------------------- --..._-------------------------------------.._...------................... --- ------------------------ -------- --------- --------- ----------------------------------------------------------------------- ------------------------------------------ =----------- --------------------- Da[e Permit No. -----------f --...1.. ---------- ---------- Issued ---------........................... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tuertifira e of Gntyi.. nre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (r by--------------------------------------------------------------R :: -��^?.........C..._...`T a.'ssl,r,.-4---------------------------------------------------------------------------------------.---------------------------- p Installer aC ...... - - Sc-J- -�I Q:R ........... .................. -----------------------------------__............................. d., has been installed in accordance with the provisions of TITLE 5 okThe State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... --1-------J�......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... .. ... --------------...... Inspector ........ ---------'--------. ----------------------------...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......�1 TOWN OF BARNSTABLE a :.��.��.. Disposal Vorks Tunatrur#i.an f rrmt# Permission is hereby granted.. ) " .......... . ....................................................................••--....... to Construct ( ) or Repair (v) an Individual Sewage Disposal ystem at No..••....-•�,�------ •! _:._: a, ..........--- !�:z $��1------ •------------------------------------------------------------- ..._.. -•,- •------•----••- Street as shown on the application for Disposal Works Construction Permit No :Za___ Dated.......................................... ....................................a.9 J '�1----------------••--- -•=---•----•------------•-- DATE.............................................................................. / Board of Health FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS L O CATION SEWAGE PERMIT NO. 2Z-: l� 0r Se i n� VILLAGE INSTALLER'S NAME A ADDRESS mo �S Q U I L D E R OR OWNER DATE PERMIT ISSUED .�Z�� �y D A T E COMPLIANCE ISSUED 4 2,41- ?,Y .1 ' t'1 F r N ' I� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ......................OF......................................--........._.......-----------..................... Appliration for Disposal Works Tonotrnr#ion ranfit Application is hereby made for a Permit tq Construct ( ) or Repair ( ) an Individual Sewage Disposal Systgtn at A a-77 O 0 1 M Iq I H ��9 l ya ............... v ?� -----...--------------.....----------...--------------------------........--------........----•- Location-Address �� or Lot No.09 cle ................ ................................... --•---......-- .................. -•----------..................................Owner Address a -•-•--••---•--•-•-�.. .........../®.. e 5---------------------------•----'---- ---------.....------------...---------•------..........-----------------------------------........ Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........:................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ W Design Flow............................. _'._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity .gallons Length.............•.. Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total,leaching area....................sq. ft. S o--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil......................................f-•�c 0.....6. ---------•-•• � ------....:-.............. -E ri✓r x .. --------- -------------- .. W VNature 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 iITLi: 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 board of health. Signed . --- .................... .�_.._.........-._a/_ Date ApplicationApproved By..... --•- - -----------•----------------------------••-•-----•-----------•------•---.-- ........................................ Date Application Disapproved for t e following reasons-------------•------------------------------------------....................................................... .............................................._.................................................................................................................................. ` Date Permit No. tl ���a S' .--. Issued-------------•-------------------•--- -..... Date No zl- ?e Fzi&................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ........................OF ��vpliration for Disposal Works Tonstrurtion Vrrmit,, Application is hereby made for 'a Permit to Construct or Repair an Individug! Se'wlee, Disposal at: Ay.s�l e-,O? el;;wAl •�.W.-rvvdrlooe woe, .0.................. ............................................... Location-Add s . 3��;'No.7............................. e,S' /�le or ..................................................................... ............................................ Owner �Zr,e,s,s -------------------­-- .............. k1l............ I ene.S...................................... .................................................................................................. ............ ' Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.... .................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of.persons............................ Showers Cafeteria Other fixtures .......................................................... Design Flow.................................., per person per day. Total daily flow--- .................gallons. _Z.,,-_gallon ---------*--------------- Septic Tank— capaci6l ..gallons Length................ Width.........._..... Diameter___.......__.... Depth.............__. Disposal Trench—No..................... Width.................... Total Length.__................. Total leaching area...................sq. ft. SL-epage-+Iff-11T-o-7-AP.......... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Other Di9tribution box Dosing tank Percolation Test Results Performed by........................................................................... Date............ ----------------- Test Pit No. I................minutes per inch Depth of Test Pit.__.__........._.... Depth to ground water.._...........__....._.. H 44 Test Pit No. 2................minutes per inch Depth of Test Pit.__............_.... Depth to ground water._._._........_....._.._ ......................................... ........ ......................................................... .................................................................. Description of Soil.................... ................._25. ........... 0 C 6r 3 f Aa 0 4-'s ------------------ .......................................................................t.......................................................................................................................... .................................................................................................................................................................. ...............;,-, ................ Naifife of"Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System;,in.accordance with L 1. further . i the provisions of'ITIE 5 of the State Sanitary Code—The undersigned a`grees�"'not' to place the system in operation until a Certificate-of .Compliance has been i§sued by the board of h1ea Signed..... ...... ................... ................. ---------- Application Approved By......... Date 7...-------- ........................I............... Date Application Disapproved for tKe following reasons:................................... ..................................................................... ................................................................................................................................. ...................................................................... Permit No......1�1-2,0 6— .............................................. IssuedL..........................................Date............ Daft J. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...OF........... .......................................................................... ....At... %luntifiratr of Toutpliaurr THIS ISIwTO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired of by................... ......... i Installer -----------------------------------------------------------------------------------*­------------------ Aj r,,l at...................................... Insla 0 ................................................................................................................................................................ has been installed in,accordance_with the provisions of TITLE 5 of The State Sanitary Code as deser;'Ded in the application for Disposal Works Construction dated......4" -7 ............. ......... ..................... THE ISSU�NCE OF THIS CERTIFICATE SHALL NOT BE>CONSTRU S A GUARANTEE THAT THE SYSTEM WIL / FUN ION SATISFACTORY. 7 or ................... DATE........ ------ �.2.1�.................................. Inspector.. ,.... ......................................................................... THE COMMONWEALTH. OF MASSACHUSETTS BOARD OF""HEALTH 7 V . ............. .............................OF..............---h car No......................... FE&Z a.:L.......I Disposal Works Tonotrartion frrmit ........... ................................................................................................... Permission is hereby granted...__... ................./K/,,- -... A/v to Construct� or�Repair O an Individual Sewage Disposal System at No......-- Street Q fl. 30-.75 as shown on the application fdrDisposal Works Cons' c to,n ifu' i " ' it No{..................... Dated.._.,Perin' .................. ........... ........................ .................................... ...... ...... DATE.----.......................... Board of Health ... ...... ................ FORM 1255 A. M. SULKIN. INC.. BOSTON