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HomeMy WebLinkAbout1489 MARY DUNN ROAD - Health 1489 Mary Dunn Road Barnstable I H zardous Materials Inventory Sheet Checklist `< Date hysical Street Address-Check database to ensure it exists Working Phone Number 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? ���---`���"--If none, note that. t/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 explain it Attach the Business Certificate with your sign off and comments " e 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 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. DATE: Fill in please: APPLICANT'S YOUR NAME/S: Ra-d At h a,K.d S'uza h n e. Ch e-,'e - PLxQ I BUSINESS YOUR HOME ADDRESS: r 4V cy Mar,H Du h r /eaad vs - s2-p -5z27 Cvna yr�d MA oo2b37 t TELEPHONE # Home Telephone Number 50,F- 3 2 - 3 1 2 2- NAME OF CORPORATION: NAME OF NEW BUSINESS Sao cx r 1^o cv G a i^ »S TYPE OF BUSINESS Lvlct5cc�pe rya rdevi 0 nc, IS THIS A HOME OCCUPATION? YES . NO_� ADDRESS OF BUSINESS p0 Box 261h Cuvnma u ict A44 026a•37 MAP/PARCEL NUMBER ; (Assessing) f`f f q my r„( 'ponn TICJ01 Gvrn^r��v;'A' Yrt n r co 2,-1 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 COM 2se R'S OFFIThis individu I h 'nfar-m f y ermi re uirem n_ is that,pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Auth riz Si na re r0 ,,!PI_.Y MAY RESULT IN FINES MMENT If)-. c/ , 2. BOARD OF LTH- This individual ha en in ed f e�p erzoiLrequirements that pertain to this type of business. Autho A AA Crcjv,Signature** MUST COMP:�:1#6TH ALL HAZNRDOl1S MATERIALS REQULIITIdNS: 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: / 2Z/ J J� TOWN OF BA►RNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: rr-o� [x,v-ACvg ��� '�� BUSINESS LOCATION: v- J y;,CA INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: S4'� � h�1 -- � �_�"1 CONTACT PERSON: 20,V,0-C C1�ver;r � ��►�� EMERGENCY CONTACT TELEPHONE NUMBER: . SD% --31 14 hi MSDS ON SITE? TYPE OF BUSINESS: `n INFORMATION/RECOMME DATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No (VOTE: 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 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 TOWN OF BARNSTABLE LOCATION �C ��'/'�/ �� �� SEWAGE # VILLAGE /ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 7 SEPTIC TANK CAPACITY l 5—CO 4Q At-- LEACHING FACILITY: (typejzz-- C.�--- N�t�P�T� NO.OF BEDROOMS WNER Ccnr— s -�'V tZ o PERMIT DATE: `�✓�—�� COMPLIANCE DATE:�Z 3)� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 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 / C.E: � No. Fee �J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for i�pooaf *patent �tConotruction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) LM Complete System ❑Individual Components Location Adddjesseo�r Lot No. t©� G Owner's Name,Address and Tel.No. Ass" esso�s p/P cel mdl,1 Y, w"I CU04IV10 0 Installer's Name,Addy ss,and Tel.No. Designer's Name,Address and Tel.No. '97f- 77 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building ,0Z_5� CC� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ile gallons per day. Calculated daily flow gallons. Plan Date 7 Z 9 Number of sheets Revision Date Title Size of Septic Tank D�1�� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 issue b Bo jai of Signed Date Application Approved by 9 44d% L.�MAw&g%dj,.._ Date Application Disapproved for th ollowtng reasons Permit No. Date Issued - _3 3 5_ UU� ice;__ . •No. a Fee x THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for . igpogar 6peum ttCongtruction 4errnit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( n) M Complete System ❑Individual Components Location Addiress or Lot No. L©; Owner's Name,Address and Tel.No. Assessor's Map/Parcel r Installer's Name,Add ss,and Tel No. Designer's Name,Address and Tel.No. 7 7P 9��9 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building s°S1 L'�Ce No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow f�� gallons per day. Calculated daily flow 3136 gallons. Plan Date '7 Z 9 Number of sheets Revision Date Title Size of Septic Tank ®2"el Type of S.A.S. Description of Soil l Nature of Repairs or Alterations(Answer when applicable) 7 r 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 issue b Bo '• of Signed � Date �'�/97 p g �� v Application Approved by Date—7 Application Disapproved.for th ollowing reasons Permit No. - 34,o Date Issued = ————————————�—————— —————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE TIFY, that the Oj-site Sewage Disposal System Constructed(Z )Repaired ( )Upgraded( ) Abandoned( )by ����G� / 4re)9 at LOI` ljI' [.!/9iJ G�� i��G�/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 38 dated Installer Designer The issuance of this permit hall not be construed as a guarantee that the system will f nction_as designed. Date (t �>r C) 19 Inspector --------------------------- — N. 77" 3&0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *pgtem (Congtruction permit v Permission is hereby granted to Construct )Repair(,t )Upgrade( Abandon( ) System located at Ld7` G laIr / �e/A►n r° 'Gt1y?-*Y741'eu/,0 ` ! 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: ��'- / Approved by 4 / r 34 10701 14 ti TOWN OF BARNSTABLE / LOCATION L �/Y ��/10�, SEWAGE VILLAGE G�rl'IiyllrQl�/�D ASSESSOR'S MAP & LOT G - INSTALLER'S NAME& PHONE NO. �O/7�l0/�`1 SEPTIC TANK CAPACITY I f/i0 LEACHING FACILITY: (type b i�lr �•J— u�1 L i its A( NO.OF BEDROOMS ' GAT tPEITDATE:17�Ij '� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. 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 Feet within 300 feet of leaching facility) Furnished by TOP OF FOUNDAl10N 20 FT. MINIMUM FROM CELLAR SOIL 7 S T �--' ELEV. 103 0 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE DATE OF SOIL TEST CLEAN SAND SOIL TEST DONE BY _1 C5 . t i CON E WITNESSED BY =a, C,a"Jt; v c I 16 i4"F+ 4" SCHEDULE 40 PVC PIPE LOAM AND SEED OBSERVATION HOLE 1 ELEV.- f` OBSERVATION HOLE 2 EtEv.= MIN. PITCH 1/8" PER FT. 2" LA,ER OF _ PERCOLATION RATE G '-� MIN.,4NCH AT 0 INCHES / - 1/8" 4NE DEPTH HORIZ TEXTURE COLOR MOTT. OTHER DEP HORIZ COLOR MO TT. OTHER WASHI 4' CAST IRON PIPE f l p p• g' VENT (OR EQUAL, MINIMUM T REQUIRED We°'9r PITCH 1 4 PER FT. O—(, �/nn VtJaDc. ►''1 n-►�' r / CU. FT. OF J D ¢�d1i5ONCRETE FLOW UNMIN. ELEV 100,1� g ` S ' SU EIFV �9Z ' o98 fib•�r3 1 i Z ��.J _. _.._ B ELEV. � _ DISTRIBUTION Dr^'s'r OUTLET BOX �'a (T10 BE PLACED ON FIRM BASE) INFILTRATORS WITH STONE IN XI 96-I� `� �CL4� !�L-�3Z � SA4%4 4 14 TO BE WATER TESTED Z 3 5 19 IF MORE THAN ONE OUTLET t A �r{� TRENCH FORMA ION � 6 T 2g4 IN s 1500 GALLON r4IW ZyT q 8 34 IN S SEPTIC TANK (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION L'I ZONE----5 WATER ENCOUNTERED AT ELEV. _ �9' WATER ENCOUNTERED AT I Z r ELEV. _ a 3/4 TO 1 1/2' SYSTEM (SAS) INDEX_4 5 j WASHED STONE ADJUST 4, LEGEND: DESIGN CALCULATIONS 3 USGS PROBABLE WATER TABU ELEV. EXISTNG SPOT ELEVATION OOxO NUMBER OF BEDROOMS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( T/ t�/8� ELEV. € EXISTING CONTOUR ----oo---- GARBAGE DISPOSAL UNIT NOT TO SCALE BOTTOM OF TEST HOU ELEV. a FINAL SPOT ELEVATION TOTAI. UMATED FLOW FINAL CONTOUR (_LLU GAL./$R./lDAY X 3 BR.) GAL/DAY SOIL TEST LOCATION REQUIRED SEPTIC TANK CAPACITY GAL ' UTIUTY POLE --o- ACTUAL SIZE OF SEP11C TANK �' _ GAL j TOWN WATER -�-W �� SOIL CLASSIFICATION L_ CATCH BASIN DESIGN PERCOLATION RATE 5.. 5 _ MIN./IN. I GAS LINE G ` EFFLUENT LOADING RATE GAL/DAY/S.F. LEACHINf, AREA SQ. FT, *LEACHING CAPACITY (AREA�X RATE) 3s/' GAL./DAY 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND FOR A V 7 V, 3 W 0 '-7 y ,. A� MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND BE REPLACED RESERVE LEACHING CAPACITY 3� U GAL/DAY WITH MATERIAL AS SPECIFIED IN 310 CMR 15.255:(3). gA�'s. a't,:.;. �/Z x 3-7) X 0.-75' — 333 a 1. NOTES: tJ / 1. ALL WORKMANSHIP AND MATE ALS SHALL_ CONFORM TO D.E.P. _ _ TITLE 5 AND THE TOWN OF " RULES AND OF FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO o - WITHIN S' OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL E CAPABLE OF WITHS�I i( 0 FT. OFDING DRIVESIORLPARKNG UNLESS ING AREAS. HE 20 RE UNDER OR IN LOADING SHALL E USED UNDER OR WITHIN 10 FT. OF DRIVES,OR PARK" AREA& � 4. ANY MASONARY UNITS L#SPP BE MORTARED W -jk4 -,,....-_. fQ'oY �-t 6'N� '.�,,n _, pin 7F rrA,,• „�,. .,w, .. r�' � : __ � - _ � �. ti��- t, '. .'.-....�►.. " ,.,,_ _... U L.._1,'t it l,h �,J4K.iv +F,W r.R ,.�r.D. -a,r..1� .w, r APPROPRIATE AUTHORITY. :i�TA'r. ;u�,r, ttE TEKMINA i10N RU#A AF" q� f" 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR � 484"` - - - 4 AT LEAST 72 HOURS �. ---__ qy,��•j � ' ''� ' IS TO CALL 'DIG-SAFE' AT 1 eoo 322 t !�A r ' PRIOR TO COMMENCING WORK ON SITE. ' A., t'__1/ r " �" r SSG J rt c. � 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL A5 I 1 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. 01T gY cC = y6� 3 8. PARCEL IS IN FLOOD ZONE 9. LOT IS SHOWN ON ASSESSORS MAP > AS PARCEL ly �tiZ OX 619 '° C; ` wq�k�,r ..� �� � .�. . � APPROVED: BOARD OF HEALTH DATE AGENT - - v PROPOSED SEPTIC DESIGN !> •r�, FOR FPROJECT LOCATION o T _ - /,:_ % Jam...;...' /�--� `.Jr✓p.r�'7ry . f; ,�. X S WEETSER ENGINEERING v 1 s 235 GREAT WESTERN ROAD 1 l 398-3922 SOUTH DENNIS,7MASS. 02660 REVISED - 8 NO. LOCATION -MAP REVISED LSHEET I OF l 1996 SWEETSER ENGINEERING