HomeMy WebLinkAbout0090 THORNTON DRIVE - Health 90 Thornton Drive
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A =-296 -014-OOB
TO ALL NEW,BUSINESS OWNERS v O 107,2
DATE:
Fill in please: AA ,,
APPLICANT'S YO R NAMEQ, -�3-e
BUSINESS YO HOME ADDRESS: 6 lA ' le
TELEPHONE Tele ho Number Home
NAME OF NEW BUSINESS . 4 TYPE OF BUSINESS-
IS THIS A HOME OCCUPATION? YES
Have you been given ap oval from- a building divas o ` O �'� _�
ADDRESS OF BUSINES ® MAPIPARCEL NUMBER___& (.0 .
When starting a new busines are several thins ou ust in order to be incompliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures,
listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first
you MUST go to the following office to make sure you have all the required permits and licenses..
GO TO 200.Main St.-(corner of Yarmouth Rd. & Main Street) and you will find the following offices: ,
1. BUILDI MISSIONER'S OFFICE
This indivi,ual as eR in a any permit requirements that pertain to this type of business.
Aufhodzed i tur **
COMMENTS:
2. BOARD OF HEALTH
This individual has bee rrmedpf the ermit requirements that pertain to this type of business.
lQ/a/ot� � oke w fr ivA of Nrift" Cat
Au , rized Signature** _S - ( 5{��u6 VvoAac -(� �ma-+) at-
COMMENTS: 2 /J? U
d r Cf�!IrtY;S&*Uf'
3. CONSUMER AFFAIRS (LICENSING AUTHORITY) .be*re 001 60_ � (_"M--jA (x Gt- „����
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGIS Y R NAME in the town (which you.must
do by M.G.L. -it does not give you permission to operate -you.must get that thr gh com etion of the processes from the various
departments involved. 1 'i ft -
**SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. �
ry
Date: &
TOWN OF BARNSTABLE f
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
BUSINESS LOCATION: INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: y a099
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: �" LooWin
INFORMATION/RECOMMENDATIONS: F' ire 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 materials 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
A I Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive
(U 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
Misc. 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 Misc. 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 (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers I Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers `ptu u oT176 ' -?---
(including bleach)
Spot removers &cleaning fluids `
(dry cleaners) G
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
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NO...... .. Fss. ��......
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
'e6 .
.0. V...6r,J:.............OF..)�.b .X'. .-----/ --------.....................-...
Apptira#ion for Dhgpoii l Works Tontitrurtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:. _
.......�,;:_!..a.....1. !.�s9 cZ�u. .n....� e3..l..Lf.c............... .....•---••-...._................._..------•-----------------------------•-•••--•••--........_....
Location.Address or Lot No.
Owner •—, �1dc}ress
Installer Address d Type of Building Size Lot,
�j__`1 I..........Sq. feet
Dwelling—No.....af._Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of BuildiiigSIZFfi.I..laiwritu a`No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ---------------------------•---- - ---
W Design Flow......-........ -_.-___-_G-L-gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity--.._....gallons Length................ Width---------------- Diameter................ De th................
x
Disposal Trench—No. .................... Width...__... _........ Total Length.................... Total leaching area -._&.____sq..ft.
Seepage Pit No------/............ Diameter... .._K_. ... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (A ) Dosing tank ( )
0-4 Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................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........................
--------•--- --------------•---....... ---•--.........................-••-•-•••-_-_.........................................
0 Description of Soil =.. 1Q-L�.�,. fi._ ._,�a* r 7--.•--...C4 c_...�t.&.�
U ,
W ..-•-------------------------------------------------------------------------•--------•---.........----------------...--------------------------------------------••--......-----•-----......-•--
U 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 LITL i� 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.
Date
Application Approved BY--- _: � ��= -----•------
v Date
Application Disapproved for the following reasons:..............................................-••-----•---------••-•-.........----------------••----•.._...•---
.............•-------•-----•-----...--•-••---•--•-•---•--•--•-••-••-••--•----------••-••-------•---•-••---•----•-•---•----- ----------------•------------------------------------------------------
Date
PermitNo........ -`�/o.---...---•---•-----•--------•-------. / ssued.......................................................
Date
- / t
No...... ._'....... Fmm -,.O'..�U ....
THE COMMONWEALTH OF MASSACHUSETTS ',
BOARD OF HEALTH
Appliration for U44pniial Works Ton,otrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage 'Disposal
System at:
....................
Location;Addressl or Lot No.
!! �hl..UF. `., --•--•--•-•-•----•----•-... _.. ----------•-•........................................•-----•--••-- ....---...
Owner ddress dV
1' . .�.......... _d" E......................... . .....................Z,:
Installer Address
Type of Building Size Lot2>----IS ...........Sq. feet
U Dwelling—No--a—Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of No. of persons____________________________ Showers — Cafeteria
a g .........xt ur 's. hlr.- ------••• --•• •--•-••-•- ._.._..-- •---.--•--•--•-- •--------:•••-••••-----•-•••------••--•------••--•---------------
� Other fixture � 1 gallons.
WDesign Flow_.__:- _.___ gallons per person per day. Total dailyflow____________________________________________
WSeptic Tank—Liquid capacity.__.________gallons Length................ Width................ Diameter Depth................
Disposal Trench—No..................... Width_.__._ ._.__.___. Total Length.................... Total leaching area__ _.f',�......sq. ft.
Seepage Pit No....../............ Diameter..4....�_ ... Depth below inlet____________________ Total leaching area..................sq. ft.
Z Other Distribution box K ) Dosing tank ( )
Percolation Test Results Performed by---•-------------••••••--••••------••-----•------••----•---••-•--•-••---• Date---------..............................
aTest 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.........................
O Description of S � ...._-- .. _._.__.... .� � = A
t -SA...'--------- •---•-•--•-••-••---•-----•-------•------...-•-•- ----•-----
W p r
v;
------ •---------• •-•-•------------• ) •-----•--------------••.._.._I.....................
UNature 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 TITi.�. 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
�o�f,health.
Signed__ 6;i t� ' - _F =w ----•--•---••---•-----•-•. .... f. '_
Date
ApplicationApproved By. ..................................................................................... ........................................
Date
Application Disapproved for the following reasons---------------------------------------------------------------•----------------------------.._.___._...____..._
.............................•-.....---------•--.....----•---...-------------------------------------------•--•-•--•-•-------------••-••----------•--------------•---••-----••-•-••-•-••--••••----------
Date
PermitNo.1 A.......................................... Issued.......................................................
Date
F ..
y r'THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?............oF..,,,.�A....:.iv: /C............................
�rrtifiratr of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
y ,' 1 �> 1 off' t ! --...-•--•-•...................••---................------.._..--------•--.._..._......•---
_ vA I.Ftaj,ler
at......
t%..q........... .......I___)_�tJC..i4. :.1:'.._.__!_. 4_u IJ_f__.r_______________________
has been installed in accordance with the provisions of TITLE j of The State Sanitary-Code as described in the
application for Disposal Works Construction Permit No_........��'/�____________________ dated--------------------- ..........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......:....................•--•-..._............---••----•--..............--... Inspector...................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
t
BOARD ,OF`HtALTH
t .
No......_._ , x FEE........................
%V� isal Work nntrurtiati ern it
Permission is hereby granted_ 'l = .t` _s �... ? -------------------------------------------------------------__--_-_----___-__._--__
to Construct ( ) or Repair (. ) an Individual Sewage Disposal System
atNo...k_Z--r...... .... ....1 s)_ 1.. ..... ..2%_. 1 i " '.............--------- --------•---------------------•.......•-•-••.......
Street ,gt
as shown on the application for Disposal Works Construction Permit N@7_,�_____________ Dated_fr/!_�".d.'17.....__........
Board of Health
DATE..................................... ..........................................
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