HomeMy WebLinkAboutAPD 12924 Unit A-1 �T�^Ry TOWN OF YARMOUTH BUILDING DEPARTMENT
{ APPLICATION FOR DETERMINATION OF NON-APPLICABILITY
•
AQUIFER PROTECTION BYLAW§406.5.1.1
Applicant/Business Name: -(,(,C 1hh Q ( �� I� Date: I 12—C42 y
Property Owner:Property location: I !1- t G1)� ,s e+ Unit* /q!" Map&Lot#
Proposed Use: i('and /&up fl-a ')i UDC; `l'i Lm f C -1
I. Has applicant has fully complied with the Submittal Requirements of§406.5.2?
(Attach copy of Hazardous Materials List)
2. Does the proposed use meet all of the Design and Operation requirements of§406.5.7,
3. Are the chemicals,pesticides,fuels and other potentially toxic or hazardous materials used or
stored at the site,or produced by the proposed use,in qualities not greater than those
commonly associated with normal household use,
4. Does the proposed use meet all of the objectives and water quality criteria of the bylaw:
The above applicant hereby acknowledges that the Building Inspector may require the applicant to submit the
matter to the Health Agent or Board of Health,and may require the applicant to demonstrate that he/she has
received a favorable report from the Health Agent or Board of Health. The Determination,if made,shall apply
only to the individual applicant and proposed use and shall automatically expire upon any change of use or
transfer of ownership of the business. There shall be no appeal from an unfavorable Determination of any such
application,nor from a failure to act,except for 'n\y the applicant f as Special Permit from the Board of
Appeals as otherwise provided herein.
ze
cant ate
\C IIn Cif
Print Nam
7)8. coy e_820
DETERMINATION: The Building Inspector, based upon a review of this application and information
supplied by th plicant,hereby determines that the proposed use satisfies the requirements of§406.5.I.1 and
Ap ' a of apply fora Special Permit under§406.5
2k' 21 a&V E t--3 1-2`t'
Buildin Date Health Agent Oafe
Form must be filed with the Town Clerk and copies of this form must be sent to the following
departments(as listed in§406.5.4);Water,Engineering,Fire,Health,Planning,Conservation,Board of
Appeals.
Aquifer Protection District Waiver 05/08
v.3.fi 1 r He 1.4h Dept;
cam( /ccemslr��c
LD 1 Ion 5 01
TO: Commercial Applicants in the APD
•
FROM: Yarmouth Health Department
r
SUBJECT; Hazardous Materials
As part of the application process for a Board of Appeals hearing or Determination of Non-Applicability,
please complete this form and return it with your application. For Rather information concerning hazardous
materials regulations, contact the Health Department Office.
In the conduct of your present and/or proposed business, do you store, use, generate any of the
following types of products? Please check all which apply and list quantities.
Antifreeze, Engine & Radiator Flushes Motor Oil
Hydraulic, Brake, Automatic Trans. Fluid Gasoline/Fuels
Grease, Lubricants Degreaser/Cleaners
Floor/Driveway Degreaser Battery Acid
Rustproofing/Undercoating Vehicle Detergents
Vehicle Waxes,Polishes Asphalt, Tar, Sealers
Paint, Varnishes, Stains, Dyes, Thinners Wood Preservatives
Dry Cleaning Solvents, Carbon Tetrachloride Floor/Fumiture Strippers
Other Cleaning Solvents r_/ Rock salt, Road salt
pi -ry wto tn+ ,bd-HIrti.MS
Drain, Toilet, Cesspool Cleaners Refrigerants
Bug& Tar Removers _ Photo chemicals
Printing inks & Dyes Pool Chlorine
Pesticides, Insecticides, Herbicides Rodenticide, Fungicides
Nitrate Fertilizer Jewelry Cleaner
Leather Dyes PCB=s
Electroplating Sludges
Others (List)
Applicant Signature: Date: t.
HEALTAPDDETERI 0-99