HomeMy WebLinkAboutAPD 4/20/23 TOWN OF YARMOUTH BUILDING DEPARTMENT
oT Y'�R APPLICATION FOR DETERMINATION OF NON-APPLICABILITY
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s AQUIFER PROTECTION BYLAW §406.5.1.1
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Applicant/Business Name:�cP M � \\.1L�1ekc��4,"-;fit:1/6-1o;•1 Date: 31 I /7
Property Owner: �= 4T
Property location: 0 \--c(—— .w L.. 1 . Unit# Map&Lot# ;
Proposed Use: =Vx P, t' k-kc411/41 Wilt-t
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, He,
4. Does the proposed use meet all of the objectives and water quality criteria of the bylaw:eft ti
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 filing by the applicant for a Special Permit from the Board of
Appeals as otherwise provided herein.
Applicant Date
Print Name
DETERMINATION: The Building Inspector, based upon a review of this application and information
supplied by the Applicant, hereby determines that the proposed use satisfies the requirements of§406.5.I I and
that the Applicant need not apply for a Special Permit under §406.
3 )61/1
Building Inspector [)ate Health Agent ate
Form must be flied with the Town Clerk and copies of this form must be sent to the following
departments(as listed in §106.5.4); Water, Engineering, Fin,Health, Planning,Conservation, Board of
Appeals.
Aquifer Protection District Waiver 05,08
TO: Commercial Applicants in the APD
•! FROM: Yarmouth Health Department
T I
SUBJECT: Hazardous Materials
As part of the application proems for a Board of Appeals hearing or Determination of Non-Applicability,
please complete this form and return it with your application. For farther information concerning hazardous
materials regulations, contact the Health Dept Office.
In the conduct of your present and/or proposed business, do you store, use, generate any of the
following types of products? Please cheek all which apply sad list qa a atiid..
Antifreeze, Engine& Radiator Flushes 1\1 e Motor Oil `to
Hydraulic, Brake, Automatic Trans. Fluid \o Gasoline/Fuels
Grease, Lubricants ,t.u Degrea er/Cleaners
Floor/Driveway Degreaser
Battery Acid
Rustproofng/Undercoating N u Vehicle Detergents t u
Vehicle Waxes,Polishes \1u Asphalt, Tar, Benicia 1\-,
Paint, Varnishes, Stains, Dyes, Thinners n Wood Preservatives ij
Dry Cleaning Solvents, Carbon Tetrachloride Oo Floor/Furniture Strippers kl
Other Cleaning Solvents � Rock salt, Road salt 1tt
Drain, Toilet, Cesspool Cleaners Refrigerants
v
Bug& Tar Removers Photo chemicals
Printing Inks& Dyes �i Pool Chlorine
Pesticides, Insecticides, Herbicides c Rodenticide, Fungicides 1V c
Nitrate Fertilizer 1U Jewelry Cleaner (,
II ,
Leather Dyes �u PCB-3 �l
Electroplating Sludges
1\b Others (List)
Applicant Signature:
=� --- — Date•
/MALTAPDDETER 10-99
„t TOWN OF YARMOUTH
HEALTH DEPARTMENT
V . �
�`'- ,`` '� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET �/
To be completed by Applicant: GL-
Building Site Location: ='0 11-\ E - .le”
Proposed Improvement: Otis -ii lire 0 -A- N-ew ---av\tom,►J G W\-n-c-
bcPI 5? _ A 7s-,...)0nt)12.._ APV5v Lc ? (CA Ni 6 P pc
Applicant: C..4,10 I_- Eblc1-t.._ ---C,rL nr�n znhN 5Te1. No.: `JbS• 49`l- (08 Z
Address: 2 `I -ta,oti e kr,A) S 02.C, t Date Filed: \11\ /13
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: ,, Ft.'" `Tcw4r
Owner Address: P.O. BOX 108, BARNSTABLE, MA 02630 Owner Tel. No.: 568 12 - I2-
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floor plans not required for decks,sheds, windows,roofing;
(3.) If necessary,Title 5 application signed by licensed installer
with fee.
REVIEWED BY: GTJX2 E 5 IO4,dn, 92_, DATE: *--ZO-23
PLEASE NOTE
C MMENTS/CONDITIONS:
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RECEIVED
APR 20 2023
, BUILDING DEPARTMENT