HomeMy WebLinkAboutAPD 3/19/25 �g47
,� TOWN OF YARMOUTH BUILDING DEPARTMENT
', AO APPLICATION FOR DETERMINATION OF NON-APPLICABILITY
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oab. AQUIFER PROTECTION BYLAW 406.5.1.1
Applicant/Business Name: SL C 0 CE-1-&i. ( -frOMP S S iri aiS Date: 3'j3)ac
Property Owner: SaYyl ct rl-th 11 i C)9 k I 11 OH O ZL S
Property Location: 939 RA- to Pt- `I(k( Unit A Map& Lot
Proposed Use: i(1 t O J C J i Oj
1. Has applicant fully complied with the Submittal Requirements of§406.5.1.1?
(Attach copy of Hazardous Materials List)
2. Are the chemicals,pesticides, fuels and other potentially toxic of 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? Yes No
3. Does the proposed use meet all of the objectives and water quality criteria of the bylaw?
The above applicant hereby acknowledges that the Building Commissioner may require the applicant to submit the matter
to the Health Agent of 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.
3 )aS
Ap cant Date
SQ.VVVOL , NI c '3 u (I()
Print Name
DETERMINATION: The Building Commissioner,based upon a review of this application and information supplied by
the Applicant er by determines that the proposed use satisfies the requirements of§406.5.1.1 and that the Applicant
d not . .ply 'or a al Permit under §406.5
11
,r , ) zr 7-29 ,
,9, 3—6---2,5—
Building Ins lector Date Health Agent Date
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 Rev: 07/24
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,, �,�og .,� TO: Commercial Applicants in the APD
o ,`A FROM: Yarmouth Health Department
•d 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 further information concerning hazardous
materials regulations, contact the Health Department Office.
In the conduct of your present and/or proposed business,do you store,use,or generate any of the following types of
Products? Please check all which apply and list quantities.
Antifreeze, Engine&Radiator Flushes N(Pr Motor Oil J i r
Hydraulic,Brake,Automatic Trans fluid '"lA Gasoline/Fuels IN\ l tT
Grease,Lubricants NV Degreaser/Cleaners '
Floor/Driveway Degreaser 1 PI Battery Acid N l
Rustproofing/Undercoating Vehicle Detergents N 1
Vehicle Waxes, Polishes AO' Asphalt,Tar, Sealers N I A--
Paint,Varnishes, Stains,Dyes,Thinners Wood Preservatives il
10—
Dry Cleaning Solvents, Carbon Tetrachloride Ni l ft Floor/Furniture Strippers 0 1
Other Cleaning Solvents /f Rock Salt,Road Salt 1 V ►►t
Drain,Toilet, Cesspool Cleaners N ) I° Refrigerants 0
Bug&Tar Removers AO Photo Chemicals 1A0
Printing Inks&Dyes Pool Chlorine 1 v I k-
Pesticides, Insecticides, Herbicides 1v i rc Rodenticide,Fungicides ,"1
Nitrate Fertilizer N I ik Jewelry Cleaner
Leather Dyes I i PCBs _*.
Electroplating Sludges N ` Others(List) �i
n.`
Applicant Signature: Date: 31 V J I a S
Rev: 07/24