HomeMy WebLinkAboutAPD 2026 o �Lk\ TOWN OF YARMOUTH BUILDING DEPARTMENT
RECEIVED
ii O' APPLICATION FOR DETERMINATION OF NON-APPLICABILITY
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N,CORPORATEO\b AQUIFER PROTECTION BYLAW §406.5.1.1 BUILDING DEPARTMENT
By
Applicant/Business Name:DFC GR I2PElo`7'ts y G L C Date: 04 - / 3 - ai6
Property Owner: S116LDCA COO WO
Property Location: 44CDP,P0 t2 ITION k1 b. Unit 3 Map & Lot
Proposed Use: S 1 )RAGE
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.
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APR 7 3 �026 App icant Date
HEALTH DEFT a16go (6TA
Print Name
DETERMINATION: The Building Commissioner,based upon a review of this application and information supplied by
the Applicant,h- - •: -rmi 1-s that the proposed use satisfies the requirements of§406.5.1.1 and that the Applicant
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Buildi _ nspector 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
4-74— TO: Commercial Applicants in the APD
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P-- • —ti FROM: Yarmouth Health Department
_° ri, 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 /0 Motor Oil 4/0
Hydraulic,Brake,Automatic Trans fluid �� . Gasoline/Fuels N°
Grease,Lubricants AO - Degreaser/Cleaners N O
Floor/Driveway Degreaser Battery Acid t7
Rustproofing/Undercoating i0 - Vehicle Detergents
Vehicle Waxes,Polishes Asphalt,Tar, Sealers dO
Paint,Varnishes, Stains,Dyes,Thinners _4LCL . Wood Preservatives
Dry Cleaning Solvents, Carbon Tetrachloride ;2 Floor/Furniture Strippers .41
Other Cleaning Solvents _jL, Rock Salt, Road Salt /VC)
Drain,Toilet,Cesspool Cleaners ALL 7 Refrigerants /AJ ,
Bug&Tar Removers IA11 / Photo Chemicals //Al
Printing Inks&Dyes R i Pool Chlorine Art)
Pesticides,Insecticides,Herbicides -ii), Rodenticide,Fungicides /1/a
Nitrate Fertilizer , Jewelry Cleaner N '
Leather Dyes i, PCBs ./(7) '
Electroplating Sludges 4// , Others(List) _
Applicant Signature: �L 2' Date: 04 "/3 .21)Z6
Rev: 07/24