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HomeMy WebLinkAboutSigned APD 4/23/26 Oc yq.4 TOWN OFYARMOUTII BUILDING DEPARTMENT i 4OJ APPLICATION FOR DETERMINATION OF NON-APPLICABILITY "i '[' [3L OC -2�— `7 o.....,.0s, AQUIFER PROTECTION BYLAW 4406.5.1.1 Applicant/Business Name: a_ .I) li\ uiiA 1/(0/741 Date: Dili..2,-1-/ / i 0_ Pros... tion:11.90\"jU)V }"i(JXC,( go,wit00'[Inil Map&Lot 95 /S !, I Proposed Use: --Pa.01 ©Q.._. 1. Has applicant fully complied with the Submittal Requirements of§406.5.1.1? 'on (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? r/) The above applicant hereby acknowledges that the Building Commissioner may require the applicant to submit the matter to the Health Agent of Board of I lealth 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. II - -IcitVVIIIIIIIIIIIIIIIIIIIIL 0 it/.2/1.1 c Applicant Date Print Name C0/1Q , 4,01 k2,- 4--25-16 DETERMINATION: The Building Commissioner,based upon a review of this application and information supplied by the Applcan incs that the proposed use satisfies the requirements of§406.5 .1 and that the Applicant of:..or ` .ermit under§406 5 B i g ins r Date Ilealth 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§4065.4);Water,Engineering,Fire,Ilealth,Planning,Conservation,Board of Appeals. Aquifer Protection District Waiver Rev: 07/24 Dc --Z6- 3 /oE 4 TO: Commercial Applicants in the API) 'g e ;` l ltOM: Yarmouth I Iealth Department SUl33I:C 1': I lazardous 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,usc,or 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 - 2 e"'1 Floor/Driveway Degreaser Battery Acid Rustproofing/Undercoating Vehicle Detergents Vehicle Waxes.Polishes Asphalt,Tar,Scalers Paint,Varnishes,Stains,Dyes,Thinners Wood Preservatives Dry Cleaning Solvents,Carbon Tetrachloride Floor/Furniture Strippers Other Cleaning Solvents Rock Salt,Road Salt Drain,Toilet,Cesspool Cleaners _.Z Refrigerants Bug&Tar Removers Photo Chemicals Printing Inks&Dyes Pool Chlorine Pesticides,Insecticides,Herbicides Rodenticide,Fungicides Nitrate Fertilizer Jewelry Cleaner Leather Dyes PCBs Electroplating Sludges ) Others(List) Applicant Signatur . ✓ Date: otil0,2,9/&(,- Rev: 07/24