HomeMy WebLinkAbout4598 APD Determination Signed May 19 2015! TOWN OF YARMOUTH BUILDING DEPARTMENT
1' �t•Y^R.y APPLICATION FOR DETERMINATION OF NON -APPLICABILITY
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°•s AQUIFER PROTECTION BYLAW §406.5.1.1
Applicant/Business Name:' WHiTt 0W '1`t AV1k(, Date: S S • o?dl�
Property Owner: (_rRZi`; LotJGN�t r'
Property location: S 3 s 41660S
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Proposed Use:. ►y �oo(�
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1. 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, U
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, PO
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, ifmade, 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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Applicant Date
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Print Name
DETERMWATION: 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 §406.5.1.1 and
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ply for a Special Permit under §406.5
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Building Inspector Date "Health Aidint Date
Form must be tiled with the Town Clerk and copies of this form must be seat to the following
departments (as listed In §406.5.4); Water, Engineering, Fire, Health, Planning, Conservation, Hoard of
Appeals.
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Aquifer Protection District Waiver OS/OS 0u5tata
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TO: Commercial Applicants in the APD
FROM: Yarmouth Health Department
SUBJECT: Hazardous Materials
As part of the application process for a Board of Appeals hearing or Detaminstioa of Non -Applicability,
please complete this form and return it with your application. For Ruther in binnstion concerning hazardous
materials replatioa+, coated the Health Department Office.
In the conduct of your present and/or proposed business, do you store, use, generate any of the
Wowing types ofproducts? Please check all which apply and Ild quantities
Antifreeze, Engine dt Radiator Flushes N A Motor Oil t .
Hydraulic, Brake, Automatic Trans. Fluid Gasoline/Fuels
Grease, Lubricants t Degreaser/Cleaners
Floor/Driveway Degreaser Battery Acid
RustprooSng/Under+coating Vehicle Detergents
Vehicle Waxes, Polishes Asphalt, Tar. Sealers
Paint, Varnishes, Stains, Dyes. Thinners Wood Preservatives
Dry Cleaning Solvents, Carbon Tetrachlori Floor/Furniture Stri;
Other Cleaning Solvents Rock salt, Road salt
Drain, Toilet, Cesspool Cleaners Refrigerants
Bug dt Tar Removers Photo chemicals
Printing Inks & Dyes Pool Chlorine
Pesticides, Insecticides, Herbicides Rodenticide, Fungicides
Nitrate Fertilizer Jewelry Cleaner
Leather Dyes PCBas
Electroplating Sludges Others (List) I
Applicant Si Date: S , a0 I
HEALTAPDDETERI O-99