HomeMy WebLinkAbout0020 BRETWOOD LANE - Health 20 BRETWOOD LANE, CENTERVILLE.
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UPC 12534 '
No.2_ 1_53LORgs
HASTINGS, MN
07-14-1999 03:32PN CENT OST FIREDEPT 5087902385 P
MaKe application to local rtre uepartment_
Fire Department retains original application and issues duplicate as Permit. /(of
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APPLICATION and PERMIT Fee: 25ron
for storage tank remcvai and transportation to approved tank disposal yard in.accordance with the provisions
of M.G.L. Chapter 148,Section 38A, 527 CMR 9.00, application is hereby n.nde by:
Tank(Owner Name(piw-se print) Anna Adams X
sormre(W aP 9 W Pe/ma)
Address 20 Bretwood Lane. Centerville
sneer ao, spa vp
Advanced Environmental Advanced Environmental
Company Name Co, or Individual
pant PMI
Address P.O. Box 472, S. Dennis, MA
Address
Prmr
P/hf
Signature(if appl 'na; -ermit) Signature (if p ying, ,Dermit)
CISI CI Cart;fke Other ` I I ertified = Other
Tank Location 20 BrQtwood Lane, Centerville
Stesr naCress �,
Tank Capacity(gallcrs: L000 Substance Last Store: #2 Fuel Oil
Tank Dimensions(di2rrc-c-x length)
Remarks:
s
Firm transporting was:a Advanced Environm nral State Lic. # _ My508 856100
Hazardous waste marts E.P.A.
Approved tank dsooszJvs d _ J.G. Grant Tank yard i# 03501
Type of inert gas Tank yard address Readvil e A
City or Town Centerville FDID# 01920 Permit#
Date of issue July 14; 1999 - Date of expiration July 28, 1999
Dig safe approval number, 19992806769 0i Safe I.Number-S00 322.4844
Signature/Title of Of;Sr---- wanting permit
After removal(s)send Fcc r,FF".290R signed by Local Fire Dept. to UST Regulatory omplia-xxx Jnit,One Ashburton Place,
Room 1310, Boston, MA ;:�:08-1618.
FP•292(revised 91261
07-14-1999 03:32PN CENT DST FIREDEPT 5087902385 P
nrraKe app•tcanon to local rtre uepartmen-L
Fim Department retains original application and issues dupfic:ate as Permit. /loin
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APPLICATION and PERMIT
for storage tank remcvai and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148_Section 38A, 527 CMR 9.00, application is hereby rreee by:
Tank Owner Name(piee_�print) Anna Adams 6� X
-agnarure r aP 9 peann)
Address 20 Bretwrood Lane Centerville
Srrear QY Srsre ZIP
---F==��
Advanced Environmental Advanced Enviromental
Company Name Co. or Individual n
pRnr Address P.O. Box 472, S. Dennis, MA
Address PM?
PW.
P17nr
Signature(if appi 'nc; -ermit) Signature (if p ying f zermit)
C15I Ct Car¢ft Other I I ertified _ _ - Other
rTanktLocation_ 20 Bretwood Lane, Centerville
StBer Aocreas �
Tank Capacity(galicrs 1,00 Substance Last Store= fit Fuel 'Oil
Tank Dimensions(diare c-x length)
Remarks:
Firm transportingwas:a _Advanced State Lic. 9 MV;Q8y 3g56�0�
Hazardous waste merits:,' E.P.A.
Approved tank disposai vard T_(;_ , ant Tank yard# 03501
Type of inert gas Tank yard address _ Reedville A
. . .
City or Town Centerville FDID# 01920
Permit# .
Date of issue July 14; 1999 Date of expiration July 28, 1999
Dig safe approval numb:-r- 199928067619 It IDi Safe I.Number-800-322.4844
Signature/Title of Cf;•s�wanting permit
After removal(s)send Fcr-:7-P.290R Signed by Local Fire Dept. to UST Regulatory omplia.•=-Jnit, One Ashburton Place,
Room 1310, 6oston, MA c:08-1618.
FP.292(revisea 9r961
TOTAL_ P.02
07-14-1999 03:32PM CENT OST FIRE DEPT 5087902385 P
.02
MaKe appucanon to..ocal rare vepanmenT_
Fire Department retains original application and issues duplicate as Permit. %lo�
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his
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-7APPLICATION and PERMIT Fee: aLDD__
for storage tank remcvzi and transportation to approved tank disposal yard in accordance with the provisions
of�M.G.L. Chapter 148,Section 38A, 527 CMR 9.00, application is hereby ffnde by:
1
Tank Owner Name(plees print) Anna Adams X
• yyl,a/ure 1 . 8 penno
Address 20 Bretwood Lane, Centerville
Street (ity Stste Z/p
1
Advanced Environmental Advanced Environmental
Company Name Co. or Individual
Pont mnt
Address P.O. Box 472, S. Dennis, MA
Address
P/ml Pnnr
Signature(if appf 'ng, -ermit) Signature (if p ying permit)
CI C e;fiec Other IFel ertified = T Other
Tank Location 20 Bretwood Lane, Centerville
Sleet Address �
Tank Capacity(gallors 1,000 Substance Last Store: #2 Fuel Oil
Tank Dimensions(diarrcacr x length)
Remarks:
Firm transporting waste Advanced_E=.jx nznental State Lic.#V5Q838561 O0
Hazardous waste m2rits:,' E.P.A. #
Approved tank disposaifir;rd J_G_ Grant Tank yard# 03501
Type of inert gas Tank yard address Readville. MA
City or Town Centerville FDID# 01920 Permit#
Date of issue July 14; 1999 Date of expiration July 28, 1999
Dig safe approval number. 1999280676R It 4 011 Safe 1.Number-800-322-4844
Signature/Title of Off wanting permit
After removal(s)send Fcr-?-290R signed by Local Fire Dept.to UST Regulatory ompliance init,One Ashburton Place,
Room 1310, Boston, Ma C2:08-1618.
FP-292(revised 9/961
TOTAL P.02
No...... �G/......... Fwic..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Tow. . . .......... OF..... AANSTR$LPc................................
Appliration -for Uhivviittf Workii Tonmrurtion Vrrniit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
LET-_. 5?. .......................
-----------------------------------------------------------•------------._...------------------.
...10 Texi
. .................................. P .�1 T.l�, t �
O er Address ........................
Installer Address
Q Type of Building Size Lot_.����lDC1Q.....Sq. feet
U Dwelling—No. of Bedrooms.............3-_----...-___-.____-------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building'9A�>�`� .° __.._.. No. of persons .............. Showers ( ) — Cafeteria ( )
QOther fixtures ------------------------------------------------------------------------------------------------------------------------------------------------•--..
w Design Flow..............ems........_..__.____......._gallons per person per day. Total daily flow.__.__.____.3 4?___________..__.._..gallons.
WSeptic Tank—Liquid capacitvI allons Length-------y'----- Width_._8_....... Diameter................ Depth.-..-_--_-.-._.
x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No_____________________ Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box K Dosing tank ( )
aPercolation Test Results` Performed by------- ----------------•-----........._...........---•--------•-•--..... Date----.--------------------------•-------
a Test Pit No. 1----------------minutes per inch Depth of Test Pit..............__.___ Depth to ground water------------------------
Li, Test Pit No. 2................minutes per inch Depth of Test Pit---_____---___---- Depth to ground water-:--..---_------•_____..
P1 ---------------- •-----------------------------•-------------------------•----•-•---•---------------•---•-----•-------•--•-----------------------------------
G Description of Soil-----C�nl0..---.;,..P%!�---64---SU S.?1-1......... -------
x
w
U Nature of Repairs or Alterations—Answer when applicable.._.................._-.-._---..-__--_-.-._--_.---__-_-----_-_____----_._._._-.-____---___.
---•------•-----------------------•-------------- -------------•----------------------•----.---------------•---------------••-----•-_--•--•----------------------------------------------•-•-----•-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until.a Certificate of Compliance has been issued by the board of health.
Signed_c.. ► tttJ ___----- +'�e..----, ........�
'/\ �pN'►�S7 ate
ApplicationApproved By------ �G--- ----- -------------------------------------------------------- -------------
Date
Application Disapproved for the following reasons:---•-•-•---•---•--••----••----------------------------•----•-•-•-•-•---•----------_-----•----------•------••---
-----------••----•-•--------------•-----------------•----------•------ ------------------••-•-----•-•---
s� Date
PermitNo. .4-------------------------------------- Issued------ c
Date
.0...•.....��. l.•...1.......s...cl..lnw��-w...w ..v...... ................s.......s.•-s...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7r5?.L4.w..............OF..... P1< .�.��1?. ...............................
(9rrtif irate of QW.Tontphatta
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( or Repaired ( )
by........U E TO.&INo------''.tiro-S..•----------•.._....-----
Installer
at.... L*'T. LEIJT .1�VIV .&--------------------------------------------------------------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No--------- dated---- 7. '____._..____
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------:G= l- 7 ---------------------•------•-•--••------- Inspector-- - '�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. pphratinn -fur Ui,ipuiittl Works Toustrnrtiun Vrrm t
Application is hereby made for a Permit to Construct ( ) or-Repair ( ) an Individual Sewage Disposal
System at: _
-•---••
Location Address . y or Lot No.
Owner Address
..........................'' s' �� M �3 z � ...................................
Installer Address
Q Type of Building Size Lot_. _X'x -_._.Sq. feet
U Dwelling—No. of Bedrooms--._-.---. _Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building" - ------- No of persons........ +n.............. Showers — Cafeteria
Q' Other fixtures ________________________________ _
W Design Flow-------------%_ _______________________gallons per person per day. Total daily flow------------ . ....................gallons.
WSeptic Tank—Liquid capacitvt gallons Length------ ........ Width-. ......... Diameter_----_...-._--_ Depth_..--___-----
x Disposal Trench—No..................... Width-------------------- Total Length..................... Total leaching area--------------......sq. ft.
'Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area_.._.._._.___-__--sq. ft.
z Other Distribution box A Dosing tank ( )
aPercolation Test Results Performed by---------------- ---------------------------------------- ............... Date----_____----------•--- --•----.-----
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water._...-____--_-....___-
f� Test Pit No. 2......_---------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
---------------------------------------------------------------------------------------------••-•--....................................... -----------------
O Description of Soil-----Q-y f ----- .- -_��ta a ti-4 ..... _. .... ... ..........
W
U Nature of Repairs or Alterations—Answer when applicable._____________---------------------------------------------------------------_-----------------
---------------------------------------------------------------------------------------------------------------------- _
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI,,of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed .. t" ------ -- --
Application Approved By______ _ _______._pI
Y + • — ate
- - - -----•---•- -------------'---------
Date
Application Disapproved for the following reasons::------••----------------••-----•---------------_-_---••----------------•---------•--•--•---•------_-----------
---._.-•-•-------------••-------._._._..__._....._....---------•-•---_ ...----------•--•••••••-••-•-•••__.. ------------------
Date
Permit No.- --=---- -.-•••---------------------••--••- .._. _...... --..A-••-----•-
7/ Issued. =f'_1'tyl`�
_+ _ Date
TjH,EaCOMMONWEALTH OF MASSACHUSETTS
4y
BOARD OF HEALTH
g.
...... .......OF.... 3Nt .' ".. .s .-...
Orrtifirate of 01 1IMPHanrr ;
T�HI IS TO CER"lIFY3 That the Individual Sewage Disposal System constructed (ror Repaired ( )
} ram. �tqZ �~ ----.---------------------------------p---.-----------------------_._..___..-----------------•-------------
Inst
ler
at-------•---"� ----- -"------?- -`.�4� — --�'-- -4-- ".« al t: '-------------------------------------------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------- __________________ dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------- 3............ . dq24
�. ..... . Ins ------------•----•-------•-----•---•----••----•-•---------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF i,HE-ALTH
;t w<
No. ----•---• FEE ----
Bitipn,gttl Norkii Qlunitrnrtinn Vrrmit
Permission hereby granted__��: `*\(et_: ` __-__ _b' 4f.............____.-
to Construct O or Repair ( ) an Individual Sewage Disposal System
atNo.__-!6.".T._..'_%C5------�?VMT. JMMJj�---•-•-..--••-----'-------- ..._--------••--------------------------------------•----------__.---•-••--•----•---
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated... �. . - 7
---------------•--•----
-----•--- ----------
k.Y= j 7 Board of Health
DATE..- '//- -
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
LOCATION SEWW� PERMIT NO.
4 0 7�30 . R�lste�3b L 11-
YILLAGE �✓
INSTALLER'S NAME & ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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•`a`v x. XAi �>'o0Ic PR ! j -'✓ . 'v CS OUTLETS AND LEACf,//ti/G /7
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I HEREBY CERTIFY THAT TYE EXISr/N �r Ep\.tNOF�4e.
FDUIVDRT/DN LOCAT/ON /5 CORRECT AS
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