HomeMy WebLinkAbout0460 MAIN STREET (HYANNIS) - Health ain#Str'ee
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Hyannis
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Fire Department retains original application and issues duplicate as Permit.
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APPLICATION- and PERMIT Fee:
for storage tank removal 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 made by:-
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Tank Owner Name(please prfnt)��l l�. I)CVMUS fl-111tl-11 X
Address $NJO>1
Sdraet Gry
Company Name _ > `'t�AC... SV?jY_—S Co. or Individual
Prsnt Pf
Address \dM Address
Si Hato _
g applying for permit) Signature(d applying for permit)
C Certified Other ❑ IFCl*Certified ❑ LSP r Other
Tank Location cST' WY6K'V :r U 4
26WAftess cay ,
Tank-Capacity(gallons) 2. CX (S V•s1 Substance Last Stored='
Tank Dimensions(diameter x length)
Remarks: ,
Firm transporting waste '�b�' � ' State Uc.#
Hazardous waste manliest# EPA.#
Approved tank disposal yard W01—_TV'4--Z<Q�S Tank yard#1rFC_N<(I—
Type of inert gas Tank yard address
7or Town �yL� FD1D# i'��C,L'L Permfi#ate of issue Date of expiration
Dig safe approval number Dig Safe Toll Free Te Zw 800-322-4844
Signature i Title of Officer granting pennfi 'E S ENT
oM AB �
After removel(s) (`Consumptive Use fuel oil tanks exempted)segi G� bylacal Fire Department to Office of the
State Fire Marshal,UST Regulatory Compliance Unit,P.O.Box 1025,Slow,MA 01775.
'international Fine Code Institute
292(,•revised 4197)
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TOWN OF BARNST
LOCATION 7�D �}1 Q�t..ti SEWAGE#
VILLAGE �j,�C.�y�' ASSESSOR'S MAP&PARCEL`122- ?g� 080
INSTALLER'S NAME&PHONE NO. LZ. oX
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) s lurle019 1
NO.OF BEDROOMS
OWNER Q �r, �.
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
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