HomeMy WebLinkAbout0035 LITTLE RIVER ROAD - Health ver-
~TOWN OF BARNSTABLE — UNDERGROUNDIFUEL%.AND CHEMICAL 'STORAGE REGISTRATION
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OWNER AND INSTALLER I;NFORWIM ON
..,,,'ADDRESS
35 Little River Road l .MAP NO 0� ,�R�' a.J PARCEL NO:�A3
Robert J. Smith, Jr.
OWNER NAME: -- ,t t V I LLAGE: _ r
Octobe vember;� .
INSTALLATION DATE: 1 BY: � + ' geeting►-Oil airnlmq,
Street, t?steIle, 655
ADDRESS: Osterville, JMassachusetts 02655 CERT. NO.
(l have the original biLle t6". and payment checlse t ►-from Les-lute when an entire 2�)ating system, .inc .
tank, were installed. 2 can provide
TANK I NFORMAT ION copies of,,th,s jaterial if You want tom•
LOCATION OF TANK:. Underground rear hof upej ate . old-�ape,-cel ,rouad a/crawl. spaces
Oil
CAPACITY 275 TYPE' AGE20 yogra FUEL/CHEMICAL
TESTING CERTIFICATION a. E 7 PASS C 7 FAIL DATE
ZONE OF CONT'R,IBUTION C ] YES CR 7 NO DATE TO BE REMOVED Iq t j
taav�e eppo� aJ tut Dept. At
that tie 196?)ovezyaw was not
FIRE. DEPT. PERMIT' �ISSUED C 7, I YES C� '``NO DATE
t auwmavj "quUW vo have a
CUNSERVA i ION EX ],.. CHECK,, IF N,/.A,, Permit'
�, .. z.DATE
BOARD OF HEALTH TAG NO. C - 7C 1[ 1[ 7 DATE A h.q We.
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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C a to i t Fire Depa,r,tme n t
64 High Street, Cotui. t
428-2210 _ Cy
FDID No. 41921 Date. +
PERMIT FOR REMOVAL OF RESIDENTIAL UNDERGROUND FUEL TANK
Permission is hereby given to remove and transport an underground
fuel oil tank from the property described below-
Location of property: ............ ...1... L.4�°:__.._.�.1.�.E?{ . � ...� ._......._ ��:.j..t:.)r_r ... ._
Owner of recardrl..j . .p..IJ °J� ..__...._.z�,. ...t " .._.._..._.
Berson/Contractor removing tank : .._.._1Z�.��`�_�t� .......... .,�f.� .. ....5�,��'t► 1C..4�'..._..,s E�e�c� ��Gi��r'�
AdClress. Ce:rt. No, ..........__............,....._..._....._....
Dig Safe No. ( If applicable) _ ..•�.._( ���._��..t/ �j'..1�......._. Start Date ....���..�1r?�......_
Notice; All-, work shall bca performed in accordance with applicable
regulation's/restrictions. Theexcavation and tank...__must......b,e_..._i.nspect,ed
f.i�r ...,_ce,p ,r t rrertt._.C�e.K�► e !i. � a.!!e.. r a r r _.t! ba. }�f . .� .!�.
( Fire Department Use Only)
TANK TNFQRMATION
Size [ 112 755 [ 330 500 1000 Other
Type Steel_.....(_!!. :ai:.e. _s.e...._ p ., .i.f _ed..).__-._._....__..
Age __._.... . ..._. lsr,knowr'i l
Board of Health `fag No. ...... .�. Tag No. Unavailable or Not IssuedL
r ...1.. ._..
C.ECTION/RIEMOVAL INFORMATION
Contents of tank; L�J Empty L I Disposed of by: ..._........__.,......_.,.._.._._._..........................._.._................... ....
Inspection of tank: No de -to
I }� Evidence of damage Pound
Inspection of excavation.[,excavation. [,>XNo contamination [; 7 Contamination found
If contamination found, reported to: L ) Board of Health D. E.Q. E.
Tank transported to: --. ......._.
Inspectors Comments: _• ,.
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Paul A. Frazier
Head of Fire Department Tnspert<<r ��
fall copies of this form wil 1 be di. vtr xbut-J l L ♦ .
White - Contractor/Tank Vai d yel luw F ;
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