HomeMy WebLinkAbout0746 MAIN STREET (COTUIT) - Health 7Y& llhatn 31PW-
TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: /' r► u&mt MAP NO. r:' PARCEL NO. 0 -'!:3
OWNER NAME: /orbs. /1llhLttQ.� �ll VILLAGE: �t
INSTALLATION DATE: vNK BY: I/pxp -
ADDRESS: CERT. NO.
L/KJ � TANK INFORMATION
LOCATION OF TANK: LIN dj* eumL(
CAPACITY TYPE ` AGE • FUEL/CHEMICAL t e1
TESTING CERTIFICATION E ] PASS C ] FAIL DATE
LEAK DETECTION Ct/7�CHECK IF N/A TYPE/BRAND zp
AEMOVU
ZONE OF CONTRIBUTION C ] YES Ca✓] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C ] YES [,/l NO DATE
CONSERVATION CV/]CHECK IF N/A DATE h
t'"jam •..
BOARD OF HEALTH TAG NO. �C ]C ]C ]C ] DATE i n 7_
PLE!ASE. PROVIDE A SKETCH ;SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
1
Cotuit Fats Department ~
64 High Street', Cotuit
428-22 2 b
FDID No. 01921 Date_
.. f
Y 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 belows
Location of propertye --7:' 6��?
Owner of records _�� _ ' i �"_GN
Person/Contractor removing tank:_ -Z
Address s_/ ,�lalu2f1011�<�1 Cert. No. -'
Dig Safe No. (If applicable). y 33'2- Start Date!
Notice: All work shall be performed `in accordance with applicable
regulations/restrictions. The excavation and tank must be inspected
by a fire department representative i2rior to back-fill and- removal .-
(Fire Department Use Only
TANK I NiFORMAT I ON!
,r3d0.
Size C✓3,,.; &'"' t 3 330` C 3 500 E 3 1000 i3ther - -
Type Steel (unless otherwise specified) Age Unknown Cv�(
Hoard of Health Tag No._ Tag No. Unavai l abl t #:or Not Iasued,xvoloe
INSPECTION/REMOVAL INFORMATIONi
Contents of tank: C 3 Empty E v"I" Disposed of byt _ Z,,,-_' _
Inspection of tank: C 3 No defects t .Evidente of damage found
Inspection of excavationxE 3 No contamination E Contamination Bound
If contamination found, reported to% EV/J 'Scaa;rd of Health C . 3 D.E.O.E.
Tank transported tox
Inspectors Comments: 008o
AQQ vcJ �Vv J . ��0 &-t 7A J
a ,-�� -
0.1
Paul. A. Frasier
Head of Fire Department Inspector
All c9:301== of thlo 4vrm w111 be lneppction..
Wh!to -- Contractpr/?'snit YQI^c! Yrri 3 ow - F'.[y. t='i nit - Aodrd aaf Noel ttf