HomeMy WebLinkAbout0882 MAIN STREET (COTUIT) - Health �2 ` ��
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
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ADDRESS: Ii }� � MAP ND. ! /._ .��PARCEL
OWNER NAME: L�' �?�'/�/�1V VILLAGE:
INSTALLATION DATE: I4?6Q BY:
q DDR ES ; � , CERT. NO.
. TANK INFORMATION
LOCATION OF TANK: '' to
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CAPACITY TYPE fE-'G> AGE 'g FUEL/CHEMICAL?
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION CV�CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED d1go
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FIRE DEPT.. PERMIT ISSUED C ] YES CV] NO DATE
CONSERVATION CV7 CHECK IF N/A DATE
BOARD OF- HEALTH TAG NO. C I[ I[ ]C ] DATE
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PLEASE PROVIDEaA :SKETCH. SHOWING THE TANK- LOCATION ON ,THE, BACK .OF .THIS CARD
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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
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/ f OWNER AND INSTALLER INFORMATI N
ADDRESS: i X ' / / 7 MAP NO. PARCEL NO.
OWNER NAME: 1�% �. �7'"'/ G.�S VILLAGE:
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HcLre 606 t" 19 50
INSTALLATION DATE:
BY:
ADDRESS: - / CERT. NO.
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TANK INFORMATION
LOCATION OF TANK: f��' �''� �'
PRE SUM ,�-
CAPACITY f 00 TYPE - AGE ZOWS• FUEL/CHEM CI AL 'r1lel
TESTING CERTIFICATION C I PASS C ' ] FAIL DATE
LEAK DETECTION CVlf##CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES C J NO DATE TO. BE. REMOVED
FIRE DEPT. PERMIT ISSUED C I YES C/3 NO DATE
UUNSERVATION 1y1 CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. I[ I[ ]C ] DATE I (J-ru f r
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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Co to i t ' F i rk';`Depa r tmen t
64 High Street, Cotuit
4.28-2210
FDTD No. 01921 Date: . . .
PERMIT FOR REMOVAL OF RESIDENTIAL UNDERGROUND FUEL TANK
Permission is hereby given to remove and transport a,n underground
fuel oil tank from the property ;described below:
Location of property:
Owner of record: Me.
Person/Contractor removing tank: ........._...... r1_i. _._.lf?►i_ .......... � .. .....__.
Address:
Dig Safe No. (If applicable) _..... "1.1...�....•��....._'....27.4.:. ...... Start Date
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Notice. All work shall be performed in accordance with applicable
recgulati ns/restrrictions. Ttle...._ _x.c,a.v.a.t;.�.41.i�....._�►?.��......�_�..t?4c....._mt�_ .:�..«..1��....._�_!�,s.pe.c.ed
!py..._g�_._fire...department rep Jq_ta_t. _v.gbac.kf._?..l..l . rr�l. removal .
I, (Fire Department Use4 Only)
i TANK INFORMATION
Size [ ] 275 C ] , 330 (; ] 500 1000 Other' ...... ._._._..._._. _. .
.. ---
Type 3 eel ( ll ? ra: h .rw. . c ..).... ....«_..... Age �Cj_#_.. Unknown C
'ward of Health Tag No. ..4.&_3.._...... Tag No. Unavailable or Not Issued C )
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INSPEr�TION,if1ENIOVALdFORMATIOr!
Contents of tank.-. V Empty C ] Disposed of by: ...... .:.........._....
_.._.__..__._.____._.
Inspection of t�ink: C o defects C ] Evidence of damage fourfLd
Inspection of excavation: r t;/No contamination Con' t.amination found
If contamination. found, . repented to: C Board of Health C ] D. E.Q. E.
Tank transported to:
.:.:. ..__.._..._.. ............_..._......... .._.... ....__.........
Inspectors Commer�i s: 1`�.d..Q.,..._....._� :..C ___ .f ._._..." ..A..�U...d , ... ?. 1.. ,.,
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KAPaul A. Frazier -
Head of Fire Department~ Impectar-
All copies of this forrr14111 be distributed following inspection .
Whig - Contractor / Tank Yard YeEi.c�w - F . D . Fink 9�Sard of Health