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HomeMy WebLinkAbout0102 BRIDGE STREET - Health (2) ai102,Brid 'e' Str eet Osterville D 05-05-1998 02:01PM CENT OST FIREDEPT 5087902385 P.02 rr••�•--•�.• •� .v ai 1 11c"JOI u11CIit. `» Fire Department retains original application and issues duplicate as Permit. 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: • Tank Owner Name(please print) �Y Vt G Q t,l 4rtx — 8•,z p,.,, Address 0 to a R 1 . Q S}�, QY� mMit r, stare Tjp • • • Company Name Envi ro-Safe Co.or Individual PMt P.O.'BOX 810, E..Sandwich, MA Address Address Plmr roll UZb Sig (it ap Ying for permi Signature(if applying for permit) G. FCl Certified Other 0 1FC1 Certified O LS P # Other . 1 Jill Tank Location toz ��i r� G S' .o„�-t tom ; 16 NA St raddmsaA City Tank Capacity(gallons) 0L`_ Substance Last Stored _ Z. D r Tank Dimensions(diameter x length) Remarks: Firm transporting waste Envi ro=Safe State Lic.# 329 MA Hazardous waste manifest# O `4$ _E.P.A. # MAD 985269323 Approved tank disposal yard Turner Salvage Tankyard# 002 Type of inert gas Tankyardaddress 235 Commercial Street Lynn, MA. City or Town Osterville FDID# 01920 Permit# Date of issue May 1, '1998 Date of expiration_ May 15, 1998 Dig safe approval-number. 98 80600 D' afe T Free Tel.. rt�ber- 0.322-4844 Signature/Title of Officer granting permit After removal(s)send Form FP-29OR signed by Local Fire DepL to UST Regulatory Compfiice Unit,One Ashburton Place, Room 1310,Boston', MA 02108.161S. =P-292(r4vsed 9196) TOTAL P.02 TOWN OF BARNSTABLE LOCATION 'p,2, L%jf,- f f EWAGE # VILLAGE 2V[(.[ ASSESSOR'S MAP & LOT 1 16 601 0 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 000 Gj¢�(� LEACHING FACILITY:(type) w43 i4-v o 51-oiLIC (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER + BUILDER OR OWNER fiKaJ 5 iA ( A1474I0 Qgin DATE PERMIT ISSUED: [`l w�) DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 'snit f �q 44A �o 2� f — - - I f THE COMMONWEALTH OF MASSACHUSVTTS BOARD (� HEALTH WA.................OF.......... 7 6.L-G.......................... \X Appliration for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct or Repair (� an Individual Sewage Disposal stem at:-I&, 9V........................... ............. ................................. L tion-Address or Lot No. ......................... .......... .......�. .......................................— ... Owner Address ........... .......... Installer Address Type of Building Size Lot..13:�R'51.Sq. feet U ...3.......................Expansion Attic ( )Dwelling—No. of Bedrooms.............. Garbage Grinder (W) '4 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ....................................................................................................................................................... Design Flow.................S<.:... gallons per person per day. Total daily flow......................'33,0.........gallons. WSeptic Tank—Liquid capacity gallons Length................ Width.......e._..... Diameter..._......_..... Depth.._............. Disposal Trench—No. .................... Width....11 ........ Total Length..... 24..... Total leaching area_.34aa...sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box Dosing tank ( Percolation Test Results Performed by. V.61Z_.f".AY..ff....... ..1�6..e6 Date... .............. Test Pit No. I.....7?n-=.minutes per inch Depth of Test Pit.................... Depth to ground water....A.d.......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..........."'"".......................*...*....*....................*­.....*---**......­ 0 Description of Soil................. ........................S............................................................................................................... .......... ....... 1;.................................................................................................... ----------------**-------,------- ........................................................................................................................................................................................................ 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 TAIT4 U 5 of the State Sanitary Code— TV undersi ed 4furthe rees not to place the system in led 0 f operation until a Certificate of Compliance has/been is t e boa d of health.e ................ Sigte ...1Zz , .1.. .. . .................. .................... ............................... Date ............... Application Approved By............... ,6ZA,........... ............................................... .....3 _r_vu ............... Date Application Disapproved for the following reasons:...........................................................................................................--- ..................................................................................................................................................................................................... Date PermitNo.................................................. Issued............. ........................................ Date A THE COMMONWEALTH OF MASSACHUSETTS TBOARD QF HEALTH .................OF.......... 0........................... Appliratiun for Disposal Works Tonstrixrtiun rtrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Z � . D..JT..............:................................. -- Ly��ion-Address _ or Lot No. ~ ......2:A,t�1-�=��. .....LC h.l�."z-h h1_P.................. .... ..........�� !-!�5.+�.-•--•. .._..............------........._ ... Owner Address W Installer Address Type of Building Size Lot........r2 .....Sq. feet U Dwelling—No. of Bedrooms..................3.......................Expansion Attic ( ) Garbage Grinder to 'k Other—Type e of Building ............... No. of ersons............................ Showers — Cafeteria a YP g ............. P ( ) ) 04 Other fixtures ........................................................ W Design Flow.................S<.................. per person per day. Total daily flow..................... .........gallons. WSeptic Tank—Liquid capacity1CCO.gaflons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No...................... Width....1 7....._.... Total Length........... Total leaching area..:�.&...sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box (V'� Dosing tank ( ) P6. Percolation Test Results Performed by. K.?L-> :.� `.i ........N.... Date.. .: `1. �Z ............... ,.a Test Pit No. 1.....?r=..minutes per Inch Depth of Test Pit.................... Depth to ground water....�:d........... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+ •---•----•-.......---•••-•------•............................. ............ ---.-...--........................................ _......... O Description of Soil................. -----....----........... �I.Q.yy�s.........` ............................. .. W UNature 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 TI'A1 5 of the State Sanitary Code—T undersigned furthe grees not to place the system in operation until a Certificate of Compliance has been issue he bo d of health. Sigr .......... " ............... ................... .........................._.... Date Application Approved By..............a.- �..u--'` :... ------•-•--.............------••---•--. ----- " -8 ............. Date Application Disapproved for the following reasons:.........................................................................................................•--- ............................•...-•----........................_..---.............._...-------•--••••------.....•--••---•-•-•-----•-------••---•--...................•----------... . .......---.. Date _ PermitNo..................................................._.... Issued......................................................_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........Ol.<UJI ..............OF........V.a. .!.7. c').� �.�' ..........................n.. -- awl rfifiratr Of fauutplianr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by................................................. •.........----••---...--•••-..... --..........--•--••••••--•-•--.......................-•---•-•------•-......------..-------__------_ Iggaller at..................... 'J Z :............ ...... .Q ...._---------••-------.....----------•----.....----•--------------•--.........................----- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code.as described in the application for Disposal Works Construction Permit No......9.• -Zd.)!............... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A UARANTEE THAT THE SYSTEM L FUNCTION SATISFACTORY. DATE.• -. •.. -•....................•--•---•--•----...----.........•......---.. Inspector.... -. ........ :............................................................ THE:COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y .... !.�• ..........OF.. . :�................................ t�✓ NOS Fay... ................. 13isposal Works Tonstrurtiun f rrut t Permission is hereby granted..............................................._ to Construct ( ) or Repair ( kidividual Sewage Disposal S tem 'Y atNo........... ......... ......... : ---...----•-------------------------•------.............--•---........_... Street° as shown on the application for Disposal"Works Construction Permit No............ ....... Dated.......................................... s.. .._..:. ........................................................ DATE................................................................................ Board of Health FORM C-1255 CITY& TOWN FORMS, INC. 369-9708 TOWN OF BARNSTABLE . LOCATION p2. 'l�!� -5—t . 05it-e-v*f _-t--SEWAGE # VILLAGE .(2V(C.e._6 . ASSESSOR'S MAP & LOT 1 G 601 e INSTALLER'S NAME PHONE NO. 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