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Home My WebLink About0174 ROBBINS STREET - Health Icy ✓lo5b;,,z �F , o�P 7 CE JTER+VILLE-OSTERVILLE-MARSTOOS MILLS • FIRE DISTRICT 1875 ROUTE 28 CEFITERVILLE, MA 02632 (508) 790-2380/F AX C(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A.# LOCATION: ADDRESS OF RELEASE: RA SAM PnTNT RQA'n n.qTFRVTLT.F_ MA_ n?6%s DATE OF RELEASE I""MORN PRODUCT RELEASED• 09 rim- nTT_ ESTIMATED QUANTITY- ,nmmnm CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY- NOTIFICATIONS: FIRE DEPARTMENT: YES( NO( ) DATE: 949406 TIME• J A M NATIONAL RESPONSE CENTER YES( ) NO(o DATE:-TIME- DEPT.OF ENVIRONMENTAL PROTECTION YES( ) NO(X�, DATE: TIME 0IL SPILL COORDINATOR: YES( ) NOf DATE TIME: TOWN BOARD OF HEALTH: YES(A NO( ) DATE: S/R/Q�T HIE: IAAn TOWN HARBORMASTER: YES( ) NOS) DATE: TIME: OTHER AGENCIES: COMMENTS: COPY OF FIRE REPORT ENCLOSE I REPORTED BY �� '/°-• F� D ATE: S/g/A6 WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH C-O-MM FORM #58 CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DEPARTMENT INCIDENT REPORT Type of Call: /AI1/1�-5 10A✓ Alarm No: ?6-F-03/!F Brief Narrative Required on all Calls (�i/JT Date: Location: S�( a PROCEEDED TO THIS LOCATION TO CHECK ON n SkY�� .S� ��,1� Called by: 116S'P. iA�J[..rG Tel # y28-3-72--7 R.ES , SECOND TIGHTNESS TEST BEING PERFORMED BY 14 bS 2zS - MIKE'S PETROLEUM. ON LOCATION, I SPOKE TO Time rec'd 1f31 On Air: q�k IOn Location: KEVIN FROM RIEDELL PLUMBING & HEATING WHO Weather: Cc..oJ1Y Temp: .57 Wind:. -fie At: S STATED THEY FOUND A FITTING IN THE OIL LINE Zone 2-7!, THAT HAD FAILED, WHICH WAS PROBABLY THE CAUSE OF THE TEST FAILURE. HE HAD REPAIRED Buildings -Type of Occupancy: THE PROBLEM THIS MORNING. MIKE'S PETROLEUM Owner: Address: HAD JUST STARTED TEST ON MY ARRIVAL. Tenant: Telephone # KEVIN POINTED OUT THE FUEL LINES THAT HAD Equipment/Type: _ Location: BEEN REPLACED. THEY ARE BOTH LOCATED IN A Year: Make: Model: 3" PLASTIC PIPE, WHICH WAS INSTALLED WITH Serial No. THE TANK APPROXIMATELY 10 YEARS AGO. HE STATED THE FUEL THAT LEAKED WAS CONTAINED IN THE PIPE Motor Vehicle -Year: Make/Model: HE PUMPED APPROXIMATELY 5 GALLONS OF OIL OUT Color: —VIN: Reg. #: OF THE PIPE PRIOR TO LINE REPAIR. Owner: Address: I ASKED THE EXTENT OF CONTAMINATION, AND HE. Operator: Address: DIDN'T SEEM TO KNOW.STATING OTHER PEOPLE WERE RESPONSIBLE FOR THAT. I THEN ASKED Brush Fire-Class: Area/size: WHERE THE CONTAMINATED SOIL IS, AND HE DIDN'T SEEM TO KNOW. AT THIS POINT, I NOTIFIED THE TOWN HEALTH Automatic Alarms- Classification/Code: DEPARTMENT TO EVALUATE THE SOIL AROUND'THE Form#62 left at: EXCAVATION BEACAUSE I DIDN'T FEEL COMFORT— ; ABLE WITH SITUATION AT THIS TIME, I CLEARED Other Agencies Notified THE SCENE. Name/Agency Te/e. No. By Reported by: C� C-O-MM Form#19A Date: i No. ! .... Fns..: ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F H E;ALTH d1/L----------------OF........ . ..4 44—4& ........................ Appliratiuu -fur 43itipuitt1 Workii Tutudrurtiuu Vantit Application is hereby made for a Permit to Construct ( l�) or Repair ( ) an Individual Sewage Disposal System at �y �J - L ati •AddYess or Lot No. L .............. ..........•-•-- . -------- -------- Own r Address W . I staller Address Q Type of Building/ ,/ Size Lot-./.,3, I__2.S....Sq. feet U Dwelling No. of Bedrooms-------------/�._.-------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) PaOther fixtures ...................................................... �` W Design Flow_________________ U---------------gallons per person per day. Total daily flow______________=L...............gallons. WSeptic Tank Liquid capacity -gallons Length................ Width................ Diameter---------------- Depth_..__.__._.... x Disposal Trench—No- -------------------- Width----- _� otal engtl __--_ .__ Total leaching area--------------------sq. ft. J 13 p w � . Total leaching area -- .---_- SeepagePit No....... ............ Diameter. ......... . _ e t o met_..__..__ .._.__._ . � � Esc. It. Z Other Distribution box (PI) Dosing tank ( -� . " ` aPercolation Test Results Performed by..................... _'._. .. .: td....... Dae .. Test Pit No. 1----------------minutes per inch Depth of "lest Pit.................... Depth to ground water-----------.._-.-..----- L%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ a' --------------------------------- ---------- - ------------ -- --•---••----------------------------------------------------------- O Description of-Soil------------------------------------ -- ----�`�"-� V --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article XI. of-the State Sanitary Code—The undersigned further agrees.not to place the system in operation until'a Certificate of Compliance has been i ed by the and of>ak gned. . .. ---- -- --------------- ---- .S J_ Date Application Approved By...... --- -- Z Date Application Disapproved for the following reasons:............. ........ � -•------ •------ ----------- ---•- ------ ------------------------------------- Date Permit No. ---........................ issued.......................................................... Date -- .. - - ------------------------- ---- -A Fa a... ................. No. -••.............. THE COMMONWEALTH OF MASSACHUSETTS 'RA''R D F H LT H OF...in .... ........... .. ... .. ....-. ,� gtrtt#tun -for Uiiipuitt1 Workii Towitrurtiun Permit f.` Application is hereby made for a Permit to Construct ( Y) or Repair ( ) an Individual Sewage Disposal Z. Syst at T s: . _. _ ..... .i A�.d�te�s,s,j or'Lot No40t` -- �. ec ieE• . ^ •. ....-_--•... ......................... ...- ------ `4, _d� Owner Address a . ... ................. + Installer Address Q Type of Buildi Size Lot_14__A__2,$.....Sq. feet . j U Dwelling No. of Bedrooms,-__ ..... ..........................Expansion Attic ( ) Garbage Grinder ( ) aOther_=Type of,;Building -_--'______________________ No. of persons---------------------------- Showers ( ' ) — Cafeteria ( ) p' Other fixtures Q ---------------- --------------•---•. -- ------. ------------. r __ W Design Flow;}_....------•-_-i t._..�: _____.... gallons per person per day. Total daily flow---------------- -��_.__.--- -..gallons. WSeptic Tank 1—Liquid c�citv&_gallons Length________________ Width..-_-- - ._.- Diameter_-__-. ` Depth_. .__.-_... . x Disposal Trench—No .................... Width,....y._______/� T�,oetal�en tl Total leachingarea......... Seepage.Pit No-------�--------- Diameter..�;'t±-�yQ�` eU pta�b�io in a ......� otal leaching tre.l:_ _�sq. ft. z Other Distribution box (A,) Dosing tank ( ,�p • a Percolation Tesb Results Performed by_______ ____ ______ .f--C. _ t------- Date!r... j � � a Test Pit No. 1................minutes-per inch Depth,of'Test Pit............_....... Depth to ground water-------.-__--_.__�---- (Tq Test Pit No. 2................minutes per inch Depth,.pf Test Pit._-:___............... Depth to ground water,_.___._____:_:__'__.... - =--•------ •-- DDescription of Soil--------- - ----------------------- / - --- _----- -------------------- --. --------------- V -----------------------------------------------------------=----------------------------------------------------------------------•---------•--------------------------------------------------------- W ------------------------- ------------- -------------------------------------------------------------------------------------:---------------------- ------------------------------ ------ 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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been t ed by the and of i. r r gned..- ---------•• ------ - t;Y/�: ........ --------------•-- �� Date Application Appro•v„ed 1. yBY e r Application Disapproved for the following reasons:-•-•--------------••------ ---- - •--•----------••---•-•=r----•-•-•-------•-•.......................... --•----------------•-•---•------------------ ,..----------------------------------------------------------------------------------------------- """ - Date PermitNo......................................................... Issued............................ .......................... Date THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH ,gam :..............:.............................. Ter:.,d g #r of blunt littnre �- T I I TO IFY, That the Individual Sewage Disposal System constructed ( ) or Repaii-4.,( ) by ' P {ad , �------- has been installed in accordance with the provlslon of Article XI of Th State Sanitary ode ;Sde cribe m the .; application for Disposal Works Construction Perm No._______ _ dated_ _.-.� �ALL,T IE ISSUANCE OF THIS CERTIFICATE` NOT BE CONSTR ED AS A G ARA TEE THAT T'AE SYSTEM WjLi. F,,U, TION SATISFACTORY. DATE- ; .. L .. ---.7 ......; Inspector . ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH _ ) .....O F..... F EE -�- ..................................................1 No.e _--•......... •t hi� l<ttd u k� IT ��rnriu$trruti w Permission 's hereby granted_`.'c = to Constr t he Rep ( ) n IIdividualc Dispo` tem at No.- ----- . ... ----------------------- ... ✓ et . f :.. as shown on the application for Disposal Works Construction it ______________ Dated------------------------------------------ - 1 i --- . - Board of Heal]jf ~ 1X DATE �,� /;/7--------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I . i�