HomeMy WebLinkAbout0969 SEA VIEW AVENUE - Health ��� � �
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TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE aSDt�9 i/A- ASSESSOR'S MAP &LOT 9�
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 1660
LEACHING FACILITY: (type) / E`SS Xl 66 (size)
NO.OF BEDROOMS
BUILDER OR OWNER. Yr:;,Q
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility, Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching FacifiqV4f any wetlands exist
within 300 feet achinyg aci ) Feet
Furnished by "
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MAY29 "91 t99 CEfJT.t�ST.r IRE
DEPT.'-P.4i4 �.
1. µ -;FORM-FP. 292 -
i (rev. 9190)
r Departmont of Public Safety
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Division of Fire Prevention and Regulation
APp"T" Fk pERWI AM PEAW, FOR RFEMOVAL AND TRMSPORTATION TO APPROVED TANK YARD
FDID#f,. Permit Date__ „��
City,Town or Distdet G f,>1� r f C . $Z S : 40 H . G . R
DIG SAFE DUMBER
Fee Pa id t
start date
In ac'coa;dahae with the provisions of Chapter 140, Sec. 38A, M.G L. ,
527 CMR 9.00 application is hereby made by. k 7-A-
Street Address & city or Town: c-1
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signature of applicantt
Applicants name printed: L
For permission to .remove and transport one underground storage tarok from.
Street Address: uP ..
Firm transporting waste: -State Lao. # - P- �C)
Hazardous waste Minitest # 1✓.1?.A. #
Approved tank yards 1 # L .
'dank yard Address: -
Type of inert gass_ UL tank :
60 Substance last stored:
Tank capaoity: -
If Date of issues tiA-A-,�- Z17 199 'Date .of expiration: e ;� .j
Signature/Title of officer granting permit:
KEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE AS PERMIT
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HAY 29 '91 ,09:10 CENT.O T.FIRE DEPT. " o . - P.5„.1
CENTERVILLE-OSTERVILLE-MARSTONS MILLS
r FIRE DISTRICT
1875 ROUTE 28
Ai CENTERV I LLE,MA. 02632
(508) 790-2380\FAX-V (508) 790LL-2385
OIL/HAZARDOUS MATERIAL RELEASE FORM
F.A 0: ?51
LOCATION:
ADDRESS OF RELEASE 969 Seaview,.Avenue
Osterville, MA. 02655
Cook Residence
DATE OF RELEASE: Unknown
PRODUCT RELEASED: #2 fuel oil
ESTIMATED QUANTITY: Unknown
CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: N ified To Bok:rd of ezl�h
NOTIFICATIONS: 6/2$/9l 1100
FIRE DEPARTMENT: YES4X) 'NO ( ) DATE: __ TIME _, "
NATIONAL RESPONSE CENTER: YES ( ) NO (4 DATE: - TIME; ,
DEPT. OF ENVIRONMENTAL PROTECTION: YES C NO DATE; TIME
OIL SPILL COORDINATOR: YESXX) NO ( DATE: 5/28J915/28/gl TIME: -1100
1100
TOWN BOARD OF HEALTH: YES TX) NO ( ) DATE: � TIME: .
TOWN HARBORMASTER: YES ( ) NO ) DATE: - TIME: _.R —
OTHER AGENCIES:
COMMENTS:. On location of UST removal at above location.Tank removed b Shore-_
line Tank: Services (Osterville) (Size: 1000 allon) .
Product found to be on sides of tank, both ends. Possibly leaked down
from fill pipe and feed lines. No visible si ns of holes in tank.
Contractor tookp preliminary readings of soil with reaclin s u to
34 Rpm. Town Board of Health notified at this time.
REPORT FILED I3Y:r Lt. Glen S. Wilcox DATE: 1ZL21
WHITE COPY-FIRE DEPARTMENT YELLOW COPY- D.E.P. PINK COPY--50ARD OF HEALTH
C.O.M.M, FORM 58 ;
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
'ltiorf ` OWNER AND INSTALLER INFORMATION
ADDRESS: Jit ifT�,f�� MAP NO. t 1C) PARCEL NO.t 1/
OWNER NAME: VILLAGE: °3 -,;��
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INSTALLATION UTE: r>---- '"" BY:
ADDRESS: CERT. NO.
Col v y` A C J TANK INFORMATION
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LOCAT I ON OF TANK:
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CAPACITY TYPES AGE FUEL/CHEMICAL
TESTING CERTIFICATION i I PASS C ] FAIL DATE
LEAK DETECTION CX,CHECK IF N/A T PE/BRAND
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ZONE OF CONTRIBUTION C I YES C N DATE TO BE REMOVED `--.-I
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FIRE DEPT. PERMIT ISSUED C I YES [) NO DATE
CONSERVATION C}(] CHECK IF N/A DATE /
BOARD OF HEALTH TAG NO, ,, C ]C ]C ]C ] DATE 19-
PLEASE PROVIDE A ..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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I 'N � 4 OWNER AND INSTALLER INFORMATION
ADDRESS: %g (""}6 JQ:` MAP NO. 9d CEL NO -
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OWNER NAME: ---- ..._-VILLAGE: �•,, �
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
, TANK INFORMATION
LOCATION OF TANK:
„ CAPACITY TYPE AGE U L/CHEMICAL ^
TESTING CERTIFICATION C I PASS C I FAIL DATE
LEAK DETECTION C�(] CHECK IF N/A TYPE/BRAND
,^
� ZONE OF CONTRIBUTION• C. ] YES L7 NO DATE TO BE REMOVED
FIRE DEPT.;,# PERMIT ISSUED C I YES C ] NO DATE
CONSERVATION L ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. ]C ]C ]C ] DATE
PLEASE PROVIDE A SKETCH. SHOW I,NG THE .TANK. LOCATION ON THE .BACK OF THIS' CARD
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