HomeMy WebLinkAbout1328 OLD POST ROAD (CT & MM) - Health os�� L�wz-
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TOWN OF BARNSTABLE
LOCATIONc} t _� QC �r SEWAGE# Jot 0
VILLAGE ff q1 f ,f4joLLPASSESSOR'S MAP&PARCEL -7—p►FJ-- �
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) _&a! ice•C3 kJ,
NO.OF BEDROOMS �-�),
OWNER p-
PERMIT DATE: ,•mil-t! COMPLIANCE DATE: 0 7
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 Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
rigc O r 4:tb Li i=
,2g Q.l.� ol� l�u• 3 � �- i 37 P e
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CEE,TfERVILLE-OSTERVILLE-MARSTOi3S MILLS
FIRE DISTRICT
1875 ROUTE 28
CEEITERVILLEt MA 02632
(508) 790-23801FAXCI(508) 790-2385
OIL/HAZARDOUS MATERIAL RELEASE FORM
LOCATION:
ADDRESS OF RELEASE: /'ewter
,„1 t t S'
DATE OF RELEASE: _ ?
PRODLICT RELEASED:
ESTIMATED QUANTITY::; ,A.4 �5
CORRECTIVE ACTION TAKEN 13Y RESOONS IBLE P ARTY: r_X.p A4,% 10 ^ ;
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NOTIFICATIONS:
FIRE DEPARTMENT: YES(, } NO( } DATE• -` 2-TIME: LQ 44
NATIONAL RESPONSE CENTER YES( } NO( ) DATE: TIME:
DEFT.OF ENVIRONMENTAL PROTECTION YES(PK_ NO( ) DATE: 4TIME: lJ ;y )}?0 7t�
O!L SPILL COORDINATOR: YES( ) NO( ) DATE TIME:
TOWN BOARD OF HEALTH: YES(c ) NO( } D ATE: ; F'�T IME: 6,-`rT,>.
TOWN HARBORMASTER: YES( ) NO( ) DATE: TIME:
OTHER AGENCIES / q
COMMENTS: e�►-yA 1 i_ --4 cc ;:44 �� I t — --►�-aYi—�i �?vy—��++ —�rsx-ivsj
i i ie a r!c i Tl t i�e i�"' f 4 i !�"yi[r err--•j'��'F`-F1e �T--s�c�i�r��'
max!l Y tta; =pf e`t v r rrto:3 lava':it;—(9f-i+t;;;*-Oe"r :[l Ae�"� rest-r
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r_r ry"`ds _t_" i r7 e e 7-r �`e� 1` s��t�i tr�"" r r�•�a4 l+�xf 4'4'e�`I
s"o It fe f i'i e^aw es e r A r s 0l 1.i;l 6•.t l t+t v rid 4
REPORTED BY �`,ram- 7 �ja _r ►`SATE - -
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WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PIW COPY-BOARD OF HEALTH
C-O-MM FORM #58
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