HomeMy WebLinkAboutPermit for Storage Tank - Permits - 1 MASSACHUSETTS AVENUE 6/21/1988 U tT sr a" "s
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1 IRE: DEV°f• "'TA]'F USE ONLY2 ri�rt�ic�itaa
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OC1y FIRE' 1 C \111ry"A 4
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s`utlfkatn Is rrirrd IY�rderal fast/furl underground frill yrEhwla\r Irrel r � gr a' f u � � `t `r m a, '��
t ,l �; f l sis t
lil,linc taululcs Inc ludttr Ithvtua lmt,l m ilocd rl++del the dal oral ll,l, f
R r 4, I i 1 p }�, it (��,
used lu stare reputaled substance,since Jarluar} 1,1974,flip[are In Ills groond as of I'rpelnle S;ociv Are it 196K.au Ihr I Iitnodoo,I nluld I'tla Inac k,,oety cAcl of 11) of
NIA)9,1996,rrr that Are broup ht(nto"se after NIAN 9,1986.7 for iador mn6icnt rellucsteal sv h1.11 1,sin lutes,laic'I+il,rlinc Lli LIIly le' ohtol under Slcltc I'mv. 1
1%required by Section 4002 of the tte:source C osisrn"aliort and Iaecovery Acl,tN HA 1, S,,ult,lrr nupoundlals nt,.pu,,hunch.oI klpotnr,:
#%Amended. 6,stol at m illc l nc ss,r,tr%Viatcl r„Olt.rtu,n
The primery�urpose of Ihi,nor if Ica tIon fnopt;un in tit locale and ctahroc antler ' 7:Ilo%v-Ihnlugh Is,Ocev%tiutks.
yrouod rank« Itlat sloic or hasc ,too-d petroleum Of hilratllou,suh,trnce, it i, R.liciuitlltisl„an,I,.occarrdfaathrlfile low,dnrcllllel;oeli Ill od tit
Na,q,ll lua'tlw,nrrrYd
rspeLaed that the Inforinotion Mitt lul\Idt' %sill he based On tva,onahh Itilll;lhlt' Irllh4'11111+t5I14'ii1r61111,;
it-cord.,ar,In the ab,enL:e Of Nocil records,Vlllir klumictive,heliel,llr rccollel"tlnn. 9, ,tolilve lank% ,Ilu'llclf In ;Ill Iltldt"ip olvid illea (,ut'h it, ,1 i1�I,enit'Itt, l'eiI.II.
'hn bloc! NOW)? ticrticnl ')f)(l2 of lt('ItA, it, amended, rtyuys u lhal. ullh.s nsineu,ulkinh,,alnli,%bids,oa Itillo" 1 fl 1i Ihr,lorafx hulk ls,ou:ucd ulu,o of altovr Iltl'
,tnhoc of rite 11oau
cwnipted.owners of undcip ound Caulks that dote levulalvd substance,nnust nolift ,
dcsiynalyd State or locili ilgcrik.iv,of the esi.iencc of 0161 Yanks. Miler nlcalls Whal Suhslaners Are ('cloned". I he nottlualltut Iceluuenac'nts ap(,iy to under•
fill in the case of;ill onde'Igiound slorage lank in use nil h.'oyeInhcr N. 198-1. or hound sloroix looks that coluanl rrftuliatrd,tAh1t:IM:V1 lilt,ule'laldr,,nt� .tih,lane'e'
broorlo into use after that d oc.ant per,on µ ho nun,an undcrl'roond,lolgc lank dclincd it, hivardous ill ,c(tloo 101 (LW of the C'oluprrhrtt,ivc I'm ito ollental
used for the,iurgt,use.or dt per».inp.of icpulated whsl�utrc.,fond ltv pones.C onlpcn,ation and I,lahitos Act tit 19hal1C`F12('I.A)..%%lilt ncc ewe7wnn of
(il) in the case of ans undetpround stonlgc lanl. in use beime Nownnccr R, 1984, lhosc,ufl,lancc, rcf;ulalc'd it, hanudnu,wa,te under Suholle•C of IWIl A. It also
bur no lorilm Ino c onihao dale.ulli person 1%ho o%%]left such lint,lltnlcdlall'h hL'lore lac°ludc',pot ole'ion,e`.V.el It&oil tit am flilclion tho Col\\filch 1,liquid at%lalld,ild
the diwomintuoion of its use, condition,of tcntperiotuo•and plc„urc(f,4)dep vvs flthictihcit and 14.7 pounmh f,cr
4b hat Tanks Air lociudrd? Undcgkio rid .iom gt noel; is dclincd its am one of squalc inc1;ah,uhne).
combination of tanks that(I)is used to conlain an aceumal lilt lot)of"Icgr h,ml suh- Where 'ill NotifO Cooupictcd noti a Mion forms shnutd lie scot to tilt/ addle.,
stalYcc,,"and(2)s%ho,c v Monte(inc`lu(finf,Connected underground piping)is 10,i or given ill the tap of t1li,pdpc.
more hcncathIhegiourid,Some exa Ill
presarcu ode IgiIIundtank>storinp:1.}'avofIItc.
uscd oil.ordicwllueL;rnd2.industrialsuhcnls,pc,(iodcs,hcrbicidcs orfulruhimf,. \)tell IoNolifl,? 1,O%%Itcr,ofuudrtglound,lot-ge lank,intr,c lit[)lilt flaw bl":
What Tanks Are Lxcluded? Tanl.s rcmoveel flown the gloonci are not subject sal lulus nui of opcialion allcl ,lanum I, 197.1.d>ul wif to Ihr plound.tilust nolill is
notification.0ihcr taank%excluded from notification;ire: htav K i+ i 2.(7%v net,%vho blinp rntdclplound slolgi—lank,info u,c alter hhv x,
I.farm or residential tanks oft.100polion%or less calrl6h itself for Mutiny motor Ind 198ii6nlostnotilywnlo11alldal,ofhrnlattnaaihesulks Into u•c
for noncornincr'cirl porposcs' Penalties: Any ostler who krtuwingl� fail%tl nsoifr or stltrrnifs false iilfurrrrallcln
2.tanke t Cd nllN: s9urlrlghcdtioif Oil l+irCulasunlfllivcu,y'r+ntileplcnli%e,v%Itcrc,,rotvd: shall he subject to a visit prnalll' not to tweed 110,000 for rash tank for which
1 %epos t Inks nolifivedon is not ghen or for sihfch fal%c inturmaflon is suhulitted.
M�jr•&o',pG,'"�" :, i. '✓� d' m� 11°, 1: ,N",y^,,�;. "�/ �n�w.,�' }�''"^, �p ?"5,; ',. p,�r '. "/G^'14,V", ✓+p, ,�,, r.:. :+s; �rvri ^r ,�.z, -,;� ,,....6+, ,'�. I ��.d��ix� k�✓'":�L-rmi�� ."�wu`YreAda:.r,>r"� .i
ac,"
('lease ty'lrc or print in flak all itcrlix excel""4i�n;aturL:"in`�iCcviorl V.This forlaa triplet b) cornpleled for lntlic,ln�ntnaltx'r ol"
each lrrc ation collinfrahag tilldergrourlrl slorARC Issnks.If more than 5 lank%arc ow fled al lhis location, � ctlntinriltioll shecis
�n
photocopy tiae rC\4rtiC StClt r � 1 and tit fie ctmurau aeon shcus to likes fo€ttl
�m
� Ph + a r i^r a Y`rr, r ✓nbm a #" aYw r� w mr �,� ,'�
na lm4mvl�
Owner Name(Corporation,Individual.Public A000cy,or Othor Entity)
.Sire r..
(1f same as Sectiora I,mark tacYx hire
.°�"al�t,�e��-��.RU"y-�-_.—�-----•----..--�.----------..--_-_..______ Facility h�fam<l or Canataany Site Ccientitier,as afrplicabie
.1-3 MASS AVENUE�___ea____ _ MERRIMACi; VALLEY OIl_ CO, g
C oust StrceC Address or State f nrsi,its applicable '�� _..___
ES SE ( 1 -3 MASS, AVC:N�IE
Gil Slale 7_If,Code Counly
Nobi ANDOVER PEA 01845
EX
k �( �.._____ ___... _..._, ._. _....
Area Co do fshotic 1Jurnbc;r ......__.,..._.,_._____
E717`- _ _ E33 31:I1 C:i ncare; la to
URTlI:;C�HOVER �13 `pie
Type of Owner (Mark all that uppl y W)
ElCurrent State or Local Gov't Private or Indicate --
Mark b<!x here it tank s)
Corporate �
Federal Gov't number of are 10CAtted on land within
E-] Former (C�°fw fa � Ownership I<anks at this (y " an Indian leservalion or El
cifily I.D no, uncertain location --- ���JJJ on othrI Indian trust Iands
a !I � aa. "14" "
h a m ��
r' & d t tvhls Y oc r r® l,°, ,° Li " ° axr45la
Name(If caane as Section I,mark box here 0 I Job T itle Aren CtYclo t'laorae Numtrer
4JIILLIA7fi D. O f3FZIEN q �e 517 • 683-3131
1,Icy as at ,ell ", dos �, s na 1,",.i.1,� r� Y o r ar eve? u`"°" °tit??m6`. t''l ','*'rr°"' mU s nr r,'
s r�
a °°l. ��,. r k x qq �tl __ryry r 1," �aq #rp�m r: ry;, ,l�zI
,>P .b a.m..mma""a.J�¢:dl. y.„dI4 ,w,. r �. � 'Y f.$Oo� W I""�'11 r. 'm;.L�"nit��,�.Y
-t, r r^� � � u� �.',l lS tC)f atiQn.
Mark box hater;only if this is an amcrlc,ed or subsc c uc nt nofahcation for th
-�e 1 ^ r w^s^. m�.r a5 s;m&'u :w ,,. �dimh7.�, :�a�it .vra�nIa rd"'�mLe rmsr^"3°Ma"�:nurdwfMrv�,mi��r�%,irVYc..Ed ` M :w "w��
I certify under ponally of law that I have personally e xarnincd and earn familiar with the information sub II)itted in this and all fattfatched
documents,and Ihaat based on nay in(autry of tfao,,a indiVOWIIS iralmediaitoly r(,sl)onsible(of'obtainino the infornaaatiora, I believe that tho
submitted inforfrl.'llion is true,aCcurfalo,and Cornplete.
me ro Ir to o fi sal lal <� r ownc,r s Itulhcxire d Iciprr ,tirllative c,ir2 �
G ° f nwnr r o f DateSuint:'d
WIltIAM D. O CRTEN
a v tfrl ill fixa„-l"'pi lT`7p r Yu sy q�
,rij,r,er�' o' ,,.'.fG�t� l✓„t��ii,�r' aW""ld,r"q",'Y h 4 „�",,,t' ;Mt i+�,�'gf'�4"�,�r ;NPPMri rp f:t$ '� l� �. a'""�l "''' ,S,'l "P'W, rk '", fr,�%^q';r�ia';"ray
PATOB REALTY TRUST '1 -3 MASS. AVE,
Ownor fdbtne(from Section t) _ — __- Location(from suction 11) -��1 � �[3� - Paga Cdn,,-______of. Palos
+n
s t•�fiL��+3 �'�4 �.� .� 9�' .fit "�" �
��.[YYS°el:'� 'k»•�is'«�5.�-'�.Jk.�`Ca�L::..:.:...X.L.�.i.-' J_;,..,,.,i.."7.�.'—�iw. k�`�.�7��,3 ��' }�¢-�w�y.C� ����x..a.-.,.i�L ' ,�,�"" r .5 � �3'" � di� _r�,p�.
Tank Identification No. (e.g..ADC-123),or Tank No. Tank No. Tank No. Tank No.� V Tarlk No
t�rbitrarify Assigned SegUenllial Number(e.g.,`I,2,3...) 2 -� 3 4 �
1 t.Stelae of Tank ._
r Mark all that apply 1 Currently in Use (_� C ] [_�{_ 3C- �-
l f p Y -1 1 Tempowl oy()(it of Use
Perrrrint'nlly Oul of Usc
E3rncrghI into Use after 5 8/8f, [ ��
' E slrmaled Ago r
(Ytsnrs) --
—_. - .s � ors , l)-Yrs . fjL r fJ_ Yrs .
3 Estirty7led'fol i Capacity Gallons --
14.Material oiConstiuction
(?4ar*Ono 0)
Concrete
3�ii,t�ryl,ts5 f3t�iftlorcrxf i'faslic �-��] L_� C� � (_� �—J
3 Unknown C--] C..:.�
9 01her,Please Specify
1 Internal f rolec:tion _
(Ma(ls all that applyT) Cathodic Protection
nlerlor I.Joing (e.g.,epoxy resins)
i None
UnknownC_A ]
I Other,PleaseSpocify ---
r fi,External Protection ��----
r c arhodic Protection
( (mark all that applypa)
{tinted ((:.g.,;,sf>halt'sc) CMS [. L—K] CC C J
? Fiberglass Reinlorced Plastic:Coated r=
1 NoneUnknown
Other, Please Specify
� }'.Piping --._--_-- _ __----- E3are Steel � ----- ___-----_ _�-� —_.--�—_— `�- ---
(Alafk all th)t apply M) __1
k GSrlvaniLed Steel
Fiberglass Reinforced Plastic
CalhOdically Protected E A
Unknown L C-]
i
I Other, Please Specify
a.Subsi ruse Currently or fast Stored Empty
In Greatesl Qcbrrrtdly key Volume r-- E: [— C__ -_J
t b. Petroleum
(A9ark all that apply[u)
j Diesel
Kerosene
Gasoline(inCluding alcohol blends)
i Used Oil
othor,Please Specify 112 Cui7T] Oiift?_ �ie�(] 011 #2 t("aeT Oi #2 �elJ 017#2 �ue� Di
c, Naxardous Substance -
3
011
F'Icasc� lndirale Nanr��t�f Princifral CEw13Cf_.il Sul,;lance -----_-- _ _ ._.�-__—_-� ___ y
Chemical Abstract Service (CAB)No.
Mark box Ul if tank stores a rn€xtute of substances
d. Unknown
9.Additional Information (for larks permaneritly
E taken t7rrt of service)
a. FstrnralVd
j ta. Sritia�tt'c)ctri,lnrilycif str1,5t< o r.remaining (q;tl )
1
c. F. ark box lh if tank was Iil It,cf v;ill, inert material
Pa t,z
1 -3 Mass . Ave.
-T2
► L3
�WE
Tank Identification No.((�.q,,ABC-123),or Tank No, 'I"Ink No, Tank No. Tame No. Tank No.
Arbitrarily Assignee{Stquential NUMbef
�'I.Status of Tank
(Mari,oil that apply w)
Currently in Use
Temp,,)ttrsly C)Ijt 01 Ilse
i'M118flV1111Y Out Of Use
Brougfit into)Use rifler 518/86
Estimai t cd A 94 (Years}
at Capacity(Gallons)
j,rAatorial of Cons ruction
(hfj A anth Vj
Concreto
Fiberglass Reinforced Plastic
Unknown E-—D
Other,Please Specify
Infamal Prolecuon Cathodic Prolection
(hijA all that apply t1o)
Interior Lining (c q.,epoxy icsills)
None
Unknowrl
Other,Please Specify
ExlemN Protection Cathcxfic Protection
(Polo t*all that&Pj4Y 10)
Painted fe 9.,asphalft)
Fiberglass I lomforced Plastic Coated
Nono
Unknown
001pr.Plotl�o Specify
y..__.___�7 --�-��--•-- (�_� � r......_-_]�—'w �Cw.�
(ma A all thh t apply W) Pare Steel
Galvarlizod SWO1 F=j
Fiberglass Reinforced Plastic
CalhNfically Protected
Unknown
Other,Please Spocify
suh,5tance curreotty of Last Stowd Z� Emply
fn Greatest Ou-anUly by Volume
b. Nlro"rn
Diesel
Keroseno
Gasoline(including alcohol blands)
Used oil
Other,Pleaso Specify
subst.-unce
I
i"lease Indicate Name of Principal CIELROLA Substance
OR
Chernica I Abstract Soivico(CAS)No.
MIfk 00X 03 it 1,L(1k stem";a MAILWOf substances
d. Unknown
AdLfliional Information (for tanks periunneritly
taken oral of service)
a. FslmwilM date la-sl usod (iw/yr)
c. Mar X box 13 if lank w,)s fair it arl material
.-oncrete)
r� vf A"Bax*wttg
DEPARTMENT OF PUBLIC -SAFETY—DIVISION OF FIRE PREVENTION
APPLICAT14)N FOR PERMIT TO MAINTAIN AN EXISTING/NEW UNDERGROUND
STORAGE FACILITY
` To: Head of Fire Department
North Andover 6-21-88 19
City or Town Date
J
Application is hereby made for a permit to maintain an existing/new
underground storage facility as required by 527CMR9.00: Permits.
r Location of property: 1-3 Mass. Avenue (MVO
I Street address
Owner of property: Patob Realty Trust
Full name of person, firm or corporation
Signature of owner or authorized representative:
Fee:$ 10. 00 (M.G.L.A. Chapt. 148 Sec. 10A)
(Fire Department's Copy to be Filed with F.P.290 part 2)
Form F.P. 290
Part.4
DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION
PERMIT June 21 1.9 88
Date
i' TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY
In accordance with the provisions of 527CMR9.24 this permit to maintain an
existing/new underground storage facility is granted to:
Location of property: 1-3 Mass . Avenue (MVO.)
street address
Owner of property: Patob Realtv Trust
Full name of person, firm or corporation
Restrictions: must be renewed annually
Fee Paid:$ 10. 00 (M.G.L.A. Chapt. 148 Sec. i0A)
Form F.P. 290
Part This permit will expire 6-21 19 89
Date Slgnatm of dead of Fire Dept. or appointed designee
(Owner's Cogv to be posted at the storage facility with F.P.290 Part 3)