HomeMy WebLinkAboutTank Permit - Permits - 1 MASSACHUSETTS AVENUE 6/1/1987 • • • • • • • Storage.
3
FIRE DEPT. STATE USE ONLY f{f�RtllFfC3
I.O Number { 1V r
Submit to: c 10
LOCAL FIRE DEPARTMENT gale Received
imENERAL • •
Notification Is required by Federal law for all underground tanks that have been 4. pipeline lacilaics (inc)udutg gathering line,) fcgulated under the -Natural (;a,
used to store regulated substances since January 1.1974,that are in the ground as of Pipeline Sall% Act of 1968.or the Haiardou,l.iquid Pipeline Salcty Act of 1979,of
Ma)8,1986,orfhat are brought Into ustsirler Mayll,1986.The information requested \\hichi%;minlrastale pipeline tacilil\ regulated under Slate taus:
is required by Section 9002ortheRtsourceConservation and RecovergAcl.(RCRA), 5,surlace impoundments.pit%,ponds,oi lagoons:
as amended. 6.storm s\alcr or%aslc\\aler collection%\stems:
1.11ou-through pt'occs,lank%:
l he primary'purpose of this notification l oredln piole tnl o to(naafi'and ub tan a s. It is g,liquid trapsm aNNoenttcd gaathering linesdirec'tly related to oil or gas productioai and
ground links that store or ha\c +toted peernleunt or ha:ardou, substances. It i,
expected that the information you pro\ide tilt be bused on rcasonably a\ailable gatheringoperatiom:
records.or,in the absence of such records.%out knov ledge,belief.or recollection. 9. storage tank, situated in an underground area (such as it bawalcnl. cellar.
Who Must Nolif ? Section 9(x}2 nl RE'ItA,as amended, rctiers th;tl, unless mincs\oiking,drift.shaft.of lunncl)it the storage lank is situated.upon or ahu\e the
y q surface of the lloor.
exempted.owners of underground tanks that.ture regulated substances most nosily
designated State or local agencies of the existence of their tank,. O\\ner mc;tns-- What Substances Are Covered' l he notification requirements apply ut under-
(a) in the case of an underground storage lank in use out S'o%entbcr S. 1984, or ginund,uor.age tanks that contain regulated substances.phis includes an\ suhstance
brout,ht into use aster defined
that date,an\ person Aho ou ns an underground storage tank a, haiardous in scclion 101 (14) of the COT rchen,itc Enlitonmenial
used for the storage.the.or disprnsing of regulated%t&liinces,and Response.�ompen,iation fund Liabilat\Act of 1980(C ERl LA).Aith[he exception it
(b) in the case of any underground storage lank in use before Noscmher 9. 1984. those substances regulated ah h;vardoti,Haste under Subtitle C Lit RC Jt A. It a1,o
but no longer in u,eon that date,an\person%%ho cmnvd wch lank immediately before includes petroleum.e.g.,crude oil or an%fraction thereol a hich is liquid at standard
u the disconntiation of its use. conditions n) tentperatu€e;end pressure(h0 degrees 1 ahrenheit and 14.7 pounds per
What Tanks Arc Included' L nderground ,enrage lank is detincd its any one or %quaic inch ahsolute).
combination of tanks that(l)is used io contain an accumulation of"regulated sub- Where To Nolify' Completed notification forms should he sent w the addics,
stances."and(2)a hose\olume(including connected underground piping)is Ior'i or gisen fit the top at this page.
more bcnemb the ground.Some cxampiesare underground tanks scaring:1,gasoline.
used oil,or diesel fuel.and 2.industriul,olicnts,pesticide+,herbicides or lumiganis. When To Notify? I.�\\ners of underground storage tanks in use or ttru hale axon
What Tanks Are Excluded' Tanks rento\ed Irom the ground arc not subject to taken out ut operutinn alter January I. 1974.but stilt in the ground.must notify fit
notification.other tanks excluded front nutilicalison:ireL lvlav S.19ttb.2.0%;news\oho bring underground,outage Ian):+into u,e aster hfay 9,
1,farm of icsidentialtanks of 1.100 gallons or IC„eapacity used for siorine motor fuel 198ta,must notify within ZOdaysof bringing the tanks into use,
feu noncommercial purposes: Penalties; Any owner who knoviingl►fails to notify or submits false information
2.wriksusedforsturing heating otiforcunsumpmcuscontlicprcnikesl\hcrestored; shall be subjeel to a civil enally not to tNceed$0,000 for each tank for which
1.septic tanks; notifrcallon Is Plot given or for which false information Is submitted,
INSTRUCYI•
Please type or print in ink all items except"signature"in Section V.This form trust by completed for Indicate number of
each localionconlaining µnderground storage tanks.If more than 5lanksare ow rued at this location, continuation sheets
photocopy the reverse side,and staple connnumion sheets to this form. attached
1.OWNERSHIP •FTANK(S)
11.LOCATION :
Owner Name(Co rporalion.Individual,Public Agency,or Other EnliIy) (if same as Section 1,mark box here ❑}
PATOB REALTY TRUST Facility flame or Company Site Identifier,as applicable
Street Address
1-3 MASS. AVE. Merrimack Valley Oil Co.
County Street Address or State Road,as applicable
ESSEX 1 -3 Mass. Ave.
City State ZIP Code County
NORTH ANDOVER MA 01845 Essex
Area Code Phone Number Cit (nearest) St e
617 683-3131 �N to
o. Andover MA � 8
Type of Owner (Mork all that apply®j
1_I
ot-1 Private or Indicate Mark box here if tank s
® Current ❑ State or Local Gov'to
Corporate number of are located on land within f-
❑ Former ❑ Federal Gov't ❑ Ownership tanks at this an Indian reservation or L.J
(GSA facility I.D.no, uncertain location on other Indian trust lands
Name(if same as Section 1,mark box here ❑y Job Title Area Code Phone m er
William D. O'Brien President 617 683P3M l
❑ Mark box here only if this is an amended or subsequent notification for this location.
CERTIFICATIONV. . sign after completing Section VI,)
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
documents,and that Based on my inquiry of those individuals immediately responsible for obtaining the information. I believe that the
submitted information is true,accurate,and complete.
Name and official title of owner or owner's authorized representative ign Ke, • D t ,Sid
William D. O'Brien
.7777
CONTINVE ON REVERSE 61P
Form F.P. 290 Part 2 F'ago i
1-3 -MASS. AVE.
PATOR RFAI TY MIST— Location Irorns lion11 NO. ANDOVER, MA pa eNo. of�! - pe es
Owr►ar Name(from Sacltan t)_. { ) s, 0
r
k Identification No.(e.g.,ABC-123),or Tank No. Tank No. Tank No. Tank No. Tank No.
itrarily Assigned Sequential Number(e.g.,1,2,3...) 1 2 3 4 5
tatus all
Tank Currently in Use ® EM
(Mark all that apply®) Temporarily Out of Use
Permanently Out of Use
Brought into Use after 5/8/86 Q 0 n C]
2.Estimated Age Years 11 Yrs. I I Yrs. 11 Yrs. rs. rs.
3.Estimated Total Ca cll Gallons 20,000 , ,
4.Material of Construction Steel ® ® ® C t
(Mark one®) Concrete
Fiberglass Reinforced Plastic �] 0
Unknown
Other,Please Specify
5.Internal Protection Cathodic Protection
(Mark all that apply )in
terior Lining(e.g.,epoxy resins) 0
None
Unknown [ [�
Other,Please Specify _
6.External Protection Cathodic Protection
(Mark all that apply®) Painted(e,g.,asphaltic) [ [ C
Fiberglass Reinforced Plastic Coated
None
Unknown (� 0
Other,Please Specify
7.pipi; Bare Steel ] [ �D
(#Mark all that apply M) Galvanized Steel
Fiberglass Reinforced Plastic
Calhodically Protected
Unknown �]
Other,Please Specify
8.Substance Currently or Last Stored a. Empty
In Greatest Ouantity by Volume b. petroleum
(Mark all Omf apply®) Diesel
Kerosene
Gasoline(including alcohol blends)
Used Oil
Other,Please Specify #2 Fuel #2 Fuel #2 Fuel #2 Fuel #2 Fuel
c. Hazardous Substance
Please Indicate Name of Principal CERCLA Substance OR
Chemical Abstract Service(CAS)No. T
Mark box IN if tank stores a mixture of substances
d. Unknown
8.Additional Information(for tanks permanently
taken out of service)
a. Estimated date last used (mo/yr)
b. Estimated quantity of substance remaining (gal.)
c. Mark box IN if tank was filled with inert material
(e.g.,sand,concrete) Q ��
Page 2
1 -3 {SASS. AVE.
0,,4,~P am4(Ir=&"lion P) PATOB REALTY „ Lsacutton(Iror�a a�ctlan iq NO. A�1DOVER, MA
a a a a s Imamr
�.
TNik Identifirallon No.(e.g.,ABC-123),or Tank No. Tank No. Took No. 'rank No. Tank No.
4rbliradly Assigned Sequentlal h-0urt bor(e.g..1,2,3... 6 �
1.Status of Tank Currently in Use
(Mark aft that aipplym) "temporarily Out of Use
Permanently Out of Use
1310ughl into Use after 5/8/86
�,Esthnale�l6� a 1`4ar� l^5. 3
3:C�sikr�tecl'lr�t�slCa�ritjl�C�Ilons�� .�����.� y_ -•------ --- �__.. �_______...__W �
4,Moterial of Construction
C LAC E--__� _�
(Mark one X) SW
Concrete CD
Fiberglass Reinforced Plastic CJ C-7 17---J L.__J F=)
Unknown L_-a C ] r..U,. C_ ] _-W. )
Othili Please Specify 3
5. internal Puff action
(Mark ail that apply vu) Cathodic Protection
Interior Lining(e.g.,epoxy resins)
None 1=
Unknown
Other,Please Specify
€.External Protection Cathodic Protection
(Mark�ttlthat efapt, M) ...�
i P l
Paintod(e.g.,asphaltic) CID E= [-__-j
Fiberglass Roinforcod Plastic Coated
None
Unknown
Other,Please Specify
7.P>ipi. lure Steel C0
%,taro all W1 apply M) Galvanized Sttx+!
Fiberglass neinforced Plastic
Cathodically Protec-tecl CJ L...____.� L E---D
Unknown
Other,!'lease Specify
8.vubstan"Currently or Last Stored - a. Empty
In Greatest Qwu)ntfty by Volume 1
(Mark au that spplyM) b. Petrofcum
Diesol
Kerosene . :..-
(iosoline(includifig alcohol blends)
Used oil
01har,Plca&e Specify
c, kfa�arctr�us at+ft�rcu:e { �7 C_. .. C.. ] C. ._)
Please Indicate Niurie of Principal Subs€once
ola
Chemical Abstract Service (l No.
14Saik box fIt if tank st<trr�s a rrtixture of 5ubc�lances
d. Unknown
9. Additional Information(for tanks permanently
taken out of service) €
a. Estimated date last uz�.ed (rno/yr}
b. Esimialed gr:antity of substance lefflaining (girl.)
c. Mark box®if tank was filled will) ir7t r1 material
(e.g,,sand,concrete)
at
DEPARTMENT 00 PV13LIC SAFET'1("' 61VISION OF FIRE PREVENTION
APPLICATION FOR PERMIT TO MAINTAIN AN EXISTING/MEW UNDERGROUND
STORAGE FACILITY
To: Head of Fire Department
JUNE 1 1987
City or Town Date
Foy F.P. zgo Application is hereby made for a permit to maintain an existing/new
Part4 underground storage facility as required by 527CMR9.00: Permits.
Location of property: 1 -3 MASSACHUSETTS AVE. NORTH ANDOVER, MASS.
Street address
Owner of property: PATOB REALTY TRUST
Full name of person, firm or corporation
Signature of owner or authorized representative:
Fee:$ (M.G.L.A. Chapt. 148 Sec. 10A)
(Fire Department's Copy to be Filed with F.P.290 part 2)
rafth 1f Ausaripmts
Y DEPARTMENT OF PUSL1C SAFETY—DIVISION OF FIRE PREVENTION
PERMIT Jung 1 1987
Date
Form F.P, z94 TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY
Part i
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 MASSACHUSETTS AVE. NORTH ANDOVER, BASS.
Street address
Owner of property: PATOB REALTY TRUST
_ Full nape of person, firm or corporation
Restrictions: To BE RENEWED ANNUALLY
Fee Paid:$ (M.G.L.A, Chapt, 148 See. 10A) k(,
This permit will expire � / Iq fjd-`
Data Signature of (lead of Fire Dapt, or appointed desipllae
(Owner's Copy to be posted at the storage facility with F.P.290 Part 3)