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HomeMy WebLinkAboutTank Permit - Permits - 1 MASSACHUSETTS AVENUE 5/6/1986 0 0 r 0 D FIRE DEPT. STATE USE ONLY FIRE CERTIFICEPA1.T QN Submit to: 11) Number LOCAL FIRE DEPARTMENT Date Received EM Notification is required by I"edcral hill for all underground tanks(hat have been 4. pipeline facilities (including gathering lines) wgukited under the Natural Gir, used to store regulated substances since January 1,1974,flint are in the ground as of Pipeline Siflci\ Act Of 1968.or the fla/ardouN Liquid Pipelllle.sillet) Act of 1979.ill May 8,1986,or that are brought into use after May 8,1986.'rhe information requested %v hich i,an inu atate pipeline la(,tilt\ regulated under Stall:lams is required by Section 9002 of I lie Resource Conservation and It ecovery Act,(RCI?A), S.surface IOIPOUOCIMCIVIn.Pits,ponds.or lagoons: as amended, 6,stortn%karcr or waste vuuci collection s\sterns: 'I lie Ill irllilly purpose of this notification program is to locate and evaluate under- 7.lie%%-through process tanks: 1pound tanks that store or ha\c stored Imioleurn or ha!ardoos substitrico, It k 8.liquid traps or associated gatheiing linesdirectl\related it,(ill orgas production and expected that tile infoiniation you pt-o\ide will be base(] oil reasonably mailable gathering 9. stolag underground tanks situated in an underround area (Such ;Is it basement. cellalInn ine`wl)l king, . reco rd s.or.in the absence of.such records,your kirtm ledge,belief,or recollection. drift.shaft,or tunnel)it 11,c storage tank is siloatcd upon or abo\e tire Who Must Notify." Section 9002 of 1WRA, its arnended, requites that, unless surface of tile floor. exempted,owners of underground tanks that store wgrikired substances must notify designated State or local agencies of tire existence of their tanks. Wrier means What Substances Are Covered? The nonlication requirements apply to under- (it) in tile case of all undergroundstorage tank in itse oil Nmernbei K 199,1�or glound Storage tanks that Contain regulated substances. Fhis includes an\substance brought into use after that(],lie.an\ person\%ho owns an underground storage tank defined its ha/atdous its section 101 (14) of the Comprehensive F-1161oliniental used tot the storage,use.or dispensing of'regulated substances,and 12csponsc.Compensation and liability Act of 1980WERCLA).with the exception of (b) in tire ease of any underground Ntoragc iiink in use before November 8. 1984" those substances regulated as ha/aidous waste under Subtitle C of RCRA. It also but no longer in use oil that(Late,any person%%ho owned such unik unniccliately before includes licuoletior,e.g.,crude oil or any \ Traction thereof\%hich is liquid ill standard the discontinuation of its use. conditions of leniperinure and pressure(00 degrees Fahrenheit and 14.7 pounds per What'ranks Are Included? Underground stoiagc tank is defined as any one or sqoalc inch absoluie), combination of tanks that(1)is used to contain an aCCUMUlatiOn Of"regulated sub- Where'to Notify? Completed notification lornis should be scut to the address stances,"and(2)whose volume(including connected underground piping)is lVi or given it the top of this page. more beneath tile ground,Sorneeminiples are underground tankssionrig:1.gasoline. use(]oil.or diesel fuel.and 2.industrial solvents,pesticides,licibiculLs or luilligants. When'l'o Notify? taken out of operation alter January1. 1974�but still in the ground.must nolil'\ b\- What I'anks Are Excluded? Tanks icnio\ed lion) the ground are not subject to Ma\ K 1986.2.Owncts\kho bring underground storage tanks into use alter May 9. notification,Other tanks excluded from notification are: I 1986,num notify within 30 days of bringing the tanks into usc. 1.farm or residential tanks o1'I.100 gallons or less capitcii\used liar storing motor Firel for noncommercial purposcs: Penalties: Any owner who knowingly fails to notify or submits false inforniation 2.tanks use(]for storing heatingoil forcorrsurnpu e useon tile fircriniseswiterestored: shall be subject to a civil penalty not to exceed $10,000 for each tank for which 3—septic tanks: notification is not given or for which false information is submitted. li�:!:Jgm I WIN 11 11 ifflil 0:1iii ;�ii;;ii :I EMENEEMME I I i I SEMEN= Please type orprint in ink all items except"signature"in Section V.This form must by completed for Indicate number of each location containing underground storage tanits.Iftnore than 5 tanks are owned at this location, continuation sheets photocopy the reverse side,and staple confirmation sheets to this form, attached Owner Name(Corporation,Individual,Public Agency,or Other Entity) (If same as Section"l,mark box here RAMB3EUTY TRUST Facility Name or Company Site Identifier,as applicable Street Address 1-3 MASS. AVENUE MERRIMACK VALLEY OIL CO. Count Street Address or State Road,as applicable ESSEK 1 -3 MASS. AVENUE State ZIP Code Count N'66TH ANDOVER MA 01845 ESEX Area Code Phone Number CiNnearestX State 6JP8�fgfe 617- 683-3131 RT NDOVER MA 'Type of Owner (Mark all that apply 1:1 o Private or Indicate Mark box here if tank(s)Current E] State or Local Gov't Corporate number of are located on land within El Former D Federal Gov't Ownership tanks at this 6an Indian reservation or (GSA facility I.D.no. Uncertain location on other Indian trust lands i UM Name(If same as Section 1,mark box here Job Title Area Code Phone Number WILLIAM D. O'BRIEN 617- 683-3131 1:1 Mark box here only if this is an amended or subsequent notification for this location. 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 Sig ture Date Signed WILLIAM D. O'BRIEN /I , � MAY 5 1986 CA -s' Jvv Form F.P. 290 Part 2 Page 1 1 -3 MASS. AVE Owner Name(from section 1).PATOB R ALIY--MQS-T— Location(from Section 11) NO ANDOV ER,. A Page No. of Pages MOM MMM 7Arbitradly tification No. e.g.,ABC-123j,or Tank No. Tank No. Tank No. Tank No. Tank No. Assigned Sequential Number(e.g.,1,2,3...) . ausof Tank (Mark all that apply®) Currently in Use Temporarily Out of Use n Permanently Out of Use Brought into Use after 5/8/86 0 . 2.Estimated Age(Years) 10 Y 3.Estimated Total Capacity(Gallons) jZ0'0U0 20,000 20,000 20,000 0 00 4.Material of Construction Steel ® C"� (Mark one®) Concrete 0 J (} Fiberglass Reinforced Plastic [� r Unknown n Other,Please Specify 5,Internal Protection (Mark all that apply®) Cathodic Protection U Interior Lining(e.g.,epoxy resins) U {� None Unknown (� 0 Other,Please Specify 6.External Protection Cathodic Protection (Mark all that apply®) Painted(e.g.,asphaltic) ® © �] Fiberglass Reinforced Plastic Coated None 0 n 0 Unknown U Other,Please Specify 7.Piping Bare Steel ® F—x--] ® E:Z-1 (Mark all that applyM) Galvanized Steel (=] ] 0 Fiberglass Reinforced Plastic (� 0 Cathodically Protected Unknown 0 L� Other,Please Specify 8.Substance Currently or Last Stored a. Empty In Greatest Quantity by Volume (Mark all that apply M) b. Petroleum Diesel Kerosene U [— Gasoline(including alcohol blends) Used Oil Other,Please Specify 2 Fuel Oil q2 Fuel Oi 1 2 Fuel Oil#2 Fuel Oi 1 2 Fuel Oi c. Hazardous Substance Please Indicate Name of Principal CERCLA Substance OR Chemical Abstract Service(CAS)No. Mark box®if tank stores a mixture of substances U 0 d. Unknown �� n 9.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®if tank was filled with inert material (e.g.,sand,concrete) Page 2 1 -3 Mass. Ave. ow"r Name(ttrromsrctlongPJ-1-01JIBI TY TRWL T Location(trom Section li)JIO- -A3Id0-_Cr-- ,+y Page No.2_�.ot_r isag,�s } i n e c t r r • r, arrti�t°v�+ ♦ �i �a 9 l.a 1' '� -is^''"'p. ^ ✓' Tank Identification No.(e.g-ABC-123),or Tank No. Tank NO. Tank No. Tank No. Tank No. ! Arbitrarily Assigned Sequential Number(e.g.,1,2,3...) 6 1.Stalus of'rank CiarentlY in Use -Y i (Mark oil that apply 4o) U Temp-,+rrii dy Out of Use perwaneriliy Out of Use BfouO, ' mto Use after 518/86 2. _ 'irnated Age(Years) 10 '-- 3.Fslimatod Total Capacily(Callorns) 20 000 Material of Construction Stcra1 (!.#ark one M) Concrete i ihefgta,,s 11;?mforced Plastic L_-] (- -� Unknown [W-_ .1 Ll F L� � i I 01har,Please Spoc:ify S.Internal Protection ------ — --^-T (Mark all that apply,)) Calfioclic Protection Interior Lining(e q.,epoxy resins) (_= None Unknown i Other,Please Specify v"".External Protection Cathcxiic Protection [= (A9a►k oil that apply®) Painted(e.g.,asphaltic) i Fiberglass Reinfoi ced Plastic Coated None Unknown ._...] Other,Pleaj�o Specify ------- --- _-��- ------ - �--- --- -- 7.Piping r Bare Steel (Mark all flat nlVlyM) Galvanized stml Fibeiglas,11einforced Plastic Calhodic:ally Protect ed L Unknown E—J Oil ier,Please specify --------- - -- ----' -v- _ -.__ - ------ 9.Substance Curre_nfly or Last Stored a. Empty In Gmate,l Quantity by Volume b• petroleum (Aitarfr all that apply 01) Diesel F-70 Kerosene �--1 1-= Gasoline(including alcohol Wends) Used Oil t Other,Please Specify i c. Hazardous Substance i Please Indicate Name of Principal CEf3CLA Substance --- - - - _-- -_-. - • a� Chemical Abstract Service(CAS)No. } Mari:box III if tank stores a mixture of substances - d. Unknown L-1 E=1 [-] 9.Additional Information(for tanks permanently taken out of service) a. Estimated date last used (molyr) b. f slanaled quantity of substance remaining(gal.) c. lvlark box DI if tank w'is filled wit` art material (P.. n- concrete) 4 - r Tam IM10 of Ausalrm DEPARTMENT OF PUBLIC SAFETY` DIVISION OF FIRE PREVENTION APPLICATION FOR PERMIT TO MAINTAIN AN EXISTING/NEW UNDERGROUND m - STORAGE FACILITY To: Head of Fire Department North Andover May 5, 19 86 City or Town Date Application is hereby made for a permit to maintain an existing/new underground storage facility as required by 527CMR9.00: Permits. Location of property: 1-3 Mass. Ave. North Andover, Mass, Street address Owner of property: PATOB REALTY TP.IIST s� 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) Form F.P. 290 Part 9 OJ4,r Q1m=un=rAffi of Amar*wkM 4 DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION PERMITMay 5, 1986 19 Date 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, North Andover, MA Street address Owner of property: PATOB REALTY TRUST Full name of person, firm or corporation Restrictions: T4 BE RENEWED ANNUALLY Fee Paid:$ (M.G.L.A. Chapt. 148 Sec. 10A) Fonn F.P. 29U Part a This permit will expire (✓ n�r� 19 �� / ' ����� l� '�" ,�� - patd Signature of Head of Fire Dept. or appointed designee qtoir (Owner' s Copy to be posted at the storage facility with F.P.290 Part 3)