HomeMy WebLinkAboutUnderground Tank Removal Documents - Oil Tank Removal - 767 GREAT POND ROAD 8/4/2021 Aft
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August 4, 2021
Fire Prevention
North Andover Fire Department
795 Chickering Road
North Andover, MA 01845
Re: Underground Tank Removal Documents— 767 Great Pond Road, North Andover,
MA
Dear Fire Prevention;
On July 19, 2021 CommTank removed one (1) 500-gallon underground storage tank (UST) at the
above referenced address. Enclosed is the tank closure report and tank disposal receipt
following the removal of the UST.
Should you require any further information on this please contact us at 617-628-8260.
Sincerely,
Miguel Portillo
Project Manager
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rP r ° ! r sh 1X'A1`NK' SLIF� Y.
PM: CREW: C.GII .(. 06, J�aAaosa DATE:9-
l0>3 NAME: CUSTOMER PHONE# -
SITI ADDRL'•SS:
CITY: n����`P r STATE: ZIP CODE: O
Whhln 24 hours after the removal of a UST the omier/operator shrill measitre for the presence of it release of oil or hazardous inoterhrls to lire
euvlronment where contamination Is most llkely to be present on the site,
HOMEOWNERIBUSINESS OWNER QUESTIONS
21I r CLL ONL)
SINGLE FAMILY RE IDENCE MUL'CI-FAMILY RESIDENCE BUSINESS -TYPE
❑ UST AGE: YEARS OLD YEAR INSTALLED
US"I'SIZE GALLONS
❑ UST F UE CIRCLE ONE)
f U .L OIL GASOLINE•' OITICR
❑ IS'I ETA USl:?(CIRCLE ONE)
YES NO WHY?
❑ HAVE T BEEN ANY ERRATIC CHANGES IN YOUR USAGE OR BILL?
NO YES EXPLAIN
❑ LAST FI ATE AMOUNT Of LAST FILL GALLONS
❑ HAS YO t f 0K EVER BEEN RELINED?
NO YES WI-IY?
❑ HAVE ZE BEEN ANY SPILLS IN THE PAST?
o DATE DESCRIBE
❑ IS THEI N OTHER FLAMMABLE OR HAZARDOUS MATERIALS STORED ON-SITE?
O NO
O LIST;
❑ NOTES`
EACH BOX MUST BE CHECICEll BEFORE REMOVAL OF THE UST
❑ TANK PERMIT FORM#FP-292
❑ DIGSAFL""• # DATLOBTAINED DIGSAFE# 1-800-322-4844
❑ TANK INFORMATION : FIBERGLASS STEEL
CYLINDRICAL TANK
Forinula for a CYLINC3RlCA1.TANK
\ 1
z x J x 3.1464 L
Q
f 231 gallons
L O a inches L= inches
a UST SIZE GALLONS
q 16daA GALLONS OF OIL EMPTIED FROM TANK
a 4 r- GALLONS OF WATER EMPTIED
0 � 1 INCHES or OIL IN'rANK INCHES OF WATER
❑ IS Ti-iERrA-N,,Y STRESSED VEGETATION OR DISCOLORED I'LANTS IN THE AREA?
0 0
YES ESCRIBE:
❑ 1S THERE ANY BROKEN OR PATCHED PAVEMENT AROUND OR NEAR THE(CIRCLE]I�YES)
TANK FILL PIPES PUMPING ISLANDS OTI.IER
Cl IS THERE ANY STAINING ON/AROUND/ABOVE Ti-iE.(CIRLCE IF YES)
'PANIC FILL/VENT PIPES LINE AREA OTHER
❑ FILL MATERIAL - GRAVEL NATIVE BILL OTHER
❑ DEPTI•I TO TOP OP TANK 9 FEET
EACH BOX MUST BE CHECICE,D DURING THE REMOVAL OF THE UST
❑ I'D PERSONNEL ON-SITE : NAME A/tfet TITLE
❑ ON Tl-E TANK IS 'THERE ANY VISIBLE SIGNS OF:
0 I-IDLES/BREAKAGE DESCR€BC
O RUST/CORROSION DESCRIBE fin,
O STAINS DESCRIBE yip
O OTHER DESCRIBE ),0
❑ IN THE EXCAVATION IS THERE ANY VISIBLE SIGNS OF:
o SOIL STAINING DESCRIBE N
0 OTHER DESCRIBE >l_o
❑ GROUNDWATER EVALUATION:
IS THERE OUNDWATER IN THE EXCAVATION:
NO YES
IF YES IERE:
FREE PRODUCT DESCRIBE
SHEEN DESCRIBE
TABULATE
DATE TIME SAMPLE ID SAMPLE DEPTH PIA PIll 1BACKGROUNDI SAMPLER NOTES
(MIDDIYY) O:OO AM/I'M) (1 LG'i') (PFM) (PI'Ivl (INl'I'IALS
SIDEWALL I r
SIDEWALL 2
sw3 SIDEWALL 3 6 U h 0 p'
_5u)P1 SIDEWALL 6 O
t,05 PIT BoyroM fFp' u v
PIPING AREA
No,rEs:
❑ ARE TIAERE PETROLEUM ODORS IN:
O NEARBY STORM SEWERS-I'ID READING_(I ppm
0 DRAINAGE DITCHES -I'll) READING a pm
O BASEMENTS-PID READING a ppm
0 WETLANDS -P1D READING_C._,._Ppin
CJ HAS THE TANK BEEN CLEANED?
O OUTSIDE
O INSIDE
- 2 -
❑ BACKFILL MATERIAL- GRAVEL LOAM SAND WILLPACK OTHER
❑ EXCAVATION (CIRCLE ALL THAT APPL
0 LINED WITH H POLY
0 COVERED W1'1'H POLY
O FENCED IN WITH: SNOW FENCING CHAIN LINK FENCING CAUTION TAPE
❑ #OF PHOTOGRAPIAS'17AKEN: PIPING TANK )6V4 FXCAVA'PION
❑ #OF DRUMS LEFT ON SIT : CONTENTS:
❑ LOCATION OF DRUMS: (DRUMS CAN NOT BF LEFT ON GRASSY AREAS)
❑ #OF TOTES OR Fl2RC TANKS' CONTENTS:
❑ NOTES:
SITE SKETCI'I:
ilOk'rii
0
5I
PLEASE INDICAI'E: 1,The location o1'the UST
2,'ncc UST piping
3. Field screening points&laboratory sample collection
4.General observations
NOTES:
ATTACHED IIOCUMCN'I'ATION
0 WITHIN 72 HOURS OF CLOSINC'rr1L'UST,PROVIDE RECEIPT TO'ITH♦~LOCAL FIRE DEPARTMENT FOR DELIVERY 01;UST To*rl e
DISPOSAL SITE DESIGNATED ON PERMIT
❑ IyrniIN 30 DAYS OI,REMOVING'I'I1Es UST,SEND NOTICE TO DPS'l'O CHANOE REGISTRATION INFORMATION FOR THE HE UST,FP-
290R
0 BILLS OF LADING(BOL)OR IG1'LARDOUS WASTE,MANIFLSTS USED'1'0'1'RANSPOR'I'C:ON'1'AMINATI"D MEDIA OFF-SITL•',A
COPY M UST'RE ATTACHED.
G COPY OF FORM FP 292(PERMIT'FOR REMOVING UST AND FOR TRANSPORTATION TOT'ANK YARD)
D COPY OF FORM 291 (RECEIPT OF'rHL'UST AT DISPOSAL FACILITY,INCLUDING STATE LICENSE NUMBER OF FACILITY).
- 3 -
Within 24 hours after the removal of the UST, measure for the presence of contamination at locutions where it is
(Host likely to be present, as required by 527 CMR 9.07(h)(4), Steps 13 through 15 describe DEP and DPS
recommendations for fulfilling this requirement.
E 41-P- -1'� ..I3;�;}. 7 � 3}7. r �t i_, :'f ,.f k. ;:i,1�''i!r.,: iq i+ ;SC of---�•}'K?7`r','�e3`i,+l7 i, 1°JJr ,'t -r 1� _ 1�� t_ 7 '�c .';h 1 tt , i 1 - ;Ile. Its s' - ,r, lrlI 1 1.+I11Iii
:�;. ��,} �f....tdp�,k>_G.,�wlt...id lo.t.:?�•�u!-,.&li.;`��I7.F?J.�JCis7i11.r�.iu��F7.r,',.:�i.nllti::_;i+ _1,�.i f:..t.�i., �'11'i,r,;.. ..7 a I- �:.....115j�.,.f7t:'i�
TABLE 1, Sunirnary of Follow tip Procedures to(-leads ace Screening
RESULT ACTION
Readings> 100 pPmv L Notify tltc DEP within 72 hours
2, Notify the local Fire Dept.
Readin&<10022niv, but>ambient air Obtudn a minimum of one sample for lab wtulysis
Readings<or= to nmbient air Gasoline only Assume"clean"
Duet oil only 1 composite sample for lab
Other contaminates I cunlpwite sample for known/suspected contnttlinutes
?Greater than
<Less thwt
TAW II: Amtlpilcal(Methods stir venwetim 1,motwis
I'strtilc11111 l'ruduel Still us'Water Alnlril
Anal'tts, Amd1 fiend h ld hoth
GusoliaenttdSimilol-Weight Ir0C.A 6020,9240,S260,orI)I.M11711
Fuel0iln(No,2,-I,{.G) VOC:, SOD.3240,S260.or 1)1:11.1 P11
DiC�1,Lubriauilly oils uucl siulillir mcilm.€"
�lri�'11t plotlt�:la
ROD,S276,er DEP-li11I4
PAII mriliod'
GCA'tp or 418.1
TITH
Unknown I1o11v61nt modticl voCa 8240,UK or DI'sl'-Vill-I
modidd'
PAI I W10,U70,ur IM11-1".111 I
n1c111od''
'l't't1
CiCil�ll)
111:DI:P his desigllcd iwn n1ClhLMs fur i4lcnniliillf lltc kmtwc111nninns of Ixlroleum hydivi lIK-Im ill
n:tlermulwiIto ontl)IcnittlgntlwI111o116: 10Ct'Anatehmilli1IvId11I]ImMs111nl
ulny my li lium Cxpasurr to such c01111munds. 'I'lic Molw%l for iltc i)c1u'lninulistn of I°xalmlrsb1c 11%uvkznll
llyclloalrbon;t (Ii1'1-1) collcelisvly luutsuna tics eoncela fit Ikws of ctilllvl k aliphtstio uad nrontalio
It)"drutmtLUna,€ind n1dividonl CVrltvwm1iujis of P,ii'Is, 111C NIC111"I rvr the I,lentn1111Ig11 of vat}nlc
PCIIPletim Ily(l1willbolm nlat,nrCt e011CC6w tUIItC11p1l111171ti of whlllh al1011mie 1110 IllUmnlie,
hydrocasIX)lts,xidh(1sIl'I'I Xi131lrcnc,Tohdlie,lilh)'lhrnzCnc,Xy4�nC).
'I'llhl.Ill: stlltcnlary orMC:P ltellurtolilc Cunditiow and ncquh'vmvw%G,r
Nollllcnilnn to DIA,
C'untullon 'I'linerrmlak.
Gwawthan It1A I.I:t. 214ount
RAMS,!al elCatCr I11311 10 uti Ions in 24 how-, 2 hours
1 em6 lieu uIVIIIN Ilnlrt 100 )hilly 72 t1.1urx
NAI'I-allow lerlllnoc'rctualto 112" 72h.mn
CC111:CIlllglltln)}�,1\�11Cftholl Rcsill Ell'4lnilntitt`rt1'Itllilt 40)A OftlUbli:a,€ICr:a,q:isly or X0 73 hams
Ill 01'lrivnir unlerSupply
M-1 ncprcuudutncrnl lS tl IV kw plucllul surlit:e=>5 11110.within lrl 11 d 72 haw
xhaol1Ccct11icd rrticl:utirrl:+llueRt€c
Concenirntiont in$oil cluttcrthm 110C, l2tl:ttr+
'NotdtCd1101t 100t?P 111111' dal bC 1vvIuimI if n LimilM ltcmovul Aclian Carl lL Inkcn,
Table IV: MCP Report ble Concentrations for Selected Petroleum Constituents
ANALYTC SOIL WATER
(111glk(g) rn,It
RCS-1 RCS-2 RCGw-1 RCCW-2
13er1Zene 10 100 0.005 2
Toluene 30 1 300 1 4
- 4 -
Eth lbencene BO 500 0.7 4
X lenes total 500 '500 6 b
Total Petroleum H drocarbons('rpl-l) 200 2000 0.2 1
Sm'TiplitILT Loca iul! s Ala,
Dill Iaipo,
AQh
{{ y
r
it
'�i hil't
AMA
SIDEWALLS l
i•}7)��! �•tiFj
•'��}:1 lug
PIT BOTTOM
• it Is 11pure kwill.1.t ow litlon iitl wanspon nC st[mrulaiana 0S1'IJA Mill 1111WR A ap[WIN p,ulaua}'�.
r Cy I nld nj Vet l ct IiVL ll
residual Sol C+ nl nmlltnlloll
Gasollnc Mil-ors
9 2 S1 ll�5 4F1����Stt3ft7�,�3r4l�F�J tyn�}"��,T_{'��Ct„Y�kt�•"St3 r_,�r3 h ty
f•) is Isr�,,t �C �A 111 u r ttg�,}}}1r�lti }
�-.�«'ld�i q��tk�{,;h�[/i�,il����.��r.hti:c..�'�5tir�.is 1.•:..
1:1'u-410.1t ll)g ROAM
G1•D111TN-Utor I,luw
_ 5 _
RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK
FORMERLY CONTAINING FLAMMABLE LIQUIDS
NAME AND ADDRESS OF APPROVED TANK YARD:
Approved Tank Yard Humber:
t
Tank Yard Ledger Number(527 CMR 1.00:66.21.7.8,2):_._.
I certify under penalty of law that l have personally examined the underground steel story e t nk delivered to this"approved tank yard"by(firm,corporation or partnership)
Arad accepted same in conformance with 527 CMR 1.00:66.21.7,11 Provislons forApproving Underground
Steel Storage Tank Dismantling Yards.A valid permlkwas Issued by the head of the LOCAL fire
department FDIDA
to transport this tank to this yard, I
Dame and ofiiclal title of approved tank yard owner or owners authorized representative:
Slgnatur [tle CIA M', Date signed:
TANK DATA; TANK REMOVED FROM:
Gallons: No.and Street:
i
Previous contents: City and Town:
Diameter: fire Dept. Permit#:
Length: Rotes: T
Date Received:
Serial#(if available):
Tank I.D.##(Form FP 280):
i
EACH TANK MUST HAVE A RECEIPT OF DISPOSAL.
{
Owner/Operator is responsible for notifying the Department of Environmental Protection:
Department of Environmental Protection
Bureau of Waste Prevention- UST Program
Boston, MA 02112
r
This signed receipt of disposal must be returned to the head of the local fire department.
f
Form PP-291(Rev.8.1.2017) f