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HomeMy WebLinkAbout0375 BARNSTABLE ROAD - Health 375 Barnstable-Road Sewer.Ac&A ,1596. — -- — —— H Y',aArl i, y `a rf ° I� � o o e 1 Massachusetts Fire Incident Report Hyannis Fire Department Date of Time Of Arrival Time In FDID Incident No. Exposure #. IF03ht Day of week Call Time Service 01922 1 5/ /2 Tuesday 3 16:34 16:39 16:54 Address Zip Census Tract 3 7 5 Barnstable Road 4-431 Hyannis 4 0 I or Type of Situation Found Type of Action Taken Mutual Aid 41 Spill/leak W/o Ignition F41 F 4 Remove Hazard Fixed Property Use Ignition Factor ublic Service Station." FOO No Fire Fognd_ Occupant Name Occupant Tele h e Cumberland Farms 790-71 Owner Name Owner AddressfCE1�rEG Owner Telephone EP Method Of Alarm Shift No Of Alarms o PersbnknelLFiesponded Hazardous 1 Telephone 1� © � 3 o us Materials Engines Tankers Aerial Other Vehicles ,�_� Present 001 00 00 0� � j ' Fire Service Other Injuries Injuries 0� Fatalities 0] Injuries 0� Fatalities 0� Rescues 0� Mobile Property Use Is Car Stolen Insurance Company Mobile Property Make Year Model Color License Number VIN 0 0 0 E Complex Area Of Origin Estimated Loss Equipment Involved In Ignition Form Of Heat Of Ignition If Equipment Was Involved In Ignition Material Ignited Year Make Model Equipment Serial Number 0 Method of Extinguishment Level Of Fire Ori ig n Number Of Stories Construction Type Detector Performance Sprinkler Performance 0 ❑ Extent Of Damage Flame I J= Smoke Material Generating Most Smoke Type Of Material Generating Most Smoke ❑ E Avenue Of Smoke Travel Weather Conditions Commanding Officer C.I.e.ar.................................................................. Lt Cadrin Report By JUCadrin � .Ny rl Comment Page for Incident No. A200541 Address 1375 1BARNSTABLEROAD 4-431 Date of Report 5/30/2000 Commanding Officer JU Cadrin CALLER REPORTED A GASOLINE SPILL AT THE PUMP. RESPONDED WITH E-822 UPON ARRIVAL WE FOUND A SMALL SPILL APROX 1 GAL AT THE ISLAND BY PUMP#7 THE STORE EMPLOYEE CHARLENE VIOLA COULD NOT EXPLAIN HOW THE SPILL HAPPENED BUT THAT A CUSTOMER REPORTED IT TO HER. WE REMOVED THE HAZARD WITH JANSOLV AND DRESSED THE AREA WITH SPEEDI DRY. I INSTRUCTED THE STORE EMPLOYEE TO NOTIFY THE STORE MANAGER DEBBIE PAYNE EMEDIATELY AND TO INSTRUCT HER TO HAVE THE FUEL PUMP CHECKED FOR POSSIBLE MALFUNCTION. SHE WAS ALSO TOLD TO NOT ALLOW USE OF THIS PUMP UNTIL CHECKED BY CERTIFIED TECH. THERE WAS NO SIGNIFICANT ENVIRONMENTAL HAZARD AND NO ONE WAS INJURED IN THE INCIDENT. REPORT BY LT.CADRIN Massachusetts Fire Incident Report Hyannis Fire Department Date of Time Of Arrival Time In FDID Incident No. Exposure #. Incident Day of week Call Time Service 01922 A990250 0� 3/19/99 i d a y © 17:29 17:32 17:49 Address f Zip Census Tract 3 7 5 Barnstable Road 4-431 U Hyannis 4 0 Type of Situation Found; Type of Action Taken'; Mutual Aid Type ..... .......__ ....._.._. ...__..__ y.._.... 41 Spill/leak W/o Ignition 41 4 Remove Hazard Fixed Property Use; I Ignition Factor "public Service Station." J5 7 1 00 No Fire Found01 0� Occupant Name Occupant Telephone Cumberland Farms Barnstable 7 9 0-71 1 8 Owner Name Owner Address Owner Telephone Personnel Responded _ Method Of Alarm Shift No Of Alarms # of Perso_ �'� � Hazardous 4 1 Telephone � u t^� 3 Materials Engines Tankers Aerial Other Vehicles Present ' 000 No 001 OOOi OOOi Fire Service_ Other Injuries — ' nluries j_0 0 0 Fatalities 00 0 Injuries 0 0 0 � Fatalities 0 0 0 Rescues 0 0 0 or Mobile Property Use Is Car Stolen Insurance Company Mobile Property Make Year Model Color License Number VIN 0 0 0 omp ex rea Of Origin- Estimated Loss Equipment Invo Involved In Ignition g Form Of Heat Of Ignition Co; 01 If Equipment Was Involved In Ignition Material Ignited Year Make Model Equipment Serial Number Method of Extinguishment Level Of Fire Ori in Number Of Stories Construction Type Detector Performance Sprinkler Performance Extent Of Damage __ _ Flame �� Smoke I 1 Material Generating Most Smoke Type Of Material Generating Most Smoke 0 Avenue Of Smoke Travel Weather Conditions Commanding Officer 0 Cat Grant C e r� Comment. Page for Incident No. A990250 Address 1375 1BARNSTABLEROAD 4-431 Date of Report 3/19/99 Commanding Officer lCapt Grant RECEIVED A CALL FROM THE CUMBERLAND FARMS ON BARNSTABLE RD.FOR A GASOLINE LEAWSPILL.UPON OUR ARRIVAL WE FOUND A SMALL SPILL APPROX.3TO 4 GALLONS,WE PUT SOME JANSOLV ON THE SPILL AND THE COVERED IT WITH SPEEDY DRI. _ LS`V Z/ a14/. C)/& useCC6 - ��e��rGi/tenCu/C>rrre Ln ^`� /e aeCii - 2� ��� ulata.>� an �a.�cce'��lrtiC rt,-t ecuGir/Ace 7 f Notification for Storage Tanks Regulated Under 527 CMR 9.00 - • Forward completed form,signed by local fire department,to:Mass UST Program,Dept-.. of Fire Services,P.O.Box 1025-State Road, Stow, MA 01775 i09Z0 VW `SINNd ate Received: Use Form FP-29OR to notify of tank removals or closures in place. 1X3 .QZ VW 'SI N Dept. ID# OF Telephone (976)567-3710 IN31NIM30 3811-St N. -.pt•Sig. (Fire Department retains one copy of FP-290) I A.New Facility(see instructions,#1) �",�B:Amendid ;,1.J7C—Rerf9wa - • RIST U MONS: Form FP-290(Nolification for Aboveground-and Underground-$torage Tanks)is l0 be completed for s97 CMR 9.0 if more man live oath location containing underground or soovagnouonndstare; lands pie continuation ks regulated ud encore to Ih°form. The FP•290 A. Facility Number tanks are owned at this location,photocopy g pages must be completed to duplicate. Although the form may be photocopied.the faculty,owner or owner s representative must B. Oahe Entered sign each copy separately photocopied Slpfh81tXe9 are not sufficient. Both copies of the FP-290 are to be forwarded to the local fin department.who will check all information and certify the-forms.The fire department will retain one copy of the FP•290 for its records,and the facility owner shall be►esponsiblo for forwarding the other copy to the C. Clerk'S Initials Dept of Fire Services at the address above• The local fire department will issue the permit portion of the FP-290: howtwer.registration is not complete until the FP-290 is received and checked by the UST Regulatory compliance Unit. D. Comments AO questions on this form are to be answered.Incomplete forms wil be returned. Mew Facility'means a tank or tanks located at a site where tanks have not been previously lacated- 2'Fnoliry street address'must Include both a street number and a street name. Post office boar numbers are not acceptable.and win cause a leprstrallon to be resumed.If geographic location or facility is ngnprovided.ouehessLd to distance and direction from closest inlersecdon,e.g.. (facility at 199 North Street is located) - GQMm2nS Mond(Intersection). GENERAL INFORMATION Excenli0>LIa)afarmorresbenUaftankof1.100ganoruorless=ac usedtor:toringmote Notification Requi ed a tank used for swring heating Oil for consumptly Fire Prevention Form FP-2901s to be used as Nol licat on,Registration.and Permit for lucttornoncammercialpurposes,or(b) anoveground and underground storage%ties and tank tl:MUe$regulated under S27 use orilhepmmises whom atored ��tnotiuorr5ubmtstalScv+toemaUonsnaube_uD►e` Cade of Massachusetts Regulations 9.00.No regulated aboregrouno or iaraerground p IAnyownerwho who ^0 Y fY storage tank t3cWty shall be ruraUed.mhinlatned,replaced,subsnntieny modeled or to a civil penalty not to ercoed sea—for each tank for which notilicaGon is not preen or Ic mmavcd wMeut a perms(FP-290)issued Dy m head of the local Piro department wfych Ialse information is submitted.(MGL Chapter 149,section 39H,527 CMP 9.00) The owner of any storage facility shall within seven working days notify the head of the Aboveground Storage Tanks - locsl tits department and the Dept.of Fire Services to any storage orag f the name. MR 9.00 requires there Stratton of any aboveground storage lank which meets the aJoress,or telephone number of the owner or operators I a storage facility subject to f ll win delinIPon:a horitanmi or vertical tank,eQual to dr leas than 10.Oo0 gallons rogulaliou by Chapter 14f1,Mass.General Law and by 5Z7 CMR 9.00. capacity.dial is intended for fired installation without Dark Nt above or below grade,and i Underground Storage Tanks used for the storage at MaZa=us Subs;ances,Hazardous wastes,or FNmnote or Ea,Ji owner of an underground tank rust Put into operation on or ahgr Jan.1,1991, Combustible Liquids.. srlalt.within thirty days after the lank is first put into operada^.notify the Department of r Above rounotlnhrs*(more than 10.000 gaeonscepaOrY regulated by520CM Fire Services(the der^rartinent)of the existence of such lank.spepMng•to the extent. E-lq�R W bents for the Insra(more of TeNa Containing Fluids Other Than water known,the owner of the tank datE of Wplleiion, capacity.type.location,and uses of 12.00( eq such lank.sy no Later than Jan.31.1991,each owner of an underground storage tank Excess of 1C,000 Gallons)ere not required to be registered under 527 CMR 9.00. that was in operation at any time sftsr Jsn.t.1974. regardless of whether or not such FrCnciton nz(a)a farm or rasidenUat tank of f.100 gelatins or tens capering healing figfor ORrt11 lank was removed from beneath the surface of the ground at any time.shaft notify the motor fuel tot noncommercial purposes, or(a) a tank used for staring heating Oil rr department of the existence of sur-n tank,:peciying.to die extant known,the owner of consumptive use on the premicas where stored are not required to be registered under 52 me tank date of imlaUaficM capacity,type,and location at pie tank,and am type and CMR mpti auandly of 2-h nces steed in such lank or wnldh were stared at such fink before made utc tank ceased being in operation it the tank was removed from bencadh um surface penxlnes Regulations eginny a coon son lL 11=knowingly as a rie any rule provided.ded.be o nished by a tine on of Is.- oft the ground prior to the submittal of such notica to the deparenent Such notice Shall Prevention R ulatbns shall a,cce !as otng mov p Fir Y also specify,to the extem known,the date the lank was removed from beneath the than one hundred dollars not more than one Utousand dollars (MGL Chapter t 4a,sect;: surface of the ground prior to the submhd of such notice to Me department.The I OB.and 527 CMR 9.00) operator of any tank Nat nu no owner or whose owner genet be definitely Where to Notfly?Two completed notification oft forms slued should the ru signed department,and k Or ascertained.sheu notify the department of to existence of su:h lank.spedfyf+tg.to the and we local Gre department.One copy Y cxicnt known,any information relating to ownership of the lank and date of met shall sand A sePw=COPY TO'he address at the lop of this page. installation.ca.dactly,type.and Ideation oft the tank.and the type and om,th y of lank beflore 01e lank When to Nolity)1.Owners of storage tanks in use or that have been taken out of opCraut substances stored in such tank.or which were stored In such ceased being in operation 1 the tank was removed from beneath Pia surface of the must notify within InM days• ground Prior to the submittal of such notice to the depertmerM If the lank was owners and Operators of Regulated Storage Tank Systems must maintain retort awnddmed btdheim the sulfate of dw ground prior to the submittal of such notice to eertilying.that all leak detection.inventory control end tightness to must be the department such notice shall also specly.to he extent)mown to the owner or for"Regulated Storage Tank System arc current.These►ecorde must ba readi operator,the date Ute lank w do as abanned In g �M1and an methods used to avaaeble for inspection. slastabilizeIhhe lank after the lank ceased being operation. Dare 1. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) If known,give the geographic location of tanks by degrees,minutes,and Owner Name(Corporation,Individual,Public agency,or Other Entity) ``,�,,�,� II �- seconds.Example:Lat.42,36.12 N Long.85.24,17W G�rYIYJ�'r�(1C1 `flan Latitude7� Longitude e ` ! o Di: e.ano otreot on ma:c J...J �Y flit r7 a reecuon JW�trun.on:dtl St,achn0atxx _ _ I,Prin;�t� a�i�z5 �y� -�. F_acttt None Carnpany5a liferiuttar:a' Lcabte ^ L D f3�l�,l aC42 — t , r oc SO= Addm=IP.0.Stir not aceepabl••tee JL•INCdblf+21 ��2 Stau Mn fi Q i , 'y 77/ �s �t City sure LitCola• vnry� ab� .. Peon•r+uTo•r(twure Nea CadcJ• Qwnri;Employs Fr0•mI10 a County Par L FP•290[revised 11196) Ill. TYPE OF OWNER IV. INDIAN LANDS , Federal Government Commercial (storage and sale) I I: Tanks are located on land within an Indian Reservation or or State Government other trust lands. ;Private III Tanks are owned by native American nation,tribe,or individl I Local Government (storage and use) V. TYPE OF FACILITY Select the Appropriate Facility Description: (check all that apply) Gas Station Marina Trucking7ransport Petroleum Distributor Railroad utilities. Airport Federal-Military Residential Aircraft Owner Industrial Farm Vehicle Dealership Contractor Other(explain) VI. CONTACT PERSON IN CHARGE OF TANKS Name: Icin I A 5TAddress: Phone Number(include area code): .. v Job Title:l �t'c C_ . l�tfJ�r1 L<, 7 r/)1 ���• Home: Susiness: (' 9?' C)o VII. FINANCDAL RESPONSIBILITY ! I I have met the financial responsibility requirements in accordance with 527 CMA 9.00. ------------- ------ - Check all that apply: -----'---r----------- ASelf Insurance ( I Guarantee ( ! . Letter of Credit i I Commercial Insurance f I Surety Bond Trust Fund ! Risk Retention Group f01 State Fund i Other Method Allowed-Specify VIII. ENVIRONMENTAL SITE INFORMATION This information should be available from local health agent, conservation commission, or planning department. 1.Tank site located in wellhead protection area I l Yes I l No unknown 2.Tank site located in surface drinking water supply protection area r I Yes I I No unknown 3.Tank site located within 100 feet of a wetland I I Yes I ;No ,�Unknown 4.Tank site located within 300 feet of a stream or water body I ;Yes I No unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS t.ocAMON) Tank Identification Number Tank No.L Tank No.-O_ Tank No- Tank No. Tank No. 1.Tank status a.Tank mfes serial#(if known) b. Currently in Use c.Temporarily Out of Use (Start Date) d. Permanently Out of Use e.Aboveground storage tank(AST)or I I AST UST I !AST UST I I AST UST 1 :AST I VST I -AST I UST Underground storage tank(UST) �0 3 2. Date of Installation (moJday/yr.) an l9 6 3 a7 qz 3. Estimated Total Capacity(gallons) ID,Do0 101 DU O J O OOO FP•290(revered 11/86) ' i Tank Identification Number(cont.) Tank No._�_ Tank No. 2- Tank No:3 Tank No. Tank No. 4. Substance Currently or Last Stored a. Gasoline �� [� ® F �� PMV I I Marina V LI Marina )omV I •Marina I MV ' :Marina MV 'Marina Motor vehicle or Other use I I other I I other 1 r1—other ! ,other other-� b. Dlesel l_� r-� L 0 ' I MV U Marina 1)MV I I Marina i I MV , I Marine ' :MV I Marina MV I Marina Motor vehicle or other use 1•1 other : I other ' 'other I other i other c.Kerosene d. Fuel Oil' "consumptive Use*ranks need not be registered. 'Consumptive Use'luel used eirdusively for area heating and/or hor water. �---I e.Waste Oil f. Other. Please specify Hazardous Substance (other than 4a thru 4e above) CERCLA name and/or - CAS number gn° l- -61-- ---- ----- Mixture of Substances Please specify 5. Material of Construction-Tank(mark only on ) Bare steel (includes asphalt,galvanized r� and epoxy coated) r--, Cathodically protected steel �] . Composite (steel with fiberglass) �� U Fiberglass reinforced plastic (FRP) Concrete F Unknown Other Please specify 6.Type of Construction-Tank (mark only one) Single walled Double walled Unknown Other Please specify Is tank lined? t.I Yes p No I J Yes )0 No 1 i Yos o.No i I Yes i !No :Yes I No Does tank have excavation liner? I 1 Yes ,4 No I.1 Yes )Q No I I Yes %bND I i Yes I .No i Yes No Pant-.: i 'l'Tank Identification Number(cont.) Tank No. J Tank No. Tank No. Tank No. Tank No. 7. Material of Construction-Piping(mark only one Bare steel(includes asphalt,galvanized L� C❑ and epoxy coated) Cathodically protected steel [---��—❑ �� Fiberglass reinforced plastic (FRP) �—] t__—_� �� —� • —� Flexible ® I_--=� Copper �] F L Unknown F__ 71 Other Please specify 8. Type of Construction-Piping(mark only one) • • —1 � �❑ �� �� Single walled � CJ Double walled Unknown L Other ��] ❑ �� Please specify Has piping been repaired? I 'Yes No t 1 Yes } No 1 Yes 1bNo I •Yes 1 :No : I Yes : :No Is piping gravity feed? t I Yes>ZNo I I Yes/PNo I I yes�o No 1 Yes 1 ;No Yes No Date X. CERTIFICATION OF COMPLIANCE 1. Installation A. Installer certified by tank and piping manufacturers B. Installer certified or licensed by the L E--J implementing agency C.Installation inspected by a registered engineer D.Installation inspected and approved by the implementing agency E.Manufacturers'installation checklists have been completed F.Another method allowed by 527 CMR 9.00. Please specify 2.Tank Leak Detection Tank Tank Tank Tank Tank (mark only one) A. Double-wall tank- Interstitial monitoring ® ❑ ❑ B.Approved in-tank monitor ❑ ❑ ❑ ❑ ❑ C.Soil vapor monitoring (check one below) ❑ El El ❑ Monthly I ' Continuous E. Inventory record-keeping and tank testing ❑ ❑ ❑ ❑ ❑ _ 1 F. Other method allowed by 527 CMR 9.00. Please specify Page Tank-identification Number(cont.) Tank No. Tank No. Tank No.3 Tank No. Tank No. Piping Piping Piping Piping Piping +3. Piping Leak Detection (mark only one) A.Pressurized ® ❑ ❑ ❑ ❑ a. Interstitial space monitor ❑ El ❑ b. Product line leak detector El ❑ oo (mark all that apply below) I Automatic flow restrictor' I Automatic shut-off device' Continuous alarm' Also requires annual test of device and piping tightness test or monthly vapor monitoring of soil. B. Suction: Check valve at tank only ❑ ❑ ❑ ❑ ❑ (Requires interstitial space monitor or line tightness test every three years) I Interstitial space monitor 1 Line tightness test C. Suction: Check valve at dispenser only ❑ ❑ ❑ ❑ ❑ (No monitor required) D. Other method allowed by 527 CMR 9.00. Please specify �•��{q 4. Date of last tightness test (tank & piping) q Q io �tja!�" ,- +1-�- I 5. Gravity feed piping ❑ VA ❑ NSA ❑ ❑ ❑ 6.Spill containment and overfill protection Tank Tank Tank Tank Tank � A. Spill containment device installed ❑ ® ® ❑ ❑ B.Overfill prevention device installed ® ® ® ❑ ❑ 7. Daily Inventory Control (mark only one) A. Manual gauging by stick and records ❑ ❑ ❑ ❑ ❑ reconciliation B. Mechanical tank gauge and records ❑ ❑ ❑ ❑ ❑ reconciliation C. Automatic gauging system Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping t3. Cathodic Protection (if applicable) ❑ ❑ ❑ ❑ ❑ El ❑ El ❑ ElA. Sacrificial Anode Type B. Impressed Current Type ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 C. Date of Last Test Certification of Compliance No.: 1 oga x1. CERTIFICATION (Read and sign after completing all sections) NOTE:Both the copy being sent to the Not.of Fire services and the copy retained by the local fire department must be signed separately. A photocopied signature will not be accepted on either documcnL I declare under penalty of perjury that I have personally examined and am familiar with the Information subrruhed In this and all attached documents,and that based on my Inquiry of those individuals immediately responsible for obtaining the Wormalion,I believe that the submltcd Informailon is true,accurate,and complete. Name and official Glle of owner or owner's auihorlu:d representative(Print) Signature Date. IC`.S 5 LJ , 1 1(7) T �I�1 c +1�1LlZ�t° c r - - - Page 5 fi Q r$ '' Date: 3- �� I TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: rA I n. � ^� BUSINESS LOCATION: 315 NS MAILINGADDRESS: Mail To: TELEPHONE NUMBER: 1�1U �1 I I$ Board of Health II __� nn Town of Barnstable CONTACT PERSON: STD N i P.O. Box 534 EMERGENCY CONTAC TELEPHONE NgMI�BER: � - �� Hyannis, MA 02601 TYPEOFBUSINESS: �,3o�tsw� [ C Does your fir store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS .The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. \Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils �� Pesticides STNEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Slops _ O unsatisfactory- 4.Manufacturers COMPANY ��u�ud �' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 3" S GetrKAb 0z) Class: 7.Miscellaneous A'�wU QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots ]Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: l ply j Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic X Synthetic Organics: degreasers L4jb yo_ vt / .2- X Miscellaneou — / 2 ref s A,c,u S-e Addt DISPOSAURECLAMATION REMARKS: 1 nitary Sewage 2.Water Supply ZTown Sewer )'ublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES—)< NO ORDERS: O Holding tank: MDC Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person (s) Int ewed Inspector Date Mike's Petroleum Service Inc. I 15 Jan Sebastian Way 3 Sandwich, Ma 02563 508-888-8785 800-564-031.1 fax 508-833-0186 1.2117/ 7 Hyannis Fire Department 95 High School Road Ext. Hyannis, MA 02601 To Whom It May Concern: This letter is in regards to Cumberland Farms #2073, located at 375 Barnstable Road, Hyannis, M.A. We precision tested three product lines at this site on December,l; The test was completed in strict compliance with the latest CMR-9, Federal, anU� ' uirements. We also tested three crash valves and three leak detectors for operation.'y NN p The lines did meet NFPA requirements. ?s The crash valves and leak,detectors are operational. Enclosed you will find: 1 - a copy of the line test results If you should have any further questions, please call us at the above noted number. Very Truly Yours, Mike's Petroleum Service Inc Michael R Camara President Enclosure cc: BCBOH Richard Etzold -y r PAGE 1 Pf ..:J TITE LINE TEST ' X " DATA CHART DATE:-----------11/17/97---------------- CONTRACTOR: LOCATION: Cumberland Farms,#2073 Mike's Petroleum Service Inc. ADDRESS: 375 Barnstable Road 15 Jan Sebastian Way TOWN: Hyannis Sandwich, Ma 02563 STATE Ma ZIP: 02601 508-888-8785 / 800-564-0311 CONTACT: Richard Etzold REASON FOR TEST: CMR-9 IS TANK TEST BEING CONDUCTED WITH LINE TEST: NO TYPE OF SYSTEM: Pressure DISPENSER/PUMP MANUFACTURER: G&B WEATHER: 50's COMMENTS: Tested 2 Lines 1-11: IDENTIFY EACH LINE AS TESTED: Regular DATE: 12117197 ------------------------------------------------------------------------------------------------------------ 12.) 13.) 14.) PRESSURE 15.) VOLUME . LOG OF PSI READING TIME: TEST _________________________________ NET PROCEDURES BEFORE AFTER BEFORE AFTER CHANGE ----------- 2 55 PM Start Expansion Test 90.0 0.0900 3.25 PM 65.0 90.0 0.0900 0.0420 -0.0480 Drop to 60 LB test 60.0 3.40 PM 56.0 60.0 0.0780 0.0750 -0.0030 3.55 PM 54.0 60.0 0.0700 0.0660 -0.0040 4.10 PM 56.0 60.0 0.0630 0.0610 -0.0020 4.25 PM 56.0 60.0 0.0600 0.0590 -0.0010 4.40 PM 56.0 60.0 0.0580 0.0570 -0.0010 BLEED BACK 60.0 0.0 0.0000 0.0995 0.0995 PIPE LENGTH 60 BLEED BACK CALCULATION=(PIPE LENGHT*.0053)+.05 BLEED BACK NOT TO EXCEED 0.368 LINE PASS OR FAIL (RATE IN GALLONS PER HOUR): PASS -0.008 LINE LEAK DETECTOR OPERATIONAL: YES 2-11: IDENTIFY EACH LINE AS TESTED: SUPER DATE: 12117197 ------------------------------------------------------------------------------------------------------------ _ 12.) 13.) 14.) PRESSURE 15.) VOLUME LOG OF PSI READING TIME: TEST _________________________________ NET PROCEDURES BEFORE AFTER BEFORE AFTER CHANGE --------------------------------------------------------------------- --------------------------------------------------------------------- 2.55 PM Start Expansion Test 90.0 0.0420 3:15 PM 62.0 90.0 0.0420 0.0220 -0.0200 Drop to 60 LB test 0.0750 3.40 PM 50.0 60.0 0.0750 0.0700 -0.0050 3.55 PM 56.0 60.0 0.0660 0.0630 -0.0030 4.10 PM 58.0 60.0 0.0610 0.0600 -0.0010 4.25 PM 58.0 60.0 0.0590 0.0580 -0.0010 4:40 PM 58.0 60.0 0.0570 0.0560 -0.0010 BLEED BACK 60.0 0.0 0.0000 0.1400 0.1400 PIPE LENGTH 50 BLEED BACK CALCULATION=(PIPE LENGHT*.0053)+.05 BLEED BACK NOT TO EXCEED 0.315 LINE PASS OR FAIL (RATE IN GALLONS PER HOUR): PASS -0.006 LINE LEAK DETECTOR OPERATIONAL• YES Y TINKNOLOGY - NDE P 22 December 1997 Lo `0 Hyannis Fire Department 95 High School Road Hyannis, MA 02601 Dear Fire Prevention Officer: Enclosed, please find-copies-of thereport for tanks, line and/or leak detector testing at the following Cumberland Farms service stations: Location #2073-375 Barnstable Road If you have any questions, please call this office at (800) 666-2605. Sincerely, Tanknology-NDE Corporation cc: Cumberland Farms, Inc. Richard Etzold enclosure PIS HYANNIS FIRE DEPARTMILi.;( : 5 HIGH sctioo1 °0. :tT YANNIS, �A caul 39 Sullivan Street • Springfield, Massachusetts, 01104. 1 (800) 666-2605 • Fax (413) 733-7972 • Phone (413).733-7900 CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING T NKNOLOGY-NDE TANKNOLOGY-NDE ' 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: pTK—gg PURPOSE: COMPLIANCE TEST DATE:� WORK ORDER NUMBER: 7106999 I / CLIENT: CUPggERLAND FARMS SITE: CUMBERLAND FARMS�2O777 DEDHAM STREET 37-5 BARNSTABLE R CANTON, MA 02021 HYANNIS, MA 02601 ATTN: RICHIE ETZOLD The following test(s)were conducted at the site above in accordance with all applicable portions of Federal,NFPA and local regulations Line and Leak Detector Tests ::,...,:.. �.�:. ... ....., ... ........' :.,,..:• ;.f.. ,t .V�lA�1�F� MFs.. ..`:�'=iSr6C';{° - F.p»c:'�'��7ii `�t<;f��•%.'.���'�'� LEAWfy`: .........:... fY .... ........ ..... ....... v .::....,.... ..«.Y y�........ .. ..........:..».:..................... ...:....» .:,.R:..::::. r..:.»:..:::: :..y:.ny»:.,.:,. ...w yr �y� »::: ........:��s■� ...::::.:...::::..........l�.l�.l� ra..:::,:::....:.........,.....:. .:.::...:...:..n:. .:.:::nr.::tf::...»:.. ..S.a .;h...�.....,,:}��1 .. ...,:.:..co-»..w........................... .:.:.....::.:...r..�:h.t.r ,.::�F��Iw��:� ,.w,r„». .::..�:».t..•,.�:..»,.»{».,,..,�::,n,..•.��•.•.�,»:».�.tyrA,��{,�.,.�, ,,..,.�..��r., .;�,,�.�.{ ,r>:6r,.�;wf.:.»„ . 'f���,�.;; <<> SLAVE 1 REG UNLEAD 2 REG UNLEAD 0.000 P Y P 3 SUPER 0.000 P Y P Tanknology-NDE appreciates the opportunity to serve you,and looks forward to working with you in the future.Please call any time,day or night when you need us. TANKNOLOGY-NDE Representative: Services conducted by: TOM PRESNAL LUIS_F. RAMOS,—JR v Reviewed: Technician Certification Number: 30i5 Printed.12/12 97 11:03 KOHLMEYER , I Y INDIVIDUAL TANK/LINE/LEAK DETECTOR TEST REPORT TEST DATE: 12/09/97 WORK ORDER NUMBER: 7106999 CLIENT:r CUMBERLAND FARMS SITE: CUMBERLAND FARMS 2073 ........................... .........................,.................................::.,,::.::.:a„:o..,...r..........�+::.::: .c.. ....�::SS"Yt :,..:.".n...'i;'s;%;:z:: .::'C:^>n.:`.:t Tank ID: 2 Material: Dw FIBERG Bottom to top fill in inches: Product: REG UNLEAD Tank manifolded: YES Bottom to grade fill in inches: Capacity in gallons: 9,684 Vent manifolded: YES Fill pipe length in inches: Diameter in inches: 89.00 Vapor recovery manifolded: YES Fill pipe diameter in inches: 4.0 Length in inches: 364 Impact Valves Operational:y Stage I vapor recovery: DUAL Tank age(years): Overfill protection:yES Stage II vapor recovery: ASSIST Fuel pure rating: Overspill protection:yEs Installed: ATG COMMENTS e5t0 PSI at tank bottom: New/passed Failed/replaced New/passed Failed/replaced Fluid level in inches: L.D.#1 L.D.#1 L.D.#2 L.D.#2 UFT/OFT: Make: FE pETRO Fluid volume in gallons: Model: Hm Tank water level in inches: S/N: *********** Test time: Open time in sec: 3.00 Number of thermisters: Holding psi: 21 Specific gravity: Resiliancy cc: 185 Water table depth in inches: Test leak rate mUm: 441.0 Determined by(method): Metering psi: 16 Leak rate in gph: Calib. leak in gph: 7.00 Result: Results: PASS COMMENTS COMMENTS ULLAG __....,E 3EST:RESL[LTSTest: e _M thud C ��S f Test time: Material: ENvIRoFLEx Ullage volume: Diameter(in): 2.0 Ullage pressure: Length(ft): 60.0 Results: Test psi: 50 Bleedback cc: 30 DATA FOR UTS4T ONLY: Test time(min): 30 Test 1:Start time: 11:00 Time of test 1: Finish psi: so Temperature: Vol change cc: 0 Test 2:Start time: 11:io Flow rate(cfh): Finish psi: so Time of test 2: Vol change cc: 0 Test 3: Start time: 11:20 Temperature: Finish psi: so Flow rate(cfh): Vol change cc: 0 Time of test 3: Final gph: 0.000 Temperature: Result: PASS COMMENTS Flow rate(cfh): Pump type: PRESSURE Pump make. RED JACKET COMMENTS I Printed 12/12/97 11:03 KOHLMEYER 8900 SHOAL CREEK, BUILDING 200,AUSTIN,TEXAS 78757(512)451-6334 i i I t INDIVIDUAL TANK/LINE/LEAK DETECTOR TEST REPORT TEST DATE: 12/09/97 WORK ORDER NUMBER: 7106999 CLIENT? CUMBERLAND FARMS SITE: CUMBERLAND FARMS 2073 ..vvf:..yy^^.,k .;. .. r :. ......................^....�,.. ...:.r....,:.:.a. C,...^...<... ......s.....<. .. .,»l;.. .. 'u:Z, 'Lr'.... ...__......._ ..-..-,............_... »..r:::r;:or:::::..........v. . . .%;:8:.q.:::..........5�:..::^:<:........ry:.:a�:::«E:•n`<::r:^..<m sSi.:,<.rxi?;cy�E; Tank ID: 3 Material: Dw FIBERG Bottom to-top fill in inches: Product: SUPER Tank manifolded: NO Bottom to grade fill in inches: Capacity in gallons: 9,684 Vent manifolded: YES Fill pipe length in inches: Diameter in inches: 89.00 Vapor recovery manifolded:yES Fill pipe diameter in inches: 4.0 Length in inches: 364 Impact Valves Operational:y Stage I vapor recovery: DUAL Tank age(years): Overfill protection:yEs Stage II vapor recovery: ASSIST Fuel pure rating: Overspill protection:yEs Installed: ATG COMMENTS r.. , <..... , est. etho. .. .».....::.. ,..., GT R S L: .: « PSI at tank bottom: New/passed Failed/replaced New/passed Failed/replaced Fluid level in inches: L.D.#1 L.D.#1 L.D.#2 L.D.#2 LIFT/OFT: Make:F'E PETRO Fluid volume in gallons: Model: mw Tank water level in inches: S/N: +++++++++*+ Test time: Open time in sec: 3.00 Number of thermisters: Holding psi: 20 Specific gravity: Resiliancy cc: 180 Water table depth in inches: Test leak rate mVm: 441.0 Determined by(method): Metering psi: 16 Leak rate in gph: Calib. leak in gph: 7.00 Result: Results: PASS COMMENTS COMMENTS iILLAf3E TEST:, iiLTST st:fittett Test time: Material: ENVIROF= Ullage volume: Diameter(in): 2.0 Ullage pressure: Length(ft): 60.0 Results: Test psi: 50 Bleedback cc: 30 DATA FOR UTS4T ONLY: Test time(min): 30 Test 1:Start time: 11:05 Time of test 1: Finish psi: 5o Temperature: Vol change cc. 0 Test 2: Start time: 11:15 Flow rate(cfh): Finish psi: so Time of.test 2: Vol change cc: 0 Test 3: Start time: 11:25 Temperature: Finish psi: so Flow rate(cfh): Vol change cc: 0 - Time of test 3: Final gph: 0.000 Temperature: Result: PASS Flow rate (cfh): Pump type: PRESSURE COMMENTS Pump make: RED JACKET COMMENTS I Printed 12/12/97 11:03 KOHLMEYER 8900 SHOAL CREEK, BUILDING 200,AUSTIN,TEXAS 78757(512)451-6334 SITE DIAGRAM T N/YNOLOGY-NDE TANKNOLOGY-NDE 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 12/09/97 WORK ORDER NUMBER: 7106999 CLIENT: CUMBERLAND FPS SITE: CUMBERLAND FARMS 2073 BARNSTABLE7 ' • + wr winshield service_ ED—winshield service center center S F V I SUP ICE S F V I Rig [.GULF.]-` S F V I RJR CUMBERL_; AND FARMS A VEN #2073. Printed 12/12/97 11:03 KOHLMEYER Mail completed forms with test results to: Charlotte Stiefel, Barnstable County Dept. of Health &the Environment, Box 427, Barnstable, MA 02630 i TIGHTNESS TEST SUMMARY REPORTING FORM FOR BARNSTABLE COUNTY Testing company: Tankni)togy-NDE Phone: 1-512-451-6334 Date of test: 12i09i97 Site name: CUMBERLAND FARMS 2073 Location: 375 BARNSTABLE RD,HYANNIS Site phone: 508-790-7118 Name of contact person at site: m6r TANK TYPE OF PRODUCT TANK PUMP SYSTEM TEST SEPARATE TEST METHOD NAME LEAK RESULT: # SIZE TYPE (tank and lines LINE TEST RATE PASS/ (gals) -(E,N,P) together) Y/N Y/N (gph) FAIL I REG UNLEAD 9684 NONE No No NONE 2 REG UNLEAD 9684 PRESSURE No Yes PTK-88 3 SUPER 9684 PRESSURE No Yes PTK-88 LINE TYPE OF PRODUCT ORIGIN SEPARATE TEST METHOD NAME LINE PUMP LEAK RESULT: LEAK DETECT # AND DISPENSER (TANK TANK TEST TEST TYPE RATE PASS/ OPERATIONAL? LOCATION #) Y/N PSI -(E,N,P) (gph) FAIL Y/N or N/A 2 REG 2 PRESSURE PASS 3 SUPER 3 PRESSURE PASS I I I - i i I 'E=European suction system(only one check valve,at dispenser), N=non-European suction system(check valve at tank, P=pressurized system COMMENTS: ONLY LINE AND LD TEST................. L1JIS_F.RAMOS,411 certify that the above information is true and correct, and that the tests were carried out technician name and certification number n according to the testing equipment manufacturers' guidelines. Signature: d� �On1` Date: 12/09/97 r Mail completed forms with test results to: Charlotte Stiefel, Barnstable County Dept. of Health &the Environment, Box 427, Barnstable, MA 02630 TIGHTNESS TEST SUMMARY REPORTING FORM FOR BARNSTABLE COUNTY Testing company: Tanknology-NDE Phone: 1-512-451-6334 Date of test: 12/09/97 Site name: CUMBERLAND FARMS 2073 Location: 373 BARNSTABLE RD,HYANNIS Site phone: 508-790-7118 Name of contact person at site: mgr TANK TYPE OF PRODUCT TANK PUMP SYSTEM TEST SEPARATE TEST METHOD NAME LEAK RESULT: # SIZE TYPE (tank and lines LINE TEST RATE PASS/ (gals) -(E,N,P) together) Y/N Y/N (gph) FAIL I ItEG UNLEAD 9684 NONE No No NONE 2 REG UNLEAD 9684 PRESSURE No Yes PTK-88 3 SUPER 9684 PRESSURE No Yes PTK-88 LINE TYPE OF PRODUCT ORIGIN SEPARATE TEST METHOD NAME LINE PUMP LEAK RESULT: LEAK DETECT # AND DISPENSER (TANK TANK TEST TEST TYPE RATE PASS/ OPERATIONAL? LOCATION #) Y/N PSI "(E,N,P) (gph) FAIL Y/N or N/A 2 REG 2 PRESSURE PASS 3 SUPER 3 PRESSURE PASS 'E=European suction system(only one check valve,at dispenser), N=non-European suction system(check valve at tank, P=pressurized system COMMENTS: ONLY LINE AND LD TEST................. LUIS_F.RAMOS,-JR , certify that the above information is true and correct, and that the tests were carried out technician name and certification number !� according to the testing equipment manufacturers'guidelines. Signature: d�° i°"°` Date: 12/09/97 TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL' STORAGE REGISTRATION MAP .NO. 3D- PARCEL NO. IN ADDRESS OF TANK: 37!Y' 80.cns k,_ gk VILLAGE: N Numbdor atrw�t D I J MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 77.7 �e�C hum �/-, ma nZoz/ OWNER NAME: Cym Ap,rdc"_%j fcLg-lvn-s PHONE: INSTALLATION DATE: - Z7 BY: Cvrr/fie da d/ gamS 7,-,-_ INSTALLER ADDRESS: 3YE A&nS �llQ V�dC/�c.e� 'CERT.iJO. *TANK LOCATION: l Q' c aamora:as TANK LOQAT 2 N W 2 TN wQOPQCT TO aU S LD 2 NO) CAPACITY /0 TYPE OF TANK AGE _ _YRS. FUEL/CHEMICAL L ¢n� TESTING CERTIFICATION PQ PASS [ ] FAIL DATEllg� LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND Aek�orm-_ nsto-,yrr n4- ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED F.I RE DEPT. PERMIT ISSUED j 9 YES C ] NO. DATE CONSERVATION [�] CHECK IF�, N/A DATE BOARD OF HEALTH TAG NO. [ " ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE - UNDERGROUND ,FUEL AND CHEMICAL STORAGE REGISTRATION t. MAP 'NO. PARCEL NO. �//Q-` ADDRESS OF TANK: �� 61 =, '- .y l, EO — VILLAGE: �4 Number `Ytr�4" C ,j MAILING ADDRESS ( IF DIFFERENT FROM'-ABOVE) nti�g��'Y1_ A ,/)?O2l . OWNER NAME: PHONE: 00 t INSTALLATION DATE: BY: C�s-v, o� lr:� � 11Z r4r INSTALLER ADDRESS: t,'CERT.' . *TANK LOCATION: � (DCCOPtZaC TANK LOQATZO WSTH I�QOPQCT TO YUILDINO) CAPACITY_- TYPE OF TANK �� AGE �_YRS FUEL/CHEM I CAL .(n. l, rt TESTING CERTIFICATION [� PASS [ ] FAIL DATE �2s- LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND umnr. ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [>], YES [ ] NO DATE CONSERVATION [ un CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP. NO. _3j 0 PARCEL NO. //R o s ADDRESS OF TANK: .�7 � 8u, , ,��,`� ,. VILLAGE: Numb40r Ylr��t r MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : OWNER NAME: CL, i�����-=a' i �,;1 r� ,��� PHONE: INSTALLATION DATE: 3��7f (D BY: INSTALLER ADDRESS: J � t"�I����5 �� �1te��`nc.e.. �'CERT.1-JO. *TANK LOCATION: 1 A,, (DCmOii I aC TANK LOQAT I�N WITH RCOPCCT TO =U I LLD I NO) CAPACITY /0 90© TYPE OF TANK g i4411;k s S AGE � YRS. FUEL/CHEMICAL '6o Scb �` c_ r TESTING CERTIFICATION [�j PASS [ ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRANDu�� ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED (k] YES [ ] NO DATE el d0J CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE * PLEASE PROVIDE A SKETCH SHOWING THE .TANK LOCATION ON THE BACK OF. THIS CARD TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL 'STORAGE REGISTRATION MAP NO. PARCEL NO. l/9 ADDRESS OF TANK: 32 VILLAGE: • Number Ytr��t ' J LI MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : ,927 �o cha.m 15+ 1'ymx-n?ozl OWNER NAME: �y►�►1r1�/ra_ti./ aw rx� f2n c PHONE: INSTALLATION DATE: BY: �1�m/�eit.[ tivrt� �itL INSTALLER ADDRESS: 3N8 AilgeLS ALlQ -:a f,cYonce., -CERT.NO. *TANK LOCATION: .00 Td UL[ (DCmCFQ I nG TANK I-OQAT I ON W 2 TH mmama T TO nu S IUD I NO) CAPACITY TYPE OF TANK AGE -'&_YRS. FUEL/CHEMICAL b,Cr TESTING CERTIFICATION PASS [ ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND I�ldcL�/1� �n�; wr►pT ZONE OF CONTRIBUTION [ ] YES C ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED 90 YES C ] NO DATE CONSERVATION [)Q] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE - UNDERGROUND FUEL ,AND CHEMICAL STORAGE REGISTRATION t MAP/ NO. -3/ b PARCEL NO. 119 ADDRESS OF TANK: .32 �., n�{-ti/�,��_ r�/ . VILLAGE: Number Ybr��t r /�J C MAILING .ADDRESS -( IF DIFFERENT FROM ABOVE) : ',77 �o�t i� rr%o-0 F/ OWNER NAME: PHONE: INSTALLATION DATE: 3,/ 7A74 BY: INSTALLER ADDRESS: 'CERT.140. STANK LOCATION: �o�K �o ode 1./d_�esT" 7p ya.l�r;,o (DCmORi Z aG TANK t�OQAT I ON W Z TH RQOPQ�'T TO DU Z t�D I NO CAPACITY /D CVQ TYPE OF TANK.-rib . G AGE )&, _YRS. FUEL/CHEMICAL S0 4 n c_ TESTING CERTIFICATION (, PASS [ ] FA I L DATE �I/ZS /fib LEAK DETECTION [ ]. CHECK IFIN/A TYPE/RAND --);I?ALan�. ZONE OF .CONTRIBUTION [ ] YES [ A NO DATE TO BE REMOVED FIRE DEPT'. PERMIT ISSUED YES [ ] NO DATE CONSERVATION CHECK IF; N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE PLEASE PROVIDE A SKETCH SHOWI;NG• THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP/ NO. 3/ L) PARCEL NO. /r/ ADDRESS OF TANK: 3�5 <_�c�, •�?-t ,ti/�_ �IrL . �/ VILLAGE: << • L�-a MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 2,.� `4)r OWNER NAME: C;. . ,x -a [r, c PHONE: INSTALLATION DATE: 3/7711 h BY: C� roc is l� , / �"C• + ,�_ , T I NSTALLER ADDRESS: S'`� r4 m ZS /�do . !• �l�� .,r �_� -CERT.iJ0. *TANK LOCATION: "7ari� ocar�� C �� SPS � T �t �l.l .p (D C O Pi I a C TANK L O O A T Z ON W I T H R Q G P Q O T T O O U Z"D Z N O) CAPACITY /DODO TYPE OF TANK 4�60Z r,ss AGE YRS. FUEL/CHEMICAL r TESTING CERTIFICATION [X7 PASS [ ] FAIL DATE `9r Ib LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND )�I2AZOf10 .. "�,�1�i /A,0411,0 T" ZONE OF CONTRIBUTION [ ] YES C ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED CXI YES [ ] NO DATE CONSERVATION [A CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. .31D PARCEL NO. 11' 07 ADDRESS OF TANK: 32,S7- VILLAGE: I�VgAAI,<cn MAILING ADDRESS ( I F DIFFERENT FROM ABOVE) : 77� /LAr� �o► �n rna_ dZDZ OWNER NAME: Cl•.vn ./I_/anc� �Ac�m:R�. 2'�i e _ PHONE: 6/7- 8?-F-S/90 0 INSTALLATION DATE: Z7 BY: CcA-vn e �a-nc� ati yYV� . T nc__ INSTALLER ADDRESS: —Y? Aflens AUQ�. IL�V nc�� -CERT.NO. *TANK LOCATION: l c- ,ego -r,.A b 4a AV, %, (OCmonzam TANK LOOATZON WZTN QmPQCT TO au2LOINa) t CAPACITY TYPE OF TANK AGE �_YRS. FUEL/CHEMICAL 5 TESTING CERT I F I CAT I ON bo PASS [ ] FAIL DATE Sir'��f 4o LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ��a?rn�1a� L�1t1'Ylc h ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED �V] YES C ] NO DATE 1Z122�2 S� C/,I� %d 3116D CONSERVATION �J CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C ] . DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE �''UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. .3 /U PARCEL NO. IN ADDRE-SS OF TANK: 32.S' VILLAGE: Nuambwr MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 22,7 �/fir .-►� �a ►,-t-anr� rna c'7?!�� / OWNER NAME: rv. ►"moo /I (0 ^C1 -JQt AtM I Tn r PHONE: INSTALLATION DATE: (a BY: v-y) r5.Pd land' fo,A r-rr'►n =rc INSTALLER ADDRESS: .I/q'g AM t r,S A11Q.. —?,0- ni;, lOn ca kr -CERT.140. *TANK LOCATION: /o��� G ...tee f e.at lhcs /ta»� Aln (namom 2 aG TANK LOQAT=oN WITH QOPQCT TO 'U 2"o S NA".) 'a CAPAC I TY fT n TYPE OF TANK Q0prlc.jn-,S AGE 10 YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ PASS C ] FAIL DATE zS9G LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND Aex?nna— vrAg K' _ ZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED J FIRE DEPT. PERMIT ISSUED CV] YES [ ] NO DATE 1 Z/�z�� Fal/7, n/J )Z!?1/60 CONSERVATION 00 CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. PARCEL NO. ADDRESS OF TANK: VILLAGE: MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) OWNER NAME: PHONE: INSTALLATION DATE: BY: INSTALLER ADDRESS: 'CERT.1-40. *TANK LOCATION: CAPACITY TYPE OF TANK AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION PASS FAIL DATE LEAK DETECTION C ] .CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C I YES C I NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C;flj YES C I NO DATE CONSERVATION [;�] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD 7, Y A PARKING CALCULATIONS LEGAL - DESCRIPTION T A N K, D E T A I L S PLANT ING SCHEDULE RETAIL SA :� LES PROPOSED 34' X 37' CONCRETE PAD With qultclalm covenants the land In Hyannis. Barnstable. Barnstable County. Massachusett�!� one M per 200 sq. ft. of gross SYMBOL NAME , (SPECIES) No. SIZE - "�'PROPOSED 3' EXTRACTOR TUBE W/ 233-MSD-2422 VALVE floor area & 1 separate enterprise together with the buildings thereon situated on the comer ASS., OPW 233-VM W/ 53-M FLOAT OVERFILL PREVENTION of Barnstable Road and Lewis Street In said village consisting of two Youngstown Juniper 15 2' mature height (2) lots, bounded and described as follows, VALVE AND STAGE 11 VAPOR RECOVERY (2) 11 SPACES REQUIRED (Junipers h9riz. plumosa) PROPOSED 4' FILL RISER W/ OPW 61-T-4" DROP TUBE W/ VAPOR SEAL, 633-T TIGHT FILL CAP (2) (9\ Pfitzer's Juniper 19 18 24 high PROPOSED SPILL CONTAINMENT MANHOLE. MF G. TOTAL SPACES REQUIRED 11 SPACES (Juniperds chinensis pfitzeriana) PARCEL 1. 8 8 -------BW ING., MODEL 705-BG (25 GALLON) OR EOUIV. (2) -4- On the North by said Lewis Street -nine and 80/100 (59.80)feet., -1801 TAW LEVEL PARKING SPACES PROVIDED-7 SPACES On the East by.said Barnstable Road, fifty f A B C NOTE: __ _-PROPOSED FED JACKET ST On the South by Lot No. 10 on said plan, one hundred forty and 32/100 (140.32)feet 0 0 0­4 MONITOR, PROBE *FE400-333-5 (2) Mix 2 shovelfuls of peat moss or other organic material in each tree it PARKING SPACES PROVIDED 8 SPACES Being Lot No. 11 on a plan of building lots of Cape Cod Development Co., mix 1 shovelful of peat moss or other organic material In each shrub pit. It i AT GAS ISLANDS surveyed by H.L.Croker on March 21, 1922 and recorded with Barnstable 0 0 0-4--PROPOSED RED JACKET ST-1801 INTERSTITAL TAW ThrouMly mix In at moss Into roots of wIntercreeper ground cover. -333-5 (2) County Registry of Deeds, Plan Book 1, Page 103. MONITOR. PROBE #RE400 TOTAL SPACES PROVIDED 15 SPACES If sub-soil is very sandy, add *SOIL MOIST' polymer water retention gel PROPOSED SUBMERSIBLE PUMP w/ LEAK DETECTOR PARCEL 2 REDJACKET 1Y2 HORSEPOWER (2) crystals per manufacturers recommendations. Lot No. 10 shown on a plan of subdivision entitled '"Plan of Land in Hyannis of the Cape Cod Development Company, dated,March 21. 1922. by OPOSED FIBERGLASS SUMP,,MFG. BY FLUID CONTAINMENT Henn L Crocker, Surveyor" referred to hereiribefore and said lot being MODEL TE42-3 (2) situated on the Westerly side of Barnstable-Hyannis Road, said Lot having a frontage on said road of sixty (601 feet and a depth of PROPOSED 20 IN PROPOSED 4:1 DIA. SLOTTED OBSERVATION WELL (4) 3" SYPHON BAR approximately One Hundred Forty (1401 feet. PROPOSED 3'�- 10,000 GALLON (96" DIA. x 30'-91 AND For title see deed from Alma I E. Alberghini to us dated May 29, 1969, FIBERGLASS DOUBLE WALL GASOLINE STORAGE TANK. (TOP OF TAW IS 3'-0* BELOW GRADE AND LOT 58 recorded In Barnstable County Registry of Deeds In Book 1438, Page 509. BOTTOM OF TANK IS 11'-0 GRADE) NOT TO SCALE 44.3 X11, 44.4 44.0 44.2 PHOTOMEVRiic LIGHTING PLAN TANK INSTALLATION NOTES -------------- 0/ 44.5 443 NOTE, LEV9 5 ARE SHOWN IN FOOTCANIIES. WF GRAVEL DRIVE I 1. The underground gasoline storage tanks were Installed In the K. PORKKA month of 44.1 ------------ 2. All underground tanks to be double-walled fiberglass. N V 53' 18 'E 9.05 3. TANK" CONTENT CAPACITY LOT 50. gasoline tc.000 gallons A 442 N 04* 19 t 00 0 E 501T� 1 S1 ON 43.9 • B 0=11ne 46,OW gallons existing chain link fence- gasoline '40,000 gallons 43.7 C ----------- ------ ---- ------- ----------- ----- ---- 1.001, LOT 12 71 - 4. The Interstitial space of a double-walled tank shall be continuously 6 monitored (RED JACKET ST-1801 dry arnulus space probe *RE400-203-5) 1:1 Cl r_1 and be equipped with an audio and visual alarm system (RED JACKET prop.� 'asp It berm 43b ST-1801) see 'CURB DETAIL* proposed 3 10.000 gallon (960 dia. x 30'-91 underground El 1771 El 5. All supply lines are double-walled fiberglass, all vapor recovery and fiberglass double-wall gasoline storage tanks vent lines are single-walled fiberglass below grade and galvanized "_�(tv of tanks are T-0" below grade and 13 [3 6 schedule 40 above grade. 1.930 SQUARE FEET 16;� bottom of'tanks are 'IT-O" below grade) (see "TAW NOTES") A 6. Piping shall be designed and Installed to allow for testing without excessive excavation. ----- ------ - ---- -------------- existing 3 - 10,000 gal. u/g -- --------- steel gasoline storage tanks 7. Provide a float vent valve at the vent line In an extractable tee 0 (installed February 19, 1976) " 00 , 0 0 assembly (OPW parts 233-MSD with a 53VM- or equal) and an overfill 0) 1 container on the fill pipe EBW model* 705-BG, 25 gallon) to be removed proposed double-wall LOT 9 10, 8. A line. leak detector shall be provided on the discharge of a remote 1­� 0 0 pump. (RED JACKET ST-1801 double-walled piping and manway sump 5' conc. walk fiberglass fuel lines d I ----------- probe *RE 400-203-5.)�proposed stage 11 1 2 3 4 74--- -------- ­77 vapor recovery line 7 17. ----------- ;,60 9. There are 4 - 4" slotted PVC observation -wells. (1 a each comer of proposed 3' x 12' concrete gas CD ".7 the tank Installation.) N/F Island w/ 1 (2-hose) BLENDER rn 5'-C" 13'-0" & 1 service -R/OPERATOR: (day or night) Cf) & / � maid (2) �;_o=1�0 10. OWNE K. PORKKA 43 0 91 46'-0' 4' proposed 46' x 46' conc. pad Cumberland Farms, Inc. (hps) 53.00' I_(t v�6�) - ------- 777 Dedham Street Z: 8 9 proposed 28' x '46' canopy existing concrete gas Canton, Massachusetts 02021 43.1 T=�. Islands to be removed SCALE: N.T.S. (617) 828-4900 EXISTING BUILDING 42.8 C) exist. leaching pits (3) I cl� C.B. existing area lamp 12 pole sign 14 existing 6' x 8' LOCUS MAP existing asphalt paving- CURB DETAIL proposed 3' x 10' concrete .442 4 3411 19.98 gas Island with 1 r 43.7 432 U.P.-39 (2-hose) BLENDER (2) 43.0 42.4 43.4 x-- 43.9 43.7 43.2 LOT -10 �.M-cwter CB. Grate 43.1 existing asphalt berm Now= 43.0 v. 4Z.M asphalt curbing 42.7 ation E o�imat� IT 43.6 6" X 4729 38 42.4 Ovate main- pomt, iocatioo 4,qp r s;, - plppro)6mate INV. EEV. 35.96 0 RIM ELEV. 44.66 t. cLirb opening) 24.00 exist. existing conc. curb (t P.) (exist. curb OPening) e A.C. sar)itary sewer P!P 4 AD 154 R LE INV. ELEV. 3428 ST ,AB I asphalt pavement RIM ELEV. 42.28 A A tV5 LAYOUT WIDTH 4 - 4 T 14 UP A0 0 AD W Ow►L OR U.P.-37 L DRAINAGE CALCULATIONS THE DRAINAGE PATTERNS AND SYSTEMS ARE TO REMAIN AS THEY CURRENTLY EXIST. THE SITE CURRENTLY CONTAINS APPROX. 10,799.88 SQ. FT. (80%) OF IMPERVIOUS LOT AREA. THE REAR OF THE LOT DRAINS IN A NORTHEASTERLY DIRECTION TO AN EXISTING LEACHING PIT ON THE NORTHWEST SIDE OF THE LOT. THE FRONT PORTION OF THE LOT DRAINS TO TWO EXISTING LEACHING PITS LOCATED IN THE NORTHEASTERLY 375 BARNSTABLE ROAD LEWIS STREET AND SOUTHEASTERLY C014aS OF THE LOT. REVISIONS 13,397.20 SWARE FEET UNDER THE NEW PROPOSAL. THE IMPERVIOUS AREA WILL BE __V H ANNIS. MASSACHUSETTS DECREASED BY APPROX. 513.50 SQ. FT. (4%) AND THEREFORE 2-6-96 UPDATE PER CHECKLIST 0.31 ACRES THERE WILL BE LESS OF A DRAINAGE IMPACT THAN 2-28-96 ELIMINATE 1 CURB CUT 20.00' THAT WHICH CURRENTLY EXISTS TODAY. OWNER/OPERATOR Business Phone (800)255-9702 V# 742 oA February 2. 1996 _1 44.5 EXISTING SPOT GRADES 0 Store* 2295 0 /usr2/lInda/db.V742 DRAINAGE FLOW Gas Station* 852073 777 Dedham Street Canton. Massachusetts 02021 LAX. T _j P A N 1596-1133 A 4 i