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HomeMy WebLinkAbout0049 MAIN STREET (OST.) - Health (2) �q ma.�� s}�.ect-- t�zr►�- � 85-a2o- C� � / - - - - - - � � �C HP '08'201Ei'I'LIE 09:29 N FAX Fla. P. 005 The Commonwealth of Massachusetts �td Department of Public Safety 627 CMR 4.00 J-P rm Fo 1 [J'� A)1;TZ70, _9Z � Application for Permit, Perm Certificate Permit, and of Completion for the'Installation or Alteration of Fuel Oil B ment and the Storage of Fuel 'Oil Cente a'-Oster�+ili ,.M�'airstons Nfalls � ' or Town) (>aatc) 1�� 01920 Permit Vs; FD u Eiec. . FDID #: Fee Paid: Owner!Occu ant Name- Installation S p installation Address: Serviced Floor or Unit #: 6 - ❑Heating Unit ❑ mestic Water;7�0Power Vent U Other Burner: ©Existing Trade Name:. Mfg: - -- =- - Type: Model# or Size: Nozzle Size: 5Vue1 Oil q Kerbsefte a Waste 011'Ar - - Storage Tank: Cl N'ew xistix>tg.' Location: Gli Type: Capacity: ()O gallons .No. of Tanks: Special re ire ents(or additional,safety devices) &Z&z ® Z,0' . •} .;t. L Lms�cc�r U OSV Valve p 031 Line Protected, ❑Sheet Rock ❑Sprinkler 'AFLJE: q.yes lj no E. ym Ono mumacc at and Boilers) Water heated Co. Name: Address: 1111;26 City:Ake-C&O—�. Zip: Completion Date: .T /I Combustion Test: Oaross Stac emp.: Net St emp: COZ. B ch Draft: Smoke: rflre Draft: Efficiency Ra 1. the undersign certify that the installation of fuel burning equipment has been made In accordanec with M.G.L. e. 148 and 627 CMR 4:00 currently,in effect, Furthermore,tbis installation has been tested in accordance with such requirements,is now in proper operating conditiorx and complete Instructions as to its use and maintenance have been furnished to the person fnr whom the installation(or alteratto made: Installer: 4,4 Print Name Cert of Comp.# S mature(nos ) Address: , _U once signeaWy a fire t, a P torage and use of oil burn g pment. Approved Fay: hate C7 5 REFFA_f6 CH EC UON REVE:R9�SIDE; Form distribution:White:Fire Dept.(Application) Yellow: installation(Permit To Store) Pink:Installer(Permit To Install) This forrn approved by the State Fire Mmhai and provided aaurbesy of the Masss.01 Heat Cam& Pom deign In NCR by CptA and COMM Fire Depb. ' Jwy I,1W6 PERMIT EXPIRES 60 DAYS AFTER ISSUE DATE. 00=1i1"Ul 4 C-0-441 FIFE DEFT .. F-'. PIo..50:'' 112_85 1 Make application to focal Fire Department. P Fire Department retains original application ana issues duplicate as Parr-pit^ q F ::�\ .-� .. ( /,fy}•y2 i�'?.f�%'i�G�Cill�t�i1�L, �`��!t;ilr��f�?iLCtli � - j1 cJcr?:lnz� rl r �ialn,. na,r cr, -- ` jce r t✓ C� !t�lc�t =t,C�'i�f Lm r: tzb i DUI and IT39 r for storage tank renlovai and transportation to approved tank disposai yard in accordance 'oAtl"i F; provisiOlIS of M.G-L.Chaptar 148, Section 38A, 527 C;JOA 9.0iJ, appiicaLion is hereby made by: am Tank Owner �"t��'��Name( ease print) �'i i �.�,_ X AB U1P atpp%y{ng for pemal} Address_ t �• �i `�'— c'�`zg ,�r t 1 .. __� — 4 MY - biota =�-: + f iv ,l/Ud{'1\(v-S C1 Cu.or in. ual :ll�C it ! f�l�.� Company { Vv i: ,C Gti� p � Nam 1�� Prfnr Address r , l!�� �' pRn, 1—° AcjcJress %FT "-1•rcvv��ti t c3 }V J , C}Z cf? t^ /1 Signature iyIng for permit) Signature(if applying for permit) J 6 +F ert(fied Other_�._ i [IFCf"C=_rtified• LSF# Other Tank Location. �; _ ' ✓�. �` !�'`»' '-�'tU�/ :__ _ -� — Zl Substance Last Stored r Tank CRpactty(gallons) E`x'7 --- . l Tank C mensions,PamOer xlength) Remarks:._ Tt�.lY7 C��4r— Or If A ae e I Mrm transporting waste&iM'L(SC~�" �tC.��t' State Lie.si Hazardous waste manitEstk �; ERA.# —_-- - Approved tank ftpoaal ya d.— ark yard - =-� 1 Type ai finer 9-as �_Tanr Yarn attdress ( .�" � City o Town i lY. '1�'�V t 1 �. � _ - rDIG# _ A r Penn r r, � r � Gate of issue 1 � � �? _ Date of exp ration J r Cj D'sg ssic approval number ` l 'Jt� 4~. r Uig S e T oPl rrae'T I.N�!mt,er-5CU�82^-�tB4d 13i;r+ature;Tina f officer rran ,frn pe rrnit JI , ` After removal(s)t^Ganst rnpttve Jse 'uei"o!l tan is exE nptsd)senc Form FP 2 3QFs sig��jad try L4ocal Fire Dap[.to UST Regulatory �Jompllana-�Jnd,Qet)artnjent cif. F'.re Servlc s,P.Q.Box 111025,State Pont,Stow,MA 01775., -Intarnaticnal Fire :ode Institute FP-2f2(revised 4197). q` CENTERVILLE-OSTERVILLE-MARSTONS MILLS.FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508) 790-2375/FAX#(508) 790-2385 OILIHAZARDOUS MATERIAL RELEASE FORM F.A.# 09-0000453 LOCATION: ADDRESS OF RELEASE:" 49 Main Street 0sterville, MA 02655 DATE OF RELEASE: PRODUCT RELEASED: aso-Line . . . ESTIMATED QUANTITY: n nown CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: Notifications NOTIFICATIONS: FIRE DEPARTMENT:_YES(xx) NO( ) DATE: 2/13/09 TIME: 1146 . NATIONAL RESPONSE CENTER YES( ) NO( X)K DATE: TIME: DEPT. OF ENVIRONMENTAL PROTECTION YES�x) NO( ) DATE: TIME: Letter OIL SPILL COORDINATOR: YES( ) NO" DATE: TIME: TOWN BOARD OF HEALTH: YES(xj NO( ) DATE: 2/13/09 TIME: 1200hrs TOWN HARBORMASTER: YES(, ) NO" DATE: TIME: : OTHER AGENCIES: COMMENTS: See incident #09-0000453 for additional information REPORTED BY: `DATE: 2/2 5/2 oo9 COPY-FIRE DE ARTMENT COPY-D.E.P.. COPY-BOARD OF HEALTH , C-O-MM FORM#58 - - A MM DD yyyy ❑Delete NFIRS —1 ` 101920 U 1 02 1 1 131 1 20091 11 109-0000453 1 000 Change Basic FDID * State* Incident Date * Station Incident Number * Exposure ❑No Activity Check this box to Indicate that the address for this incident is provided on the Wildland Fire B ❑Module In Section B "Alternative Location Specification". Use only for Wildland fires. Census Tract I (— Location�c u ®Street address 49 ( I IMAIN ST ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of J ❑Rear of I OSTERVILLE ' I U 102655 I-1 � Apt./Suite/Room City State Zip Code ❑Adjacent to I I ❑Direction Cross street or directions, as applicable C Incident Type * El Date & Times Midnight is 0000 E2 Shift & Alarms 411 (Gasoline or other flammable I check boxes if Month Day Year Hr Min Sec Local option dates are the Incident Type same as Alarm ALARM always required In I C� 1 Aid Given or Received* Date. Alarm * 02 13 ' 2009 j11:46:03 I 1 I D Shift or Alarms District Platoon ARRIVAL required, unless canceled or di&not arrive 1 ❑Mutual aid received 'UI ❑ Arrival * 02 13 120� 11� •47:07 E3 2 ❑Automatic aid reCV. Their eDin Their State CCNTROLLED Optional., Except for wildland fires Special Studies 3 ❑Mutual aid given I I - 4 ❑Automatic aid given I I ❑Controlled " I�� I 11 I Local option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I 1� N ❑ Incident Number Last Unit 02 13 2009 12:23:35 StudyalD# Study None u u 1 I I ❑ Cleared F Actions Taken G1 Resources G2 Estimated Dollar Losses & -Values ❑ Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or 82 INotify other agencies. I Personnel form is used. for non fires. None Primary Action Taken (1) I Apparatus Personnel Property $1 , 000 J . 0001El B0 (Information, Suppression $ �� �—� I ( contents • I , 000 000 ❑ Addition (lal Action Taken (2) EMS PRE—INCIDENT VALUE: Optional I I I Other 0001 I 0001 I Property $1 r 000 1 000 ❑ Additional Action Taken (3) ❑ Check box if resource counts $1 ' include aid received resources. Contents 000 i 000 ❑ Completed Modules H1*Casualties❑None H 3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ❑None NN Not Mixed 10 Assembly use Structure-3 Fire 1 II I I II ow leak, no evaoation er Ha:Mi actions a Service I ❑Natural Gas: .l 20 Education use ane gas: <2a lb. tank (as in home BBQ grill) 33 Medical use ❑Fire Serv. Cas.-5 civilianL_____j I� 1 3 ❑Gasoline: vehiole feel tank or portable container 40 Residential use ❑EMS-6 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores Detector 53. Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 []Diesel fuel/fuel oil:,,ehicle fuel tank or portable 58 Bus. & Residential ❑ ❑Detector alerted occupants ❑ ome Wildland Fire-6 6 [-]Household h /office spill, aleanep only 59 Office use 1 QApparatus-9 7 ❑Motor oil: from engine or portable container 60 industrial use QPersonnel-10 2❑Detector did not alert them 8 []Paint: from paint cane totaling< 55 gallons 65 Farm Military are use ❑Arson-il U❑Unknown 0 ❑Other: Speoial HaxMat actions required o spill>559a1., 00 Other mixed use Pleascomplete the HazMat form J Property Use* Structures 341❑Clinic,clinic type infirmary 53 9 ❑Household goods,sales,repairs ' 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 [:]Church, place of worship 3 61❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 41 9®1-or 2-family dwelling 599 ❑Business office 162 ❑Bar/Tavern or nightclub 42 9❑Multi-family dwelling 615 [:]Electric generating plant 213 ❑Elementary school or kindergarten 4.3 9❑Rooming/boarding house 62 9 ❑Laboratory/science lab 215 [-]High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 []College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 4 64❑Dormitory/barracks B82 []Non-residential parking garage 331 ❑Hospital 519❑Food and beverage sales 891 ❑warehouse Outside 936❑vacant lot 981 ❑Construction site 124 ❑Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river., stream; 669 []Forest (timberland) 951 ❑Railroad right of way Lookup and enter a Property use code only if g y you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 [:]Other street Property Use 1419 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling I NFIRS-1 Revision 03 11 99 m oon noiigi,)nno no—nnnna,;i - MM DD YYYY 1 01920 1 U 1 21 13 2009 1 1 09-0000453 1 L001 Complete `r FDID * State* Incident Date * Station Incident Number * Exposure * Narrative f Narrative: Caller Name : FPO MACNEELY OIC : MACNEELY Pats. . 0 rcrosby 2009/02/13 12:10:07 - 329 AT EVENT MANNING IS 1 rcrosby 2009/02/13 12:13:03 UNDERGROUND TANK REMOVAL - REQUEST .BOH rcrosby ; 2009/02/13 12:23:32 CONTRACTORS WAITING FOR BOH 329 on location for removal of 120 gallon ust with unknown product. Tank currently contains seawater as it in a marsh location to the rear of the property on side A/B of the boat house. The tank likely previously contained gasoline. Upon removal no obvious holes found in tank (see attached photos) . However,1 as water from the marsh filled back in the excavated site what appears to be a petroleum sheen would also show in the water. An LSP John . Tadema-Wielandt from Bennent Environmental Associates (508.) 896-1706 took prliminary soil samples which showed readings as high as 29ppm. Those numbers would require further testing and analysis to determine extent of contamination. The Barnstable Board of Health was notified by dispatch with an eta of 30 to 45 minutes. No further action by FD 329 cleared scene. 02/23/2009 15:08:30 mmacneely ----- ^•'•-` nio9n 02/13/2009 09-000045 �(1 person/Entity Involved 1 71 1 Local Option Business name (if applicable) - Area Code Phone Number ❑Check This Box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Iu I I Then skip the three duplicate address Number prefix Street or Highway - Street Type Suffix lines. I ' L Post Office Box _ Apt./Suite/Room City State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-IS) as necessary K2 Owner Same as person involved? Then check this b skip section. The rest of this section. Local Option Business name (if Applicable) I I Area Code Phone Number Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three duplicate address Number Prefix Street or Highway � Street Type Suffix lines. I I I I (Post Office Box ( Apt./Suite/Room City State Zip Code [j Remarks Local Option Caller Name FPO MACNEELY OIC : MACNEELY Pats. : 0 rcrosby 2009/02/13 12:10:07 =, 329 AT EVENT MANNING IS 1 rcrosby 2009/02/13 12:13:03 UNDERGROUND TANK REMOVAL - REQUEST. BOH rcrosby ; 2009/02/13 12:23:32 CONTRACTORS WAITING FOR BOH 329 on location for removal of 120 gallon ust with unknown product. Tank currently contains seawater as it in a marsh location to the rear of the property-on side A/B of the boat house. The tank likely previously contained gasoline. Upon removal no obvious holes found in tank (see attached photos) . However, as water from the marsh filled back in the excavated site what appears to be a petroleum sheen would also show in the water. An LSP John Tadema-Wielandt from Bennent Environmental Associates (508) 896-1706 took prliminary soil samples which showed readings,as high as 29ppm. Those numbers would require further testing and analysis to determine extent of contamination. The Barnstable Board of Health was notified by dispatch with an eta of 30 to 45 minutes. No further action by FD 329 cleared scene. � F L Authorization 18350 I IMACNEELY, MARTIN 0. ISR. INSPEC I I I1 021 LL3j2009 Officer in charge ID Signature Position or rank - Assignment Month Day Year ameif® 18350 I MACNEELY, MARTI SR. SPEC I I �J u 2009 il Member makin re ort ID Si n re Posit n A' or rassignment Month Day Year is Officer 9 P 9 .n charge. r�......,.4 ni QW) - m ii'i i,?nna no_nonna cZ