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Certified Sourcing POST-CONSUMER
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S"1290
MADE IN USA
GET ORGANIZED AT SMEAD.COM
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DATA
I plan to rarma tank and make it above ground bp the fall.
TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: f1 , 14
J� MAP NO. jj PARCEL NO.
OWNER NAME: � c = VILLAGE: _ .
INSTALLATION DATE: . % ��' t ---
ADD-
° TANK INFORMATION
LOCATION OF TANK: e`
CAPACITY /e' 6 '' ' n TYPE �C t { (( ��AGE FUEL/CHEMICAL n_r�
TESTING CERTIFICATION I ] PASS E ] FAIL DATE
LEAK DETECTION E ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION E ] YES. E ] ..NO. . -DATE TO' BE REMOVED
FIRE DEPT. PERMIT ISSUED, C ] YES. C ` ] NO DATE
CONSERVATION E ] CHECK IF .N/A DATE "
BOARD OF HEALTH STAG .NO. fi ]E - ]C ]E. . ] DATE ti.J 'I
PLEASE PROVIDE'A SKETCH .SHOWING. THE TANK. LOCATION. ON THE'IBACK: OF .TH'I S ,CARD
.,R„�.4 ,. ,. .,._,".r,e t.s.a ': `.cd�-.'�,c�k.:Lk .i'G2..+`z!.,,.. r..F2 . .✓. �..,.:�S.x.. t s� t....,.. ..5:r ,... .. .�.,. .„ _.._9 ... . ki „-.....n,.W.^. - -. ., ....
891 Main Street, Osterville
Health Division Comments
Underground Fuel Storage Tank- Contents were emptied completely and
the tank was abandoned in place after a permit was issued to do so by Lt.
Martin McNeely of the Centerville-Osterville- Marstons Mills Fire
Department (permit dated June 4, 1998). Sampling and analyses indicated
there was no contamination below the tank itself. The tank was filled with
cement slurry in accordance with MGL Chapter 148 Section 38A and 527
CMR 9.00.
Septic System - The septic system was upgraded to meet Title V. The
disposal works construction permit number is 95-814 dated 3/29/95 issued to
Walter Lewis.
Contamination- When the tank was accidentally over-filled on January 21,
1998, the oil spilled and traveled over the top of the pavement and across the
property line into #885 Main Street Osterville. The oil spill contamination
was removed from both properties (891 and 885) in strict accordance with the
standards of DEP during April 1998.
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Date: Z-sd 2�
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: u ` e-- l
BUSINESS LOCATION:
MAILING ADDRESS: Mail To:
TELEPHONE NUMBER: - Board of Health l Town of Barnstable
CONTACT PERSON: eo agitr P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPEOFBUSINESS:_ _Cet `Lj &-
Does your firm 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 otherthan 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(forgasoline orcoolant 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
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil __L--PdEW ✓USED
Other petroleum products: grease, 24 f,&'/Photochemicals (Developer)
lubricants, gear oil _ SEW i-� 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 R `
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
Z)
Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: J TIMID 1 O O
BUSINESS LOCATION: S'll XI AIAI 57. 05WY1LLEf. MA 0269 �<
MAILINGADDRESS: I MA/145 L[.EFrA4 02 Mail To:
TELEPHONE NUMBER:
Board of Health
��o�) �2 � ' ?7� � Town of Barnstable
CONTACT PERSON: 'j
EMERGENCY CONTACT TELEPHONE NUMBER: 737 ^ 630Hyannis, MA 92691
TYPEOFBUSINESS: jCP7-A1L o2Uc� MGin S�Yee
Does your firm 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
NEW 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 fluidsNod � &L 04-
hSiq
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
c/
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
, p ,O unsatisfactory- 4.Manufacturers
COMPANY T,t / a + (see"Orders") 5.Retail
etaFuel 8u p]ers
ADDRESS Class: 7 .7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIAL Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
,. asoline;duel_(A)
Heavy Oils:
was _uiot& -eiLQ
tr draulic
Synthetic Organics:
degreasers
Miscellaneous:
. ,
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply Z-1 41k.,
O Town Sewer A Pub lic
&On-site OPrivate
3. Indoor F1oor.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
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
d YES NO
2.
Person (s) Interviewed Inspector Date
a 06-04-1998 04:20F'rit CENT DST FIREDEPT 50B7902385 P.02
make appucauen ►o rvca. le uepartmen`
Fire Department retains original application;and issues dupliieate as Permit.
e •
APPLICATION and PERMIT l i0.00
for storage tank remcv-,l and transportation to,approved tank disposal yard in accordance with'the provisions
of M.G.L. Chapter 148,Secton 38A, 527 CMR 9.00, application is hereby made by:
MUG-
Tank Owner Name(p6easee print) Walcott Ames x
15vwule Apflying fm pe-9
Address 891 Main Street, Osterville,MA
sneer Qw ` snare r�
• • . . . _
Coma Name Advanced Environmental Advanc_d Envirenrtent:al
Company Pmr Co. or Individual
P»m
Address I.O. Box 472, S. Dennis, MA Address
P�� r
Signature Signature(if applying er cermit)
G IFCI Certify Other 1✓ Z; IFCI Certified = _S=w Other
•riotrtIT.
Tank Location 891 Main Street, Oscerville, MA
S1ear,4ddm—, r y
Tank Capacity(gallcrs: 11000 Substance Last Stores #2 Fuel Oil
Tank Dimensions x length)
Remarks: 11/ PYZQC
FirFtransporritngwarze Advanced Environmental State Lic.# MV5083856100
Hazardous waste mar:ib`=
Approved tank dispcs*9yard Abandon in place Tank yard#
Type of inert gas Tank yard address
Centerville 01920
City or Town FDID# Permit#
Date of issue June 4, 1998 Date of expiration Juge 18, 1998
Dig safe approval number. 981702329 Pig S#Toll:,—_) tuber-860-322-4844
Signature/Tilde of 011cer=nting permit
�A& I V .
After removal(s)send F:^_r FP-290A signed by Local Fire Dept.to UST Regulatory Complierxa Jnit, One Ashburton Place,
Room 1310, Boston,AM M::-8-1618.
FP-M(revised 91961
TOTAL P.02
�,,py
f
�.
� _ _ t
TANKS] 81 FUEL STORAGE TANK RECORDS ] HELP [ ]
FOR PARCEL NBR: 1171 0401 ] ] MAIN ACTION I]
Action Tank Nbr Tag Nbr Installed Location ----Notification Dates-----
[ ] [ 11 [ 2661 [0101701 [B ] Test 0214971 Rem 0706931
---- Test --- andoned-- -- Removed -- -- Variance -
[1] [0529971 [ [,060498] [ ] [ ] [ ] [ ]
Fuel Reason Capacity Constr Status Leak-Det Cath-Det
[D ] [H ] [ 1000] [SS] [TP] [N] [N]
Additional Details [ABANDON ]
--------------------------------------------------------------------------------
Action Tank Nbr Tag Nbr Installed Location ----Notification Dates-----
[ ] [ ] [ ] [ ] [ ] Test ] Rem ]
---- Test --- --Abandoned-- -- Removed -- -- Variance -
Fuel Reason Capacity Constr Status Leak-Det Cath-Det
[ ] [ ] [ ] [ ] [ ] [ ] [ ]
Additional Details [ ]
--------------------------------------------------------------------------------
Cancel [ ]
END OF DATA
NEXT SCREEN [HMENU] ACTION [ ]
PARCEL NBR [ ] [ ] [ ] ] TANK NBR [ ]
[ ]
7
f
TANKS] 81 FUEL STORAGE TANK RECORDS ] HELP [ ]
FOR PARCEL NBR: 1171 0401 ] ] MAIN ACTION I]
Action Tank Nbr Tag Nbr Installed Location -- Notification Dates-----
[ ] [ 11 [ 2661 [0101701 [B ] Test 0214971 Rem 0706931
---- Test --- --Abandoned-- -- Removed -- -- Variance -
[1] [0529971 [ ] [0604981 [ ] [ ] [ ] [ ]
Fuel Reason Capacity Constr Status Leak-Det Cath-Det
[D ] [H ] [ 10001 [SS] [TP] [N] [N]
Additional Details [ABANDON ]
--------------------------------------------------------------------------------
Action Tank Nbr Tag Nbr Installed Location ----Notification Dates-----
[ ] [ ] [ ] . [ ] [ ] Test ] Rem ]
---- Test -- --Abandoned-- -- Removed -- -- Variance -
Fuel Reason Capacity Constr Status Leak-Det Cath-Det
[ ] [ ] [ ] [ ] . [ ] [ ] [ ]
Additional Details [ ]
-----------------------------------------=--------------------------------------
Cancel [ ]
END OF DATA t
NEXT SCREEN [HMENU] ACTION [ ]
PARCEL NBR [ ] [ ] [ ] ] TANK NBR [ ]
a
east cape engineering, inc.
44 Route 28
P.O. Box 1525
CIVIL ENGINEERING Orleans, Mass.02653 LAND SURVEYING
WATER RESOURCES LAND COURT
ENVIRONMENTAL 508-255-7120 SITE PLANNING
SANITARY CERTIFIED PLANS
STRUCTURAL Fax 508-255-3176
WATERFRONT
December 23 , 1998
Barnstable Board of Health
P.O. Box 534
Hyannis , MA 02601
Members of the Board:
RE: Notification of Submittal of a Response Action Outcome
Statement for 885 Main Street, Osterville, MA
Dear Mr. Anderson:
This letter is intended to provide notification to the Town
of Barnstable that a Response Action Outcome Statement has been
completed in accordance with the Massachusetts Contingency Plan
for the property located at 885 Main Street, Osterville, under
Release Tracking Number 4-13616 .
A spill consisting of No.2 fuel . oil occurred at this site
and reported to the MaDEP as a 2 hour notification. The owner of
the site failed to provide proper notification and, therefore,
the Board of Health notified DEP based on complaints by the
responsible party ' s neighbor . The spill occurred in January
1998 .
T
An Immediate Response Action was taken at the site to remove
contaminated soil in April ' 98 and the Response Action Outcome
Statement closed the site as a Class A-2 RAO. Copies of this
report are available from East Cape Engineering, Inc .
Any questions should be directed to Mark A. McKenzie , L.S.P.
Sincerely,
/*�
Mark A. McKenzie, P.E. ,L.S .P.
Treas . - East Cape Engineering, Inc.
MAM:jlo
_ s
r _ IMETown of Barnstable
Department of Health, Safety, and Environmental Services
+ BAMSTABLE,
0 9. � Public Health Division
�EDN1�A P.O. Box 534, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
June 3, 1998
Mr.Mark A. McKenzie,P.E.,L.S.P.
East Cape Engineering,Inc.
44 Route 28,
P.O.Box 1525
Orleans,MA 02653
RE: 891 Main Street,Osterville
Dear Mr.McKenzie,
Upon review of your letter requesting abandonment of the 1000 gallon underground storage tank at the
above referenced property,it appears that the confirmatory sampling/analyses indicate no apparent release
below the tank itself.
Therefore,the tank may be abandoned-in-place as long as Centerville-Osterville-Marstons Mills Fire
Department concurs.
Sincerely,
Thomas A.McKean,
Director of Public Health
cc: Glenn Wilcox
C-O-MM Fire Department
Arthur McCormic, Advanced Environmental.
4
COMMONWEALTH OF MASSACHUSETTS
a EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
m a DEPARTMENT OF ENVIRONMENTAL PROTECTION
SOUTHEAST REGIONAL OFFICE
' f t
q v
ARGEO PAUL CELLUCCI TRUDY CORE
Governor Secretary
DAVID B.STRUHS
Commissioner
Fly
Q
January 27, 1998
Mr. .- Wolcott Ames RE: BARNSTABLE-BWSC-ER
891. Main Street 891 Main Street
Osterville, MA 02655 - RTN# 4-13616
-NOTICE OF RESPONSIBILITY
M.G.L. c . 21E, 310 CMR 40 . 0000
ATTENTION: , Mr': Antes
On January 21, 1998 at- 1 : 30 p.m. the Department of
Environmental. Protection (the "Department".) received oral
notification of a release and/or threat of release of oil and/or
hazardous material at the above referenced property which requires
one or more response actions . The reported condition is as
follows :
During a transfer of oil - from an underground storage tank to
an above-ground storage tank at . the above indicated address;
approximately 30 gallons of petroleum .was spilled on the ground
surface.
The Massachusetts Oil and Hazardous Material Release
Prevention and Response Act, M.G.L. - c . 21E, and the Massachusetts
Contingency Plan (the "MCP" ) , 310 CMR 40 . 000.0, require the
performance of response actions to prevent harm to health, safety-,
M publc ` welfare ' arid the environment which may result from this
release and/or threat of release and govern the conduct of such
actions . The purpose of this notice is to -inform you of your
legal responsibilities under State law for assessing and/or
remediating the release at this property. For purposes of this
Notice of Responsibility, the terms and phrases used herein shall
20 Riverside Drive-Lakeville,Massachusetts 02347- FAX(508)947-6557-Telephone(508)946-2700
Ia Printed on Recycled Paper
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2
have the meaning ascribed to such terms and phrases by the MCP
unless the context clearly indicates otherwise . .
The Department .has reason to believe that the release and/or
threat of release which has been reported is or may be a disposal
site as defined by the M. C. P. The Department also has reason to
believe that you (as used in this letter, "you" and "your" 'refers
Wolcott Ames) are a Potentially Responsible Party (a "PRP" ) with
liability under M.G.L. c . 21E §5, for response action costs . This,
liability is "strict" , meaning that it is not based on fault, but
solely on your status as owner, operator, generator, transporter,
disposer or other person specified in M.G.L. c.21E §5 . This
liability is also "joint and several meaning that you,. may be
liable for all response action costs incurred at a disposal site
regardless of the existence ..of. any other liable parties .
The Department encourages parties with liabilities under
M.G.L. . c. 21E to take prompt and appropriate actions. in response to
releases and threats of release_ of oil and/or hazardous. materials .
By taking prompt action, you may significantly lower your
assessment and cleanup costs and/or avoid liability for costs
incurred by. the Department in taking such actions . You, may also
avoid the imposition of, the amount of or . reduce certain permit
and/or annual compliance as fees payable under 310 CMR
4 . 00 . Please . refer to M.G.L. c . 21E for a'-complete description of
potential liability. For your convenience, a summary of. liability.
under M.G.L. c . 21E is attached to this notice .
You should be aware that you . may have claims against third
parties for damages, including claims for contribution or
reimbursement for the costs of cleanup. Such claims do not exist
indefinitely but are . governed by laws which establish the time
allowed for bringing litigation. The.Department encourages you to'
take any action necessary to protect any such claims you may have
against third parties .
ACTIONS REQUIRED
Additional submittals are necessary - with regard to this
notification including, but not limited to, the filing of a
written IRA Plan, IRA Completion Statement and/or an RAO
statement . The MCP requires that a fee of $750 . 00 be submitted to
the Department when an RAO statement is filed greater than 120
days from the date of initial notification. Specific approval is
required from the Department for the implementation of all IRAs
and Release Abatement Measures (RAMS) . Assessment activities, the
construction of a fence and/or the posting of signs are actions
that are exempt from this approval requirement .
3
In addition to oral notification, 310 -CMR 40 . 0333 requires
that a completed Release Notification Form (BWSC-103 , attached) be
submitted to the Department within sixty (60). 'calendar days of
January 21, 1998 .
You must employ `or engage a Licensed Site Professional (LSP)
to manage, supervise or actually perform the necessary response .
actions at this site. You may obtain a list of the names and
addresses of these licensed professionals from the Board of
Registration of Hazardous Waste Site Cleanup Professionals at
(617) 556-1145 .
Unless otherwise provided by the Department, potentially
responsible parties ( "PRP' s" ) have one year from the initial date
of notification to. the Department of a..release or threat of a
release, pursuant to 310 CMR 40 . 0300, or from the date the.
Department issues a Notice of Responsibility, whichever occurs
earlier, to file . with the Department one of the following
submittals : (1) a completed Tier Classification .Submittal; (2) a
Response Action Outcome Statement or, _- if applicable, (3) a -
Downgradient Property Status The deadline for either of the
first two submittals for this disposal site . is January 21, 1999 .
If required by the MCP, a completed Tier I Permit Application must
also accompany a Tier Classification Submittal;
This site shall not be deemed to have had all the necessary
and required response actions taken unless and until all*
substantial hazards presented by the release and/or threat of
release have been eliminated and a. level of No Significant Risk
exists or has been achieved in .compliance with M.G.L. c . 21E and
the MCP.
If you have any questions relative to this notice, please
contact Dan Crafton at the letterhead address or at (508) 946-
2721 . All future communications regarding this release must
reference the following Release Tracking Number: 4-13616 .
Very truly yours,
Cf -
Richard F. Packard, Chief
Emergency Response / Release
Notification Section
P/MEP/re
1
CERTIFIED MAIL #Z 333 584 194
RETURN RECEIPT REQUESTED
r
4
Attachments : Release Notification Form; BWSC-103 and Instructions
Summary of Liability under M.G.L. c . 21E
CC : Town of Barnstable
367 Main Street
Hyannis, MA 02601
ATTN: Town Manager
Board of Health
367 Main Street
Hyannis, MA 02601
Centerville Fire Department
1875 Falmouth Road
Centerville, MA 02632
ATTN: Fire Prevention Officer
DEP - SERO
ATTN: Data Entry.