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Mr
s , CI r'O.,, ' DPW I
October 31p 1991
::... s
Mr. Russell P. and Mrs . Jonn 22 Winsome Road N. Caron
South Yarmouth, MA 02664
Tho Tow
n of table
that �, 13arne Health De
connected property
o the t.oI 10
c aced l�d�ctmont Was racentl
at; 336 Sea Streets Hyannis,y�nformec�
n n sewer is not
The Maseachusette General Law Number. 83
Board of Health Section u on tan may require the owner or oceu a 11 states tt�e
n d abutting on a public or p Pant of an
$ common, sewer, to connect the same y building
drain, and such Pri-vats wad, in which there is
be punished b owner who falls to mom herewith by a eufficiont
Y a Erne of hot More to two hundred dol with suoh lars,,
shall
You are ordered, to connect the .
Hyannis to the dwe�,ling located at 33G Sea Street
any applicattiionpuforc a ewer on or y 1, 336 or
building bafaxe May
( including any proposed addit 9 permit for before
dwelling) at the property is i$ubm3,ttedat won, or any co
first. Pair to
whichever the
date occurs
You may request a hearing
submitted to the Bo g if written petition re ues�data this order was sedved,Of Health within seven q tins same is
„ ( 7) days of the
FailtiarA to comply
hundred A y with an order may
r"Ult inoalseparatecviolats failure to comply in a fine of two
ion. �' y with an order, will
PER ORDER OF THE SOARO OF 11BALTH
TllOma s
A. McKean
Director of public HO&Ith
Town of Barnstable
Health nepartment
cas Peter Doyle, Supervisor WPCD 7: :
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
N PARCEL NO. f"//-,�
,f '
ADDRESS: �(.,/ �2/ aa--p �.I � MAP O. gq
1
Y OWNER NAME: HERBL�'�..f f1/ 1i`/ UC1 VILLAGE: tl
INSTALLATION DATE: EI BY: C1,11 �t/pul" Nk14-A5 I;d AlMV )a -t kl?V4t
-tkt 1k ror�. P f
ADDRESS: CERT. NO.
TA K NFORM T ION
J111q/11N A 1�E S ' I"7. IFr6fc-�:./ a _1`� l�r L 5 � p,")- 4),A� 1 'f A..�? ,�f J) 0!7.7(p
`LOCATION OF TANK: nu I-)q Ila_yJ trGa you r,cr )iyts �IOWAr to
CAPACITY ..S.O Ad.4 TYPE 6e AGE " � ` �®L/CHEM I CAL FL J d!f
4,
TESTING CERTIFICATION C ] PASS= C ] FAIL DATE
LEAK DETECTION, ` + CHECK IF N/A TYPE/BRAND
ZONE IOF CONTRIBUTION C ] YES J')1 (3 'NO DATE TO BE. .REMOVED
t.
FIRE DEPT. PERMIT ISSUED C ] YES- 1 .1 ] NO DATE
X� .., •� .
CUNSERVA i ION C�]<CHEC K IF N/A DATE / r / � /
BOARD OF HEALTH TAG/ NO.1C i ]C ]C ]C ] DATE l� � y�
r
m PLEASE PROVIDE SKETCH SHOWING `THE TANK LOCATION ON THE BACK OF THIS/CARD )
�P F�l:r�` rrr{,ter a7Y cvq of' `-, t
_ _
�4
1
THISSE&16N COMPLETE / ON'DELIVERY
■ Complete'items 11,2,and 3.Also complete A. Si re
it4 if Restricted Delivery is desired. � ❑Agent
"4
01 Print your name and address on the reverse ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C.Date of l7elivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits. -
D. liie. dtl're's's different from item 1? ❑Yes
1. Article Addressed to: n ed' �
If YES,e 0jAry`address below: ❑No
Ttfe Estate of Fredenck,J '' h/op
{ Schobel
295 Anawan St. 3\. Setvicetype .
Rehoboth, MA OV69` C1�Ce,r ifsd Mail® nonty Mail ExpressTM
��� —,"0
❑Regis eret d Iii6ft rn Receipt for Merchandise'-'
— ❑ Insured Mail ❑Collect on Delivery
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7 014 12 10358 710 1
(Transfer from service/abed
PS Form 3811,July 2013 Domestic Return Receipt
UNITED STATES 9STA4 S,ERV4 ai
e Pa
Per .�k dita -• ,.,,
! Sehder Please print your name, address, and ZIP+40i this box*
I
Town ofBainr table
_
Health Division
ET! c j 200 Main Street
! Hyannis, MA 02601
I
I
Illt,iiil, iilIIII Jill ij,ii„ifIIliI;i,1111111 illllltiit lf�ili �
ron• :� +x � e GAS tS.
MI. f wi
O
CO
Ln
O Postage $ �(0
Certified Fee Cb
rq B)14
Return Receipt Fee _
M (Endorsement Required)
0 Restricted Delivery Fee
(Endorsement Required) n
rU Total Postage&Fees 1$
Sent To ;' "The Estbte. of Frederick'J.
,Sch0bei
Street,Apt IVo
or PO Box No. 295 AnaWan St.
M1 City State,ziP+a Rehoboth, MA 02769
Certified Mail Provides:
n A mailing receipt
o A unique identifier for your mailpiece
® A record of delivery kept by the Postal Service for two years
important Reminders:
■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®.
■ Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
■ For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return,
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for.
a duplicate'return receipt,a USPS®postmark on your Certified Mail receipt is
required.
e For an additional fee, delivery may be restricted to the addressee ors
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail-
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an Inquiry.
PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
S
�5. DAA#fi 41-0-i4vali
34 -7
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j-o$-
e • • • - • • • • • -
FIRE EPT.
FIRE DEPT. STATE USE ONLY CERTIFICATION
Number
Nu
I.D.
m
Copy to be certified by local fire departrlent er H annlS
and: POSTED AT STORAGE FACILITY Date Received
RAL
GENE • •
Notification is required by Federal law for all underground tanks that have been 4. pipeline facilities (including gathering lines) regulated under the Natural Gas
used to store regulated substances since January 1,1974,that are in the ground as of Pipeline Safety Act of 1968.or the Hazardous Liquid Pipeline Saletp Act of 1979.or
May 8,1986,or tha f are brought into use after May 8,1986.The information requested which is an intrastate pipeline facility regulated under State laws:.
is required by Section 9002 of the Resource Conservation and Recovery AcQRCRA), 5.surface impoundments,pits,ponds,or lagoons:
as amended. 6.storm water or waste water collection systems:
The primary purpose of this notification program is to locate and evaluate under- 7,flow-through process tanks;
ground tanks that store or hate stored petroleum or hazardous"substances. It is 8.liquid traps or associated gathering lines direct]\related to oil or gas pi oductionan.d
.expected that the:information you provide will be based on reasonably available gathering operations:
records,or.in the absence of such records.Four know[edge,belieL or recollection. 9. storage tanks -Situated in an underground area (such as a basement. ccllm.
mncworking,drift,shalt,or tunnel)if the storage tank is situated upon or abuse the
Who Must Notify? Section 9002 of RCRA. as amended, requires that, unless surface of the floor.
exempted,owners of underground tanks that store regulated substances must notify
designated State or.local agencies of the existence of their tanks.Owner means— What Substances Are Covered? The notification requirements apply to under-
(a) in the case of an underground storage tank in use on November H. 1984.or ground storage tanks that contain regulated substances.phis includes any substance
brought into use after that date,any person who owns an underground storage tank defined as hazardous in section 101 (14) of the Comprehensive Em ironmental
used for the storage,use,or dispensing of regulated substances,and Response.Compensation and I.iability Act of 1980(CERCLA).with the exception of
(b) in the case of any underground storage tank in use before November 8. 1984. those substances regulated as hazardous waste under Subtitle C of RCRA. It also
but no longer in use on that date.any person who owned such tank immediately before includes petroleum,e.g.,crude oil or any fraction thereof which is liquid at standard
the discontinuation of its use. conditions of temperature and pressure(60 degrees Fahrenheit and 14.7 pounds per
What Tanks Are Included? Underground storage tank is defined as any one or square inch absolute).
combination of tanks that(1)is used to contain an accumulation of"regulated sub- Where To Notify? Completed notification forms should be sent to the address
stances."and(2)whose volume iincluding connected underground piping)is Zvi or given at the top of this page.
more beneath the ground.Some examples are underground tanks storing:1.gasoline, When To Notify? ].Owners ul underground storage tanks in use or that hale been
used oil.or diesel fuel. 2.industrial soh ents.pesticides.herbicides or fumigants.
taken out of operation after.lanuarn I. 1974.but still in the ground.must notify by
What Tanks Ar E.elude •nks remmed from the ground are not subject to Mas 8. 1986.L Owners who bring underground storage tanks into use alter May 8.
notification.Other I' xc u cd Irom notification arc: 1986.must notify within 30 dad:+of bringing the tanks into use.
1.farm or residential tanks of L!00 gallons or lesscapacit\used lorstoring motor fuel
jdlr noncommercial purposes: Penalties: Any owner who knowingly fails to notify or submits false information
(r,anksusedforstonngheatingoilforcunsumptitcuseonthepremiseswhcrcstored; shall be subject to a civil penalty not to exceed S10,000 for each tank for which
3.septic tanks: notification is not given or for which false information is submitted.
INSTRUCTIONS
Please type or print in ink all items except"signature"in Section V.This form must by completed for Indicate number of
each location containing underground storage tanks.If more than 5 tanks are owned at this location, continuation sheets
photocopy the reverse side,and staple continuation sheets to this form. attached
• • . • OF
Owner Name(Corporation,Individual,Public Agency,or Other Entity) (If same as Section 1,mark box here❑)
H1f_::;1f b'P_f+ 01• NaYISo►1 Facility Name or Company Site Identifier,as applicable
Street Address
14 @t-bor tkbu
Co
un
ty Street Address or State Road,as hpplicable
Gl'66leze-_ C �arnstabl
City State ZIP Code County
( �I )oJ k HUDinfl175 (-))
Area Coe Phone Number City(n arest) State ZIP Code
L4
Type of Owner (Mark all that apply®J
Current ❑ State or Local Gov't Private or Indicate Mark box here if tanks)
Corporate number of are located on land within
❑ Former ❑ Federal Gov't ❑ Ownership tanks at this EQ an Indian reservation or ❑
(GSA facility LD.no. uncertain location on other Indian trust lands
r ,far ts¢e f�l�.�
CONTACT • LOCATION
Name(If same as Section I,mark box here ❑) Job Title D Area Code Phone Number
Nero-t, C. Ha���on Cra-b''7f- Sod �5a_-1gIy
IV.TYPE OF NOTIFICATION
❑ Mark box here only if this is an amended or subsequent notification for this location.
CERTIFICATION.V.
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
documents,and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the
submitted information is true,accurate,and complete.
Na a and official title of owner or owner's authorized representative` Sign 4ue Date Signed
SEEM
Form F.P. 290 Part 3. Page t
Owner Name(from Section 1) Location(from Section 11) Page No. of Pages
Tank Identification No.(e.g.,ABC-123),or Tank No. Tank No., Tank No. ,Tank No. Tank No.
ArbitrarilyAssigned Sequential Number e. . 1,2,3...
9 q d 9� )
1.Status of Tanks,;
Y
Currentl in Use
0 0
(Mark all that apply®) Temporarily Out of Use 0
Permanently Out of Use [�
Brought into Use after 5/8/86
0 0 0 o a
2.Estimated Age(Years)
3.Estimated Total Capacity(Gallons) no
4.Material of Construction Steel F 7A0
(Mark one®)` O
Concrete
Fiberglass Reinforced Plastic
Unknown
Other,Please Specify
5.Internal Protection Cathodic Protection
(Mark all that apply X) -
Interior Lining(e.g.,epoxy resins) [� 0
None
Unknown 0
Other,Please Specify
6.External Protection Cathodic Protection 0
(Mark all that apply®) Painted(e.g.,asphaltic)
Fiberglass Reinforced Plastic Coated C]
None
Unknown ULJ
Other,Please Specify
7.Piping Bare Steel 0 0
(Mark all that apply®) Gavanized Steel
Fiberglass Reinforced Plastic
Cathodically Protected
Unknown O
Other,Please Specify
8.Substance Currently or Last Stored a. Empty
In Greatest Quantity by Volume b. Petroleum
(Mark all that apply®) Diesel
Kerosene
Gasoline(including alcohol blends)
Used Oil
Other,Please Specify _Z i,UP( 0 t
c. Hazardous Substance 0 0
Please Indicate Name of Principal CERCLA Substance OR
Chemical Abstract Service(CAS) No. _.
Mark box IN if tank stores a mixture of substances
d. Unknown
9.Additional Information(for tanks permanently
taken out of service)
a. Estimated date last used (mo/,yr) _.
b. Estimated quantity of substance remaining (gal.)
c. Mark box 13 if tank was filled with inert material
(e.g.,sand,concrete) 0 0 O
Page 2
DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION
i;
APPLICATION FOR PERMIT TO MAINTAIN AN EXISTING/NEW UNDERGROUND
STORAGE FACILITY
l To: Head of Fire Department
LLpf)n10 Uc;- Zg{ 19-6$
_r City or Town Date
-Application is hereby made for a permit to maintain an existing/new
underground storage facility as required by 527CMR9.00: Permits.
Location of property: Zo rbor WGC
Street address
Owner of property: corbert C HQnson
Full name of person, firm or corp
Signature of owner or authorized representative: ora i n se-S
4-hr
Fee:$ (M.G.L.A. Chapt. 148 Sec. 1OA)
(Fire Department's Copy to be Filed with F.P.290 part 2)
Form F.P. 290
Part 4
04-r T P of Awaar4mtta
DEPARTMENT OF PUBLIC SAFETY—DIV15lON OF FIRE PREVENTION
PERMIT 0C+ . 2L4 19 3-9=
Date
TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY
In accordance with the provisions of 527CMR9.24 this permit to maintain an
existing/new underground storage facility is granted to:
Location of property: ZO arbor- " -4
Street a ress
Owner of property: He rbPrt C • Hanson
Full name of person, firm or corporation
Restrictions: SOO QaOnn
-�o r- 5b t qe- and Use c 2 -�( o c
Fee Paid:$ (M.G.L.A. Chapt. 148 Sec. 10A)
Form F.P. 290
Part 4 This permit will expire Oct-- 31 19% UaLt& _ ki-I TIP- pip—op— 4lOA
Date Signature of H ad of Fire bJt. or appointed besjgnee
L_—,_ ! mwnAri-c rnni, +, ho nnct,3d at tho ctnranP fari 1 itv with F_P_290 Part Il n