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HomeMy WebLinkAboutMIS93-0227 Cancelled Underground Tank Removal - MIS Permit / Conditions - 7/13/1993 M. Ll 3> w to 0 � � Z X t Cri *4 lob to m w I" ol all m rr CJ) CO cO 0 (> :3 Z Z (D 0 (P OL 0 ca (> 10 a- C) qp 7- VII, .09 Ju 0 MASON COUNTY BLDG 3 4277798 P. 02 MIS _ MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W.Cedar/P.O.Box 188,Shelton,WA 98584.427-9670 PLEASE PRINT #1 Owner Bob Harris/Bob's General Storfhone# 275-4501 Fire District# Site Address 22551 Highway 3 City Belfai_r Mail Address Same City Belfair St WA Zip 98528 Applicant O'Sullivan Petroleum f6n1 jE nent Company Phone# 682-2440 Applicant Address 3214 - 16th Ave S.W. City Seattle St WA Zip 98134 Directions to Site: _Head North on highway 3, the site will be on the left before you enter Belfair. #2 Parcel No. 12332-50-00103 Legai Description Sam B- Thelers Holman Garden Track, Track #43 #3 Indicate by circling the applicable source it any water Is on or adjacent to the property site: saltwater lake river creek stream pond wetiand seasonal runoff marsh other #4 Project Start Date zmm 7-6-93 Project Completion Date '— 7-13-93 #5 Use of Building N/A Describe proposed construction N/A '13"r dlrp upon the type of permit,a flea plan and plot plan may be required. 'This permit le valid for ISO days from the date of issuance. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED CON- MENTS OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WASHINGTON AND I AM RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT- ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PERMIT IS ISSUED AND IS ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE- FORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST WITHOUTFIRSTOSTAININGAPPROVALFROMTHEBUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DEPARTMENT. MENT. X OWNER X BY r Show following on the site plan Lot Dimensions Flood Zones S N Existing Structures Fences Structure Setbacks Wells Water Lines Shorelines I Drainage Plan Easements a Septic Systems Name of Fronting Street Indicate directional by Proposed Improvements Name of Flanking Street N, S, E, W etc. 13&b,s 6n�) lox Applicant Signature Date: 5-25-93 FOR OFFICIAL USA dNLY Accepted`by, x Date Receipt Noy Amount Paid . : DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Proposal Proposal Approved Denied Planning: P is Building: Fire Marshal: �� MASON COUNTY BLDG 3 4277799 P. 06 MASON COUNTY FIRE MARSHAL Mason County Bldg. 111 426 W,C90or P.O.Sox 1" 31101104+,WCW *ton M&A (206)427-%70 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION UNDERGROUND STORAGE SYSTEM CLOSURE C=CX LIST Site Owner/Operator. Bob Harris DBA Bob's General Store Address: 22551 Highway 3 Belfair WA-98528 Phone Number: ( 206 ) 2`75 - 45 Inspecting Agency:Fire Department Type of Closure; Rerwva Date Notified of Closure: 5-25-93 Expected Closure Date: 7-8-93.of Closure (circle) : Temporary In-Place Removal Reason For Closure: No longer selling gas Tank No. 1 2 3 Material Stored Gasoline Gasoline Gasoline Manufacturer — Serial No. -- Capacity (gallons) 10,000 10,000 6,000 Diameter (foot) 8 8 8 Length (feet) 28 28 17 , Tank Materiala ©F C J pS F C J F C J S F C J Tank Type (�O DW Q DW ©DW SW DW aMaterial: s, Steel; F, Fiberglass; C, Composite; J, Jacketed bType: SW, Single Wall; DW, Double Wall Temporary Closure Tank Drained Yes No Yes No Yes No Yes No Corrosion Protection Yes No Yes No Yes No Yes No Vent Lines Open Yes No Yes No Yes No Yes No Other Lines Secured Yes No Yes No Yes No Yes No Planned Closure Time Months Months Months Months MASON COUNTY BLDG 3 427779e P. 07 UNDERGROUM STORAGE SYSTEX CLOSURE CHZCR LIST,, CONTINUED . I In-Place closure or Closure by Removal of Tanks Piping Drained Yes No Yes No Yes No Yes No Tank Emptied Yes No Yes No Yes No Yes No Vapors Purged Yes No Yes No Yes No Yes No Sludge Removed Yes No Yes No Yes No Yes No Lines Removed Yes No Yes No Yes No Yes No Visual Inspection Yes No Yes No Yes No Yes No Soils Sampled Yes No Yes No Yes No Yes 'No Ground Water Sampled Yes No Yes No Yes No I Yes No Type of inert material used to fill tanks (for in-place closure only) : N/A Leaks/corrosion noted during visual inspections; other remarks: To be inspected Tank Excavation Contractor: O'Sullivan Petroleum Equipment company Contact: Karen Sa Tank Disposal Site: i.ne acuum Liquid/Sludge Removal Contractor: Marine vacuum Contact: Tcm Myler Liquid/Sludge Disposal Site: marine Vacuum soil/Ground Water Sampling Contractor: O'Sullivan Contact: Karen Say . Analytical Laboratory: Pacific Testincf Attach sketch showing location of tanks, piping, and soil/ground water samples. Inspecting Agency Inspector Date