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UNDERGROUND STORAGE JPG.I of I STATE OF CONNECTICUT
Department of Environmental Protection EPHM-6 NEW 10/85
a FACILITY NOTIFICATION 2' UNDERGROUND STORAGE FACILITIES PROGRAM 3. FOR STATE A.SITE LD.
HAZARDOUS MATERIALS MANAGEMENT UNIT AGENCY USE ONLY
Z _ 165 Capitol Avenue,Hartford,CT 06106
O FIRST B.DATE RCVD BY D.E.P C.DATE ENTERED
F la. NOTIFICATION -- — TEL. 556-4630
U SITE LD.
LLJ
h OR PLEASE TYPE.ALL THREE COPIES MUST BE LEGIBLE! 4�hy r rx
GRID COORDINATES E DOES FACILITY MEET NEW REQUIREMENTS?
b. ❑ SUBSEQUENT I/checked,
NOTIFICATION enler No.) Refer to INSTRUCTIONS FOR FILING NOTIFICATION before completing form. Y ❑YES ❑NO
LOCATION SITE NAME NO AND STREET N REST INTERSECTING TREET CI OR TOWN ST 5AATITOUDE �y i LONGITUDE
4. OF FACILITY %M-4. RL S v �{1 Zj J,\ Odv � �I� I
BUSINESS NAME AND NAME c NO AND STREET ` CITY OR TOWN STATE ZIP CODE TELEPHONE
6. MAILING ADDRESS J1arh�.Q./ Swv�XJ S�yy`�� obo lit 81-14�vYYVV
as N AND STREET^ R T I ST T ZIP�ODE TELEPHONF •-�_� �
ZO 7. FACILITY OWNER )Yj`p Ma��. N o%L�Jhy ( ) y
I -
N 8. TYPE OF OWNER PRIVATE ❑ STATE ❑ MUNICIPAL ❑ FEDERAL(G.S.A. No.
omft
OPERATOR CONTAC NAME ,1N NO S{j/R+EE_T t R 1. , �(
/ �1 � �„ ��OV ��1�.1V- (IT C VTR W � IP��^U4 'T (ELEPHONE��'1���`,�
9. PERSON V L
10. I la. 1lb. 12o. 12 b. STATUS 13. TYPE OF 14. CONTENTS- 15.CONSTRUCTION 16.PROTECTION 17. INTEGRAL
DATE CONTENTS MATERIALS RNAL b. EXTERNAL PIPING SYSTEM 16. 19. FAILURE
TANK ID. DATE OF Z TOTAL p I EST.QUANTITY CHEMICAL NAME OF PRINCIPAL a. b. DATE OF MONITORING DETERMINATION
I o CAPACITY Z w TANK SUBSTANCE w V O �o v Z Z INSTALLATION
INSTALLATION w> V I LEFT STORED O O p v >a p w O - SYSTEM CONDUCTED?
O a w LAST a not trade name. .._ W" ` w a o oc an d
o-. (Gals.) 0 > O V N w.� w O V a_ w ;,_� i�a a OR
(Mo./Yr.) X o w a. I (if any)- p C9 O = y_ =w O V ` v _ (If"YES",enter DATE"
wR N Z O USED a s (Enter C.A.S. No.rlf known) w w i a aE Z a n E �`� = REPLACEMENT
w� D m Z I (Gals.) : J w w m—a Ovt o Q O O O„� E 2 O (Specify type and attach results).
—w Z Z QO
Z Q I (Mo./Yr.) O w V O w z : V a V 3 V a O a _ (Mo,,Yr.) from list 8) (if"NO",enter"NO")
lu
Example p 5/75 30 5000 X X Heating fuel #2 X X H 5 5/75 U NO
1 ljl,.Trichloroethane
Example 7/60 — 8000 X 8/78 v X CAS#79016 X X E 7 7/60 U
1 0 A 9(000 X /1 �uJ fir*
z
w
20. HAVE YOU ATTACHED SKETCH OF TANKS AND LOCATION? ❑ YES 22.CERTIFICATION: I certify under penalty of law that I have personally a.MINA TURE 22b.DATE SIGNED
examined and am familiar with the information submitted in this and all attached
z 21. COMMENTS: documents and that based on my inquiry of those individuals immediately responsible
0 for obtaining the information,1 believe that the submitted information is true, ik 64
I-' accurate and complete.Penalties:any owner who knowingly fails to notify shall be 22 OFFICI L TITLE(.-owner or authorized
U subject to a civil penalty not to exceed S10,000 for each tank for which notification a esentative).
� I p b 22c.NAME(Type or Print) r Pr
is not given or for which false information is submitted.
COPY 2 . SEND TO LOCAL FIRE MARSHAL
UNDERGROUND STORAGE PG of STATE OFCONNECTICUT EPHM-6 Rev. A.DATE ENTERED
2. Department of Environmental Protection FOR STATE
Q FACILITY NOTIFICATION i� UNDERGROUND STORAGE FACILITIES PROGRAM 3' AGENCY USE ONLY
Z ( \ Bureau of Waste Management i B.FEE BILLED C FEE RECEIVED
O 79 ELM STREET.Hartford,CT 06106-5127
FIRST ��
U 1a. ❑ NOTIFICATION TEL.(860)424-3374
w OR SITE I.D. D.GRID COORDINATES E.DOES FACILITY MEET NEW REQUIREMENTS-)
U PLEASE TYPE OR PRINT.ALL THREE COPIES MUST BE LEGIBLE X Y El YES ❑ NO
b SUBSEQUENT (if checked. Refer to INSTRUCTIONS FOR FILING NOTIFICATION before completing NOTIFICATION enter no.) p 9 form.
LOCATION SITE NAME NO.AND STREET NEAREST INTERSECTING STREET CITY OR TOWN STATE 5.LATITUDE LONGITUDE
4. OF FACILITY l - t t ✓r 1 Tc H �t_ Vl� �T�t L 6 ��t 4�� r , o ., o „
/i/ N r)S -T Z
BUSINESS NAME AND NAME NO.AND STREET CITY OR TOWN STATE ZIP CODE TELEPHONE
6. MAILING ADDRESS �, I AJ I'> 6 r i C K / lqqo Jo y v I rTL H D L Ir
m NAME NO.AND STREET
Z 7. FACILITY OWNER .` n T�,( r � J [ CITY OR TOWN STATE ZIP CODE TELEPHONE j
O _ �r J A N V 1 L',! _ / ; 71 i C't•f*jlt >a�IP,A, V �� 7 �3G r V v
�rL trey Seca' T /`7r) 2 f 9S ( jG. ' 3.770()
U
w 8. TYPE OF OWNER PRIVATE ❑ STATE ❑ MUNICIPAL ❑ FEDERAL(G.S.A.NO. ).cn —
OPERATOR/CONTACT NAME NO.AND STREET _ [LY TOWN STATE ZIP CODE TELEPHONE
9. PERSON l rV.VrVINVH/ )yHU vNVr 'ilNI�CVJ -r T ( ho) -) '
10. 11 a. 11b. 12a. 12b.STATUS 13 TYPE OF 14.CONTENTS 15 CONSTRUCTION 16.PROTECTION 17.INTEGRAL 18. 19.FAILURE
CONTENTS MATERIALS a.INTERNAL b.EXTERNAL PIPING SYSTEM DETERMINATION
b. CONDUCTED?
TANK I.D. DATE OF TOTAL o I EST.QUANTITY DATE � CHEMICAL NAME OF PRINCIPAL " E zo o g E _» Z DATE OF MONITORING
INSTALLATION .=a CAPACITY w z I LEFT STORED w TANK ¢o Q o SUBSTANCE a L) o 60
o OE
Mo./Yr. " Cn O a I > , o u- w w ¢ a w o� vi a o r of-m �v _ INSTALLATION SYSTEM (If"YES",enter"DATE"
( ) a o (Gals. o w If an O LAST w w w z O U o U w > =N
( Y) n a g C+ (not trade name) o o _ H z J =w <a = ,, _ N - w OR and attach results).
w . ? a Z I (Gals.) w USED � i (Enter C.A.S No..if known) w z a m� � z f- o¢ d zQ o REPLACEMENT (Specify type (If"NO enter"NO")
LL m- cc Mo./Yr. 0w U mwa Ocn Cain U3 �ir Ocn 8a to
a ( ) f w¢ a a a (Mo./Yr.) from list B)
Example 5/75 30 5000 X X Heating fuel#2 ' X X H 3 H 5/75 U NO
Example E7/60 — 8000 X 8/78 X l,l,l,-Tricloroethane X X E 7 W 7/60 UCAS#79016
Ab X 7/57yc3
U t 3� ► r In )0 v 91`+
0 ? iSFe Fl rC I(." X
6 �vv X X E 1 i Q it sp
U "
LU
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i
20.HAVE YOU ATTACHED SKETCH OF TANKS AND LOCATION? ❑ YES 22.CERTIFICATION:I certify under penalty of law that I have personally examined 22a.SIGNATURE 22b.DATE SIGNED
21.COMMENTS: and am familiar with the information submitted inrthis and all attached documents and that
U 11� / based on my inquiry of those individuals immediately responsible for obtaining the information, X
H )7 r�t�L L7 S t�� t'1 I L t4 3 t E I believe that the submitted information is true,a4wrate and complete.
U /L Penalties:an owner who knowingly fails to no 22c.NAME(T a or Print) 22d.OFFICIAL TITLE(of owner or authorized
y g y lily shall be subject to a civil penalty not to
W � representative).
W exceed$10 000 for each tams for which nobficatiohls not given or for which false information L /`7 t L h. �- �it t',t w L/1h, / b
is submitted. l i}r'ti ti
COPY 2. SEND TO LOCAL FIRE MARSHAL
^"UNDERGROUND STORAGE PG Of wu STATE OFCONNECTICUT. EPHM-6 Rev.5,90 A DATE ENTERED
FACILITY NOTIFICATION 2 ' ' UNDERGROUND STORAGE FADepartment of CILITIES Ption ROGRAM131a Y�,
FOR STATE
USE ONLY Sei
z Bureau of Waste Management ^ " B FEE BILLED C.FEE RECEIVED
O 79 ELM STREET,Hartford,CT 06106-5127 "se• �'
X FIRST
w 1 a NOTIFICATION SITE I.D. TEL.(860)424-3374 `
OR D.GRID COORDINATES E.DOES FACILITY MEET NEW REQUIREMENTS?
PLEASE TYPE OR PRINT.ALL THREE COPIES MUST BE LEGIBLE
b ❑ SUBSEQUENT (if checked. '" X i YES ❑ NO
NOTIFICATION enter no.) Refer to INSTRUCTIONS FOR FILING NOTIFICATION before completing form.
LOCATION SITE NAME O
r NO.AND STREET NEAREST INTERSECTING STREET CITY OR TOWN STATE 5.LATITUDE LONGITUDE
4. OFFACILITY rio5HrIZ r' N;rl- ' RSSFS k3i ?ljo'm FT-kvi 1304 SouTkA W?N05,,k C-7 1 c �r
BUSINESS NAME AND NAME NO.ANDSTREET ^^ CITY OR TOWN STATE! ZIP CODE TELEPHONE
6. MAILING ADDRESS �;) S t-1 tZ I^a i t,: I Li 3 C, -J U H 1 I C-'"� 8L v,J J
_ t5"vuTt1 (��Nos�rt �T� Obo � ( ,��,' 1 64y - 532-
m NAME r NO.AND STREET CITY OR TOWN STATE ZIP CODE TELEPHONE
zO 7. FACILITY OWNER RALP11 143"I -'DUI-N-J ("TTLI-1 13LVO iH WTMQSuk C , 060-4 `t ( 3651 644 - ILt53L
U w 8. TYPE OF OWNER L�I PRIVATE ❑ STATE ElMUNIPPAL ❑ FEDERAL(G.S.A. NO.OPERATOR/CONTACT NAME NO.NO.AND STREET 41 TY OR TOWN STATE ZIP CODE TELEPHONE
9. PERSON ►cA L P11 f�lasll('2 Iy3�1 jL) t l r `� -1 13LJ'� SoV 41, liu,n) jr 061q-1 6411 - 4S?2
Io. 11a 11b. 12a. 12b.STATUS 13TYPE OF 14.CONTENTS 15.CONSTRUCTION 16.PROTECTION IT INTEGRAL 18. 19.FAILURE
CONTENTS MATERIALS a.I T RNA b.EXTERNAL PIPING SYSTEM DETERMINATION
b. CONDUCTED?
TANK I.D. DATE OF i TOT`1L w EST. QUANTITY DATE c~i CHEMICAL NAME OF PRINCIPAL u)o E U O p c�O z DATE OF MONITORING
INSTALLATION CAPACITY w z v I LEFT STORED TANK Q o a off' SUBSTANCE v v ¢° o w om INSTALLATION SYSTEM, (If"YES enter"DATE"
U W O I > F-O U— W �¢� Q O -•e'W OF- wtl. �F- �_m g �"y
(Mo./yr.) t^ (Gals.) If an O LAST w w w z O c� O O w y �._
w a Z a I ( Y) a s w 0 (not trade name) ¢O J =Z N Z =w a Q =w = Z n w� OR and attach results).
? Q z (Gals.) w USED _ (Enter C.A.S.No.,if known) to w z a ~ =n M z o¢ t— a;_ H o 1 REPLACEMENT (Specify type (If"NO enter"NO")
(Mo./Yr.) O J v mesa- Ora ✓= v¢ L3 L)0 Oto � ¢`=
a ( ) iz¢ a 4 a (Mo./Yr.) from fist B)
Example 5l75 30 5000 X X Heating fuel#2 X X H 3 H 5/75 U NO
Example 7/60 — 8000 X 8/78 X l,l,l,-Tricloroethane X E 7 W 7/60 U —
CAS#79016
5 � 6 30 1000 325 X 12/91 X b� HecAL%% Fair 1 Z rq o
o
w
rn
j
20.HAVE YOU ATTACHED SKETCH OF Ji NKS AND LOCATION? ❑ YES CERTIFICATION:I certify under penalty of law that I have personally eKtyn n E 22b.DVI 91GNED
O an"m familiar with the information submitted in this and all attached documents nd that
z 21.COMMENTS:
O based on my inquiry of those individuals Immediately responsible for obtaining the information, X /23 0)
F IUlieve that the submitted information is true,accurate and complete.
U n�lVZ any owner who knowingly fails to notify shall be subject to a civil penalty not to 22c.NA (Typ or Print) 22d.OFFICIAL TITLE(ofowner or authorized
w representative).
U) 75111r.514..000 for each tank for which notification is not given or for which false inb(mation /� /� _
mated. '•i A L PI-1r'1j /-r/1�OSHI. /Z
PY 2: SEND TO LOCAL FIRE MARSHAL
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UNDER PREVIOUS ORWINAL
a jtI
N/ F• ".CONSTRUCTION ADDITION BLDG. (� r'
, R4BERT WIL6ER tt . .
Ln Sly.
o - _ '
JAN 11 1991
South VVIndsor
13UILCING D EPAR HAI ENT
Thi;cc Itifi-1i to PI lo -nd 1;-'1
coal s of the proposed bus 1 c;ir,;, ur
crcclod at
,,Ih �31 1 9 ,d I n1:1— to COrW,
w.d,sUto. laws and sk,ch cri,rs i; r-!,
by t!c nL'Rding Depart-neat 1-vine, P�nucr.
and final issuant of 3
J�•'rml"
d1t n
Tr,is ii -lorrrved su b jeCt to t c
c r
, j,r s -,r J r-linarxeS regulating build;�g so
C 0, 1-1,j , , .1.
Conaai.nall/ Approvecl These filed with
qdilding Inspector, Clerk
Date Nd: _a W
4a�
'Zoriffic; nJAME
PMPO$ed bulldlng(s), USe(S) and/or structures)
0- SS shown Of' this Plan appea6s) to be In
c0'nf0"4ftc9 wfth current south Windsor
regUf4tbML Vgd"** and special exceptions
may SOPIY..
Date 14,io
701MAW nf&ce
Ernie Pierog
Q'0� 1439 John Fitch Boulevard(rear)
South Windsor,CT 06074
(860)291-0424
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a d HEREBY
n A T 11 t C' T A !� !�T ' ;`,l-.f-..-.. rt i i j-•-l..-.�t :
I 1 +cREC�I vECL oRE THAT THIS 1v1Arr' IS �UBSTA(1i ,lr�LLY �C7RRE� i. HEREBY CER-nIPFY � `'1r� � m L t' `; w
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SKETCH IS AN ACCURATE REPRESENTATION ,r�s5 tv,Ar A,•3v ovrt v�Y rvcR' PREPARED 'IN n� �v�'ur�,vti � tiv, In I j � T);,S �,��`.i� TC�, �F
THIS THE STANDARDS OF A CLASS A-2 SURVEY AS DEFINED !"d THE
o OF THE PROPOSED LiCElSED AREA. e SUBSTANTIALLY PROJECT:
Q ECO� �1ENDLD STANDARDS FOR JV,��VjEYS rAkin ib APS iN i 'jC' {� i RE , �^!("SICP 9 A 1 & 3`!ar° li i 4'$ a® $a#/�
T CONNECT! , AS PREPARED AND ADOPTED BY THE I CORRECT. + t 1 tear r�r �, +�1�•a
STA .E OF .�ONNE
m a r �rn3E,STiC+UT ASSnOi c Tin�i OF LAND c+ R�>EynRe INC. I I 43 J �01 FI TCH B O I E V A RD
�yl i a 9 J a a i D v L�l._ d !"61
G ON SEPTEMBER 13, 1984.
o SOUTH • l SOOq ifvN C T1 11C`1v1T
e
ENGINEER.—
DATE:1 lVilJ.
SCALE:
Date aae 's�
4Q`Appiicant Signatu YR. HOR!Z.
f "'FRT.JL 0 C CD
f �ae (� Surveying c �i1 Ef1L'?i"II1CI i
a
1 � t � Sl,l I"L��i I �
t �ViE'v�iED $
IS LOCATION HAS BEEN REVIEWED � F�n�,-,� � t�o�; 46s-�3��
THE SITE Or THIS _. TS THE APPROVED LOCATION. �
_ . . ' i i ��ANSFIEEV (GROVE ROAD L
AND GENERALLY REPKESE `
I EAST HAVEN, CT 06512
can 4FAN—_;�. 'Ci1V(7rfd1� °�3®� DA `\_
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SHEET NCB.
APPROEJEL' BY: DATEC3a ,(Local A€athority Na€�rre, True) 1