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Home My WebLink About2022-23The Commonwealth of Massachusetts Fee Town of Yarmouth $150.00 HANDLING AND STORAGE OF TOXIC OR HAZARDOUS MATERIALS Number: B01111IM-17-4778-05 Issue Date: 7/1/2022 Mailing Address: Location Address: EVERSOURCE ENERGY 484 WILLOW STREET 247 STATION DRIVE SE 270 WEST YARMOUTH, MA 02673 WESTWOOD, MA 02090 IS HEREBY GRANTED A 2022 — 2023 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires June 30, 2023, unless sooner suspended or revoked and is not transferable. Conditions Yarmouth Board of Health Hazardous Materials Regulation, Section 12A: Must report any spills over one gallon in size to the Health & Fire departments. Additionally: (1) No outside washing of vehicles. (2) All vehicle washing must use the vehicle wash system. (3) Utilization of the vehicle wash system is contingent upon written approval by the State Department of Environmental Protection. (4) A continuous alarm system connected to the alarm panel and with an audio (hom) and a visual (light) alarm device is required to detect leaks in the vehicle wash system. (5) Submit annual report by June 1. (6) Annual report must include the following: a. A narrative on any leaks, reportable spills, or other events during the previous operating year. b. Vehicle wash system water usage. The vehicle wash system must have its own water meter. c. Vehicle wash system pumping records including a summary of the frequency and amounts of water pumped from the system and the location to which the water was transported. d. Logs listing at least monthly verification of proper operation of all circuits, monitors, probes, alarms and systems. e. A certified (stamped) letter from a Massachusetts Registered Professional Engineer trained in the discipline of civil, mechanical, or sanitary engineering regarding the following: (1) annual testing for proper operation of all vehicle wash system circuits, monitors, probes, and alarms; (2) annual testing and verification of tightness for the vehicle wash system holding tanks and piping and (3) verification of competency of the oil/water separator. A plan or diagram highlighting the piping and tanks tested must accompany the letter from the engineer. (7) In the event Eversource no longer operates the facility, the underground vehicle wash tank shall be emptied within seven (7) days of termination of such operation. (8) Any waste oil, waste anti -freeze or other hazardous waste generated at the site shall be removed from the site within 180 days by a licensed hazardous waste hauler. Documentation of same to be in the annual report filed with the Board of Health. (9) The license for Handling and Storage of Toxic or Hazardous Materials is non -transferable and non -assignable. It is exclusively for Eversource use only at the above location. (10) There will be no salting or use of other chemicals in ice or snow removal or control measures. Sand only will be allowed. Board Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman Of Charles T. Holway, Clerk _ Health Debra Bruinooge Eric Weston Bruce G. Murphy, MPH, R.S.,FHO / es G. Health Director / Assistant I dDirector LICENSE Y7 )HP /T�( �-1 TTy-►�Ut/ FEE: $150.00 TOWN OF VARMOUTH BOARD OF HEALTH 2022/2023 HANDLING AND STORAGE OF TOXIC OR HAZARDOUS MATERIALS LICENSE APPLICATION PLEASE COMPLETE THIS APPLICATION AND RETURN IT WITH THE LICENSE FEE BY PLEASE COMPLETE ALL QUESTIONS June 30, 2022 NAME OF BUSINESS Eversource Energy BUSINESS TEL. # 617.424.2000 BUSINESS ADDRESS 484 Willow Street, Yarmouth, MA 02675 R E-5CEF QED MAILING ADDRESS 247 Station Drive, SE270, Westwood, MA 02090 MAY _�_2022 EMAIL ADDRESS alexandra.labella@eversource.com HEALTHDEPT. MANAGER/CONTACT PERSON Brian Smith OWNER NAME HOME TEL. # 617.429.0663 TEL. # HOME ADDRESS CORPORATION NAME (IF APPLICABLE) Eversource 800 Boylston St, Boston, MA TEL. # 508.982.2325 CORPORATION ADDRESS Boston, MA 02199 MAILING ADDRESS TAX 1D (FEIN OR SSN) 04- RUN ANNUALLY FROM JULY I TO JUNE 30. 1T IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S) BY JUNE 30. FAILURE TO DO SO WILL RESULT IN CLOSURE OF YOUR ESTABLISHMENT UNTIL THE REQUIRED APPLICATIONS(S) AND FEE(S) ARE RECEIVED. A HEARING BEFORE THE BOARD OF HEALTH MAY BE REQUIRED PRIOR TO REOPENING. Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. Please check appropriately Under Chapter 152, Sec. 25C, subsection 6, the Town of Yarmouth is required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certification of Workers Compensation insurance. As part of renewal or issuance of your permits, you must complete the enclosed Workers Compensation Affidavit. It not applicable, please explain: REGISTRATION FORM SIGNED AND COMPLETED CHECK AND WORKERS COMP AFFIDAVIT ENCLOSED ALL SAFETY DATA SHEETS ON FILE Y N Y N ANY NEW CHEMICALS MUST BE PRE -APPROVED BY THE HEALTH DEPARTMENT. RENEWAL APPLICATION X NEW APPLICATION APPLICANT'S SIGNA DATE The Commonwealth of Massachusetts �t Department of Industrkd Accidems t O,fue of Investigations Lafayette City Center 2Avenue de Lafayette, Boston, MA 02111-1750 www mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Aanlicant Information Please Print Leeibly Business/Organization Name: NSTAR Electric Company dba Eversource Energy Address:800 Boylston St., SUM SE 260 City/State/Zip: Boston, Me 02199 Phone 4:617-424-2000 Are you an employer? Check the appropriate box: Business Type (required): 1. ® I am a employer with employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2. ❑ 1 am a sole proprietor or partnership and have no 7• ❑ Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] g• ❑ Non-profit 3. ❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]* 4. ❑ We are a non-profit organization, staffed by volunteers I I •❑ Health Care with no employees. [No workers' comp. insurance req.] 12.❑ Other *Any applicant that checks box 41 most also fill out the section below showing their workers' compensation policy inforr atim. "If the corporate officershave exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box W 1. I am an employer that Is providing workers' compensation insurancefor my employees. Below is the policy information. Insurance Company Name: Everest National Insurance Company Insurer's Address: Westgate Corporate Center, 477 Martinsville Rd City/State/Zip: Liberty Comer, NJ 10036 Policy # or Self -ins. Lic. ItEn4EW00025-201 Expiration Date: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date} Failure to secure coverage as required under § 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cep' ,-tm*F4he pane and Ae Iti�e nfn ri,•ry that the informadon provided above is true and correct 704 AAA Oran Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License Issuing Authority (check one): l.[]Board of Health 2Z3 Building Department 5Q Selectmen's Office 6. DOther 3,❑City/TownClerk 4.❑Licensing Board Contact Person: Phone www.mass.gov/die Tighe&Bond Engineers I Environmental Specialists 145042271 May 26, 2022 Carl Lawson Hazardous Waste Inspector Town of Yarmouth, Health Department 1146 Route 28 South Yarmouth, MA 02664 Re: 2022-2023 Annual License Renewal Application Dear Mr. Lawson: Tighe & Bond, Inc. is submitting the attached Hazardous Materials Storage License, Workers' Compensation Insurance Affidavit, and a check in the amount of $150 on behalf of our client NSTART Electric Company dba Eversource Energy located at 484 Willow Street, Yarmouth MA 02675. This supplements the tank certification packet submitted to your office electronically on May 25, 2022. If you have any questions regarding the enclosed, please contact me at 781.708.9843 or via email at wmpotochniak(o)tighebond.com. Very truly yours, TIGHE & BOND, INC. RECEIVED William Potochniak, PE MAY 27 2022 Senior Project Manager HEALTH DEPT. Enclosures: Hazardous Materials Storage License Workers' Compensation Insurance Affidavit Check Copy: Brian Smith, Eversource Ali Labella, Eversource l:\E\E5042 Eversource#CW2266810\271-Yarmouth_Tank_Support_2022\Data\Cover Letter —Mailed —Submittal. Doc 4 Barlows Landing Road, Unit #15 • Pocasset, MA 02559 Tel 508.564.7285 www.tighebond.com