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Home My WebLink About1990-Storage Tank (install 3 tanks) DATE c AG 9a APPLICATION FOR FLAMMABLE LIQUID STORAGE TANK PERMIT Name of Owner / a� rk ca_k tO/ Address of Owner /02 Application is hereby made to place - 3 tank(s) for the storage of {0 f� -ooY c� t } on the property known as O /U. r ya. _ , f o r - zsV= / — /Eboo Size of tank(s) Z - 8'00O gallons. Tank(s) to be placed below (above) ground level. Location (Width of Lot) Zone Fee 2h9C7 0 0 Fire Prevention Bureau Approval (Front of Lot) �v y The undersigned agrees that the above tank(s) will be placed in accordance with Section 13 -17 to 13 -23 of the Municipal Code of the City of Oshkosh. Signed, /o5C 1/+ dv-c- Permit Number /774 p,927/4. A Permit Issued '�j/ / 7 ?O ITTE NOTE: AT LEAST 10 DAYSANOTICE BE GIVEN THE FIRE INSPECTION DEPARTMENT PRIOR TO REMOVAL OR INSTALLATION OF TANKS. , N y Q . ...,,.- c r _ . c1/2`) N ,g . g }... ELCi Ca -'cc ; 0 . ' J p = 4 >1.1J � •' a Ca Cil 4 19" i ' � p ., g 6 N . - . ... o 4 › --6 = LU J c r cc Li: S � 6 - C o Q 0 u.J Q a<. U1 c..— ..< . L 0 T 3 I L 1 I 'o T� 4 H 0 0 ‹ -CI .--- ri < —, 0 K a q Y laz -k-` c'-' Revised: 8/89 ZONING /LAND USE COMPLIANCE CHECKLIST JOB LOCATION: / 0 3 /j' ,,..E:Q f ' -- ZONING: d l PROPERTY OWNER /CONTRACTOR: p_ 4 O CONSTRUCTION DATA: NEW CONSTRUCTION ADDITION (ALTERATION PARKING LOT TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.) /— /o000 GG [ . .� gO6 o --,,f COMPLIANCE CHECKLIST (Check only those applicable) COMPLIES DEFICIENT DEFICIENCY /COMMENTS Use Lot Width Lot Area Floodplain Front Yard Side Street (front yard) Rear Yard Side Yard (R) Side Yard (L) Parking Spaces Building Area Lot Area Per Family Corner Lot Landscaping Transitional Yard Off- Street Loading Vision Clearance Height REVIEW AUTHORITY: The Director of Community Development, or designee, must approve all plans, except the following: (1) Alterations or interior work when the use is conforming and when no change in use is proposed. (2) Maintenance items e.g. siding, windows, etc., when the use is conforming and when no change is proposed. Instances where work complies with the above criteria, the permit can be reviewed by the Building Inspector without referral to the Director of Community Development, or designee. / APPROVED DENIED Plan Commission Action Required Variance(s) Redd •d r REVIEWED BY: -I A' KIP/ DATE: 4 c 0 0 0 �^^ Q VJ co - C ZI O •. OE � m co W M CC w .M "ii ce = ..,..., klitz d co a I C 3 W" tr> N . - 0 0 7. N C) � Z w cc , ., 0 / , 4 )1 mac:, cc lit ,„:1 k-.. l O 0 L.l.l Cl cc w T 9 c i 1 1 I 1. 0 r A ti 0 0 o N. I)O 4 4 4 < r D j 0 c6 Y Department of Industry, FLAMMABLE LIQUID TANKS Safety & Buildings Division Labor and Human Relations INSTALLATION APPLICATION P.O. Box 7969 . 201 E. Washington Avenue Madison, WI 53707` (608) 266 -8981 Application is made to the Department of Industry, Labor and Human Relations to (check all applicable boxes):nstall tanks and /or lines ❑ Revise a plan ❑ Convert full service to self- service or convert to key- card -code ❑ Upgrade for spill protection and /or overfill only All work is to be done in accordance with the following detailed statement and attached plans subject to the orders of the Department of Industry, Labor and Human Relations. The installation, in all respects, will comply with applicable provisions of Chapter ILHR 10 of the Wisconsin Administrative Code (FLAMMABLE AND COMBUSTIBLE LIQUIDS). DIRECTIONS: Submit this form and four copies of the design and plot plan, along with the required fee to the address in the upper right corner of this page. The check is to be made out to: Safety & Buildings Division. Each plan must show (1) property lines, (2) buildings, (3) tanks, (4) load and unload racks OR pump islands, (5) streets and highways, (6) Streams and bodies of water within 200 feet of tanks, (7) vehicular routes, (8) distances, (9) wells, (10) spill containment device, (11) Overfill protection method, and(12) leak detection system to be used, including location of monitoring wells, if used. (If groundwater or vapor monitoring wells are used, data must be submitted to show that the installation complies with ILHR 10.61 and/or 10.615.) Two copies of the plans and a letter of conditional approval will be returned to you after approval. A final inspection of the site must be performed by the local fire inspector or other authorized individual before the tank is covered and put into service. LOCATION: Owner /Operator Establishment Name � maN UkL Ph; 11i 5 ec Street Address Ci i County State Zip Code �� /03 _tt,t/ P t V S k VO 5 1'>. i in ri ` e g a. WI - ' O Fire Department Providin Coverage Where Tank Is Located 1 q TANK SPECIFICATIONS: (each tank) Horizontal Vertical Underground Above Ground Capacity Length Diameter Contents New Used * Gauge 1 x rvo(.)u a I 9 Ga I Al- 2 - g a e .) t 8 G (1_.5 x- `!ei- 3 X S 0606 t g (' a.. 5 x / /V- 4 5 6 . Is pump motor B" es Are pump switches -fes Are bonds and grounding ❑ Yes What type of overfill protection explosion proof? ❑ No Explosion proof? ❑ No I Provided at load /unload racks? ❑ No I provided? 1 sm-k M01111(14( * If used, indicate what manufacturer What type of spill containment device: has recertified the tank(s): _ E HS CI) TO (..;t_ 5 0._/ UNDERGROUND TANKS: Distance Buried: 3 ! I Size Of Fill Pipe: t/- I Size And Height Of Vent A. X 1 . The tank is psfeel ❑ Fiberglass ❑ Other (specify) - I Approval: Nat'l Std ❑ gilt 0 Other: I Doubled walled? ❑Yes B1K6 Capacity How Many Anodes Size Of Specify: Dielectric Union Name Of Approved Tank Coating Of Tank (if steel tank)? Anodes Or Isolation Bushing 1 !0 00 6 0 DU Erli Si 7 5 2 S 0 D lirrB ST"I 7 3 3 c o c-) ❑ DU lit ST / P 3 4 0 D 0 I 5 0 D 0 1 6 0 D 0 I TANK LEAK DETECTION METHOD (location of all monitoring wells and /or monitors must be shown on plans) E Automatic tank gauging ❑ Vapor monitoring ❑ Groundwater monitoring ❑ Interstitial monitoring ❑ Inventory control and tightness testing (every 5 years for 10 years) PIPING: The piping is feel ❑ Fiberglass ❑ Other (specify) - I Approval: ❑ Nat'l Erar❑ Other: [ Doubled walled? ❑ Yes` Corrosion protection for steel piping provided by: ( athodic protection ❑ Impressed current Pipes coated? Erces ❑ No I Name of approved coating (identify): $ PP 9 y) � � m c.04 L k. CO c-1T SBD- 9(R.01/90) - CONTINUE ON REVERSE SIDE - PIPING (continued): Indicate whether laliessurized ❑ Suction with check valve at tank ❑ Suction with check valve inspedablp dirpctly elow pump at dispenser If pressurized piping, indicate if ❑ Alarm 0-Prow restrictor ❑ Auto shutoff Provide Model K . -1 L 1, , PIPING LEAK DETECTION METHOD (location of all monitoring wells and /or monitors must be shown on plans) If pressurized or check valve at tank, indicate leak detection method used ❑ Vapor monitor ❑ Interstitial monitoring ❑ Groundwater monitoring ❑ Tightness testing restilie Leak Detector ABOVE GROUND TANKS: Regular Vent PressureNacuum Make Number Size Emergency Relief Vent Make Number Size Emergency Internal Vent Make Number Size Diking provided? ' Remote Impounding? Are the dike walls and base impervious? Specify distance between tanks ❑ Yes ❑ No ❑ Yes ❑ No Walls: ❑ Yes ❑ No Base: 0 Yes 0 No VERTICAL TANKS - LIST THICKNESS OF METAL: Bottom Top Shell - Lower Remainder Bottom Top Shell - Lower Remainder 1. Course 4 Course Bottom Top Shell - Lower Remainder Bottom ' Top Shell - Lower Remainder 2. Course 5. Course 3 Bottom Top Shell - Lower Course Remainder Bottom T Shell - Lower Remainder 6. Course FEES -1ND 69: Number Installation Of Tanks Cost Sub Total Plan Examination - 5,000 to 100,000 gallon capacity X $32.00 = $ Over 100,000 gallon capacity X $43.00 = $ Site Inspection - 5,000 to 100,000 gallon capacity X $43.00 = $ Over 100,000 gallon capacity X $43.00 = $ SELF SERVICE OR KEY -CARD -CODE Plan Examination $22.00 = $ Site Inspection $43.00 = $ REVISION OF PREVIOUSLY APPROVED PLAN $22.00 = $ GROUNDWATER SURCHARGE (Wis. Stat. 101.14 (5)) = $ 100.00 TOTAL FEE = $ WHERE SHOULD PLAN APPROVALS BE SENT? Name ❑ Owner /Operator ❑ Installer 5 ( O yyt. c S e_ t-- Street Address Cam Cit State, Zip Code C� l7/c) 1 Pv» r v - c.� / Dan , -. 2_ r, 13c. l W .-� S 3 CERTIFICATION: I certify by signature that provisions of ILHR 10, fisted or not listed on this document, will be complied with. Also, no tank will be installed within 100 feet of a well (DNR Rule). �rr) . ,1 5 — 1I-- 9u .. 4499 -- s' Signature Date Signed Telephone Number