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Appendix D .pdf



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APPENDIX D
OWNER/KEY SITE MANAGER
PROVIDED INFORMATION

PROPERTY OWNER/KEY SITE MANAGER QUESTIONNAIRE
ASTM E 1527-13 PHASE I ENVIRONMENTAL SITE ASSESSMENTS
ALL APPROPRIATE INQUIRY
Site Locations:
Lot 50-57-06-01 (“Parcel 6-02”; Former Pennysaver Building – abuts 109 South Street);
Lot 50-57-06-02 (“Parcel 6-01”; Putnam Hotel – 101 South Street);
Please answer the following questions to the best of your knowledge:

Are you aware if any of the following documents exist and, if so, whether copies can be
provided to Sanborn Head?
Document

Environmental site assessment reports
Environmental compliance audit reports
Environmental permits (for example, solid
waste disposal permits, hazardous waste
disposal permits, wastewater permits, NPDES
permits, underground injection permits)
Registrations for underground and
aboveground storage tanks
Registrations for underground injection
systems
Material safety data sheets
Community right-to-know plan
Safety plans; preparedness and prevention
plans; spill prevention, countermeasure and
control plans; facility response plans; etc.
Reports regarding hydrogeologic conditions on
the site property(ies) and surrounding area
Notices or other correspondence from any
government agency relating to past or current
violations of environmental laws with respect
to the property or relating to environmental
liens encumbering the property
Hazardous waste generator notices or reports
Geotechnical studies
Risk assessments
Recorded AULs

Document
Exists

Copy to be
Provided

Unaware of
Document

August 10, 2016
20160810_Hale.docx

Page 2
4092.00

Do you know of any pending, threatened, or past litigation relevant to hazardous
substances or petroleum products in, on or from the site property(ies)?
No

Do you know of any pending, threatened, or past administrative proceedings relevant to
hazardous substances or petroleum products in, on or from the site property(ies)?
No

Do you know of any notices from any governmental entity regarding any possible violation
of environmental laws or possible liability relating to hazardous substances or petroleum
products?
No

Respondent Type:
Contact:

Property Owner

Mr. Jon Hale

Company Name: Hale Resources LLC
Personal interview by Tim White
Signature:
(Sanborn Head)

Key Site Manager

Date: August 10, 2016

Tim White Notes from Interview:
Mr. Hale has been affiliated with the properties since September 2015. Mr. Hale did not
have specialized knowledge of environmental reports for the site, he indicated
environmental reports were likely prepared as part of Applejack Real Estate’s acquisition
of the property in or around 2005. Mr. Hale also indicated he was aware of investigations
performed in the past several years on the Greenberg’s property, but indicated he did not
have copies of the reports, nor was he aware of the findings. Sanborn Head has requested
copies of environmental reports from other parties (refer to text for additional discussion).
P:\4000s\4092.00\Source Files\App D - Owner Info & Questionnaire\20160810_Hale.docx

PROPERTY OWNER/KEY SITE MANAGER QUESTIONNAIRE
ASTM E 1527-13 PHASE I ENVIRONMENTAL SITE ASSESSMENTS
ALL APPROPRIATE INQUIRY
Site Locations:
Lot 50-57-18-00 (“Parcel 18”; Martin’s Mini-Mart – 301 Main Street);
Lot 50-57-12-00 (“Parcel 12”; Oldcastle Theatre – 331 Main Street);
Lot 50-57-17-00 (“Parcel 17” – Former H. Greenberg & Sons Hardware – 321 Main Street);
and
Lot 50-57-11-00 (“Parcel 11” – [part of] Former H. Greenberg & Sons Hardware “Winslow
Building” – 335 Main Street).

Please answer the following questions to the best of your knowledge:

Are you aware if any of the following documents exist and, if so, whether copies can be
provided to Sanborn Head?
Document

Environmental site assessment reports
Environmental compliance audit reports
Environmental permits (for example, solid
waste disposal permits, hazardous waste
disposal permits, wastewater permits, NPDES
permits, underground injection permits)
Registrations for underground and
aboveground storage tanks
Registrations for underground injection
systems
Material safety data sheets
Community right-to-know plan
Safety plans; preparedness and prevention
plans; spill prevention, countermeasure and
control plans; facility response plans; etc.
Reports regarding hydrogeologic conditions on
the site property(ies) and surrounding area
Notices or other correspondence from any
government agency relating to past or current
violations of environmental laws with respect
to the property or relating to environmental
liens encumbering the property
Hazardous waste generator notices or reports
Geotechnical studies

Document
Exists

Copy to be
Provided

Unaware of
Document

.

• GREENHERG, NORMAN
"

'

VERMONT, STATE OF, AGCY. OF ENV. CONSERV •

to

T 8ke\1 r,'om the office



II

By!(

'I

r{

iSS

Document. R.ecorded in Book 0 - 267 at Page
D. 1987 at 9 o'clock 10 minutes A.M.
By" r Yl (JIjN~~~J
Town Clerk.

Sept. 8 -,-.,t~.

PAGE I

VERMONT NOTIFICATION FOR UNDERGROUND STORAGE TANKS
-READ INSTRUCTION PAGE CAREFULLY BEFORE COMPLETING THIS FORM­
PLEASE TYPE OR PRINT IN INK ALL ITEMS EXCEPT "SIGNATURE" IN SECTION 'll1 ON PAGE 2,
SEPARATE NOTIFICATION MUST BE FILED FOR TANKS OWNED AT A DIFFERENT LOCATION,
FOR ADDIT IONAL INFORMATION, CALL THE VERMONT UNDERGROUND STORAGE TANK PROGRAM AT (a02) 828-3395,
I

I. OWNERSHIP OF TANKS

m.SITE LEAK HISTORY

IIAME ICuRPORAlluN,INOIV(UUAL ,PUBLIC AGENCY OR OTHER ENTITY I

I

YEAR OF LEAK

Norman Greenberg

(COMPLIT! nUl .~cnOH)
DNLY 1r APPLtCAILI

ESTlMAT E OF QUAIn lTV
LEAKED IN GAI.I.ONS

STREET ADDRESS

SUBSTANCE LEAKED

321Kain Street

TOWN OR CITY

Bennington

COUNTY

IoZ:?C~~E

STATE

V",rmont

SOURCE OF LEAK (CHECK AL L THAT APPLY)

Benninaton

AREA CODE
( RO?

II CONTACT PERSON


PHONE NUMBER

}1l1l?-':l1 ':1,1

0

o PUMP
o TRANSFER

TANK

'. o PIPING

(P£••OHft••POHOI8LHOR)

CONTAMINATION (CHECK ALL THAT APPLY)

DA'("TO-04Y OPERATION

YES

Of TANkS.

NAME !IF SAME ASIN SECTION I, CHECK BOX HEilE 0)

I

D.... ++

M"Y";t\Y'lO

i

JOB TIT'LE

AREA CODE

J

Sprretarv

I

I

STAT<

DON'1' KNOW

0

g

E

0
0
0

CORRECTIVE ACTION (CHECK ALL THAT APPLY)

':1, 1 ~ 1

0
0
0
,0
0
0
0

TOWI'! OR CITY

COUNTY

NO

0

SOIL
GROUNDWATER
SURFACE WATER

PHONE NUM8EIl

( flO? U ? _
MAIl.ING ADDRESS !IF DIFFERENT fROM SECT ION I)
STilE ET ADDR ESS

o OVERFILL
o OTHER

ZIP CODE

PRODUCT RECOVERY WELLS INSTALLED
SURFACE WATER CONTAINMENT USED
CONTAMINATED SOIL EXCAVATED
TANK REPLACED
PIPING REPLACED

.

NO ACTION TAKEN
OTHER (SPECIFY)

Dl. LOCATION OF TANKS
fACILITY NAME OR OTHER SIT E IDENTifIER, AS APPI.ICABLE

I

Putnam SOllar!" BII i 1rl i no
STREET ADDREsS,STATE ROAD, R,R, #,AS APPI.ICABI.E

COUNTY

Bennington

I

STATE

Vermont

o
o
o
o

Bennin( ton
NUMBER OF TANKS
AT THIS I.OCATION

ZIP CODE

05201

ONE

NAME OF I."MCOWNER

Nnrmlln

0
0
0

,

Main Street & South StrflPt

TOWN OR CITY

TYPE OF FACILITY (CHECK ONE)

1

r,Y'PpnnpY"f1

INSTITUTIONAL

IXl

o
o
o

BUI.K PLANT
STATE
TOWN

RETAIL/CONVENIENCE STORE
INDUSTRIAL/COMMERCIAL,
RESIDENTIAL
SERVICE STATION

FARM
FEDERAL (GIVE FACILITY 1.0, NO,

I

OTHER (SPECIFY)

USE THIS SPACE TO SKETCH AND/OR VERBALLY DESCRIBE FACILITY LOCATION. INCLUDE ESTIMATED DISTANCES
TO CENTER LINE OF ROADS, BUILDINGS,STREAMS AND OTHER LANDMARKS. USE DIRECTIONAL DESCRIPTORS
(NORTH,SOUTH, ETC.) WHERE APPLICABLE.

L~~-L

v,

$

~ A~'
.~
u. H.:r",( 81-b~
'Lr~ltV 'SI

t +~
tJ

"

.---------,-~~--.~.~,--

I!

';J f~ t;,) /,) I .;i

FACILITY I.D. NO,

WAS

ItYj'­
~N <-.d~-'.kt,.x
J
a ,';.,

RECOR,.ED
C~
0 / /
"
7
BOOK NO, ,!) -

)

("\t:'

TUe::

CI

/

.• 1 / ,71

,PAGE

",>(-;'1,1

........

o

AMENDED

fACILITY IDENTIFICATION NUMeER

IN

()(}O jL/IZ

/

--_ ... __ ......

I

OATE RECEIVtu

/00
/

...- .

STATE USE ONLY
!:i:I-1"IRST

(OATiO

"

,2 :;, q

/")r11

r

f

LOCA L USE ONLY

--­
I

D

'J.l.i.~,-,

II

1!·3J ·8'7
RECEIVED ,BY

j

A

""

APPj!.0VEO

9; .J./ L:37

-

~

0

PAGE I

VERMONT NOTIFICATION FOR UNDERGROUND STORAGE TANKS
- READ INSTRUCTION PAGE CAREFULLY BEFORE COMPLETING THIS FORM­

~----~-~---------------------------------------------------------------------------------;
PLEASE TYPE OR PRINT IN INK ALL ITEMS EXCEPT "SIGNATURE" IN SECTION lZI ON PAGE 2.
SEPARATE NOTIFICATION MUST BE FILED FOR TANKS OWNED AT A DIFFERENT LOCATION.
FOR ADDITIONAL INFORMATION,CALL THE VERMONT UNDERGROUND STORAGE TANK PROGRAM AT (802)828-3395.

I. OWNERSHIP OF TANKS
YEAR OF LEAK

NAME (CORPORATION, INDIVIDUAL ,PUBLIC AGENCY OR OTHER ENTITY)

ESTIMATE OF QUANTITY

Norman Greenberg

1 LEAKED

STRHT ADDRESS

321 Main Street

I

TOWN OR CITY

ZIP CODE

STATE

I052()1

Vr.>rmorrt

COUNTY

­

SOURCE OF LEAK (CHECK ALL THAT APPLY)

Bpnninotnn

Benninqton

/AREA CODE

PHONE NUMBER

)LlII?_~111

(RO')

NAME (IF SAME AS IN SECTION I ,CHECK BOX HERE

TANK

o

PUMP

o

PIPING

o

TRANSFER

0)
PHONE NUMBER

~ 1~ 1

( R n? JLJ.ll ? -

Secretarv

MAILING ADDRESS !IF DIFFERENT FROM SECTION X)
STREET ADDRESS

TOWN OR CITY

I

i

STATE

OVERFILL
OTHER _ _ __

YES

ZIP CODE

DON'T KNOW

NO

o
o
o

SOIL
GROUNDWATER
SURFACE WAT ER

AREA CODE

o
o

CONTAMINATION (CHECK ALL THAT APPLY)

DY'::'++

JOB TIT'i.E

COUNTY

o

PERSON AESPONSIBLE FOA)
( DAY-TO- DAY OPERATION
Of TANKS.

n. CONTACT PERSON
M.::lrinrir.>

IN GALLONS

SUBSTANCE LEAKED

o
o
o

o
o
o

CORRECTIVE ACTION (CHECK ALL THAT APPLY)

o
o
o
o
o
o
o

PRODUCT RECOVERY WELLS INSTALLED
SURFACE WATER CONTAINMENT USED
CONTAMINATED SOIL EXCAVATED
TANK REPLACED
PIPING REPLACED
NO ACTION TAKEN
OTHER (SPECIFY)

N. LOCATION OF TANKS

FACILITY NAME OR OTHER SITE IDENTIFIER, AS APPLICABLE

Putnam Souare Bui

TYPE OF FACILITY (CHECK ONE)

o

ldino

STREET ADDRESS,STATE ROAD, R. R.~, AS APPLICABLE

BULK PLANT

Main Street & 30uth Stref't
COUNTY

TOWN OR CITY

IBennincton

Bennington

ZIP CODE

STATE

Vermont
~N-A-M-E-O-F-L~AN-D-O-W-NE-R-----

NUMBER OF TANKS

I05201

INSTITUTIONAL

ATTHISLOCATION

ONE

Norman Gref'lnhpro

1

~ETAIL/CONVENIENCE
~INDUSTRIAL

STORE

/COMMERCIAL

o
o
o
o

FEDERAL (GIVE FACILITY I. D. NO. _ _ _ _ _ )

0

OTHER (SPECIFY)

STATE
TOWN

0
0

RESIDENTIAL
SERVICE STATION

FARM

USE THIS SPACE TO SKETCH AND/OR VERBALLY DESCRIBE FACILITY LOCATION. INCLUDE"ESTiMAflio DISTANCES
TO CENTER LINE OF ROADS, BUILDINGS,STREAMS AND OTHER LANDMARKS. USE DIRECTIONAL DESCRIPTORS
(NORTH,SOUTH, ETC.) WHERE APPLICABLE.

r

._­

l

P<!-I"fII'/SI/JIe,./

Iv] -~ rv"'-'

lq


.~ Pu~y\ --~-··Z~
J)
H4'~( ~~3__Ai
J

-----.

<Q 'I

YYHr t A1



LOCAL USE ONLY

STATE USE ONLY

..-----.---------:,.....--,---r-----------I1-------------------------j
/J /i {\
/,~/ / ;-.1
o AMENDED _______________
FA CIII T Y I. D. NO. --".t;../~6_:-1--"'---'----------"-'2-'---- WA S
~IRST
//

1/;

qN,.<::;rCq'w.~r,~
/ yJ
9· / J C\ . fir)
(DATIO
7
NO. "'j) - .2 ,{, q
,PAGE

REC9. RDED
,:.:~l
BOOK

.)_,

OF THE

yJ

FACILITY IDENTIFICATION NUMBER

IN

I

/

i ,
. /...

(\..!Q /!L.f/Z..J.>t1._${C4///
(rOWN)

LAND RECORDS.

//

SIGNATyfE OF TOWN OR CITY OFFICER

( ) n(']
DATE RECEIVED

Jt./1Z­

~~3J ·87

I

APPROVED

91,,//1'7

o

Norman Greenberg

'/NER NAME

"1;:"

(FROM SECTION 1)



:sr. TANK

INFORMATION

(COMPLETE FOR EACH TANK AT THIS LOCATION)

~

N

TANK NO.

TANKS SEQUENTIALLY
WITH TANK CLOSEST TO BUILDING, IF POSSIBLE)

(:,

t--­
I. STATUS OF TANK
(CHECK ONE)

TANK NO.

TANK NO.

Cf=J

c:=:J

c:=:J

c:=:J

c:.=:J

TEMPORARILY OUT OF USE

c::J

c::J

c::=:J

PERMANENTLY OUT OF USE

c:::J

L

I

c:::::::::::J

c:.=:J
c=::J

l

r==J
c::::::::J
c::::::::J
c=:::J
c::=::J

CCLJl..Q

.f() tJ A

TANK NO. TANK NO.

...J­

CURRENTLY IN USE

2. ESTIMATED AGE IN YEARS

PAGE 2

, INDICATE NUMBER OF COPIES
OF PAGE 2 ATTACHED

To

ritlr'('Jt-\e,

'1/""

T

3. TOTAL CAPACITY (GALLONS) I

c::J
J

'1'2
10 000
cx:J

CONCRETE

c:=J

c:::J

c:::::J
c::=:J

FIBERGLASS REINFORCED PLASTIC

c:=:J

c::=::J

L.-..-J

c:::::J
c::::J
c=:::J

c.:::::::J
c.:::::::J

r:::=::::J
c:=:J

c::J

c::=:J

c:::::::::::J

c:::::J

c:=::J

c.:::::::J

c=:J

c::=:J

c=::J
c:=:J

c.=J
c==J

c:::::J

c:=:J

c:::::J
c:::::J
c:::::J
c:=:J
c::::::J

c:=:J

c:::::J
c:=::J
c:::J
c:::::J

c:::::J
c::J
c::J

c=J
c=:J
c::::J

c:::::J

c:::J

[==:J

c::=::J
c=:J

c::::J

r=:::::J

STEEL

4. MATERIAL OF CONSTRUCTION
(CHECK ONE)

OTHER (SPECIFY)
UNKNOWN
LINING (E.G. EPOXY RESINS)

5. INTERNAL PROTECTION
(CHECK ALL THAT APPLY)

OTHER (SPECIFY)

c::::::J
CLJ

NONE
UNKNOWN
CATHODIC PROTECTION

6. EXTERNAL PROTECTION
(CHECK ALL THAT APPLY)

PAINTED COATING (E. G. ASPHALTIC)
FIBERGLASS REINFORCED PLASTIC COATED

c::::::J
c:::::J

[==:J

c:=:J
c.:::::::J

c::::J
[==:J

OTHER (SPECIFY)

crJ
c=J
c::::J

NONE
UNKNOWN
DOUBLE-WALL TANK

7. SECONDARY CONTAINMENT
(CHECK ONE)

CONCRETE VAULT

r=:::::J

IMPERVIOUS LINER

c=:J

c=:J
c=:J

c=:J
c:=:J

OTHER (SPECIFY)

c::u

NONE

DAILY INVENTORY CONTROL

8. LEAK DETECTION
(CHECK ALL T HAT APPLY)

CONTINUOUS SENSOR
ELECTRONIC IN - TANK SYSTEM
GROUNDWATER MONITORING WELL

f*1

it PRECISION TEST (ENTER MO'/YR IF WITHIN LAST 5 YRS.)

PRECISION TEST IS NOT AN AIR PRESSU~
TEST. BY DEFINITION, A PRECISION TEST
IS ACCURATE TO .OS GAL./HR.

c=J
c::=:J

c::::::J
c:::J
c:::J
c:::::::J
r=:::::J

UNKNOWN

0

c::::::J
c=:J

c:::::::::::J
0

I

/

OTHER (SPECIFY)
NONE

c::x::J

c::::::J

BARE STEEL

c=J

GALVANIZED STEEL

c:::J
o:J
c:::::J

c:=:J
c:::J

'--­

9. PIPING
(CHECK ALL THAT APPLY)

BLACK IRON
FIBERGLASS REINFORCED PLASTIC
CATHODICALL Y PROTECTED

c:::::J
c:::J
c::::::J
c=:::J
c:=:J

c:=:J
c.:::::::J

r==:J

c=:J

c::::::J

c::::::J
c::::::J

0

c.:::::::J
C:=J

c:=:J
c=::J

t=:J

c:::J
c::=::J

==:::J

0

/

c::=::J
[=:J

/

0

/

c:::J
c:=:J

c=::J

c=::J

c=::J

C:=J
c:::J
c::=:J
c:::::J
c:=:J

c:::J
c::::::J

c::=:J
c:=::J
c:=:J
c=:J
c:=::J

c:=:J

c:::::J

c=::J

L.-..-J

c:=:J
c:=:J
c::::::J

OTHER (SPECIFY)
UNKNOWN

10. SUBSTANCE CURRENTLY OR
LAST STORED IN GREATEST
QUANTITY BY VOLUME
(CHECK ALL THAT APPLY)

GASOLINE (INCL. ALCOHOL BLENDS)
DIESEL

c=:J

NOS 2 OR 4 FUEL OIL

CYJ

NOS. 5 OR 6 FUEL OIL

c:::::J

AVIATION FUEL

C:=J
c=:J

KEROSENE
USED OIL

c=::J

c:=J
c:::J
c:::::J

c:=::J

c::::::J
c:::::::::::J

c:::J
c:::::J

c:::J

c:::::::J
c::::J

c:::J

c=::J

c:=::J

c:::::J

c::::J
c:=:J

c:::J

[==:J

c:=:::::::J

c::=:J
c:::J

c=::J
c:=:J

c:=:J

c:::::J

c=:::J

c=J

~-..J

c:::::::=J

_L­

L

L

/

I.

OTHER PETROLEUM SUBSTANCE (SPECIFY)
HAZARDOUS SUBSTANCE (GIVE NAME OR CAS NO.)
MIXTURE OF SUBSTANCES
UNKNOWN

II. ADDITIONAL INFORMATION (AI ESTIMATED DATE LAST USED (MO.lYR.)
FOR TANKS TAKEN PERMA­
(B) ESTIMATED QUANTITY LEFT STORED (GAL.)
NENTLY OUT OF SERVICE

:2I. SIGNATURE

I CERTIFY UNDER PENALTY OF LAW THAT THE INFORMATION PROVIDED ON THIS FORM AND
ALL ATTACHED DOCUMENTS IS TRUE, ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

Norman

Greeoberg

.

PRINTED NAME A9{,FFICIA\T ITLE OF OWNER OR OWNER'S AUTHORIZED REPRESENTATIVE

r('\
! \ ~h
i

\

A \oJ'

f\

In

\ lrlJ ( r-,
\ I\~..

SIGNA~'-t.

\ )

Aug us t 28. J 98 Z
DATE SIGNED

LAW OFFICES

PRATT VREELAND KENNELLY MARTIN & WHITE, LTD.
P.O. BOX 280

RUTLAND, VT 05702-0280

JOHN J. KENNELLY
TIMOTHY U. MARTIN
ROBERT S. PRATT
NEAL C. VREELAND
JEFFREY P. WHITE

TELEPHONE: (802) 775-7141
FACSIMILE: (802) 775-6483
E·MAIL: lawyers@vermontcounsel.com
Website: www.vermontcounsel.com
OFFICE LOCATION:
64 NORTH MAIN STREET
RUTLAND. VT 05701

SHAREN D. UNDERWOOD

WRITER'S DIRECT:

Email:
NCV@Vermonlcounsel.com

Telephone: 775-7141, Ext. 211


\

November 8, 2005

Vermont Agency of Natural Resources

Department of Environmental Conservation

Underground Storage Tank Program

103 South Main Street, West Building

Waterbury, VT 05671-0404

Re:

Applejack Downtown, LLC - Notice of Transfer of Ownership of Underground

Storage Tank - Putnam Square Building, Main Street and South Street,

Bennington, Vermont


Dear Sir/Madam:
Enclosed find a completed Vermont Underground Storage Tank Form indicating
transfer of ownership from Norman Greenberg to Applejack Downtown, LLC. We also
enclose a check in the amount of $7 payable to the Town of Bennington for the filing
fee for same.
Thank you, and please call with any questions.

t~.urs;
~//rtltJv~4

Very

/
NCV:kac
Enclosure
cc:

Applejack Downtown, LLC
Peter Holden, Esq.

Neal C. Vreeland

'. '

/ . ;. , . /

.

Vennont Secretary of State - UCC Artic1e9

Page 1 of 1

VERMONT SECRETARY OF STATE

Deborah L. Markowitz
ARC1mi'ES

CORPORATIONS

ELECTIONS

OTHER
PROGRAJ.ts

PROFESSIONAL
REGULATIONS

Limited Liability Company Information
LLCName
APPLEJACK DOWNTOWN, LLC
STATUS
ACTIVE
File Number
LOO14158
Type
Domestic
VT
State of Origin
09/06/2005
Origin Date
Abreviation
N
12
Fiscal Year End
Registered Agent JACK P APPELMAN
6378 RTE 7A
Address
City State Zip
ARLINGTON VT 05250­
~anager~anaged? YES
Principal Address 6378 RTE 7A
City State Zip
ARLINGTON VT 05250­
[n lonna tion Contacl
Home I Site Search I Help

V()rmont Stat() Page I Contact

This Web Page is

http://cgi2.sec.state.vt.us/cgi-shl/nhayer.exe

I Disclaimer


i 4BOBB~~J
,\ji.
...P.Itft1'ED

111912005


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