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NASSAU COUNTY, NY
Department of Health
Small Petroleum Tank Closure Inspection
Scheduling System
Application CSS
Oil Tank Removal
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Date & Payment Information
Date to Schedule Removal
(Value Required)
Paid By
(Value Required)
CONTRACTOR
HOMEOWNER
Contractor
Contractor
(Value Required)
Street Number
(Value Required)
Street Name
(Value Required)
Street Type
AVE.
BLVD.
BROADWAY
CIRCLE
CRESCENT
CT.
DR.
GATE.
HWY.
LN.
PATH
PKWY.
PL.
RD.
ROW
ST.
TERRACE
TPKE.
WAY
RD N
RD E
RD S
RD W
Village
(Value Required)
State
NY
Zip Code
(Value Required)
Phone #
(Value Required)
E-Mail
Homeowner
First Name
(Value Required)
Telephone
(Value Required)
Last Name
(Value Required)
E-Mail
(Value Required)
Homeowner
Type your full address and click on the address below that match
Street Number
(Value Required)
Street Name
(Value Required)
Street Type
Village
(Value Required)
State
NY
Zip Code
(Value Required)
Existing Tank Information
Number of Tanks to Remove
(Value Required)
1
2
First Tank to Remove
Tank Contents
(Value Required)
Tank Size
(Value Required)
240
275
285
330
550
1,000
Other
Tank Location
(Value Required)
Indoors
CrawlSpace
Basement
Above Ground Outside
Pad/Containment
Below Ground
Monitoring Well
No
Yes
Soil Boring
Yes
No
Tested on
Expected format: Month dd YYYY
DEC Spill # (if applicable)
Tank Comment (Example...Tank is located in the front yard.)
(Value Required)
0
of
300
New Installation
Gas Conversion
(Value Required)
Yes
No
Please enter a tank size and location.
Tank Size
240
275
285
330
550
1,000
Other
Location
Above Ground on Pad/Containment
Below Ground
Basement
Crawlspace
Other
Indoors/Above Ground
Outdoors/Above Ground
Second Tank to Remove
Job Type
REMOVAL
ABANDONMENT
Tank Contents
Tank Size
240
275
285
330
550
1,000
Other
Tank Location
Indoors
CrawlSpace
Basement
Above Ground Outside
Pad/Containment
Below Ground
Monitoring Well
NO
YES
Boring
Yes
No
DEC Spill # (if applicable)
Tested on
Expected format: Month dd YYYY
Tank Comment
New Installation
Gas Conversion
Yes
No
Tank Size and Location 2
Tank Size
240
275
285
330
550
1,000
Other
Please enter a tank size and location.
Location
Above Ground on Pad/Containment
Below Ground
Basement
Crawlspace
Other
Indoors/Above Ground
Outdoors/Above Ground
HIDE REGION
Removal cost2
Res removal date2
Expected format: DD-MON-RR
Above Ground Outside on Pad/Containment
Yes
No
Above Ground Outside on Pad/Containment
Yes
No
Above Ground Outside on Pad/Containment
Yes
No
Multiple Tanks
Confirmation Day
Confirmation Year
Removal Datex
Expected format:
Tested Onx
Expected format: Month dd YYYY
Plans Approved
NO
YES
N/A
Time
7: 55
Present Date
September 22 2021
Zip Code
Present Date
(Value Required)
Zip
(Value Required)
Branch To
Rem Date Char
Todays Date
Gas Type
Revieved Hour
Recieved Minute
Recieved Time
Num Of Tanks
Removal Fee
Fee Paid
New Install
New Install2
Error Date
Full Address
Full Name
Cost Stored
Res Type
Res Type Cnt
Res Conf Year
Res Conf Month
Multiple Flag
Multiple Items
Rem Credit Cost
Confirmation Month
Refund Flag
Full Con Address
Con Zip
Home Zip
Payment Type
Display Cost
Multi Tank
Multi Tank Id
Individual Cost
Main Table Number2
Second Key
Removal Cost Char
Display Address
Entered As
Above below
Article XI Notice
*** All removals / abandonments, installactions etc. must be done in accordance with Article XI of the Nassau County Public Health Ordinance.
This form is to be used only when the individual storage tank capacity is 1,100 gallons or less
.
I Acknowledge And Accept
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