James Heart Residence

Incident Name
. .,
Page 1 of 1
Complaint Data Ent Printout
Com Taint In ormation
01/06/2004
lComplaint
Com Taint Number -
1753
Type
Site Name
JAMES HEART RESIDENCE
Complaint Address
117 MULLINS AVENUE
Complaint City/Town
FAYETTEVILLE
Complaint Zip
Coun
CUMBERLAND
e ion
OContact
Sean Boyles
Contact Person Information
Contact Name
JAMES HEART RESIDENCE
Contact Phone Number
910-433-1741
Date Received
6/30/2003 jDate Responded
7/l/
Response Type
SITE VISIT
Status In ormation
Date
ate Lab Results
1Sample
ction Taken
CONTACTED PROPERTY OWNER BY PHONE AND SPOKE WITH DAU,
OV Date
OV Type
Nc
30 Day Response Datel
L30 Day Ins ection Date
dditionalInformation
Driller First Name
James H. Heart
Driller Middle Initial
9
Driller Last Name
117 Mullins Drive
Certification Number
0
Permit Number
Incident Number
0
Enforcement Number
ocationalInformation
atitude (DMS)
[at/Long
0
on itude MS
0
atitude Decimal Degrees)
0
Longitude Decimal Degrees)
0
C
NoD
omments
FIRE MARSHALL CALLED TO REPORT THAT SOMEONE BROKE INTO MR. HEARTS RESID
HE VALVE ON THE HEATING OIL TANK AT HIS HOUSE. MR. HEART WAS OUT-OF-TOWN
[BURGLARSBROKE INTO THE HOME USING THE TANK AS A MEANS OF ENTRY.
http://gw.ehnr.state.nc.us/P_irf/ComplainiiASP?UserID'=FAY2013B&RegType=3 &Incd=1753 1/6/2004

06/30/2003 20:40 9104331067
FAY FIRE STA.#1
PAGE 01
FAX COVER SHEET
FAYETTEVILLE J 1 - -
HAZMAT DI1
433-1731
433-1067
TO: SHAWN I ,m r I H
i 49.E -- 92(-
PAGES TO FC
.f
9
_J
I

06/30/2003 20:40 9104331067 FAY FIRE STA.#1 PAGE 02
A Nc
02604 u
gDID 9& State y�
B Location*
®street. address
Intersection
❑ In front of
11 Rear of
❑ Adjacent to
rain( DD yY^yy'
06 � I,,w'� 003
Incident Date .* station
103-0006664 11 000
Incident Number * exposure
dad on the ❑ xeduleCheckt Jr) Section shis bOX to vAio■rnactve loc■tion speciELcailon"1 QV■a onLy 9" wildlaD0 firma. Firm
Delete NFIR9 _ 1
chan5e Basic
No Actildty
Census Tract I
117 I IIMULLIN13 —� AVE
Street Type suffix
NumnerlMilepoat Pret x street or High -ay
I 11FAYETTLMLLE NC n- �
SEACe Zipip Code
�
e
Apt. /suite/Room City I
Midnight is 0000 E2'Shift B Alarms
C incident Type * E1 Date & Times Local Option
Check Loxes i£ Month Day year Hr fain Sec
4 13 Oil or other combustible liquid I O 1
dates are the ALARM always reQuiXCd IA� l.—� R3
Incident a maws as Alarm 4
Date. Alarm * 06 30 2003 14s40t17 sniff or Alarms uletrice
D Aid. Given or Received* Platoon
ARRIVAL. required. unless Canceled or did not arrive
1 ❑MUtual aid received I _i�� ® Arrive, �r 06 301 2003 14145:06 E13
2 FlAuLcmatic aid recv. Their IDID Their Special. Studies
State CONTROLLED Optional, Except fox wildladd tires
3 ❑Mutual aid given 06 3()20�15 s 0
03 6 s 32J Local option
4 ❑ Automatic aid given ® Controlled I�
LAST UNIT CLEARED, required except Eor wildland tires
5 ❑Thei>! Other aid given Incident Number Last Unit I Spec al Special
N ®None ® Cleared 06 t=J 2003 15 s 06 : 32 Study Lax Study Value
F Actions Taken *
40 lHazardous condition
''primary J%1CC}on Taken (1)
l
Additional Action Taken (2)
I
Additional Action Taken (3)
G1 Resources * G2 Estimated Dollar Losses & Value'
❑check thin box and akio thin LOSSEH: Required for all fires 1C known. optional
section it an Apparatus or for non fires. None
Personnel form is used. I 0 ^ 0 ' 0001 ❑
Apparatus Personnel property $ �J , L
Suppression UJ Contents $ 1 F L_000 , 000 ❑
PRR-SNCIDZNT VALU3s Optional
other 0005 001E y $l 1 000 , 000 ElPropert ,
❑check box if resource counts 1� , 0 � (I0 0 0 ❑
include aid receivad resource:. Contents
�4 ]xedNo Use Property
Completed Modules
H1tCasualtiee❑None H3 Hazardous Materials Releae• I� ❑Not Mixed
❑ Fire-2
Deaths Injuries
N ❑ Noae
10
Assembly use
0Structure-3
I I
sire I�J L�
1 d Natural Gas s ■lo. reek, ae avanatica or ysasat «"Lon.
20
33
Education use
Medical use
❑ropane
Civil Fire Can.-4
8erV1Ca
gaseaa sAo ia. tack Asa L. non. arllll
2 P:
40
Residential use
❑Fire eerv. CAB-5
I
civilian) l ��J
I
3 ❑°aeolines ..n►ol. ca.l c..k er o•scel. =aatAin•r
51
Row of stores
❑ EMS-6
M Detector
4 ❑Kerosene: cuesu<n mi.9 eQu,punt or Peeeabl• "tomes
5 ❑niessl fuel/fuel oils..Mele tu.& r nk or Pc=rrbl•
53
58
Enclosed mall
DUN. R Residential
❑HazMat-7
❑Wildland Fire-8
Required for Confined Sires,
1❑Detector alerted occupants
6 ❑ Household solvents: nose/ache. "Plil, al.anvp onir
59
60
office use
Industrial use
DUApparatus-
7 ❑Motor oil: C.— magm. or paetabse ==neon.:
63
Military use
Qpersonnel-10
2❑Detector did slot Alert tbwm
8 []Paint- erns paint can■ totaling c Da aAllona
ssp.i.,
65
00
farm use
Other mixed use
❑Arson-11
LJ❑Ontnorn
Others spear ns-ul.t action .wia.R of "piss ,
0 ❑ I
341
❑ Ciinic,clinic type infirmary 53 9 ❑ Household goods, sales, repairs
j Property U6611 structures
342 ❑ Doctor/dentist office 579 ❑ Motor vehicle/boat sales/rep+ r
131 ❑Church, place of worship
361❑ Prison or jail, not juvenile 57 1 ❑ ass or service station
dwelling 59 9 ❑ ffice
genera
Restaurant or cafeteria
16 1 ❑1-or
2-family
slectrBusiness
43.9[3 Sr
6 15 ❑ Electric generating plan[
162 ❑ Bar/Tavern or nightclub
42 9 ❑ Multi -family dwelling
house 629 ❑ Laboratory/science lab
213 ❑ Elementary school or kindergarten
high
43 9 ❑ Rooming/boarding
449 Q Commercial hotel or motel 700 Manufacturing plant
215 ❑ High school or junior
241 ❑College, adult education
4 5 9 D Residential, board and care 819 ❑Livestock/poultry storage(bara)
882 []Non-residential parking garage
311 ❑ Cars facility for the aged
464 ❑ Dormitory/barracks
beverage sales 891 Warehouse
331 ❑Hoepitnl
519 ❑coed and
outside
3.24 ❑ playground or park
655 []Crops or orcW-d
669 ❑ Forest (timberland)
807 ❑ outdoor storage area
91.9 ❑ Dump or sanitary landfill
931 ❑Open land or field
936 []Vacant lot 981 ❑ Construction site
938 pCiraA AJcare for plot of land 984 ❑ Industrial plant yard
946 ❑Lake, river, stream
951 []Railroad right of way
960 Mother street
961 ❑ Highway/divided highway
962 ❑ Residential street/driveway
youkhavenNOT checked apProperty 0c bode x' if
Property Use 400
IReSidential, Other
n2F04 06/30/2003 o3-0006664

06/30/2003 20:40 9104331067 FAY FIRE STA.#1 PAGE 03
;(1 Parson/Entity involved LJ
Local Option Business name (i, applicable) Area C006 Phone Number
JJAMES HEART �I
®Check Thin Box if Mr „ Ma Mrm. Pirst Name MI Last Name Suffix
same ed6rese as
incident location: 117 �MULLINS AVE ��
Then skip the three
duplicate addee¢s Huff0ber Prefix Street or Highway Street 'type suffix
lines.
JFAXETTEVILLE
Poet office Box Apc./suite/Room city
NC 1 128301
state Zip Code
❑ More people involved? Check this box and attach Supplemental Forme (NFIRS-1S) as necessary
K2 Omer game as pereofl Involved?
❑
Then cDeck this box and skip
I
I�
The rest Of thin section.
Busi.nesa name (i£
Applicable)
Area Code Phone Number
Local option
IFirst
I
U
❑Check this box iE Mr „ MB-. Mrs-
Name
MI Last Name
suffix
same entrees
1
j
r9 I�
incident lOCdCl,On.
Then skip the three
U I
Pre£iX Street or
Highway
I L_..J
stress Type suffix
duplicate addrees Number
lines. I
Ape./Suite
Room city
Post Office Box
state Zip Coda
L Remarks
Local Option
RESPONDED TO A REPORTED HOUSE FIRE. ALSO RECEIVED INFO THAT PROPANE GAS LEAKING INSIDE
RESIDENT. THIS RESIDENT USED FUEL OIL NOT PROPANE. SOMEONE HAD BROKE INTO THE RESIDENT AND
USED THE 250 GAL FUEL OIL TANK AS A LADDER AND BROKE THE FUEL LINE OFF. THERE WAS AN
UNDETERMINED AMOUNT OF FUEL OIL SPILLED ONTO THE GROUND WHICH RAN DOWN THE DRIVEWAY BUT
DIDN'T GET INTO THE ROAD NOR THE STORM DRAINS. EMERGENCY MANAGEMENT WAS NOTIFIED OF THE
SPILL AND WE WERE RELEASED BY BCl.
L Authorisation
�7104 IJOYNER, MARK A
Officer ie charge ID signature
1 1CP
Position or rank Assignment
06
Month
YO
Da
2003
Year
Check ^1104 I JOYNER, MARK A
Box if ®
aa°e Officer Member making report ID Signature
CP
PoeitiOn or rank Aseiynme4t
061
Month
U
Day
L--!-—
Year
In charge.