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HomeMy WebLinkAbout0074 CAMP STREET - Health 74 Camp Street Sewer Acct# 2303 Hyannis A-- 328 — 178 ✓ e � ij i a i u TOWN OF BARNSTABLE Dater / / TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: S BUSINESS LOCATION: ' INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: C 0-- 5� CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: — G MSDS ON SITE? TYPE OF BUSINESS: 06 uj r t 0,sktyL� INFORMATION / REC MMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 ,.. Main Street, Hyannis, MA 02601 (Town Hall) P DATE: Fill in please: � APPLICANT'S YOUR NAME: 1 ! Y> - . BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number O O-141 NAME OF NEW BUSINESS �- til TYPE OF BUSINESS JUdY_%U!Z U AOM IS THIS A HOME OCCUPATION? 1 YES NO Have you been given approval rom the building ision? YES NO ADDRESS OF BUSINESS cam MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate ermits and licenses required to legally o e i YP q 9 Y P �IQ ��. 7 OCCUPATION 1. BUILDING COMMISSIONER' OFFICE RULES AND REGULATIONS, FAILURE TO This individual has been for d of an per quirements t at pertain to this a of business. COMPLY MAY RESULT IN FINES, Ll COMMENTS: Authorized Si na ure* 2. BOARD OF HEALTH This individual has e n informed of th r quirements that pertain to this type of business. Aut orized Signature** Mus, HALL COMMENTS: KAZARD©U&'NIAtER�ALS RE6l7.LAV i15- 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: �i -tea Hyannis Fire Department (MA) 95 High School Road Hyannis, MA 02601 t Fire Dept Violation Notice July 15, 2016 RESIDENCE 74 CAMP, X 2 Hyannis, MA 02601 An inspection of your facility on Jul 15, 2016 revealed the violations listed below. ORDER TO COMPLY. Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on Jul 15, 2016. If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violations 31.01 Failure to comply Note 2nd floor co alarm has broken test button unsure if it works 148-SECT 26E No Approved smoke detectors and locations Note Basement smoke detector missing 1st floor smoke in kitchen had batteries in backwards NFPA 28A Violation of State Building Code Note Town of Barnstable building inspector Paul Roma on scene It appears and it is reported by other occupants that people are sleeping in basement. Inspection Note Health Inspector,Stanton and Zoning Officer Anderson on scene. Owner Barbara Terrell is on location and lives in 1st floor bedroom. She was advised to get all smoke detectors and CO detectors back to working status. She was advised no open burning in her yard.. 198704 William Rex Terrell on scene Inspector 09/29/2006 10:53 FAX 508 790 6226 TOWN MANAGER HEALTH lao01 R Se 28 2006 6 :05PM No ,6314 p P 1/5 C0MM0NWEAL'T7-j OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTREAST REGIONAL OFFICE 20 RIVERSIDE DRIVE, LAKEVILLE. MA 02347 508-940-2400 MITT ROMNEY ROBERT W.GOLLEDGE 7r_ Governor Secretary MERY BEAISY ARLFTN O'DONNELT, Lieutenant Governor Commissioner FAX COVER SI- ET FAX#(508)947-6557 DATE. _ D FROM.� � _ TELEP140NE#(508) PLEASE DELIVER T0- --- COMPAN''NANM ADDRESS; TELECOP,IER NUMBER: "�9- ) -7ct 0 ',ro O TOTAT,NLJMI3FR OF PAGES: _ ;(INCLIMING THTS COVER PACrF) PLEASE CALL TF YOU DO,NOT RC:CEIVE A COMPLETE FAX REMARKS: I This infarmatioais available in alteruate formal Cull buonid K Goma,ADA Coordinator ar 617-556-1057,TDD Servicc-I4 -298-2207,. DUP on the World Wfde Wob: http:llwww.maas.gov/dep Printed on RM016d Paper 09/29/2006 .10:53 FAX 508 790 6226 TOWN MANAGER HEALTH 2002 r S,.p . 28 . 2006 - 6 : 05PM No , 6314 P . 2/5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE Oh' ENVIRONMENTAL _41_ DEPARTMENT OF ENVIRONMENTAL PCUP Y SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE,LAKEVILLE,MA 02347 5 5- - MITT ROMNE'Y' ROBERT W,GOLLEDGE,Jr. Governor Secretary HERRY TI MALEY ART,P!,RN&DONNELL Lieutenant Governor Commissioner I September 20,2006 Phillip Ellsworth RE.. BARNSTABLE- DWSC/ASM 257 South Sea Avenue 74 Camp Street,Hyannis West Yarmouth,Massadhusetts 02673 RTN 4410287 i NOTiCL OF AUDIT FINDING AUDIT INSPECTION Dear Mr.Ellsworth: On August 8, 2006, the Massachusetts Departmcnt of Environmental Protection ("MassDEP" or "the Department") conducted an audit inspection at the location referenced above(the site). The purpose of this inspection was to observe conditions related to an area subject to a Notice of Activity& Use Limitation (AUL)- In particular, the audit inspection focused on the obligations and conditions of the AUL and AUL Amendment recorded for the property in April 1995 and in September 2003 This Notice informs you of the results of MassDGP's audit inspection.. A single story ranch style home is located on the property. The release occurred in the crawlspace located beneath the easterly addition to the residence.. The AUL restricts a portion of the property, approximately seventy(70) square feet in size. The A.UT, area is Located beneath the eastern addition of the home The AITT.,restricts access to residually contawinated soils present in this area by restricting any activity that would remove the existing easterly addition of the home. Access to the interior of the Dome was not possible during the site inspection,, However, compliance wit)) the terms and conditions of the AUL could be determined by observing the exterior of the residence to determine if the easterly addition h.-ai been removed or disturbed in any way. The easterly addition on.the home had not been removed and evidence of recent construction or disturbance on the property was not observed at the time of inspection~ Site activities observed during the inspection of the property by Itathryn Carvalho of MassDEP's Southeast Regional Office, were consistent with the terms and conditions of the AUL as amended. MassDEP did not identify any violations of the requirements applicable to the AU.. at the site. A copy of the AUT.,rield Screening Form is attached. This informllon is avaidable in 41teronte Format.Call Donald ft riomev,ADA Coordinator Pr 617-556.1057 TDD Service-1.800-298.2207 I Mas,DEP onthe Wodd Wide Web; http:lhvww.mass.gov/dep �„� Printed on Recycled Paper 09/29/2006 10:53 FAX 508 790 6226 TOWN MANAGER HEALTH 2003 r S4-A • 28 . 2006 6.06PM No •6314 P . 3/5 74 Cmnp Street,Hyannis,MA Page 2 Notice of Audit Find,.nay RTN 4-10287 LICENSED SITE PROFESSIONAL A copy.of this notice has been sent to the LSP-of Record,Leland J.Fi,ggins,Jr.., LSP#9370.. L15UTATIONS The Audit inspection did not include a coayapl ian,ee review of the Response Action Outcome (RAO) Statement, or the Notice of Activity and Use Limitation (AIJI,) document.. However, the RAO and AUL were reviewed as part of a previously conducted audit. The current audit primarily focused on field compliance with the obligations and maintenance conditions set forth in the AUL.. The Department's fmdi gs were based upon the certainty of the information reviewed during the audit_ These findings do not: (1)apply to actions or other aspects of the site that were not reviewed in the audit; (2) preclude futare audits of past, current or future actions at the site; (3) in any way constitute a release from auy liability, obligation, action or penalty under M.G.L.. e. 21E, 310 CMK 40.0000 or any other law, regulation or requirement; or (4) limit the Department's authority to take or arrange, or to require any Responsible Party or Potentially Responsible,Party.to perform,any response action authorized by M.G.L..c., 2 1 E which the Department deems necessary to protect health,safety,public welfare or the etwironXtlent. If you have any questions regarding thus Notice, please contact Kathryn Carvalho at (508) 946-2742. . Please reference the Release Tracking Number 4-10287 in any future correspondence to MassDEP regarding the site. Sincere s� orate A. Marshall, udit& Site Mana m nt Section M/KC:/rr Ongoing audits/26/1_evel 11/4-10287/noaf Attachment A' AUL i,eld Screening Form fc„ Town of Barngtable., Board of Selectmen (508)790-6226 Board of Health 7oring Code Enforcement Official&Building Inspector (508)790-6304 ec- Leland J.Figgins,LISP#9307 T�-te1 a�i'�i z�irla_cnm DEP-SERO Dated Entry,AUL SNAUDI AUL NAFNVT) 09/29/2006 10:54 FAX 508 790 6226 TOWN MANAGER HEALTH 1a 004 • - Ssp ' 28 , 2006 6 : 06PM No '6314 P . 4/5 ' R-N:1+1 ASL TRAmNG NUMKFR MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION <; Southeast Recional OfficeZBureau of WasteSite Cleanup �• AUL FIELD SCREENING FORM Town fIyartnis ti >, ' :- _ '=f- : y y y il'�:1 "F..t't B:„`" �.,d:,ra �..• .... Slt,.``: ,T: ..�...,%.:• I�','ki:: ` dn't'3Ct'l�ISc] li; 1iTTlli` .,. MA. >y, •ri.-:.'t:•.:._,.._„ ;.r ' 1;��"�a.- c.l'�aiiic.ls:l�cstdcnc>ei•}`• :t:•� "r,'i1G:�t'„n •{#'^ .a '-� ,p:''{.. ra:+:c.,ty�, .:•.yF �'Y•'� ^r+,n°t1si •.r, ;aG:.::: *w 'Iyrp•�.' :{•"�. .Ta F `fir'{:a,,,'.;``^C';�':E.f:r.,{4.;: ..r'. 'I''�Y ! ••a I e. sv, - ':la.: �x-•a,'sIF La �..' :'V':I d.^'•. I'Wb4 '.1' `:ly'' x\. .._..'..I..... U e^.P'AN ,u.... .' .. 4..,. :: 1. .0 u .I..i„l,..:v:�••-�s ',.:.'li" •. I .li+�,•'L:..� t' Ir'n ;y„7QC1 rl .v Jyf�. , i"'p l'I":C�i� ��4y�^•• ,;�. .}�.. .�mF: .I � ''oTie'.. �-0�•7'7��,=�. �i.,� +��,i�� i:'�". +:1,;,•��'''�„ .e.`�6.'•u�'''.I•�.: - '" ':�• ;.,P�. y° �).,!Lt,x., :"x ti�_ -k �,'+h':v ,,%?'.r',1,.',.F%iG7�,.., :ly:' xl.e•3.W r.l.- �;'.`1�7i:.':;. ,y::.4R'y*W%'f••1ti•,:.:.:;,,'`,...1 _ 'n,' ;y, ..uw;�" ram•. ,-.,kr'jC :vJk.4'„ �"La",:,. mI,NS>ti`•' ,�'"! !M., ''!+y� -•:p��. M..� _ .. r r y; ,g, _ ,a• r} ..2::•t. �I�,i'`ri: G.,; i.'t�t•I'.. -.'� d�s{„a• :r •: "'d"" " 4 4� .;h':.� 5'i,1:.:rt'. -1 !'ierlfl 1tri e.!'G;7l�lr'n1 11ltA'Y 'Q V ` ICed':o'ut:bu5 nri`rj` ,ti ;��r1`.,' '•�_'{.`;`''_:^�: SITE INSPECTION filled o by areas identifiable? •Yes No. V.,av i e x':� x" O ;'�ri't1>:::t 'Boundaries of AUL nr s ti"'A+°F'•�'-"..,' •`+' '' ,,•,. ;r. '1':�'�d,,:Nt',�y y�:�s a.,.;,•"i$yl llpii;M��; :ATjL;ATncncl' leJ:;;:: Br li ^gtl avcibcn .p, apCiiig ,I' I CortipleTe access to all AUL area(s)? o Yes • No CSC 1�03• _ s `,y s �t�nd`s r►v1JlUt��er:::F; k EvidGnoC of recent excavation/disturbtmc+v? o Yes •No �i:l i" - •''�.,'=iJ. 31e1:AtFL. rd''"u-•':+pr •' oXes • NU0. 4 Evidence of recent euns[ruc[on? 04128%95_ p%',"•;f;, i ,':' RcTriediation Waste:present? oyes No Add"iri'tiiat,d'ctaaEs! •crr¢lcwaml iitTp';.ui<' ]I area ,:,i' ;f ;.',':'„ Indication ofpoteraially serious site conditions? o Yes •No Y'b'Y,.'(„gfYf.�'A�'. 1'.' {: '• T fhm�.n �;�,�j :i.. '�y g ,f r�l�'PL? J x,.+}nlr :�"!'I:t' Ai•Z1'.Sl}c{tit[A:'J�'f',15,3�Dr0,262;r1.�fk�'•7'OSltsiyeeri.5izcand" ' Other Notes; Ibctil"ell""b ci'�''``ict hirz astcrii ar o iyoF?liic io r1" ,'1 ,tri'iallv`'buiic ' The release occurred iii the erawtsnace located bcnca[h the easterly ?;x5;:'; ;; 1 e`1'°"Sfi%;w d'forti�t'e "'.'loc Lfc?°'` ti s;is"i'cT�v:;r: 's; cti K tLl), T1,FU', pj(lJ. 1 acldltl011 LO the TCS]dCnCe. Access t0 the 1ntCIIDT of the�lOrtle Wa.0 1lOt ' ''n n;. ` ? 'm "i3 ' :'�� t:^F ,`•:'' o n. I lowevcr,com litmce With'the tern-Li ,:�:`�'g possible dut"in,.the site insDce[io D �;?ti"t:,i';{s� ,•�� rati;^ :s�-•'t :. •,T::,:141,.tr!ir,`zi �'S•: y6'cl'i':" r ; 4�,a'I eLermined b observing the e,Tel'iQC bzyrI and conditirnis of the AUL mould bed v of ale residence. :' ,��`'�'S'a.% :'>af ''a*;'• •YyiiYgSs3'I•,�i:: ''ut- Iijislksp,'•� a��rvii `u�i.: `c'V,' ;. rce "W�,Ih�'•i la :I::"""'•,IHr,:Y,p�!i;U�,l t'�:ih._v. s` ,.� ri'lted^ ittYlk UK'. ._ Observed Activities and Uses :: ;. ;:.:,'1 ? air: v'F J :eiai'^ iYr.: & : n :Sr:;y;'ar.; r '•: 'Isddeiiial„':, o,:1wtLra:�;1;' ktt,�, = `aYountl;; " : • Residential o Daycare o Sellool u Playground I. .; r» rat r;Wi'J " �,; Milli,.:3,,,,. Excavation o Construction ;c�Culiiiii r;l i ;: ,;itt�us tal,'I:I. avtiC1011 I(.,9 luctio�(,,i��1 ii,rii yh:l o Commercial o Industrittl o :YtC F 3 rout; "•i7tlidkdNll11P10T1S'',G' k' I" •�i?�' " " o ReLaettt.tott (OlnmcnLs rT�riy':: r; �`�[' •':,b':,... ,a' :.:.,'�": y�;ev' _ caster.i , f Jnc: ti t r'C ;;h��5se, lL tl r'` ,p :yt }t:? by+I ;`r' N'';a` The easterly addition on the home had riot been removed and evidence of potCnfl�DA><11?zoi7eatht tdg>��v�it"c;Wijebd:`cat4c t. rcccnl construction or disturbance on ltza property was not observed kit the . V �' '',t f •' M Rf :t;t, :1�E' { r l:r 4'`:} '.a,�'��,�';,": -y""I:,:.ti C�aeHit .o cdntttmiriitiil'.s; zi .f)ie;BrgllLYtlsr aicx',: ?�: r�.,,,r :s.S.' ;,. time of inspecrion. Site conditions jtppeared consistent with the tcrrtis and 1y:.�4; ::�.�= -.x�i�•K��' `>rJr,r;;r;„r;, "';;� �:�:'',;•:.,4:� ;� 'zl,�.,,, conditions of the AUL,. a,dl'I`ip�1�.1':�,r•4 .i�hl' �� ,;;'',::..• .:Ytw,'I.�(C,1 ,`fe„' ..V,.N � 1':�r," a:P.Sj y'!I...'S� �'.�4' . G , t�J�:�' �jlRl �' '�L a• i`:Sf. tN�U... .�4, i..31:,1"1��j6;1,ii� 9,t:ir;�;(i y'� CI;�•�'FS�tS'1�• 'A.. Ir:t�E., .I.n �:is=."1rt: ,:S:r., :Ssr. '•w:J "'n`•I d6', anc".:,4r11i ':l�i�%:: i� i:4x;} 4"��.',�„? ! yti. .es'q,5a'�i1,`t'�':1`"7��l":�;• 'tl '4�:r.,, .yam! ,i.n'. •.,' „� ,,J.•Zlt" ! :,µ::}_.'•^r'•�'w. '.i `" JVi%'s•, '1�� �'"�r,';L::LY,`-:k;;i,' VIOLATION OBSERVED: •Noo Yes Possible ':.5.'1..:,Mri. .k'w'''I':+ti' '1',•':„'.,f"'•. !'no��"1:'',•••• tY,.; iL°u'''3rw "' 1',C?;'":n,,.,:'w aR'', .' r s r esret iiF"�thr iti._ Observed Activitie s and Uscs . i;i{:6;`. i'•,a •"��':�>;;^'..' r, • Residential Da Cttite o School 1DT]�c 4?:t!_:�*..a.� P( _^'113ae:•�- /m� a ,�+j R o v .I iyP;l4rrm i''•I Iiri,ini.,iP,• ,Ili VS,:_: :,II.'I 9:,�`.. I�'li j, ,� i r.�'M T�II}� �'�r, t I. ,� �d:�r'lf: 1'�f xU tlYd_t.G ? tv"iLbct�aii'un ? ! ', x,:Id���, a, '� o Playi'ound o Park p RACYeat10 r'�r�,�'.�'��Yy�" w°,•�+::•;�:.,�K= 'rca9,{�'�:is'�Nn '� �'�'iN," "" D'i tttnc �c,: '' t, Construction o Fxcavation o Disturbance Is r,} t�.,,Fi.:i' {:fi•,,;"��'hTab,:-{':c'a➢"' �:h';I'i":Q"_ .... it's.;;.. It�Ii��J,TrS/,4v� QICS;.jfFl�yltiyer,"sbf 'hTC31:r�a1'Cii';; r,�:7;.. o CiaJdenine' O Fruits/Veggies O) lowcrs✓Ltt.ndsailiing '•v L+M1" ti' V;uA^'Jyti:'•�V'" .�;'_„n •i:'k 'r`�tt., ti: f.swe_ x'r:•.,': �i(�k�ro� S.,1..;.;''..�:'1.::;"!�'�.'� Comments, •Aiiyi;activiCy^;aft,l�Yf�!!!invgiUe>tcriiovi�i�-JiC��`��5tarly,ad`diiid>z of'th�' The easTerly addition on the home had not bccn removed and evidence of :e7t5f'i� .'housets; tiPop�r:Cy',,^ `'ii;fbr':.,'r -•'a''-", :; :. ": ;; •`r ,; " +' /J2`::e' A'� c:e of the >roperty was not observed st the '��. '�,•;� �r:1 recent construction or dishuban I ':'..1'a:...,•l,;yy:l .I{I',;I::'a`'',I",i1...1,1{1 ;h ,'..T-,v,;, ',''I.rAu - • ,. "{'';';:ra,, ,p. :,; 1,:;,"i; '';. 3.,I�. I,r•I vitics d uSCs ittcgnsistent with the tetrn5 and _ �:,L.�^;ta..!,• _ „r,,,s, ..," ',,>;',' ;:�_, ';'n{;,? timC of]nSpeCT1QIL ACIi Lin .,F:-„ �3�',. 'i7i= tis'i`i•,4'""'-r'.Y i�'•:'"••I' ''d: 's7i' 8 •) ;c�,-�:F-:"'b:�.°rw;::':�"t,+",;:�'•�•. ,5.�, ��1:�,':; ,` ::;;��w!��„�'; conditiuns of the At IL were not ocuurring at the t1Illc of insp euL1.t ` ,,.' :;a• .'�l•• I!t. •�`�^fir:,s:, r• 4`}'• 'r..„�:,<I�;.:,;•{,,'s ;+r .� _•i: '�' ,1rx;,y., ;;y:�..: ybnlll.� ,:C',,C:.;;r''.y{','�;�ay; '';9�i;x;,�>,i•i:1.�'`• i<,r-'uidr-'�,,ttti,;�_ ::r!5i;,:�r"1'+ri.•3, ',�'"� ,cn�l:r' t,tip;'X•�et';.'• :.a!:ftilil!�; },;'>" '�� VIOLATION OI3SF•RVED• •No n Yes 't Possible �_�,�,���.'-, 'r.,. i;'•; '. 4'•,,.�,i: �hadni�iatd�:OKr Observed CQt3lt101S Ir':•:;: •n�_'r.'.;•>w-an;;rip,: ".lt,, r' -jf�r^?q:"�:'�1.5?. .L_,:.,. ,.,.tp,;•64i'.:.:;y'y^'.+:" �'!'.; - n°,A�a]itain>F�avtIir�' n;: uit apt `" _;e'tkhnetz •''f''+ u Pavement o CaD/Cover/[,finer o Signs/Notices Soti'.lMaaQcizieJ. ii;Il>r 1t1aF;5'ai; '' ti' r''` '" Comments' g• f x'> tf p��}';•c�:.::"': ,htt a 'f t`:;�k t C':.T I I'�7 lwgli!t.;�RI:Yi. SI'„ I„`r.�,�il, d�eJ . :�:iLVl'iilIr];iiiiiS���s6;Nnttees',. �"�,hcr�'?b "€tfdit'I�an ��:��•���'1;,.�,.�,i �' 1?rc c"''`sry ',tictiv' "Ehai*to il` , "'' i itiiovit ''1ti�c casfcrL •< '�'„'r The easterly addition on ate home had not boon removed and evidence of '::: _L:i:;.tV::'!:::i'i"r,"::!':'•�+'' F "s�{,li ,,.Jr puyS�l iv. rwnf s{v.,,,l - 11r1';,p'll",P;,6�i:::'.:i..: I c.'K��': aTidihunr.'e�I,;tlfie'ex.i�TItr w ciuse:;',oi tl ci�crty: ! : r Y:;;;., a pF'I,' ,,:.,;:, recent consnucticn or tlisn�rba,ice on the properly moos not observed at the },r� N, x'_ �::.. ;_,• ''..,- a pro perry a eared consistent i-:�.:'��: -:�::�= ; . :"`t"�F, >•f ^:' ,'; � with Lhc �ali:+,. :i`•� '•i4ie''n"w,L�:i.x,l,�. 'asap,, ':. �.r.>.;;:�:.���' Little of inspection. Use of the p p 'Ty Dp r3'i i,i�„•:?. '.,5,: r:.,?.,i. hs�. •ribs and conditions of the AU1., >'y�.. :sTRa?m:iiT.�y-4':3r'iri" .i::i;'a'L' '.'i'.a3i)n„�''".+':w_�„{•,� ,.rr, tt[tj4 •tt�,L 6- k I I, OLA TION OBSERVED,• No o Yes n Possible AG3L.Skctc 'f1l lidii'`foim_2"`'o. zs, :,: "r' ::' :':~ . :;:'i',''";,•;.," AdClif'icinglC'o�iiiiriciitsli`utes'c�ii:;t ; 'e"seSidc>' i•� Nosir:j Ycs ':j`'' ".-:::tc Additional C.omments/Notes on ltevctsc Skin: • No o Ycs : : : ,.:.;..:•.:�.. ,,;:•.:',..:: . :.;..ut„•, •„:.: .:',:,•:,,' i ection Dtttc:0810S12U06 Coliplctcii' y+'Kutlitynto D.n[z 0:$%U''4/,bfi :;i�" r''A` :? Completed bY: Kathryn CarvtLiho Impaction I - Sep , 28 . 2006 6 : 03PM No . 6314 P . 1/5 _ COMMONWEALTIi OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVI.RONmENTALAFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 508-946-2700 MITT R.OMNEY ROBERT W.GOLLEDGE Jr_ Governor Secretary BERRY HEALEY Lieutenant Governor ARL TN O'DONNrT Tr commissioner FAX COVER SHEET FAX#t(508)947-6557 DATE:_ —FROM.f 1(, _ . (DD .0 TELEPHONE#(508) PLEASE DELIVER TO: 10 6 COMPANY NAME: ADDRESS: TELECOPIER NUMBER: 5'y ) 7 O Cd TOTAL NUMBER OF PAGE,S: (INCLiTDINCT THTS COVER PAGE) PLEASE,CALL TF YOU DO NOT RECEIVE A COMPLETE FAX.. REMARKS: This information is available in alte=1e format Call bowild X Comes,ADA Coordinator at 617-556-1057..TDD Service-1400-29S-2207.. DF.P on me World Wide Web: http:ilwww.mass..gov/dep �� Printed on Recycled Paper t : Sep , 28 , 2006 6 03PM No , 6314 P - 2/5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL _ _ DEPARTMENT OF ENVIRONMENTAL P twySOUTHEAST R EGIONAI� OFFICE; 20 RIVERSIDE DRIVE,LAKEVI LE,MA 02347 5 — — MITT ROMNEY ROBERT W.GOLLEDGE,Jr. Governor Secretary KERRY HE ALE Y ARTX.R.N O'DONNBLL Lieutenant Governor Commissioner September 20,2006 Phillip Ellsworth RE-. AARNSTABLE--BWSC/ASM 257 South Sea Avenue r74 Camp Street,Hyannis,, West Yarmouth,Massachusetts 02673 RTN 4-10287 - NOTICE OF AUDIT FINDING AUDTT'INSPECTION Dear Mr.Ellsworth-, On August 8, 2006, the Massachusetts Department of Environmental Protection ("MassDLP" or "the Department") conducted an audit inspection at the location referenced above(the site). The purpose of this inspection was to observe conditions related to an area subject to a Notice of Activity& Use Limitation (AUL). In particular, the audit inspection focused on the obligations and conditions of the AUL and AM.., Amendment recorded for the property in April 1995 and in September 2003 This Notice informs you of the results of MassDEP's audit inspection.. A single story ranch style home is located on the property. The release occurred in the crawlspace located beneath the easterly addition to the residence,. The AUL restricts a portion of the property, approximately seventy(70) square feet in size. The AUT.area is located beneath the eastern addition of the home The AU.L restricts access to residually contan►inated soils present in this area by restricting any activity that would remove the existing easterly addition of the home. Access to the interior of the home was not possible during the site inspection. However, compliance with the terms and conditions of the AUL could be determined by observing the exterior of the residence to determine if the easterly addition had been removed or disturbed in any way. The easterly addition on the home had not been removed and evidence of recent construction or disturbance on the property was not observed at the time of inspection. Site activities observed during the inspection of the property by Kathryn Carvalho of MassDEP's Southeast Regional Office, were consistent with the terms and conditions of the AUL as amended. MassDEP did not identify any violations of the requirements applicable to the AUT.. at the site. A copy of the AUJ..Field Screening Form is attached. This in(ormaLion is available in altetrnte formal..Call Donald M.tjomex,ADA Cooi dinntor at 617-556.1 D57 TDD Service••1.800-299-2207 MasOr-P on the World Wide Web; httpJ/www.mass.gov/dep t3 i,h� Printed on Recycled Paper Sep . 28 . 2006 6 : 03PM No . 6314 P . 3/5 f . 74 Camp Street,Hyannis,MA Page 2 Notice of Audit Findings RTN 4-10287 LICENSED SITE PROFESSIONAL A copy of this notice has been sent to the LSP-of-Record,Leland J..Fi.ggins,Jr., LSP#9370.. LIMITATIONS The Audit Inspection did not include a compliance review of the Response Action Outcome (RAO) Statement, or the Notice of Activity and Use Limitation (AUL) document.. However,lowever, the RAO and AUL were reviewed as part of a previously conducted audit. The current audit primarily focused on field compliance with the obligations and maintenance conditions set forth in the AUL., The Department's findings were based upon the certainty of the information reviewed during the audit. These findings do not: (1) apply to actions or other aspects of the site that were not reviewed in the audit; (2) preclude future audits of past, current or future actions at the site; (3) in any way constitute a release from any liability, obligation, action or penalty under M.G.L.. e. 21E, 310 CMR 40.0000 or any other law, regulation or requirement; or (4) limit the Department's authority to take or arrange, or 'to require any Responsible Party or Potentially Responsible Party to perform,any response action authorized by M.G1..c. 2 1 E which the Department deems necessary to protect health,safety,public welfare or the environment. If you have any questions regarding this Notice, please contact Kathryn Carvalho at (508) 946-2742. Please reference the Release Tracking Number 4-10287 in any future correspondence to MassDEP regarding the site. Sincere orah A.Marshall, udit& Site Maria to nt Section M/KC/rr Ongoing audits/26/Level 11/4-10287/noaf Attachment A- AUL Field Screening Form fc;, Town of Barnstable Board of Selectmen (508)790-6226 Board of.Health Zoning Code Enforcement Official&Building Inspector (508)790-6304 ec; Leland J.Figgins,LSP V9307 Lee(��rgint corn DEP-SERO Data Entry,AUL SNAUDI AUL NAFNVn fI SeP , 28 , 2006 6 : 04PM No • 6314 P . 5/5 Sep • 28 . 2006 6 : 03PM No ' 6314 P . 4/5 R. REI.FAs>:TRACKING Nium R MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION Southeast Regional Offices Bureau of Waste Site Cleanup AUL FIELD SCREENING FORM T"wr' 'I�r""s :f! i — r,.� I .,....,.. . ,^, ,r. ,.�;:..�:.'.,. r:•"�+:r':�' ,N rl I:l'S'hIy N]•flklt';r!�. , .Srtc-Namc.,.RcSldonc;z...,�' . .:,.�:m ,.. ar<;'.._>::' .. ,.�.,:-•_::. :�,�,,y.�f�ontact':P�rs�iil�:� .. .. .-. $.� .-:".:.--.'.::'• ,.°f.YU rid+, ...._.. .. ...: .... .. .... ^w.- :..:..n:,•,..:t'a.... I.�.. .5. ids'': o' ne:`;'..4�GtlrnnaSl t,';HV�) 5�°�: �*• „I :,. ry� �t :•: .. .. .--.' .... ...... ... ',. -... ... ,I. .5 ,.... .. .., ... I .. I!III 1,I. 1.6i'�:' egry,•:;:�:':.:.: ... ,:. :7 . . ... � .. .._. ... .,,•..;,..e.,his ';"R7? _ ..._ .. .. ... ... .. . �. ... ....::..... T . .:. ..r... ...r., n . .. .. .:. .. .�1�:,. .�':. r, 'mac'-.. ... .....4 :�-5-.. : ., n ... ... -..� ..., ..J.,... '�-1.. 4d 9Pn ll�l.�w.l,".7�J�S.:.-.4.. :.f.:'.'�id.'":" ,a!•h.t'.':v':i:;:Vv�•;'� A.C1.11L`.:TN'N'nit11Y1*EtiPIC1T'i 1dl:ouE:butS<tr�eenrr• 1C7.zcplt� ';r.-i:'t.- '''' 'n....�,I SITE INSPECTION 1!!Cd out by Field Stafo Da ` 1 L`:'tile'cir r`"•'":a:ue'scrinfa�SRI A r ;Grr 'Boundaries ofAUL areas identifiable? • Yes o No_ -;A= „ ;, �;> ,l - Yes . No ,men �lz l = $ i pdi '';l::agcincii=.,o tr~ii' Ciivgi: I' Complete access to all AUL trrea(s). o r' ,.:: bf 1x03•.` :; :;>::._:`:: ' 'sbdsp .(l" iC)lier':< Evidence of recent exeavationldisturbancc? o Yes •No ':,^'.::��:�...; '• ':.':,'t::.;'.::F.Q,-:.`0^ti,.i1 :"i;';'i is<•.: r=•r;; ' -r� '<A::'a'r..;*.:rir.';',: (J•ra 1nhl:Al FL'' r :��roui.�s�;';: F.videncc of rcccnt construction? u Yes •No :''::F'``:•i • '04128%95'. Rotrlediation Waste present? o Yes No Additio'i'iataQbtls/Y' hcr>'rcicv'in i'nfo"u %A1I :ar•'e"a'<,'' >?'<,.;;•:' Indication tentiall serious site conditions? Yes •No .•:r.:q�,...;. ,t .4.. ,;. '.�... �� ' .`:`�:c,'•' i n of potentially . O AiciD.Slx :c"GLt� i 'l:`kris;avvro�iirlritc, ''70•sg arz e ;iii:'�izc and.ts �i ,° x. '' �,' Other Notes: lbcritctl'rb'eeii [ k}3e>:e"a�tcrii«a 'd �on`vf:thd.Ii�ipt '=A{ 3riall :buiicdi fhc release occurred in the crawlspacc located beneath the easterly �:...,::�... ., n_, �Si� I,':'':::5::"r,'"::::">itr:{+'.+^���•'�?"' ?75;gallon luy�:;eY) tFurk.;wwa •form,rN.locytc 3l eituelutca G;>'sriticfc� addition to the residence, Access to the interior of the home was not by.thi:,lkrrsy,.•;•.•;:";iF;�`.=;.;};•; mm'!'. ;,r . --':yi'•:-' pOSslhle dlll'llla the site mSDtCtl0ll- I Iowever.COmDhtulCe Wlth'Ihe tefnlS ,�;�:+^:': ,d,,,. ,�+..,:.t:;>,I `•��`` ;i,�,_ ,:'. a etermin¢d b obscrvin' the exterior ,.:;,I,,_; 1�_...y.�-,., :��"� :i,,;,;;;•;.�,r:;l '.�': and conditions of the AUL could b d Y � aV'tl' d•':'L ..r� •``� .ear. "•.,.,.t.,..r..$Y�;:.�Sm. ,.:••':. er :;;.:._ .'...44. �rv::a;,w.l.,..,•., �.'..9.a!''�4:'.+. ;:'i Uf the residence. .< :.:.Pgr•mi:Eted rAt' t Yittp ' id'a11tie ` r�•J°:"'.:�••. i:' Observed Activities and Uses - .S:,-:ci•,&;::>',,...r„t:3�';r,,.i..;•:,::<,.r ;..'.�,,�;i:�._^.R'�.:; :r::>•a,". .F; ;Residentta !:' ktrrc:.t'?;•� t �1L: :: a ou'ntl:r. ?ia1 ,!, • Residential o Daycare o School u Playground 9 u:,.ct:t',.(.:oi.+:aIl,,.;�' ';{> o ConslnictionoommercaonusriooC ..r - "iz: •i•..;k:9!�r.'!'��;k'�i;:.i?:.}'?;y � o:Itccca't'i'ont 0(1}zrf �inditions aryt o Rcrzttltion (ommcnts , Y1'ny'lglvfiil'usczerll? r{f'pzrry:.,`flier:dgcFt�fr2{'.u1ve1,I'x'e'•fiC .�. rni caster. ;addatio'n� 'lhc etistrri ';hoi5s�4o iahc iv`.'�'"4 }Ii'crzti:-" `.''::; "'" The easterly addition on the home hud not been removcd and cvidcncc o't- noiGiaf131CaDPin ,l}i�;scikd;blleath°rrto' ;1.7iaic;',_wl}ehb. "d:casc:;;:'.. recent construction or disturbance on the property was not observed at the uacF - �; ..!::.:".':'_: ,::; :,'`,?�:: '1:d":'1' •.', o-�:::'F'.':''!.n*!yo-„il•,x ,:y'•'::. ,'�;t;"!:" . ll e'o conttimmnnts arl�o"f)•ie;'�iquiY',dna` cr,%':;,.„%;'•:.;r'4:.:'': ;..-,<>:::::c:,:>;;� ' time of inspection. Sitc conditions appeared consistent with the terms artd F., ,ti... :x"�...'r ,�^�?'.'•;.• conditions of the nIJL.. •:air'; s,l •I• w... ;r,:• ti: ::;<.': x . _ , . •No Yes Possible ;.�;:= �� ;;,•.:.-.,.> :�.�.�, - �'�,:;�a :;�x�:: VIOLATION OBSERVED: r,,.' �>,uy;::;::rt.'" .•�r.'^:�•'Qn;L- ^.�q�-�l: ,,r, ;;t,�. ::�.G�',��r.:�1;9;r�N1 ;' LncrxiistiCifirResf'rirt�ii'Ac'tii"f� icl' ses '- ': Observed Activities and Uses dad;:': "i. ,:vp.- _ :•.c%. r:Pi! ,. w:re;$,-g„:y; .,J ,.. ,,��ay, �;:i:J'3u: . ' .; • Residential o Day Care o School .:oi. 'cs' cr�liti��ri;�>...:";�:;�EA�v �'�£:,. o:: ,>��u• �?�'� �.,�.,r•':#a��"I"�,._I;�'. ;;,.�: ys�'::;:., ram';• .:,:,..; ml ,r:;,, . tceund_;'- -';,j:'IIN::: t! :iLeelcai or[ y a <,i''�;;,.. !"i :.;i o Playground o Park o Recreation Gr<':Ei`.x ,f... - f•,�; :s; r*t . ?.': gist: ctiAn �I E'c"'' "°' =nisturafiicc'>�t' '!ri: i� `'`':',,;::;.: o Construction o Excavation o Disturbance "'C N ,.b ,.'.� icz ., .04 ;; :;.:i. r :.'_:;a•: � ;.,: '<. ;' :q,-,•Tad: =: aa5= O e des O Flowcrs/Landsca yin i?tudcrllnK':.;.'r.=0a:rl.: u.Lsba.;C �ICS:;-;; .luwzrs/t�>a ..e o C;aldenine Fruits/V RD r ©tlie ci'ilslCoti �fis: :: ' •5• " �' >* :;: ? Comments AiivactivitY:<thtiG�:}1y�.rl,(l !I T.e7tis x'` r The easterly addition on the home had not been removed and evidence of f�l}P.{iousc.u. t ,Piope;.ty. Y �,a. lr',':':' :L..;ri•;.:.,:,•. ?:.; .. s:.., observed at the recent construction of dishlrbancc orl the property was not obse ve , Vie;., - •, •.•. �._�,.,.I,. , . ,,,�,;.,,, ;,�,:::_;. time of inspection. Activities and uses inconsistent with the leans and t r in at the time of inspection `•" �""' " conditions of the At were no uc, urr � p .'*' .,....z':.:�,i:.�:.t.r..•;.' 'r:•1•"r,'; ...@!L; '.:�•' :.rr° <olj9il�' .•.l' ,,f...,, '•;ij4" .xl'tio'•A" ,:1d;cf :::f.',,::i'r `r .y r'`.i,?'!" y::*'«^::,;:.'•; VIOLATION OBSERVED: 9 No o Yes o Possible ' i:e' '•ti Observed Conditions Wj ci:'Nlaingma ..av4lile, k:',,.,:,••,. 'Ei :cm..:.M3mtanvthcr. £tpuei�liner,W..a...,.,al;, !.' o Cap/Cover/Liner o utl�es o Pavement Ca ! d' tart •'U: S...o..r;�M!ar.i.a•.:::.Yc>•;,:,'� l,eR,,ri, ':=' e,l7:i,r.o-.{rt:.l::'.RIl;.,•r,��.i'-�Cld _i'a�ll• ,' - 'T:a,l'•;' :J Comments'pe saint'iiuiS;iir'1s/N'otzres:.:, 0. cr1D_ir i1C �e�'itran `;.,:•i; ' '': -' p✓ "+ . `:}''oa.:°°hir. xr. ''i., •:'prev cri 'ruiy Actrvrty',that;W..oula uiy:l v 'rernovm' 'if�ic:_casforly .`.; The easterly addition on ette home had not been rttn.oved and cvidcncc of aaaihiin:'e�r:;ttie�x'i°t'iii' 3 ouse:'on'rth't!' r�.Derty'Aj : :::;•;•;'`::>.z:�':;; :"`:;:.•.::• recent eonshUetion or disthrbarlce ai the properly was not obscrvcd at the :'!'',.r;._:• - ;;u�.,,'.•�:•',.'<'.' - �.� :':;,:•:'-<`:'i"J time of inspection. Use of mpelty'aDDearcd consistent with the p p =Y'! F� lc:�F•• rrrts and conditions of the AU I , .. ... .. :..... ..'.iJ lrsl:w....a._...PI�,,; ,.G!•.',.:' :'.::.. .a.e.•r.^,.,,tC.,..::: ... . AUL.;SkctchAtilStiz. ti,'this:form'?''o:5zs;'f`a :;<;. -•..':•:: VIOLATION OBSERVED: • No o Yes o Possible QdCI'it elnal' :.g rimcnts(l utes on-- eveisc:Sid'c; •i TNa 'ia Yet;'`:':'''•:::; Additional Commcnts/Notes on Reverse Side: • No o Yes ;:- Corz Completed by:Kathryn Carvalho Inspection Dmc:08/08/2006 E___j 20o3 f' GeoSi• PT ht;dL te Environmental, Inc. Consultants • Scientists • Enoneers 26 September 2003 Mr. Tom McKeon Health Director Barnstable Town Offices 200 Main Street Hyannis, MA 02601 RE: Amendment and Ratification of Notice of Activity and Use Limitation 74 Camp Street Hyannis, MA 02601 Dear Mr. McKeon: Pursuant to the requirements of 310 CMR 40.1403 (7), a copy of the Amendment and Ratification of Notice of Activity and Use Limitation, which was recorded at the Barnstable County Registry of Deeds on September 12, 2003, is enclosed for your files. If you have any questions please contact our office at your convenience. Thank you. Sincer , 7, LSPP cip OSIT' E VIRONMENTAL, INC. attachments cc: Barnstable Town Manager - John Klimm Barnstable Zoning Official - Tom Broderick Barnstable Code Enforcement - Tom Perry MADEP - Southeast Regional Office 1017 TURNPIKE STREET • CANTON.MA 02021 • TEL 781-821-8588 • FAX 781-821-8688 f Y AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIMITATION AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIMITATION (for amending and ratifying a Notice of Activity and Use Limitation recorded on or before October 29, 1999) WITNESSETH: This Amendment and Ratification of Notice of Activity and Use Limitation ("Amendment and Ratification")is made as of this 12th day of September,2003, by Philip J. Ellsworth of 257 South Sea Avenue, West Yarmouth,Massachusetts 02673,together with his successors and assigns (collectively y WITNESSETH: WHEREAS,Owner is the owner in fee simple of a certain parcel of land located in Barnstable (Hyannis),Barnstable County,Massachusetts('Property"), pursuant to a deed recorded with the Barnstable County.Registry of Deeds in Book 9676, Page 30. WHEREAS,the Property comprises a disposal site, or part of a disposal site, as the result of a release of oil and/or hazardous material("the Disposal Site"). Response actions have been selected for the Disposal Site in accordance with M.G.L.c.21E("Chapter 21E") and the Massachusetts Contingency Plan, 310 CMR 40.0000("the MCP"). Said response actions are based upon(a)the restriction of human access to and contact with oil and/or hazardous material in soil and/or groundwater,and/or(b) the restriction of certain activities occurring in,on, through,over or under the Property or a portion thereof. The Department of Environmental Protection has identified the Disposal Site as Release Tracking Number 4- 10287: WHEREAS,on April 28,1995,National Credit Union Administration Board Kempe C. Hayes, Liquidating Agent, filed a Notice of Activity and Use Limitation with the Barnstable County Registry of Deeds in Book 9648,Page 30 imposing an activity and use limitation on a portion of the Property("the Original AUL").The portion of the Property affected by the Original AUL and this Amendment and Ratification is hereinafter referred to as"the AUL Area."The AUL describes activities and uses that are permitted within the AUL Area, and defines obligations and conditions that must be maintained within the AUL Area.The AUL also describes uses and activities which, if carried out within the AUL Area,could result in Significant Risk to health, safety,public welfare or the environment due to potential exposure to residual contamination. WHEREAS,the following amendments to the Original AUL are necessary to ensure that a condition of No Significant Risk is maintained at the Disposal Site. WHEREAS,the basis of the Original AUL and this Amendment and Ratification is an Activity and Use Limitation Opinion prepared by a Licensed Site Professional and attached to the Original AUL. NOW,THEREFORE, Owner hereby amends the Original AUL as follows: AUL Area The Property.(Disposal Site)is bounded and described u=Exhibit A while the AUL Area is bounded and described in Exhibit A-1,both attached hereto and made a part hereof. Both Exhibit A and Exhibit A-1 replace and supercede any descriptions of the AUL Area contained or referenced m the,Or4ginal AUL. The Property is shown on a Certified Plot Plan.in Exhibit B. ... while_hei_ rea-isshown on a Srte_P1an-in.Exhibit-B A,both attachezi hereto ari:d.=made"apart _ - - -Hereof. Both Exhibit Band Exhibit 13-1 replace and supercede any plans of the AUL Area contained or referenced'in the Original AUL. . �j Except as expressly amended herein,the Original AUL is hereby ratified and confirmed. Owner authorizes and consents to the recordation and/or registration of this Amendment,which shall be deemed to be effective as of the date the Original AUL was recorded and/or registered. WITNESS the execution hereof under seal this day of 120 Name of Owner COMMONWEALTH OF MASSACHUSETTS ss ,20_ Then personally appeared the above-named and acknowledged the foregoing instrument to be his free act and deed before me, Notary Public: My Commission Expires: The undersigned.Waste Site Cleanup Professional certifies that, in his opinion,the terms of the Original AUL, as amended herein, are consistent with the AUL Opinion attached to the Original AUL, and are appropriate to maintain a condition of No Significant Risk at the Disposal Site. Date: � r Name of LSP LSP SEAL ;lam, �lt^.'i2�i�Flt Vl�. JIt((f3if. If � No,Ga f tJ /. CCQ1Yt�vFflNWEALTH OF MASSACHUSETTS ss ,20_ Then personally appeared the above-named and acknowledged the foregoing instrument to be his free act and deed before me, Notary Public: My Commission Expires: Upon recording, return to: Massachusetts Department of Environmental Protection BWSC-114S Y Bureau of Waste Site Cleanup Release Tracking Number A ACTIVITY & USE LIMITATION (AUL) OPINION FORM a - 10287 COMPLETE THIS FORM AND ATTACH AS AN EXHIBIT TO THE AUL DOCUMENT TO BE RECORDED AND/OR REGISTERED WITH THE REGISTRY OF DEEDS AND/OR LAND REGISTRATION OFFICE. A. LOCATION OF DISPOSAL SITE AND PROPERTY SUBJECT TO AUL Disposal Site Name: Residential Property Street: 74 Camp Street Location Aid: Map 328 Parcel 178 City/Town: Hyannis ZIP Code: 02061 Address of property subject to AUL, if different than above. Street: City/Town: ZIP Code: B. THIS FORM IS BEING USED TO: Provide the.LSP Opinion for an Amendment and Ratification of a Notice of Activity and Use Limitation, pursuant to instructions provided by DEP in a Notice of Audit Findings issued to Mr. Philip Ellsworth..................................................................................... Name of Organization or person: Date issued: January 27, 2003 C. LSP OPINION: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this submittal,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2) and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge, information and belief. The Amendment and Ratification of the Activity and Use Limitation that is the subject of this submittal is being provided in accordance with instructions provided by the Department of Environmental Protection in a Notice of Audit Findings issued to: Name of Organization or person: Mr. Philip Ellsworth Date issued: January 27, 2003 I am aware that significant penalties may result,including, but not limited to, possible fines and imprisonment,if I submit information which I know to be false,inaccurate or materially incomplete. Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s)and/or approval(s) issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicableaprovisions-thereof. Leland J. Fi ins, Jr. LSP 9370 LSP Name: gg Stamp: �.,^-•-�:. Telephone: 781-821-8588 Ext.: 781-821-8 8 FAX: LSP Signature: 1A A - Date: Se her 1 T — — - = -- f f YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY FIND THE DOCUMENT TO BE INCOMPLETE. I Revised 4/2/2001 Page 1 of 1 a EXHIBIT A A certain parcel of land with building thereon situated on the East side of Camp Street in said Hyannis, bounded Westwardly thereby sixty-six (66) feet; Northwardly by land now or formerly of Edith F. Terry and Abbie K. Bearse one hundred fifteen and one-half (115.5) feet; Estwardly by land now or formerly of Donald H. Chase and Patricia T. Chase fifty-eight (58) feet; and Southerly by land now or formerly of John L. Terry one hundred fifteen and one-half (115.5) feet. Being a portion of the premises conveyed by Mary A. Terry to John L. Terry by Warranty Deed dated September 23, 1914 and recorded in the Barnstable County Registry of Deeds in Book 332 Page 509. EXHIBIT A-1 This Activity and Use Limitation ("AUL") covers a portion of the parcel which has previously been fully described in Exhibit A (attached). From the northwesterly corner border of the aforementioned parcel heading eastwardly seventy two (72) feet, then southwardly thirty two and one-half (32.5) feet, the point of origination of the AUL commences.. Beginning at that point, which is currently the southerly corner of the northeast entry stairwell, then extending northwardly four (4) feet, then westwardly ten (10) feet, then southwardly seven (7) feet, then eastwardly ten (10) feet, then northwardly three (3) feet to the point of origination, encompasses the entire AUL area. For further description, please refer to Exhibit B-1: Sketch Plan (attached), which delineates the AUL area. i EXHIBIT B 1 -7 -7 7 7e)0 +� i i j PR E PA Re E D Fo ie r -�iSTcwo��� 1t17AI` 32( _ .yEeEBY GEeT/FY TN.4T T.�/E 6C//LD��c./G ,�• G.eOCI,VI� qS ENO WN HEeEOiI/. If. '� r a. L - � �istE c�o�un came en9/r,�crir,c� "a`° � I ci✓ice E.c/Gi.t/EEGS ZF cOCJTE Gq - `�X�eti1OCJTs-i, .NASA. Di97-C .e L.4va scievcro.e EXHIBIT B-i : SKETCH PLAN i 1tiI'1 I I I I I I I I I I I I I I I I . I I I I . I I . I I I I 1 1 I I I I I I I I I I I I I I I I r 72' = 32 6 _ I I1 i. E-+ -- I tx 7, E-+ I 131 v�l ---- i , TA ¢I i,1 I — ' - -:d�- - - - - - - - - - - — — - — — — - , — — - - = ' - - ' - - ' —� G e o S i tell aEnvironmental, Inc. = AUL AREA Consultants O S entists • Engineers 1017 TurnplkeSt. Canton, MA 02021 L—————J CINDER BLOCK HALL EXHIBIT B-1: SKB H PLAN = CONCRETE RETAINING HALL Dis Isal Area = CONCRETE WAIL FOUNDATION 74.1 ginp Street = H3' Ls, 8-18-03 JOB: C941003 SITE BOUNDARY II = T REFERENCE OF AUL AREA c1star ENVIRONMENTAL RESOURCE CONSULTANTS ASSOCIATES, INC. May 4, 1995 Mr. Thomas McKean Director, of Health P. O. Box 534 Hyannis, MA 02601 CERTIFIED MAIL: RETURN RECEIPT REQUESTED Dear Mr. McKean: Pursuant to 310 CMR 40.1099, the Massachusetts Contingency Plan, we hereby notify you that a Notice of Activity and Use Limitation has been recorded for the property known as 74 Ca Street in Hyannis, Massachusetts. A copy of said Notice is enclosed for your file. �s Very truly yours, ��OF G . s LELAND w� , J. FIGGINS,JR. Leland . Fig r., MGe, LSP No.9370 Principal 9FGI STE�`�� CISTAR ASSOCIATES, INC. sr� Enc. 2.1003N0'1'1F.WP 1017 TURNPIKE STREET CANTON, MASSACHUSETTS 02021 a 617-821-4142 1240 PAWTUCKET AVE. e EAST PROVIDENCE, RHODE ISLAND 02916.401-431-9044 NOTICE OF ACTIVITY AND USE LIMITATION M.G.L. c. 21E, §6 and 310 CMR 40.0000 Disposal Site Name: 74 Camp Street, Hyannis, Massachusetts DEP Release Tracking No: 4-10287 This Notice of Activity and Use Limitation("Notice")is made as of the 28th day of April, 1995, by the National Credit Union Administration Board, as liquidating agent for Barnstable Community Credit Union,together with their successors and assigns, (collectively "Owner"). WITNESSETH: WHEREAS, National Credit Union Administration Board,as liquidating agent for Barnstable Community Credit Union, are the owners in fee simple of that certain parcel of land located in Barnstable, Barnstable County, Massachusetts, with the buildings and improvements thereon, ("Property'); WHEREAS,said parcel of land, which is more particularly bounded and described in Exhibit A, attached hereto and made a part hereof("the Property")is subject to this Notice of Activity and Use Limitation. WHEREAS,a portion of the Property comprises all of a disposal site as the result of a release of oil and/or hazardous material. Exhibit B is a sketch plan showing the relationship of the Portion of the Property subject to this Notice of Activity and Use Limitation to the boundaries of said disposal site. Exhibit B is attached hereto and made a part hereof. WHEREAS, one or more response actions have been selected for the Disposal Site in accordance with M.G.L. c.21E ("Chapter 21E")and the Massachusetts Contingency Plan, 310 CMR 40.0000 ("MCP'). Said response actions are based upon the restriction of certain activities occurring under the Property. The basis for such restrictions are set forth in an Activity and Use Limitation Opinion("AUL Opinion'),dated 28 April 1995, which is attached hereto as Exhibit C and made a part hereof; NOW, THEREFORE,notice is hereby given that the activity and use limitations set forth in said AUL Opinion are as follows: 1. Permitted Activities and Uses Set Forth in the AUL Opinion. The AUL,Opinion provides that a condition of No Significant Risk to health, safety, public welfare or the environment (such condition being :refined in 310 CMR 40.0000),exists for any foreseeable period of time so long as any of the following activities and uses occur on the portion of the Property: (a). Any lawful use of the Property which does not involve removing the easterly addition of the existing house on the Property,thereby potentially exposing the soil beneath it to rain water, which could cause leaching of contaminants into the groundwater, and (b). Such other activities or uses which, in the Opinion of an LSP,shall present no greater risk of harm to health, safety, public welfare or the environment than the activities and uses set forth in this paragraph. (r f 2. Activities and Uses Inconsistent with the AUL Opinion. Activities and uses which are Inconsistent with the AUL Opinion, and which, if implemented at the portion of the Property,may result in a significant risk of harm to health, safety, public welfare or the environment are as follows: (a). Any activity that would involve on the Provolve removing the easterly addition of the existing perry. 3. Obligations and Conditions Set Forth in the AUL Opinion. If applicable, obligations and/or conditions to be undertaken and/or maintained at the portion of the Property to maintain a condition of No Significant Risk as set forth in the AUL Opinion shall include the following: (a). Prevent any activity that would involve removing the easterly addition of the existing house on the Property. 4. Proposed Changes in Activities and Uses. Any proposed changes in activities and uses at the portion of the Property which may result in higher levels of exposure to oil and/or hazardous material than currently exist shall be evaluated by an LSP who shall render an Opinion, in accordance with 310 CMR 40.1080 et seq., as to whether the proposed changes will present a significant risk of harm to health, safety, public welfare or the environment. Any and all requirements set forth in the Opinion to ensure a condition of No Significant Risk in the implementation of the proposed activity or use shall be satisfied before any such activity or use is commenced. 5. Violation of a Response Action.Outcome. The activities, uses and/or exposures upon which this Notice is based shall not change at any time to cause a significant risk of harm to health, safety, public welfare, or the environment due to exposure to oil and/or hazardous material without the prior evaluation by an LSP in accordance with 310 CMR 40.1080 et seq., and without additional response actions, if necessary, to achieve or maintain a condition of No Significant Risk. If the activities, uses, and/or exposures upon which this Notice is based change without the prior evaluation and additional response actions determined to be necessary by an LSP in accordance with 310 CMR 40.1080 et seq., the owner or operator of the portion of the Property subject to this Notice at the time that the activities,uses and/or exposures change, shall comply with the requirements set forth in 310.CMR 40.0020. 6. Incorporation Into Deeds: Mortgages, Leases, and Instruments of Transfer. This Notice shall be incorporated either in full or by reference into all deeds, easements,mortgages;leases, licenses, occupancy agreements or any other instrument of transfer, whereby an interest in and/or right to use the Property c_ u portion thereof is conveyed. Owner hereby authorizes and consents to the filing and recordation and/or registration of this Notice to become effective when executed and sealed by the undersigned LSP, and recorded.and/or registered with the appropriate Registry(ies) of Deeds and/or Land Registration Office(s). WITNESS the execution hereof under seal this -��fh day of 6 wner So . y COMMONWEALTH OF MASSACHUSETTS '2 Then personally appeared-the ve named G _ acknowledged the foregoing to be _:s_free act and deed before me, �O��nrr��, JODIE M JONES Notary Publi N NOTARY PUBLIC ` State of Texas My Commission Expires: 7/;7 % 1. Comm. Exp.07.07.96 The undersigned LSP hereby certifies that he executed the aforesaid Activity and Use Limitation Opinion attached hereto as Exhibit C and-made part hereof and that in his Opinion this Notice of Activity and Use Limitation is consistenl avh s set forth in said ctivity and Use Limitation Opinion. LELAND Date: J. FIGGINS,IlE3PV*7 No(1 SE G �O. F01 S-T COMMONWEALTH OF MASSACHUSETTS 4 , Then personally appeared the above named � 9 - Ai904a'-9-e. and acknowledged the foregoing to be S free act and deed before me, Notary Public My Commission Expires: r c ' f i / 77 770o - s� +� 32 f 74 I � I r C 8 �iclD. �u�v1>E,�'i c/C ✓f77Z I W,4 Y� i I i i PREPARED FOR: L oc.4-r-io.v: �� G.4MP Sr A1,4VUW 437 2 f/EeEBY CEeT�FY T T-A. 8l//LD�t/G �ory v o v 7-AWI-5 .oL q V /S LOCfiTEa O.V T.NE mm o�own cam en9/n�crir�9 "�° � ciVi� E�c/Gi�t/EEt3 \ 4A7A.10 SUtV6YOQ3 �Oc./TE G�q^-`,'�'7.eMOC.JTs�-/, ML7S3. agTt a L,q,�,ia sue��roe i i j: I Basement Extent of Excavation Concrete Floor Crawl Space x (Addition) Porch Brick Foundation Supports Original Structure Inaccessible Impacted Soil costar ❑ 1017 TURNPIKE ST. • CANTON,MA02021 ❑ 1240 PAWTUCKET AVENUE ASSOCIATES INC E.PROVIDENCE,Al 02916 Exhibit. 8: Site Plan 74 Camp. Street Hyannis,. MA onrs: scA'E: �o Na 28 Apri1. 1995 11 301 +1- C941003 i • EXHIBIT C vs a ENVIRONMENTAL RESOURCE CONSULTANTS ASSOCIATES, INC. 28 April 1995 Ms. Julie Hutcheson Massachusetts Department of Environmental Protection Southeast Regional Office 20 Riverside Drive Lakeville, MA 02347 RE: 74 Camp Street Hyannis, Massachusetts Release Tracking No. 4-10287 CISTAR Project No. C941003 ACTIVITY AND USE LUMTATION OPINION Dear Ms. Hutcheson: CISTAR ASSOCIATES, INC. ("CIST.AR") is submitting this letter as an Activity and Use Limitation (AUL) Opinion for a limited portion of the property located,at 74 Camp Street in Hyannis, Massachusetts. This portion is hereafter called the "Site". On 18 February 1994 a partially buried 275 gallon #2 fuel oil storage tank "tank" was removed from the crawl space area under the easterly portion of the structure on the property. The subject tank was partially buried and installed on its side., After removal, a pinhole perforation was observed on the tank. As a result, the subject tank was found to have released product and contaminated surrounding soils with TPH at levels above the relevant Reportable Concentration, RCS-1, of 500 parts per million (ppin). A, confirmatory subs�Zace investigation of the Site was performed which included soil borings, monitoring wells, and laboratory analysis. The results of this program revealed that the extent of soil contamination was limited and that groundwater was not found to be impacted by the subject release. All soil contaminated above the RCS-1 standard of 500 ppm was removed from the Site except for some inaccessible contaminated soil located under a portion of the north foundation wall of the structure. After a Method 3 Risk Characterization (310 CMR 40.0990) was conducted relative to contaminant levels in soils present under a portion of the building foundation at the Site, it was deemed by CISTAR that a Permanent,Solution under an Activity and Use Limitation (AUL, 310 CMR 40.1070) was the optimum solution. This decision was based on a Benefit- 1017 TURNPIKE STREET• CANTON,MASSACHUSETTS 02021 • 617-821-4142 1240 PAWTUCKET AVE. •:EAST PROVIDENCE,RHODE ISLAND 02916.401-431-9044 f Cost Analysis which found that the incremental cost of conducting the remedial alternative to achieve or approach background levels would be substantial and disproportionate to the incremental benefit of risk reduction, environmental restoration, and monetary and non- pecuniary values (310 CMR 40.0860). It is the opinion of CISTAR that once the AUL is in place, the TPH will not "present a significant risk of damage to health, safety, public welfare, or the environment during any foreseeable period of time," in accordance with 310 CMR 40.1005. As such, any lawful use of the Property is permitted which does not involve removing the easterly addition of the existing house on the Property. If said structure were removed from the Property then the contaminated soil shall be remediated pursuant to.all applicable regulations. Therefore, it is the opinion of the undersigned that a Class A-3 RAO has been achieved for the Site, pursuant to the MCP. Please call if you have any questions or comments regarding this Site. Very truly yours, D yam Gs� J. � INS,JR. CD1 J. g , Jr., LSP No.9370 Principal STE ' CISTAR ASSOCIATES, INC. 2.10030P.WP _ cis-tar LOC&.TIOh1 : 5 WNC4E PERMIT UO. VILL E — — IWSTNLLER•5 &ME 1>DORE5� BUILDER 'S Q &MF— ADDRESS Dt.\TE PER"IT DATE COMPLI bJ ACE ISSUED : de w. '4 �. I le iv ,f i x .. je 741 lee k n J. CRAIG ME®EIROS rucking ulldq.1*1119 Hyannis, Mass. 775-0828 L 1 ply/�/��'/rr•J �tl o u i �y r 1 1 , Q-- 9 Z q o c { LOCQT ON �, 5EW&C4E PERMIT UO.' - V I LL IWSTL>, L.ERa5, U& AF— ADDRESS bUII.DER ' Q X ADDRESS — DIaTE PER"17" 155UED D ATE "'.COMPLI WACE ISSUED ; 7 �`� .����� .1 - ,� . .�,. .�. . :. `1. ro o � ' '���� { - No......................... Fmc''�1=----- THE cowmoww/suLTH or mASsAo*ussrrs ������ ���� HEALTH ���~"^" ^�� " "��"^�� " " " � ~- ��F--' ---------------- ���~~ �� ���«��liruotmwu� ��/� ��������xo�o� W«xrko Tu*witrwrtx«»n Prruwd Application is, hereby made for u Permit to Construct ( \ or Repair ( ) an Individual Sewage Disposal System at: ------ -----»~'-J�'--'---------- --------------------- L. mo. =�� ............................................................. .---_--_----_-.-------------------------_-----. Address ......~-'~~�'�~~~'----�p- -'---------------' --------'-'---'-----'_�������------'---'------'' Installer TypeofBuildi Size Lot---.------Sq. feet Dwo����'No. of Bcdr000,x----°,------------- --------Expansion Attic ( ) Czcbugc Grinder ( ) Other—Typeof Building _------._--' No. ofyersous----.------' Showers ( ) -- Cafeteria ( ) P4 (}t6rr fixtures ---------------.--__ . . ~~~-____ Design }�o�.-.-..---[��-'��-.-.-_.gJ)ouaprrpr,aouyrrday. Tntu daily flow--._�����'��.----..gd)ons. Septic Tank—Liquid .. .. ..gallons Length-_-_ - Width----_ Diameter---------------- Depth----- � . Z Other Distribution oox ( ) uvxo�g tank \ / � - ucscnyuou of Soil C ro�so�a�.�� _ ------------ The undersigned agrees to install the foredescribed Individua, I Sewage Disposal System in accordance with operation until a Certificate of Com , ce has been issued by the board of health. ----------------------------- Date s to tallsw t e fore es e Individual the puvv�v� of ru� e ^I m bl ca wc StateAn � of Com ce has been issued b y the board Date Application Disapproved for t6x /,"lvoiny reasons:---------------------------------------------------------------------------------------------------------------- nau _____--------------------------------__------------------------------------------------------------------------------------- S F{{ 4 _ n 1`1 toe e t e 9 4 b 0 0 0 r1 - �`sJ 2 No......................... Fiziz . ,................ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0��-�HEALTH ' AppliratiOO -fur BitipOiittl Works TowitrOrtiou Vamit t Application is hereby made for a Permit to Construct ( ) or Repair ( ') an Individual Sewage Disposal System at: , jI t �2-rr _ t r/ Location-Address r ,�� or Lot No. ----•---------------------------------- ---OWner b� Address.... ............` .................................................. Installer Address UType of Building Size Lot_____________________ ______Sq. feet Dwelling—No. of Bedrooms---------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________+No. of persons..______._._________-______- Showers ( ) — Cafeteria ( ) Other fixtures _ 1 ��` -------- ---------------•-•--------------------------------.-------- --- --------..g on � .-- --•-----gallons. W Design Flow__________________..__..._.._._..__gallons per person per day.�Total daily flow........._ _ _ _______. _ _ g� WSeptic Tank—Liquid capacity------------gallons Length_______________iWidth..___..._...._.. Diameter-------......... Depth---- x Disposal Trench—No. .................... Width........... Total Lengtl\_________---___-__. Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter................... Depth below inlet_.._..._______{ Total eaching area--________._._._.sq. ft. z Other Distribution box ( ) Dosing tank''( ) !f •Ste'' Percolation Test Results Performed by I-----F--------------//;...............--- .._..._._ Date..---.------.----------.---------- Test Pit No. 1................minutes per inch Depth of Test Pit--------------------- Depth to'ground water__-__-_______.__-__----- rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._._.______-.__._-____-- P4 -----------I-------------- -------1-------I-------- ......-- Description of Soil-------------------- ' ...... --- G- ! t f n f� -- Awl./ .... ---------------- W -------------------------------- ----•---•-•------------•--------•-•---•-•-•-- ...............................-------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------'--�-------------:------------------------------.--------------------------------- U Nature of Repairs or Alterations—Answer when applicable ,.._.i-- � - / /` ' --- ---` -- - -- -? Agreement: Cf The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'Article-XI•of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe j t ��"-�'z' �%?.- ,.:�_:� — ------------------------- t -� -Date _ Application Approved BY---- '' / ��* ''t' '- -f^►t}---------- Date Application Disapproved for the following reasons: �---------------------------�----------------------------- ---------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fZ '.............OF....... � f•�- ..........................................t- 0wrrtif iratr Of TOmpliatta THIS IS TO CERTIFY Th tthe' Individual Sewage Disposal System constructed or Repaired ( ) by.=.......��� �. - rJ 1��!Z---- Installer ----------------0 '--- -r'----- has been installed in accordance with the provisions of Article XI of Th State Sanitary Code as described in the application for Disposal Works Construction Permit No._���__-2__r/............... dated__.0 __'_ '_l__'_-7J._.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS I— BOARD OF HEALTH 7` C� ......... ..... ... ......OF........... . .. ?/r....._........................_ No.------�-�l-- �J� FEE--- .............. BitnpOfittl Workii Qlaypitrurtion Vrrmit Permission is hereby grant d ............. to Construct'`( ) or Repair �an Individual Sewage Disposal System v v ................................... Street as shown on the application for Disposal Works Construction Permit No.....__ Dated.... .,�_ .._._ � .. S� Board of Health DATE--lk-------•- /------7-----/-----------------------------------------•-• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .. � .- .._r----._^ (� � �_ ' ,\\\�' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .....OF..........A.44 �� Application is hereby mad 6 � � u/� u � � Construct ( ) or Repair (�� ao Individual Sewage Digmud System at: _ ----_ -----------.----- ...............~_-- ---- --------'----------------.----__----_.----'----- °= Address ....—....--T'--.........--'........-.....'-' -------.......--.............. -------------'---'--'----------'--'-------' ��, AddressTypeo[ 8u8d' Size Lot--------.—Sq. fc� DvvcDiog�rI�o. of 8odroonos----.�����-------IZryzosiou Attic ( ) � Garbage Grinder ( ) Other—Type of Building —------------------------ No. of persons. ----_--.-- Showers ( ) -- Cafeteria (' ) ~4 Other fixtures— —.----.---__---'---------------------------------------------- Dco��o Flow---- ..guDoos per person per day. Total daily Oo`"—.—s�� -�--.--�---g�}oo,. Septic Tuuk--I.��@ cup�r��y----�zDnou I.co�t6-_—__- YV�dbb-----. Diam���c----.- Dqxk----- Dioposa Trench--No .................... Width ------ Total I.eugt6.----.-- Total leaching nroz------..sq. h. Seepage Pit No------'- Diametrc_—'---.. Depth b6wv inlet-------------------- Totalleaching area---- —. ..ug. ft. �� Other DimLribu600box ( ) Dosing tank ( ) ~~ Percolation Test Ilrsu)tu Performed by--------.----_---.---.--------' Date—.------------ � Icy Pit No. l................minutoxperinch Depth of Test Pit.................... Depth to ground water ------- �4 Test Pit No. inch D�� � O Description of Soil------------------------------------------- --------------------_--------------------' ---`-`----`----``--'---`-----------`------'—`---------------------'------- '—'--'''-------------------'--------------' ---- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until-a Certificate of Compliance has been is d b the board of health.. I. Date Date ~ �� x�~ � o� -_--_-. --_--------___'-- ~^~ | __--___-_—_—_-_-------' — —] r r r e r $ 0 o P x e Lol Mary �- No......................... Fis.......Al................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.._ �Gr��- -oF ......... .......ice..,.•-�. ............ Appliration -for IN-4priiitti l�xk -��tt # itr#��tt Prttti# 1 Application is hereby made for a Permit to Constrict ( ) or Repair (21'an Individual`Sewage Disposal System at:................................................................................................. ............. .. ....................................................................A/ ....... .� Location-Address or FLoil No._ 1 d �L f J / Owner Address v�/ r •--------------- t --• f Installer Address d Type of Building., Size Lot..._________________________Sq. feet U Dwelling- "No. of Bedrooms-------------- - ................ -----Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ----___________________--_- No. of persons.._...._ ___._-_- Showers (I ) — Cafeteria ( ) dOther fixtures ---------- ------------------------------ Design Flow________________C� gallons per person per day. Total daily flow_-_____ - ____-�--.-.-gallons. W i P4 Septic Tank—Liq-iid capacity------------gallons Length____-,_........ Width------.-_------ Diameter.......--------- Depth---..--_--.---. xDisposal Trench—No_____________________ Width•-.-__-____-_-_----_ Total Length------------------.- Total leaching area--------------------sq. ft. Seepage Pit No-----------_------_ Diameter.................... Depth below inlet..........z!+___- Total leaching area..----------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-- vN Date-------- W , . t i � 1 Test Pit No. 1----------------minutes per inch Depth of Pest Pit-------------------- Depth-,to ground water...---__--_._-.--.---. �14 Test Pit No. 2................minutes per inch Depth of Test Pit._-...._--.____-____ Depth.to ground water........................ -------•--•---•--•- ---------------- DDescription of Soil------------------------------------------ �� 1 ''t --------------------------------------------------------1'------------------------------ x ,`* 1 w Nature of Repairs or Alterations—Answer when applicable... %"/ ' -%�r":_----:_r_ �'- } U P" - ... _ ---- ---- ; �• -�-=---s•-_./.�,_= - ----- ------�=�,..-ffi`---/ .:. '=a-'-�"_•---�- �. F !---••----•-=/ �,� f"f ..,.-r F.er ;:fps: r m� V ---- .... =--- ----------- Agreement: -� , The undersigned agrees to install the aforedescribed IndividualfSewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of'Compliance has been issued by the board of health., Signe .....-.. n.. �-•-•--. -------�f!?''/G�'�'. "�--------------------- Date y Application Approved BY -/�� ----�� F ll'G1 ............... �J �'�=•----- - t r �rDate Application Disapprovedifor the following reasons:.------•--•---•---------/----/----•--•--•-•---•--•------••---•-•--..-....--•-•--------•-••------------------------ t • Date Permit No......... ................................ - 1�a - Issued.-_-•-----------------------------•-• ------ Date THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH •t• �j S j `G?YJ.! �3''`'O F.t.........!,}�'ir.��. ...... ...:............... Tntifir�#r of om itatta THIS IS TO CB12TI Thl Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..... f - 6 - } Installer -" - _�C/ -4--- ................. has been installed in accordance with the provisions of Ar "b XI of The fate Sanitary odd'as described in the application for Disposal Works Construction Permit No. /_.. _�_� ' r - ---------- dated..... -- --;%'.-.1----- S THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE {-----------------------•------•------------•-- Inspector ---------='-------------------------------------•--------.................... I THE COMMONWEALTH OF MASSACHUSETTS t BOARD O, HEALTH 67� ..�� ......OF....... ClJ'I.. No. ................ FEE DiriVaiittl l�xk� C nit #r�tr#//i�$t rxmi# Permission is hereby granted ------- G/1.1.tic------------------------------------------------------•---•----- to Construct ( ) or/Repair ( t'ran Inc�va} ewage Disposal,System at No..-- A 1 V_.� ` �✓ --------------------------- -- = � � Street as shown on the application for Disposal Works Construction P-r�nit �No:....-�i...�_��. Dated _. .r.. _I__.�_75. ______._ DATE----- --�-- ` 'J..._ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -,t �,- -f S �� � � � -_