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HomeMy WebLinkAbout0038 ROSARY LANE - Health 38 ROSARY LANE,HYANNIS 17 o 0 U.S. Department of Labor PQ MENT °p Occupational Safety and Health Administration o 639 Granite Street - 4th Floor ? . Braintree, MA 02184 Phone: (617) 565-6924 Fax: (617) 565-6923 SrgrEs °F 05/04/07 Reply to the attention of: Patrick Catino Inspection Numbers: 310669163; 310669411 Ms. Tina Fontaine, Division Assistant Health Department 200.Main Street Hyannis, MA. 02601 Dear Ms Fontaine: In response to your inquiry concerning safety and health hazards at: Cape Cod Marble and Granite 38 Rosary Lane ' Hyannis, MA 02601 the Occupational Safety and Health Administration conducted an inspection at that site. That inspection was completed on 12/15/06. The results of our investigation of your referral items are as follows: Complaint item 1: Employees are using an unstable attachment with the forklift to lift granite slabs. Finding: See enclosed citation. Complaint item 2: Employees are overexposed to silica from stone dust generated during cutting and grinding operations. Finding: No overexposures were found during this inspection. Complaint item 3: Employees do not wear respirators when cutting marble and granite stone. Finding: Respirators are not required when overexposures do not exist. Employer has fitering facepieces available for employee use. Please see additional enclosed citations. Attached for your information is a copy of the OSHA-2, Citation and Notification of Penalty, which was sent to the employer on 05/03/07 and should have been posted at the workplace for at least three days after receipt. Thank you. for your interest in safety and health in the workplace. Respectfully, Brenda J. Gordon Area Director Enclosure 2 U.S. Department of Labor Inspection Number: 310669163 PQS�ENT OF Occupational Safety and Health Administration Inspection Dates:0 1/25/2007-01/25/2007 Issuance Date: 04/19/2007 e p0 PAW STATES OF Citation and Notification of Penalty Company Name: Cape Cod Marble and Granite, Incorporated Inspection Site: 38 Rosary Lane, Hyannis, MA 02601 The alleged violations below have been grouped because they involve similar or related hazards that may increase the potential for illness. Citation 1 Item la Type of Violation: Serious 29 CFR 1910.178(a)(4): Modifications or additions which affect capacity and safe operation of powered industrial truck were performed by the employer without the manufacturer's prior written approval: Location: Facility A Lift Master telescoping Econo Boom(LM-EBT) attachment with an Abaco Lifter 50 attached to the end, was being used on the forks of the Nissan 60 LP forklift to move stone slabs. No written approval from the forklift manufacturer was obtained by the employer. The addition of the boom and slab lifter decreases the capacity of the forklift. 130-2- Y:::.::.;:::: ::: ire` ' '> > > > > <> < < <»< < < > » >' < > t .......................................................................................................................................................................................................................... See pages 1 through 3 of this Citation and Notification of Penalty for information on employer and employee rights and responsibilities. Citation and Notification of Penalty Page 4 of 6. OSHA-2 (Rev. 9/93) U.S. Department of Labor Inspection Number: 310669163 WPQS�SNT °F Occupational Safety and Health Administration Inspection Dates:0 1/25/2007-0 1/25/2007 0 9 Issuance Date: 04/19/2007 Srgres of Citation and Notification of Penalty Company Name: Cape Cod Marble and Granite, Incorporated Inspection Site: 38 Rosary Lane, Hyannis, MA 02601 Citation 1 Item lb Type of Violation: Serious 29 CFR 1910.178(a)(5): The employer did not request that the truck, equipped with front-end attachments other than factory installed attachments, be marked to identify the attachments and show the approximate weight of the truck and attachment combination at maximum elevation with load laterally centered. Location: Facility The Nissan 60 LP forklift was not marked to reflect the use of the Lift Master telescoping Econo Boom(LM-EBT) and the Abaco lifter. . . hhlt>«n.: 1u1:.br✓;;:11btc:,.:: :::::::::::.:: .:::::::: Citation 1 Item lc Type of Violation: Serious 29 CFR 1910.178(a)(6): Nameplates or markings for powered industrial trucks were not maintained in a legible condition: Location: Facility The dataplate on the Nissan 60 LP forklift was not legible. al 'tt xcatxcriu bbd .: lf10`r See pages 1 through 3 of this Citation and Notification of Penalty for information on employer and employee rights and responsibilities. Citation and Notification of Penalty Page 5 of 6 OSHA-2 (Rev. 9/93), r U.S. Department of Labor Inspection Number: 310669163 PQS�E"T °F Occupational Safety and Health Administration Inspection Dates:0 1/25/2007-01/25/2007 0 P Issuance Date: 04/19/2007 FQ PAW rTq TES �F Citation and Notification of Penalty Company Name: Cape Cod Marble and Granite, Incorporated Inspection Site: 38 Rosary Lane, Hyannis, MA 02601 Citation 1 Item 2 Type of Violation: Serious 29 CFR 1910.178(1)(1)(i): The employer did not ensure that each powered.industrial truck operator was competent to operate a powered industrial truck safely, as demonstrated by successful completion and evaluation specified in paragraph (1). Location: Facility Operators of the Nissan 60 LP forklift were not trained and evaluated as required. There was no formal instruction and/or practical training and evaluation of the operators' performance in the workplace. its.BgY.: pjijtatn:� bte , ... . 20t ' .::::::::::: ..� .. ......................................................................... ................ ... ..................,. ...... Brenda J. Gordon Area Director See pages 1 through 3 of this Citation and Notification of Penalty for information on employer and.employee rights and responsibilities. Citation and Notification of Penalty Page 6 of 6 OSHA-2 (Rev. 9/93) U.S. Department of Labor Inspection Number: 310669411 PQS�ENT of Occupational Safety and Health Administration Inspection Dates:01/17/2007-01/25/2007 0 Issuance Date: 05/03/2007 C`Q PAW ST4 TES OF Citation and Notification of Penalty Company Name: Cape Cod Marble and Granite, Incorporated Inspection Site: 38 Rosary Lane, Hyannis, MA 02601 Citation 1 Item 1 Type of Violation: Serious 29 CFR 1910.37(b)(2): Each exit was not clearly visible and marked by a sign reading "EXIT": In the following locations each exit was not clearly marked by a sign reading "EXIT": Slab Cutting Area: door leading to the outside; Fabrication Area: door leading to the outside. .;.... .:.;:.;:.;:.;:.: ....: D tB::`<> iuI1tivn >>aa >1 »:crr a ..�.. ....:: � .:..�:::::::�a d:::.: : .:::�.:: :e�t�d:: i. En :>I�: et�c�n .......................................................................................................................................................................................................................... .......................................................................................................................................................................................................................... rip©sad. ' 1 '.:::;::>:>::>;::.>::;:.;.: :.:. .:.4 00, Citation 1 Item 2 Type of Violation: Serious 29 CFR 1910.305(g)(2)(iii): Flexible cords were not connected to devices and fittings so that tension would not be transmitted to joints or terminal screws: Slab Cutting Area; Fabrication Area: Energized electrical cords, used to power electrical equipment in wet areas, had their insulation pulled away from the plug due to a lack of strain relief mechanisms. ................................................:......................................................................................................................................................... ate . � » .< : t .::: :.::::::: ...:::: :: :' xtx :.b t ed,: : rkd.: a .::::: .::.:: .::: :: d..Pena�l...:.:::::::.::::::::::::::::::::::::::::::.:::::::.:::::::::.:::::::::.::::.:: :: : ::::::::::::::: . ... .P:::.::::::::::......::::::: ':::::::::::: .::::::::::::::::: ::::::::::::::.::::::::::::::::::::::::::.::.::::::::::::::::::::::::::::::::::::::: .._ .::::: :. ::::: :::::. See pages 1 through 3 of this Citation and Notification of Penalty for information on employer and employee rights and responsibilities. Citation and Notification of Penalty` Page 4 of 6 OSHA-2 (Rev. 9/93) U.S. Department of Labor Inspection Number: 310669411 ¢PQSMe0T 0,`9m Occupational Safety and Health Administration Inspection Dates:0 1/17/2007-01/25/2007 0 Issuance Date: 05/03/2007 z SQ PAW STATES Of Citation and Notification of Penalty Company Name: Cape Cod Marble and Granite, Incorporated Inspection Site: 38 Rosary Lane, Hyannis, MA 02601 Citation 1 Item 3 Type of Violation: Serious 29 CFR 1910.334(a)(4): Portable electric equipment and flexible cords used in highly conductive work locations, or in job locations where employees were likely to contact water or conductive liquids, were not approved for those locations: Slab Cutting Area; Fabrication Area: Employees are exposed to shock and electrocution hazards by using energized portable electrical equipment and energized flexible cords in locations where water is used in cutting stone products. ` aain�u1 k1 <Cited.Dti< tt ........... .........: :::. ................................ 8 Pe 00 P.: : ::::::::::: :::::: ::: :::::::::::::::::: :::::: .:::: ::: : :::::..................:::::::... The alleged violations below have been grouped because they involve similar or related hazards that may increase the potential for illness. Citation 1 Item 4a Type of Violation: Serious 29 CFR 1910.1200(e)(1): The employer did not develop, implement, and/or maintain at the workplace a written hazard communication program which describes how the criteria specified in 29 CFR 1910.1200(f), (g), and (h) will be met`. Facility: The employer did not develop or implement a written hazard communication program for employees exposed to chemicals during stone cutting and fabrication activities. These chemicals include, but are not limited to, Regent Stone Products Silicone Impregnator, Stone Wax, Acetone, and engineered stone products.. ::.:::::: .::. ::: ltt .. .. tx. zc?azc�nt.b .. t .:::;>;:.:.:;;:;;;;.>::<.;:.>;::;::.;.;::;:;<;;:«;;; .��/2.:1.1200 . vpo na11 .......: . $ +D See pages 1 through 3 of this Citation and Notification of Penalty for information on employer and employee rights and responsibilities. Citation and Notification of Penalty Page 5 of 6 OSHA-2 (Rev. 9/93) U.S. Department of Labor Inspection Number: 310669411 "T OF Occupational Safety and Health Administration Inspection Dates:0 1/17/2007-01/25/2007 0 Issuance Date: 05/03/2007 z ST4 TES OF 'Citation and Notification of Penalty Company Name: Cape Cod Marble and Granite, Incorporated Inspection Site: 38 Rosary Lane, Hyannis, MA 02601 Citation 1 Item 4b Type of Violation: Serious 29 CFR 1910.1200(g)(8): The employer did not maintain copies of the required material safety data sheets for each hazardous chemical in the workplace: Facility: The employer did not maintain copies of Material Safety Data Sheets for all hazardous substances in the workplace. This includes, but is not limited to, Regent Stone Products Silicone Impregnator, Acetone, and engineered stone products. Date:<B:> VI >< h lvlat I�Iu t :: ::> < .............. > 0: .: 1a . . 7 .::::::........... ... .:::::::: . t :.: bt? d : . I.:::::: .:: . .................... .................................................................................................................................................................................................... .......................................................................................................................................................................................................................... .......................................................................................................................................................................................................................... Citation 1 Item 4c Type of Violation: Serious 29 CFR 1910.1200(h)(1): Employees were not provided information and training as specified in 29 CFR 1910.1200(h)(2) and (3) on hazardous chemicals in their work area at the time of their initial assignment and whenever a new hazard was introduced into their work area: Facility: The employer did not provide hazard communication training .for employees exposed to hazardous chemicals including, but not limited to, Regent Stone Products Silicone Impregnator, Stone Wax, Acetone, and engineered stone products. .;:.;:.;:.;:.;:.::.: .::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.::.....;...:.; Date.. :: t�h t�att�n u .. e.. t :........ ...... . ..... .. . ... Y:.......;;::::.........:::::;:.;::::.::;:.:::::::.::.::;:;:.;:;:;:.;:.:>:.;:.>:.>:.>.... .::.;:.>:.>:.>:.>:.::...........:.>:.>:.>:.>:.;: ..;:...;.....::;::»:;:;;;»......... Brenda J. Gordon Area Director See pages 1 through 3 of this Citation and Notification of Penalty for information on employer and employee rights and responsibilities. Citation and Notification of Penalty Page 6 of 6 OSHA-2 (Rev. 9/93) Town of Barnstable 6 0. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. July 17, 2002 Mr. Donald Perkins 38 Rosary Lane Hyannis, MA 02601 £� �.� �� ,s;fix{ G34� �n ��I �:�., � 3s�t, .:��.. `�. "�•$'4 Dear Mr. Perkins, You are granted conditional variances, on behalf of your client, Ronald Andrews, to construct an onsite sewage disposal system at 37 New London Avenue, Marstons Mills. The variances granted are as follows: PART XII: The new onsite soil absorption system will be located 132 feet away from the easterly neighbor's well, in lieu of the 150 feet minimum separation distance required. PART XII: The new onsite soil absorption system will be located 132 feet away from the westerly neighbor's well, in lieu of the 150 feet minimum separation distance required. The variances are granted with the following conditions: (1) The designing engineer shall provide revised plans to the Public Health Division showing all of the variances requested. (2) No more- than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (3) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three (3) bedrooms maximum. A copy of the Perkins recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (4) The septic system shall be installed in strict accordance with the revised engineered plans. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised plans. These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to the proximity of the existing private wells in the area. It is the opinion of this Board that the proposed new soil absorption system will be constructed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sine ly your , W yne Miller, M.D. Ch irma Perkins o� °FIME Town of Barnstable BARNSTABM Department of Health, Safety, and Environmental Services cry 9� 1MASMS 639. ,�� Public Health Division p'ED1i"0�A P.O. Box 534, Hyannis MA 02601 Office: 508-790=6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION flGr-M�— %( — d�l'f (,��o�4.�0� C�-� ✓y�,�..e v�7 e�ru.�o�-� Q�.t-v�c� a�i�ct�,�..sJ EA�11J Gwe.�.e_- - ,l i ;J e¢w/ ?ix V- 6 ® C,s �- �. zy verbcomm.doc TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY 1� c�`� � ��� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 39 Class: 7.Miscellaneous ] ` QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks i IN OUT IN OUT IN OUT #&gallons Age Test Fuels: ` asoline et Fuel(A) Z 29 X Diese Kerosene, #2 (B) Heavy Oils. 1_ 5' waste motor oil(C) JT � new motor oil (C) 1 Z4- transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 7.9 o� 3� .x � DISPOSALIRECI AMATION 'REMARKS: 1. Sanitary Sewage 2.Water Supply Y L4,L ' t twk C,v ) a C 0 Town Sewer Public �U ki �� �W 4 /LZ so J On-site OPrivate 3. Indoor Floor Drains YES N0 0 Holding tank:MDC_ O Catch basin/Dry well 0,On-site system 4. Outdoor Surface drains:YES-NO 1� ORDERS: , k/t-j A d, aGu,;� d f�. la.6e./e d '' c�a� � G / 0 Holding tank:MDC i 0 Catch basin/Dry well 11Vita-c4rvs �a,/r•J � "Toy�--t 0 On-site system 5.Waste Transporter WdI -1 S f l4a AA4 Name of Hauler 1 � � YES NO 2 ,Person(s) Interviewed Inspecto Date :TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH 2.Printers satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY I6�'� (see"Orders") 5.Retail Stores -` 6.Fuel Suppliers ADDRESS .4 �? .t�' s��' Class: -J� 7.Miscellaneous 4D6* Xi*T,#/,QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJORMATEMALSUnderground /V, IN OUT IN OUT IN OUT #&gallons a Test Fuels: �� Gasoline Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil(C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: '7 ,. DISPOSAL/RECLAMATION REMARHS: 1. Sanitary Sewage 2. ter Supply zk� O Town Sewer Public On-site OPrivate 3. Indoor Floor Drains YES LNO O Holding tank:MDC O Catch basin/Dry well O On-site system R 4 4. Outdoor Surface drains:YES NO ORDE#iS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination �Waste Product 1. Le "If YES I NO 2. Person (s) Interviewed Inspect.or Date M4 SACS S r - B ATE b A �Yc _' , DATE ISSUED: 02/17/2000 , St� 'iWED: BOOK:185 1 .BOOK: RENEWAL PAGE:E`� -�6 y, PAGE 00-046 DATE DISCONTINUED: CERTIFICATE EXPIRES: 02/17/2004 DISCONTINUED BOOK: DISCONTINUED PAGE: In conformity with the provisions of Chapter One Hundred and Ten(110),Section Five(5)of the General Laws,as amended,the undersigned hereby declare(s)that a business is conducted under the title below,located as shown,by the following named person,persons or corporation: LINE-X OF EASTERN MASSACHUSETTS 38 ROSARY LANE,HYA A TRUE COPY ATTEST MAILING ADDRESS: BOX E HYANNIS, MA 02601 ` D. SCOTT RUSHNAK 1008 MAIN STREET CHATHAM,MA 026 3 Town Clerk.- - . BARNSTABLE Signatures: ~~ THE ABOVE NAMED PERSON(S)PERSONALLY APPEARED BEFORE ME AND WDE OATH THAT THE FOREGOING, STATEMENT IS TkIjE. loll LE Identification Presented: DATE: February 17,2000 CONDITIONS: NONE LISTED In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the date of issue and shalt be renewed each four years thereafter. A statement under oath must be filed with the city clerk upon discontinuing, retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. • s CERTIFICATION CLAUSE I certify under the penalties of perjury that I,to the best of my knowledge and belief,have filed all state tax returns and paid all state taxes required unde law. * Signature of Individual or Corporate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) ** or Federal ID Number * This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Mass. G.L. Cha 62C, S.49A. TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH O 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY -rBf!' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS . �� 6'1 -, Class: 7.Miscellaneous 1V/& 4UANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneou,s: �- DISPOSAL'RECLAMATION REMARKS: 1. Sanitary Sewage 2. eAzv-ode ter Supply O Town Sewer Public �s ,Von-site OPrivate L t , 3. Indoor Floor Drains YES N0-L,-4 O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YESJ::�'NO ORD RS: r O Holding tank:MDC atch basin/Dry well . / V On-sitesY stem 5.Waste Transporter Name of Hauler Destination V a9te Product 2. -7-4 -- Person(s) Interviewed Inspector Date ICKEY �aizatbG►,G�la9L �a. .Q�izc. DON PERKINS (508) 771-4128 TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Re it satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY z' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 4 CIBSs: _,� 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Tank- "Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Dieseljkezasen4r#2_(j4 Heavy Oils: " waste motor oil (C) new motor oil (C) 4 transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: o -z DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O�own Se Public O On-site 0oe.. OPrivate r 3. Indoor Floor Drains YES_—NO _ O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES2NO ORDERS: Holding tank:MDC c Catch basin/Dry well.-Sl — On-site system 5.Waste Transporter Name of"auler Destination Waste Product 2. Person(s) Interviewed Inspector Date TOWN OF BARNSTABLE , COMPLIANCE: CLASS: 1.Marine,Gas Stations,Rep 'r 2.Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY 30L'2J12 (see"Orders") 5.Retail Stores � 6.Fuel Suppliers ADDRESS 3 � ZSg� Lam. 4_- -4,Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums, Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: I SS Y, qmS x waste motor oil(C) �j Dc Jl O a new motor oil(C) �� 1 c5 y� transmissi/n/ draulic 2-S- Y pc Synthetic Organics: degreasers Miscellaneous: �O Am A/V w&sle w/(av�IA e, •eon DISPOSALIRECLAMATION REMARK: ,,Vo was 4e &I"e c �' Pos.l 1. Sanitary Sewage 2.Water Supply �'0 C�Q jv-� O Town Sewer Public oed 0-) e&$_a, •-c,c Mon-site QPrivate 3. Indoor Floor Drains YES L/NO Holding tank: = A-i�'1,,�- /o O Catch basin/Dry well T 7 (iv w!� • e-(e C O On-site system q j /OS®E aVA,'4 44 01� i 4. Outdoor Surface drains:YES V"'No ORDERS: Q Holding tank:MDC gr l I hS�`c%P I-SS_ A/ ,z,u.r V-0, "I a ;Qi O Catch basin/Dry well a j Z y (n dYi-1 On-site system 5.Waste Transporter Name of Hauler Destination', od YES NO 1. 2. Li Person(s) Interviewed Ihsilbctoi Date Of SHE r, DATE: Oe FEE: • RARNSTABLE, MASS. g cbAlf1639. REC. BY Town of Barnstable SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kau$nan,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION A,� Property Address: j 7 /�' e".; G':� ��+,+ ✓G C--�s�� n S / �S Assessor's Ma and Parcel Number:p /"I /� ._� i C'/._7 Size of Lot: Y e! A _t. Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME C TACT PERSON J Name: /j n e�r-ei.7 Name: a� ��r�e-\%,-A 1 Address: 0 1.31 01,/ 1 k, h.Address: 3g- \Qb L ,1 c� '1ie--r-.0kit", !33-36 3 Phone: one: - _— VARIANCE FROM REGULATION(List Reg.) REASON FOR CE-(May attach if more space needed) 7A 2► X 1 I \w cc.L- Z G G U L1l.1'1C iC S i 5Z7 F E c i 0 sz F E d 1 Q t S 2a r�erTlon; ?A e = Sv�,St cZc;p; 1 1 \Q t=L(_,,, LCGA'TNo 0 NATURE OF WORK: House Addition 1100000 House Renovation Repair of Failed Septic System Checklist(to be completed by office staff-person receiving variance request application) _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) ` _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Fttsatfttted(for grease trap variance requests only) _ Vequest application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Summer Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\WPFILES\VARIREQ.DOC r -�- ' S i J i 3 t � � � _ � o =�- { � � � � ��� r t � � � ^— -� ck� �..� �� �/ ,, -r ��j �� �� � Op �� � Y Yc-i COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of e>wy- item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. C. Signature ■ Attach this card to the back of the mailpiece, X Agent or on the front if space permits. _ ❑Addressee �D. s delivery addre erent from item 1? ❑Yes I 1. Article Addressed to: I If YES,enter delivery address below: ❑ No �j (��� �� ►y„ 3. Service Type ` ❑Certified Mail ❑ Express Mail /1� ( ❑ Registered ❑ Return Receipt for Merchandise to�'b ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ransfer from seivice label '' 7 0 01 11.4 G G QG,.3 f3 8i6 3i i.G 7 8 0 r I (r ) i[ it t . , PS Form 3811, March 2001 Domestic Return'Receipt 102595-01-M-1424j I� UNITED STATES POSTAL SERVICE �� RFirst-Chris IGlal^---- 1 ,Yi P_ostage-&`Fees-Paid I P"m 6, 1Permit.No,-G-1:0.__ • Sender: Please print your nate,,ddress, aril ZlP �thls box�� IJ fi - .i t f Li i d li i SECTIONSENDER: COMPLETE THIS . ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) F — • ate of Delivery item 4 if Restricted Delivery is desired. Man 7 �- Print your name and address on the reverse so that we can return the card to you. C. Signat ■ Attach this card to the back of the mailpiece, X El Agent or on the front if space permits. ❑Addressee Is delivery acl s different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 17 Q- Se ice Type r ertified Mail ❑ Express Mail egistered ❑ Return Receipt for Merchandise ��W ❑ Insured It ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 1 7201 1140 ���3 3863 �742 (Transfer from service label), . -.. _ t { PS Form 3811 tl\kkh'2001'`�j'j t f l j '1 Domestic Return Receipt`` 102595-01-M-1424 MA UNITED STATES POSTAL SERVI O D� - First-Class Mail w P" �A Postage&Fees Paid a. USPS Permit\No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • i I i i; COMPLETE THIS SECTION ON DELIVERY SE IN 6E,R: COMPLETE THIS SECTION ■ Complete items 1,2,and 3.Also Complete A. Received by(Please Print Clearly) B. Date of Delivery item 4 if Restricted Delivery is desired. (1 ■ Print your name and address on the reverse so that we can return the card to you. C.'Signature e Attach this card to the back of the mailpiece, ❑Agent or on the front if space permits. ❑Addressee D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No �11D n Oil. Its V e— �-� y�� , `��s `r't 3. S rvice Type / Certified Mail ❑ Express Mail ofb q egistered ❑ Return Receipt for Merchandise 1 ❑ Insured Mail ❑C.O.D. 0 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Transfer from from service label) f 7�0 01 114 0 0 0 0 3 3 8 6 3 0 7 7 3 PS Form 3811, March'2001 t ' Domestic Return Receipt III I I I 102595-01-M-1424 C=r MA UNITED STATES POSTAL SERVrft' First-Class Mail Postage&Fees Paid USPS Permit No.G-10 L. �� • Sender: Please print your name, address, and ZIP+4 in this box • 4 i :�F..+�17.'�tr.�i"..>'.'t+� ��irrattitltl�tsi�raruurtOtrrlaliirtrittrjt�tlttt��ajat{tttE��1 III COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) 7p7a o Qf DeHOT item 4 if Restricted Delivery is desired. HOT item ■ Print your name and address on the reverse so that we can return the card to you. C. ig to ❑Agent ■ Attach this card to the back of the mailpiece, X III or on the front if space permits. —8-Addressee D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No r 3. S ice Type ertified Mail El Express Mail egistered ❑ Return Receipt for Merchandise (_ ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (fransferfromsere 7�01 , 114� 0003 3863 �797 .It Y l "�I i :'li PS Form 3811,March'2001 " ' "` bomestic Return Receipt . `Y' "'' ' ' " ''' 102595-01-M-1424 UNITED STATES POSTAL SERro,, M4 O ,.,T First-Class Mail p � Postage&Fees Paid PerLISPmit No.G-10 %GCS • Sender: Please print your name, address, and ZIP+4 in this box • l-If e�� ?C) ,Isa,- I I I I III - f +! jJ } j f jJi \1j ..�..i1r_5�1.'r.2WC.�".''..S. 1'Iltili��l��i��E-31'iillllt11111111.11tIfI1111111:1dIIlilIt1111'll', SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. DaV of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. C. Signature ■ Attach this card to the back of the mailpiece, X ❑Agent or on the front if space permits. ❑Addressee Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No SeAcr , 3. ervice Type ❑Ce ified Mail ❑ Express Mail i( gistered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ��.GI v is 2. Article Number ---- 3863, 0735 I (Transfer from service'latiel) FF "" ""' 11140 I't 1)1F7� 1 PS Form 381 1March 2001 Domestic Return Receipt 102595-01-M-14241 l ill it I illiliiii i III III 1i Iii I UNITED STATES POSTAL$ERVI 5` 6i)S�0 Fi t Iass,MailJ— i.. �? ` 'Po stag&Eees Pallid USPS r �Perrnit-No G 10 "— r JUL d�tl _ • Sender: Please pf*t-your-nlme, address, d~Zf +P 4 in-�thrs--sbarnc• 3 r& �� 14X J-� C-,K AcS , ma / r d�6 �/ SENDER: COMPLETE THIS SECTION COMPLETE TH IS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Re by(Please Print Clearly) B. Date of DeliMery item 4 if Restricted Delivery is desired. 0d, ■ Print your name and address on the reverse so that we can return the card to you. C. Signat a Attach this card to the back of the mailpiece, ❑Agent or on the front if space permits. X ❑Addressee D. Is a addre rom item 1? ❑Yes 1. Article Addressed to: If enter delivery ddress below: ❑ No C. �-- V-L J\,�J�� � Service Type Certified Mail ❑ Express Mail Registered ❑ Return Receipt for Merchandise LA � ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number. (Transfer from rvice`label)ii 7 0'�+= 11;4 0 0 33863 r ;8q 3�9 PS Form 3811, March 2001 Domestic Return Receipt 102595-01-M-1424 now UNITED STATES POSTAL SERVIf� (First-Class Mail w ��' + �; Postage&Fees Paid c USPS c Permit No.G-10 C�13 r_ ./ • Sender: Please print your name, address, a6d'ZlP}4`t this boz i Ot- 70scv Lr__ ,e l I .L'�.+�..?�'ff'r.{'.�..?�.�.°�.�i I�IP-l77lr.Ip�1�I7F'litifFf lli7�tlf�lit!!li'F71!'•f111/l�it�ttft'�P I: • • COMPLETE THIS SECTIONON DELIVERY i ■ Complete items 1,2,and 3.Also complete A. Re eived by(Please Print Clears) B. Date of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. AS', ture ■ Attach this card to the back of the mailpiece, El Agent or on the front if space permits. -� ❑Addressee D. I delivery address different fro tem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No �� �-•e�..r� sue— U �A�\� 7nn7"rn 1W 3. Se Type l( if Mail ❑ E Mail El n Receipt.for Merchandise ❑ Insu d O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number = -- _ (Transfer from service label) i 0 0 1 {114 0 '0 3 3 8-6 3 t M1€076Lt i PS,Form 3811.,.March 2001 . Domestic Return Receipt 102595-01-M-1424 H ti hi It ti li lit, i11 1 1 11 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • 9 c- & ST— ck 4sc_b� k ) 1 For ThiFs Lot is Municipal water. 1`G.86.0e Water Supply p Crawl FG. 86.0 t /7(;I 2.Loceticn cf Utilities Shown on This s P!an Are Aoorax. - I, !/Ir7/�pl �, bounty At Least 72 Hours Prior to Any Excavation For This jPUCe �I I, =: o i1 rr Fairground5�� Project The Contractor Shall Make The Required Notificaticnto DIG SAFE-1-888-344-7233. 84.0 83.0 q Appropriate 15CO Gallon 3.The Contractor is Required to Secure A Top E1.84.0 Permits From Town Agencies For Censtructicn 83.8 Septic Tank 83.6 ° pef ned by This Plan. d• '�° Bot.El.81.0 i `<��\�� 4.instal Risers as Required to Within 12"of Finished _ 83.4 63.2 C�t�. Grade. 5' M f\\�. Bedding as Bot.of T.H. EI. 76.0 ; �( \ �I � � 5.All ructures,Buried Four Feet(4')or More or / ��a•;o-� •'�\ 1 •�• r' \ , Subject to Vehicular to be H-20 Locding. Per Title 5 No Ground Water p c t.•� 5 w� �.� 6.Septic System to be Installed in Accordance With 310CMR15.00Latesl Revision Ana The Town cf DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM / �•.` ; ';; .:=•., �� so Barnstable Board of Health Regulations. 7 All Piping robe Sch.40 PVC. Not to Scale .�, �� ¢ ➢lC �•+' .. Finish ' a��� 11) �•;+•`r• ":�1 Shub el` Grade DESIGN DATA _ a LOCUS PLAN f Filter ` c Single Family-3 Bedroom m'n Fabric`�Compacted FIII " Scale I = 20001 No Garbage Grinder Daily Flow: 110 x 3 = 330 gpd r� Assesors Map 103 Parcel 013 Use a 50 330 g Septic °/=660gpd fp k Pea Ground Water Overly Use a I500 Gallon Septic Tank. LEACHING AREA Leaching GP y v Chamber 3/4"-I I/2"Double 330 gpd/0.74=446 s.f.Required / J a I washed Bottom Area 1 a 25 = 300 s f. f (� L 4_to S.I —_� OF 448 .TotalPrC'Vlaed. -�....� I`---' LEACHING CHAMBER DESIGN Iz o AI I Pipes to be Schedule 40 PVC. Used law -500 Gallon Leaching Chambers in �� CROSS SECTION OF CHAMBER , L NOT TO SCALE 12'x 25 Washed Stone Field as Shown. IL <O / qp ;' TEST HOLE 40 l► ' LOhM/ ORGANIC PO O n1ATGr21AL_— f 50 y xISTING i_—_ STf20NG 8(2N S1L,.T LpAM 7, S Y GL 5/G Yam.L'15H. 13RN .GtZ Av ELL�I LOAMY G Is rIN� SO 13 C0AR5E SANG to YR S/-/ C-xQN 15N YGL. SANp 4 z _ - E ' S -CRN, COS. (l LT Y L1 H RSt v � 9 C-4 SAND IOYR (✓�/ <<i r 90 C PALE pRN, GRAV tiY Co<\RSt= 1 TFs�n O 7 �:. S k'N E> 10 Y r2 (0/3 --- 1GR0Li rN 0 WATGC2 SUL.t_t ENGINt=ERIN& 1NC. '�N;S `�_ a \�2 \7ATF MAY 2.8 2002- P xraT �_ T p PcRcor_ATION EST ' i' Mt�TI=R\A1_ DE'?-Phi (c0', C`c"'`<-yi`" n. `ti\J�'r` -�30Y �( "�--.-_--� LESS T�-1AN 2MIN/Ii�tGl: AN CA y `IT o, /'; N;TNC55 : l7. STANTO'\l T, O Too r;t vTy&�` _.� `�_/"'T f � -_/ =rz0 Pe42-ry ,-INS TC7 f3 L. �T.1 u'u`17 - - t SITE PLAN / ( 1 SEPTIC SYSTEM UPGRAD E AT ON DO A 37 NEW L N VENUE a MARSTONS MILLS MASS. PLAN VIEW FOR Scale : 1 301 S1TL= OATH mot.,, T O.VN of ROLAND S. ANDREWS onFZNs raot_a G t s SCALE: AS SHOWN DATE: MAY 30, 2002 Rt=VISIOtV O( L7 "OZ /ITV ED PLl<C, t SULLIVAN ENGINEERING INC. I � ASS I r OSTERV A ILLE MASS. I j