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HomeMy WebLinkAbout0401 MAIN STREET (CENT.) �� �� ° � . . z � . r _ r ,� ., . :� .. . E r„ .. ,� �' . r 1 � . Town of Barnstable uld111 a Post This Card;So That at I; is We Fro,rn thilStreet=A . roved;PlansW st'be Retained on Job:and this Card IVlust:be Kept BnYtNSCitBi '' '. ,. � . ; pip; _' : .` %, "' . . s:" • SPosted Until;Final Inspection.Has Been Made , ; a �, ` v , y.� Where a Cert�ficate;of®.ccu; anc sRe uired_sucht Bu�ldmshali Notbe,Occupied until a Final,I„nspect�on hasbeenmade� + el l , .� Y:a. ...�,r,p Vice.F ice.sad ,..$ , _.,;�:.r: ;�. :� ,l ,_ ,°:; : "� ,�: ;. _ t. . k. .. Permit No. B-20-30 Applicant Name: James Curley Approvals . Date Issued:. 01/06/2020 Current Use:' Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/06/2020 ; , Foundation: Location: 401 MAIN STREET(CENT.),CENTERVILLE Map/Lot 208-124 Zoning District:, SPLIT Sheathing: Owner on Record: FEENY MARY L ; � Ii ConCractorNName : ,JAMES P CURLEY Framing: 1 ' i Address: 1.18 HIGH STREET A 41 oritra'tor�License: CSSL-099138 2 BRISTOL, RI 02809 Est Protect Cost: $ 16,000.00 Chimney: Description: Strip and re-roof approximately 40 square of asphalt roofshingles. Permit Fe€e: $81.60 ,Insulation: 1#{ f Project Review Req: Fee?aid , 5 81.60 ' Final: 1/6/2020 40 ,. � /"� �y Plumbing/Gas Rough Plumbing: ` s Building Official. LAI, Final Plumbing: This permit shale be deemed abandoned and invalid'unless the work a thonzed,byths permit is commenced within six months after issuance: All workauthoriied by this permit shall conform to the approved applicationand the=approved construction documents for which,this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zon g,by laws anc!codes. This permit shall be displayed in a location clearly visible from access street or road and shall be main tained open for public inspection for the entireduratic n of the ,Final Gas: i = work until the completion of the same. F, All Electrical The Certificate of Occupancy will not be issued until all applicable signatures by*he Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: V It Service: 1.Foundation or Footing M I 2.Sheathing Inspection ,... .2 � _ �i.� ._, Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: FINSHESS ENyiRoNMENTAL October 2, 2003 Building Code Enforcement Official Building Department Town of Barnstable 200 Main Street 16 Hyannis, MA 02601 Re: Response Action Outcome Statement&Activity& Use Limitation r� 401 Main,Street Centerville, Massachusetts RTN 4-11672 Dear Sir or Madam: Finsness Environmental has recently completed an environmental investigation on the referenced property in accordance with applicable regulations of the Massachusetts Contingency Plan-(310 .CMR 40.0000),..Due to residual petroleum concentrations on the property below a former fuel oil underground storage tank, an Activity & Use Limitation has been filed for the property to limit future exposure to such soil. A certified copy of the Activity & Use Limitation, registered with the Barnstable County Registry of Deeds, is attached. A copy of the completed report can be reviewed and/or copied at the Massachusetts Department of Environmental Protection's (MADEP) Southeast Regional Office in Lakeville, Massachusetts. This letter and attachment were submitted to satisfy public notification requirements of the MADEP. Sincerely, FINSNESS ENVIRONMENTAL 4/Nat4iL. Finsness Licensed Site Professional(#5156). cc: Barnstable Town Manager's Office Barnstable Board.of Health,. Barnstable Zoning Official MADEP-Southeast Regional Office Atty. George Zevitas 206 Palmer Street . Tel.: (508)679-2002 Somerset,Massachusetts a Fax: (508)679-2205 02726 0 E-Mail: finsness@comcast.net C09--19-2IJ03 Co I o-I� NOTICE OF ACTIVITY AND USE LIMITATION M.G.L. c. 21E, §6 and 310 CMR 40.0000 Disposal Site Name: 401 Main Street,Cente'-ville,Massachusetts MADEP Release Tracking Number: 4-11672 This Notice of Activity and Use Limitation ("Notice") is made as of this 19th day of September, 2003, by. George Zevitas of _3291 Main. Street, P.O. Box 730 in Barnstable, Massachusetts 02632,together with its successors and assigns (collectively,`"Owner"'). WITNESSETH: WHEREAS, George Zevitas .of Barnstable, Barnstable County, Massachusetts is the owner in fee simple of that parcel of certain land located in Centerville, 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 ("Property") -is subject to.this Notice-of. Activity and Use Limitation:-The property is.-shown on.a plan recorded with Barnstable County . Registry of Deeds, in;Plan Book 482 Plan 13,` WHEREAS, the Property comprises a disposal site as the result of a release of oil and/or. hazardous material Exhibit B is a copy of the recorded plan showing the Property subject to this Notice of Activity and Use Limitation (to the extent such boundaries have been established). Exhibit B is attached hereto and'made a part hereof; and 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 (a)the restriction of human access to and contact with oil and/or hazardous material in soil'and/or (b) the restriction of certain activities occurring in,on,through,over and under the Property. The basis for such restrictions is set forth in an Activity and Use Limitation Opinion("AUL Opinion"),dated September 19,2003- NOW, THEREFORE, notice is hereby given that the activity and use limitations set forth in said AUL Opinion areas 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 exists for any foreseeable period of time (pursuant to 3 I CMR 40.0000)so long as any of the following activities and.uses occur on the Property: (i) `Residential uses and activities associated therewith; including, but not limited to, pedestrian and/or vehicular traffic, landscaping, and routine maintenance of landscaped areas, which do not cause and/or result in the disturbance and/or relocation of petroleum-contaminated soil located at13-Q+ feet below surface grade: (ii) Short-term (three''months or less) underground utility repair and/or construction activities including, but not limited to, excavation (including emergency repair of underground utility lines), which are likely to disturb petroleum-contaminated soil Notice ofAUL—401 Main Street., Centerville, MA—Page 2 located at 13-24 feet below surface grade, provided that such activities are conducted in accordance with Obligations/Conditions (I) and (ii) in,Section 3 of this.Activity -,,and, Use.,Limitation. Opinion.("Opinion".), the soil. management procedures of the aMCP.cit.q&at 310-CMR 40.0030.and all applicable workef8ealth and safety practices 4 pursuant to.310'CMR 4.0.0018;' tt{{ (iii)Activities and uses.which are not identified in.this.Opinion as being inconsistent with maintaining a condition of No Significant Risk; and (iv) Such other activities and uses which, in the Opinion of a Licensed Site Professional (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. 2. -Activities,and'Uses`Inconsisterit with the-AUI Opinion: ~' Aivities�arid uses which are µ inconsistent with the objectives of this Notice, and which, if implemented at the Property, may result in a significant risk of harm to health, safety, public welfare or the environment, or in a substantial hazard, are as follows: (i) Any activity including, but not limited to, excavation, which is likely to disturb Petroleum-contaminated soil located atl'r-df feet below surface grade associated with underground .utility and/or, construction work, without prior development and . implementation of a,:Soil Management Plan and; a Health and Safety Plan in accordance with Obligations(i) and (i) of Section 3=of the'AUL;' (ii) Any activity which is .likely to disturb petroleum-contaminated soil at)3-.I4 feet <, _ -.-,-.below.surface grade for'a period _of=time greater;than three..months;. unless such activity is first evaluated by an LSP who renders an Opinion stating that such activity . is.consistent with maintaining a condition.of No. Significant Risk and that such activity is conducted in accordance with Obligations (i) and-(ii) of Section 3 of the AUL; and (iii)Relocation of petroleum-contaminated soil at 13-24 feet below surface grade, unless such relocation is first evaluated by an LSP who renders an Opinion stating that such relocation is consistent with maintaining a condition of No Significant Risk. 3. Obligations and Conditions Set Forth in the AUL Opinion. If applicable, obligations and/or conditions to be undertaken and/or maintained at the Property to maintain a condition of No Significant Risk as set forth in the AUL Opinion shall include the following- (i) A Soil Management Plan must be prepared by an LSP prior to the commencement of any activity which is likely to disturb petroleum-contaminated soil located at 13��4 feet below surface 'grade. The Soil Management Plan should describe appropriate soil management, characterization, storage, transport, and disposal procedures in accordance with the'provisions of the 'MCP cited'at 310 'CMR 40'.0030 et seq. Workers wh`o-may come in contact with•the petroleum-contaminated soil should be appropriately trained-on the requirements of'the Ptan,'`andrthe Plan must remain available on-site throughout the course of the.project; - Notice of AUL-401 Main Street., Centerville,MA—Page 3 .(ii) A„ Health, and 'Safety .Plan must be prepared and implemented prior to the commencement'of any;activity which,may.result in the disturbance of petroleum- y , ,.contaminated soil located'`at.l3�ay feet=,below: surface:grade' The Heath and Safety „>x,Plan;_shou;id, be prepared;by,.a :Certified Industrial'}Hygien•ist',or other qualified individual appropriately trained in"'worker.:'health'And Safety procedures and requirements. The Plan should specify the.type of personal protection, engineering :_ controls,.:and -environmental:.monitoring'necessary. to yprevent worker and other potential receptor=exposures 'to ,petroleum-contaminated 'soil:,through ingestion, dermal contact, and inhalation. Workers who may come in contact with petroleum- contaminated soil should be appropriately trained on the requirements of the Plan, and the Plan must remain available on-site.throughout the course of the project; (iii)The petroleum-contaminated soil located at 1311 feet below surface grade must, remain at depth and may not be relocated, unless such activity is first evaluated by an ,LSP who renders,an-Opinion which states that such activity poses no'greater risk of harm to health, safety,.,public' welfare, or the environment:;and ensures that• a condition of No:Significant Risk is maintained. 4. Proposed Changes in Activities and Uses. Any proposed changes in activities and uses at 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, ,,•ti ,in accordance.with 310 CMR 40. 1:080 at,,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 recquirements.,set forth in:,,thd'Opinion'tb.,meet thelobjective of this Notice shall be satisfied before any such activity or use is commenced. Violation of a Response-Action Outcome.; The-activ_ities;wuses?and/or'exposures upon - wh ch this,Notice tis;based shall-hot:`change:at:any time to cause•a.'significant risk of harm to health,,safety,public,welfare,or the environment or to create:substantial hazards due to exposure'to oil and/or hazardous material without the prior,evaluation by an LSP. in accordance with 3 10 CMR 40.1080 et seq,,and without additional response actions,if . necessary, to achieve or maintain a condition of No Significant.Risk or to eliminate. substantial hazards: „ If the activities, usesand/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 se"q.,the owner or operator 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 orany.other instrument of,transfer, whereby an interest in:arid/or,right to-use the Property,or.a portion thereof is conveyed. iOwner hereby authorizes and consents to the filing and.recordation and/or is of .:this,.Notice,,-,said, Notice:,to.-become, effective,.when. executed.,;under seal by the undersigned LSP, and recorded and/or registered with:the appropriate Registry(ies) of . Deeds and/or Land Registration Office(s). i ,u r� Notice ofAUL—401 ALlain Street., Centerville, MA—Page 4 Witness the execution hereof under seal this 191h day of September 2003. Z, evitas _ - , •° � ,.::_.,.� a Owner .. . COMMONV6'EALTH OF MASSAC14USETTS Barnstable, ss September 19, 2003. Then personally appeared before the above named George Zevitas in his respective capacities as Owner of the Property and acknowledged the foregoing to be his free act and.deed in his aforesaid respective capacities before me, Notary Public: My Commission Expires The undersigned LSP hereby certifies that he executed'the aforesaid Activity and Use Limitation Opinion attached hereto as Exhibit C and made a part hereof and that in his Opinion this Notice of Activity and Use Limitation is, consistent with the terms set forth in the said Activity_and Use,Limitation Opinion. V Date: L —Nato(no.r. Finsness COMMONWEALTH OF MASSACHUSETTS Barnstable, ss September 19, 2003 Then. personally appeared before the above named Nathaniel L. Finsness and acknowledged the foregoing to be his free act and deed before me, I �V Notary Public: My Commission Expires 3291 Main Street, P.O. Box 7307 Barnstable, MA 02632 Attn.: George Zevitas EXHIBIT A:. : a r (Descnp`tion-of Parcel ofLand Subject to AUL) A certain parcel of land.situated.in_Centerville,=Barnstable County, Massachusetts, shown as land owned by George T. Zevitas, deed recordeds in the Barnstable Registry of Deeds, Book 2749,-Page 270, on a plan entitled, "Plan of Land in Centerville,,Barnstable, Ma.- dated May 7, 1991, prepared by Baxter & .Nye,. Inc., Osterville, Massachusetts, and recorded with the Barnstable County Registry of Deeds, in Plan Book 482, Plan 13, and being more particularly bounded and described as follows. BEGINNING on the Easterly,side of Main Street. at. a stone bound at land now or formerly of Emma J. Cosby; Thence running South 79. 20' 40" East and bounded Northerly by said Crosby land, 247.71 feet to a stone bound at land now or formerly of Evelyn Crosby and Sumner Crosby; i 4�. Thence running ,south 8' -50' 10",;West and, Easterly by said. ��,.._.. :.� Crosbyland,}11.T.56 feet to a post; Thence running north'80° 16' 50" West land'-bounded:Southerly'b "'land now'or formerly of Evelyn Crosby, Sumner Crosby and Alonzo P. Crosby-, _ �264 12Ao.a stone botmd'sset at Main Street;r v - Thence in a curved line along said Main Street, 116.62 feet to the point of beginning; containing two-thirds of an acre, more or less. . a. AO��ELo EXHIBIT B S , jPti? I CERTIFY THAT THIS PLAN HAS G BEEN PREPARED IN CONFORMITY WITH B Ito. LOCUS THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS. er 4�Q• � R.LS, N LOCUS MAP SCALE 1 25,000 ASSESSORS , MAP 209 PARCEL 125 ZONE M RD-1 & A.P. GRAPHIC SCALE 0 15 30 60 S:B. FND. S_ stf i -, S.B. FND., it' . 3 R� N p ryry. I N69 76O4w N ^� O1 - _ p N � S.B. FND. 3 :'L ORGE T. ZEVITAS BK 2749 PG 270 W _ S.B..FN0 co p R= Sal.51'S 3� 7 V-R= N8272J2W 58259'41,E o `Ln R�1 o r 203.69' `t ,o "CtCC J U 13,096 S.F. 0 o z � 3. R.8. FND. "2 Z °' Fm b N POST FND. ri S.TK SET.IN MAIN HOUSE �ARpGE j v POST HOLE FND. CD n ® o LP fND; i lY. 6•35.1�E �I r 199:8Q '' IN ' i �r' •W S.B. FND- N MELv1NA C• HERBERCER \� ate, r^ S.B. FND. a- a C.B. FND. NO D.H. PLAN OF LAND 05=SEPTIC SYSTEM IN ( CENTERVILLE � . .._ _..._ BARNSTABLE MASS. FOR I HEREBY CERTIFY'THAT THE PROPERTY MILDRED E. & EDWARD H. WHITE LINES SHOWN HEREON ARE THE LINES-DIVIDING DATE MAY 7,1991 EXISTING OWNERSHIPS,:AND THE LINES' OF THE STREETS AND WAYS SHOWN ARE THOSE OF BAXTER & NYE,INC. PUBLIC OR PRIVATE STREETS OR WAYS ALREADY REGISTERED LAND SURVEYORS ESTABLISHED AND THAT NO NEW LINES FOR CIVIL ENGINEERS DIVISION OF EXISTING OWNERSHIP OR FOR NEW OSTERVILLE; MASS, WAYS ARE SHOWN, DATE, 7_25.9/ #91029 70 zfuzo,:13 XHIBIT C "ACTIVITY AND.USE LDIITATION OPINION ;.In;:accordance with the requirements of 310 CMR 40.1074, this Activity sand Use Limitation- Opinion has been prepared for a parcel of land owned by George.Zevitas, located at 401 Main Street, Centerville, Barnstable County,Massachusetts 02632.• As of the date of this Activity and Use Limitation Opinion, this property is zoned for,residential use. The property remains developed with two structures consisting of a two and one-half story residence and a garage, with landscaped areas, and an asphalt driveway located thereon.' Site History The subject property has been used as a residence since original construction prior to 18598. One, underground storage tank, formerly containing fuel oil, was removed from the' property in September 1995 subsequent to the detection of a fuel oil release during septic system upgrades in September 14, 1995. The detection of petroleum triggered certain notification requirements of ' - the Massachusetts Contingency Plan(the "MCP", 310.CMR 40.0000). . , [Note: The "MCP is the Commonwealth of•Nfassachusetts' code of.regulations.-for. .the notification, assessment, and cleanup,of disposal sites where a:release;of oil.and/or=hazardous materials has occurred.]: t^'�- x Through environmental investigations and remedial-activities performed>from F1995 to 2003, fuel oil was further characterized in subsurface soil and groundwater:- Results'of the investigations determined that total petroleum hydrocarbon (TPH) concentrations from 16 to 24 feet below. ground surface (bgs)exceed the MCP Method 3 Upper Concentration Limits. Prior to excavation of.impacted soil to a depth of 8 feet, TPH concentrations in a composite soil sample from 6 to 14 feet bgs.exhibited concentrations of TPH in excess of MCP Method-1, S-1, S-2, and S 3 Soil Standards but .were below Upper Concentration Limits (UCL)... Subsequent excavation of impacted soil was performed to a depth of.8 feet bgs. Remaining impacted soil was determined to be located below the former tank grave, at an approximate depth of 13 d4 feet bgs. Petroleum was detected in groundwater samples. However, Exposure Point,Concentrations of detected petroleum in groundwater" samples do not exceed any of. the MCP Method I Risk Characterization standards.. [Note The, "MCP Method 1 Cleanup Standards" refer to numerical standards for chemical contaminants in soil and groundwater, which are published in the MCP.. The soil standards are broken into three categories:�S4, S-2, and S-3. The S-1 Soil Standards are the most strict, or lowest, numerical values. since they were derived to be protective of a residential.exposure scenario by.considering a receptor's incidental ingestion:and dermal contact exposures.to soil ,C while garden ing.`and playing: :The-S-2 and S-3 numerical standards are less strict and therefore higher., having"been developed' using passive recreational and construction related"exposure f scenarios, respectively J Reason forAeiivity and-Use Limitation! IA A Method 1 Risk Characterization was conducted to evaluate the risk;posed by contamination remaining in soil at.the.site.. Using the Method 1 approach, concentrations.of TPH remaining in A UL Opinion—401 Main Street, Centerville, MA—Page 2 soil were compared to the MCP.Method 11 Soil Standards to determine.if the site poses a risk for current and future activities and uses',.,,. The Method 1.Risk Characterization concluded, since levels of fuel oil in soil located at 13-a4 feet below ground surface on the property exceeded their respective Method 1, S-1 Standards, an unacceptable risk exists should future activities and uses of the'p'roperty'.result in unrestricted human exposure to the soil, such as those associated with a child's exposure through direct contact and/or ingestion. Therefore, in order to ensure that such exposures do not occur and that .a condition of No Significant Risk be maintained for future activities and uses, an Activity and Use Limitation is required to restrict activities and uses of the property. Permitted Activities and Uses i ,(i) 'Residential,-uses and activities associated.,therewith including,_but not limited to, pedestrian and/or vehicular- traffic, landscaping,' and routine maintenance of landscaped areas, which do not cause and/or result, in the disturbance and/or relocation of petroleum-contaminated soil located atL3 a¢feet below surface grade. (ii) Short-term (three months or less) underground utility, repair and/or construction activities including, but not limited to, excavation.(including emergency repair of underground utility lines), which are likely to disturb petroleum-contaminated soil located at l'3 A: feet below surface grade, provided that'such,activities are conducted in accordance with.Obligations/Conditions.(I).and-.(ii)•in Section 3 of this Activity and Use Limitation.Opinion ("Opinion") the soil.:,management procedures of the MCP.�cited at-310 CMR40.0030.and all..applicable worker.health and safety practices •_.pursuantto:310.CW:40.0018; „ (iii)Activities and uses which are not identified in this Opinion as being inconsistent with maintaining a condition of No Significant Risk; and (iv) Such other activities and uses which, in the Opinion of a Licensed Site Professional (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. Activities'and Uses Inconsistent with AUI,Opinion (i) Any activity including, but not limited to, excavation, which is likely to disturb petroleum-contaminated soil located atIN4 feet below surface grade associated with - underground utility and/or construction work, without prior development- and - implementation of a Soil Management Plan and a Health and Safety Plan in accordance with Obligations (i) and (ii) of Section 3 of the AUL; (ii) Any activity which is likely to disturb petroleum-contaminated soil atl3 a¢ feet below surface grade for a period of time greater than three months, unless such activity is first evaluated by an LSP who renders an Opinion stating that such activity is consistent with maintaining a condition of No Significant Risk and that such activity is conducted in accordance with Obligations (i) and (ii) of Section 3 of the AUL; and ! .A UL Opinion-401 Main Street, Centerville, MA-Page 3 (iii)Relocation.of.petroleum-contaminated soil`atl3'94 feet below=surface gradd;;unless such relocation is first evaluated by an LSP4wh6 renders an,Opinion statingtFiat such relocation is consistent with maintaining a condition of No Significant Risk. - - _ a <;:;S t r. '' i'.. _(. •ice. r e!� t- e t_3;,�-:+ t;l`.,. TObliQations and Conditions .'. .aR' (i) A Soil Management}Plan must be prepared by-an LSP prior to the commencement of any activity which is likely to disturb petroleum-contaminated soil located at]3 a�= feet below surface grade: The Soil Management Plan should describe appropriate soil management, characterization, 'storage, transport, and disposal procedures in accordance with the provisions of the MCP cited,at 310.CMR 40.0030 et seq... Workers who may come in contact with the petroleum-contaminated soil should be :l appropriately trained-on :the=requirements :of the -Plan,:and`the. Plan'must remain available on-site throughout the course of the project; .• (ii) A Health and Safety Plan 'must be prepared and 'implemented prior to the. commencement of any activity which may result in the disturbance of petroleum- contaminated soil located at 13-apt' feet'below surface grade. The Heath and Safety Plan should be prepared by a Certified Industrial Hygienist or other qualified :individual appropriately trained ,in workeri'healih and safety procedures and requirements. The Plan should specify.the,type of'per"sonal 'protection, engineering controls;.?arid':environmental. monitoring-_,necessary'to:.prevent.•worker and other. potential,�receptor...exposuresR:to petroleum-contaminated 'soil 'through ingestion, 1- _ ldermal:.:contact; and inhalation:1Workers.who:.iriay`coine n'ontk with petroleum contaminated soil should be appropriately_+.trairied:on ttie-requirements of the Plan, _ and the Plan must remain available on-site throughout the course of the project; (iii)The petroleum-contaminated. soil located at 13-cN.71feet below:surface .grade must . remain at depth and may not be relocated, unless such activity is first evaluated by an LSP who renders ari Opinion which states that such activity poses no greater risk.of harm to health, safety,. public welfare,-or the environment and ensures that a. condition of No Significant Risk is maintained. LSP: `2= thaniel L`` s. ss,Licensed Site Professional (MA#5156). Date: r EXHIBIT D Massachusetts Department of Environmental Protection BWSC-114 Bureau of Waste Site Cleanup Release Tracking Number ACTIVITY & USE LIMITATION (AUL) OPINION FORM,. ;. Pursuant to 310 CMR 40.1070-40.1084(Subpart J) a. 15176 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..:r A. LOCATION'OF DISPOSAL SITE AND PROPERTY SUBJECT TO AUL: H" osal Site.Name: Residential Property DisP 401 Main Street Street: Location City/Town: Centerville ZIP Code: Address of property subject to ALL,if different than above. Street: City/Town: ZIP Code: B. THIS FORM IS BEING USED TO:. (check one) �n Provide the LSP Opinion for a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1074(complete all sections of this form). Provide the LSP Opinion for an Amended Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1081(4) (complete all sections of this form). Provide the LSP Opinion for a Termination of a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1083(3) (complete all sections of this form). Provide the LSP Opinion for a Grant of Environmental Restriction,pursuant to 310 CMR 40.1071,(complete all sections of this form). Provide the LSP Opinion for an Amendment of Environmental Restriction,pursuant to 310 CMR 40.1081(3) (complete all sections of this form). El Provide the LSP Opinion for a Release of Environmental Restriction,pursuant to 310 CMR 40.1083(2)(complete all sections of this form). i 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, > if Section B indicates that a Notice ofActivity and Use Limitation is being registered andlor recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(ii) complies with 310 CMR 40.1074(1)(b); > if Section B indicates that an Amended Notice ofActivity and Use Limitation is being registered andlor.recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c. 21 E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1080(1)and 40.1081(1); > if Section B indicates that a Termination of a Notice ofActivity and.Use Limitation is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c. 21 E and 310 CMR t 40.0000 and(ii)complies with 310 CMR 40.1083(3)(a); > if Section B indicates that a Grant of Environmental Restriction is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal (i)is being provided in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(ii) complies with 310 CMR 40.1071(1)(b); > if Section B indicates that an Amendment to a Grant of Environmental Restriction is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L. c. 21 E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1080(1)and 40,1081(1); > if Section B indicates that a Release of Grant of Environmental Restriction is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L. c. 21 E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1083(3)(a). 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 applicable provisions thereof. SECTION C IS CONTINUED ON THE NEXT PAGE. Revised 5/8/95 Do Not Alter This Form Page 1 of 2 Massachusetts Department of Environmental Protection BWSC-11.4 Bureau of Waste Site Cleanup R61eas Trkking Number r ACTIVITY&USE LIMITATION (AUL) OPINION FORM . y o t? 4 x Pursuant to.3,10.CMR.40:1070 40::1084(SubpartJ)- i "15176 t .r2 C. LSP.OPINION . (continued) ? Nathaniel L F" � 15 insness r LSP'Name: �. LSP 5 6 Stamp �f �_. r W �A0% . Ass (508) 679-2002 Telephone Ext.: o NATHANiEI - a Gr. FAX: 679-2205. c L._ INSN"_SS y � v F No.5156 LSP Signature: ` 2"'�/ .. c 9 O �� F S Date: SlTE PROT YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY FIND THE DOCUMENT TO BE'INCOMPL'ETE-' tl ra a ?^......_. ... ...�i iS.. ..r.. O� .���s�}r 1?:s ;:r ...{ st�:.♦ x:a«a.7.i _1-.sYsal.-' ide: .aJ 'iF S-.:..'s• Z:., t?7 .��`.C 1v i_,1iiV -I. i c .. 1 r - .. -.v.......-� v.......,.>y,.,.. w..�,.P-.-.>a',..•....+...,.�..,'-,..�..r. ...r«.,...: v,«M..�, ....:...�....-F.... -ten r�-.�,.�.,..�.�,.z.,,..,,..a�«.a+>.... ,�.._... ,..,. ..., 3 ,ti t. I(t)I{ 0$7�7,.I ri. .u ..`s'." .Fr-,i:,.,a4" ii. ca,. r5.c-,�', 9 y r,....§}+rib:. .i_ t:at.,r,t.) _ I,i',- :.fil _ .Kti-1 cIaJ 6b,n'J i _ 3 ;' -(::%. . . -.-.: , .,; i"1..... s:,.:: r'i,.a.7� U wi!�:, �i S a z r f. _ .,...?.,"♦r ,iXry .° ,C ,. _ � ... t��zc: r.: r .... _ _. �i:: Revised 5/8/95 Do Not AlterThts«Form r+ '' Page 2 of 2 ) ri`.