Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1416 OLD POST ROAD (CT & MM) - Health
1416 Old Post Road Marstons Mills A= 057-071 I i I i ®®� SMEA M6 24ULY un 1 c =29&s= ® Undo to UOA 4 I TruGreen-ChemLawn 20 Raffaele Rd. P.O.Box 869 Plymouth,MA 02360 508-747-6925 FAX:508-830-0379 Town of Barnstable Heaith Department P.O.Box 535 Hyannis, MA 02601 April 26,1999 Dear Mr. Harrington, Enclosed please find copies of the MSDS sheets that you requested when we spoke. If you have any rurther questions please do riot hesitate to give me a call at the orfice at 8007888-0845. Si er iy at oh son Field Service Manager TruGreen Chemlawn Call1-800-WE SERVE ServiceMaster•Terminix•Merry Maids V/ Tru6reen-ChemLawn-American Home Shield Furniture Medic•AmeriSpec•Rescue Rooter MATERIAL SAFETY DATA SHEET Manufacturer: Agriturf, Inc. Date of Preparation: August 18, 1992 59 Dwight Street Hatfield, MA 01038 Phone: 413-247-5687 Health Emergencies contact you local Poison Center Transportation Emergencies call 1-800-424-9300 (CHEMTREC) PRODUCT INFORMATION PRODUCT NAME: 13-3.25-6.5 Chemical Name and Synonyms: Nitrogen, Phosphorus, Potassium fertilizer solution. Chemical Family: Inorganic Salt Trade Name and Synonyms: N-P-K Mined Liquids, Starter Fertilizers, Suspension Grades CAS Number: Not listed. PHYSICAL DATA Boiling Point (F): Loses water at 212 F Melting Point (F): -5 to +50 Vapor Pressure (mm.Hq): N/A Specific Gravity: 1.1 to 1.55 Vapor Density (AIR=1): N/A Percentage Volatile by Volume (%): N/A Solubility on Water: Complete Evaporation Rate: N/A pH: 6.4 to 7.6 -.Other: 9 to 13 pounds per gallon Appearance and Odor: Green to gray colored liquid with slight ammonia odor. FIRE AND EXPLOSION HAZARD INFORMATION Flash Point (method used): Not flammable. Flammable Limits: LEL - N/A; UEL - N/A Extinguishing Media: N/A Special Fire Fighting Procedures: Wear full protective clothing and self contained breathing apparatus. Unusual Fire and Explosion Hazards: Release ammonia and nitrous oxide fumes. HEALTH INFORMATION Threshold Limit Value: None established. Effects of Overexposure: Eye, Icdtant, Skin: Non listed. Inhalation: Causes irritation of mucous membranes, coughing or difficult breathing. Ingestion: May cause nausea, vomiting, stomach pain, diarrhea and shock. Animal feed ingredient. Page 1 LILL Emergency Phone:617-636-4400 General Phone:1-800-352-6776 DoWEA 1MC0 EPA Reg.Number:62719-92 Effective Date:September 23, 1993 �; Product Code: 12169 (.ON RONT" 003599 Herbicide DowElancobe Indianapolis,IN 4628 6thdr*11se noted) STABILITY: (CONDITIONS TO AVOID)Store under Triclopyr(3,5,6-trichloro-2-pyridinyloxyacetic acid), cool,dry conditions. Avoid elevated temperatures and as the triethylamine salt direct sunlight. CAS#057213-69-1 ....................................33.0% INCOMPATIBILITY: (SPECIFIC MATERIALS TO f Glopyr,alid (3,6-dichloro-2-pyridinecarboxylic acid), �• AVOID) Avoid acid, oxidizing material, halogenated u :cs the tnelhylanune salt .................................12.1% organics,brass, copper,zinc, and aluminum. I" Other I rig redierits(total), Including: HAZARDOUS DECOMPOSITION PRODUCTS: Water. . . CAS#007732-18-5 Hydrogen chloride, nitrogen oxides under fire condi- Proprietary Emulsifier&sequestering agent tions;chlorinated pyridine. Triethylamine . . . CAS#000121-44-8 This docurrnent is prepared pursuant to the OSHA HAZARDOUS POLYMERIZATION:Will not occur. l-la:.ard Communication Standard (29 CFR r 1910.1200). In addition, other substances not S.IENVIIIONMENTALAND 131SPOSAL 'Hazardous' per this OSHA Standard may be listed. ' ' • Where proprietary ingredient shows, the Identity may be ACTION TO TAKE FOR SPILLS: Absorb spills with made available as provided in this standard. inert material such as Zorball, Hazorb or sand. Dike areas In case of large spills. Do no I� g p t contaminate water ►(- supplies and irrigation ditches. In case of large spills, BOILING POINT:Approx. 212°F, 100°C contact DowElanco. DISPOSAL METHOD: Pesticide wastes are toxic. VAP. PRESS: Similar to that of water Improper disposal of excess pesticide,spray mixture, VAP. DENSITY(Air=1): Not determined or rinsate is a violation of Federal Law. If these wastes SOL. IN WATER: Completely soluble cannot be disposed of by use according to label SP. GRAVITY: 1.14 @ 68°F/68°F instructions, contact your State Pesticide or Environmental Control Agency, or the Hazardous t9 APPEARANCE: Clear amber liquid Waste representative at file nearest EPA Regional ODOR: Slight amine smell Office for guidance. TV FLASH POINT: 150°F, 66°C EYE: May cause severe Irritation and moderate corneal METi IOD USED: SFCC injury. Effects may be slow to heal. Vapors of amines FLAMMABLE LIMITS: may cause swelling of the cornea, resulting In visual 6 LFL: Not determined disturbances, such as blurred, smoky, or halo vision. UFL: Not determined SKIN CONTACT: Prolonged exposure not likely to EXTINGUISHING MEDIA: Foam, CO2 cause significant skin irritation. Prolonged or frequent- ly-repeated skin contact may cause allergic skin reac- FIRE AND EXPLOSION HAZARDS: Irritating vapors tion in some individuals. 1 under fire conditions. Material is awater solution and SKIN ABSORPTION:A single prolonged exposure is ercept under gross fire conditions should not burn. not likely to result in the material being absorbed Avoid contaminating water supplies with run-off water. through skin in harmful amounts. The LD50 for skin FIREFIGHTING EQUIPMENT: Under fire conditions absorption in rabbits IIs>2000 mg/kg. use positive-pressure, self-contained breathing appa- ratus INGESTION: Single dose oral toxicity is low.The oral and full protective clothing. LD50 for male rats is 2164 mg/kg and for females 1521 ! mg/kg. Small amounts swallowed Incidental to normal �i handling operations are not likely to cause injury; swallow-ing amounts larger than that may cause Injury. Ingestion !I may cause gastrointestinal irritation or ulceration. if 'f iaclninnib,ra 1 rnvl=hnco i 1 r II `• M. w w , 001 Emergency Phone:517-636-4400 General Phone:1-800-352-6776 DoivElanco EPA Reg.Number:62719-92 f Effective Date:September 23, 1993 j� �] Product Code:12169 IVISDSHerbicide DowE Number:Indianapolis, DowElanco • Indiana oils,IN 46268 It-if IALATION: Single exposure to vapors is not likely ,VENTILATION: Provide general and/or local exhaust I)e hazardous. ,ventilation to control airborne levels below the expo- !::YSTEMIC(OTHER TARGET ORGAN) EFFECTS: sure guidelines. l'),cessive exposure may cause liver, kidney or heart RESPIRATORY PROTECTION:Atmospheric levels -!sects. should be maintained below the exposure guideline. r4JCErI 114FORMATION: Did not cause cancer in When respiratory protection is required for certain i, g-terra animal studies (active ingredients). operations, use an approved air-purifying respirator. "i I"RATOLOGY (BIRTH DEFECTS)Triclopyr did not SKIN PROTECTION: When handling concentrate, r-,use birth defects in lab animals. Clopyralid has wear protective clothing such as long-sleeved shirt, caused Mitts defects in laboratory animals only at long-legged pants, rubber gloves, and footwear, i.e., fIoses toxic to the mother. neoprene or nitrite butadiene rubber. Remove contam- inated clothing and wash before reuse. f .:PRODUCTIVE EFFECTS: In animal studies, tri- EYE PROTECTION: Use chemical goggles. If vapor Onpyr and clopyralid have been shown not to interfere exposure.causes eye discomfort, use afull-face respi- viiih reproduction. rator. MUTAGENICfTY(EFFECTS ON GENETIC M1A,rERIAl_): Results of in vitro ('test tube') mulagenic- ity tests oil triclopyr and clopyralid have been negative 9.ADDITIONAL ' ' ' (;;dive ingredients). Results of mutagenicity tests in SPECIAL PRECAUTIONS TO BE TAKEN IN ;mimals have also been negative. HANDLING AND STORAGE: Keep out of reach of children and animals. Do not swallow.Avoid contact 01 ►1� 1 with eyes, skin and clothing.Wash thoroughly after handling. Remove and wash contaminated clothing. E- ES:Inrmediately flush eyes with plenty of water for Keep container closed. Do not ship or store with food, :,,t least 15 minutes and get medical attention promptly, feed, drugs or clothing.Avoid breathing spray mist. Do :;!:IN:Wnsh with plenty of water. Get medical atten- not contaminate water supplies (domestic or for irriga- lion. tion). !tl GESTION: Promptly drink a large quantity of milk, MSDS STATUS: Revised sections 6, 7, 8 and ^(Ig whites, or gelatin solut;on,.or, if these are not regsheet. ,r:ailable, drink large quantities of water. Avoid alcohol. r •Al a physician. REGULATORY INPOOMAINON: )NHALATION: Remove victim to fresh air. Get medical (Not meant to be all-inclusive-selected regulations represented). :rllention. NOTICE:The information herein is presented in good faith and TOTE TO PHYSICIAN: May cause tissue destruction believed to be accurate as of the effective date shown above. loading to stricture. If lavage is performed, suggest However,no warranty,express or implied,is given.Regulatory. endotraclieal and/or esophagoscopic control. No spe- requirements are subject to change and may differ from one loca- tion to another;it is the buyer's responsibility to ensure that its activ- judgment of tile physician in response to reactions of ices comply with federal,state or provincial,and local laws.The fol- aerit . lowing specific information is made for the purpose of complying ilie P with numerous federal,stale or provincial,and local laws and regu- lations.See MSD Sheet for health and safety information. I =: 'T 'A SARA HAZARD CATEGORY:This product has been reviewed according to the EPA"Hazard Categories" !-_XPOSIJRF GUIDELINE(S):3,5,6-trichloro-2-pyridy- promulgated under Sections 311 and 312 of the I()xyacelic acid (triclopyr), triethylamine salt: Dow Superfund Amendment and Reauthorization Act of Industrial Hygiene Guide is 2 mg/m3 as acid equiva- 1986 (SARA Title III) and is considered, under applica- leiit, Skin. Triethylamine:ACGIH TLV and OSHA PEL ble definitions, to meet the following categories: :ue 10 pprn TWA, 15 ppm STEL. PELs are in accord .vilh those recommended by OSHA, as in the 1989 ;: visic,n of FELs. i i i Material: Safety Data Shee' t Emergency Phone:517-636-4400 General Phone:1-800-352-6776 o Elanco EPA Rag.Number:62719-92 Effective Date:September 23, 1993 Product Code:12169 CONFRONT* Herbicide DowEla cobs Indianapolis,IN 46268 An immediate health hazard A delayed health hazard A fire hazard TOXIC SUBSTANCES CONTROL ACT(TSCA): All ingredients are on the TSCA inventory or are not required to be listed on the TSCA Inventory. STATE RIGHT-TO-KNOW:The following product components are cited on certain state lists as men- tioned. Non-listed components may be shown In Section 1 of the MSDS. CHEMICAL NAME CAS NO. LIST N,N-DIET HYLETIIANAMiNE 000121-44-8 NJ3 NJ PA3 PA1 NJ1-New Jersey Special Health Hazard Substance (present at greater than or equal to 0.1%). NJ3=New Jersey Workplace Hazardous Substance (present at greater than or equal to 1.0%). PA1=Pennsylvania Hazardous Substance (present at greater than or equal to 1.0%). PA3=Pennsylvania Environmental Hazardous Substance (present at greater than or equal to 1.0%). OSI IA HAZARD COMMUNICATION STANDARD: This product is a"Hazardous Chemical'as defined by the OSHA Hazard Communication Standard, 29 CFR 1910.1200. The Information Herein Is Given In Good Faith, But No Warranty,Express Or Implied,le Made. Consult The IowElanco Company For Further information. 3 SANDOZ CROP PROTECTION Date Issued:Navember,1989 Supersedes:April,1988 MATERIAL SAFETY DATA SHEET BANVEL' HERBICIDE Product/Material BANVEL®HERBICIDE Manufacturer SANDOZ CROP PROTECTION CORPORATION Address 1300 East Touhy Avenue,Des Plaines,IL 60018 Emergency Phone 708/699-1616 PRODUCT • • Trade Name BANVEL®HERBICIDE or BANVEL®4S Synonyms None known Active Ingredient Dimethylamine salt of dicamba Chemical Family Substituted benzoic acid Chemical Formula C.H6CI,O3'C,H,N CAS Registry Number 2300-66-5(Active Ingredient) EPA Reg.No. 55947-1 Regulatory Status Regulated by EPA under FIFRA,Clean WaterAct and CERCLA (Superfund). 11.HEALTH/SAFETY ALERT WARNING HARMFUL IF SWALLOWED.AVOID CONTACT WITH SKIN, EYES AND CLOTHING. 111.FIRST r PROCEDURES Eye Flush eyes with tap water for at least 15 minutes.Consult an ophthalmologist if symptoms persist. Skin Wash with mild soap and water.Rinse with copious amounts of water.Launder clothing thoroughly before reuse. Ingestion Drink 1 or 2 glasses of water.Induce vomiting by touching back of throat with finger or blunt object.Do not induce vomiting or give anything by mouth to an unconscious person.Consult a physician. Inhalation Remove to fresh air.Apply artificial respiration if necessary. Consult a physician if symptoms persist. IN ALL CASES OF EMERGENCY,CONTACT A PHYSICIAN. f PRECAUTIONSVill.SPECIAL Storage Keep in an area suitable for pesticide storage.Store in cool, ventilated area away from seed,fertilizers,insecticides or fungicides.Keep away from children,wildlife,domestic animals, and pets. IX.HEALTH HAZARD INFORMATION Primary Routes)of Entry Oral:No Inhalation:Yes Dermal/Eye:Yes Carcinogen as determined by: NTP:No. IARC:No OSHA:No Signs and Symptoms of Nonspecific.Symptoms may include exhaustion,muscular Overexposure spasms,urinary incontinence,dyspnea and cyanosis.Severe eye damage may occur.Skin irritation may occur. Acute Toxicity:Oral The acute oral toxicity(LD50)in rats has been reported to be 2629 mg/kg. Dermal The acute dermal toxicity(LD50)in rabbits has been reported to be>2000 mg/kg. Inhalation The acute inhalation toxicity(LD50)in rats has been reported to be greater than 200 mg/liter(nominal concentration)for a 4-hour exposure. Other Toxicological Information Skin Irritation:Mildly to moderately irritating to the skin of rabbits but not a primary skin irritant. Eye Irritation:Extremely irritating and may be corrosive to the eyes of rabbits. Target Organs Repeated high levels of dermal exposure to rabbits has resulted in skin irritation and toxicity.The liver,kidney and lung appear to be the most sensitive organs affected from repeated oral,dermal, and inhalation exposures in experimental animals. Dicamba,the active ingredient in BANVEL®HERBICIDE,has been studied extensively to determine potential health effects.Animal experimentation with dicamba has not demonstrated any carcinogenic,teratogenic or other reproductive effects with the exception of slightly reduced fetal body weights and post- implantation losses reported at the Maximum Tolerated Dose level.The preponderance of experimental data suggests dicamba is not a mutagen. • 0 • -121 Personal Protective Equipment Under normal conditions of use,respiratory protection is not required.In cases where inhalation is likely,a MSHA/NIOSH approved respirator for pesticides is recommended.In cases where eye and skin contact are likely,use of chemical safety goggles,impermeable gloves,and clean,body-covering clothing are recommended. NOTE TO PHYSICIAN Treatment is symptomatic.For ingestion,lavage stomach with tap water.Instill 30 gm. activated charcoal in 3-4 oz.of water.Catharsis with 15 gm sodium sulfate in 6-8 oz. of water. EXPLOSION INFORMATION NFPA Rating Health:1,Fire:0,Reactivity:0 Special Properties None Explosive Limits Lower:Not applicable Upper:Not applicable Flammability Non-flammable Flash Point No flash point noticed up to 200°F Extinguishing Media Water spray,foam,dry chemical,CO2 Special Protective Equipment In case of severe fire involving dicamba solution,protective clothing and self-contained breathing apparatus should be worn. Special Fire Fighting Procedures Use water to keep fire exposed containers cool.At first opportunity,remove from fire. Products of Combustion May yield steam,dicamba amine salt,HCI;organochloride products,oxides of nitrogen,carbon monoxide. Unusual Fire and Explosion Hazards None IU401 0 It C191 Steps to be taken Contain spill and absorb with clay granules,sawdust or equivalent.Collect and place in suitable container for disposal. Area can be washed down with water and detergent to remove remaining herbicide. DO NOT ALLOW WASHINGS IN SEWER. Absorbents Clay granules,sawdust or dirt Counteractants Not applicable Incompatibles None known Reportable Quantity(CERCLA) 1,000lb.of dicamba(168 gal.of product) pillo 0 . e 2. Dispose of product or waste at an approved chemical waste facility. • • %I FIN i rol k Hazardous Ingredients Component WT% TLV/PEL (As defined by OSHA) Dimethylamine salt of dicamba 48.2% Not established Dimethylamine salt of related acids 12.0% Not established Inert Ingredients(non-hazardous) 39.8% N/A 100.0% Exposure Limits OSHA PEL:Not established. ACGIH TLV:Not established NIOSH Limit:Not established XII.PHYSICAL INFORMATION Appearance and Odor Amber solution,mild amine odor Molecular Weight 475 Boiling Point 2121 Melting Point Not applicable Vapor Pressure 18 mm Hg as water @ 680 Vapor Density >1.0(Air = 1) Specific Gravity 1.190 @ 210C(H2O = 1) Solubility Miscible in water Evaporation Rate Some as water Stability Stable Reactivity Not reaefive Decomposition Products N/A Will UU111 WA • • SARA SEC.311/312 HAZARD CATEGORIES: Immediate Health Yes Delayed Health No Fire No Sudden Pressure No Reactivity No The information presented herein,while not guaranteed,was prepared by technically knowledgeable personnel and to the best of our knowledge is true and accurate.It is not intended to be all inclusive and the manner and conditions of use and handling may involve other or additional considerations. 8anvel"Herbicide is a registered trademark of Sandoz Ltd. A-816 L258 LESCO , ® CAUTION:For northern or cool season grasses,such as Rye Grass, Fes- PC IV B ( 12 5 /o) cue, Bluegrass, Bent or similar grass, application is not recommended > ■ + when temperatures exceed 75'F. 1, 10 3 23 � ■ Approximate Lesco Rotary Spreader Settings ' A GRANULAR FUNGICIDE FOR CONTROL OF CERTAIN #Product/ Effective 3rd Approx.* SOIL-BORNE TURFGRASS DISEASES 1000 sq.ft. #AI/A Spreading Width Bole Setting 't ACTIVE INGREDIENT: 4 22 7' OPEN D'h(11132") Pentachloronitrobenzene. . . . . . . . . . . . . . . . . . . . . . . 12.50% 6 3 .8 7' OPEN Ph 05/32") w, INERT INGREDIENTS: . . . . . . . . . . . . . . . . . . . . . . 87.50% *IMPORTANT: These settings are only approximate. Age, condition of TOTAL: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.00% spreader,and operator speed can cause wide variation. Be sure to calibrate GUARANTEED ANALYSIS your spreader with each application. TOTAL NITROGEN(N) . . . . . . . . . . . . . . . . . . . . . . 10.00°% STORAGE AND DISPOSAL 0.63%Ammoniacal Nitrogen A.STORAGE INSTRUCTIONS: 9.37%Urea Nitrogen* Store in original container only, separate from other pesticides, fertilizer,, AVAILABLE PHOSPHORIC ACID(P,O). . . . . . . . . . . . . 3.007o food and feed.Do not store near open flame or heat sources. SOLUBLE POTASH(KZO). . . . . . . . . . . . . . . . . . . . . 23.00% B.PESTICIDE DISPOSAL,INSTRUCTIONS: SULFUR(S)(TOTAL). . . . . . . . . . . . . . . . . . . . . . . . 13.57% Do not contaminate water, food or feed by storage or disposal. Wastes 5.31%Sulfur(S)(Free) resulting from the use of this product may be disposed of on site or at an 8.26%Sulfur(S)(Combined) approved waste disposal facility. ; INGREDIENTS:Sulfur Coated Urea,Ammonium Phosphate, CONTAINER DISPOSAL: Sulfate of Potash. Completely empty bag into application equipment.Then dispose of empty I 3%slowly available Nitrogen bag in a sanitary landfill or by incineration, or, if allowed by state and E.P.A. Reg. No. 10404-37 local authorities,by burning.If burned,stay out of smoke. E.P.A. Est. No. 10404-OH-04 WARRANTY KEEP OUT OF REACH OF CHILDREN LESCO warrants that this fungicide conforms to the chemical description c' CAUTION on its label. When used in accordance with label directions under normal conditions, this fungicide is reasonably fit for its intended purposes. Since STATEMENT OF PRACTICAL TREATMENT b; 4 timing,method of application,weather,plant,and soil conditions,mixture (First Aid Procedures) with other chemicals,and other factors affecting the use of this product are If swallowed, induce vomiting. If on skin, remove contaminated clothing beyond our control, no warranty is given concerning the use of this prod- and wash skin with soap and warm water. If inhaled, remove to fresh air. uct contrary to label directions or under conditions which are abnormal or If in eyes,flush with water for 15 minutes. not reasonably forseeable.The user assumes all risks of any such use. For further treatment,get medical attention. #015942 PRECAUTIONARY STATEMENTS a HAZARDS CAUTION TO HUMANS AND DOMESTIC ANIMALS FHer�bicide -M A ■ 3 EC Harmful if swallowed,inhaled or absorbed through skin. Avoid breathing v{ dust.This material may cause skin irritation.Avoid contact with eyes,skin or clothing. Wear long-sleeved shirt while handling product. Wash handsble Concentrate for Use as a Pre-emergent Weed Control in and faceafter use and prior to eating,drinking or smoking.Wash contami- d Areas,Lawns,Turf,and Ornamentals. nated clothing before reuse. Do not handle or apply product with bareGREDIENT: hands.Keep out of reach of children. penmetan,N-(1-ethylpropyl)-3,4-dimethyl-2, ENVIRONMENTAL HAZARDS 6-dinitrobenzenamine . . . . . . . . . . . . . . . . . . . . . . . 37.4% This product is toxic to fish. Do not apply directly to water. Do not con- INERT INGREDIENTS: . . . . . . . . . . .. . . . . . . . . . . . 62.6% tarninate water by cleaning of equipment or disposal of wastes. Do not apply directly adjacent to potable water supplies. TOTAL: . . . . . . . . . . . . . . . . . . . . . . . . . 100.01/0 DIRECTIONS FOR USE (I gallon contains 3.3 lbs.of pendimethalin) it is a violation of Federal law to use this product in a manner inconsistent EPA Reg.No. 241-341-10404 with its labeling. KEEP OUT OF REACH OF CHILDREN Chemigation: Do not apply this product through any type of irrigation CAUTION/lPRECAUCION! system. 1PRECAUCION AL USUARIO;Si usted no lee ingles,no use este LAWNS AND TURF producto hasta que la ctiqueta le haya lido explicada ampliamente. In case Brown Patch and Dollar Spot:For southern or warm season lawns such as of an emergency endangering life or property involving this product,call St. Augustine, Bermuda and similar grasses: Make one application in the collect day or night Area Code 201-835-3100. fall or spring at first indication of infection. Apply 6 lbs. per 1,000 sq. ft. FIRST AID Following application,the.treated areas should be lightly watered to insure If in eyes:Hold eyelids open and flush with steady,gentle stream of water movement through the grass to soil level. If the treated area is subjected to for 15 minutes.Call a physician if eye irritation persists. unusually heavy rainfall,or flooded,or if the disease is severe or reappears, Con- the area should be retreated 3 to 4 weeks later. For Dichondra: Treat as If swallowed:me NOT induce vomiting. Calla physician or Poison Con- above, using 6 lbs. per 1,000 sq. ft. For Northern or cool season lawns trot Center a physician i skin skin contact:Wash thoroughly with soap and such as Rye Grass, Fescue, Bluegrass, Bent or similar grasses: Apply 1.6 water.Call a physician if skin irritation persists. to 2.0 lbs. per 1,000 sq. ft. at first sign of disease. Repeat every 7 to 10 NOTE TO PHYSICIAN: Because of increased risk of chemical pneumo- days during warm, damp weather. Water treated area lightly to wash nia or pulmonary edema caused by aspiration of the hydrocarbon solvent, chemical down to soil. Under certain growing conditions, a temporary vomiting should be induced only under professional supervision.. discoloration of the grass occasionally may occur. 'This causes no harm See inside for Additional Precautionary Statements and Directions for and will disappear in a short time. Use Helminthosporium Leaf Spot:Apply at rate of 4 to 6 lbs. per 1,000 sq. ft. Precautionary Statements—Hazards to Humans Preventative applications should be made in spring or fall of each year. CAUTION For control of existing infections,apply at the higher rate as soon as symp- toms are first noted. Following applications, the treated area should be Causes moderate eye irritation. Harmful if swallowed or absorbed through lightly watered to insure movement through the grass to soil level. If the the skin. Wear goggles or face shield. Avoid contact with skin, eyes, or treated area is subjected to unusually heavy rainfall, or flooded, or if the clothing. Wash thoroughly with soap and water after handling. Use with disease is severe or reappears, the area should be retreated 3 to 4 weeks adequate ventilation. later. ENVIRONMENTAL HAZARDS Snow Mold(Typhula Incarnata, Fusarium Nivale): Apply at the rate of 4 This product is toxic to fish. DO NOT apply directly to water or wetlands to 6 lbs. per 1,000 sq. ft. using a granular lawn spreader or comparable (swamps, bogs, marshes. or potholes). Drift and runoff from treated areas equipment.Application should be made prior to first snowfall. may.be hazardous to aquatic organisms in adjacent acquatic sites. DO Do not graze li-ated areas or feed clippings to livestock. NO'l contaminate water when disposing of equipment washwaters. �ti ailOki Pre-M 3.3 EC Herbicide L259 GENERAL INFORMATION Common Oleander Nerium oleander i LESCO PRE-M 3.3 EC Herbicide is recommended for pre-emergence Dogwood Cornus cardinal control of grasses and certain broadleaf weed species as they germinate on European Fan Palm Chamaerops humilis non-cropland areas,ornamentals,and established Christmas trees.LESCO Fir,Balsam Abies balsamea PRE-M 3.3 EC Herbicide treatments are most effective in controlling Firethorn Pyracantha coccinea i weeds when adequate rainfall is received within 30 days after application. Holly,Dwarf Burford) Ilex comutanana LESCO PRE-M 3.3 EC Herbicide will not control established weeds. Holly,Japanese Compacta Ilex crenata compacta Therefore, areas to be treated should be free of established weeds at the Holly'Savannah' Ilex attenuata time of treatment, or LESCO PRE-M 3.3 EC Herbicide may be used in Hosta Hosia lancifolla conjunction with herbicides registered for post-emergence use in non-crop- Juniper,Andorra Juniperus horizontalis plumosa land areas, ornamentals, and established Christmas trees. Consult the la- Juniper'Pfitzer' Juniperus chinensis g, bels of these herbicides for suggestedJuniper'Sea Green' Juniperus teatments,rates to be used,and pre-_ Juniper'Blue Chi chinensis media cautions or restrictions for use in non-cropland areas. p p' Juniperus horizontalis Juniper,Savins'Broadmoor' Juniperus Sabina DIRECTIONS FOR USE y Liriope,Green Liriope spicata It is a violation of Federal law to use this product in a manner inconsistent Liriope,'Monroe White' Liriope muscari with its labeling.This labeling must be in the possession of the user at the Liriope,Variegated Liriope muscarl'Variegata' time of herbicide application. DO NOT apply this product through any Maple,Red Acer rubrum type of irrigation system. Mondo Grass Ophlopogon japonicum Observe all cautions and limitations in this label and the labels of products Mountain Laurel Kalmia latifolia used in combination with LESCO PRE-M 3.3.EC Herbicide.The use of Natal Plum Pitt spa rum t fl ira LESCO PRE-M 3.3 EC Herbicide not consistent with this label can result Privet,Japaorumnese Pittosporum tonic in injury to crops, animals, or persons. Keep containers closed to avoid Privet,Japanese Ligustrum japonicum spills and contamination. S "ea, Bridal Wreath Spirea vanhouttel Mixing instructions Ground Cover Ornamentals 1. Fill tank one-half to three-quarters full with clean water. LESCO PRE-M 3.3 EC Herbicide may be used for line pre-emergence 2. Add LESCO PRE-M 3.3 EC Herbicide to the partially filled tank control of the weed species listed in and around the following established while agitating and then fill the remainder of the tank with water. ground cover plants: 3. MAINTAIN CONTINUOUS AGITATION WHILE ADDING Common Name Scientific Name LESCO PRE-M 3.3 Herbicide AND UNTIL SPRAYING IS COM- Ca eweed p' Arclotheca calendula YLETED. If.the spray mixture is allowed to settle for any period of Daisy,Trailing African Osteospermum fructicosum time, thorough agitation is essential to re-suspend the mixture before Gazania Gazania splendens spraying is resumed.Continue agitation while spraying. Rose-of-Sharon Hypericum calycinum 4. if LESCO PRE-M 3.3 EC Herbicide is to be used in tank mixtures Iceplant,Large Leaf Carpobrotus edule with other registered herbicides, tile" follow directions on the labels of Ivy, English Helix hedera those products which recommend tank mixing. Ivy,Geranium Pelargonium peltatum Spraying instructions Myoporum Myoporum parviflorum Uniformly apply with properly calibrated ground equipment in sufficient Pachysandra Pachysandra terminalis water per acre to uniformly treat the area with a spray pressure of 25 to 50 Potentilla Potentilla jimiamanii psi. Maintain continuous agitation during spraying with good mechanical Potentilla or bypass agitation. Non-Cropland Weed Control Precaution! LF.SCO PRE-NI 3.3 EC Herbicide is recommended for pre-emergence Apply only to established plantings. DO NOT apply LESCO PRE-M 3.3 control of most annual grasses and certain broadleaf weeds as they genni- EC Herbicide in ornamental seedling nurseries. hate on non-cropland areas such as railroad, utility,and pipeline rights-of- way, highway guardrails, delineators, and sign posts, utility substations, Weed Species Controlled , For pre-emergence control of the weed species listed,apply LESCO Pre-M 3.3 petroleum tank farms, pumping installations, fence rows, storage areas, i windbreaks,she►terbelts,and other similar areas. Herbicide at the following rates: For post-emergence control of weeds, tank-mix combinations of LESCO PRE-M 3.3 EC Herbicide plus ARSENALO herbicide are recommended. Length of Control LESCO PRE-M 3.3 EC Herbicide DO NOT tank mix with ARSENAL. in California. Recommended rates Short-Term Control(2-4 months) 2.4 Quarts/Acre for the tank-rnix compounds should be determined from the product_labels Long-Term Control(6-8 Months) 4.8 Quarts/Acre of both LESCO PRE-M 3.3 Herbicide and ARSENAL prior to use. LESCO Pre-M 3.3 EC Herbicide will not control established weeds. O Registered Trademark of American Cyanamid Company. The efficacy of LESCO PRE-M 3.3 EC Herbicide will be improved if the Weed Control In and Around Oranmental Plantings application is followed by one-half inch of rainfall or its equivalent in LESCO PRE-M 3.3 EC Herbicide is recommended for use on the follow sprinkler irrigation. ing established field grown and container ornamentals, plants and trees, The following grass and broadleaf weeds are controlled by pre-emergence and established ground covers. Care must be taken that soil or planting treatments of LESCO PRE-M 3.3 EC Herbicide at the rates recom- mixes have settled firmly following transplanting and that there are no mended: cracks that would allow direct contact of LESCO PRE-M 3.3 EC Herbi- cide and roots. Directed sprays where soil and niedia surfaces are uni- Grasses Controlled formly covered will result in best weed control and ornamental tolerance. Common Name Scientific Name LESCO PRE-M 3.3 EC Herbicide sprays can be safely applied over the lop of those plants listed below. Barnyardgrass Echinochloa crus-galli Meld and Container Ornamentals Bluegrass,Annual Poa annua Crabgrass Digitaria app. Common Name Scientific Name Crowfoolgrass Daclylocteniuni aegyptium Azalea'Coral Bells' Rhododendron Foxtail,Giant Setaria faberi Bamboo, Heavenly Naiidina domestics Foxtail,Green Setaria viridis Birch, River Betula nigra Foxtail,Yellow Setaria lutescens Bottle Brush Callistenion citrinus Goosegrass Elcusine indica Boxwood,Common Buxus sempervirens Itchgrass Rottboellia exaltata Bush Honeysuckle Diet-villa ionicera Johnsongrass(from seed) Sorghum halepense L260 LFSCO L Common Name Scientific Name months after application. Prior to seeding or sprigging, the soil surface Junglerice Echinochloa colonum should be disturbed or worked to dilute any remaining chemical residue. Lovegrass Eragroatis app. On newly planted areas, wait until the grass has been mowed at least 4 Panicum. Browntop Panicum fasciculatum limes and has filled in before applying product. f: Panicum, Fall Panicum dichotomiflorum On turf that has been severly thinned due to winter damage,excessive soil Panicum.Texas Panicum texanum moisture, low temperature (below 40°F), scalping, insects, disease, etc., Sandbur,Field Cenchnrs incerhis wait until turf has filled in and rooting of stolons is complete before apply- Signalgrass Brachlaria platphyiia ing' Sprangletop,Mexican Leplochloa uninervia This product may stain, thus avoid contact with areas such as sidewalks, Sprangletop, Red Leptochloa fillforrnis driveways, etc. if contact with the spray mixture occurs, promptly rinse with water. Wooly ass Panicum cvillosre Weed Control in Lawns and Turf Wooly Cupgrass Erlochloa villosa rt' Broadleaf Weeds Controlled LESCO PRE-M 3.3 EC Herbicide can be used for weed control in lawns and turf. ` Common Name Scientific Name Torfgrass Types: LESCO PRE-M 3.3 EC Herbicide should only be ap- Carpehveed Mollugo verticillata plied to well established lawns and turf. LESCO PRE-M 3.3 EC Herbi- Chickweed,Common Stellaria media cide can be used on the following turfgrasses: Bahiagrass, Bermudagrass, Chickweed,Mouseear Cerastium vulgatum Ceti tipedegrass, Fine Fescue, Kentucky Bluegrass, Perennial Ryegrass, St. Clover,Hop Trifolium procumbeuS Augustinegrass,Tall Fescue,Zoysiagrass. Cudweed Gnaphallum app. Weeds Species Controlled:When applied as directed, LESCO PRE-M 3.3 Fiddleneck Anisinckia interniedia EC Herbicide will control the following weed species: Filaree Erodium spp. Grasses Controlled Henbit Lamium amplexicaule Common Name Scientific Name Knotweed(prostrate) Polygonum aviculare Annual bluegrass Pon,ail nua Kochia Kochia scoparia Barnyardgrass Echinochloa crux-gaill i Lambsquarters Chenopodium album Crabgrass Digitaria spp. i Pigweed Amaranthus spp. � J Fall panictini 1 anicum dichotomiflorum r Puncturcvine T'ribulus terrestris Foxtail Setaria spp. Purslane Portulace pleracea Pusley,Florida Richardia scabs Goosegrass Eleusine indica — Rocket, London Sisymbrium trio Broadleaf Weeds Controlled Sheperdspurse Capsella bursa-pasloris Common Name Scientific Name Smartweed,Pennsylvania Polygonum pensylvanicum Common chickweed Stellaria media 'i Spurge,Annual Euphorbia spp. Cudweed Gnaphallum spp. Spurge.Prostrate Euphorbia maticulata 1-lop clover Trifolium procumbens Woodsorrel,Yellow Oxalis stricta Henbit Lamium amplexicaule Velvetleaf(Buttonweed) Abutillon theophrasti Knotweed Polygonum avicularc Mouseear chickweed Cerastium vulgatum GENERAL INFORMATION _ Prostrate spurge Euphorbia supina Use only on well-established turfgrass with a dense and uniform stand. Purslane Portulaea oleracea LESCO PRE-M 3.3 EC Herbicide treatments will not control established Oxalis Oxalls spp. weeds.Applications must be made prior to a germination of weeds-. Evening primrose Oenothera blennis Three applications per year may be made. Allow at least 2 months be- Rate and Application Chart tween applications except where indicated under RATE AND APPLICA- Turf Weeds Rates of Comments TTON CHART. Species Controlled LESCO PRE-NI Mixing and Application Instructions 3.3 EC Add LESCO PRE-M 3.3 EC Herbicide slowly to partially filled tank (1/1 Northern Grasses to 314 full)of water while agitating and then fill the remainder of the tank Fine fescue Barnyardgrass 3.6 to 4.8 pis Apply in Spring with water. MAINTAIN CONTINUOUS AGITATION WHILE ADD- Kentucky bluegrass Crabgrass per acre or 1-3 before weeds ING LESCO PRE-M 3.3. EC Herbicide AND UNTIL SPRAYING IS Perennial ryegrass Fall panicum to 1.8 oz.per germinate COMPLETED. If the spray mixture is allowed to settle for any period of Tall fescue Foxtail 1,000 sq.ft. time,thorough agitation is essential to resuspend the mixture before spray- Ilop clover ing is resumed. Continue agitation while spraying as needed. Apply with Prostrate spurge properly calibrated equipment in sufficient water per acre to provide uni- Yellow woodsorrel form spray distribution. Low pressure (25-50 psi) sprayers are recom- Cudweed mended.Avoid application when winds may cause drift. Goosegrass 7.2 pis per acre 5 Apply in LESCO PRE-M 3.3 EC Herbicide treatments are most effective in con- Evening primrose or 2.6 oz.per Spring trolling weeds when adequate rainfall or overhead irrigation is received 1,000 sq.ft. before weeds within 7 days after application. germinate. Avoid contact of spray solution with driveways, stone, wood, or other Repeat porous Surfaces.if contact occurs,rinse immediately to reduce staining. application if Compatibility necessary in 8 weeks at 3.6 LESCO PRE-M 3.3 EC Herbicide is compatible with most commonly pis per used herbicides. When LESCO PRE-M 3.3 EC Herbicide is used in tank acre or 1.3 oz. mixture with another herbicide, refer to each label for rates, methods of per 1,000 application, proper timing, weeds controlled, limitations,and precautions. sq.ft Always use in accordance with the more restrictive label limitations and Annual bluegrass 3.6 is to 4.8 Apply m late precautions. When tank mixing be sure to add LESCO PRE;M 3.3 EC ip' pp 5 . Herbicide to the partially filled tank first, mix thoroughly, and then add Common chickweed pis per acre. Sunnily §_ Mouseear chickweed 1.3 to 1.8 oz. to early Fall ] combination.products to the mixture. DO NOT'apply tank mix combing- rr iicnbil per 1,000 sq.ft. before bons unless previous experience indicates the mixture is effective and will '#. 1 not result in application problems or plant injury. DO NOT attempt to weeds germinate mix LESCO PRE-M 3.3 EC Herbicide directly with liquid fertilizer. Pre- mix one part of LESCO'PRE-M 3.3 EC Herbicide with two parts water Bahia Barnyardgrass 4.2 to 4.8 pis Apply in Spring r` and add this diluted mixture slowly into the tank while agitating. Bermudagrass Crabgrass per acre or before weeds Precautions Centipedegrass Fall panicum 1.6 to 1.8 oz. germinate. St.Augustinegrass Foxtail per 1,000 sq.ft. Repeat I. Not for use on bentgrass or Poo am ua (putting greens and tees) or on Tall fescue Prostrate spurge application if C dichondra,where these are desired species. Zoysiagrass Pillow woodsorrel necessary in 8 F This product may cause yellowing and thinning of cool season grasses in Cudweed weeks using 3.6 11 winter overseeded turf. Delay seeding by 4 months and sprigging by 5 pis per acre. II sc Y e_ y Pre-M 60 DG Herbicide L261 . Turf Weeds Rotes of Comments PRECAUTIONARY STATEMENTS Species Controlled LESCO PRE-NI HAZARDS TO HUMANS AND DOMESTIC ANIMALS ' 3.3 EC CAUTION: May cause eye and skin irritation. Avoid contact with eyes, ` Goosegrass 6.4 to 7.9 pis skin and clothing. Wash thoroughly after handling and before eating or Hop clover per acre or 2.4 smoking. Evening primrose to 2.9 oz.per ENVIRONMENTAL HAZARDS I,000 sq.h. _ This product is toxic to fish. Do not apply directly to water or wetlands. Heabit 3.6 to 4.8 pis Apply in We Do not apply when weather conditions favor drift from target areas. Do Annual bluegrass per acre or 1.3 Summer not contaminate water when disposing of equipment washwaters. Common chickweed to 1.8 oz.per to early Fall DIRECTIONS FOR USE chickweed 1,000 sq.ft. before weeds 6crminate It is a violation of Federal law to use'this product in manner inconsistent with its labeling. Disclaimer CIIEMIGATION: Do not apply this product through any type of irriga- The label instructions for use of this product reflect the opinion of experts tion system. based on field use and tests.The directions are believed to be reliable and MIXING AND APPLICATION INSTRUCTIONS should be followed carefully. However, it is impossible to eliminate all risks inherently associated with use of this product. Crop injury, ineffec- Add LESCO PRE-MO' 60 DG slowly to partially-filled tank(nil 10 3/4 full) tiveness or other unintended consequences may result because of Such fac_ of water while agitating and (hell fill rile remainder of the lank will) water. tors as weather conditions,presence of other materials,or the use or appli- MAINTAIN CONTINUOUS AGITATION WHILE ADDING LESCO cation of the product contrary to label instructions, all of which are PRE-M" 60 DG. If the spray mixture is allowed to settle for any period beyond the control of LESCO, Inc. All such risks shall be assumed by the of time, thorough agitation is essential to reSuspend the mixture before user. spraying is resumed.Continue agitation while spraying as needed. LESCO Inc. warrants only that the material contained herein conforms to Apply will, properly calibrated equipment in sufficient water per acre to the chemical description on the label and is reasonably fit for the use provide uniform spray distribution. Low pressure(25-50 psi)sprayers are therein described when used in accordance with the directions for use,sub- recommended. Nozzle screens must be no finer than 50 mesh.Avoid appli- ject to the risk referred to above. cation when winds may cause drift. a Any damages arising from a breach of-this warranty shall be limited to Treatments are most effective in controlling weeds when adequate rainfall direct damages and shall not include consequential commercial damages or overhead irrigation is received within 7 days after application. Avoid such as loss of profits or values or any other special or indirect damages. contact of spray solution with driveways, stone, wood or other porous LESCO Inc. makes no other express or implied warranty, including other surfaces. Rinse immediately to avoid staining. express or implied warranly of FITNESS or of MERCHANTABILITY. CONIPATlinuTY STORAGE AND DISPOSAL. LESCO PRE-Mn 60 DG is compatible with most commylIlly used herbi- cides. When tank mixing be sure to add LESCO PRE-Mg 60 DG'to the Storage: DO NOT STORE BELOW 40°F. Extended storage at tempera- partially filled tank first, mix thoroughly,and then add combination prod- lures below 40'F can result in the formation of crystals on the bottom of acts to the mixture as directed or its instructed on its EPA approved label. container. If crystallization does occur, store the container on its side at Do not apply tank mix combinations unless product is approved for such room temperature(70°F)and rock occasionally until crystals redissolve. tank-mix use and previous experience.indicales the mixture is effective and DO NOT contaminate water,food,or feed by storage or disposal. will not result in application problems or plant injury. Do not attempt to Pesticide Disposal: Pesticide wastes are toxic. Improper disposal of excess I"nix LESCO PRE-MU 6Q DG directly with liquid ferlilizers. Premix one pesticide, spray mixture, or rinsale is a violation of Federal law. If these part of LESCO PRE-M fl 60 DG with two parts water and add this di- wastes cannot be disposed of by use according to label instructions, luted mixture slowly into lank while agitating. contact your Slate Pesticide or Environmental Control Agency, or the GENIRA1,INFORMATION Hazardous Waste representative at the nearest EPA Regional Office for LESCO PRE-M R 60 DG lreaunenls will not control Established weeds. Contaguidance. Applications must be made prior to germination of weed seeds.Three ap- recondner Disposal:`triple rinse(or equivalent)."Then offer for recycling or plications per year may be made. Allow at least 2 months between applica- eratio ilio if al or puncture and dispose of ill a sanitary landfill, by undo- lions except when otherwise indicated on this label. station or if allowed by slate and local authorities, by burning. If burned, Use only on well established turfgrass with a dense and uniform stand. Do stay out of smoke. uol use on newly seeded or sprigged turfgrass. Do not use on winter-over- seeded turfgrass. Do not use on turfgrass severely thinned by winter stress. LESCO PRE-MU 60 DG provides effective residual weed control which may affect new turgrass seedlings or sprigs. Do not reseed or winter over- PRE- seed treated turfgrass within 4 growing months after application. Do not 'Y, sprig turfgrass within 5 months after application. Do not use on 13entgrass or Dichondrt maintained as desirable turf. HERBICIDEApplication Rates and Comments For Use On Lawns SoTurf Turf Weeds Pre-NI 60 DG A 60% Water Dispersible Granule for Species _Controlled Rate/Acre Comments Pre-emergent Weed Control in Lawns, Turf CC ------------ - _ Northern Grasses Fine liaruyanlgrnss 2.5 to 3.75 Apply in spring Ornamentals Fescue I Crabgrass lbs.per acre before weeds ACTIVE INGREDIENT: Kentucky Fall I'anicum or germinate. Pendirnethalin[N-0-elhylpropyl)- liluegatss Foxtail 0.9 to 1.4 oz. Repeal application if 3,4-dimelhyl-2,6-diititrobenzamitie. . . . . . . ... . . 60.07;, Perennial Hop Clover per 1,000 sq. necessary in 8 weeks INERT INGREDIENTS:. . . . . . . . . . . . . . . . . . . . . . . 40.0`7" Ryegrass Prostrate h. using 2.5 lbs.per acre -- — Tall Spurge or 0.9 oz.per 1,000 TOTAL . . . . . . . . . . : . . . . . . . . . . . . . . . . . looff;, Fescuc fellow . is One Pound contains 0.6 lbs. Pendimethali°. Woodsoirel 9 n PRE-M@ is a Reg.Trademark of Lesco,Inc. Cudweed EPA Reg.No. 10404-52 Goosegrass 5.0Ibs.per KEEP OUT OF REACH OF CHILDREN I'°"" g" acre or . � , I'rinuou 1.8 oz.per CAUTION 1,000 .PI. STATEMENT OF PRACTICAL TREATMENT Annual 2.5 to 3.75 Apply in late summer 131uegrass lbs.per acre to early fall,before IF SWALLOWED: Do not induce vomiting. Call a physician or Poison Common or weeds germinate. t Control Center immediately. Chickweed 0.9 to 1.4 oz. IF IN EYES:Flush eyes with plenty of water.Get medical attention. Mouscear per 1,000 sq. IF ON SKIN: Remove contaminated clothing and wash affected area with Chickweed ft. d, soap.and water.Get medical attention if irritation occurs. Ilenbit r n Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection .Join Grad One winter Street,Boston,Ma. 02108 D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket,MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI 7 8 Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION y A , \ 6 do�0 1 ~ Property.Address: 1416 Old Post Rd.Marstons Mills Imo} Address of Owner: 6 j Date of Inspection: 3126/98 (If different) Name of Inspector: John Graci John Homstra:171 Union St.Hingh m d� I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) V Company Name,Address and Telephone Number: 2 j CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This Inspection Is based on criteria dented InTltle V _ al P ses code 310 CMR 16203.My findings are of how the system is Condition performing at the time of the Inspection.My Inspection does r valuation By the Local Approving Authority _ Needs Fur e notImpyanywarrantyorguaranteeorthelongevityofthe Nee septic system and any of Its components useful life. Fails Inspector's Signature: Date: 3130198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 3W CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by.the Board of Health. (revised OOD97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1416 Old Post Rd.Marstons Mills Owner: John Homstra:171 Union St.Hingham Date of Inspection:3126199 _ Sewacie backup or.breakout.or. hioh.static water level observed.in•the distribution box is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1), SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged- cesspool. SAS is in hydraulic failure. (revieed 04127W) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1416 Old Post Rd.Marstons Mills Owner: John Homstra:171 Union St.Hingham Date of Inspection:3126199 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No _ the system is within 400 feet of a surface drinking water supply the system Is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (reyleed 0412707) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 1415 Old Post Rd.Marstons Mills Owner: John Homstra:171 Union St.Hingham Date of Inspection:3126199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. V — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected — — for condition of baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 04r17197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1416 Did Post Rd.Marstons Mills Owner: John Hornstra:171 Union St.Hingham Date of Inspection:3126198 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S. Design flow: 330 g p Number of bedrooms: a Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yee Water meter readings,if avaiI able:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: Na COMMERCIAL/INDUSTRIAL: Type of establishment: rda Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: rds Last date of occupancy: n1a OTHER:(Describe) Ma Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: rda System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(If known)and source Information: 18 years Sewage odors detected when arriving at the site:(yes or no) No (revised 007)87) fi SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1416 Old Post Rd.Marstons Mills Owner: John Hornstra:171 Union St.Hingham Date of Inspection:3125199 SEPTIC TANK: x (locate on site plan) Depth below grade: 12" Material of construction:x concreate_metal_FRP_Polyethylene_other(explain) If tank is metal, list age n1a . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: LOW'1457"W416^ Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle: 23" Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle:0 How dimensions were determined: measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Leach pit and all components are structuraity sound and functioning properly.Recommend pumping now,then pumping every year. GREASE TRAP: (locate on site plan) Depth below grade: rda ( lainexp_other Material of construction: _concrete_metal_FRP_Polyethylene ) Dimensions: nla Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: nla Date of last pumpingn't_ Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) nfa BUILDING SEWER: (Locate on site plan) Depth below grade: Lv3 Material of construction:_cast iron_40 PVC_other(explain) i Distance from private water supply well or suction linetown Diameter: 4"_ Qmments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127)97) SUBSURFACE SEWA GE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1415 Old Post Rd.Marstons Mills Owner: John Hornstra:171 Union St.Hingham Date of Inspection:3126199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Na Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nra Capacity: rda gallons Design flow: rda allons/day Alarm level:_nia Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: ala Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) rda i i (revised 04127)87) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1415 Old Post Rd.Marstons Mills Owner: John Homstra:171 Union St.Hingham Date of Inspection:3126199 SOIL ABSORPTION SYSTEM(SAS):x ,(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) 'If not determined to be present,explain: nra Type: leaching pits,number: oneleachplt leaching chambers,number:r9a leaching galleries,number: rda leaching trenches, number,length: rda leaching fields,number,dimensions:rda overflow cesspool,number:rile Alternate system: nra Name of Technology:_we Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Leach pit and all componerds are structurally,sound and functioning property.System has had 4S"ofwater in IL There Is 1'of leaching left.system Is cunentty empty. CESSPOOLS: (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: rJa Depth of solids layer: nra Depth of scum layer: Ma Dimensions of cesspool, We Materials of construction: Na Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rya PRIVY: (locate on site plan) Materials of construction: rda Dimensions: r0a Depth of solids: Na Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) We 1 I y i (revised042797) I� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1410 Old Post Rd.Marstons Mills John Homstra:171 Union St.Hingham 3126198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) J�C� A 0 0 AAc (6 3�10 CIA Ui ys Pay 9 of 10 (rwlaad 04r17197) ` 0 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1416 Old Post Rd.Marstons Mills John Hornstra:171 Union St.Hingham 3126199 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts (revised04127197) page 10 all 10 TruGreen•ChemLawn --TRLIQU 20 Raffaele Rd. P.O.Box 869 Plymouth,MA 02360 508-747-6925 FAX:508-830-0379 Town of Barnstable Health Department P.O.Box 535 Hyannis, MA 02601 April 26,1999 Dear Mt. Harrington, Enclosed please find copies of the MSDS sheets that you requested when we spoke. If you have any further questiut4S please do not hesitate to give me a tali at the orfice at 800-888--0845. Si r 1 at ob on Field $e:vice Manager TruGre®n Ghemlawn Gid11-800-Wl..Sl.'RVl' T••f,"I,,•\I:•„'f•I'fll,l l,Il \�•!Y'\la"I: I'r.M.r,••„t h,lid.10 it-A11 N.Itl 1hinh•N111.1I .SAINDOz CROP PROTECTION �-- Date Issued:November.1989 Supersedes:April,1988 MATERIAL SAFETY DATA SHEET BANVELe HERBICIDE Product/Matsriol BANVELO HERBICIDE Manufacturer SANDOZ CROP PROTECTION CORPORATION Address 1300 East Touhy Avenue,Des Plaines,IL 60018 Emergency Phone 708/699-1616 Trod*Nome BANVELd°HERBICIDE or SANVEL*4 S Synonyms None known Active Ingredient Dimethylomine salt of dicomba Chemical Family Substiluled benzoic ocid Chemical Formula C,H,CIzO,-C,H,N CAS Registry Number 2300-66-5(Active Ingredient} EPA Reg.No. 55947-1 Regulatory Status Regulated by EPA under FIFRA,Clean Water Act and CERCLA (Superfund). WARNING HARMFUL IF SWALLOWED.AVOID CONTACT WITH SKIN, EYES AND CLOTHING. • - Eye Flush eyes with top water for at least 15 minutes.Consult an Ophthalmologist if symploms persist. Skin Wash with rnihf soap and water.Rinse with copious amounts of water.Launder clouting thoroughly before reuse. Ingestion Drink 1 or 2 glasses of water.Induce vomiting by touching bock of throat with Finger or blunt object.Do not induce vomiting or givo anything by mouth to an unconscious person.Consult a physician. Inhalation Remove to fresh air.Apply artificial respiration if necessary. Consult a physicion if symploms persist. IN ALL CASES OF EMERGENCY,CONTACT A PHYSICIAN. Treatment Is symptomatic.Farrngeshon,iavage stomach with Fop water.Insti1130 gin activated charcoal in 3-4 or.of wafer.Cothorsis with 15 gm sodium sulfate in 6-8 oz. of water. NFPA Noting Health:1,Fire:0,Reactivity:0 Special Properties None Explosive limits Lower;Not applicable Upper:Not applicable Flammability Non-flammable Flash Point No flash point noticed up to 2001 Extinguishing Media Water spray,foam,dry chemical,CO, Special Protective Equipment In case of severe fire involving dicamba solution,protective clothing and self-contained breathing apparatus should be Worn. Special Fire Fighting Procedures Use waterto keep fire exposed containers cool.At first opportunity,remove from fire. Products of Combustion May yield steam,dicambo omine salt,HCI,or onochloride products,oxides of nitrogen,carbon monoxiTe. Unusual Fire and Explosion Hazards None Steps to be taken Contain spill and absorb with clay granules,sawdust or equivalent.Collect and place in suitable container for disposal. Area can be washed down with water and detergent to remove remaining herbicide. DO NOTALLOW WASHINGS IN SEWER. Absorbents Clay granules,sawdust or dirt Counteradents Not applicable IncompaAbles None known Reportable Quantity(MCLA) 1,000lb.of dicamba(168 gol.of product) Dispose of product orwoste at an approved chemical waste facility. r Storage Keep in an area suitable forpesticide storage.Store in cool, ventilated area away from seed,Fertilizers insecticides or Fungicides.Keep away from children,wildiif e,domestic animals, and pets. Primary Routes)of"try Oral:No Inhalation:Yes Dermal/Eye.-Yes Carcinogen as determined by: NTP:No. IARC:No OSHA:No Signs and Symptoms,of Nonspecific.Symptoms may include exhaustion,muscular Overexposure spasms,urinary incontinence,dyspnea and cyanosis.Severe eye damage may occur.Skin irritation may occur_ Acute Toxicity:Oral The acute oral toxicity(LDso)in rots has been reported to be 2629 mg/kg. Dermal The acute dermal toxicity(LDSe)in rabbits has been reported to be�_-2000 mg/kg. Inhalation The acute inhalation loxicity(LD,)in rots has been reported to be greater than 200 mg/liter(nominal concentration)for a 4-hour exposure. OlherToxicologicol Information Skin irritotion!Mildly to moderately irritating to the skin of robbils but not a primary skin irritant. Eye irritation:Extremely irritoling and may be corrosive to the eyes of rabbits. Target Omens Repeated high levels of dermal exposure to rabbits has resulted in skin irritation and toxicity.The liver,kidney and lung appear to be the most sensitive organs affected From repealed oral,dermal, and inhalation exposures in experimental animals. Dicambo,the active in redienl in SANVEL®HERBICIDE,has been studied extensively to determine potential health effects.Animal experimentation with dicamba has not demonstrated any carcinogenit,leratogenic or other reproductive effects with the exception of slightly reduced fetal body weights and post• implantation fosses reported at The Maximum Tolerated Dose level.The preponderance of experimental data suggests dicamba is not a mutagen. sI Owl ----- -- -- -- Personal Protective Equipment Under normal conditions of use,respiratory protection is not required.In cases where inhalation is likely,a MSHA/NiOSH approved respirator For pesticides is recommended.in cases where eye and skin contact are likely,use of chemical safety 90991es,impermeable gloves,and clean,body-covering clothing are recommended. Hazardous Ingredients Component WT% TLV/PEL (As defined by OSHA) Dimethylamine salt of dicamba 4 8.2% Not established Dimethylamine soh of related acids 12.0% Not established Inert Ingredients(non-hozardous) 39.86/6 N/A 100.0% Exposure Umits OSHA PEU Not established ACGIH TLV:Not established N1OSH Limit:Not established Appearonc•and Odor Amber solution,mild amine odor Molecular Weight 475 Boiling Point 212OF Melting Point Not applicable Vapor Pressure 18 mm Hg as water @ 68' Vapor Density >1.0(Air= 1) Specific Gravity 1.190 @ 2VC(H20 = 1) SolubRity Miscible in water Evaporation Rate Some as water Stabil+ty Stable Redcli.4tT Nat reactive Decomposition Products N/A SARA SEC.311/312 HAZARD CATEGORIES: Immediate Health Yes Delayed Health No Fire No Sudden Pressure No Rene" No Tl+e in aka++piel�nled MreiR whllle not0exrranMed wesp�et��adb►r t*Anically 6owledgeoble penonnei and b the beet of our knowledge is hue endoccu".his,wtnftwded to be oNinehrsive and dro manner and conditions of use and handling may invoke other �,•additionof coesrderatiohs. Bonvel'HerWc We is a registered trademark ot5on&i,Ltd. A 816 y p Emergency Phone:517-636.440f; MwElanco General Phone:1-8o0-35,2-6T76 EPA Beg.Number:e2tt0.82 Effective Date:September 23,199: Product Code:12169 C-ONFRONT* Herbicide MSDSNumber: diana! Herbicide OowEtaneo . Indianapolis.IN 462 4.REACTIVITY i • Triclopyr(3,5,6-trlchtoro-2-pyridinyloxyacette add), STABILITY: (CONDITIONS TO AVOiD)Store unde ns the friethylarnMe salt cool,dry conditions. Avoid elevated temperatures or CAStt 057213-69-1 direct sunlight, •pyti••••--•..•.........,....acid . INCOMPATIBILITY: (SPECIFIC MATERIALS TO f;lni,yr:,licJ(3,G dlcirioro-2-pyrldinecarboxylic acid). AVOID)Avoid acid. oxidizing material,halogenated an il+e hi0thylamine salt .................................12.1% cs bras InclUdIorgans s,copper,zinc,a+id aluminum. Olt++tr or. . .CAS(t 007 32-16-itg: 5A.9'/° HAZARDOUS DECOMPOSITION PRODUCTS! Wopri . . .CAmtt 0lier& 18-5 Hydrogen chloride. nitrogen oxides under fire condi- l'n,i�rielary Frnulsifier&sequestering agent i 'i'rielliyfamine. . .CAStt 000121-U-9 Lions:chlorinated pyridine. I'irif;rlocurttent is prepared pursuant to the OSHA HAZARDOUS POLYMERIZATION:Will not occur. Hazard Commurticallon Standard(29 CFR 1910,1200),in addition,other substances not 13.EFMRONMENTAL • • • 'I lnzarouus'pear this OSHA Standard may be listed. • " • Wh0110 wopriulary ingredient shows,[tie Identity may be made available as provided in this standard. ACTION TO TAKE FOR SPILLS:Absorb spiiis with i inert material such as Zorball. Hazorb or sand.Dike fI areas in case of large spills. Do not contaminate wale supplies and Irrigation ditches. In case of farge spills, BOILING POINT:Approx.212°F, 100°C contact DowEfanco. VAP.Pf iESS' Similar to that 01 wader DISPOSAL METHOD: Pesticide wastes are toxic. ' Improper disposal of excess pesticide, spray mixture, VAh,UENSITY(Air=1):Not determined or rinsale is a violation of Federal Law. If these waste! SOL.IN WATEn:Compielely soluble cannot be disposed of by use according to label Sr). (311AVITY: 1.14 @ 68°17/681F instructions,contact your State Pesticide or APPE-AI LANCE., Clear amber liquid Environmenlal Control Agency,or the Hazardous Waste representative at Me nearest EPA Regional 000fi: Slight amine smell Office for guidance. ti FLASH POINT: 150°F,66°C EYE:May cause severe irritation and moderate cornea METI iOD USED:SFCC injury. Effects may be stow to heat.Vapors of amines I' FLAMMABLE LIMITS: may cause swelling of the cornea.resulting In visual �4 LFL•Not determined disturbances,such as blurred,smoky,or halo vision. t' U{=L:Not determined SKIN CONTACT: Prolonged exposure not likely to 7 cause significant skin irritation. Prolonged or frequenl- EXTlIIGUiSf LING MEDIA:Foam, CO2 ty-repeated skin contact may cause allergic skin reac- FIRE AND EXPLOSION HAZARDS:Irritating vapors tion to some individuals. under fire conditions.Material is a water solution and SKIN ABSORPTION-A single prolonged exposure is ! except under gross fire conditions should not burn. Avoid conlarninaling water supplies Willi run water. not . likely to result in the material being absorbed I-IiiE-FIG iTING EOUIPMENT:Under fire conditions through Skin in harmful amounts. The LD50 for skin i+NW posilive-pressure, self-contained breaths absorption in rabbits is>2000 n+y/kg. apPa ralt+s anti full protective clothing. INGESTION:Single dose oral toxicity is tow. The oral LD50 for mate rats is 2164 rng/kg and for females 1521 mg/kg.Small anrounts swallowed Incidental to normal handling operations are not likety to cause injury;swallow- frig amounts larger Min that may cause Injury. Ingestion ,,q,, may cause gastrointestinal irritation or ulceration. 1 Sheet 1; Material Safety Data Emergency Phone:517-636-4400 , Y DowEla lc0 General Phone:1-000-352-6776 Y r I EPA Reg,Number:62719-92 Effective Date:September 23,1993 Product Coda:12169 "ONFRONT* Herbicide DowElancobe Indianapolis.IN 46269 I;'r IALATiON:Single exposure to vapors is not likely VENTILATION:Provide general and/or local exhaust lin haz;odous. ventilation to control airborne levels below the expo- ;YSTEMIC(OTHER TARGET ORGAN)EFFECTS: sure guidelines_ r:assive exposure may cause,liver,kidney or heart RESPIRATORY PROTECTION:Atmospheric levels r..ts. should be maintained below the exposure guideline. NCEfI INFORMATION:bid not cause cancer in When respiratory protection is required for certain ' •,i Tetra animal studies(active ingredients). operations, use an approved air-purifying respirator. I IATOLOGY(MIRTH DEFECTS)Triclopyr did not SKIN PROTECTION:When handling concentrate, {use girth defects in lab animals.Clopyralid has wear protective clothing such as long-sleeved shirt. "),cd birth defects in laboratory animals only at long-legged pants, rubber gloves, and footwear,i.e., :cs toxic,to the mother. neoprene or nitrite butadiene rubber. Remove contain- j:':PRODUCTIVE EFFECTS:in animal studies,tri- inated clothing and wash before reuse. ' •pyr rind clopyralid have been shown not to interfere EYE PROTECTION; Use chemical goggles. If vapor riIi ieproductiori. exposure causes eye discomfort,use a full-face respi- +iTAGENICrTY(EFFECTS ON GENETIC ralor- r .vvrEnIAL): Results of in vitro('lest tube')mutagenle- ilv lostS uri triclopyr and clopyralid have been negative 9.ADDITIONAL ' " ' t:•,dive ingredients),also Results t mutagenicity rests In SPECIAL PRECAUTIONS TO BE TAKEN IN ,irnals have also been negative. HANDLING AND STORAGE: Keep out of reach of children and animals, Do not r.wallow.Avoid contact with eyes, skin and clothing.V12sh thoroughly after 'ES-Immediately flush eyes with plenty of water for handling. Remove and wash contaminated clothing. Keep container closed. Do not ship or store with food, least 15 tninutes acid get medical attention promptly, feed, drugs or clothing.Avoid brealliing spray mist. Do :If4:Wnnh with plenty of water-Get medical atten- not contaminate water supplies(domestic or for Irriga- tion). r '+,ESTiON: Promptly drink a large quantity of milk, MSDS STATUS: Revised sections 6,7,8 and i whites,or gelatin solution,or,if these are not regsheel. :►ilable,chink large quantities of water.Avoid alcohol. Of a pl,y,ician. nECULATORY INFORMATIONt 11 IALATION: Remove victim to fresh air.Gel medical ��i�;rltiort- (Not meant to be all-inclusive--selected regulations represented). +UTE 7 O PHYSICIAN:May cause tissue destruction NOTICE:The information herein is presented in good faith and y believed to be accurate as of the eliective date shown above. ':trlinq to siticture. It lavage Is performed,suggest However,no warranty,express or implied,is given.Regulatory •rrdolracheal and/or esophagoscopic control.No spe- requirements are subject to change end may differ from one loca- iliC antidote. Supportive Care.Treatment based on lion to another;it is the buyer's responsibility to ensure that its activ- +dgatont of the physician in response to reactions of ices comply with federal.slate or provincial,and local laws.The fol- i!+e patient• lowing specific information is made for the purpose of complying With numerous federal,slato or provincial,and local laws and regu- lations.Sea MSD Sheet for health and safety information- A. SARA HAZARD CATEGORY:This product has been VGFMW-7- t reviewed according to the EPA'Hazard Categories" XPOSURE GUIDELiNE(S):3,5,6=trIchloro-2-pyridy- promulgated under Sections 311 and 312 of the °•,xyacelic acid(tric(opyr),triethylemine sail:Dow Superfund Amendment and Reauthorization Act of 1dustrial Hygiene Guide is 2 mgfm3 as acid equiva- 1986(SARA Title tit)and is considered,under applica- I•>rrt. Skin.Triethylamine:ACGIH TLV and OSHA PEL ble definitions,to meet the following categories: �. »4; •10 pprn TWA, 15 pprti STEL.PELs are in accord ilh those recommended by OSmA,as In thei 1989 2 i SafetyMaterial Data Emergency Phone:517-63t3-4400 DwElanca General Phone:1-800-352-0779 EPA Reg.Number:82710.92' Elteetive Date:September 23, 1993 Y Product Code:12169 J TR ONT* Herbicide oow�Number:Indianapolis,IN 98269 An imtnediale health hazard A delayed health hazard A fire hazard TOXIC SUBSTANCES CONTROL ACT(TSCA): All ingredienis are on the TSCA Inventory or are not recluired to be listed on gte TSCA Inventory. STATE BIGHT-TO-KNOW:The to"product components are cited on certain stale lists as►nen- lioned.Non-listed components may be shown In Section 1 of(lie MSbS. CNEANCAL NAME CAS N0. LIST NA-DIETRAPIIANAMINE Witt-44-8 NJ3 NJt PA3 PAt Nil-Now Jersey Special Health Hazard Substance (present at greater than or equal to 0.1%). NJ3--New Jersey Workplace Hazardous Substance (present at greater than or equal to 1.o%). PAI=Pennsylvania Hazardous Substance(present at greater than or equal to 1-0"Ye). PA1.-Pennsylvania Environmental Hazardous Substance(present at greater than or equal to 1.0%). OStIA tIAZApD COMMUNICATION STANDARD: This product is a"Hazardous Chemical"as defined by the OSHA Hazard Communfcailion Standard,29 CFR 1910.120D. tip The Information Herein Is Given In Good Faith. Out No Warranty,Fatpres3 Or Implied,Is Made. Consult The DowFlanco Company For Funnier Inrrmaiion. 3 MATERIAL SAFETY DATA, SHEET Alanufacturer: Agriturf, Inc. Date of Preparation: August 18, 1992 59 Dwight Street Hatfield. MA 01038 Phone: 413-247-5687 1lealth Emergencies contact you local Poison Center Transportation Emergencies call 1-800-424-9300 (CHEMTREC) 21RODUCT iNFORMAJ 4 PRODUCT NAME: 13-3.25-6.5 Chemical Name and Synonyms: Nitrogen, Phosphorus, Potassium fertilizer solution. Chemical Family: Inorganic Salt 'Pride Name and Synonyms: N-P-K Mined Liquids, Starter Fertilizers, Suspension Grades CAS Number: Not listed. PIIYSIC,ALSIATA Roiling Point (F): Loses water at 212 F Melting Point (F): -5 to +50 Vapor Pressure (mm.Hq): N/A Specific Gravity. 1.1 to 1.55 Vapor Density (AIR-1): N/A Percentage Volatile by Volume (17o): N/A Solubility on Water: Complete Evaporation Rate: N/A pil: 6.4 to 7.6 Wither: 9 to 13 pounds per gallon Appearance and Odor: Green to gray colored liquid with slight ammonia odor. I:IRE AND EXPLOSION HAZARD INEQRMATIONN Flash Point (method used): Not flammable. Flammable Limits: LEL - N/A; UEL - N/A Extinguishing Media: N/A Special Fire Fighting Procedures: Wear full protective clothing and self contained breatbing apparatus. Unusual Fire and Explosion Hazards: Release ammonia and nitrous oxide fumes. .l 1 -AIH:EQBlMATI-ON Threshold Limit Value: None established. F,ffects of Overexposure: Eye: Irritant. Skin: Non listed. Inhalation: Causes irritation of mucous membranes, coughing or difficult breathing. Ingestion: May cause nausea, vomiting, stomach pain, diarrhea anti shock. Animil feed ingredient. Page 1 1.2511 1,ESCO CAUTTON:I-io, rititiliem it,-citol • 'It0i as Rye Orwis, VC.." uvr, Rent or ,imilar rtra arrlll::%limi is not PCNB ( 12.5%) + when ternporralurc%exceed 75^F. 10-3-23 N GRANULAR 171.11"1113100F I"OR COWROI,OF CERTAIN '4M.-I)ORNE TVIRFC IJA Nyirisod;ng 0.11 1 I'd.. Sollid MAPS 1)19FASFS ACI JVF')NORFDIENT: 4 21 k; 7 0111:N I)- It It 3�-1 IY'I I . . . . . . . . . . . 7 Fy,(15 02") I Ni*R I INGREDIENTS:. . . . . . . . . . . . . . . . . . . . . . 9 7.Wlo "Itsll"ORTANT; llivsc scijivigN mr ovily Age. colwilioll of spreader.and(sts,i-nim t'll" .41C W"P'k-if,calibr:Ite Pit ARAN'TEFT)ANALVSIS you.r..sprcadrr with...0.101 31)13110�1 IiII IP. (I)I'Al NITPOOEN(W) . . . . . . . . . . . . . . . . . . . . . . i mxnp SMORAGE AND DISI'OSAI. ArTirrionincal NitrogenA.--.:Fri J_N'S I R11 1-110N'S: t!rLn Nitrogen"' Slorc its original Container only. lw,fividra. !sail'.".A All A111,RPHOSPHORIC AC11)(P201). . . . . . . . . . . food and feed.D.,Plot mote near ortn naniv n1 local%ouivrx N(71 t!01,1:POTASH(KZO). . . . . . . . . . . . . . . . . . . . . 2 3.(WI P. B.1INK11C111F DISPOSAL INSTRIA"TIONS: o I lq I R is)cr(YrA V- - . . . . . . . . . . . . . 1.57% O,, not conlmuinatr w:14rr, rooj or feed I,%: unraKr fir dialanal W;oNw, stilfut(s)(Free) rertifflng froill (lie me of tins plodlic, 11JAY 10 .M 10 dkl)" •tl of I'll'olv t'r al all Stiltur(5)(Combined) apprt)1VC(i waste klispo'al Nvility. l.N(;I(Fj)lI.NTS:Sulfur Coatca Urea.Ammonium PhotphRie. CONTAINER MSPOSAU Corriple'dY enlr(y hag into arrolk"11 i kill 1101 tfi'fI0SV klf'•Iilpvy 6,I)t in .1 -Aniinry J;mtifill or INN :111owt,ts hV smitt. :111A FT Rog. No. 10404-37 1"(:0 owl'o,ifics.I'). If IN1.1vivil. lily om.4"looko. I A.USI.No. 10404-OH-04 WARJUNTV KFFP OUT OF REACH OF CHILDREN 1.17SCO w;immis flizil (hi., fu"Fik:41C .......it,Plot.0'( iv�'l dr�Cnhri CA 1:rION (Ili iiz 1;ih0 When 1,11rd in 4S'C4;fd;1fl4y %%ifil lab.-1 dirvvlioro, ,mils; tit A lT*'"IlENT OF 11"RACTU.-Al,-rRrA-T-NtFNT Ckloditi(loi. Phis(01160,le ii, feiiowilo'%, fit ft,, it:iiii,.iti,ti iiniinR.nimhod of'I i1rhe:iIi-1.uo-tho,01:.111.;1"(l No';,......(1114Is.ftlixltlf*e I Vir'l Aid I'llociedo. with irht,,.i ant}other0)(-also,iJ ibis prodifol ate If-is,ollnwrd,iuduce vomiting. It an skin, remove contaminate(I elolhiiIS heyond oatconlrol I no Wxmilly is Fivol ollwelfliltg file Post-or ltli%lifoil. :"Id kxi-11 skin with RoAp And *arm witler.If inhaled,remove to tr(Kh air. tic[contirnry lit lMiM liieoions.or iontlei If it,cyr!g-Nish with water for 15 Miollle5. not rcistitin-hly for.,u-e:)hIk,. Mc.usciat,t,ink-N all r"k, N4.01 low. f1willer Irtalmetit,get medical attention. #01 iq42 I"RIA:AULIONAR Y-��EA:fFhj.t__ I IAZARDS TO"VMAN9 ANI)IN)NI M� 'IC ANIMALS C.%IVj*I()N I Vii mful if wallowed.inbalext or shzorbW through skin.Av(,id breathing PRE-M 3.3 EC d-1. I his material may cause-kin irritation.Avoid contact with eve-,-kin Herbicide n 17 - I' - I - chtil-ing. Wear loing-r4eeved qhirl while handling product. Wash hands An Er"obtRioble Crincenlritte for Use as i Pre-emergtrit WC(d Control in (!occ after use and prior III eming,driiikittg to toritoking,Wiluth cos-lams-FNnn-i.'r9pland Airems.I awns.Turf.and Ornamentals. ,i:urd dolhing before rettitc. T)o Pool handle lie apply product with hare Keep our of reach of 0ildmn A('Tfvi'IN(;Rrl)lr:.Nl*. F,'%A'IRONMF,NTAL HAZAROS 1111,proiluct is toxic to fish. 1)n not apply()irecilly to water,. 1.)o viol con- r:iwmaie, w;ifcr by cleaning of equipment or disposal of wastes. Do not Pliecelly AdjaMt to potable water supplies. '10 1 A I,: . . . . . . . . . . . . . M RVIL11ONS FOR USE (I gallon Contains 3.1 It%%.of EPA Reg. Nis.241-a41-10404 ;vIalion of Federal law to use this product in a mariner inconsimew 0.0,4KIlinp., KEEP OUT OF REACH OF CHILDREN I hvirnigitlion: Do not apply this product rhr0U0 any tyre of irriftation CAUTION/!PRECAUCION I IPRF('Aij('(ON Al.USXIARIO:Si listed Ill,Ire i.iglv%.no lost-r%le LAWNS ANQXWE_.__. procliecto llwwk 11k.e lZI cti(Ittoul to 11:1V1k'6tIo vXI'liemla:11III'liallit-.11c In V;11" VIr—ro Ilptch and Dollar or southern or warm season Lkwn,'t.kjl w, fir an rsvvy ...16,1j.,,his i,lodlit-T,rail Isl Augustine. I)crrnudR and similar grasses: Make(Ine 3PP)iC360" in thit: Collect day or nighi Area 6Ar lot). (-,It ,, at,iirig at first indication of infection. Apply 6 lbi. per 1,000sq.fi, FIRST Aln 1.1,11owing application.tile-Ircated areas should be lightly watered it)I'Afturt If In eyes: I lo'l')cvchds 011VII J111(l flllQ1 Willi sll!:I(Ito.. Of WZI(t'l through the grass to toil level.It the treated area is-.tlbjmled to for 15 Itti'lolirs.Call a physiviall if eye it ril"16"ll pri-0%l';. wlil,willy licavy rainfall,or flooded.or if the disease i5w. vere or re3ppear.j. ,1,;* aiva should he retrealetl I to 4 weeks(ater. for Dichomdra:Treat as 111'swallowed: rX) NOT intitic,,vomiting. (".III p 1,11Ysicizill ,, 1,oisoll, 'h%r. ki..'illig 6 [bit. per 1.000 q. ft, For Northern or cool season lawn.; irol('enter imnieP,li:,icIY. For skin ors."Ilict:Rash 111or"Ilgilly W1111.0.0,311and ,11,11 As Rye GraM, IF*= BluegrASS. Bent or similar grasses: Apply 1.6 W,'Ii(!r.Call a physi6lij if skin irrilali-,Ptl rcrsisl%. 'o Ibx. lvr 1.000 sq. it. at first sign of disease. Repeat every 7 to 10 Nolt W I'llYSICIAN! ll(,citivir of risk of 01i'mical plielifilo- A:i (Iliving warm. damp wralher. Water treated area lightly it) with ilia of rillillon"ITY cdcm"t C;sAmcd by i-;rir;oion ist the hcilnaaIhon 1.1-t"itol d0wit to Rod. Undct ccelairs grouting conditions. a temporary vornilinr illotild tv irtillived oto)y midcr protcvnitnlitl,prervi:ioll. ,li-No,alinn of the grass occe.gionifly may occur. This causeit no harm See imide for Addl4itinAl Pritcarilionary Sisurnitcrits field 1hrectiont ifir :-ill will I'li'tappear in A short time. Use I ItAfflin(hinpiarlitim TAsit'Spoll:Apply at rate of 4 to 6 11n.per 1.0(10 sq.ft. arvicaiinns qN%tild he made lit string or rAII of ench year. to,I kur"a Vot--itirtsi of existing defections.apply at the higher rate as anon sittymp. CA11TION wm are first noted. FcAlnwing applications, the treated area should be Causes mollernie eye inil-witin. Mornihil if%w;,P)Iivwrd Pit abskirlied through 11611v watered in insure movement rhrough the grata to totif level, 11 The the skin. Wear goggle- or Nee %hi0d, �'-(Wid ('olllacl Willi ekin, eves. or area ki%jibjected it,tillusually heavy rainfall,of Ilmded. or if The C1011fitig. W;,.,h 01"'.4mlithly will,%(",tr :111tj %A%l1e, afir, lussillit'g, Um: With kh'k,"v ilz Severe or reapWrit, the area should be retreated 3 to 4 weeks adequate vemilA0011. 1AI"t YNVIROMMENTAI.IIAZARI)S Snow Auld ITyphiste Inewmats. Filisarlaost Nivo#O)-Aprdy:it the rate of A This litodtti-t is toxic I.,fish.DO NO I :ipl,lv I., it wt-tI;jjj(j, io i. 11s, lwr LOW ititi. ft using a granular lawn spreader or comparable ('qWAMpI,.hags,marshes.or rolhoh-0 Drift :list' runoff fl-ni Itealed areas. r'ltrl,nn fit.Arip)icatipit Ithtsul,*!,,:made prior to fast snowfall. may bed. liaezirdou% to a(Iiiniii: orgovisios in adjaveni :w(IlIzilik silt.s. 00 0—ii),Ararr 1 -led arewt or feed clippingF 4o livestock. NOT C0111""Pi't")(e%VAIC"Mit'n Ilrc-M 3.3 EC Illerbicide 1.259 -I-"NYRAI INFORMA1110N ' I'SUO I I I It E,-M 3.3_h( $It-rbjejlIv S C,41.... tW-q,JIvjft:y Ili PA111 ................. . ).umajls . . 1;.l....... I.LSC0 M 3! VC Iferbiriat: 01IN :11C 1710.11 C,dio- ;,jljl.,Ij t,*kvI%,'j wilhio o)(Iay> Ow;jll Isulf"1411 Pvx ITP.-M 3.3 I.IC Ift-rhicide will litil [I,,.\oc.la[J "I"Lis lo I..: l(valul 0-o111d I,,- licl: oI cslahlisboj %%IvdN 'At clic Ilv% m ol' uala ill PIM-Al 3.3 EC 11tirbikidt: i,;: tl.Ne%l I,) I 111.ma I"llololta huxNk-1,101,lv.1110vd Im, tl,�'m Itoti-1-i,p- AiAtl,.ILU lumpt,"N Ilol .tlAlf1di'd i lawm^ lclxs. C-qtolt lilt. ii,. TIIIA C jlt-ilsj ljo lol N, I 141*4:1.I>I--, I,, .., ," :,r'-as )01111 I I'I FONS fillit I'SU k,\ ill...ii, mkpc N"Ilitt".11u,q Al......1,: mw-co-1 )If I NJ)'I jpIll Mold, 1(,,l Nlotlw'oo I auld K'A11111.1 6111"ll't lb,\1,160..till flit-lAyIN lill"It"11 ... ....... With I I:N*l 0 33 I,C Ilvrlpicidc. ([.%� Ll�%: )I I illma I:......lifillf:t i N,( (I 1IRFAI AA CC IN-rbi"itle-alIrjj, I'll 10,1..1:M11 n,ln11 till.,C.Ajll�k Split" Grotonq) 'over 4 Irnijoicillul.% -w-lutill tu 11"". Ovall\161;,10. 1'1():, Al 4.3 I:C 11oll.o0Q fila% bQ V>caf Io, Imv plv oljogk it I'St'd i ,4..q II'( livrbicidu lo life Itmicill% pIlc(I I;... mc."I1 il,v tvkl N11ccles IMIk"I 117.1"'d'11"kind it.,:1,111I-w... al"I 11wil III(dw 1.1 Ill.. wlk %%lilt-.1k 1% ?')md,-it,z I'Law, I It I N I A t N N I I r%(11)I'S At it I A I ION A'11 III.I: A I)I)IN(j omm"ll Nalilk: %imir 1.1 tivebiciolk. A NIN I N Yll SlIk A YPNI(; ),, (().kj. i'k'kl the '11.m.% 11-1\I M" ., 2111,1t, A it I" I": -at., •1�vnod ,I 1--ollot:Ali I. 111V it usol I'l Eml, 11LIAltilk Ivgmoed fii ii-lod. iluk-oloil,oli fit, 1,flwk 4 1 1 le-,iuct,-'Shah."I1111h"I'l 1,114 t.1 ill'tillctiolt., Willi J.-P'At, millo.ocl% I-"ill I ii" it It 'Jjt-j y J',, �(j uliVlllla 041tLow".11 ..... ...... C(.kl it I i if! I'M'-NI 33 I-A I II-rhicidt, i, 'o URFAI'W ailillcd A-�[.0(;00 14�mlmgl- 0() NOI ,ppl) I+,,,Sj grunt ;.•. jili'l litili-Illii titAll".0 yomk)-wl" allA -.1gli I.il'is. ullIIII, %til"Imitm'. I'd 81wri,,I...1frolloj m I Itlul ihq'. I7,.LI Il.tt-,'I]" k.1,t. I- A fill veci, appI!, I EM(I t*fv M 3.j .11.4itiv.-t 0w "01111"t .I latti, 0 LEM*0 111:1-IsicitIv oh,, NIV\t N Ili rJ,.,jkjk ;,4,1 :-,, -*:ill 11 1 of C1.01 If Ilkl.\I I.A vc 11"am.ov w"li i ,1..:.I 1,,,"A 1,dd I, Hw( lit,I it,I,Slow h.1 I+.S('I MY-NI 3.3 1 ILI hil-i0v:tll,l.It R.'.-A:NA I lnt, Il', I I�;9,,at I,.A, I tag1.1,S11 ........I I 0I Av,,;I. m I 1 J.3 Eil,I Ivorbivi4le will 11'.1 k-tititio) I;A to and/tortitcall Or;lnnratat PIjnIiIlK,% I F,SUO ITE-M %.J I C Ilet-bici.14:%%:III lit- Ilic .3.,4 E('I it r1picitti, I.i it -1 1"1 h) ),I quivalcm ill 11, L-1 f4mo\ liv lAc., ml alertfjjlpjj , :Intl 11tal (I."I, .-I,: Ilk 3J V( Imld wdl, 1) PRI--M 3.3 1-'( Illcrbi 011k.kica ;okdi;' ,ml.11k,k .nit toill '"c.Id will ["%pll m 't oql(col d'ItnwIl.m;,I .I if 111( .-M .1.3 YC 114-11licith. .ppjI,-.I • IN 111 1 11o,l.xId,?j o1j,g,1111 "t-14;11-11 '0-A,lu-0maincollal., Po;.armu., • !mii lameN�6voillifiv "Jill )I,,if 1,. k Fohlad 'I !hush i 26n USCO l'ammnn Name Sclentilk Name Innnlhc afl,•r xlyuical;oo Prim I., ,cc.Gng or ki,ri�fim•.. Ow ,,,it ,n.G,t•+. !•nlglmice f?chinpchina s'olouput should 6 thovd od fir workcil U,tliltifr:ulv rt nlait.iul iht)nii;d,t,i4ur. I.•c,•FIasS FX,ttn,alig,pp• (fi newly ),lane(:d AtCt„• tv'21il Imill fill, I:I:ls% h:l, I,t'ch I1N,UTd at 1l':f,l d I•:mii•tlln.nrownlnp P-inicurn lawiculaluni limes and has Til),`tl in bcforc:tpl,lY ini;prodit,:l. I':nUi n,n.frill Paniettnt(lichnt(llnino,uln 01, lurf that haN hello v,-%c;ly_ thionv%I<hu-of,,;utt', f(o o,;,):.•.f>,:CNSi,'i,;ail I'CxA% Pttnit'uln texanun, Mni.hlrr. hoc Ipn,permill.,• (1)0ow 40,11, :i:,l l,in F. in`cri 1N. lii,ra•.C. I.Ic_ mll-m.Field Ce+tchrtts iticerfis wait until t!,r)I,a.3 fillotl fit;,fill r„mine fir,lobos iv iiunf,lit,•he•htre alll,ly- �,f;n:tll(rass (Irat•htaria platphyiia iu iz. \t•r:,nglctnp-Mexican Lepu,chlon unincrvip Thic prnduel M:ty stain. ihtlN av"fd iolw t wills ar,•,,,loch aN Niilrw'alkN. Nrcntl;icfop,Red lerl(n.•hhY.l fillrnt'Ini, drivellkm%. '9c. it oiniaif toill Illc kinnc nlixlnrr ni'nrN. iv i,mpllr fill1v with war(." Wooly C: 1 1lanicnm�,illosre weed Conirnl in Lawns and Turf Wooly t:u+truss (;rlth'hl,+a.illvsa --...-, .. ._.._.--.. ...-.....-...._.. . -8r0Adkrif ll'ccds Controlled (,1%SCO PRE M 3.3 VC ileehicick t':+n I,,-tiwd for t,rral rowtol ill {:t„r1,t immon Name Scientific Name t,nt)lut'f. T,nrfgrnsN (vpt•s: 1,1,1('O 1'141•:\i 1.3 VC firrhivide ,Ilan!,) only h,• .III. olaltvsrd Moihlgo v'cnicfllala plit•d in W.•iI rsahli,h ,l la,rr)s:ntd I1111. LFSCO Pltv-m 3.l I',(' lit•rhi. ( lei t,a'.•cil.Common Stt 111ris olndi:l idr in i,,• nsrd Pn f hi(eilloai„, C C: 1 n,rryr:,,:r,' I►:,hctra,;. 11,'nl,ad,�r;1N,, t,t•:k,v(td.Mnt+see:u ('clststinnl vulgnulnt ('rnNl+rtlt•s!race, Tint`Fc,cue• Kvimlckt' ltlu,ltrn,. I'oomial Rp.•ltian,.St. I.......lfup l,'ifolitnn tw(wi mhene Au�uctin••(;t a.N. 1:.11 Fe.•, .w.�Nyw+qtt r,,. { .0wreti Ona(+lialhlm App, N'ecds Speries Cohlrnlied:Wh,:n al,(,livd:I.,brcrrr,L LF:SC'O PRE-'M 3.3 1 i'1,11t neck Am.intkia inicrmcilij VC iierhiridr Aill co,m,ol Ili,-rAl,liNnn,„red,III`,1.1 I tile.:; landinm slap. I),,If hi I l.all,il/m alnplexicauie Common Name Scientific Name V,, Il,vccd(proctrAlcl Phly(?onuuf evil ularc Annnni hlnep,as, 1'na:uuiUa K„Olin K of ilia scoparin leanly:tn{.l`,a,N Iirbn,,ihl.wofu,.uatlt I:,,fd„clue+tree t•hcne)pndium album I`mn'rctl Amaranfhtic spp. <•'rt+h$t:t<, 1)ign:n'i:r I' fli Nlh'y'lll. Trihnius lerrrsltis 1';111 patlleutt, f'nnlruut dit lu gnn,ifl(u not t c L:roSl:,il �riaf is,pl•. 1'n„i:vtr pnrfulace pler:Ical linosegfa,% I{lttru,+e,+ttbi;, rn,4•c.iRnridn ltich:u/li:i 5rabra .. _ . . R,,,k.•I-I:onllon Sim;nlhrium(rio l{roadicaf tvrcds C'ontn,lled Sl,vr• rdsryusc (':+rIla bursa-pasunis t'nmmon Name Scientific Name_ `o1;Irlwet'(!.PCnncylv8t)la i'M,vgoramt pensylv:lnicum C ornMnll,:hikA%%k7rtl... _ Slella,ie mrdi;l `;lalrl;q•.Annttfii Fallhorbia,pp• 0-owt.4-d (;nl.111r 1lnn,Nrp, Sv t ur,i'romraic F•ul'h(trhia maticulf+ta IInr cola 1Iifolitnn pf„tomb,n> ye'-v,,buirrel•Yellow Ox:die striela I Ienhil 1 m mar+,an,l+it\it'nIll,- •IvOlef,f(ilullonwecd) Ahulillon lhcophrasti Knnruittl !,file€.noon);Ili,111atr ML ii,(••:ir rhi•:k,.,v,l ('arl,liem tnicotnro (:I•.NF;RAf.11tfl%QRM�TIUN —_ Pf.wu;or Nrntvr I nrh„rl•i:,.,ll,imi I'.•:•;,net'on well-eslablished turrgr,lsv with+dense,Ind uniform slanti. 1'111 lnrn ('•,n uh,r:,vi.ru'ca O:alis (ft;lll,kill, 1 I•S('O PRF;-M 3.3 VC herbicide Ira`atmegia wiq nod ennln)l eslablishe(1 F,ve;pin imre,sc •a��,•tl,.Appliraiinns mUat he nrtdc prior In it gcrminafiorl of wct`tls. ... E I,r .. t•tt I I nut, I ho:• applicutions per year may he made•. Allow at letf.d 2 voo,,Ihs be- F KAts•and Application('hart !tt,TII apca pllliolts CxCepl 11•hiic indicated tn)der RATE ANY) APPLICA- 'rll.f 1 vve.k Rah•,..I C—Ai•nr, 1 1 MN CIIART. .tipCcipz C.,nimilcd 1,f.51'l)1>R4•\I \1;Ning rind Appllcatina Instrurtionv 1.1 1•:(' tdd LFSCO IIA&M 3.3 Y:C•Iferbiride slowly In partially filled rank (' ' Nmihrrn(:,,e,t•, ruill l,r water while agitating and then rill the remistirider of life lank Pinr actor tla,.,�:•r l•r. f e.h'a s ,n tt,Ut tv:uel. MAINTAIN CONTINUOUS AOITATiON WHILE ADD- Krntrtckv hlti tn« 1'nd`:r:,s� .1 a,Ii or 1 , f\I+I,in�l•nnl: t}t f I' a,.N•tl. M'ri I.F;SC•O PRF..-M 3.3. VC Ilerbieide AND UNTIL SPRAYING iS I'v,ctrdat t,t Cr;trc Pau r,hit•utn I.,I x.'r ih•r Y.• nni,ear t t IMPITTT:1). If the spr;iv rreixmuro ix allowed to sPltic for mly rt!riod of 'Intl rt•,c,,• 1`ov:dl iMRf v, n ,,.,,,•.Ihonlogh agiliiliop is Csxrrilitlt It)resuspend the mixutre befurc xprny- u r f, rc<umcd Gutlintle:I0alion while spr:fying as itc.Jttf. Al,l,ly wilh P,• f,:rt,•<r.n l••• r,••pofly ellibrated equipment in stifficient water Per acre it, prov,je uni- Yrn;oc,vra,dco ,I I•nm ,pray disiri;bulicn. Low rrc,slire (ZS-.T psi) sprAyers arc atom- C'ud„rrd tivndcd.Avoid application witch winds may cause drift. f;,,"t.•INIIN 7.11u,per a,rr s Appiv.., I.TSC'U PRF,-M 3.3 HC Herbicide ireanmenis are most effective in etIn r"•,nn,r,p.in,.•„• r••„ po, �l„fill: ,i„lling w'ccds when adequale rainfall or overhead irrigation is received y.11 NI,O,•,r,,.Rl. uphill 7 tl;tv.s offer application. !,r„I f It• ,l,ud ,',+nlA0 of s lu+ion will+ dri s. Slone. wood.vewa or other k'r• •,Pray fit' y surfa4c.q.If conlaci occ,lrs.i'ince imnitilime)y fo reduce staining. arpf,•ali„fi ll r ompalfbillty m x„r••l,'nl)h 1 I•aCO ['RF,•M 33 igC Ilcrlriddc is cnmpAtibk with moll commonly a,,d herhicielcs. When iI,F.(;V0 PRF.M 3.3 Y,C llrrMeidc is used in tank !nrtuur with another herbicide, refer to each label for ralcs. mcihodS or I 1•Ixtl :q'I'li,:hint.proper timing.weeds c„ntroilcd,limi(Alions.and preenituons. t+,c•evc ,Kc In ntrnrdnnce with the mart•restricl;ye label limitlli,.oa a,ld C() 1' E-M 3.3 EC A......:d t,I,,,l:cr,, l i•I,I.,1 N Avr .. . n In I;-w I•trr=nuirma. When tlnk nuxn)a In pure In fold LYS . R (•,�n„n,.,n, �tv.e•,l 1h'rbicidc 1t)Tile partially tilted tank first, Illix Illoroughly.and litelt add ;hi, I° I-t-'"'"...l''•' Mn�.e•,:u' 1 I,•�:vle •,'•ulhinlli,vl prtt(IUcls to Ilse mixture. D(')NOT apply lank mix combine- l,•r,hi,• rhiit,,••' 1 1 I,•I.:,./ fall 1I"', I r,r,rt,n rl h,•f.,n•.h.ni, imlecr previous exl eritait'e indicates the mixture is cfftclive and will i ,11 n-,n11 in (,pptiention prohlenis or plan! injury, OO NOT attempt to .. ++'t1•d,gt,,m;nph.. h„t I,EFCO PRF.-M 3.3 FC;Herbicide directly wish liquid fertilizer.Pre- tiotuhcra n,•, „nc parr of T,M. 0 PRY;M 3.3 FC Ylcrbleide with two rarm water lInhi. n?to.1 v pl, A1,1nv.is.Spling adsl lhis diluted mixture Nloimly imv the tank while agitating, Ilcnnttd:tpmc Crilh.G-„ 1,'.n,le,,, Ilk-llr,v,•.r,l, 11r.-or:inll„n, Crntierd,il,t,,, t501,•ynican, I I.n•1 K.•r i-,•r„If..ar.• y, S1.AtIftmirw9rp„ Tn.tlail (ll,, ldrxt,n if Rereal f (e,r u,c on bentgrass ,tr Am Unnua (putting gredns and lets) or On roll ficlow I'rn,lraer,pf,.r,• .yq J;,•n li-m if h,hondra•where thew arc tte%iee(i specieq. %„vaia>:r:,.,c \',•bolt,r•'txl,•+n t'1 nr••�•„iuy rn N t In, iIIthluel MaY cause yellowing and thinning of Cool scaion grasses in «hn,'r,'i „•:1,n,mF'.a „a,r••I „v,:r%ccs:fed lurf. Ihlav amling by 4 months and sprigging by 5 pf,1're nr�••. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Pre•M 60 DG Herbicide L261 1; UaI NARYSTATFNI NTS species *RDS TO HUMANS AND WMt:STtC ANIMALS _ ,Y'.. ON:May cause ey e a and skin imtatiAvoid Y Y oo contact with eyes, f akih and clothing. Wash Thoroughly after handling and before Baling or l ' i:•''K WIRONMENTAL HAZARDS :!T1aa prodtret I.toxic to fish. Do not :spply dtntay to wader or wetlands. not apply when weather coaditions favor drift from target arras Do no(contaminate water when disposing of equipment washwaters. Tt NSFC R US E 5O___.- 41 is a violation of FLjtgal law it)we this product in n,um+cr ineonsisletri Disclri +;' XVA its labeling. CHEMIGU : h.tY Yoini a _r u t aP t) lh,�!nduet thr lv tiYc label .., •�,;tioa sya(ttn. based oa should DING AND APPLICATION INb4RUC.TIONS ' risk-.in ``-Adilf LESCO PRE-0)60 DO slowly a,parlially-illed lank(tl;to 514 full) ti.cness twC. r while agitating and tbcv fill(he renwiuder of the Tank with wailer. IOr%as 1VT IN CONTINUOUS AGITATION WHILE?AIMING . S '( Cr 1 EEC ) cation Of P1E !M''60 DO. if the spray mixture a allowed to settle for any period he on d 'ot�tme. thorough 'tali rt i' •.Y g agt o a �,aYnti;d to rcsusPeod tlrc mixwrc tYehrre r- n + to p y g s r uceded user. a -{.; l i,s4 afuy(yi g s rnumcJ.Cvotinu a Gdiun while s rn in l.F1GO f i i Ajly with properly calibrated c4t.ipnp;nt in sufficient water per u rc to r the chc (t.. :pr(awde u++iform spray d611ibution. Low lrressurc(25-50 psi)sprayers are therein jp: „Co=411kemended.Niu2le screens nwst b.:Ili)finer Chan 50 ntcah.Avoid appli. a v jtvt ,l s : on when winds may cause drift.: I ae Any da tt; Lt�Ftftteals arc nits1 cffcelive in controlling wt:cds wbcu adcyuale rainfall dimes r ;ot twoncvad irrigation is received within 7 days after appliestinu. Avoid such as I of spray soluti(w with driveways. Stolle. wthrd or olirer porous LFSCO I Is.Rinse immediately to avoid staining, express O a , IPA718111TY til'URA E$SCO PRr lvl("'6t)D(i is will,most cpn1,11) I u.sod lserbi• Scar • Who, wok mixing be sure NY add l.f:S(Y)IrRti-Mt''b0 lite twlly fllkb tank first,+uix Il'orou hY•l nth[lhet add a+tnbinutiot Prod- Lure.b Kiticii(u Iltc mixture as doceteJ oe v`,ltstructed at its EPA upprove.'tl label. rt>n,tt to „ 0 so)apply lank nix ctnnbinations unless product is approval for such use and l)()NOT previous experieliVO indi Wes the nlixturc is cffectivu and :. r r� ',!. . r �F, wUEnot U-6ul(in aPrMemion Probleora or plant injury. Du nut altea+Pl to 1 vs(kke i" .:? rgst'1.F:SCO PRI M") OG directly will'Hyoid(crliliters. Premix one Pcsti iJtr j M.; t of 1-FSCO PRE W)bO 06 with two inns water and add ,his di- Y+'astes utep ntixturd slowly into tank while atitu(ing. liai,,rdrwi. E1tAf.1NFORh1AT10N---- . . . .--- ... ._, aid .R�rV i Ire T.It.f�c�nr. ...�.......... ...:n .:,.-.,..�-•:.. .._.-- ,: 1`! ll !f`� d�t1 r` -� ' C 0 R P" : 0 R .. A` _T, I `. 0. N _ - .April 28, 1999 Mr. Glen Harrington_'' Barnstable°Board Of Health P.P. Box#534 - y H annis, MA 02601 RE: ., , Trugreen,Chem'Lawn Release . Marstons'Mils,-MA Dear Mr.-Harrington; Attached;please find a copy of the Hazardou's Waste Manifest used .to'dispose.'of the material which was'the result of. the Trugreen ChemLawn spill on April 23, 1999. The`material was; disposed.of at Olson's.Greenhouses, 590,South Street East,-Raynham, Massachusetts: If you have any questions,regarding this information,.please'do not hesitate to,contact me: Sincerely,,, Heathetod President HMA/dmh Enclosure , P.O._ BOX . 810 EA:S_T SANDWICH, MA,�02537 '(508) 8.88-5478 FAX (508) 888',9/093. 1 COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR IN-STATE WASTE DIVISION OFHAZARDOUS MATERIALS OIL ONLY One Winter Street IN-STATE VSQG HW/WO Boston, Massachusetts 02108 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) UNIFORM HAZARDOUS 1.Generator US EPA ID No. Manifest 2.Page 1 Information in the shaded areas WASTE MANIFEST In PI 7 oc m t 1 of 1 is not required by Federal law. 3.Generator's Name and Mailing Address "S re i@ i ib $rhumb e TruGreen ChemLawn1�.� l" N . 20 Raffaele Rd. Plymouth, NA 02360 � 4.Generator's Phone( 508) 747-6925 12-1 5.Transporter 1 Company Name 6. US EPA ID Number " Late s� ,5 Enviro-Safe Corporation 9 8 -D 5 r sr Ln 7.Transporter 2 Company Name 8. US EPA ID Number 0" DO)r . % rotate W. M, O9 Designated Facility Name and Site Address 10. US EPA ID Numberz OD Olson's Greenhouses ►>�nap �rPe� � n 00 590 South Street East GLi�c�Fac�ttrty s Ion rtotRenrect N 7 It Raynham, NA 02767 Fadliiv t r y �, r.,r. Fhcn41 12.Containers 13. 14 � 0. 11.US DOT Description(Including Proper Shipping Name,Hazard Class,and lD Number) Total Unit 000 No. Type Quantity WtNol a. Waste Petroleum Oil, N.O.S. m not DOT re ulated S . U rrl ai E b. ¥ Z C N g rn a 70 E w D fn 4) R c. --1 a: Al i O T C O o R: d. r x 1, r*1 Z y _ V111 H +.w ,a.,i rr» v t&:.r £ .SA?r k;,,^ '�.{h. + .<'S• k`4i,- dk"%"" Y*'$ d6 1{4;3• Jt Additional Descriptionsfor Ma, reels List °Abovey(tncludephysrcel staie geode ,' � r �I� HantUl ad®skf Wale LtsL"°L e, ;M{. . V) 76 5 ram. cN% 1 i x tt A Y �i t' "' + - •Mg a �"' k T*�a •. t�.y^,-t?s ✓"� x `wtltt $ Co e- ,,,�.;5S Y s r.h. 4 a saa ,,. ,'. r-# •'. s � 2 s4 b w$ _ c,,m �w d .,, s.. E 15.Special Handling Instructions and Additional Information .E Material tested being marketed as MA99 a 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by shi in name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport b highway i proper shipping P P P P P Y O according to applicable international and national government regulations. U If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable O and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environ- O men hat OR,it I am a small quantit y y generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. O E Det@ Printed/TypedName Signal Mon h Day_ Year 0 V t2?" L N R 17.Transporter 1 Acknowledgement of Receipt of Materials Date co q� Printed/TypedNime rftnat a ay C 0 r ll ransporter 2 A' owledgement of Receipt of Materials Date T Printed/rypedName Signature Month Day Year E R 19.Discrepancy Indication Space F A C I L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. I T Date �. PrmtedfTyped Name Signature Month Day Year J Form Approved OMB No.2 50-0039 ' EPA Form 8700-22(Rev. 9-94) Previous editions are obsolete. COPY>4 : GENERATOR RETAINS TOWN OF opt ILW BARNST,(ALE LOCATION "I oc , l\' d SEWAGE # VILLAGE w S A��S ASSESSOR'S MAP & LOT��� II'iSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) (D` ' NO. OF BEDROOMS \ n I BUILDER OR OWNER )O YA PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) afflC Feet Furnished by �'���b2 I Q ccr- AA ApAr 36 io p Ap a, g COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION d jd: h i Va 1 t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE. SEWAGE DISPOSAL SYSTEM FORM RECEIVED PART A CERTIFICATION J U L 2 5 2002 Property Address: 1416 OLD POST RD.IAARSTONS MILLS, MA 02648 C)-j I TOWN OF BARNSTABLE Owner's Name: JOE KELLY HEALTH DEPT. Owner's Address: 1416 OLD POST RD MARSTONS MILLS, MA 02648 Date of Inspection: 7/10/02 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS �nC/ Mailing Address: '11 P.O. Bok,2119 TEATICKET, MA.02536 Telephone Number: 508-564 6813`FAX 508-564-7270 CERTIFICATION STATEMENT ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and inaiitenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally P, 'es _ Needs Further aluation by the Local Approving Authority Fails Inspector's Signature: Date: 7/10/02 The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspectio► . If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION.'RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****Phis report only describII` cori�, -, 't the time of inspection and under the conditions of use at that time.'Phis inspection does not address how the,sys.tem will perform in the future under the same or different conditions of use. ,• i, r. it ' t Titlr- 5 lncnrrtinn Rnrm (,/i v)nnn Page 2 of 1 l _. OFFICIAL INSPECTIONYORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1416 OLD POST RD.MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Sectir n D x, A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.' B. System Conditionally Passes: _ One or more system componein&.as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacemenf,or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y;N,ND) i ithe for the following statements. If"not determined"please explain. n/a The septic tank is metal and over`20�years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is'aw.ilable. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the dirt.ibution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken piipe(s)are replaced obstruction is'removed _ distribution box is leveled or replaced ND explain: n/a s % Jai. ..n/a The system required pumping more than 4 Ji. mes a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board'of Health): _b'roken'pipe(s):are replaced _obstruction is removed ND explain: n/a 4 ,j Page 3 of I I i OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1416 OLD POST RP MARSTONS MILLS, MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02, C. Further Evaluation is Required,by the Board of Health: k Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or tWenvironment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner''which"vll protect public health,safety and the environment: _ Cesspool or privy is with in,`50,'feet'of a surface water _ Cesspool or privy is within.50 feet of a bordering vegetated wetland or a salt marsh s . 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic'tank and,soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water'supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septictank and, SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic,tank'and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method us"edlo.determine distance n/a "This system passes if the we V.11 water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compoundsindicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is`,equal to'or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attach'ed'to this form. 3. Other: n/a . 'Page 4 of I 1 • �hi ;4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1416 OLD;POST RD MARSTONS MILLS, MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 D. System Failure Criteria applica'61e to all systems: You mast indicate"yes"or"no"to eacti'of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped PUMPED 5/1/nl-RORTOLOTTI BY OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspA,or p'r vy'is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy isiless than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratorx,for£colifo.rm bacteria and volatile organic compounds indicates that the well is free from pollution from•'tha,t facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form:',: '. (Yes/No)The system fails.'.1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails,=The,system owner should contact the Board of Health to.determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no air + c - X the system is within 400 feet of„a surface drinking water supply X the system is within 200 feet 66 tributary to a surface drinking water supply X the system is located in'a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped ,I ;,: ;,• Zone 11 of a public water supply well If you have answered;"ye "to any gitestion in Section E the system is considered a significant threat,or answered "yes" in Section D above the The owner or operator of any large system considered a significant threat under Section E or failed under Section;D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. is d Page 5 of 11 10. OFFICIAL INSPECTIONTORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1416 OLD POST RD MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water,been introduced to the system recently or as part of this inspection ? X Were as built plans of the,system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling ilnspected for signs of sewage back up? } X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For e'xariiple,a plan at the Board of Health. X _ Determined in the f0d�(if`any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] • x s, Page 6 of 1 1 3 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t SYSTEM INFORMATION Property Address: 1416 OLD POST RD MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 -,,.Number of bedrooms(actual): 3 DESIGN flow based on 310 CM 11 5, .203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): Wa•- Sump pump(yes or no): NO 0 ( _ S-71 06b Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203):�n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a', Last date of occupancy/use: n/a OTHER(describe): n/a c GENERAL INFORMATION Pumping Records Source of information: PUMPED 5/1/01-BORTOLOTTI BY OWNER Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: n/agallons`-'`F ow'was,quantity pumped determined? n/a Reason for pumping: n/a t' 52 . . TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,,date`installed(if known)and source of information: 20 YRS BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO 1 1 X 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1416 OLD POST RAJ MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction: cast-iron _40'PVC,Xother(explain): 20 PVC Distance from private water supply well or suction line: 0" Comments(on condition of joints,venting, evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete metal fiberglass_polyethylene other(explaii:)n!a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7g,;W'4' 10";' Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TW,01 YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) , Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping reconuncndat eons. hnlct and outlet tee or baffle condition—structural integrity, liquid levels as related to outlet invert,evidence of leakage,.etc.,: n/a ' 1 7 •Page 8 of I1 t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1416 OLD POST RD.MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 TIGHT or HOLDING TANK':z"(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working'order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a :s , DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): i D-BOX IS STRUCTURALLY SOUND. !, PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or5no) "NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a p% ,k 1+ i. S3' ,, R Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1416 OLD POST RD MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 � , SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a s Type 1000 GAL 6' X 6' i, leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a 1;41 •.innovative/alternative system e j, s ,Type/name of technology: n/a Comments(note condition of soil,•s`igfis'afhydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. PIT HAS 2' OF LEACHING LEFT IN IT. BOTTOM IS AT 81. } CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a PRIVY: (locate on site plan)_lt, . Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 5z; z 4 Q Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1416 OLD POST RD MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 ' SKETCH OF SEWAGE DISPOSAi:S' YSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. s, I Deck , 1 u 6 AA 91 E A 4 16 G C BO 1 .v in ` Page 1 1 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t' PART C t ,SYSTEM INFORMATION(continued) Property Address: 1416 OLD POST.RD MARSTONS MILLS,MA 02648 Owner: JOE KELLY Date of Inspection: 7/10/02 ; a SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local,excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established'the High ground water elevation: HAND AUGER- 12-FT. t i f COMMONNWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ; TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS - SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ,PART A rC�ERTIFICATION Property Address: 1 lQ La�DS� ' _Qa a Owner's Name: V-Z-,4Q'All 'Ff' Owner's Address- �J Date of Inspection: Name-of Inspector.(please print) Co_mpanyName: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number.- (5081 775-87T6 CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and-that the information reported below is true,accurate and complete as of the time of the inspection-The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems_I am a DEP approved system inspector pursuant to Sec-on 15340 of Title S(3I0 C11IR I5.000). The system: Passes Conditionally Passes • Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: t yi bz,T%_S The system inspector shall submit a copy of ihis inspection report to the Approving'Authority(Soard of Health*% DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,006 gpd or greater,the inspector and the system owner shall submit the report to the appropriate iegional office of ttte DEP.The original should be sect to the system owner and copies sent to the buver,if applicable,and the approxng authority- Notes and Comments '. ""This report only describes conditions at the time of inspection and underthe conditions of.use at that �✓ time-This inspection does not address how the system will perform in the future under the same or different conditions of use. Title S Inspection Form 6/15/2000 page t / � I Page 2 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: LA1 1p (Q k6 P - - Owner: Date or laspectioa: t 5 Inspection Summary. Check A,B,C,D or E/ALWAYS complete an ofSectioa D A. Sys( Passes: V I have not found any information which indicates that any of the failure txiteala duuibed in 31 t)CMR " 15.303 or in 310 CMR 15.304 exist_Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: r t One or more system components as described in the"Conditional Pass"section need to be replaced or ' repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,door not determined(Y,N,ND)in the, for the following statements.if Mot determined"please ` explain. . The septic tank is metal and over 20 years old-or the septic tank(whether metal or not)is structurally 4 unsound,exhibits substantial inf Itration or exfiltration or tank failure is immioenL System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health •A metal septic tank will pass inspection if it is structurally sound,not leaking aitdrifa Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or bleak out or high static water level in the distribution box true to or obstructed pipes)or due to.a broken settled or uneven 8istt<bation box,S ¢ approval of Board of Health): System will pass inspection if(with . , broken pipe(s)are replaced: obstruction is iemoved distribution box is leveled or replaced ` ND explain: The system required_pumping more than 4 tit es a year due to broken or obstructed P (s) The system Will Pass inspection if(with approval Of the Board of Health): broken pipe(s)are replaced obstruction is stmovod ND explain: Page3oflt OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM', PART A CERTIFICATION(continuedj- Property Address: Owner_ a i� -- Date of Inspection:' a C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment_ 1. System will pass unless Board of Health determines in accordance with 310 CMR 15303(i)(b)that the, system is not functioning in a manner which will protect public health,safety and the environment: D _ Cesspool or privy is within 50 feet of a surface water ?; Cesspool or privy.is within 50 feet of a bordering vegetated wetland or a salt marsh _ 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a e surface water supply or tributary to a surface water supply. ' _ The system has a septic tank and SAS and the SAS is within a Zone i of a public water supply.' . E v 1 The system has a septic tank and SAS and the SAS is within-50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a' private water supply well!' Method used to determine distance "This system passes if the welt water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered;A copy of the anafysismust be attached to this form. "`- 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.: PART A ..° . CERTI FI CATION(continued). Property Address: NLktlo Old QOSt— z �''i . Owner: C�GCA.v� ' Date of Inspection: t%7 J-0c1 D. System Failure Criteria applicable to all systems: You must indicate"Yes",or"no"to each of the following for all inspections: t Yes No Backup of sewage into-facility or system component due to overloaded or clogged SAS-orcesspool' t Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or /cesspool If Liquid depth in cesspool is less than V below invert or available volume is less than'/:day flow ZRequircd pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 Beet of a surface water supply or tributary to a surface water supply. .: . r _-Z Any portion of a cesspool or;privy is within a Zone 1,of a public well. } �y portion of a cesspool or privy is within 50 feet of a private water supply well. y portion of a cesspool,or privy is less than 100 feet but greater,than 50 feet from a private watrr supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.i have determined that one or more of the above failure criteria-exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: ` t.. To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following (The following criteria apply to large systems in addition to the criteria above) yes nv the system is within 400 feet of a surface drinking water supply — ^ the system is within 200 feet of a tributary to a surface drinking water,supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E die system is considered a significant threat,or answered "yes"in Section D above the large system has failed_The u%m r or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional off ice of the Mpartment. 4 l , r Page S of 1 I OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM,INSPECTION FORM , - PART B CHECKLIST Property Address: l`4 to yid Pass P.�cz� Owner: �:q,��� Date of Inspectian: I.,�ry/azo k Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No,,,- Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks T Has the system received normal flows in-the previous two week period? /ave large volumes of water been introduced to the system recently or as part of this inspection?-.. . Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling.inspected for signs of sewage back up? _✓ Was the site inspected for signs of break out_? , Were all system components,excluding the SAS,located on site _�_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition• . ,T of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?. ' Was the facility owner(and occupants if different from owner)provided with information on the proper• ; maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: , Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance, , is unacceptable)[310 CMR 15.302(3)(b)] i 5 Page 6 of I 1 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �WU' O k(� �P05t U� n`A�•S'�5 ITS Owner: GZ,v� Date of Inspections Co t0 4 FLOW CONDITIONS l RESIDENTIAL Number of bedrooms(design):.-3 Number of bedrooms(actual): DESIGN flow based on 310 CMRR 15103(for example: 110 gpd x#of bedrooms): ��� 6Pd Number of current residents: _ , , . , : 4 Does residence have a garbage grinder(yes or no)- Is laundry on a separate sewage system(yes or no)^5 (if yes separate inspection required) Laundry system inspected(yes or no):..!2jA' Seasonal use:(yes or no):/Vi? Water meter readings,if available(last 2 years usage(gpd)): 0607 3 33 Co o -Sump pump(yes or no): ao©. Last date of occupancy: Cu r�t^a•i- COMMERCIAL/INDUSTRIAL Type of establishment: . Design flow(based on 310 CMR 15.203): �pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: t Last date of occupancy/use: OTHER(describe): - GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):�� t: If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: -�- TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) - _Tight tank —Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): I..-v 6 1'agc 7 of 1 1 • x OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , uh SYSTEAIINI,OIIAIATION(continucd) ' Property Address: 1�16 00 POSi i'�_k Owner: c Date of Inspeetlon: BUILDING SEWER(locate on site plan) Deptit below grade: 1 Materials of construction:_cast iron PVC othcc(explain}. Distance from private avater Supply well or suction lire: Comments(on condition of joints,venting,evidence of leakage,etc.): N"'a A4i..l 'fhla.r t. /\,'sit: .' Y r SEPTIC TANK: ✓ (Ioca(c on site plan) Depth below grade: _ Material of construction.✓uncrete`metal fiberglass_polycotylene _othcr(cxplain) _ If tank is metal list age:_ is age confiirtned-by a Certificate of Compliance(ycs or no): certificate) _(attach a copy of Dimensions:Sludge depth: Distance.from top of sludge to bottom of outlet Ice or bafllc: S Scum thickness: r Distance front top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet ee or baffle: t l low wcrc dimensions dcicrntincd: pPe,, ,ba yc� r►'t e•Q�w.a.tnl3 . Comments(on pumping reeotnntendations,inlet and ou(le�or ballie eondi(ien,structural integrity,liquid levels. as related to outlet invert,evidence of leakage,etc.): d FnIG .�'GS Y1rai` /C%lCC & �i� �lZrat�� i�.�y '` 7�l Y mar o� V leaf kf- 60fh 41�� f i�t:tst GREASE TRAP:11.47?r site plan) Depth below grade:_ / �� t Material of construction:_concrete—utetal fiberglass__Lpolyethylene othcr (cxplain): Dimensions: Scutn thickness: Distance Goal top of scuts to top of outlet tee or battle: Distance front bottom of scum to bottom of outlet tee or baMc: Date of last pumping: _ Continents(on pumping re contrite ndaljolts,Wet and outlet ice or baffle cunditiva,structutal integrity,liquid levels as related to oullct int•crt,cvidcticc of leakage,e(c.): 7 t• 8of11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTAIR`V ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C S YSTE61 INFORII•IATION(continued) ,erty Address: v©S� zoa t or inspection:-' ilIT or IIOLDING TANK: tank must be pumped at time of uupection)(locate on sift plan) A below grade: .trial of construction:_concrete metal fiberglass_Jloiycthylutr • otbcr(explau): tensions: tacit)•:_ Rallons Ai ..' ign Flow: gallons/day nu present(yes or no): s rm level: Alarm in working order(ycs or no): .c of last pumping: + , rnmcnts(condition of alarm and float switches,ctc.): z ss STIUBUTION BOX:" (if present must be opencd)(locatc on site plan) pth of liquid level above outlet invert: nuncnts(note if box is level and distribution to outlets equal,any evidence of solids caruover,any evidcmce of kage into or out of box,ctc.): `- p Y Z!� l w/'r}•�.••w .mac i 'e �"�X'L�e�i.7+ s •. • a JAIP CIIAAIDER:/_.Alcatc on site plan) imps in working order(yes or no):_ lam's in working order(yes or no): )numents(note condition of pump chamber,condition of pumps and appurtenances,cte.): '' I Page 9 of I i OFFICIAL INSPECTION_FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P y Pro ert Address: `L1� ��� ?OS+ p6s_-A owner. Q Date of Inspecti n: _ ��� g SOIL ABSORPTION SYSTEM(SAS): locate on site plan,excavation not required) If SAS not located explain why: Type ._ eaching pits,number: / /cam' leaching chambers,number leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typetname of technology. Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): ��j/ 1 G I— `'�'i c�K_ � /1f l 'G cd Ii/^ A P �4�/E`�X i �� a.3 �.1�C �.m�ia •�'. .�"��1 T CESSPOOLS: ^ i pool must be pumped as part of inspectionXiocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_101A�rte plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I y r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION"FORM PART C SYSTEM INFORMATION(continued) T i Property Address: )LA i U bk6 Vbs-- >^0�A,_9__\5 `►'n 5 Owner: Date of Inspecti n: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 9 a "T� 0 3- � 33 `� ' . x . 10 Page I i of I'l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 11 SYSTEM INFORMATION(continued) , Property Address: �`A t� ©�C� �OSk �G� (`�.ar`� Owner. E�jt$c,-n Date.of Inspection: S SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water ab feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 5 r 3 1fg� Observed site(abutting propertylobservation hole within 150 feet of SAS_) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: i You must describe how y u established the high ground water elevation: e -21�9- giJc dori �• �� w d':c vl 11 THE COMMONWEALTH OF MASSACHUSETTS ���~��� ���� ��' HEALTH '------------_ ��==^"" ~�� ��" " "�~""�~ " " " ..........................................OF.................................-...................................................... ---------'--'-�J -Appucation is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System I at- � 'i ;-- �'I Alzi�,_OLS \\KA I .............. ................................... ................................ ...... ........................ .................... .....05:��........................ ......................... Z...................................... ................... .............. . G -G, Installer Address Tvo� c6Bu�d�m � Size Lot 8n {e� '^ ~ ----------'-_-_.. Dwelling--No. of 8ed,000s---------. ....................Expansion ( ) Garbage Grinder (*6. Other—Type of Building ............................ No. of persons-..��................. Showers ( ) -- Cafeteria ( \ Z Other Distribution box \ / Dosin tank '- Percolation Test Result Performed by ;4vLv- Test --- Dot _- `Pit No. ]- .-miuzusper��6 Dryt66 IeetI�--_�.--.-- cot6 to ground water-�&����-�_' Test Pb No. 2................minutes per inch Depth of Test Pit.................... Depth toground vvacec-_--_---� '- ' ----.- - -..---------_-_-__--__-_-__--�-__._---__-_--_-----.'___-----'`=�-_--~---------.-.------ .................... ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations--Answer when applicable------------..--------.---_---------.- -----'---------''--'-----------'---'------'----'-----------'--------'--'--------- '�,-_-__. The undersigned agrees to install the aforedeecribed Individual Sewage Disposal System in accordance with the provisions of�Z��� � not to place the system io operation until a Certificate of Compliance has been i sue y-�e o a r d;o f:l,:e,,t h. ----........... ..........................^^ Date�...F-K)'--- ~ 7 DateApplication Disapproved . for the following reasons: ................................................. � ` � ------------------------'-------------'--------'------------'---------'---------'-'------ oat" . Permit � ` n�� � � ' / ..............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------------ -- -------......—OF......................................................................................... Appliration for Uispoii al Workii Tomitrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at :: - ..... !,... ....�.4.% : ,�-c c 5-- .�t..------... -------------- V..................... catio -AtMrrss +--- r Lot N . +- _....,.. ! --._ �— ill .............' -c� -ra+�► f irOwner 1 � ^.'._...-----•- f � ddre�s4 •—�. ........... -------------------•-- ..................... .....................--............................................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............. _ Expansion Attic ( ) Garbage Grinder ({4 04 Other—Type of Building ............................ No. of persons...... Showers ( ) — Cafeteria ( ) Q' Other fixtures ________________________________ _ W Design Flow................ 1_Q_...................gallons per person per day. Total daily flow..........1.4�---__-•-. -___-----_-_gallons. WSeptic Tank—Liquid capacitvlA©Q..gahbns Length...... ....... Width"",�............. Diameter---------------- Depth........ x Disposal Trench—tNo.____......- Widt �,. ....._r.i._ Total Length " Total leaching area __...•...._ sq:}ft. 3 Seepage Pit No... ............. Diameter .. - Depth below inlet____............_._ Total Teaching area;: �.! __..sq. ft. z Other Distribution box ( ) Dosingtank ( "-,) Percolation Test ResuI Performed by.., ��lx, r ....._ _.. r1i1! t%'._.....__. Date.....5`_./J`_S�`�� - ....... F a Test Pit No. 1..,�5.__.----minutes per inch Depth of Test Pit____________________ Depth to ground water---�t!4 �....... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ....................................... ----------------......................................................... O Description of Soil------- S 1- --------------------S......... W UNature of Repairs or Alterations—Answer when;applicable.------------------------------------------...................................................... i •••. -•••--•--------------------••••--•--•-•-•-••••---•-----•-'-••-------------•--•-•-----'-••-.._..--- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f•1 =^ the provisions of i yT,�'1.E, 5 of the State Sztrrit�ary Code -.,The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been *ssu y-th oa•d of he th. Si e . .." __t°�P_. -- ,,,, Dat Application Approved By. ?feffollowing '= - -- v ° f'Dat ..._._.. r Application Disapproved for reasons:....................�.._______.._._.__. .............................................•-•---••-•--....---•-••'•••--•--•-•.........--'•-••--•--•--...••••-••••'•-•--------•-••------•-----•-•-•-•----•---••......--•-------- ..................... Date PermitNo......................................................... Issued..................................-------------------- F Date • .r r THE COMMONWEALTH OF MASSACHUSETTS } BOARD OF HEALT ief .. O F. :. ......... ...... r ......... 1 ..`............... Tatifiratr of Tompltanrr THI IS T CE IFY, Th he Individual Sewa I sal Syst m constructed ( ) or R ai-ed ) by....._.... ---- �; 1 tall has been installed-in accordance with:the provisions of 5 of The State Sanitary Code as describe ' —the application for Disposal Works Construction Permit No. ...' !r.l................ dated:.-..4.. .A_-i�._--!�---------;....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY'. DATE.................--7_v__:L`- ...............................•----- Inspector.......•- --•-•-cZ - --=----------•---•---•---•-----•-•-----•--- fi i THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH I Li� 40 '" / (...........OF._... .. ... ........................................................ a No......................... FEE..3 ..................... Disposal or9�niiUan rrmit Permission is reby granted.- ....... ... )'1 �' •-••---•••--•----•...........................•••.................._. to Constr t K Y orAep ( an dividual =erge Dis, Sy _ at No.~ •.. ... ......... ��...-/ �_ _� � �p�:-- --�................................ Street as shown on the application for Disposal Works Construction P it N ______ ______ ____ Dated.�---�,.a �'"a� ••••• ::_ :�. ---------•--------•-••---- f -- -•---------------- Board of Healt}3 , DATE........ •.................. ......••......-- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r,. Ito 3 SEPTtG TAyK • 3V..(15o la'' R56 ��- , ` 1 USE I000 Co%L 1>I S PaSAL. %>CT V;E I©O0 G4-L- SIVeWALL Ac6A = ISM S - _ �U ISO �" K z- S = 1 � :, ,� �- - - --- r.�i --✓c --- -- GO L � A4.�i ToTA%• 'DES►6N +rN + PEZC.O .aTL low RaTT-- t 1 u Z Atu oe tom: cr 4.4 .6 +oP Ft.rc •4&,S etr-41 �,• c ��' 4 LOAIN 77 ¢"Ape. 1l7bQ IN1/ SJ6SolC. 4 �04 V"T l6hV l3�L.. 4�i.3 r .I SIC 8oi. Q5 "�►wv. '� bsL. e LEAG1-� :V Pt T J r + WIT" q i' Sp� i l•Ala t'1i :; I WAWfiV + 6, STO►16 4 38 CERTIFIED R.oT PL_A.N afiZo tr l l_E.- I�A.Tt061 ����� /Ylt�•�7 IZ �c.- �d•5 No $�q.s- SGI�L.E '�_ DAT 18o 4Jo Vt/QTt� o t C6cT1F•( TµAT r"c-. pVI4b AT1U W S16�64 PL-A.1-1 2EFEJZF_aJG�. 1-�E�EOt•.J GO/KPL-`fS wtTN Trip- Sttw-w r= LD7 ' AwD SIT�ACrC R6�i?v1eLME►•1Trj� OF -rWe TbwN of `�A121JST'1� I_� PLA�,1 Fo[Z Q1�&j c SMA t_� _ I�►c. Zf 2I-1°I VA•�E r ( " QtalilST�s �� >LAAuo Sv2vEyoe; T6414v PL4&&J tA. UOT ISA56D OU AU It.14MME►dT OSTE!.Z VI AAA.ZS. 5Uevel 4 T4iG OFFSET; 5"OUL'D 'uOT EE U4E.0 APPLtGAuT To 'PETr-ItMi L wT L.IUS4. O �sQT C.U►�hJ�;J(. +�1 1 TOWN OF BARNSTABLE LOCATION SEWAGE # � VILLAGEU.c> I ASSESSOR'S MAP:& LOT-0 INSTALLER'S NAMF&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L e t (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDA-TE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet ynrA �liala2 f Furnished by o �— AA A 33� co Z S-/ l O C A T lOey_ ` S ACE P RMIT NO. VILLAGE INSTA LLER''S NAME i ADDRESS I t U I L D E R -W DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED -7— �_ �� . ,I � ►� �� i �� ,� �� �� . ���� t��4 �-� ��� � J