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HomeMy WebLinkAboutBJS WHOLESALE CLUB - RETAIL FOOD r :--RJ's WHOLESALE CLUB - ( , 420 ATTUCKS LANE f a e. E lJ ,. ONTFNTS 00 TF i F 7 t BOARD OF HEALTH Town of Barnstable John T. Norman Board of Health Donald A.Gaudagnoli,M.D. pAR.NgTABee, F.P.(Thomas)Lee,. MAM Daniel Luczkow,M.D. Alt. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 817 Issue Date: 01/01/2022 DBA: BYS WHOLESALE CLUB #321 OWNER: BJS WHOLESALE CLUB INC Location of Establishment: 420 ATTUCKS LANE HYANNIS„ MA 02601 Type of Business Permit: SUPERMARKET Annual: YES Seasonal: IndoorSeating: 30 OutdoorSeating: 0 Total Seating: 30 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: f For Offic Initials• Town of Barnstable f� * i Date Paid G Amt Pd$ ELUMSTABIX Inspectional Services Check �� ` Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE FOOD ESTABLISHMENT DATE10/14/17 NEW OWNERSHIP RENEWALv BJ's Wholesale Club#321 NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: 420 Attucks Lane, Hyannis, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 25 Research Dr. Westborough, MA 01581 E-MAIL ADDRESS: Legalnotices@bjs.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( 1 568 -4035 TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: 0 OUTSIDE: 0 TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING.MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. no IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? no TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST _CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD _FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL.MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:Wpplication FonnsTOODAPP REV3-2019.doc OWNER INFORMATION: FULL NAME OF APPLICANT BJ's Wholesale Club, Inc. SOLE OWNER: YES/NO OWNER PHONE# 774-512-7400 ADDRESS 25 Research Dr. Attn; Licensing Westborough, MA 01581 CORPORATE OWNER: CORPORATE ADDRESS: 25 Research Dr. Westborough, MA 01581 PERSON IN CHARGE OF DAILY OPERATIONS: Roy Walker/General Manager List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1.John Flanagan Z / �1. John Flanagan 2. Hope Allen 9 / 10 / 2026 0 (g �1 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to onenine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at httu://www.townotbarnstable.us/healthdivision/annlications asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FomisT00DAPP REV3-2019.doc r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aNkeee Paull.Canniff,D.M.D. MAM 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 817 Issue Date: 01/01/2021 DBA: BJ'S WHOLESALE CLUB #321 OWNER: BJS WHOLESALE CLUB INC Location of Establishment: 420 ATTUCKS LANE HYANNIS„ MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 30 OutdoorSeating: 0 Total Seating: 30 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. Variance granted for TPHC for pizza. 1 For Qffi— Initials: Town of Barnstable ;1 �2 Date U'd` AD1tU S � BA MAIM Inspectional Services ►`� Public Health Division '' `� ®°iob Thomas McKean,Director 200'.Main Street,Hyannis,NIAA 02601 Office: 568-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT -. DATE 11/4/2020 NEW OWNERSHIP RENEWAL� ... NAME OF FOOD ESTABLISHMENT: B.J'S Wholesale Club #32.1,.,..- ADDRESS OF FOOD ESTABLISHMENT: 420 Attucks Lane, Hyannis, MA 02601 ........ .. . MAILING ADDRESS(IF DIFFERENT FROM ABOVE)25 Research Drive, AttwLicensin ; Westborough, MA 01581 E-MAIL ADDRESS: Club: GM321@_bAs.com ' Licensing: legalnotices@bjs.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( 08 )778 .7756 TOTAL NUMBER OF BATHROOMS: 5 WELL WATER: YES_NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: J I TO l J NUMBER OF SEATS: INSIDE: OUTSIDE: 0 TOTAL: T,0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST RE APPROVED BY THE HEALTH DIV.AND LICENSING. AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? fS:AN AIR-CURTAIL`PROVIDED AT WAITSTAFF SERVICE DOQR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE, XRETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST _CONTINENTAL BREAKFAST _COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE SEASONAL MOBILE& NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 5I18-862-4644 Q:Ltpplication FormsTOODAPP 2020.doc r OWNER INFORMATION: FULL NAIVE OF APPLICANT BJ's Wholesale Club, Inc. SOLI":OWNER: YES/NO OWNER PHONE# 774-512-7400 ADDRESS_ 25 Research Drive, Westborough, MA 01581 CORPORATE OWNER: BJ's Wholesale Club Inc. CORPORATE ADDRESS: 25 Research Drive, Westborough, MA 01581 PERSON IN CHARGE OF DAILY OPERATIONS: Chris Cheverie/General Manager List(2)Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. "ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must Provide new copies and POST THE.CERTIFICATES.at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I. Nicholas Mendoza 05 /29 / 2024 1. Anne Petrinotaft 01/ 04 /2(0224 2. John Finnegan 05 /29 / 2024 1J� 11 / 09/ 2020 - SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION"* SEASONAL FOOD SERVICE:All seasonal food establishments,.including mobile trucks must be inspected by the Health Div, prior to onenina!! Please call Nealtl Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the Above terms are,met. _... CATERING POLICY: Anyone who caters within the Town of Barnstable must notify thcTowm by fax or mail prior to catering event. You must complete a catering notice found at httn://www.townofbar6stable.us/healthdivision/aaalications.asn. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is-prohibited. NOTICE: Permits run annually from January l st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC I st. QA1Application FonnsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH g� Q John T.Norman a Board of Health Donald A.Guadagnoli,M.D. DAMNSTABM F.P.(Thomas)Lee MASS 16)4. 200 Main Street, Hyannis, MA 02601 IDaniel Luczkow,Alternate D � Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 817 Issue Date: 1/1/2021 DBA: BYS WHOLESALE CLUB #321 OWNER: BJS WHOLESALE CLUB INC Location of Establishment: 420 ATTUCKS LANE HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Restrictions: Thomas A. McKean, RS, CHO, Health Agent PLEASE POST CONSPICUOUSLY Towri.of Ba Initials: rnstable r. {: I Inspectional ServicesDide w& Public Health Division �alvb3 Thomas MGKem,Director - 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fix:.508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION(Non Flavored DATE 11/4/2020 NEW BUSIrNM OWNERSHIP RENEWAL /\ NAME OF TOBACCO ESTABLISHMENT: BJ's Wholesale Club, Inc. ADDRESS OF TOBACCO ESTABLISHMENT: 420 Attucks Lane, Hyannis, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 25 Research Drive, Attn:Licensing; Westborough, MA E-MAIL ADDRESS: Club: gm321 @bjs.com- Licensing:"legalnotices@bjs.com_ 01581 TELEPHONE NUMBER:OFKTOBACCO ESTABLISHMENT:-''5( 0' }-778 -7756 OWNERS NAME: B J s Wholesale Club In .c oWNER s PH#L� 512r7400 OWNER'S ADDRESS: 25 Research Drive, Westborough, MA 01581 CORPORATE NAME: BJ's Wholesale Club, Inc. CORPORATE ADDRESS:25 Research Drive, Westborough CORPORATE FID# ANNUAL:_X SEASONAL: DATES OF OPERATION: !.1 TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA-GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: httt)s://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 2701SECTION 6: https://maleeislature::ov/Laws/GeneralLawslPartIV/TitleUChanter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY*"* REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. _......... PLEASE CALL 509-375-"21 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: PRINTED NAME: Graham . Luce/Secretary DATE: 11/09 /2020 Q:1APPlicazton FormsiTOBACCO APP-NonFavor 12-18-19.doex DEPARTMENT OF THE TRE' '1RY DATE OF THIS' ITICE: 04-17-97 INTERNAL REVENUE SERV NUMBER OF T9 NOTICE: CP 575 G ANDOVER MA 05501 EMPLOYER IDENTIFICATION NUMBER: 04-3360747 FORM: SS-4 (TELE-TIN) 0825503209 B FOR ASSISTANCE CALL US AT: BJS WHOLESALE CLUB INC 617-536-1040 LOCAL BOSTON % WABAN INC-TAX DEPARTMENT 1-800-829-1040 OTHER MA 1 MERCER RD NATICK MA 01760 OR WRITE TO THE ADDRESS SHOWN AT THE TOP LEFT. IF YOU WRITE, ATTACH THE STUB OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER (EIN) y Thank you for your Tele-TIN phone call. We assigned you employer identification number (EIN) 04-3360747. This EIN. will identify your business account, tax returns, and documents, even if you have no employees. Please keep this notice in your Permanent records. Use your complete name and EIN shown above on all federal tax forms, payments, and related correspondence. If you use any variation in your name or EIN, it may cause a delay in processing, incorrect information in your account, or cause you to be assigned more than one EIN. If you're required to deposit for employment taxes (Forms 941, 943, 940, 945, CT-1, or 1042), excise taxes (Form 720), or income taxes (Form 1120), we will send an initial Supply of Federal Tax Deposit.(FTD) coupon books within five to six weeks. You can use the enclosed coupons if you need to make a deposit before you receive Your supply. Based on the information shown on your Form SS-4, you must file the following forms(s) by the date we show. Form 941. 07/31/97 Form 1120 04/15/97 Form 940 01/31/98 If the due date has passed please complete the form and send it to us by 05-02-97. If we don't receive the form by that date additional penalties and interest will be charged. If you weren't in business or didn't hire employees for the tax period shown, please file the form showing that you have no liability. If you need help in determining what your tax year' is, you can get Publication 538,. Accounting Periods and Methods, at your local IRS office. If you have any questions about the forms shown or the date they are due, you may call us at 1-800-829-1040 or write to us at the address shown above. ZesF Commonwealth of Massachusetts Letter ID:L1719943488 O Zr- Department of Revenue Notice Date:October 26,2020 fl E ? Geoffrey E.Snyder,Commissioner Account ID:CGL-11635421-115 r�L_ 4 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES BYS WHOLESALE CLUB INC BYS CLUB#1 P6 BOX 5230 _ WESTBOROUGHMA 01581-5230 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license, call us at(617) 887-6367 or toll-free in Massachusetts at (800) 392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE ------------------------------------------------------------------------------------------------------------------------------------------------ T� clivsfi��r MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 Retailer License for Sale of Cigarettes i ��,e d 'rh r OV This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. BJ'S WHOLESALE CLUB INC Account ID: CGL-11635421-115 BJS WHOLESALE CLUB#321 Location ID: 11635421-0064 420 ATTUCKS LN License Number: 171370496 HYANNIS MA 02601-8141 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 26,2020 Expiration Date: September 30,2022 Commonwealth of Massachusetts Letter ID:L1719943488 0 •r Department of Revenue Notice Date:October 26,2020 ' Geoffrey E.Snyder,Commissioner Account m:CGL-1163542 t-1 15 q �4 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES BTS WHOLESALE CLUB TNC RTS CLUB#1 PO BOX 5230 WESTBOROUGH MA 01581-5230 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 Retailer License for Sale of Cigarettes This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. BJ'S WHOLESALE CLUB INC Account ID: CGL-11635421-115 BJS WHOLESALE CLUB#321 Location ID: 11635421-0064 420 ATTUCKS LN License Number: 171370496 HYANNIS MA 02601-8141 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to. sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 26,2020 Expiration Date: September 30,2022 T �ptttl Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aARNSTAUM Paul J.Canniff,D.M.D. ,+ 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate orb'` Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 817 Issue Date: 12/10/2019 DBA: BYS WHOLESALE CLUB #321 OWNER: BJS WHOLESALE CLUB INC Location of Establishment: 420 ATTUCKS LANE HYANNIS, MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 30 OutdoorSeating: 0 Total Seating: 30 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: ( FROZEN DESSERT: _ Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. Variance granted for TPHC for pizza. t rFor Office Use Only:�oFTr�r� Initials. Town of Barnstable Date Paid Amt Pd$ ' Inspectional Services cot 0 *sC� '� CheckQl 9 a` Public Health Division ArfO�� Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12/10/2019 NEW OWNERSHIP RENEWAL CX NAME OF FOOD ESTABLISHMENT: BJ's Wholesale Club#321 ADDRESS OF FOOD ESTABLISHMENT: 420 Attucks Lane, Hyannis, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 25 Research Drive, Attn:Licensing; Westborough, MA 01581 E-MAIL ADDRESS: gm321@bjs.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 508) 778 - 7756 TOTAL NUMBER OF BATHROOMS: 5 WELL WATER: YES NO X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: 0 OUTSIDE: 0 TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) UOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT BJ's Wholesale Club,Inc. SOLE OWNER: YES/NO OWNER PHONE # 774-512-7400 ADDRESS 25 Research Drive, Westborough, MA 01581 CORPORATE OWNER: BJ's Wholesale Club, Inc. CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Chris Cheverie/General Manager List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. Anne Petrinotaft 04 / 04 / 2021 1. Anne Petrinotaft 12 / 04 / 2024 2. Nicholas Mendoza 05 / 29 / 2024 3. John Finnegan 05/ 29/ 2024 12 / 10 / 2019 SIGNATU�E OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to.do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at httt)://www.townofbarnstable.us/healthdivision/ipplications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc IME�F )i�_ � Town of Barnstable For Office Us Initials:(( �� Date Paid 1�` Amt Pd$ IfJJ BARNSTABLE, : Inspectional Services �l bS 94i 6 9. � Public Health Division Check# i Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored) DATE 12/10/2019 NEW BUSINESS OWNERSHIP RENEWAL X NAME OF TOBACCO ESTABLISHMENT: BJ's Wholesale Club #321 ADDRESS OF TOBACCO ESTABLISHMENT: 420 Attucks Lane, Hyannis, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 25 Research Drive, Attn:Licensing: Westborough, MA. m321@b E-MAIL ADDRESS: g js.com 01581 TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: ( 508) 778 - 7756 OWNER'S NAME: BJ's Wholesale Club, Inc. OWNER'S PH# 7( 74) 512- 7400 OWNER'S ADDRESS: 25 Research Drive, Westborough, MA 01581 CORPORATE ADDRESS: 25 Research Drive, Westborough CORPORATE FID# 04-3360747 ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/NIA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 2 7 0/SECTION 6: htti)s://malegislature.aov/Laws/GeneralL.aws/PartIV/Titlel/Chgpter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY *** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: PRINTED NAME: Graham N. Luce/Secretary DATE: 12 / 10 /2019 Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc 121/09/2019 10:r3 FAX Z003 ESTABLISHML,NTIS NANiI<: 'TOBACCO SALES U+;Inployee Signature IN"OMI This form is for official use to indicate that the enlployee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Saps to Minors—S 371-9 Salle and Distribution of.1gbaceo EM ands, 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The mini Lmum legal sales age in the Town of Barnstable is 21 years of age, 2, Wentification: Each person selling or distribaing tobacco products,as defined herein, shall verify the age of the purchaser by means of a-valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verificatiotn is required for.any person under the age of . The employec(s)below received and understood Section 371-9 of the'Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: Signature Printed Name Date Si re Printed'Nam® Date i nature rioted Naine+ date g ,azure wr rented Name bate 13C..4crLT eICTt_6Z A 1 3 1 t q attire 'Printed Name Date Signature m Irinted Natne Tate r I j I( J ;,L S�gna re P�r✓i cant dName / Date QAAppIJcalllon Fnnns1T0BACC0 APP-NoiFavor 11-21.19,doc 12/09/2019 10:53 FAX 2004 ESTABLIS11MENT'S NAME 'TOBACCO SALE Employee Signature Form This form is for official use to indicate that the employees)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9.of the Town of Barnstable Board of Heahh Regulation: Sales to Minors= �371=9 Sale a>7d Dietributl�n of Tobaccg pr°ooluctav I. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal salts age in the Town of Barnstable is 21 years of age. 2. Identification, Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person uotder the age of 27. 'riie employees)below received and understood Section 371-9 of the Town of Barnstable Board of health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the;Massachusetts General haws: Signature Printed Name "Date Signature Printed Name Dot Prime Name Du Signature Printed Name Date Signarit Tinted eme Date IL Sin re 'W Printed Nwne Date ~"7 Signature Printed Name 17ate Q:W.pplivabon FonnATOBACCO APP.NonFavor 11-21-19.doe 12/09/2019 10:54 FAX Fr IF,iTABLIS1IM1xNTIS NAME 'I'OB ACCO SAKES 1±'mplo,yee signature Worm This forin is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-onc (21). Below is Section 371-9.of the Town of Barnstable Board of health Regulation: Sales to Minors— ' �71� Sale aza ]CDistrl tatloii®I ohacc iroducts. 1. No person shall sell or provide a tobacco product,as defined herein,to a parson under "I"he minimim legal sales age. The minimum legal sales age in the Town of Barnstabk is 21 years of adge, 2: Identification: Each person selling or distributing tobacco products,as defined herein, shall verify thw age of the purchaser by means of a valid government-issued Photographic identification containing the bearer's date of birth that the purchaser is 21 years old of older. Verification is required for any person under the age of 27. The employees)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 (if the Massachusetts General Laws: Date $ILL Si atu r—•°— rinted Name t Ng tu1'e Erin ed Nam Iate K� -11 f Signattrie �Prin dNalne Date �.A A LL-2 L-ruaLL&Qwr. tIatre S'i'int ame 1 at i i ature- Printed Name Date Signature Printed Name Date . Signature •printed Name Q NApplicadon FQims\TOBACCO APP•NonFavar 11-21-19.doc f Commonwealth of_Massachusetts Letter.ID::L0897465216 O m .-.Department of Revenue Notice Date:July 2,.2019. Christopher C.Harding,Commissioner. Account ID:_CGL4*1635.421=09.6 co mass.gov/dor LICENSE FOR SALE OF.CIGARETTES : III.-rII-111110-1III-10 11"'IIIII'I.-IIIII VIIi 111,11-lilii BYS WHOLESALE CLUB INC BJSS-WHOLESALE CLUB 321 PO.BOX 5230 WESTBOROUGH MA 01581-5230 Attachedbelow is:your.License for Sale of Cigarettes.(Form CT-3)..Cut along.the dotted:line and display at your business location:At any time,you can log.irito your 1VIassTaxConriect account at mass.gov/masstaxconnect-to:view and re-print a-copy of this license. If you have any.questions about your.license,call us at.(617).887-636.7 or.toll=free in'.Massachusetts.at (800)39M089,Monday through.Friday,-8:30 a.m.to 4:30.p.m. DETACH HERE -------------------------------------------------------------------------------------------------------------------------------------------------- �.cHts�� MASSACHUSETTS DEPARTMENT:OF REVENUE-- Form CT-3 License for.Sale of Cigarettes- 'This license.iust be posted andwisible at all:times.The.sale of tobacco °V products to anyone under 18.years.of age is prohibited. BYS WHOLESALE CLUB INC. Account ID: CGL=11635421:-096. BJS WHOLESALE CLUB 321 License Number::153441:6896 420 ATTUCKS LN - Business: Wholesaler Branch HYANNIS:MA 02601=8141 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts GeneralLaws. This license is non=transferable:and may be suspended:or.revoked for failure to comply=with.state-laws and. regulations. Effective Date: -July:2,2010: Expiration Date. June.30,2020 DEPARTMENT OF THE TRE '1RY DATE OF THIS' '#TICS: 04-17-97 INTERNAL REVENUE SER4 NUMBER OF TF .NOTICE: CP 575 G ANDOVER MA 05501 EMPLOYER IDENTIFICATION NUMBER: 04-3360747 FORM: SS-4 (TELE-TIN) 0825503209 B FOR ASSISTANCE CALL US AT: 617-536-1040 LOCAL BOSTON BJS WHOLESALE CLUB INC 1-800-829-1040 OTHER MA WABAN INC-TAX DEPARTMENT 1 MERCER RD NATICK MA 01760 OR WRITE TO THE ADDRESS SHOWN AT THE TOP LEFT. IF YOU WRITE, ATTACH THE STUB OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER (EIN) f Thank you for your Tale-TIN phone call. We assigned you employer identification number (EIN) 04-3360747. This EIN. will identify your business account, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. Use your complete name and EIN shown above on all federal tax forms, payments, and related correspondence. If you use any variation in your name or EIN, it may cause a delay in processing, incorrect information in your account, or cause you to be assigned more than one EIN. If you're required to deposit for employment taxes (Forms 941, 943, 940, 945, CT-1, or 1042), excise taxes (Form 720), or income taxes (Form 1120), we will send an initial supply of Federal Tax Deposit (FTD) coupon books within five to six weeks. You can use the enclosed coupons if you need to make a deposit before you receive your supply. Based on the information shown on your Form SS-4, you must file the following forms(s) by the date we show. Form 941. 07/31/97 Form 1120 04/15/97 Form 940 01/31/98 If the due date has passed please complete the form and send it to us by 05-02-97. If we don't receive the form by that date additional penalties and interest will be charged. If you weren't in business or didn't hire employees for the tax period shown, please file the form showing that you have no liability. If you need help in determining what your tax year is, you can get Publication 538, Accounting Periods and Methods, at your local IRS office. If you have any questions about the forms shown or the date they are due, you may call us at 1-800-829-1040 or write to us at the address shown above. I i Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A,Guadagnoli,M.D. uiWN srawoeE «' Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth.of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 817 Issue Date: 1/1/2020 DBA: BYS WHOLESALE CLUB #321 OWNER: BJS WHOLESALE CLUB INC Location of Establishment: 420ATTUCKS LANE HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual -x Seasonal FEES YEAR: 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY � art ►c Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. 13ARNgrABLL � John T.Norman '\ A 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate. a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590,000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 817 Issue Date: 12/20/18 DBA: BYS WHOLESALE CLUB #321 OWNER: BJS WHOLESALE CLUB INC Location of Establishment: 420 ATTUCKS LANE HYANNIS MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 30 OutdoorSeating: 0 Total Seating: 30 _ FEES — ---- FOODSERVICEESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: $285.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: --- -- --- -- ------ -- - --- - _ - MOBILE-FOOD: MOBILE- ICE CREAM: . FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: $85.00 I FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. Variance granted for TPHC for pizza. OF THE Tp� For Office Use Only: Initials: Town of Barnstable ^I � Date Paid �07� [ Amt Pd ��" Inspectional Services AT 1619. A10� Check# G0-i 04gS�l� g' Public Health Division Thomas McKean, Director p 0 ` �� 200 Main Street,Hyannis,MA 02601 I/"' Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12/5/2018 NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: BJ's Wholesale Club #321 ADDRESS OF FOOD ESTABLISHMENT: 420 Attucks Lane, Hyannis, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Attn:Licensing; 25 Research Drive, Westborough, MA 01581 E-MAIL ADDRESS: gm321@bjs.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: C5D8 778 - 7756 TOTAL NUMBER OF BATHROOMS: 5 WELL WATER: YES NO x ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO I NUMBER OF SEATS: INSIDE: C)o OUTSIDE: 0 TOTAL: 7,Pro SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) ATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsT00DAPPREV2018.doc i PLEASE CALL 508-862-4644 OWNER INFORMATION: I` FULL NAME OF APPLICANT BJ's Wholesale Club, Inc. a SOLE OWNER: YE /NO OWNER PHONE# 774-512-7400 ADDRESS_ 25 Research Drive, Westborough, MA 01581 CORPORATE OWNER: FEDERAL CORPORATE ADDRESS: 25 Research Drive, Westborough, MA 01581 PERSON IN CHARGE OF DAILY OPERATIONS: Trish Fratus—Taylor/General Manager List(2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date r en Awareness Expiration Date 1, Anthony Caledonia 6 / 13 / 2023 1, Anthony Caledonia 1 / 30 / 2023 III 12 / 5 / 2018 SIGNAT&E OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at-508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q\Application FormsT00DAPPREV2018.doc �fFfEhy_ Town of Barnstable « t Regulatory Services Department SARNEPABM 'HAS& Public Health Division 039. 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT z LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL BJ's Wholesale C1ub,Inc. D/B/A 420 Attucks Lane, Hyannis, MA 02601 STREET ADDRESS 508-778-7756 TELEPHONE # FID# Do you currently possess a state license to sell tobacco products? Yes X No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided-on the next page). Each employee who sells tobacco products must sign the E ployee Signature Form (provided herein). 9 12/5/2018 Signatur- Date Q:\Application Forms\TOBACCO APP2018 dob.docx r 4 BJ's Wholesale Club #321 Establishment TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s)of this establishment received and understood sections VII b, and W c, of the Barnstable Board of Health Prohibition of Smoking Regulation and the enclosed copy of Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of eighteen(18), Below are sections VII b,and VII c,of the Barnstable Board of Health Regulation: SECTION VII—SALE AND DISTRIBUTION OF TOBACCO PRODUCTS b. Sales To Minors—In owformanee with the Massachusetts General Laws Chapter-270,Section 6, no person, FAnt, corporation, establishment, or agency shall sell tobacco products to.a minor. Each employee working in an establishment licensed to sell tobacco product shall be required to receive a copy of the Board of health regulations and State Law regarding the sale of tobacco and sign a form indicating that such regulations/laws have been received and understood, a copy of which must be placed on file,in the office of the employer and retained, Such signed forms must be made available for inspection,during the license holders normal business hours upon request of an agent of the Board of Health. c. All distributors/retailers of tobacco products or tobacco merchandise must require that, if a customer appears to possibly be under 25 years of age,the customer present a valid State issued picture identification card or drivers license with appropriate photograph to confirm that the customer is of legal age to E2L6ase the tobacco product. The following employee(s) received and understood Sections VIIb. and Wc. of the Barnstable Board of oag Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: hi w immure �Qted ! Date 2 f �� Z- a printed Name Date r�,4-Z 1�CILJc� -1 Z 1 ignatur Printed Name Date. / Signature Printed Name Date— - S furs Printed Name Date r '3� fore x Printed Name Data i Print&Name Date Q:\,Applimion Fonms%TOBACCo AP,P2018 dob,docx ZOOI�j XVi tC:LT BTOZ/WZT VE; .: Town of Barnstable For Qfi;ce Use Only: Initials: ti Date Paid Amt Pd$ snRxer,�i.E Inspectional Services Cash b?9 � � Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT BJ's Wholesale Club #321 ESTABLISHMENT NAME (D/B/A) 420 Attucks Lane, Hyannis, MA 02601 ADDRESS OF BUSINESS 25 Research Drive, Attn: Licensing; Westborough, MA 01581 MAILING ADDRESS (IF DIFFERENT FROM ABOVE) BJ's Wholesale Club, ,:Inc. legalnotices@bjs.com 774-512-6586 Do you currently possess a state license to sell tobacco products? Yes X No Each employee who sells tobacco products must.receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). t Signature Date 12/14/2018 Graham N. Luce/Secretary Q lApplication Forms\TOBACCO APP2019 dob.docx 12/13/2018 14:04 FAX 171001 B.J's Wholesale Club 321 ESTABLISHMENT'S NAmE TOBACCO SALE Rmfloyee Signature Form This form is for official use to indieato that the employee(s) of this establishment recoived and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Taws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one(21). Bolow is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors— 371-9.Salo an Distribution of Tobacco I'roduGts 1. No person shall sell or provide a tobacco product,as defined herein,to a person under The minimum legal Sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. 'Tie following eritployec(s) received and understood Section 371-9 of tho Town of Barnstable Board of Health Prohibition of Smoking:. Regulation and Chapter 270 Section 6 of the M ssachusetts General Laws: bare P ' to.Namo e Sign a Print NarnC Date a r at Pr to =e Date . atur .Printed N e ,i tom. ena a Dade =� r � d�/max/7 -••— printed AMC:N Date i Printed Name Date Q:Appiicallon Pnrms\TOBACCO APP2019 dob.doex 1 `gyp(ME rpm TOWN OF BARNSTABLE. HEATH INSPECTOR'S Establishment Name: Date: age: , of q. `OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Meyq. `02� HYANNIS, MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY�FD MPS p' 508 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat��7 Type of e Inspection Address yyl Risk I Re-inspection ' Level I Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness �^ Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP �G In: Other _ _ �^ Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ t Y r e Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ V FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities C EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 7 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashinq CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Lc G Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations J m �j Critical(C).violations marked must be corrected immediately. (blue&red items) I b�p�(� Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,t e items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.'9 or more non-critical violations, 24.Food and Food Preparation (FC73)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4nori-critical violations 9 )( ) cited in this report may result ti suspension or revocation er the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,-or lack of 28.Poisonous or Toxic Materials (FC=7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to Snon-critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: I u Print: 31.Dumpster screened from public view r Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance.Letter Posted Y N n t Dumpster Screen? Y N Violations related to Foodborne Illness Violations"Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) i FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B)jDe.onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 1 20 Time as a Public Health Control " 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control*. Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) 1 Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg rn�I/I11001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites ) ( ) ( )-( ) * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' p Game and Wild Mushrooms Approved By 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing.Contamination When Tastin * * (Blue Items 23-30) 3-202.15 Package Integrity* g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unshced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management.and Personnel, FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24, Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* . Temperature Ingredients to 41°F/45°F 25 5 . Equipment and Utensils FC-4 .00 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 2 . Water,Plumbing and Waste FC-5 .00 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.I1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Spec al Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999'Food Code or 105 CMR 590'.000.' ' a Op IMF.p TOWN OF BARNSTABLE, HEALTH INSPECTOR,s Establishment Name: S Date: -7 9 • Page:.. of OFFICE HOURS Aa E° PUBLIC 0 HEALTH NSTRETDIVISION 8:00-9:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A MASS. 3 a�0 _ HYANNIS,MA 02601 M- -FRI. 506862-4644 No Reference R-Red Item. PLEASE PRINT CLEARLY � 'EDM FOOD ESTABLISHMENT INSPECTION REPORT Name Date CII ). , T e o T ec io 1 e a 'on ou Of Address T� �� Risk Previous Inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspecto Out: . lr c< - Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands, ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS SP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY i O ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 1 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations J Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today, e i ems ❑ Embargo ❑ Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC72)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health., Failure to correct violations re ardiess of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than o6 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 rion-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FG5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9,non-critical." If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8.non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: nspect g ur In 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatur� a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N I ,� `J Ck/,� �` 2 Dumpster Screen? Y N --- Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-lOLl1 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 590.00411 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge.* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources i 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEIrEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness k 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.1](A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ctrve 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* i Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D m cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-( ) ( )-( ) Ratites-165°F 15 sec* Sources* � 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 see* Other 590.009 violations relating to good retail d Hygienic P i practices should be debited under#29-Special * 11 Goo Practices Reheating for Hot Holding 17 3-201.17 Game Animals g g Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3 403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'17 to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41*F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27ci00. . Physical Fa Poisonous FC-6 . 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 2 . Poisonous ci Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision f. 29. Special or 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p MEr TOWN OF BARNSTABLE. _ HEATH INSPECTORS Establishment Name:, yV �s Date: Page:.. of 'Y OFFICE HOURS LIC HEALTH BARE°. PUB 200 MAN STREET 3:30-4:30 P.M. DIVISION : 0-s:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 2 �A 3.e�0� HYANNIS,MA 02601 M-8 -FRI. 6 No Reference R-Red Item PLEASE PRINT CLEARLY rFo M FOOD ESTABLISHME PS T INSP CTION REPORT 50862-4644 N Name Date Tyne of Type of Inspection ' p Routine Address Risk ood Servi Re-inspectio Level Pr(viou Ins ect' AA Telephone Residential Kitchen Date: {{//���� Mobile Pre-ope 'tfo Owner HACCP YIN Temporary Su Caterer General Com Person in Charge(PIC). Time Bed&Breakfast Ot er Inspector ca Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ / FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 0 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 9 en �., ❑ 'a Neatia-4r, 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �`u/ ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 1� ! Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) � Corrective Action Required: ❑ No ❑ Yes_ Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑,Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on pection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than o 6 non-critical violations 9 26.Water,.Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical-violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-cr•tical violations. If 1 critical refrigeration. yfaW29.Special Requirements (590.009) within 10 days of receipt of this order. •on;4 to 8 non-critical viol ns= 30.Other PATE OF RE-INSPECTION: In'pe Ps i re 'P' t: 31.Dumpster screened from public viewA T,� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's ature Pn Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* PHF.Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590:004(F) 2 590.003(C) Responsibility of the Person-in-Charge to - - Other* 7'102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140'F* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control ' 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance-Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) 590.003(G) Reporting by Person in Charge* Contamination from the Consumer k 3 590.003(D) Exclusions and Restrictions* ... ..�. 7-204.11 Sanitizers,Criteria-Chemicals* _ m . .- REQUIREMENTS FOR - 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Ho[Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and _. 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 . Shell Eggs* - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155`F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 � Drinking Water from an Approved System* _ E * gg Not Otherwise Processed to Eliminate Equipment*590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* Etl cme 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.1](A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145`17* kitchen operations should be debited under RegulatoryAuthority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to ' 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* Yg 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1099 Food Code or 105 CMR 590.000. Ib � � Town of Barnstable t� 2'S� Regulatory Services GA/ BARNSPABM 2 I LQ I MASS Richard V. Scali, Interim Director v 1639. m , Public Health Division Thomas McKean, Director 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 07, 2016 ATTN. LICENSING DEPT. BYS WHOLESALE CLUB#321 420 ATTUCKS LANE HYANNIS MA 02601 ATTENTION Your food service/retail permit(s)will be invalid after December 31,2016. ESTABLISHMENTS FEE Food Service. . . . . . . . . . . . . . . . . . . . 250.00 Retail. . . . . . . . . . . . . . . . . . . . . . . . . . 285.00 FrozenDessert . . . . . . . . . . . . . . . . . Mobile Food . . . . . . . . . . . . . . . . . . . Residential Kitchens . . . . . . . . . . . . . Bed & Breakfast . . . . . . . . . . . . . . . . . Tobacco . . . . . . . . . . . . . . . . . . . . . . . . 50.00 TOTAL DUE $585.00 Food establishment inspections are ongoing by a Health Inspector;therefore, it is not necessary to make an appointment with the Health Division. However, if your establishment is not open during normal working hours(8:30 a.m.—4:30 p.m.), please call 508-862-4644 during these hours to schedule an inspection. Enclosed is a food permit application form. Please complete and sign the form, and mail it along with the required payment on or before December 14,2016, to the Town of Barnstable, addressed to the Public Health Division, 200 Main Street, Hyannis, MA 02601. Upon satisfactory compliance and receipt of your payment and copies of current ServSafe Certificates for two employees and one Allergen Certificate, you will be sent via mail your food/retail permit(s)for calendar year 2017. Important: If you are on a Private Well for Drinking Water(not Public Water Service), be sure to have your well test completed prior to our inspection. Reminder to All: 1) Maintain your logs. 2)Establishments with 25+seats are required to have a person trained in anti-choking procedures on premise while food is being served and to have insurance covering person with training. Failure to renew permit on or before January 1,2017,will result in an additional fee of $10.00 late charge. If you should have any questions,please call 508-862-4644. Q:dbfiles/inspectn.mdb reports Rest Total Fees Annual letter Town of Barnstable sAfexsr�t�. Regulatory Services Department MASS. � Public Health Division A 200 Main Street, Hyannis MA 02601 . Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $50.00 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION . 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$50.00 APPLICATION FOR A TOBACCO SALES PERMIT Luce Graham N. LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL Mailing Address Location Address BJ's Wholesale Club Inc. BJ's Wholesale Club #321 D/B/A ATTN LICENSING 420 Attucks Lane 25 Research Drive, Hyannis, MA 02601 Westborough, MA 01581 STREET ADDRESS Club# 508-568-4035 1 _ TELEPHONE # FID# Licensing # 774-512-6586 Do you currently possess a state license to sell tobacco products? Yes X No' Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). v 11 21 2016 Signature Graham N. Luce/Secretary Date Q:\Application Forms\TOBACCO APP.docx '10 ter of Barnstable � ati Regulatory Services DST A�T BARN Richard V. Scahl Director mass BARNSTABLE Fo� A'`� Public Health Division °�9-2014 iese-zaia Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: 11/21/2016 NAME OF FOOD ESTABLISHMENT: BJ's Wholesale Club #321 ADDRESS OF FOOD ESTABLISHMENT: 420 Attucks Lane, Hyannis, MA 02601 E-MAIL ADDRESS: gm321@bjs.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: C5D8 778 - 7756 NUMBER OF SEATS*: INSIDE: 18 OUTSIDE: 0 TOTAL: 18 * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: 5 ANNUAL OR SEASONAL OPERATION: Annual TYPICAL HOURS OF OPERATION MON-FRI: 9 :00 AM TO 9 :00 PM SUN 9am-7pm DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY X FOOD SERVICE X RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) I ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT BJ's Wholesale Club, Inc. SOLE OWNER: YES/NO ADDRESS PHONE IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: i IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION Delaware FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1, SEE ATTACHED EXPIRATION DATE: 2• EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1. SEE ATTACHED EXPIRA ION DATE: /_2L/2n i 6 SIGNATURE OF APPLICANT AND DATE QAAppficationFormsTooaapp1doc Graham N. Luce/Secretary 11/28/2016 15:52 FAX 5085684040 Ws (0002/007 TOBACCO SALES Employee Signature Form This form is for official use to indicate dr sections VII b. at the employae(s) of this establishment received and understood and VII e. of the Banistable Board of Health Prohibition of Smoldng Regulation and the enclosed copy of Chapter 270.Section 6 of the Massachusetts General Laws which describes the penalties fOT selling and/or giving tobacco products to any person under the age of eighteen(]8). Below are sections VII b. and Vil c. of the Barnstable Board of Health Regulation: 7BW D DISTRIBUTION OF TOBACCO PRODUCTS In conformance with the Massachusetts General Laws Chapter 270, Section 6, orporecion, establishmen or to emo !3 agency sball sell tobacco products to a minor. p Yee working In an establishment licensed to seA tobacco product shall be required receive a copy of the Board of Health regulations and State Law regarding the sale of tobacco and sign a form indicating that such rogulations/laws have been received and understood, a co which must be placed on file, in the office of the employer and retained. Such Biped formspmust be.made available for inspection,during the license holders normal business hours upon request of an agent of the Board of Health, c. All distributors/retailers of tobacco products or tobacco merchandise must require that, if a customer appears to possibly be under 25 years of age, the customer present a valid State issued picture identification card or drivers license with appropriate photograph to confirm that the customer s�i age to purchase the tobacco product. The following employee(s)received and understood Sectlons Vllb. and V11c. of the Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Soctiott 6 of the Massachusetts General Lawn; Printed"Name ate A AA Sign e e I ^ d Pruned Name Date Printe�Ne Date nac -�- � I � � I �- ted Name Date gn e ZNamName Date C , Sign hue Date ignature _ C Q Printed Name Date ^" Q\APPlicaUon FormskTOBACCO APP.docx r 11/28/2016 15: 52 FAX 5085684040 Ws TOBACCO SALES Employee Signature Form This form is for official use to indicate that the empioyee(s) of this establishment received and understood sections VII b. and VII C. of the Barnstable Board of Health Prohibition of Smoking Regulation and the enclosed copy of Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of eighteen(18). Below are sections VII b. and VII C. ofthe Barnstable Board of Health Regulation: SECTION Vu—SALE AND DISTRIBUTION OF TOBACCO PRODUCTS b. Sales To MinOrs—ln;conformance with the Massachusetts General Laws Chapter 270, Section 6, no person, firm, corporation, establishment, or agency shell sell tobacco products to a minor. Each employee working in an establishment licensed to sell tobacco product shall be required to receive a copy of the Board of Health regulations and State Law regarding the sale oftobace0 and sign a form indicating that such regulationsfiaws have been received and d which trust be placed on file, in the office of the employer understood, a copy of and retained. Such signed forms must be made available for inspection,during the license holders normal business hours upon request of an agent of the Board of Health. c. All distributors/retailers of tobacco products or tobacco merchandise must require that, if a customer appears to possibly be under 25 years of age, the customer present a valid State issued Picture identification card or drivers license with appropriate photograph to confirm that the customer is of I egal a e to Purchase the tobacco product. The following employee(s) received and understood Sections VIIb. and Vlle, of the Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: s;gmaaue Printed Name Date Signaturo I� J 41' tMcdXam Dato Print Name Date �=---- � Prin Name _, Date _ - r t Jr Print d a e bate r-- Sl e� Printed Name C Date Shalac- "Signature Printed Name Date Q%Applicadon For m9%T09ACCO APP.doax f ` MASSACHUSETTS DEPARTMENT OF REVENUE Letter ID:L1298228224 PO BOX 7044 Notice Date:September 23,2016 BOSTON,MA 02204-7044 Account ID:CGL-11635421-115 ' CONTACT CENTER " . (617)887-6367 RETAILER LICENSE FOR SALE OF CIGARETTES rlr��rrl�Irrrlil�ir�unir�ru��lldrr�I�IIIrII�Iflrir���hH�rr BYS WHOLESALE CLUB INC BTS CLUB#1 PO BOX 5230 WESTBOROUGH MA 01581-5230 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T).Cut along the dotted line and.display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617)887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE --------------------------------- cau, MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of.Cigarettes •e This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. BJ'S WHOLESALE CLUB INC Account ID: CGL-11635421-115 BJS WHOLESALE CLUB#321 Location ID: 11635421-0064 420 ATTUCKS LN License Number: 1010421760 HYANNIS MA 02601-8141 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2016 Expiration Date: September 30,2018 �.�c' � ''^^.� 4+ ��iR- wl ^•-�'.s';-r Iqt 1-• � �4-.�;t �r ti°"t"C' y—�-•L' :..�. � , i - ,. �� ��_�.�_ _� , �. :- - , , i ���;- � - :�R?�ti .:{� :�� �v = �^ n . �.��- n r� �� � � - - ; � : �.; n : i - . • _ n� _ � �� - : v� ��F� : t.:.s�:,. - = �'1.-; �'� - +- / �. - •� �� ., , . , f'1= '.�\�,.}Cl�,_;C'��,Clc7,_.C��3rCl�.'�7�c�.'C��,�Cl�c,_��7('��,_ ���_ y�: -..ti��`.� �. y yU��" �.r,.. � � �- ••t. i>.� .i i. e;��t`.,i- i ;,ty.:,,- ; — i i ;:'T,-�,�- i i �• ServSafe ry a.f CERTIFICATION ANNE PETRINOTAFT for sjocesfuly mrrpfelirg the staK6 s set forth for the Serv5a64 Food Protsrion m3Wq r Certiificdm E"mrvdion, which is occretlitecl 6y the American National Standards IndMe(AN9)-4Cor& rmxe for Food Protedion KfP). 59707 5131 UMBER EXAM FORM DUMBER 4/4/2 4/412021 UAlt OF DATE OF EXPIRATION Local laws apply. ry far mcwffimilon requnerneoti age t #W55 6 a�a W A A+09f•+• • DAIS hr� m�od.nvlsef it PEAff. � Cdbd as wh gmdcas d 175 W kc6m Blvd.5h IMO,Q:veo,L 60601 SwSd.9reir,mAs.g ServSaf�e ery nf -MAOCERTIFICATION DAWN FERREIRA for wocessfuly=V"n9 ire OwAards set fort,for the SmS V Foocl Prntedion hkcrx r Certifimion 6 mkmofi n, whick is accmcbed by tke American National Standards Institute{AM4 -on6rmw for Food Pratedion i(CFPl. 459709 5131 • UMBER EXAM FORM NUMBER 41412 4/4/2021 DATE OF E DATE OF EXPIRATION loc9l 6.apply. 6 mcmite3tim regLima nts. �a 56 90855 0 t marls 1Jofced boo cm rodwr"oFG.tl. ~ C«Jai u.dh¢..dine,s 17S W Jm:6m Md.56 ISop,Chicago,L 60MM o.5wvSm64 d=mrlop r • � _ • �002 w r... �7 r' w T -r 1 x rty� r CtRTWICATMN IAN PARENT for wcca::Afuh canw1alkr8 iks aum6cl+wj 1.4(or if,,,se s,44-Eaocl Pt'al lltal lvlanB i•CariifionNon ErttpehlulN7r1,wWeh II iaccradilad Iy the Anwei-irtill Ng00110i Siarm6clt N]lhlul'a(AldW} w4wvftp by Food Frolmciion ICED). 6046 UMBEk EXAM FORM NUMBER 04/1 04115/20120 DATE OF E DATE OF EXPIRATION Lpaal bwaegtlp�. � tcyior resallYiKa11nt1 ryYgpinmprr{a. r Sw Jt LOB66 ( 1 ' 6,vnuad�r,•ri�Mxnwn tJw• . :`ipl9 Nuk�ad bY'+uro auilwiv6 allMNWfi, ,. ..yd'�'""'�LL��� t:M11Pi0 vr.wlt N175W ... ..;�:• •9 � _ 'F"�^^� hx6xm pin09k IMN),I.lumpn,tl,60tlp4M tlMv3dMNPMUVwdwp i TOWN ARKS E BUILDING PERMIT APPLICATION Y Map �14, 2� Parcel ti0 "/ Application # 3qt� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board C� Historic - OKH _ Preservation/ Hyannis 3 70 Project Street Address Village 00( Owner f�1[26f � Itl''1 9[42 qkL UZI Address '� �1.5'fDt��tC.'WTW ,MN 0245.1 Telephone Oil ''2,t'(-q ' L•N0 0 Permit Request w9 i-n DO Lt to dog yQr-T To o Silt!�i 9N eS WRDl6grzk[4� • � � � Total new Square feet: 1 st floor: existing proposed 2nd floor: existing proposed osed �p Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 5 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 2 � � Age of Existing Structure � Historic House: ❑Yes W'No On Old King's Highway: ❑Yes 0 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other W Wempif, Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑Other I Central Air: _Ures _ Ll No Fireplaces: Existing_ New _ Existing-wood/coal-stove: ❑Yes ®,No I : ❑ xistin ❑ new size— Attached I Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new 'size _ Barn e g garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board Zes peals Authorization ❑ Appeal # Recorded ❑ ICommercial ❑ No If yes, site plan review# 01& — I I Current Use MffW T(U l5 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1G '� LOf?=SC.� Telephone Number ( 0 Address bl&011 WKY--lPea W61 icense # i 4,66 ho PWAS I IUD Home Improvement Contractor# ettk01 Email RLbes �(g'�(l�V�{'�" CoM Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 2 �� 1016 Page 1 of 1 Stanton, David From: SMGR321 [SMGR321 @bjs.com] Sent: Monday; October 15, 2012 11:27 AM To: Stanton, David Cc: Ferk, Emily; SMGR321; GM321 Subject: tphc variance Dave, The following is how we hold our pizza here at Bjs in Hyannis. The only food we hold out in the open is pizza. After cooking the pizza we immediately place the discard time on the shelf tag above the pizza. The discard time is two hours after the pizza is cooked. If the pizza is not consumed after the 2 hour waiting period it is discarded. Any questions please call. Eric Jeffery Meat Manager Club 321 Hyannis, MA The Information, including any'attachments, contained in this electronic messa k 6 5/8/2013 Goods Movement Report Article- 41 [[1.Article Description i Movement Type Quantity Unit of Entry F'Cost Posting Date t Reason Code Reason Code Text User Name i Site Purchasing Document f Article Document 27272 f W FARMS 3/16Z SLICED BACON 551 1 112.000 EA 88640 f 07/21/2016 i 187574 0321 f 14939965531 ` .�...,_.,,�.,....,w..,...,v ._.x,,..,..,._.-•m'..._.w,.x,.,�,.,.,w._ �,.»_.__._._..xw,._.,._,µ,_w....m_.w„w, .>....,.__w...w rw...w._,..w..�_,..,..w_.,..._w.w.__......._._....,_,..».,..m..w.,w».....:..w.w,w..:..w ,� � �..„w.�.,..._»...�_w. ..,� 21681 i SMITHFIELD 3LB BACON 551 46.000 EA j 37995 I I 1 187574 103 4939965531 i w� 16286 W FARMS 3LB THICK SL BACON 551 46 000 EA j 395.83- 187574 i 0321» 4939965531 y... �.. ..,._...,. r. ,... M ., ..._M._, . .,'_._._M., ,,... _.x,., 19634 OSCAR MYER 31-13 TURKEY BACON 551 37.000 EA 272.14-a i 187574 0321 j 4939965531 w 29137 ROSE 240Z CANADIAN BACON 551 ' 29.000 EA j 178.35-i 187574 0321 :4939965531 j 210051 {HORMEL 24 OZ MICRO BACON 551 29.060, EA 7 231 71 ! 187574 0321 N{4939965531 2W68 [FIORUCCI 22 OZ PANINI ASSTMNT 551 ? 23.000 EA w 249.19. ¢ 187574 0321 j 4939965531 19584 s O MAYER 9:802 RDY SRV BACON 551 23.000 FA 213.47- 187574 j 0321 `4939965531 �.�._�.,_mm ..ww.__._ 302125 ;O MAYER 3/120Z CNTR CUT BACON 551 } 2.1.000 .EA " 210.27- 187574 0321 4939965531 f :...... ............................................__...,,_.._......_,......,...,.., . ........... _.. _..... ...... _...._............... ........ .....� 23752 �.WELLSLEY FARMS PRCKD BACON 551 f 18.000. EA 120 15- 187574 0321 4939965531 27479 APPLEGATE 2l7Z SLOW COOK HAM 551 s 17.000 EA ,1 ` T09.03- 187574 1 0321 4939965531 27482 ;APPLEGATE 2/7Z ROAST TURKEY 551 14.000 EA 101 54 �' ; 187574 0321 1 4939965531 32843 API_EGATF_3/80Z GD MRNG BCN 1 551 13.000 EA 11Z 32= 187574 10321 4939965531 ! 27483 APPLEGATE 3/8Z TURKEY BACON i 551 1 10.000 EA 86.40- y i ~187574 1 0321 4939965531 }} j j.APPLEGATE 2/SZPROVOLONE 1551, 9.000 EA 5211 187574 ;0321 49-965531 27480 „ .+ w,w.ww„w.._.,.»w.ww..3„„.w.......w._�..w.,w., x�.w„..::.:: ......,,.,w_�...�..,.,,...x:1d wK:._.,,.,_,_x.,,,,r _,,..ww,.:,...,_..M....w.x_ww ,__,..,.._,,.,,.wwp µ»_ww�,w..w„��_,,_,....,x..,.M.ww,..w.,,,..3w•.�,,,. .M.x..,,w,.,._.,., x w � 4 '187574 0321 4939965531 i 27481 APPLEGATE 3/0Z SUNDAY BACON { 551 i 7.000 EA 71 12 a 1 ; _.._ _..._.t....,,...,....... _....,. ..__....._.......___.... w. .....,._.__,.7_..,..........._..._ ........ „..„......._...__....__. _..._,...,..._,,.,_,.„.,,.,.. v_....,w...-.,.. w w_. 319203 JIM DEAN 30 OZ PRECOOK PATTY .551 3.000 EA 19 48 i 187574. ;0321 4939965531 5_.•„_.„_...... :..w......,w..,._w.w.,,..w~w.�w.w.....,_..,.,._.,.w.�w»„.,.,......w,....,.,. ...._..w„w._..w,..�,w.,........». .ww. .w„ :..: p__...,..,,_..x..m....,.-.--d�...,.wmw,w.`..,,,,x.,.,.,w..w._.,,..�„_w.,.„...,:.,w...,....E,..,w.,.,.., ..._.., �w,,.,,_...x..,..�...,...w.,m...:,w,.. 30148 VRMNT BCN 2/10 ALL NTRL BCN 551 j 1.000 EA � B 0- ,.` 1 187574 }0321 { t 4939965531 ��.,,....,...,wx,..,.><.,_..,,..._,._.....,.._......................................w.,w..._»....,«_:.,,...,.., j w..w,.,..w,..,�.._.,...,,.,w.,,.{ w--Lw1 ww.,,....,•.+,•x,...,w......,.,.,..,,w..w..,w„f,..M„.,x,«x.,,...,.,.....,.......�.......,.,,....+,.,....,,.xw,..,-.,....«.,...w,.,,w.,.„,...»«,,,.,,.w,L..w..,.,_„w,w,..,x,�..,....,.,..»....�..,_..a 28327 BELGIOSO 3/8ZM MOZZ BALL #551 53.Kp EA 280.68- i.187574 0321 4939965539 i.K...,..««..,.,.,...,.,�.._,-...-................... _.,.,,,.,.....__._.,,,s,......._._„w,,..-..u..,.w..,..m. �,�.�_.,......._w,M,.,_.M.,..._...,..iw�-.... _ ..._. ..,......,,.�.... . .,.-_.. III . .,.W,.,..,.,......... ..,._,,...,,.... .....a._.._.,,,w,.,.,.,. ..,32553. L;ELGIOSO 4/607 SI ICFD Mf_iZZ 551 1 31.000 EA � f 218.9 1 187574 i 0321 �4939965539 23878 �W FARMS 32 OZ CHEESE SAMPLER }551 FJ1# 48.000 318 74 _`_"^----.,.-�...•_-.-,ww.ww,_N,.,.,�..w,....._....,.._. ..,__...._.......�.,,,.,,�.,,..,..,....,,.ww,...»..,.,....,.�.,i;..w...w�...__�„w.�., O 187574".,.....,_Sw0321 .4939965539-- 1 ,.,..,..�..,_.,.w...�.ww._. �ww..,.._, 33026 GRT LAKES 320Z PPJ CUBES 551 ( 2fl.000 EAi 145 81-i ! +187574 !0321 4939965539 i.31050 f BELGIOS0 20 OZ MZ7_RELLA PEARL 551 M,.M V ~N ! 29.000 EA 131 52-1 f 187574 10321 4939965539 . ii .jw..�.,.,,.W_,...._., 1 :.....•._. .�........... .....,_...•.,.. _....-. ,,.,�,.........:,..-.._ - ,...�w.ww..._..,,.x.., --,....:W',�...,aw„,,._..w,. „,w.w..,:..„:...,.„„..,..w..�, .mow.. .,._.,i x.....-..,...__„:............ �....,.x...._.,.a,....�...,...«,_,,..... .,,.,..,.,.,m....,,..,.m-....,..,.,...m.,..... ......:,..,«.......w i.30148 VRMNT BCN 2/10 ALL NTRL BCN 551 27.000 EA 216.16- I a 187574 0321 4939965539 121601 [[SMITHFIELD 31-6 BACON 551 i 26:000 EA 214 76 187574 ¢0321 4939965539 i .._..,........l.,,,,._..__....... ......_,..,.,.._._,_................_.._...,....._,..._.w.,.,__ .........._ .._...._...,,_........ ._.........._....,.... _................,....... ._ ..........._...i.... ........_................. .... _... ,.,.....,,.,,..i 28556 LIONI MARINATE CILIEGINIE CHZ #551 i 23.000 EA 125.61- t j j 187574 j 0321 4939965539 a_...w.,w..w. � :,,..:f..._...ww_..• x.«.., ' .w_.,.,,,„,.w,.___w,.. �187 74_......,•-..,=1 .w.w ,_........ww.w,...x _». _.,,w..._._....,_._..,.�. ( 319203 JIM DEAN 30 OZ PRECOOK PATTY � 551 15.000 EA.--I 96.39- 0321w 4939965539 I j33025 f GRT LAKES 320Z CHEDDAR CUBES _ 551 14.000 EA 63.27- 1187574 0321 i 4939965539 ...�__........-.....____,..__.__...._._._._..................._. __..._.__... .M_._ _._......_.__.,.. ._ _:.._._,..._:_......__......_..............._...._._...... .� � z..._ � .__............_......._..__..........................,....._...._._..:......_.........._.,....,........ BJ's Wholesale Club, Inc. Page 1 of Jul 21, 2016 1:26:52 'PM Goods Movement Report Article I Article Descriptionry+ Y I Movement Type Quantity Unit of Entry Cost Posting Date Reason Code Reason Code Text !User Name ,Site 1 Purchasing Document !Article Document i 32899 GALBANI 180Z FRESH MOZZ 551, 11.000 EA 54.98-�.07/21/2016 y ( 187574 0321 p 4939965539 ,...,..._.,.;w ..�<,,.�. ,m.,.,,5.,�,.w... ....,... �.w,,:,...,,. 111 ........,_..,...wWE �.._..,..,w.._,..„..,.�....!_..,.w._..,,,..w.....:....:....._,.,,.i......,..,...,.....,_�.,.i-. ,...»M,....,.,_�..,.w,__......_.,,.,.........._ 27477 i APPLEGATE 2r7Z BLCK FRST HAM 551 i 11.000, EA 70.56-'j g 187574 s 0321 t 4939965539 27484 APPLEGATE 2r7Z SMOKED TURKEY a 551 m 11.000 EA 79 80 187574 0321 4939965539 27483 APPLEGATE 3/8Z TURKEY BACON 551 '10.000 1 EA 86.40- § 187574 0321 4939965539 { f f '24019 GLC SWISS CUBES 2#BAG 551 9.000 EA 60.69- 1 187574 !0321 4939965539 3 28026 ;LIONI 16 OZ MOZZARELLA 1 551 9.000 s EA 31.09- ( j 187574 10321 i 4939965539 i 68756 BELGIOIOSO SNACKING FONTINA 180Z #551 7.000 EA 39.52- �` } 1 187574 0321 T 1 14939965539 i 30348 y BELGIOSO 16Z PARM GRANA 551 5 060(EA 23.80 187574 0321 i 4939965539 3 32992 i VT UNCRD CDR LS BCN 2110Z ((551 3'000 EA 24 01 j 187574 j 0321 4939965539 :...m..._.._..,P ..... „,...._..._......_._ .,...._.._..............0 .... ............ �..:...»_ .. ...._.», ._. ,...,_ .. _....., iii ..._ ._..-_ ...a:,. .» ..... _. ............ ... ...,... .. ,........._. .._..... ......d .,..:.�. 1 :. jj 27480 €APPLEGATE 2/87_PROVOLONE 551 1.000]EA 5 79 i 187574 0321 14939965539 . 29137 ROSE 240Z CANADIAN BACON 551 1 1.000E EA 1 6.15- j 187574 0321 1 14939965539 ..{. 5 991 88 E �0712112016 9 699188' g I e gg f ;" a t BJ's Wholesale Club, Inc..' Page 2 of 2 Jul 21, 2016 1:26:52 PM RANSOM Environmental Consultants,Inc. September 22,2010 Project 101.02042 Mr. Thomas A. McKean Director,Barnstable Board of Health 200 Main Street Hyannis,Massachusetts 02601 RE: Public Notification Response Action Outcome Statement Hydraulic Oil Rel.-ase BYs Wholesale Club No.321 420 Attucks Lane Hyannis,Massachusetts MA DEP Release Tracking No. 4-22748 Dear Mr.McKean: The purpose of this letter is to inform you that a Response Action Outcome(RAO)Statement has been filed with the Massachusetts Department of Environmental Protection(MA DEP)for the above referenced property located in Hyannis,Massachusetts. The RAO Statement is available for review at the MA DEP Southeast Regional Office, located at 20 Riverside Drive,Lakeville,Massachusetts. This public notification is being provided pursuant to the Massachusetts Contingency Plan, 310 CMR 40.1403(3)(f). If you have any questions, please contact meat(401)433-2160. Sincerely, Eric Axelrod t:- 2010.09.22 11:21:30-04'00' Eric M. Axelrod,LSP Senior Project Manager/RI Office Manager EMA:sh `, 7 REC'D i 'l SEP cc: MA DEP, Southeast Regional Office By 60 Valley Street,Building F,Suite 106,Providence,Rhode Island 02909,Tel(401)433-2160 Pease International Tradeport,112 Corporate Drive,Portsmouth,New Hampshire 03801,Tel(603)436-1490 400 Commercial Street,Suite 404,Portland,Maine 04101,Tel(207)772-2891 Brown's Wharf,Newburyport,Massachusetts 01950,Tel(978)465-1822 2127 Hamilton Avenue,Hamilton,New Jersey 08619,Tel(609)584-0090 www.ransomenv.com i Environmental Consultants,Inc. September 22,2010 Project 101.02042 Mr. Thomas A. McKean Director, Barnstable Board of Health 200 Main Street Hyannis, Massachusetts 0.2601 RE: Public Notification Response Action Outcome Statement Hydraulic Oil Release BFs Wholesale Club No.321 420 Attucks Lane Hyannis,Massachusetts MA DEP Release Tracking No. 4-22748 Dear Mr. McKean: The purpose of this letter is to inform you that a Response Action Outcome(RAO) Statement has been filed with the Massachusetts Department of Environmental Protection(MA DEP) for the above referenced property located in Hyannis,Massachusetts. The RAO Statement is available for review at the MA DEP Southeast Regional Office, located at 20 Riverside Drive, Lakeville,Massachusetts. This public notification is being provided pursuant to the Massachusetts Contingency Plan, 310 CMR 40.1403(3)(f). If you have any questions,please contact meat(401)433-2160. Sincerely, Eric Axelrod 2010.09.22 11:21:30-04'00' Eric M. Axelrod,LSP Senior Project Manager/RI Office Manager D ULD EMA:sh cc: MA DEP, Southeast Regional Office S E P 2 4 REC'D By p��Q 60 Valley Street,Building F,Suite 106,Providence,Rhode Island 02909,Tel(401)433-2160 Pease International Tradeport,112 Corporate Drive,Portsmouth,New Hampshire 03801,Tel(603)436-1490 400 Commercial Street,Suite 404,Portland,Maine 04 10 1,Tel(207)772-2891 Brown's Wharf,Newburyport,Massachusetts 01950,Tel(978)465-1822 2127 Hamilton Avenue,Hamilton,New Jersey 08619,Tel(609)584-0090 www.ransomenv.com S` Y. ,ggqq t r t. r . w, r � ,�..,..�—..,—.--..,r,--�.,�_ � �� _ .. :.: �.= t �.. � . , p� �� �.; .-: ,¢ e. �� �. +_. ,����� ` ,; �`��. �� � �. :,� .�� �, � My sue. , . . , . �� �* �� .. a!* ,' ; t• �� * � � .� �� ,,� .� `* e �,. w _ _ . . r � � v ;'frc e v < k A J ` r k. t tt� 3 x i a. y 0 a r � t r fi' r «_oil T`RG�1 S Dec q9o4<)q)c- Z)� 11 3 1 t 'a I.A1, r 10 * i 12 3W 'k t r: • f�41 t; f f l�� y, t a 70 ART 'FEN F? 2 OPEN GAS SUPPLY n {e { 4 PRESS'PR ED MAIN SWITCH .IFCAN PRES fGNtTION FAIALg TO IGN17E 7 ^ S WNEN• AIT S MINUTUS El,_ PRES READY IS DISPLAY UT AGAIN'°. - B-LOAD SSKEWER M ANCELA EDANDA—AI SOUNDS�*'4d1".,s� '+•PRESS DES RED PROGRgM BUT70N '� 3-ME SURE NTA CAN ERM WILL SOUND ADD SIM"N e-PRESS DSKEWERSF REOUIRE7DURE - TO CLOSE ND HOIp CIR'TO RESET.PRO' M Rq j Z-CLOSE ED OA MAIN gWITCR'S 9UPPlV .:� 14 1 ^ • MF T , q , Y • � a V Y l r . . s f y I a. r r f; f'. 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BacBack 5• NotusuPpi sure Y Pressure 10+ si Mrtsnded to.olheTpfiase.l.5 q rs—°!isltV'o^*��. 1nPut r ProP-nq 1�+w.c. �Kdu3.t/•C useh a�y��H�sa� Natural rating BTU/hour w•c. 1i►trp $� 2�2 oid use. Am E{e rood pro 87,000 i aids arse�between t Service Equiprhent Pane 92 0� iYM side19 -NOte_tter sarvicgl t4ssr►e and the comyu6ttbie Construction: rap l aM t ' is,it6r larvic.e MA ppRr�t For 9Ep�E call 1�O +stitµe ►oni 47 C UC 24hfs!7 0 `. ut m„><� tiE�U Rp Qfthaf num4"r49Ye $ 4e' �a - ` .4 l K f AL OL"L �..-� syg� f,l,•�� . / - ; a • d r ev Y $ 4 aD tic S " At— � 1Wife 9 4 y �,,, _._ —— "� _..� —�-_- ___ �_ :: —�f� - s, - � � ,:,t �` e� �,, _. ,<,�, ti., wti .. ,� a ,� * _ _ .. _. r �� ,� - , .. � .f �`� �.,� } �. �: # y.. � 1 ;, ' i �,. �s �.. A'r _ � *�. }t A � J t� � W � '�: 9yu { • i t _ ,f x �, °��, s "��3 / f � rr... t,. � ��: a. --: � !��N ice"' ar s�• ��i *fir ' ���y�. r t- ''t `'4�i!_ •:.,,,,ram'.' - c. � � i��M t/lt2if61` � �;�' . ,.N � -3� 'm1•_ �� ,fF or" A ri t .Y• ���4 it i �.. LY Yam• A `-C, � , ilY A�A;jY i 1/t�`�}� � � �i'�'` M � •, /7 -s. �n�. �.. Afi J atks , f✓ � Stu'.�giF+'t,�•,A�• :�At,', 1 -'S f aR a .r G„ •os `�titer" d. � �� 'r> y r 4 �e kr r OP 4 � f • ��, s' � � � �.�ix�s � ¢ x � t, fti• ., _1 S.`�ar'pp� I' i �� NY 1•� Y . Y Al f � "t IP41' +4r„ oil 4 4 �` Sig 4, �� vIAM L j � �J v u Las Made ©MF'G/TER TEST/NG Computer Test Report NATIONAL REGISTRY OF FOOD SAFETY PROFESSIONALS, INC Food Safety Manager Certification Examination NOTIFICATION OF TEST RESULTS GIOVANONI, LYNNE Scaled Test Score: 83 420 ATTUCKS LANE Candidate Status: PASS HYANNIS, MA 02601 ID NUMBER: 11111111 Test Date: 10/29/2007 The passing score on the exam is a scaled score of 75. A scaled score is a score based on the number-of`:gnestions you answered correctly that has been converted to a standardized number. Failing Candidates shdi l&caiefuliy' ' review the diagnostic score report to determine areas that need improvement. This will provide-a fr3mewoYk f'or-`.'c. preparing to re-take the exam. LaserGrade will send your examination results to The National Registry of Food Safety Prof6d-lonals ivitMin the - next few days. If your Candidate Status-is-PASS, your certificate,and wallet card will be sent,,to you witfii?; the next two weeks. If you have any questions or comments regarding this examination, pleao� .ror-tact: National Registry of Food Safety Professionals Telephone: 800-446-0257 Please note LaserGrade personnel can not answer questions with regard to exam content and score information (i.e. passing percentages) DO NOT LOSE THIS REPORT UIRUNUbTlU PORTION OF EXAM SCORE - PERFORMANCE DATA Ensure Food Protection 82% - Competent Purchase and Receive Food. 91$ - Mastery Food and Supplies Storage 828 - Competent Foods Preparation, Service & Display 83% - Competent Equipment & Facilities Maintenance and Cleanliness 50* - Needs Review Personnel Hygiene, Training and Behaviors Related to Food Safety 928 - Mastery Legal Compliance 100& - Mastery Applicant Locator: GIFE1026 LaserGrade Computer Testing Testing provided by: LAS02301 P 0 Box 87245 Bridgewater State College Vancouver, WA 98687-7245 Maxwell Library Room 001A 800-211-2754 or 360-896-9111 Bridgewater, MA 02325 www. lasergrade.com 508-531-1780 r ,xr r x T - r 7 a § o�>ooDs y THE NATIONAL REGISTRY OF FOOD SAFETY PROFESSIONALSO u CERTIFIES r y MELISSA MATOTT CEiZTIPIED HAS SUCCESSFULLY SATISFIED THE REQUIREMENTS FOR Pooastrerruarvteex # �`�� � �`r�s THE FOOD SAFETY MANAGER CERTIFICATION EXAMINATION 2 D 1 } - �. W Vf' '-M S ln" P F" President t:sP National Regtstty of Food Safety Professt+ynals Law»nce I'L}•mh is a'dnlslon of En�troninental HealtLi Testing LLG R ON-% ISSUE DATE: NOYEMBER 13,2007 CERTIFICATE NO:XE20190097 -' - Y TEST FORM:XEDA ,a #0656 �d ter 'f6iv certificate is not valid for more lhaa five years from date of issue Notification of Test Tlesult 0t�aa Y s,,,. �, „ National Registry of Food Safety Professionals CERTIFIED FOOD SAFETY MANAGER TDJJjj }x- Scaled Test Score: 88 ; MELISSA MATOTT Candidate Status: Pass: Test Date:November 13, 2007 ; � w Certificate No:XE20190097 Issue Date:November 13,2007 c t n -------------------' Congratulations!Attached is your certificate and wallet card.Please notify MELISSA MATOTT the National Registry of name or address changes at the address below. 420 ATTUCKS LANE Attn: General Manager HYANNIS,MA 02601 Ensure Food.Protection(You scored 82%correct).Competent Purchase and.Receive Food(You scored 91%correct).Mastered Food and Supplies Storage(You scored 82%correct).Competent Foods Preparation,Service&Display(You scored 89%correct).Mastered Equipment&Facilities Maintenance and Cleanliness(You scored 81%correct).Competent Personnel Hygiene,Training and Behaviors Related to Food Safety(You scored 83%correct).Competent Legal Compliance(You scored 100%correct).Mastered National Registry of Food Safety Professionals® 1 5728 Major Blvd Ste 750 1 Orlando,FL 32819-0000 Phone:407.352,3830 Fax:407.352.3603 'Y. :f Groundwater Monitoring Report BJ's Wholesale Club Hyannis; Massachusetts AM �+ ^s ozipoi February 2005 COPY Prepared For: Tarkinow Group, LTD Post Office Box 590128 335 Boyleston Street Newton,•Mas sachusetts.0245 9 ,en �� Providing Innovative Solutions For . Solid Waste e,j Health & Safety a- Hazardous Waste Environmental Monitoring R dioN- �fi 1 Materials Management ®,0 Compliance Outsourcing www.greensealenvironmental.com Phone: (508) 888-6034 Fax: (508) 888-1506 28 Route 6A, Sandwich, MA 02563 5e'0 T February 10, 2005 10 .V fi Morris Tarkinow j�0Inn TARKINow GRouP, LTD Post Office Box 590128 335 Boyleston Street Newton, Massachusetts 02459 RE: Groundwater Monitoring Report Proposed BJ's Wholesale Club, Hyannis, Massachusetts W. Tarkinow: This report has been written to provide information regarding monitoring groundwater quality at the BJ's Wholesale Club in Hyannis, Massachusetts. All conclusions in this report are based on the scope of work and the service constraints in Attachment 1. Attachment 2 presents boring logs/well construction details. Attachment 3 presents a copy of the laboratory report. Background On April 10, 2003 the Cape Cod Commission (CCC) issued a Decision of the Cape Cod. Commission to the Tarkinow Group, Ltd (TGL) regarding a Development of Regional Impact (DRI), which allowed for the BJs store to be constructed. During permit negotiations, TGL agreed to create a Groundwater Monitoring Plan and install. a groundwater monitoring system consisting of a series of monitoring wells for the purpose of monitoring groundwater quality on a yearly basis. Samples of groundwater collected were to be analyzed by a laboratory for certain compounds and characteristics that are reflective of the hazardous materials stored at BJs. System Installation On January 4, 2005 a Green Seal Environmental, Inc. (GSE) environmental scientist oversaw the installation of 5 groundwater monitoring wells at the site. Two wells were installed hydrogeologically upgradient of the store and two were installed downgradient. The remaining monitoring well was installed downgradient of a lined retention basin that is the end point of a hazardous waste collection system designed to capture hazardous materials that could be released from the store during a catastrophic event. Phone: (508) 888-6034 1 Fax: (508) 888-1506 28 Route 6A, Sandwich, MA 02563 f ee n s4,--to 6 � The monitoring wells were installed by Desmond Well Drilling of Orleans, Massachusetts using a hollow stem auger rig and following the method for water table monitoring wells in the Massachusetts Department of Environmental Protection's (MA DEP's) Standard References for Monitoring Wells (1991). Samples of the materials that were drilled through were collected with the aid of a split spoon sampler following ASTM Standard Penetration Test procedures (with a 140 pound hammer and a 2 inch diameter split spoon sampler). The collected samples were classified using a modified Burmeister System. Please see the boring logs in Attachment 2 for details. The collected samples were field screened for total fuel oil range volatile organic compounds (VOCs) using a photoionization detector (PID) equipped with a 10.2 electron volt (ev.) lamp following MA DEP's recommended Jar Headspace Method. Please note that no concentrations of VOCs were recorded above background levels in any of the samples screened. Also note that no staining, odors or other obvious signs of oil or hazardous materials was observed in any of the samples collected for field screening. Two inch diameter monitoring wells were installed in each boring so that the screened interval straddled the groundwater table and accounted for seasonal fluctuations in elevations so that a portion of the screen was always above the groundwater level. Four monitoring wells were installed within flush mounted steel protective casings equipped with locks to protect against vandalism. The remaining monitoring well was installed within a locking "stick up" steel protective casing that projects approximately 3 feet above the ground surface. All protective casings were installed in cement grout. Initial Groundwater Sampling Event On January 7, 2005 GSE returned to the site to collect groundwater samples for laboratory analysis. Although Standard References for Monitoring Wells, as well as general industry practice, recommends allowing the groundwater to equilibrate within a monitoring wells before sampling, the decision was made to sample immediately to meet the intent of the Groundwater Monitoring Plan. This decision was made due to the uncertainty of the date that the store would be initially stocked and the need to collect samples prior to that date and develop a background data set. Water levels were collected from each well using an electronic water level indicator. Each well was then purged using a low flow sampling technique and samples were collected for a variety of analyses in laboratory supplied, pre-cleaned sample containers. The collected samples were delivered to Rhode Island Analytical Laboratories via chain- of-custody procedures for analysis. A summary of the laboratory report is presented in the following table. 2 ee n Se C , 6t qP Laboratory Report Summary �GlPo nOz January 7, 2005 Sampling Event Parameter Unit - MW-1 MW-2 MW-3 MW-4 MW-5 Field Screemag " Specific conductance uS 62.6 77.3 75.5 72.4 44.2 pH units 5.3 4.86 5.32 4.72 5.64 Dissolved Oxygen 14.93 12.12 11.24 11.62 11.3 Temperature C 10.2 12.2 11.8 11.2 11.2 Alkalinity as CaCO3 m 6.1 BDL 5.1 5.1 4.0 Ammonia (as nitrogen) mg/L BDL BDL BDL BDL BDL Total Kjeldahl Nit en m 0.51 BDL BDL BDL BDL Nitrate as nitrogen m 2.4 2.5 3.2 23 2.0 VPH Unadjusted C5- C8 Ali hatics BDL BDL BDL BDL BDL Unadjusted C9- C12 Ali hatics U91L BDL BDL BDL BDL BDL Adjusted C5-C8 Aliphatics ug/L BDL BDL BDL BDL BDL Unadjusted C9- C12 Ali hatics ugfL BDL BDL BDL BDL BDL C9-C10 BDL BDL BDL Aromatics BDL BDL Target VOCs BDL BDL BDL BDL BDL MTBE ug/L BDL BDL BDL BDL BDL EPH C9-C18 BDL BDL BDL BDL Ali hatics BDL C19-C36 BDL BDL BDL BDL Ali hatics BDL C11-C22 BDL BDL BDL BDL Aromatics ug/L BDL Target PAH's BDL BDL BDL BDL BDL VOCs 8260 BDL BDL BDL BDL BDL RCRA 8 Metals dissolved Arsenic m BDL BDL BDL BDL BDL Barium m 0.014 0.049 0.021 0.024 0.007 Cadmium BDL BDL BDL BDL BDL Chromium m BDL BDL BDL BDL BDL Lead BDL BDL BDL BDL BDL Mercury BDL BDL BDL BDL BDL Selenium BDL BDL BDL BDL BDL Silver m BDL BDL BDL I BDL I BDL BDL=below laboratory method detection limit uS=Microsiemans ug/L=micrograms per liter mg/L=milligrams per liter 3 i ee n Se W PonO Conclusions In the opinion of GSE based on the scope of this project and the attached Service Constraints, TGL has complied with the requirement to prepare a Groundwater Monitoring Plan, install a groundwater monitoring system and collect groundwater samples for laboratory analysis prior to the initial stocking of the BJs store in order to develop a set of baseline data. If you have any questions or require additional information regarding this matter, please call. Sincerely, GREEN SEAL ENVIRONMENTAL, INc. Terry F. Bauer, PG Environmental Consultant attachments cc: Stephanie Foley—BJs Scott Michaud - Cape Cod Commission Donna Moirandi'Barnstable Health Department Barns ab a Fl ire Disfrict Barnstable Water Company 4 R r ATTACHMENT 1 SERVICE CONSTRAINTS 1 � Service Constraints 1. Service The purpose of this report is to provide baseline environmental data, which meets the requirements of the BJs DRI decision. This work included the following tasks: A. installing a groundwater monitoring system, and B. collecting groundwater samples for laboratory analysis. 2. Limitations A. Preliminary Findings The following limitation is applicable if the report is stamped "DRAFT" or otherwise identified as draft. Green Seal Environmental Inc. has prepared this Report at the specific request of the client. Due to Client imposed time, information, and financial restrictions, Green Seal Environmental, Inc. has not performed the services necessary for it to render any opinions or reach any conclusions. Accordingly, the studies, data, information, and findings contained in this draft report are not the final conclusions of Green Seal Environmental, Inc., but merely basic information requested by the client upon which the Client may draw its own conclusions. Client agrees that. Green Seal Environmental, Inc. shall not be liable for any claims, loss, damage, or expenses incurred by the Client or others arising out of the use of, or reliance on, any information contained in this draft report. B. General I. This Report was prepared for the exclusive use of Tarkinow Group, Ltd. No other party is entitled to rely on the conclusions, observations, specifications, or data contained therein without the express written consent of Green Seal Environmental, Inc. 2. This Report was prepared pursuant to an Agreement between the Client and Green Seal Environmental, Inc. All uses of this Report are subject to, and deemed acceptance of, the conditions and restrictions contained therein. 5 C. Purpose of Report It is Green Seal Environmental's understanding that this Report is to be used for the purpose described in the introduction of the Report. This stated purpose has been a significant factor in determining the scope and level of services provided for in the Agreement. Should the purpose for which the Report is to be used, or the proposed use of the site change, this Report is no longer valid, and use of this Report by Client or others without Green Seal Environmental's review and written authorization shall be at the user's sole risk. Should Green Seal Environmental, Inc. be required to review the Report after its date of submission, Green Seal Environmental, Inc. shall be entitled to additional compensation at then existing rates or such other terms as agreed between Green Seal Environmental, Inc. and the Client. D. Scope of Services The observations and conclusions described in this Report are based solely on the Scope of Services provided pursuant to the Agreement between Client and Green Seal Environmental, Inc. and summarized in the introduction of this Report. Green Seal Environmental, Inc. has not performed any additional observations, investigations, studies, or testing not specifically stated therein, Green Seal Environmental, Inc. shall not be liable for the existence of any condition, the discovery of which required the performance of services not authorized under the Agreement. E. Time The passage of time may result in changes in technology, economic conditions, site variations, or regulatory provisions, which would render the Report inaccurate. Accordingly, neither the Client, nor any other party, shall rely on the information or conclusions contained in this Report after three (3) months from its date of submission without the express written consent of Green Seal Environmental, Inc. Reliance on the Report after such period of time shall be at the user's sole risk. Should Green Seal Environmental, Inc. be required to review the Report after three (3) months from its date of submission, Green Seal Environmental, Inc. shall be entitled to additional compensation at then existing rates or such other terms as may be agreed upon between Green Seal Environmental, Inc. and the Client. 6 I F. Conclusions The conclusions stated in this Report are based upon: observations of existing physical conditions; information provided by the Client; and information and/or analyses provided by independent testing laboratories upon which Green Seal Environmental, Inc. is entitled to reasonably rely. Green Seal Environmental, Inc. was not authorized and did not attempt to independently verify the accuracy or completeness of information or materials received from third parties during the performance of its services. Green Seal Environmental, Inc. shall not be liable for any conditions, information, or conclusion, the discovery of which required information not available or independent investigation of information provided to Green Seal Environmental, Inc. unless otherwise indicated. Any site drawing(s) provided within this Report is not meant to be an accurate base plan, but is used to present the general, relative locations of features on, and surrounding, the site. 7 i ATTACHMENT 2 BORING LOGS/ WELL CONSTRUCTION DETAILS I I . aa (bent.,'1'arwnow Gmug Ltd. GSE Boring Log Boring Number NM-1 Well Cons&udion Data ►� Site: BXs Wholesale Club Sheet: 1 0171 Hyannis,MA Drilling Me*ad.' Hollow Stem Auger Well Depth: 19, SamplingMedrod sphtspooa Screen length: ld Project Manager. T.Bauer Geologist: T.Bauer Drill Date: Inside Diameter. 4.25" IV DriMr g Contractor:Desmond Driffing Driller:Tom Desmond 1/4/2005 Outside Diameter. 6.25" Water 13.5' Sample 9 5 00 Depth(ft Sample Dept Blow Counts(24" o Field Identification Description a (feet) 6-12 12-18 18-24 2 2'Stick-up protective casing 1 Ground Surfi ce lJroteCtIVe Steel casmg installed 1 2'above the ground surface m cement Casing 2 S-1 2.S 2 6 5 5 24" 18' 0.0 3"Dads brown silty/loamy F sand fitted with a lock Well fitted 15"light ten F to M sand Tr gravel with a flush plug 3 I 4 Bentomte plug 5 6 Fill and native sand backfill 7 S 2 7.5" 3 5 5 7 24" 76• 0.0 3"light tan F to M sand 6.5"light tan F sand bedding 8 6.5"light tan M sand,faint bedding Well screen is 2'diameter, 9 0.10 slot PVC screen with 2"PVC riser to 2'above 10 the suffice. 11 12 S-3 12.5' 2 3 4 9 24• 11.5" 0..0 T light brown sand some M to F sand(wet) 4.5'light gray F sand,Tr gravel(wet) 13 14 _ =- 15 16 17 S4 17.5 g ' S 7 8 7 24" 8" 0.0 4"light tan to ay M to C sand and gravel(wet) _ 1"light tan F to M sand,Tr silt(wet) 18 3"light brown C sand,Tr gavel(wet) End oFBoring at 19' 19 20 21 22 23 24 25 26 27 28 29 30 NR=No Recovery nr=not recorded F:Fine;M:Medium;C Coarse,Tr.trace 1 � { Client.Taridnow Group,Ltd. GSE Boring Log ca`tJ�M! �� Well Construc on Data Boris Number. MW 2 CAVZ Site: BPs Wholesale Club Sheet: 1 of 1 Hyannis,MA Drilling Method: Hollow Stem Auger Well Depth: 20.5' SamplingMe&a. Split Spoon Screen length: l0' ProjectManager. T.Bauer Geologist.- T.Bayer Drill Date: I Inside Diameter.• 4.25' Riser Length 10.5' Drilling Contractor.Desmond Drilling Driller.Tom Desmond 1/4/2005 Pubride Diameter. 6.25" Water Depth: 15.5' Sample Depth(ft Sample ID Depth Blow Counts 24 9 Q Field Identification Description (feet) 0.6 6-12 12-18 18-24 w a ro w w w w Q Pmtechve steel casing installed appmaninately flush to the surface in cement Casing 1 fitted with a lock Well fitted 2 with a flush plug 3 S-1 3' Dug down by habd to avoid electrical lines 9"dark brown F to M sandly loam Native sand backfill 4 27"light tan F to M sand 5 6 7 S-2 7-5' 8 5 12 20 24" 16' 0.0 13"light brown M to C sand w/some pebble Bentonite plug 3"Dark brown C sand w/some gavel 8 9 10 11 Well screen is 2'diameter, 12 S-3 12-5' 4 15 19 6 24' 15.5' 0..0 1.5'light tan F to M sand w/Tr silt 0.10 slot PVC screen with 3"crushed stone w/tan to brown M to C sand 2"PVC riser flush to grade 13 7"tan to light brown F to M sand 4"light brown to tan M sand w/Tr gavel 14 15 - 16 17 S-4 17.5 2 3 4 6 24" 18.5" 0.0 4"light brown to tam M to C sand w/Tr pebble 7"tan to light tan C sand 18 4"Dark tan to light brown M to C sand 3.5"brown to reddish M to C sand w/Tr silt(faint bedding) 19 20 Well Point 21 22 S-5 22 5' 4 11 11 7 24" 7" 0.7 3"light brown to tan C(wet)sand w/Tr silt some gavel 4"light brown to tan C sand w/Tr gravel(wet) 23 24 25 26 27 S 6 27.5 2 2 4 4 24" 10' 1.1 10"light tan to gay C sand w/some F sand(wet)Tr gravel End ofBoring at 27.5' 28 29 30 31 32 33 34 NR=No Recovery nr=not recorded R'Fine;M:Medium;C:Coarse,Tr.trace Ghent. l arMi ow Group,t ra. GSE Boring Log � `n/�n l�'dr►. Well Construction Data 5�9N I"''" 1� Boring Number. MW-3 r � Site: BJ's Wholesale Club Sheet: 1 of 1 Hyannis,MA Drdirng Medwd: Hollow Stem Auger Well Depth: 20.5' Sanrpheg Medrod Split Spoon Screen length: 1 tT Project Manager. T.Bayer Geo gu4:T.Bauer Dri I Date: Inside 'ameter. 4.25" RL%xL 10.5' Drillt Contractor:Desmond Drilling DrXer:Tom Desmond 1/4/2005 Outside Diameter. 6.25" Water Depth: 15, Sample Sample 5 8 5 8 �a ft Blow Counts 24" t; Field Identification Description ( ID (fee 0-6 6-12 12-18 18-24 w a' °1 a w a w a Protective steel casing installed flush to the ground surface in cement Casing 1 fitted with a lock. Wall fitted 2 S-1 2.5' 4 7 12 17 24" 20.5" 0.5 2.5"dark brown to black F to M loam with a flush plug 6"brown to dark tan M to C sand w/Tr pebble 3 7.5"tan M to C sand w/Tr gravel 4.5"light brown to brown F to M sand w/some silt 4 Native sand backfill 5 6 7 S-2 7.5' 3 5 8 7 24' 16.5" 0.7 5.5"light tan to gray M to C sand w/Tr gravel Bentonite plug 1"brown to gray crushed stone 3"brown to red C sand,bedding 8 1.5"light tan to gray M to C sand w/Tr gravel 9 5.5"light tan to brown F to M sand 10 Well screen is 2"diameter, 11 2'PVC rriot serrfflush�to g� 12 S-3 12.5" 2 3 10 5 24" 14' 1.2 2"gray to tan M sand w/some gavel 6"light tan to gray F to M sand 13 6"tan to brown F to M sand,faint bedding 14 15 16 17 S 4 17.5" 4 8 13 10 24" 6' 1.2 2"tan to brown C sand w/some fine sand(wet) 4'light tan to gray F to M sand 18 faint bedding between 2-3"(wet) 19 20 End of Boring at 20.5' 21 22 23 24 25 26 27 28 29 30 31 32 33 34 NR=No Recovery nr=not recorded F.Fine;M:Medium;C:Coarse,Tr.trace f I , Client: Taridnow Group,U& GSE Boring Log 3� 1 +® Borin Number. Mw4 WeII Construction Data Site: BYs Wholesale Club Sheet: 1 Of 1 - Hyannis,MA Drifting Medrod Hollow Stem Auger Well Depth: 19, Sampling Medmd Split Spoon Screen length: 10 ProjectManager.• T.Bauer Geologist: T.Bauer Drill Date: Inside Diameter. 4.25' Riser Length 9' Drilling Contractor.Desmond Drilling Driller.Tom Desmond 1/4/2005 Outside Diameter. 6.25' Water-Depth: 13.75' ao � Depth ft Sample Smith Blow Cormts 24' 9 o Field Identification Description n ( ID (feet) Ofi 6 12 12-18 19-24 a a w a w Q Protective stem casing instalM approwmately flush to the 1 surface in cement Casing fitted with a lack Well fitted 2 S-1 2-5' 4 5 8 10 24" 16" 0.0 3"dark tan to brown F to M sand with a flush plug wITr gravel,Tr silt 3 3.5"dark tan to brown F to M sand w/some gravel 2.5"brown M sand w/same silt 4 5"light brown M to C sand wfrr pebbles Native sand backfill 2"dark brown F to M sand w/Tr pebbles 5 Bentomte plug 6 6"light tan to gory M to C sand(faint bedding) S-2 7.5' 4 6 8 9 24" 17.5' 0.0 8'dadr tan to light brown F to M sand w/some C sand 8 3.5"brown F to M sand wfrr pebble,Tr silt 9 Well screen is 2"diameter, 0.10 slot PVC screen with 10 2"PVC riser flush to grade 11 12 5"tan to light brown M to C sand(wet) S-3 12.5 5 6 11 13 24" 17" 1.2 IT light tan F to M sand w/Tr C sand 13 14 15 16 17 3"light brown M to C sand w/Tr F sand(wet) S4 1ZS 2 6 6 6 24" 11' 4.2 2'brown to red C sand w/some pebble,bedding(wet) 18 5"light brown to tan M to C sand(wet) I°dark tan to brown M sand w/some F sand(wet) End of BomDg at 19' 19 20 21 22 23 24 25 26 27 28 29 30 31 NR=No Recovery or=not recorded F.Fine;M:Medium;C:Coarse,Tr.trace t W lent.'I arlunow Group,tin. GSE Boring Log ��y, Nl�,, r. M Well Construc>fion Data Borin NumbeW-5 ���� Site: BJ's Wholesale Club Sheet: 1 Oft aa� F Hyannis,MA Drilling Method: Hollow Stem Auger Well Depth: 18, SamplingMedw. split Spoon ScMM length: 10' ProjectManager. T.Bauer Geo gent T.Bauer Dri l Date. Inside Diameter. 4.25" Riser 8' DrillingContractor DesmondDrilHn Driller:Tom Desmond 1/4/2005 OutrldeDiameter. 6.25" Water Depth 13' Sample .5 .9 m (ft Sample Depth Blow Counts 24" . @ Field Identification Description a ID (feet) OS 6-12 12-18 18-24 a ae' w w i% w Q Protective steel casing flush to the ground surface in 1 fitted with a lock.. Went e fi i w fitted 2 S-1 15' 7 12 15 16 24" 18.5" 0.0 15"light tan to gray F to M sand w/Tr pebble with a flush plug 2"reddish brown M to C sand w/some small gravel 3 4'light tan to gray F to M sand w/Tr pebble 7'dark tan to brown F to M sand Wrr gravel 4 3"dark brown F to M sand w/Tr pebble Bentonite plug 5 6 7 S-2 7.5' 3 5 6 6 24" 16" 0.0 3"light gray M to C sand w/some pebble Native sand backfill 1"fight gray F to M sand 8 3"tan to light brown F to M sand 5"light brown to gray F to M sand w/Tr C sand Well screen is 2"diameter, th 9 4"light brown to gray F sand w/some C sand 2"PVC slot P flush just VC screen w below 10 the ground surface 11 12 S 3 12.5' 3 5 5 5 24' 18' 1.7 5"light brown to tan C sand w/some gravel faint bedding(wet) 13 6"tan to light brown F to M sand w/Tr pebble gravel(wet) 14 7"light brown F to M sand w/some gravel gravel 15 16 17 S-4 ITT 3 8 10 7 24" 3" 2.7 1.5"dark tan to brown C sand w/some gravel,Tr fine sand(wet) End of Boring at 19 18 1.5"grayish F to M sand w/Tr gravel(wet) 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 NR=No Recovery m=not recorded r F.Fme;M:Mednim,C:Coarse,Tr.trace ATTATCHMENT 3 LABORATORY REPORT R.I. Analytical Page 1 of 21 Specialists in Environmental Services CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: 01/07/2005 Attn: Mr.Terry Bauer Date Reported: 01/14/2005 28 Route 6A P.O.#: Sandwich,MA 02563 Work Order#: 0501-00349 DESCRIPTION: HYANNIS BJ'S (FIVE GROUNDWATER SAMPLES) Subject sample(s)has/have been analyzed by our Warwick, R.I. laboratory with the attached results. Reference: All parameters were analyzed by U.S. EPA approved methodologies and all NELAC requirements were met. The specific methodologies are listed in the methods column of the Certificate Of Analysis. Data qualifiers(if present) are explained in full at the end of a given sample's analytical results. Certification#: RI-033. MA-RI015.CT-PH-0508. ME-RIO15 NH-253700 A&B,USDA S-41844,NY-11726 If you have any questions regarding this work,or if we may be of further assistance,please contact us. Approved by: Data Reporting enc: Chain of Custody \n ACCpq c^ 41 Illinois Avenue,Warwick,RI 02888 u 4 131 Coolidge Street,Bldg 2, Hudson, MA 01749 Tel:(401) 737-8500 Fax:(401)738-1970 4 _ = Tel: (978)568-0041 Fax: (978)568-0078 T Page 2 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by. Z/Z Work Order#: 0501-00349 Data Reporting Sample# 001 SAMPLE DESCRIPTION: MW-1 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 09:25 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST ALKALINMY(as CaCO3) 6.1 1.0 mg/1 EPA 310.1 01/07/2005 ML AMMONIA(asN) <0.10 0.10 mg/1 EPA 350.2 01/11/2005 JW TKN(as N) 0.51 0.50 mg/1 EPA 351.3 01/10/2005 BMM NITRATE(as N) 2.4 0.01 mg/l EPA 300.0 01/07/2005 ML VPH Unadjusted C5=C8 Aliphatics(FID) <10 10 ug/l MADEP 01/13/2005 RGM Unadjusted C9-C12 Alipbatics(FID) <10 10 ug/l MADEP 01/13/2005 RGM Methyl-tert-butylether <5 5 ug/l MADEP 01/13/2005 RGM Benzene <5 5 ug/l MADEP 01/13/2005 RCM Toluene <5 5 ugh MADEP 01/13/2005 RGM Etbylbmzene <5 5 ug/1 MADEP 01/13/2005 RGM m,p-Xylene <5 5 ug/l MADE? 01/13/2005 RGM o-Xylene <5 5 ug/1 MADE? 01/13/2005 ROM Naphthalene <5 5 ug/1 MADEP 01/13/2005 RGM Adjusted C5-C8 Aliphatics(FM) <10 10 ugJl MADEP 01/13/2005 RGM Adjusted C9-C12 Aliphatics(FID) <10 10 ug/l MADEP 01/13/2005 RGM C 9-C 10 Aromatics(PID) <10 10 ug/1 MADEP 01/13/2005 RGM SURROGATE RANGE 01/13/2005 RGM 2,5-Dibromotoluene(PID) 116 70-130% MADEP 01/13/2005 RGM 2,5-Dibromotoluene(FID) 104 70-130% MADEP 01/13/2005 RGM EPH C9-C 18 Aliphatics <20 20 ug/1 MADEP 01/11/2005 RJP C 19-C36 Aliphatics , <20 20 ug/l MADEP 01/11/2005 RJP CI I-C22 Aromatics <20 20 ug/1 MADEP 01/11/2005 RJP Total EPH <60 60 ug/l MADEP 01/11/2005 RJP SURROGATES RANGE 01/11/2005 RJP Chloro-octadecane 66 40-140% MADEP 01/11/2005 RJP Ortho-tetphenyl 74 40-140% MADEP 01/11/2005 RJP FRACTIONATION SURROGATES RANGE 01/11/2005 RJP 2-Fluorobiphenyl 89 40-140% MADEP 01/11/2005 RJP 2-Bromonaphthalene 88 40-140% MADEP 01/11/2005 RJP Exh•actiondate Extracted MADEP 01/10/2005 JG TARGET PAH ANALYTES Naphthalene <I 1 ug/l MADEP 01/12/2005 DMM 2-Methylnaphthalene <l 1 ug/l MADEP 01/12/2005 DMM Acenaphthylene <1 1 ug/l. MADEP 01/12/2005 DMM Acenaphthene <1 1 ug/l MADEP 0 111 2/20 0 5 DMM Fluorene <I 1 ug/l MADEP 01/12/2005 DMM Phenanthrene <I ] ug/1 MADEP 01/12/2005 DMM Anthracene <1 1 ug/l MADEP 01/12/2005 DMM Fluoranthene <I 1 ug/l MADEP 01/12/2005 DMM i Page 3 of 21 R.I.AnalYtical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 001 SAMPLE DESCRIPTION: MW-1 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 09:25 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Pyrme <1 1 ug/l MADEP 01/12/2005 DMM Benzo(a)anthracene <1 1 119/1 MADEP O1/122005 DMM Chrysene <l 1 ug/l MADEP 01/12/2005 DMM Benzo(b)tluoranthene <1 1 ug/1 MADEP 01/12/2005 DMM Benzo(k)fluoranthene <1 1 u9/1 MADEP 01/12/2005 DMM Benzo(a)pyrene <0.2 0.2 ug/l MADEP 01/12/2005 DMM 1ndeno(12,3-cd)pyrene <0.5 0.5 ug/1 MADEP 01/12/2005 DMM Dibenzo(a,h)anthracene <0.5 0.5 ug/l MADEP 01/12/2005 DMM Benzo(g,h,i)perylcnc <1 1 ug/1 MADEP 01/12/2005 DMM Volatile Organic Compounds Bromodichloromethane <0-5 0.5 UO EPA 524.2 01/14/2005 ROM Bromoform <0.5 0.5 um EPA 524.2 01/14/2005 ROM Dibromochloromethane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM Chloroform <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM 1,2-Dibromoethane(EDB) <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM Benzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM Carbon Tetrachloride <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM 1,2-Dichloroethane <0.5 0.5 u9/1 EPA 524.2 01/14/2005 ROM Trichlomethene <0.5 0.5 119/1 EPA 524.2 01/14/2005 ROM 1,4-Dichlorobenzene <0.5 0.5 u9/1 EPA 524.2 01/14/2005 RGM 1,1-Dichlomethane <0,5 0.5 ug/l EPA 524.2 01/14/2005 ROM 1,1,1-Trichloroethane <0.5 0.5 u9/1 EPA 524.2 01/14/2005 RGM Vinyl Chloride <0.5 0.5 119/1 EPA 524.2 01/14/2005 RGM Bromobenzene <0.5 0.5 ugh EPA 524.2 01/14/2005 RGM Bromomethane <0.5 0.5 ug/l EPA 5242 01/14/2005 RGM Chlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM Chloroethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chloromethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 2-Chlorotoluene <0.5 0.5 ug(l EPA 524.2 01/14/2005 RGM 4-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Dibromomethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,3-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,2-Dichlorobenzene <0.5 0.5 ug/1 EPA 524.2 01114/2005 RGM trans-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM cis-1,2-Dichloroetheue <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Methylene Chloride <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM I,I-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM l,l-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2-Dichloropmpane <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM 1,3-Dichloropmpane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM cis-1,3-Dichloropropene <0.5 0.5 ug/l EPA 524.2 01/I4/2005 ROM tran-1,3-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM 2,2-Dichloropmpane <0.5 0.5. ug/I EPA 524.2 01/14/2005 RGM Page 4 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. �� r Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 001 SAMPLE DESCRIPTION: MW-1 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 09:25 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Ethylbemene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Styrene <0.5 0.5 ug/I EPA 524.2 01/1412005 RGM 1,1,2-Trichloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,1,2-Tetrachloroethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,1,2,2-Tetrachloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Tetrachloroethene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2,3-Trichloropropane <D_5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Toluene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM <0.5 0.5 ug/] EPA 524.2 01/14/2005 RGM 7{ylenes 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Bromochloromethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM n-Butylbemene <0.5 0.5 ug/I EPA 524.2 O1/14/2005 RGM Dichlorodifluoromethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Trichlorofluoromethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Isopropylbenzene <0.5 0.5 u9/1 EPA 524.2 01/14/2005 RGM Hexachlorobutadiene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Iso (toluene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM p pro py EPA 524.2 01/14/2005 RGM Naphthalene <0.5 0.5 ug/I n-Propy]benzene <0.5 0.5 ug/l EPA 524.2 01114/2005 RGM sec-Butylbenen a <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM EPA 5242 01/14/2005 RGM tent-Butylbe�nzene <0.5 0.5 ug/I 1,2,3-Trichlorobenzene <0.5 0.5 ueJl EPA 524.2 O1l14/2005 RGM 1,2,4-Trichlorobemene <0.5 0.5 ug/I EPA 524.2 01/1412005 RGM 1,2,4-Trimethylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,3,5-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Methyl Tertiary Butyl Ether(MTBE) <1 1 ug/I EPA 524.2 01/14/2005 RGM n-Hexane <10 10 ug/I EPA 524.2 01/14/2005 RGM SURROGATES RANGE EPA 524.2 01/14/2005 RGM 4-Bromofluorobeazene 94 80-120% EPA 524.2 01/14/2005 RGM 8D-120% EPA 524.2 01/14/2005 RGM 1,2-Dichlorobenzene-d4 89 DISSOLVED METALS ARSENIC <0.005 0.005 mg/l EPA 200.9 01/12/2005 CD BARIUM 0.014 0.005 mg/I EPA 200.7 01/14/2005 JNB CADMIUM <0.005 0.005 mg/1 EPA 200.7 01/14/2005 JNB CHROMIUM <0.03 0.03 mg/l EPA 200.7 01/14/2005 JNB LEAD <0.002 0.002 mg/I EPA 200.9 01/12/2005 CD MERCURY <0.0005 0.0005 mg/I EPA 245.1 01/12/2005 KSL ME SELENIUMRC <0.0050 0.0050 mg/l EPA 200.9 01/11/2005 CD SILVER <0.02 0.02 mg/l EPA 200.7 01/14/2005 JNB f , Page 5 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS 2 'A Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting All QA/QC procedures required by the EPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the EPH Method with the following exception:C-range values may have been blank subtracted to minimize the effect of leachable plasticizers from the SPE cartridges. All QA/QC procedures required by the VPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the VPH Method. 1 , Page 6 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS 1 Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 002 SAMPLE DESCRIPTION: MW-2 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 cr 10:45 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST ALKALINITY(as CaCO3) <1.0 1.0 mg/l EPA 310.1 01/07/2005 ML AMMONIA(as N) <0.10 0.10 n*I EPA 3502 01/11/2005 JW TKN(as N) <0.50 0.50 mg/I EPA 351.3 01/10/2005 BMM NITRATE(as N) 2.5 0.01 mg/l EPA 300.0 01/07/2005 ML VPH Unadjusted C5-CS Aliphatics(FID) <10 10 ug/l MADEP 01/1 31200 5 RGM Unadjusted C9-C12 Aliphatics(FID) <10 10 u911 MADEP 01/13/2005 RGM Methyl-tent-butylether <5 5 ug/1 MADEP 01/13/2005 RGM Benzene <5 5 ug/I MADEP 01/13/2005 RGM Toluene <5 5 ug/I MADEP 0 111 31200 5 RGM Etbylbenzene <5 5 ug/I MADEP 01/13/2005 RGM m,p-Xylene <5 5 ug/1 MADEP 01/13/2005 RGM o-Xylene <5 5 ug/I MADEP 01/13/2005 RGM Naphthalene <5 5 ug/I MADEP 01/13/2005 RGM Adjusted C5-C8 Aliphatics(FID) <10 10 ug/I MADEP 01/13/2005 RGM Adjusted C9-Cl2 Aliphatics(FID) <10 10 ug/1 MADEP 01/13/2005 RGM C9-CIO Aromatics(PI)) <10 10 ug/I MADEP 01/13/2005 RGM SURROGATE RANGE 01/13/2005 RGM 2,5-Dibromotoluene(PID) 114 70-130% MADEP 01/13/2005 RGM �,5-Dibramotoluene(FID) 102 70-130% MADEP 01/1312005 RGM EPH C9-C18 Aliphatics <20 20 ug/1 MADEP 01/11/2005 RJP C19-C36 Aliphatics <20 20 ug/1 MADEP 01/1 IJ2005 RJP C I I-C22 Aromatics <20 20 ug/1 MADEP 01/11/2005 RJP Total EPH <60 60 ug/1 MADEP 01/11/2003 RJP SURROGATES RANGE 01/11/2005 RJP Chloro-octadecane 69 40-140% MADEP 01/11/2005 RJP Ortho-terphenyl 73 40-140% MADEP 0 1/1 1 120 05 RJP FRACTIONATION SURROGATES RANGE 01/11/2005 RJP 2-Fluorobiphenyl 90 40-140% MADEP 01/11/2005 RJP 2 Bromonaphthalene 92 40-140% MADEP 01/1 1/2005 RJP Extraction date Extracted MADEP 01/10/2005 JG TARGET PAH ANALYTES Naphthalene <1 1 119/1 MADEP 01/12/2005 DMM 2-Methylnaphthalene <1 I 119/1 MADEP 01/12/2005 DMM Acenaphthylene <1 1 ug/l MADEP 01/12/2005 DMM Acenaphthene <1 1 ug/I MADEP 01/12/2005 DMM Fluorene <1 1 ug/1 MADEP 01/12/2005 DMM Phenanthrene <1 1 ug/l MADEP O1/12/2005 DMM Anthracene <1 1 ug/I MADEP. 01/12/2005 DMM Fluoranthene <1 I ug/1 MADEP 01/12/2005 DMM Page 7 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 002 SAMPLE DESCRIPTION: MW-2 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 10:45 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Pyrene <1 1 ug/1 MADEP 01/12/2005 DMM Benzo(a)anthracme <1 I ug/l MADEP 01/12/2005 DMM Chrysene <1 1 ug/l MADEP 01/12/2005 DMM Benzo(b)fluoranthene <l 1 ug/1 MADEP 01/12/2005 DMM Benzo(k)fluoranthene <1 1 ug/1 MADEP 01/12/2005 DMM Bmw(a)pyrene <0.2 02 ug/1 MADEP 01/12/2005 DMM Indeno(1,2,3-ed)pyrene <0.5 0.5 ug/l MADEP 01/12/2005 DMM Dibenzo(a,h)anthracene <0.5 0.5 ug/l MADEP 01/12/2005 DMM Benzo(g,h,i)perylene <l 1 ug/1 MADEP 01/12/2005 DMM Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ugh EPA 52C2 01/14/2005 RGM Bromoform <0.5 0.5 " ug/l EPA 5242 01/14/2005 RGM Dibromochlorornethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chloroform <0.5 0.5 ug/1 EPA 5242 01/14/2005 RGM 1,2-Dibromoethane(EDB) <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Benzene <0.5 0.5 ug1l EPA 524.2 01/14/2005 RGM Carbon Tetrachloride <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2-Dichloroethane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Trichloroethene ' <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,4-Dichlombenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 10,Dichloroethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,1,1-Trichlorcethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Vinyl Chloride <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Bromobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Bromomethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chlorobenzene <0.5 0.5 ug/I EPA 524.2 01/1412005 RGM Chloroethaue <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chloromethanc <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 2-Chlorotoluene <0.5 0.5 ug/l EPA 5242 01/14/2005 RGM 4-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Dihromomethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,3-Dichloroberrzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2-Dichlorobertzene .<0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM tratvs-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM cis-1,2-Dich loroethene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Methylene Chloride <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1;1-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,1-Dichloropropene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,2-Dichloropropane <0.5 0.5 ug/1 EPA.524.2 01/1412005 RGM 1,3-Dichloropropane <0.5 0-5 ug/1 EPA 524.2 DI/14/2005 RGM cis-1,3-Dichloropropene <0.5 0.5 ug/l EPA 5242 01/14/2005 RGM tran-13-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 2,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM L Page 8 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANTALYSIS l Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by.--_zz Work Order#: 0501-00349 Data Reporting Sample# 002 SAMPLE DESCRIPTION: MW-2 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 10:45 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED .ANALYST Etylbenzene <03 0.5 ug/1 EPA 524.2. 01/14/2005 RGM Styrene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,1,2-Trichloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,1,2-Tetrachlaroethane <0.5 0.5 ugh EPA 524.2 Ol/14/2005 RGM 1,1,2,2-Tetrachloroethane <0.5 0.5 ugh EPA 524.2 01/14/20D5 RGM Tetrachloroethene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,2,3-Trichlaropropane <03 0.5 ug/I EPA 524.2 01/14/2DO5 RGM Toluene <03 0.5 ug/1 EPA 524.2 01/14/2005 RGM Xylenes <05 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/I EPA 524.2 Ot/14/2005 RGM Bromochloromethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM n-Butylbenzene <03 0.5 ugA EPA 524.2 01/14/2005 RGM Dichlorodiflucromethane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Trichlorofluoromethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Isopropylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Hexachlorobutadiene <0.5 0.5 ugA EPA 524.2 01/14/2005 RGM p-Isopropyltoluene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Naphthalene <0.5 0.5 ug/I EPA 524.2 01114/2D05 RGM n-Propylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM sec-Butylbemene <03 0.5 ug/1 EPA 524.2 01/14/2005 RGM tert-Butylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 42,3-Trichloroben2ene <03 OS ug/I EPA 524.2 01/14/2005 RGM 1,2,4-Trichlorobenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1 2,4-Trimethyibenzene <0,5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,3,5-Trimethylbenzene <O.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Methyl Tertiary Butyl Ether(MTBE) <I 1 ug/1 EPA 524.2 01/14/2005 RGM n-Hexane <10 10 ug/l EPA 524.2 01/14/2005 RGM SURROGATES RANGE EPA 524.2 01/14/2005 RGM 4-13romofluorobenzene 106 80-120% EPA 524.2 01/14/2005 RGM I,2-Dichlorobenzene-d4 108 80-1.20% EPA 524.2 01/14/2005 RGM DISSOLVED METALS ARSENIC <0.005 0.005 mg/I EPA200.9 01/12/2005 CD BARIUM O.D49 0.005 mg/I EPA200.7 01/14/2005 JNB CADMIUM <0.005 0.005 mg/I EPA200.7 01/14/2005 JNB CHROMIUM <0.03 0.03 mg/I EPA 200.7 01/14/2005 JNB LEAD <0.002 0.002 mg/I EPAW0.9 01/12/2005 CD MERCURY <0.0005 0.0005 mg/I EPA245.1 01/12/2005 KSL SELENIUM <0.0050 0.0050 mg/I EPA200.9 01/11/2005 CD SILVER <0.02 0.02 mg/I EPA200.7 01/14/2005 JNB l Page 9 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS w Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by. 7/ & Work Order#: 0501-00349 Data Reporting All QA/QC procedures required by the EPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the EPH Method with the following exception: C-range values may have been blank subtracted to minimise the effect of leachable plasticizer from the SPE cartridges. All QA/QC procedures required by the VPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the VPH Method. L I Page 10 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 003 SAMPLE DESCRIPTION: MW-3 SAMPLE TYPE: GRAB SAMPLE DATE/TIKE: 01/07/2005 @ 13:55 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST ALKALINITY(as CaCO3) 5.1 1.0 mg/I EPA 310.1 01/07/2005 ML AMMONIA(as N) <0.10 0.10 mg/1 EPA 350.2 01/11/2005 JW TKN(as N) <0.50 0.50 mg/l EPA 351.3 01/11/2005 EC NITRATE(as N) 3.2 0.01 mg/1 EPA 300.0 01/07/2005 ML VPH Unadjusted C5-C8 Aliphatics(FID) <10 10 ug/1 MADEP OIJ1312005 RGM Unadjusted C9-C12 Aliphatics(FID) <10 10 ug/I MADEP 01/13/2005 RGM Methyl-test-butylether <5 5 ug(I MADEP 01/13/2005 RGM Benzene <5 5 ug/I MADEP 01/13/2005 RGM Toluene <5 5 ug/I MADEP 01/13/2005 RGM Ethylbenme <5 5 ug/1 MADEP 01/13/2005 RGM m,p-Xylene <5 5 ug/I MADEP 0 1/1 312 00 5 RGM o-Xylene <5 5 ug/I MADEP 01/13/2005 RGM Naphthalene <5 5 119/1 MADEP 01/13/2005 RGM Adjusted C5-C8 Aliphatics(FID) <10 10 ug/l MADEP 0 1/1 31200 5 'RGM Adjusted C9-C12 Aliphatics(FID) <10 10 ug/I MADEP 01/13/2005 RGM C9-CIO Aromatics(PID) <10 10 ug/I MADEP 01/13/2005 RGM SURROGATE RANGE 01/13/2005 RGM 2,5-Dibromotolume(PID) 109 70-130% MADEP 01/13/2005 RGM 2,5-Dibmmotoluene(FID) 97 70-130% MADEP 01/13/2005 RGM EPH C9-C18 Aliphatics <20 20 ug/I MADEP 01/12/2005 RJP C19-C36 Aliphatics <20 20 ug/I MADEP 01/120005 RJP CI I-C22 Aromatics <20 20 ug/I MADEP 01/12/2005 RJP Total EPH <60 60 ug/I MADEP 01/12/2005 RJP SURROGATES RANGE 01/12/2005. RJP Chloro-octadecane 64 40-140% MADEP 01/12,12005 RJP Oitho-terphenyl 72 40-140% MADEP 01/12/2005 RJP FRACTIONATION SURROGATES RANGE 01/12/2005 RJP 2-Fluorobiphcnyl 80 40-140% MADEP 01/12/2005 RJP 2-Bromonaphthalene 86 40-140% MADEP 01/12i2005 RJP Extraction date Extracted MADEP 01/10/2005 JG TARGET PAH ANALYTES Naphthalene <] 1 ug/I MADEP 01/12/2005 DMM 2-Methylnaphthalene <1 I ug/I MADEP 01/12/2005 DMM Acenaphthylene <1 1 ug/I MADEP 01/12/2005 DMM Acenaphthene <1 1 ug/I MADEP 01/12/2005 DMM F►uorene <1 I ug/I MADEP 01/12/2005 DMM Phcnanthratc <I I ug/I MADEP 01/12/2005 DMM Anthracene <1 I ug/l MADEP 01/12/2005 DMM Fluoranthene <1 I ug/I MADEP 01/12/2005 DMM I Page 11 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. / Date Received: 01/07/2005 Approved by. Work Order#: 0501-00349 Data Repotting Sample# 003 SAMPLE DESCRIPTION: MW-3 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 13:55 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Pyrene <I I ug/l MADEP 01/12/2005 DMM Benzo(a)anthracene <I 1 ug/l MADEP 01/12/2005 DMM Chrysene <1 I ue MADEP 01/12/2005 DMM Benzo(b)fluwanthme <1 I ug/l MADEP 01/12/2005 DMM Benzo(k)fluoranthene <1 I ug/l MADEP 01/12/2005 DMM Benzo(a)pyrene <0.2 0.2 ug/l MADEP 01/12/2005 DMM lndeno(1,2,3-cd)pyrene <0.5 0.5 ug/l MADEP 01/12/2005 DMM Dibenzo(a h)anlhracene <0.5 0.5 ug/l MADEP 01/12/2005 DMM Benzo(g,h,i)perylene <1 I ugh MADEP 01/12/2005 DMM Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Bromoform <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Dibromochloromethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chloroform <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,2-Dibromoethane(EDB) <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Benzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Carbon Tetrachloride <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2-Dichlorocthane <0.5 0.5 ugA EPA 524.2 01/14/2005 RGM Trichloroethene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,4-Dichloroben7ene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,1-Dichloroethane <0.5 0.5 ug/J EPA 524.2 01/14/2005 RGM 1,13-Trichloroethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Vinyl Chloride <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Bromobenzene <0.5 0.5 ug/l EPA 524.2 01/14/200S RGM Bromomethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chloroethane <0.5 0.5 ug/l EPA 524.2 01/1412005 RGM Chloromethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 2-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 4-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Dibromomethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,3-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,2-Dichlorobenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM trans-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM cis-1,2-Dichlornethene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Methylene Chloride <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,1-Dichloroethene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,1-Dichloropropene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,2-Dichloropropane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,3-Dichloropropane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM cis-1,3-Dichloropropene <0.5 0.5 ug/l EPA 524.2 01/14/200S RGM . tran-1,3-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 2,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 01/14!2005 RGM i Page 12 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS v` Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 003 SAMPLE DESCRIPTION: MW-3 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 13:55 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Ethylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Styrene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,1,2-Trichloroethane <0.5 0.5 ugh EPA 524.2 01/14/2005 RGM 1,1,1,2-Tetrachloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,22-Tetrachloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Tetmehloroethene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2,3-Trichloropropane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Toluene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Xylenes <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Bromochloromethane <0.5 0.5 ug/I EPA 524.2 01114/2005 RGM n-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Dichlorodifluoromethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Trichlorofluoromethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Isopropylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Hexachlorobutadiene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM p-Isopropyltolnene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Naohthalme <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM n Prnpylbenzcne <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM sec-Butyl benzene a <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM ent-Butylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM t ert-BTricblorobenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2,4-Trichlorobenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2,4-Trichloro enzen c <0.5 0.5 ug/1 EPA 5242 01/14/2005 RGM 12,5-Trimethylbmzmcene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM <1 1 ug/I EPA 524.2 01/14/2005 RGM Methyl Tertiary Butyl Ether(MTBE) n-Hexane <10 10 ug/1 EPA 524.2 01/14/2005 RGM SURROGATES RANGE EPA 524.2 01/14/2005 RGM 80 120°la EPA 524.2 01/14/2005 RGM 4-Bromofluorobenzene 109 1,2-Dichlorobenzene-d4 108 80-120% EPA 524.2 01/14/20D5 RGM DISSOLVED METALS ARSENIC <0.005 0.005 mg/1 EPA 200.9 01/12/2005 CD BARIUM 0.021 0.005 mg/I EPA200.7 01/14/2005 JNB CADMIUM <0.005 0.005 mg/I EPA200.7 01/14/2005 JNB CHROMIUM <0.03 0,03 ing/1 EPA200.7 01/14/2005 JNB LEAD <0.002 0.002 mg/I EPA200.9 01/12/20D5 CD MERCURY <0.0005 0.0005 mg/I EPA245.1 01/12/2005 KSL SELENIUM <0.0050 0.0050 mg/1 EPA200.9 01/11/2005 CD SILVER <0.02 0.02 mg/1 EPA200.7 01/14/2005 JNB I Page 13 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS 3 Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting All QA/QC procedures required by the EPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the EPH Method with the following exception:C-range values may have been blank subtracted to minimize the effect of leachable plasticizers from the SPE cartridges. All QA/QC procedures required by the VPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the VPH Method. 'I i Page 14 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: OIJ07/2005 Approved by:_/J Work Order#: 0501-00349 Data Reporting Sample# 004 SAMPLE DESCRIPTION: MW- SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 13:00 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST ALKALINITY(as CaCO3) 5.1 1.0 mg/1 EPA 310.1 01/07/2005 ML AMMONIA(as N) <0.10 0.10 mg/I EPA 350.2 01/11/2005 JW TIN(as N) <0.50 0.50 mg/1 EPA 351.3 01/10/2005 BMM NITRATE(as N) 2.3 0.01 mg/1 EPA 300.0 01/07/2005 ML VPH Unadjusted C5-C8 Aliphatics(FID) <10 10 ug/l MADEP 01/13/2005 RGM Unadjusted C9-C12 Aliphades(FID) <10 10 ug/I MADEP 01/13/2005 RGM Methyl-tert-butylether <5 5 ug/l MADEP 01/13/2005 RGM Benzene <5 5 ug/I MADEP 01/132005 RGM Toluene <5 5 ug/I MADEP 01/13/2005 RGM Ethylbenzene <5 5 ug/I MADEP 01/13/2005 RGM m,p-Xylene <5 5 ug/I MADEP 01/13/2005 RGM o-Xylene <5 5 ug/I MADEP 01/13/2005 RGM Naphthalene <5 5 ug/I MADEP 01/13/2005 RGM Adjusted CS-C8 Aliphatics(FID) <10 10 ug/l MADEP 01/13/2005 RGM Adjusted C9-C12 Aliphatics(FID) <10 10 ug/I MADEP 01/132005 RGM C9-C10 Aromatics(PID) <10 10 ug/I MADEP 01/13/2005 RGM SURROGATE RANGE 01/13/2005 RGM 2,5-Dibromotoluene(PID) 103 70-130% MADEP 01/13/2005 RGM 2.5-Dibromotoluene(FID) 92 70-130% MADEP 01/13/2005 RGM EPH C9-C18 Aliphatics <20 20 ug/I MADEP 01/12/2005 RJP C19-C36 Aliphatics <20 20 ug/l MADEP 01/12/2005 RJP CI I-C22 Aromatics <20 20 ug/1 MADEP 01/12/2005 RJP Total EPH <60 60 ug/l MADEP 01/12/2005 RJP SURROGATES RANGE 01/12/2005 RJP Chloro-octadecane 59 40-140% MADEP 01/12/2005 RJP Ortho-terphenyl 73 40-140% MADEP 01/12/2005 RJP FRACTIONATION SURROGATES RANGE 01/122005 RJP 2-Fluorobiphenyl 85 40-140% MADEP 01/122005 RJP 2-Bromonaphthalene 90 40-140% MADEP 01/12/2005 RJP Extraction date Extracted MADEP 01/10/2005 1G TARGET PAH ANALYTES Naphthalene <l 1 ug/I MADEP 01/122005 DMM 2-Methylnaphthalene <1 1 ug/l MADEP 01/12/2005 DMM Acenaphthylene <1 1 ug/I MADEP 01/122005 DMM Acenaphthene <1 1 ug/I MADEP 01/122005 DMM Fluorene <1 1 ugll MADEP 01/12/2005 DMM Phenanthrene <1 1 ug/l MADEP 01/12/2005 DMM Anthracenc <I 1 ug/l MADEP D1/12/2005 DMM Fluoranthene <1 J ug/1 MADEP 01!12/2005 DMM i Page 15 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS e Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: :z Work Order#: 0501-00349 Data Reporting Sample# 004 SAMPLE DESCRIPTION: MW4 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: W107/2005 @ 13:00 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Pyrene <1 1 ug/1 MADEP 01/12/2005 DIAM Benzo(a)anthracene <1 1 ugh MADEP 01/12/2005 DMM Chrysene <1 1 ug/l MADEP 01/122005 DMM Benzo(b)fluoranthene <1 I ugh MADEP 0 111 2/200 5 DMM Benzo(k)fluoranthene <1 1 ug/l MADEP 01/122005 DMM Benzo(a)pyrene <0.2 0.2 ugh MADEP 01/12/2005 DMM lndeno(1,2,3-cd)pyrene <0.5 0.5 ugA MADEP 01/122005 DMM Dibenzo(a,h)anthracene <0.5 0.5 ug/1 MADEP 01/122005 DMM Benzo(g,h,i)perylene <1 1 ugh MADEP 0 111 2/20 05 DMM Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/1 EPA 524.2 01/142005 ROM Bromoform <0.5 0.5 ug/l EPA 524.2 DI/142005 ROM Dibromochloromethane <0.5 0.5 ug/1 EPA 524.2 01/142005 ROM Chloroform <0.5 0.5 ug/1 EPA 524.2 01/142005 ROM 1,2-Dibromoethane(EDB) <0.5 0.5 ugh EPA 524.2 01/142005 ROM Benzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM Carbon Tetrachloride <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM 1,2-Dichloroethane <0.5 0.5 ugh EPA 524.2 DI/142005 ROM Trichloroethene <0.5 0.5 ugh EPA 524.2 01/14/2005 ROM 1,4-Dichlorobenzene <0.5 0.5 ugR EPA 524.2 01/142005 ROM 1,1-Dichloroethane <0.5 0.5 ugh EPA 524.2 DI/142005 ROM 1,1,1-Trichloroethane <0.5 0.5 ugh EPA 524.2 01/142005 ROM Vinyl Chloride <0.5 0.5. ugh EPA 524.2 01/142005 ROM Bromobenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM Bromomethane <0.5 0.5 ugA EPA 524.2 01/142005 ROM Chtorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM Chloroethane <0-5 0.5 ugfl EPA 524.2 01/142005 ROM Chloromethane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM 2-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 01/142005 ROM 4-Chlorotoluene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM Dibrumomelhane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 ROM 1,3-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM 1,2-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM trans-1,2-Diebloroethene <0.5. 0.5 ug/1 EPA 524.2 01/142005 ROM cis-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM Methylene Chloride <0.5 0.5 ugh EPA 524.2 01/142005 ROM I,I-Dichloroethene <0.5 0.5 ug/l EPA 524.2 01/142005 ROM 1,1-Dichloropropene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM 1,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM 1,3-Dichloropropane <0.5 0.5 ug/l EPA 524.2 D1/14/2005 ROM cis-1,3-Dichluroprupene <0.5. 0.5 ug/l EPA 524.2 01/1420D5 ROM [ran-1,3-Dichloropropene <0.5 0.5 ug/l EPA 524.2 01/14/2005 ROM 2,2-Dichloropropane <0:5 0.5 ug/l EPA 524.2 01/142005 ROM Page 16 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS r Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 004 SAMPLE DESCRIPTION: MW-4 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 13:00 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Ethylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Styrene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,1,2-Trichloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,1,2-Tetrachloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,2,2-Tetrachloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Tctrachloroethene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,2,3-Trichloropropane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Toluene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Xylenes <0.5 0.5 ug/I EPA 524.2 01/14!2005 RGM 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Bromochloromethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM n-Butylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Dichlorodifluoromethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Triclilorofluorometbane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Isopropylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Hexachlorobutadiene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM p-Isopropyltoluene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Naphthalene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM n-Propylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM sec-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM tert-Butylbenzene <0.5 0.5 ug/I EPA 524.2 01/14!2005 RGM 1,2,3-Trichlombenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,2,4-Trichlorobencene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2,4-Tdmethylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,3,5-Trimethylbenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Methyl Tertiary Butyl Ether(MTBE) <1 I ug/l EPA 524.2 01/14/2005 RGM n-Hexane <10 10 ug/I EPA 524.2 01/14/2005 RGM SURROGATES RANGE EPA 524.2 01/14/2005 RGM 4-Bromofluorobenzene ]lJ 80-120% EPA 524.2 01/14/2005 RGM 1,2-Dichlorobenzene-d4 112 80-120% EPA 524.2 01/14/2005 RGM DISSOLVED METALS ARSENIC <0.005 0.005 mg/I EPA 200.9 01/12/2005 CD BARIUM 0.024 0.005. mg/1 EPA 200.7 01/14/2005 JNB CADMIUM <0.005 0.005 mg/I EPA 200.7 01/14/2005 JNB CHROMIUM <0.03 0.03 mg/I EPA 200.7 01/14/2005 JNB LEAD <0.002 0.002 mg/I EPA 200.9 01/12/2005 CD MERCURY <0.0005 0.0005 mg/1 EPA 245.1 01/12/2005 KSL SELENIUM <0.0050 0.0050 mgll EPA 200.9 01/11/2005 CD SILVER <0.02 0.02 mg/I EPA 200.7 01/14/2005 JNB Page 17 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporthig All QA/QC procedures required by the EPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the EPH Method with the following exception:C-range values may have been blank subtracted to minimise the effect of leachable plasticizers from the SPE cartridges. All QA/QC procedures required by the VPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the VPH Method. Page 18 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS ti Green Seal Environmental,Inc. , Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample 4 005 SAMPLE DESCRIPTION: MW-5 SAMPLE TYPE: GRAB SAMPLE DATEITUAE: 01/07/2005 @ 11:05 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST ALKALINITY(as CaCO3) 4.0 1.0 m9/1 EPA 310.1 01/07/2005 ML AMMONIA(as N) <0.10 0.10 mg/1 EPA 350.2 01/11/2005 JW TKN(as N) <0.50 0.50 mgA EPA 351.3 01/10/2005 BMM NITRATE(as N) 2.0 0.01 mg/1 EPA 300.0 01/08/2005 ML VPE Unadjusted C5-C8 Aliphatics(FID) <10 10 ug/1 MADEP 01/13/2005 RGM Unadjusted C9-C12 Aliphatics(FID) <10 10 ug/1 MADEP 01/13/2005 RGM Methyl-tert-butylether <5 5 ug/1 MADEP 01/13/2005 RGM Benzene <5 5 ug/1 MADEP 01/13/2005 RGM Toluene <5 5 ug/1 MADEP 01/13/2005 RGM Ethylbenzene <5 5 ug/l MADEP 01/13/2005 RGM m,p-Xylene <5 5 ug/1 MADEP 01/13/2005 RGM o-Xylene <5 5 ug/1 MADEP 01/13/2005 RGM Naphthalene <5 5 ug/1 MADEP 01/13/2005 RGM Adjusted C5-C8 Aliphatics(FID) <10 10 ug/1 MADEP 01/13/2005 RGM Adjusted C9-C12 Aliphatics(FID) <10 10 ug/1 MADEP 01/13/2005 RGM C9-C10Aromatics(PID) <10 10 ug/1 MADEP 01/13/2005 RGM SURROGATE RANGE 01/13/2005 RGM 2,5-Dibromotoluene(PID) 112 70-130% MADEP 01/13/2005 RGM 2,5-Dbromotoluene(FID) 10] 70-130% MADEP 01/1312005 RGM EPH C9-C 18 Aliphatics <20 20 ug/1 MADEP. 01/12/2005 RJP C19-C36Aliphatics <20 20 ug/1 MADEP 01/12/2005 RJP C I I-C22 Aromatics <20 20 ug/1 MADEP 01/12/2005 RJP Total EPH <60 60 ug/l MADEP. 01/12/2005 RJP SURROGATES RANGE 01/12/2005 RJP Chloro-octadecane 56 40-140% MADEP 01/12/2005 RJP Ortho-terphenyl 67 40-140% MADEP 01/12/2005 RJP FRACTIONATION SURROGATES RANGE 01/12/2005 RJP 2-Fluorobiphenyl 83 40-140% MADEP 01/12/2005 RJP 2-Bromonaphthalene 85 40-140% MADEP 01/12/2005 RJP Extraction date Extracted MADEP 01/10/2005 JG TARGET PAH ANALYTES Naphthalene <1 1 ug/1 MADEP 01/12/2005 DMM 2-Methylnaphthalene eI 1 ug/1 MADEP 01/12/2005 DMM Acenaphthylene <1 1 ug/l MADEP 01/12/2005 DMM Acenaphthene <I 1 ug/l MADEP 01/12/2005 DMM Fluorene <I 1 ug/1 MADEP 01/12/2005 DMM Phenanthrene <1 I ug/l MADEP 01/12/2005 DMM Anthracene <1 1 ug/1 MADEP 01/12/2005 DMM Fluoranthene <1 1 ug/1 MADEP 01/12/200S DMM Page 19 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS t Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: Work Order#: 0501-00349 Data Reporting Sample# 005 SAMPLE DESCRIPTION: MW-5 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 11:05 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Pyrene <1 1 ug/l MADEP 01/12/2005 DMM Bmao(a)anthracene <l 1 ugll MADEP 01/12/2005 DMM Chrysene <1 1 ugh MADEP 01112/2005 DMM Benzo(b)fluoranthene <1 1 ug/l MADEP Ol/12/2005 DMM Beazo(k)fluoranthene <1 1 ug/l MADEP 01/12/2005 DMM Benzo(a)pyrene <0.2 0.2 ug/l MADEP 01/12/2005 DMM lndeno(1,2,3-cd)pyrene <0.5 0.5 ug/l MADEP 01/12/2005 DMM Dibenzo(a,h)anthmcene <0.5 0.5 ug/l MADEP 01/12/2005 DMM Benzo(g,h,i)perylene <1 1 ug/l MADEP 01/12/2005 DMM Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Bromodichform <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Bromo ochloromethane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Dibrom <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Chloroform 1,2-Dibromoethane(EDB) <0.5 0.5 ugA EPA 524.2 01/14/2005 RGM Benzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Carbon Tetrachloride <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2-Dichloroethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RCM Trichloroethene <0.5 0.5 ugA EPA 524.2 01!14/2005 RGM 1,4-Dichlorobenzene <0.5 0.5 ug/1 EPA 5242 01/142005 RGM l,l-Dichloroethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1.1,1-Trichloroetltane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Vinvl Chloride <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Bromobenzene <0,5 0.5 ug/l EPA 5242 01/14/2005 RGM Bromomethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Chloroethane <0.5 0.5 ug/l EPA 524.2 01/14!2005 RGM Chloromethane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 2-Chlorotoluene <05 0.5 ug/l EPA 524.2 01/14/2005 RGM 4-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Dibromomethane <0.5 0.5 ug/l EPA 524.2 01114/2005 RGM 1,3-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 12-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM trans-1,2-Dichloroethene <0.5 U.5 ug/l EPA 524.2 01/1412005 RGM cis-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM Methylene Chloride <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM I,1-Dichloroethene <0.5 0.5 ugA EPA 524.2 01/14/2005 RGM 1,1-Dichloropropene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM 1,2-Dichlmvpropane <0.5 0.5, no EPA 524.2 01/14/2005 RGM 1,3-Dichloropropane <0.5 0.5 ugh EPA 524.2 01/14/2005 RGM cis-1,3-Dichloropropene <0.5 0.5 ugA EPA 524.2 01/14/2005 RGM nan-1,3-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 0l/14/2005 RGM 2,2-Dichlmupropane <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM i Page 20 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental;Inc. Date Received: 01/07/2005 Approved by: _t""' Work Order#: 0501-00349 Data RepoA4191 Sample# 005 SAMPLE DESCRIPTION: MW-5 SAMPLE TYPE: GRAB SAMPLE DATE/TIME: 01/07/2005 @ 11:05 SAMPLE DET. DATE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Ethylbenzene <0.5 0.5 ug/I EPA 5242 01/14/2005 RGM Styrene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,2-Trichloroethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,1,2-Tetrachloroethanc <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,1,2,2-Tetrachlorcethane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Tetrachloroethene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,2,3-Trichloropropane <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Toluene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM Xylenes <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Brmmochloromethane <0.5 0.5 ug/t EPA 524.2 01/14/2005 RGM n-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Dichlorodifluoromethane <0.5 0.5 ug/I EPA 5242 01/14/2005 RGM Trichlorofluoromethane <0.5 0.5 ug/I EPA 5242 01/14/2005 RGM lsopropylbenzene <0.5 0.5 ug/t EPA 524.2 01/14/2005 RGM Hexachlorobutadiene <0.5 0.5 ug/I EPA 5242 01/14/2005 RGM p-Isopropyltoluene <0.5 0.5 ug/l. EPA 524.2 01/14/2005 RGM Naphthalene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM n-Propylbenzene <0.5 0.5 ug/l EPA 524.2 01/14/2005 RGM sec-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM tert-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,2,3-Trichlorobenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,2,4-Trichlorobenzene <0.5 0.5 ug/I EPA 524.2 01/14/2005 RGM 1,2,4-Trimethylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM 1,3,5-Trimethylbenzene <0.5 0.5 ug/1 EPA 524.2 01/14/2005 RGM Methyl Tertiary Butyl Ether(MTBE) <l 1 119/1 EPA 524.2 01/14/2005 RGM n-Hexane QO 10 ug/I EPA 524.2 01/14/2005 RGM SURROGATES RANGE EPA 524.2 61114/2005 RGM 4-Bromofluorobenzene 110 50-120% EPA 524.2 01!14/2005 RGM 1,2-Dichlorobenzene-d4 III 80-120% EPA 524.2 01/14/2005 RGM DISSOLVED METALS ARSENIC <0.005 0.005 mg/l EPA200.9 01/12/2005 CD BARIUM 0.007 O.ODS mg/l EPA200.7 11/11/2005 JNB CADMIUM <0.005 0.005 mg/1 EPA200.7 01/142005 JNB CHROMIUM <0.03 0.03 mg/1 EPA200.7 01/14/2005 JNB LEAD <0.002 0.002 mg/l EPA200.9 DI/122005 CD, MERCURY <0.0005 0.0005 mg/I EPA245.1 01/12/2005 KSL SELENIUM <0.0050 0.0050 mg/l EPA200.9 01/112005 CD SILVER <0.02 0.02 mg/I EPA200.7 01/14/2005 JNB i Page 21 of 21 R.I.Analytical Laboratories,Inc. CERTIFICATE OF ANALYSIS Green Seal Environmental,Inc. Date Received: 01/07/2005 Approved by: 4//Z/, Work Order#: 0501-00349 -Reporting All QA/QC procedures required by the EPH Method were followed_ All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated, No significant modifications were made to the EPH Method with the following exception: C-range values may have been blank subtracted to minimize the effect of leachable plasticizers from the SPE cartridges. All QA/QC procedures required by the VPH Method were followed. All Performance/Acceptance Standards for the required QA/QC procedures were achieved or otherwise stated. No significant modifications were made to the VPH Method. TTJ 4 k7 to}r l l .o � N .- 41 Illinois Avenue 131 Coolidge St,Bldg. 2 a, .� o • Warwick, R102888 Hudson, MA 01749 0 d 3 • Z Tel: 800-937-2580 Tel: 888-228-3334 UI a U �} Fax 401 738 1970 Fax 978 568 0078 w �, Pate Timel wes o "V 7 Collece :a )Iited Faeld,Sa�p1e tlie74i,,re��"¢MINI, a. w y Joy lJ3 M— J < k G1ieD4Inonnu�tann w, t t;k ;1>5 a'.. ;a1, 3'� se � Vill CompanyNatne: Green Seal Environmental, Inc Project Name: NI s Address: 28 Route 6A P.O.Number. Project Number. City/State/Zip: Sandwich, MA 02563 Report To: Phone: Fax: Telephone: 508-888-6034 Fax: 508=888-1506 1 sampled by: v r t Contact Person: ��Qr� Quote No: Email address: Normal EMAIL Report r_ •© 7 C 11 � ss 5 Business days.Poniblesm bwV �J Rush (baaness days) Circle if applicable: W-1, GW-2, GW-3, S-11 S-21 S-3 MCP Data Enhancement QC Package? Yes No 714 k Up Only attach field bests Cc: results to vince@gseenv.com ice L---) WorkorderNo: 03—c —O03Y Container Types: P=Poly,G=Glass,AG=Amber Glass,V=Vial,St=Sterile Preservation Codes_.NP=None,N=HNO3,H=HCI,S=H2SO4,SH=NaOH,SB=NaHSOr,M=MeOH,T=Na2S203,Z=ZnOAc,I=Ice Matrix Codes:GW=Groundwater,SW=Surface Water,WW=Wastewater,DW=Drinking Water,S=Soil,SI=Sludge,A=Air,B=Bulk/Solid,0= Page of F ANSTABLE BUl ® Recycled Paper • Larry Marston TOWN O Manager of Architecture 7q-0Yo-001 27Y-0qL and Store Planning Map fS "7P Health Division Conservation Division r � Tax Collector (� Us Wholesale Club,Inc.,One Mercer Road,P.O.Box 9601 Natick,MA 01760-9601 (508)652-7959-Fax(508)652-7935•Email Imarston@bjs.com Treasurer 1� Planning Dept. f z SLUR NG DIVISION V 1" Plupa Date Definitive Plan Approved by Planning Board �- r�► I p 0l00 wo a�'5 Historic-OKH Preservation/Hyannis �GI. _ F Project Street Address Village Owner LC Address Telephone 1 P l Permit Request Square feet: 1 st floor: existing proposed 2nd floor:existing pr pos d Total new Zoning District Flood Plaines - Groundwater Overlay P Project Valuation Construction Type -- C'4 Xx -6 ill Lot SizeTc Grandfathered: ❑Yes g(No If yes, attach supporting documentation. DwellingFa ily ❑ Two Family OMulti-Family(#units) ZAge of Ere �'' Historic House: ❑Yes J�(No On Old King's Highway: ❑Yes �No Basemull 0 Crawl ❑Walkout ❑Other Baserrae (sq.ft.) Basement Unfinished Area(sq.ft)Half:existin new NumberF II: existing new 9 Number of Bedrooms: existing new Total Room Count(not including baths): existing new . First Floor Room Count Heat Type and Fuel: Wt&s ❑Oil ❑Electric ❑Other Central Air: U4es ❑No Fireplaces: Existing -- New -^ Existing wood/coal stove: ❑Yes ;Oo Detached garage:❑existing ❑new size — Pool:❑existing ❑new size Barn:❑existing ❑new size —' Attached garage:❑existing ❑new size --- Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Ves ❑No If yes,site plan review# --0 0-2�, Current Use C�1��` �t CL �Jo 4 Proposed Use �12�L BUILDER INFORMATION Name � Telephone Number �A 2� -920 Address -c � License# Ma, /9l7�% Home Improvement Contractor# Worker's Compensation# 54 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � Gr//L�- DATE SIGNATURE �� 6 No. � �7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i Ys PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for M gpooal *pgtem Congtruction Permit Application for a Permit to Construct()K4 Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. thT �� H ¢�,� Owner's Name,Address and Tel.No. U Assessor's Map/Parcel 9 7 l e , C5 9 0 ap , Installer's Name,Address,and Tel.N_o. Designer's Name,Address and Tel.No. �6CAA_ b.0 U.Ir Type of Building: Pyri,Cc Z4790/.0 e"/V tv ere Iq Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(a ) Other Type of Building �tt�{5/P.bYCt � No. of Persons Sowers( 0) Cafeteria( B) Other Fixtures F'Oad �`Or�r� ik 0 .3's -kwkea Design.Flow gallons per day. Calculated daily flow gallons. Plan Date 4 7-0 Number of sheets Revision Date Title Size of Septic Tank /Va fl e- Type of S.A.S. Description of Soil ;�'s • Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Ale U/ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisions of T S of Enviro ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue is Boaz of H th. Signe(dL— r �� h Date )1 1 y Application Approved by( Date 6 �- Application Disapproved for the followi reasons Permit No. &004 Date Issued 1 �d t No: �` "'' ( - ... � � ' _. Fee Entered in computer: T THE COMMONWEALTH OF MASSACHUSETTS .- s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIPprication for Migonf *pe;tem Congtrudion permit Application for a Permit to Construct()K—)Repair( )Upgrade( )Abandon( ) ❑Complete System, ❑Individual Components Location Address or Lot No. �'T- �� �a Owner's Name,,Address and Tel.No. Assessor's Map/Parcel ; -7 '4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ` Type of Building: p'r,0jtt 9 WWI C�oar •Pt�e�cr < , 4 Dwelling No.of Bedrooms ((.�/� Lot Size sq.ft. Garbage Grinder('O ) Other 'IYpe of B ildi�o Nlf�F^CI G No.of Persons Showers(©) Cafeteria( ) Other Fixtures w V ir1 bou4 510k Design Flow gallons per day. Calculated daily flow gallons. Plan Date 7—OY Number of sheets Revision Date '4r Title ` Size of Septic Tank pe of S.A.S. .11�ISI• t Descr1 i#ption of Soil'b/f ���i �• t Nature of Repairs or Alterations(Answer when applicable)_ eq Date last inspected: We W Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisions of Tit e of -he Enviro mental Code and not to place the system in operation until.a Certifi- cate of Compliance has been issue is oath of lth. Signed— r �. D N Date 4 Application Approved b Date I Ic Application Disapproved for the followi reasons Permit No. r9 064 _(9/`'k Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS a V.etAlf icate of Co1mp11Cl1a THIS IS TO CERTIFY, that the On-site Se a Disposal System Constructed Repaired ( )Upgraded{ ) Abandon( )by �� c-� V at Z. rN has been constructed in accordance with the provisions of Title 5 and the for Disposa System Con struc ion Permit o. AC64 b I 4 J-dated It 19 O Q Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will fh cti'on as designed. Date Inspector \_ — ---—� -------------------------------------/ --- No ©( �-► Fee/,5o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS li5pogar *p5tem Construction Permit Permission is hereby granted to Construe)Repair( )Upgrade( )Abandon( ) System located at t'� n i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of th�dfffe—of-fits- erne . Date: Approved-by_ TOWN OF Rwi(NSTABLE BU] ® Recycled Paper Larry Marston `t.. Manager of Architecture 74-OYo-00t 271Y-60' and Store Planning Map -- - :: Health Division Conservation Division r C Tax Collector BJ's Wholesale Club,Inc.,One Mercer Road,P.O.Box 9601 Natick,MA 01760-9601 1 (508)652-7959•Fax(508)652-7935•Email Imarston@bjs.com Treasurer _ Planning Dept. /' ENGINEER VG D,MIT �f 6/ �-�a� (ANSTRUCTION.VISION PJUO.R TQ� "I � Date Definitive Plan Approved by Planning Board 1'� P Oro 000 �1 Historic-OKH Preservation/Hyannis rnu-q- 661-pw F-o 6e6w P *vLTV- o,,_`J)p(d. Project Street Address Village W Owner Address Zy Telephone 1l tl O t T�nu� Caron L-n�j P l Permit Request C)k) _ CS "DrDOS � a feet: 1 floor:existin ro osed 2nd floor: existing d Total new q uar- st _ g_. proposed Zoning District �" t�- — Flood Plain `ter� C�_ Groundwater Overlay P _ 1 _ __ 1 a Project Valuation ? QI. Construction Type - ('an4 � 0l Lot Size Grandfathered: ❑Yes &o If yes, attach supporting documentation. m y Dwellingpe: ftgle Fa ily ❑ Two Family ❑ Multi-Family(#units) m �c Age of E4tingc%ructure � �'' Historic House: ❑Yes ANo On Old King's Highway: ❑Yes XNo Basem t Typ� ❑Full Crawl ❑Walkout ❑Other 2C Baserrt Firled Are (sq.ft.) Basement Unfinished Area(sq.ft) - N Number of Baths: F II: existing new Half: existing new NumhPr of Bedrooms: existing new �THE1p � DrE: FEE: • ■ARNSTABLE 9 MASS. 16yg. REC/BY Town of Barnstable l HED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 JunichiSawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FO LOCATION Property Address:420 Attucks Lane Hyannis,MA 02601 Assessor's Map and Parcel Number: Size of ot: Wetlands Within 300 Ft. Yes X Business Name: BJ'S h esale Club No Subdivision Name: APPLICANT'S NAME: Amy Rohne Phone 203-241-5394 Did the owner of the property authorize you to represent i er? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: BJ's Wholesale Club Name: Trish Taylor Address: 420 Attucks Lane H annis MA 02601 Address:420 Attucks Lane Hyannis,MA 02601 Phone: 508 568-4035 k V Phone: (508) 568-4035 VARIANCE FROM REGULATION(List Re . REASON FOR VARIANCE(May attach if more space needed) Time as a Public Health Control Variance Request to hold rotisserie chicken for 4 hours off temperature Procedure No. 2012-004 control using time as a public health control.Please see attached supporting documentation including standard operating procedures and logs used to document cooking and holding of rotisserie chicken. NATURE OF WORK: House Additi n ❑ House enovation ❑ Renair of Failed Cenr;r CvctPm n 0 Bellaire, Dianna maces 4- From: Christiansen, Dale <dchristiansen@bjs.com> on behalf of Legal Notices <legalnotices@bjs.com> Sent: Thursday, December 17, 2020 3:36 PM To: Bellaire, Dianna; Cheverie,Chris (GM321) Cc: Legal Notices Subject: RE: 2021 permit for BYs Store#321-IMPORTANT Attachments: Club#321 Hyannis-Form CT-3-Expires 9.30.22.pdf Hi Dianna, We only sell cigarettes at BJ's,nothing else,no cigars,vaping etc. I am attaching the state license for cigarettes again just in case but I'm pretty sure I included it in the renewal packet. Best regards and Happy Holidays! Dale Christiansen I Legol Associote BYs Wholesale Club,Inc. ® 774-512-6586 FAX(774)-512-6021 ► � dchristiansen@bis.com From: Bellaire, Dianna<Dianna.Bellaire@town.barnstable.ma.us> Sent:Thursday, December 17, 20201:30 PM To:Cheverie,Chris(GM321)<gm321@bis.com> Cc: Legal Notices<legalnotices@bis.com>; Bellaire, Dianna<Dianna.Bellaire@town.barnstable.ma.us> Subject:2021 permit for BYs Store#321-IMPORTANT Importance: High EXTERNAL EMAIL-USE CAUTION Hi, I sent you an email back 11/13/20 that your tobacco application was incomplete. I need to have a copy of your MA State licenses for Cigars and Electronic Delivery Systems,this is for anything related to e-cigarettes or vaping or the delivery systems. If you don't sell,then I need a confirmation email to release the permits. This is holding up your grocery permit as well and the permits expire at the end of the this month. Thank you. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us 1 Bellaire, Dianna From: Stanton, David Sent: Wednesday, April 07, 2021 9:52 AM To: Bellaire, Dianna; Desmarais, Donald Subject: RE: BJ's Wholesale No, they closed down the front kitchen years ago Sent from my Verizon; Satnsung Galaxy stnartphone -------- Original message -------- From: "Bellaire, Dianna" <Dianna.Bellairegtown.barnstable.ma.us> Date: 4/7/21 9:33 AM (GMT-05:00) To: "Desmarais, Donald" <Donald.Desmaraisgtown.barnstable.ma.us>, "Stanton, David" <David.Stantongtown.bamstable.ma.us> Cc: 'Bellaire, Dianna" <Dianna.Bellairegtown.barnstable.ma.us> Subject: BYs Wholesale Hi, I just noticed that BJ's has a pizza variance, do they make pizza anymore? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission("e:-mail"),including any attachment(the"Information"),may be confidential or otherwri.se exempt from disclosure.It is for the addressee only."Phis Information may be privileged and confidential work-product or a privileged and confidential commtuucation.The.Information may also be deliberative Fund pre-decisional in nature.As such,it is for internal use only.The.Information.may not be disclosed wi.th.out the prior written consent of the Director.of Public.I lealth and/or the Town Attornev's Office of the Town of Barnstable. If you have received this e-mail by nustake,please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. 1 Mass` tts"Department of Environmental ManjQent , Office of Water Resources 135552 'TYPE OR PRINT ONLY Well ompletion Report 1.WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE 'Address'at Well Location . � S Property Owner �`�° �"�'' ti_��' aYtr+3 L 8 Subdivision3Name� � Mailing Addresst�' �`" t 'a �- City/Tow, CitylTown Assessor's Maps' Assessors Lot#: NOTE'Assessors Map and Lot# ma -ddto_ry"rf no streeVaddress available r ' Board of..Health'permit obtained:- Yes ❑,. "Not Required. Permit Number p e fssueda } 2. WORK PERFORMED 3. PROPOSED USE 4.DRILLING MI=THOIa, M r New Well ❑ Abandon ❑ Domestic ❑ Irrigation ❑ Cable — X,Auger Deepen El Monitoring El Municipal Q ❑ Air Hammer— Direct Push ElReplace ElOther ElIndustrial ElOther ❑ Mud`Rota " :❑ Other 5.WELL LOG oC Unconsolidated Consolidated 6.SITE SKETCH(use permanent landmarks with,distanaes)- W Permeability - a H > a 6 m a� ca c a From (ft) To (ft) High Low `� C7 m Other Rock Type ` i 8 -Zo r V� _ 7.WELL CONSTRUCTION 8."CASING O O 9 Yp � i O Type Total.Depth Drilled 23 From ft To ft Casing T e and Material Size O.D. In Well Seal T e Date Drilling Complete — 1 3 SC\,AX 9`0 Pam- F� Z 1y�zoo5 r `, 9. SCREEN From (ft) To (ft) Slot Size Screen-Type and Material Screen Diameter —(3 -T .o i o V7Tr 2 10. FILTER PACK/GROUT/`.ABANDONMENT MATERIAL 1:1. ADDITIONAL WELL INFORMATION - Developed? ❑ Yes No From (ft) To (ft) Material Description Purpose Fracture ,.. i�� Enhancement? ❑ Yes No Method --- ` ,? Disinfected? ❑ Yes No 12. WELL TEST DATA(PRODUCTION WELLS) 13. STATIC WATER LEVEL(ALL WELLS) Yield,�,Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM)- (firs&min) (Ft. BGS) (hrs& min) (Ft. BGS) Date Measured Ground Surface (FT) 14. PERMANENT PUMP (IF AVAILABLE) 15,NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description ����T J Horsepower Pump Intake Depth (ft) Nominal Pump Capacity (gpm) 16. COMMENTS 17. WELL DRILLER'S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules and regulations, and this repo is comp to and correct to the best of my knowledge. Driller: 1hVraf �QS`lr� �� Supervising Driller Signature: P Registration #:1 1 0 Firm: - � t\ Date: �" �0 '�� Rig Permit#: I I I I I NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. 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'fe•T LATOV.SIDECbIP _ i11 1 ':i r I r-I :i r i'r i 4 i t-v ;' _ _ _ _— ransE lunLL 1 I r.'.;I n `F..f •`3. 1'`p� [[1MER TOP TI SRE BOLLARD ".• I I �_ E.. V I' III I ' III +ol, I CIVIL DUGS. III le 11 I �'-1 :.�BT BJS RS1PIxl a-In''rl RERAN.TYP. j +' ' • OD DID TTP VNO. I ` JscPalAnd+ 2 I I - 1 I 1PJ }•. ITS BT Bt5 '�- 2 • --i---I L- �_ 5:` 60 �. {Ju rIR .,.._.•.,......- p p 11.\ �.�6 _ BT G�CroE ' _� ': .: U :.�J .1 L�F. f EkpPN51, L '•_,..r r -'S ._....... --g-i II I R31utFn -I 1: J ST.FLDOR FNSN R I ' I D D `� "r II ' :.'.:1 FCIFL ,,: f'O-'F `L'f C ' � TEP. L'n..l 4RW s1rE 0OL41fA. V3 --o----- 9-D•4 I - - - ' °✓- I l�gC1 D $ _ T P. Y.- xG I _ -'+- '---- ice_ -- --- --�=_lam -- ,Jmp __ O_ - ••O•-• "•ram- f 1 •`TI' ' L'I 1�\ , „. r -•--• D O 'rl `----------� I I IpLr,,-I�� DF , , /, Q` `\\� 1 PROFESSIONAL IN CHARGE •PlJ✓Y- -- J IA 1TP I o:b A -a �-Y'll GA EDE-ILS. i S ©I ij 1 A II I III ��� REAro•TE D To ���TER LNES� I ♦-+� lO ' i 'T' C I FLIABING AID SITE 6 2Q16 Pes GOlnI.fCIR n i0 ThErIXIST STORK / 1 1 OUAl1TY CONTROL R�_r•......_._._� O— —(///'.• 1 1 l /f •' NEs' 1]E S E DRAWN BY - 1 •J. I 1 d Cll,nt: J,. sT. III I kq BwPLIEo also i 1 to �q I WHOLESALE CLUB V \ Y I D ���$ Z�I LEr�bv. �/y/ /-Tv -c\ I III I - - I - i®I t%,(I'I-; BJ9 NEOLE9L�,, UB ] sCAPE cc AREA ...... Ew ExIBIDFD SIOEWnLK / `` `tiy� L J I I' i CLUB YI:LRATEWnI SITE h� � 1 I � i/I HYANNI •---_ FDnIR£ /� CQRRACtOR ttP. `,/ T "Q14�L I I a1 SA -1 //?.•', i / GATE PROJECT NO. Is DIR Go `J y /' �,•' 01R9/16 99011D5 r. G To Rini. RXII� i y I I ovcxl �l 1✓EW r0 Ex15 5TOW1 W,,R .- .. G To FFSIAN� /r'`'� � l v/ I I caanj ti / ' 9T5]ETL SEE PL ING AN�9RE SHEET TITLE :l BOLLARD SCHEDULE , Z/ �� _ _____ ______ 12iI�ETffREE I " TYPE DESCRIPTION DETAIL I / ` _�-� _ �, �� J NBa FTEtJDED SWBIMI.K BT BunnIG CLTRRAGTOR PLUUIi -u•1 1 101TdlYOW CONC FLUEDSTEBPPEW I]/AnW POLY PROPYIFNECPIER.COLOR TO MaTCN BM]WSID i Y/•� // I�� / p 7 /,• i , COOf�NATE WDI SRE CQIINY]OfI;ttP. i 'RED ROCK(BREEZEWAY EXTER1OR7 J fi-OWfDNCO c—EO STE¢PIPE- LASW I I �/. uae.e... EDROCK COVER COLOR TO IMTCN BM2WS1 LENE 0 mww+aw r/ Y . RECI ROCK TERIORI ILA I1.� _. IE% / 7 J of 6 1 9•D x -OX<ONCFlLLEDS]E¢PIPEw m OLrPROPYLENE COVER COLOR TO MATCH BM YS O O I 7 \ I ® �_* SAFEYY¢OWINTERIOR) FLOOR PLAI`I �a BMW �,11� ! i TS our• . 9.010.xJ911-ALVAMf)D SHEET NUMBER MOO¢OS&J2 NY1ffE INnW , BT BUILDING COHIRACTOR /V - � � (LSIAND CPSE51 Vb yl_0• COORDPLO WIN 5r1E i,-•. / S DIAx IT-CONC FILLED STEEL PIPE PANTED BM 15 )IABn3 / :SAFETY YELLOW I—POSTSI OR TTP. � _ A101 8 OIAx a CN CONC—EDWE¢PIPE V/ OLYPROPYLENE COVER COLOR TO MATCN BM 13 1 'SAFETY YELLON fIXTERroRI - - IJ%t! roe Y DCB-8 y0 1=43.07 (DCB-8) I pQp GQ�W r p �d R=46.08 $i``!` f 1=43.07 (DCB-9) /Q� D� .� t�S .t:'. r G • �� S =43.31 (OUT) f 1=42.97 (DMH-8)f �� >,'00', vvv / / 'ems. ` DCB-10 DMH-8 \ / R=44.20 R 4428870(DMH-4) / I• R INV IN=41.65 N r-13 GV+ C1FIARED E`1D - .87 DMH-7 �`` INV OUT=41.75 iy INV=41.10 1=42 ( ) / I P n I=42.87 (ROOF) � VAULT,PER UTILITY � Q,Ga O� STANDARD .1=42.77 (DMH-9) OCP \ o f 6 oR =0.003 nuu..t1 Q S C C` o3� R-45 0;0y C 4z12"x12 I o/�' y � _ 1=aw;O 4 •DI D 12*x12 x12 DI TE • OST INDICATOR r: 1=41 26 FIRE SERVIC , r 00 VALVE TRANSFORMER PAD PER' _ ra .. P^ $W O r UTILITY STANDARD 1� RANT 1000 GALLON GREASE TRAP-2 �� GATE VALVE / p I• G R=48.20 �O� o I, p Op 1=44.50 (INLET)�vp\� ` g• �1 ` 1=44.25 (OUTLET) 4" SCH 40 PVC SEWAGE LIFT STATION r `% �o \ I l �Q ��/� �� ( CLEANOUTS COVER ELEV=46.8 Os f QOS 4" SCH 40 PVC VENT INV IN=38.55INV ; +6 QR P�G�P$ �' ! 55 TO BUILDING ROOF R 6 Q�� PO (4" FORCE MAINS a. S A\�� S� 4" SCH 40 PVC FOOD AREA SE 6" SCH 40 PVC BUILDING SEWER S g- C PVC.-jC PUMP CONTROL PANEL WITH VISUAL yANUU ROPOSEU f tL ALARM IN LOCKED PEDESTAL MOUNT. RQ �' r CHAM REMOTE ALARM TO BE LOCATED INSIDE f BUILDING AT MANAGER'S OFICE /S / l • f SMH-3. RIM=48.50 �F`��S 6 P B-11 j 1I INV IN=39.25 (SMH-1) V� f� 800 DMH-3 p INV'OUT=39.15 (LIFT STATION) 90 Q� -4 ,06 (ROOF) h a SMH-1, RIM=48.60 I ,k5 a�,It 43.(?6 (CB-12 R=4.49 1 f °. c INV IN(4")=44.15 (GREASE TR4P) �� `�' S /' ���Wit✓ 1=42.96 (CB �P I=43.49 (DCB-5) I INV OUT(6")=44.05 (SMH-21--, 6" SCH 40 PVC SEWER 1=43.49(DMH-2)/ LS : `�� 1=43.39 (DMH-4)f t °' . �c. `\,` ASE1S h v, .N f ` SMH-2, R14=48.50 12 F. V o t' \ INV IN(6")=43.80 (BUILDING) pI� 0 0 4" SCH 40,PVC S P CLEANOUT INV IN(4�)=43.80 (SMH1) 1�6 1=438.54 (ROOF) 1 INV OUT(6")=43.70 (SMH-3) Q 0'. 143.54 (CB-13) \�Q` 2) 4" PVC --.n f I ! I3,44 (CB-11 `��Cj`` ENCASED TAP Ile REO ALIC DMH-2 FORCE MAIN R0i CLEANOUT MANHOLE R 47-69 43.74 (DCB-4) �O y,�56 -13 Q�6 i RIM=48.7 „I 0 41 �a S R=48.00 4" FM INV=42.0t I=43.7 (DMH-1) • Q I=44.02 (ROOF) QQ` / f I=43.6 (DMH-3) 1=4.4.02 (CB_14) .� k. .000000 1000 GALLON GREASE_TRAP-1 . t,/ I=43.92 (CB 1 Q � s� � � R=48.50 • , x 5 PROPOSED 4" PVC FORCE MAIN, / f c 1 1=44.50 (INLET) 12"x12^x6" TEE: Y SLOPED CONTINUOUSLY UPWARD / / 1=44.25 (OUTLET) AT MINIMUM O.Sz SLOPE, EXCEPT 0./ Ny p• S !� -14 �� AT WATER CROSSING f R=48.00 4 f / B-4 vP44.90 (ROOF) vQ f I R 46.68 PROPOSED HYDRANT . / i !o�1=44.40 (CB-13) 44.02 (OUT) VALVE .�' I ( T) WITH GATE i F / � PRUGOSED CONCRETE f /LOWER FORCE MAIN TO HFAi)WAtL �_� - "6to q / A MINIMUM OF 18" 1 / BELOW WATER MAIN TO / AVOID CONFLICT 4" FM INV=41.35 FPS - - - FORCE MAIN HIGH A i � _ PrUNT 1MTF+AIR I i i i i 284' FACE TO FACE OF 5UILDINC-4 29' 33' 3(0' 31;0' 3(0' 3(o' 3(o' 40' 1l-411 1'-4' 9._4" IV- ° �� 19'-4" 19'-4" IV-4" �� 1 �� 10' 19'-4" - IV-4" 19'-4" ' " - - 4- - - - -� _ - _ - - _ - - - _ -RF - - - - - � _ - - - -,�_ _ -- -- 4- - - - - - - - - - -- - - - - - - - - --� civ 34-10 - 25'-1" 6'-2" '-1 _ I 34'-10" 0 L 9 HIGH OPEN TO I , „ EME1;prE CY I I EMERGENCY G$lll. BELOW 8'� I I DOORS 62 1 DOORS I (HOLD) - - - - - - - - - - - - - - - - - - - - - _J rv.uraLL Mouyr RAMP LoNRACK I 32' MD/DELI RAMP p lU FREE' tla ooRs� R P�3I LocATiarr UP OFFICE Cr_ I Moron 24-8 ID. _4 eo�T. r-o AFF. Ic -CREAM14' FREE. I' II'-Z" 0 J LOUNGE _ F WE_ �4 TRAINING;RM - EL1C [1T. 23'-6" - 19'-1" rGONRACK RO = I / 5_2 s 8'-4" V-1 51" 51" 9'-�" 8'-4" 9�_1�� 51" 51" 8'-4" VEST. `t I QI 19' 0 14' '-10 I L — — —— A MEAT '-2' 6'-8" 1'-8" I I BR - O - I MEGH COOLER HOLD cr >�zs U 16'-1" U1 I th cv , OM d► 9'-4" - ROOM 0 10'CLEAR To • . •� . Gl i - (f� 6' 2 d -6 i « CEILMGF Q = - (42 PAG-M) '' J L PlCSM OFFICE I Pei • 9�_811 0 8' 4" 8,_6 OFFICE ap 12'-8" - _ �Aa-m '-"1 I I UP IF I ICIL I I 1 " I _ _ 1 rae_e BFAMILYOFFICE Z ABOVE - aq - ,o _ I I r r-- g 5' 9" I `" I w .o I I I pax lm D RA RECEIVING OFFICE MEZZANINE - - I ptD '�''; 1$ Ad. s C4 8' I ewes A® COOLER O - 5' S' RA 3 slac = 40 D FREEZER cr RAMP I d Y GsC T.V. 46 DOORS UP MEN te I « LOCA ION W � (Y 0 I h D1a to s 4' 2' 1 I I I w I� 1 , r - i N 11- RETAININGa WALL-1 I itt - - - - - 1 ITV sy mLl m � m K► a 14W CWA I C rr o r / RAIL #3 I UP r p I `� o SHRIMP 2 _ CAGE -J oaa.eR ran cr 14 �4 FISH � � L c:�w+ FOOD- •POO ace, `t PODIUM CsENERAL. MERCH. = COMPACTOR ,- 4 •ca.eRawos ° I - - W cooLElerip co I ?n OL •Poa siee• morrope IQ - I i p `' r °o I � z RE C I V IN v I NI N N I Q N N •POs 81DE• I a LL COMPACTOR r✓-,O�i(o S F. ® D dp I Q �► an aer»` a I w �r ( v L — a r- $ n $ f Lj 1 a'_4" 11 rt 12'-3" rn 10 U- POLE ar�v°�rda'a T r �Q POILER DO LY AND COMPACTOR BAKERY I I ( I r ( REI FORCED CONCRETE 02 I p a _zm HOLD � �n Q uRPAMP 12'-1" a = 9 �,� • r++seioc as,,� O �t Q 1�- 12' 29' - '- a I r ►xu r�oesx 8 I tt 0 0 #1 GUARD RAIL TAeY E I ears a r BY GC. I _ �® p II 0 I 1 PODIUM=� ° 1 i LLl • BAKERY DOUN , Is 6 4' U I n o+eA } 0 2m'-3" ® LL RETAINING WALL N '�+"�M - P.T. r i n - 10' HIGH CHAIN LINK 2O -� FENCE WITH ROOF. 12' `t �l ' ' GRADE DOOR 11, own-Q `t N - 4 1. �j� _ J l— _„J _ Al v 1* 1'-6° 8'-4° -I'-6° 8'-4" i `' a`;8'-4° 2 _ E 5'-4" 8'-1" 9'-9" �'-2" �'-6" 8' 6" 9'-6" 8'-4" a• �� >' « MAN 000 TRUCKERS _ �ti - - FOOD - - - - - - _ LOUNGE C � N O1R - GENERAL RCH - - - l LEI _ _ 10'-•4 i i 1m' l I r- p 1- -� r- -� r- -�_, -- �- -� - �, TUBE —�r- —� r- Z —�r- —� r- —�r- Vtt —� r- _,r- t r (TYP. 1 � - J- - I - 1 I - � - - O1C - I OF 4) -�r- �_�r- - 1 ll'-4" - _ _ oC � _ - w �t r-Cl RETTES - 0 L) - � 6 H C_ FEN E IG CIG CIG BY G.C. — — m O1D FREPEEMEIt LT J I I I I I 1 � � I 1 , OiT - �- - r 01E « m L 8'B1�PEENCCE I - @ I I I I I } I VERTICAL LIP r OF F ouT� ut ccl -I p 6' H FENCE J z BY G.G. r- -� 12' OiCs M I _ - 22 a 16' S'-4° 11'-3" 8'-4° 9'-fo" 51" 51u 9'-1" 8'-4° 9'-1° 51° 51° 9'-1° 8'-4° �'-1° 51° r71" 9'-�" 8'-4° '-8° 51° 51° 9'-6° 8'-4° 9'-6° 8' ° '-3° 24'-3° 13'-1m° - f{1 e I OIUJ I I a I 2 L i �R ®`R, 1 J O 1 V RAMPUP - RAMP thEr1BEP.SERVICES DESK -1 - - - COPY P - - - 1'_$" EMEFWsENCY I it i TU5E HOLD EMERGENCY DOORS DOORS - - « « « « « - « « IV-4" 19'-4" IV-4" 19'-4" 13'-4" i 101'-4" Space Data i/23/2m04 31-Dec-01 321 _ . HYANNIS I MA AREAS (SGQ FT) Sales Floor 50313 Front End 6,260 Liquor Shop 0 Freezer/Cooler 2,183 Low Freezer 258 Remote FzrJProducs Cooler 0 Offices, - First Floor Me Receiving 5,m16 Tire Installation 1,924 1.. " Vestibule echa ica l/Fixed 88 D special - P#�armacy m D 1 TOTAL BMezzanlniln FOOTPRINT tT Rcv g) 316 Property DBVeIO Mmi rlt SELLING PALLET POSITIONS (� WHOLESALE CLUB 1 FOOD 339 t7 � q. of total 31% GENERAL MERCHANDISE 561 se of Total 6390 BJ s Wholesale Club _ - One Mercer Road �/'�( NA � Tota I 906 P.O. Box 9601 - Refrigerated Produce (Linear Feet) 32 Natick, MA 01760 9601 Dry Produce (Selling Pellets,) t NEwCATED Dual TEMP c.4SE Meat Dts la Ceres (Linear Feet) 268 12/19/05 FROM RELOCATED ONE ISLAND MULTI DECIG CASE AND PROVIDED (508) 651-7400 J ,� . � I Bakery g replay (Linear Feat) 1 NEW LOBSTER STEAMER,1 NEW REc DOOR ,� /� ` �, /',y 0� � � Liquor Ceres(Selling near Feet) 92 8/30/05 ADDED I NEW STEAMS CASE,t NEQ DO RY OVEN l +/1�-dl l � /f1'�7' � � S' � Liquor p (Selltng Pallets) 0 2 NEW MULTIDECK ISLAND CASES AND R-LocATE I MD PROJECT CLUB — Freezer/Cooler/Lowbog Doors 46/40/22 8/30/05 1 NEW 12'PRODUCE CASE AND 2 NEW REGISTERS _ J��), 2/21/05 REMOVED THE CIGARETTES CAGE AND ADDED ANO,NER IIM HYANNI� MA 321 l RESERVE PALLET POSITIONS 621 / `°31V1 Ins V rye�1 B Level 621 l2/21/04 REVISED FOOD COURT SEATMG,ADDED NEW CELL JEB / 1 c Level PHONES DISPLAY RELOCATED ENTRANCE,CARDS,CELL.OPTICAL AND I il/y D Level (note a) 621 9/15/04 ���,s JEB Freezer/Cooler 19 5/23/04 ADDED SOFFIT HEWS AND SOFFIT TO MEMBER SERVICE JEB SHEET TITLE SHEET Remote Freezer /Cooler m A-v ,fin" y� Sa les Floor Bulk(ABC high) 0 - 1/23/04 ,3,�Li A HIS TCE�LAND THEATRE .JEB ' �� - (note b) Total 1,960 CHANGAW ZONE 2 LOW FIXTURE PLAN F 1 f�1 a U � �� , 6/22/04 REVISED PER M.WEDGE SIGN OFF JEB 9 Liquor Shop Reserve Pallets m Tire Facings On Sates Floor 0 PREVIOUS REVISIONS DELETED SCALE DRAWN BY DATE GAD FILE DATE REvI51oN BY 1/16'-'1'-0' J1EB 5/7/03 32fyemis-2c L:\Design\DEPT STORES\Existing clubs\321Hyannis-2c.dw9, 5/21/2007 3:00:25 PM , y •i 1 I i it APPLICANT AND DEVELOPER: THE TARKINOW GROUP C/O PATRICK M. BUTLER a P.O. BOX 1630 �°�� s HYANNIS, MASSACHUSETTS 02601 LOCU�� f (508) 790-545B EXIT 6 CAPE ATLANTIC LOCUS COD OCEAN OLD ROUTE 132 aAY o� APPLICANT'S ATTORNEY: PATRICK M. BUTLER .: l P.O. BOX 1630 y R�qD z yAD'�wgr z HYANNIS, MASSACHUSETTS 02601 s (Ro o (508) 790-5407 / R vTE �32 z �.� ,CD OWNER: CAPE COD AGGREGATES e ROUTE 2$ NANTUCKET P.0.BOX 96 SOUND HYANNIS, MASSACHUSETTS HYANNIS, MASSACHUSETTS 02601 . (508) 775-3716 KEY MAP CAPE COD, MASSAC K)SETTS NO SCALE (NO SCALE) CIVIL ENGINEER: 1 COASTAL ENGINEERING CO., INC. 260 CRANBERRY HIGHWAY 1 . ORLEANS, MASSACHUSETTS 02653 (508) 255-6511 pD TE DEVE M T TRAFFIC ENGINEER: VANASSE & ASSOCIATES, INC. TRANSPORTATION ENGINEERS & PLANNERS 10 NEW ENGLAND BUSINESS CENTER DRIVE SUITE 314 HADAWAY R AD ANDOVER, MASSACHUSETTS 01810- 1066 (978) 474-8800 LANDSCAPE CONSULTANT: ABBELLIRE, INC. B 10 RIDGEWOOD DRIVE EAST SANDWICH MASSACHUSETTS 02537 \/VHOLLSA t R -- 7 (508) 833 2 66 j, HY m T APR 2 9 2004 II • DESIGN ED F • BIDD 0 06 03 DRA WING INDEX LATEST DATE SD-1 EXISTING CONDITIONS PLAN 9/12/00 SD-2 LAYOUT AND MATERIALS PLAN 10/06/0�3 I: F SD-3 GRADING AND DRAINAGE PLAN 70/06/ 3 SD-4 UTILITY PLAN � f , SD-5 SITE DETAILS 10/06/03 i SD—b SITE DETAILS 10/06/0 AT 0 FOR I F SD-7 SITE DETAILS 10/06/0 (�C CEC 2003 Ct4825COV COPYRIGHT 2003 ROPOSE sl LOP EN I ., A I 1, ., _ ---- __ _ -- _ - . _ . '7. =:, ,• nr.. I I+ fn / t 11 J \ 11 / / / / /// i \\ �\ f`` \� �'/ J/ / /- � i / / j r \ / \ 5°' ' , -, ' ; I / -4-�� - I 11 [ ' '' 11, , / - "'Z�t , -, -_ g/ // -- ' // / \ I-11z", , // ___ , , k // , " , ­ , -_ 1. - . 'k. I I" \ \ / / / / i \1� \ ' &t -, --_�- --:-ff_--��.�� e / 9 \ l _ / 4 ' / \ \ \ \ , - .. / / __ r // // / /// // / alk/� \ a zr I \ ' ' / - / f r l f l ///// /////// / o/a! / /r"� , ._ -- -- ,1` N fi0'13'S1" W / ' 11" / /' W W/ / �/ / 1517-V , \; 1,1 / /r, / l / % // /, /// / / -- I j I / / I `_-"_ - - _ 1055.83' / ' � - IT _ / �\ 11 I !"s' ` � r- - ` yJll �l ( III Jr/ //j j///j//// / I I _ _ --/-- -- -.. __ � � ;, '11 � ""� / / 11 \ \ ,l { I \(+ / /I �/// aa. // / / (\\\', < ` L� / i / r� / / / ',' .'("v \ \ 1 \ \ / / a / . / \ / / \� / / / \ l e \ \\ \\ \\ / //// ////// / /' / / \\\\, \ ) -, / / / ' __ / / ' / - ,-1 � � Q m tr.)- v _ _ a�. / \\\ \\\\ \\ \ / / // // /� / / \ as-- / �g / // 0 d �--=` �50= \ \\ 461.99 \ \\\\ \\\\ \\\ 1) �'/ // // /// / / / \ ��\ /l� / +� / \ r i py TRIAL \ \ \ .� ✓ / / / I \ / / \ r - ' \\\ '-wo s �% a'bti I \\ \-' \\\ \ // -� /,� // / / r \ / \ 1--. - / /!- p�ry+q{ -' s- — '1 '{- l' -��\ \ \\\ -•�I,. / // //. // -j� I r / \ — .'" ./ �' i r '' ,_rhy ....,tea'! 70- / / ' --, -f --- _`��\\\\ \\\\ \ %\ { I n ` a��\ \\�`�` //'' f I J \\ _ / / '/ / Yq��yf//7/�/ En / i/ 3 \\ �� \\\\\�� \ \ \ \ I 1 i J / / / _ -.,,. - _.-. .14, / / i x , \ -• ill 11 2 In) \ / / - / / / �' LINE OF REGISTRATt�'N,R \ I l( \ \ \ l ( i 1 \ / ' - - / / '- / / '�'j ,-i' ;-'% � y JI -- l l - / / cn L.C.P. 30063E I I !( \ \ \ \ ( \ 1 / \ / / r _ / 11 / / ./ / '=_" , \ j I \ - a �� ^t J jy I11/ I \ \ +5 \`—'�\ \ / \ r / l / ° / 'y // ,� , ^�� \ \ / l11 I/ I( \ -z \\ \ t6+ \\ \ / ; i/� / I \ / / ; / /' / 1°/ ' / // // / / / ' I- ,� // / / / / / // /// �<\ ��- ,. I C � — \ \ 1 -- -_ - - �/ \ I ; / tom° / r- / / I / _ ,,,L- - - - -, \ -5 ' - ,,, " _/ - __ - --: - .<.,) r '/ . __ _ _ _ __ __ _ -1 '_ ._1 , ',5)'*� 11 // ~\ \\ \\ 1Cv''/ `` \\\\ \\\ \\\\ vl\ l/Ntkc� / \ \ \ _r `/ i `/j \\1\ \ \ / `i / — / / / / / 1,.-/,, / ,i / -/ - ��r�. / �� /. / 'I, \ \\\\ \\\ \ \S� \ / \ \ `/ \ / } \ I /I / � / � i / / i / / / / � / , _ I \ -- `\\ \\\\ \\\ \ \` /-�__� �\ \ \ \ / 1 \ �,� \\ / LOT 7 ' / / / // r"' .-/ \ /� �_ - II �• __ , � // \ \ \\ \ / -_. \ \ � l PLAN BOOK 547 PAGE 1 / ,-- l -�- � / / / �, � � ; /,� ,, '\�"� \ 1 }� y�`' `° \\ \\ \\\\\\A :-,// �� �\ \ } 1 j \ /I / / I I / AREA - 274,410 s.f.f / / -- � / / / / / / rj ///' / o/' ,/ \ \ � / +1� \\ \ \ I /.- \� \\ 1 \ / 6.30 acres / / / ' - / ' / / / / 1-1 / / / / /f / \ \.� ` \\\ \\\\` � _ '// /- ,\ \\\, \ } j j I { I- __ // 1 \ l N/f CAPE COD AGGREGATES / -r ' -- / / / ,/ 1-1 � / / '- ' ,, v� / �'D \ \' ` 1Q \ \\ \\\\ / \ \\ lIIjJjJ / - \ \ '// / l / / / - _ / i / i / / ./ r i ' -r1''�\/ \ �i \ / r \ a+ /( +10. \\\\ � 4- -- ) \ }j jJJJj / l � _ � --/ l / \ // / - / / � - / % / 1-1 // / / / / � / //j 0Z / - -- \ �� ¢ f r"ti 1�6 ��`1 1 l l ( J 1 / / _ / / / / / / �. Q __ + t if �_ ' -- - I o \ \ m / `, j X i } ! I l [Poi ,j j j ol l / \ � - \ / / ' - ' ~� 1� / ' -11 / ' ' � / --_..Z >-- Yq / ,. _ _ \ u 10� 1a`' J I ) f �1� J I IIIIjlI }/ \ / \ 1 I i \ \ v� ' ///////I,- - - �,��\�`_� = \ / l / ' - / j ( lljl Il { } A LOT \- } _ / \ I `s� // ' // / / / / // / / ' / 11 / �' ' z = � r .- / l 11 t _ r / / �LdCL � � . -� �/// /// _ - _ \ _ \ / I I - - -- - "- d c� PLAN BOOK 547 PAGE 1 / "` CD �CD 7r) k y // // // / _ _ _ _ � \ �� �\ 1 } \ / � / \ 1-1 1 "I I / / /// /Jo////// / - - �� \ \\ \ .\ 1`° \ --.,- i } } { AREA = 48 acr s.ff / r '� — \ \ \ \ � / / / /_ / i / �� / / / / l !l� — \ \-' �'` \ ` \ \ \\ ' ,'' J 9.4$ acres _ / / / / I. ,I / .] / / J j 1 I l ,1 / = .\ -" \\\ �� \ /�// " /i �- � //f ( \ N/F CAPE COD AGGREGATES ~/ � i �° / / / / / y // z / -/ w - ti / J I j I I \ \ 4 �, / �\ \ \ \. / / / --,i- __ //// 1 I / / +a / // // / / / / /' / / / �S-''� // -i' . 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I / I \ \ t I 1 I , \ \ \ _ / / / / / / / , �� / ,�� 1 DRq�NAGE EASEMENT / { I \ / P \ / / \� /,,/.- /' z/ 1 AS SHO PB. 54 PG. I \ I l , , Itl \1 � ( \ � � \ \ � � / /y i \ \ 1 11 I1 I , ti11 I I \ t \ \ I / / / / / / / //// � , �, . ' I { � 1 1illl li I I -a \ \ 1 1 \ \ 1 i \ / / / ; i / / / ,/- ���., ,j' I , �It\' I �. `s 1 1 I ,\ / \ l / / N / r / 1 / / /' �e� "'`i a I `4 \� 1 I ' i l l l 1 114 } } 1 i l 1 \ \\ 1 f \ / / \ / / / / / �', / / / �/ a�Ft� :r/ I'll ).` t I I / �g - \ i °£- ' Il, l1 `i \ \ , \\ � ! I } \ -, I I i \ I / / / / / / /' / /' / / ''''/// /�� ='/ Vie' /! �\. l j / /i ' �`$O�y `° . \ I \ \\\\\\\ \� \ I i \ / \ / J ! I l / / / / / / ' , / ' , :;;�' , �j!'`' `t `9 � / `� // 1-1 / / /�' \ \ \ \ \\\\\ \\\ t i \ / �\ / / j - LINE OF REGISTRATION \ / / / / / / / / / of / \ \� \ \\ l c , /� \ \ J I / / / / ,: / o� / \ \\ \` �\\\\\�\faro, \ // / / \ � / / l \ L.C.P. 30063E ! I l I / '/ / / / / / "'� `'�''� -� / ,�X /�✓ - / / / / // ,� -% °t / / / r \ \ \\ \ \\ / / I \ < / \ / i / / \ J \o�\\�\\\ \\\ / \ I /i- !' / 1 ( I ` \\\ \\ f \\ \ / ( / / /' f a �// / /' / /' / /�o r '`� ��'OF� j%/ .'/ // ,</ 1 60 / 11 s// , / I e I I 1 I I I I I I i l l . /� / � , \\\ \ ( \ \ \\\\ \\\\- \ , 1 1 / / l / / / / / // / / ,� / 1.111 ' ," I . /, g I i I } l / Y \ \ \ \ \ \ \ \ .:r- \ �-- -^ ___• / / / / / / / �' / / -'% /- " l � l I , , { l / t \\ \ 1 \\ \ \\\ \ / I I / Imo , / / ! l l y \ Ji \ \ \ \ \ \\ \\\\ \ - - ) /.Sc- - of /� / / %' / / _ l l i I l i , 1 ` \\ \ \ \ \ ( \\\ \\\\\\\ \ t j //f - -- ��\ \ / / I / '�, / / - - I l l y \ ` \ \\\\\ \\\ \ ! { �/ BENCHMARK - NE CORN C T`CH�B If;1 / i ,/ / ./ j l l { / � \ \ t \ \ \\� \\\�\ \\\\\ \ j( \ �� \ �\ \ \\\ ` I / - L.. - RIM - ELEV. Ci�01 N.GaID/ / / / ��1 I�.. /� \ \ \ �1�' \\ \ \ \ I / — / / \ ( l I i I j I // \+ \ \ \\ \\\ -- --- } \\\\ \ \ ,�\ _ } / '�'�� \l / � � / 4- / / / / / / / // / /11 / \ _* / }\\ l ! } \\\ \\ \ I \ � = ���`- '-- \ \ ` \\ll (/// / jI I \ \ J / a6�/' / / / /' \ > 1 \ t11 \\ \ 11 / \\ //// \ 1 / + / / / / \ ' I - •�� � \ \ � 1 \ \\ \ \ ;/ \ / J \ \ \ \ \\\\\\\//l I \ — ,_-• �\ l / / j/// / / j/ j/ \ \ ,,;en \� .5 ' 0 / / / // \ l l I \ \\ \\\- I \\ / // // // `� \ \\ \��\\\\\\\l 6��,1;5 r ` \� / / / _ / / /�'�'c���OG�PP �, / // \ } I. I i 1 1) \- -- -,11 \ \ ' � \\ 1 1 1 \\ \ \ S .te / / / / �o� oe� / <u // 11 i ( \ \ �+ { ( / J \\\\ 5 / mac. \ el I \\ � 1 \ -- \ , I \ < / I 1 / / \\ \ \� l /n'Na \ \\\\ -'�� 11, \ off . i5 / �1b // / PLAN REFERENCE. 1�6 ) �� ,- ` I } l \ \ ► j ^goy j J } i i ) ) 1 ��/ \ I\ \\ \\ `� /l I / / / \ '-.\ } , } \ \ + \ / I J / / \ \ \ \\ \ / PLAN BOOK: 547 PAGE: i DATE: OCTOBER 9, 1998 \ \\ \\ t \ \ J \\ \ lull* , r / I i I 1 �� I I F �/ I / / LEGEND PLAN BOOK: 537 PAGES: 4 & 5 i . I \ \ \\ \�\\\ \ \\ 1 \ _ / /�,\�� �/ 1 1 i 1 �a I I I � o I I \ I // /, ��yy���(���7����/�++ DATE: SEPTEMBER 18 1997 \\\ I\ \\ � / / \ / I I I \ / // // /;� / / / %' \ \\N \\ \\ \ \ \ J � ' / / - / i I \ /1 /// �, / /� ® CATCH BASIN PLAN BOOK: 455 PAGES: 73,74 & 77 I \ \ \ V\ \\ \\ I \ % / //I. ." DATE: AUGUST 1, 1988 � HYDRANT a \\1 \ \ + / � / / // d i �10- \ \ + \ • \\ \ __ / / '- _'' / I I \ % / // L.C.P. 30063E d I ' , 1 \ I 51' / / // / / ■ CONCRETE BOUND -�- �� \ \ , / / / / / + / I }\ f-,./ �/-�1. 6� DATE: OCTOBER 21, t974 9 • \ \\ 1 j ( 4 / ""i- ,�/� / / _�._.�, CHAIN LINK FENCE =� \ }} I / / - / I ) \ -, --/ I", I \ ASSESSORS MAP 274 I d_"d ` I- \ l I i " / } /�/ / / PARCEL 39, 40-1, 40-2, 40-3, 40-4, 40-7, / \�,1 l I l i / ` J ! 1 \ j / / �6 J ...- ---- STEEL GAURDRAIL 41, 44, 45, 46, 47, 48, 49 li .11 , / '� J \ 1 1 l l 11 \ \ \ 1 e�:o �� / � e 4 UTILITY POLE ASSESSORS MAP 295 a, / �,1 l i \ 1 G ,�/' o� 56' _ PARCEL4-12 4- 3 4-14 4- - 6 / i / / / 'o / y'\' I I r - �a \ ` \ / a / ����, ?�Pa��`� i�l l \ (S SEWER MANHOLE 1 , 15, 4 1 ' �g� ,10 / j / \-_ % ` LINE bF REGISTRATION // 1. �\ / / / �,��,o, // ,.._ _ / / ,_ \ L.C.`P. 30063E \ / y ! _ — - NO?"ES: \ + \ i illS� / // { l Cx is\ Q+ `v \\ 1 �' `) r,,,'", '�P. / 1. THIS PLAN IS BASED UPON A ,{�.`,/��, / X' 7"^�1 v . ,1 / \ 'q / . / / \ z ,l / * �, ,: \Q�/ FIEID SURVEY BY COASTAL ENGINEERING CQ., JNC., t 11 \. r \ c;� // =e I w#.' `` `� / ANb`;THE 8Ai2NSTABLE G.I.S. SURVEY: . . f / a ! ZWfi 1 z /'- 4 , V� E c�m // _ + % / oR 2. PARCEL IS IN FLOOD ZONE C BASED UPON- C i I I .. ,�,"'i �� FEMA FIRM COMMUNITY PANEL NO. 250001 0005C / I it /_, / c� °�R ��� REVISED: AUGUST 19, 1985. { !� 3. PARCEL IS IN ZONING DISTRICTS B AND FR-1 OVERLAY DISTRICTS GP AND AP I g . / i / . PLAN � o / /// /" 1a / Q lie . IV I �\ �` "? /'z �6 pP J 1. :'$ I . �� A //'-// / a 1-- - - \\ /��/i� / - - -- - ��� 6°6 f6° SCALE 9" = 40' t HEREBY CERTIFY THAT THE CONDITIONS SHOWN HEREON ARE ' I +1\ / //'i/ -/ r \�PQ LOCATED ON THE GR�O,UND AS THEY EXISTED 1N JANUARY, 19991. •�l l / // +�0 �� 0 10 20 40 80 4 ai I I // / /// / `��1 o;'�OFt.�� q� l % 1 / RP L Q c;Y\ . *:-I�' A 11 : S/ //� R - Drawing Number CV. .01 - / / � / PIS3 1p � . \ �� o41 ,, : ' I I - 1�".' I . / / I. . . I . . . ..'' I - . I . . .1 INay Sc R — — r., -I . . ­ . e I.; � '' . ' ' , I I 1. I (//// J \ . . I— I . I .. I 11 ' ­1 . . . ­ .x-. I . , SD I ' . , . . I . r ��/ , - - . . t -: . 'I ! ' ' 1 . \ I . . . I — . 1. . . I I. ­..­ I I 1 . . -1 -, 11 I.- - . . - 1, � . /.f/ . - I _ ­. '' ,%.1.11I.:,.-,,-,.�: ' '.. ": ,:,; rI . I : — ­. — ­.I- ": " �`"' / I.. ­._"";'."­ -"- ;'Tt "."';'�..' .. . �,- . .I I I , I ' � E e OlJO - . 1 ­1111�1' _ '" - • V V •f. . QQry1��'//,, ..,, �01? �LQQ�Cr::G1;4, ", r, qqjj I,::\ ....:x.: ....._._ .. .. .-._ ..... ._ ..- _ -. _.. N .. l ......._.... ..._ ,.. .—a...,..... ..,......1.. , _ .... _..i ,..w .._.._.... ...-e ..a.. .. .Y-. Y.L _ .._ P ; ::. .,.. . 77, f PROPOSED FENCE ' I � � a � � SEE vlEw 'a' (SEE SHT. SD-3) FOR al � RETENTION BASIN INFORMATION HANDICAP RAMP U1 TOW GALIAN PTWME TANK 3 N 60`13'S1" PROPOSED fi' _...� �,• [-� v pa fT ICE 1517,82' CHAIN-LINK FENCE*IrA �+ �. *0 WXIAMS , a t is ;: , ,. r .,,t rP^' n' ^':•= i.,^£,. �°"r a , `r j � j'' } ,'` O nR O D�lv //'�j r v _ Y Nx'Sc.,' ,' pia ,i'•, Q x RE"iTE LYt,.Y V r INDUSTRIAL , R N T' t P � Y a.. 1 S P I, +� 9 4CC y. t,'W`, y „ BUSINESS i z ` j,' ; � / A : �£�,,. ,• ' 'z yy 2 bp� ' � 1 '`z �s �'�"rga'a^ p'd.: / ("� . �f y Y !✓t �..;fi a # 'Yi" +`,yfw`^Tp t ;t r t _ are r A / . ,,v r s,r `x£ � a : POP `.i• t Q 40 Lo 4 1 �� x r-.' a r+t• ��,� r3 � ,ifi � y.{ Fa#�;i�42 L� 4x a cccaaa/// { y 6•,}y ` V`, It 0�rz CIO (� ice+• / �, It Vey •dD `'� ` x`. x >f CL ti 4p n LLJ n p 0 UI 41$ R G \� yl cn cr �n O� R Uj W m N / W _ ' co o z ,��� 1�• A51� at� v P� U �, - �1 J h GP` �G o CR ass oQd 1 EP`�M�1 �• 1 _� -�'`� C2� 40 v4_ t a "OQ G �. I � 1 ►��,� -o L► o o ® Sp a YYt QP PLAN 1 s N I pP� SCALE 1" = 40' A 0 10 20 40 80 a3° \ o ,ilP ,N51 '` r PaP � 1 00 �} 1Cl r / 5111 ZONING DISTRICTS: B do RF-1 A / OVERLAY DISTRICT: GP & AP d SUBJECT REQUIRED PROPOSED LOT AREA K000 SF 687,213 SF -✓' FRONTAGE 20 Ft 1798M FT (DWNG) / I FRONT SETBACK (BUIDgrG) - (HAI)ARkY/ROAD 'Al 50 Ft/20 FT 60'1 FT/308:k FT P� I SIDE SETBACK (MNG) NO NiVMIIAI 468f FT I / 1 ' REAR SETBACK (HUWNG) NO 61'1: FTco �10 FRONT PARKNG SETBACK (MAD WAY/ROAD.'Aj 50 FT/20 FT 74 FT/24 FT SIDE PARKING SETBACK 10 FT 192 FT pROP.QStb REAR PARKING sErBACK 10 Fr 20 Fr w I t�`: �5 ,� \� BUILDING COVERAGE (FNCLOSEIu SPACE) NO 1 AMM (69,772t s.f.) 10.2% HANDICAP PARKING �@ �`� s•rr>r 5K» MAX" (252,448t 0.) 36.7X © NUMBER PARKING SPACES ci �`� `• NIMER OF PA QNG SPM 346 SPACES 351 SPACES 1 SP SF + t SP VGC VERTICAL GRANITE CURB HANDICAP PARKING SPAM 6 SPACES 9 SPACES PCC PRECAST CONCRETE CURB Q g1 �o NTT360R LMOSCAPNG (TREES) 1 TRET:/8 PARKING SPACES 351/8 . 44 TREES SEE LANDSCAPING PLAN BCB BITUMINOUS CONCRETE BERM s, 19 PLAN —IT PROPOSED BUILDING DOOR THE BUILDING SHOWN CONTAINS 68,1W S.F. WITHIN THE MAIN BUILDING NTH AN SCALE 1" = 40 BUILDING ALS069 2C01'JTAINS D S•F.TMCREATED BYAiHEO10 FOOTOSET BAUCKDION •THEE `Yz qt` TURFSTIONE GRID PAVERS s FRONT FACADE OF THE BUILDING WMICH IS INCLUDED IN ACCORDANCE WITH COMMUNITY QP�P 0 10 20 40 80 CHARACTER FINDING CC 4 OF CAPE CM COMMISSION DRI DECISION TR#20031. THE ,y : w HEAVY DUTY PAVING USE OF 12 BLOCK, IN PLACE OF 8 BLOCK. ALONG PORTIONS OF THE EXTERIOR WALLS, TO PROVIDE ADDITIONAL ARCHITECTURAL RELIEF, CREATES AN ADDITIONAL 145 4 S.F., WHICH DOES NOT RESULT IN: AN INCREASE IN USABLE FLOOR AREA IN ACCORDANCE WITH CAPE COD COMMISSION DRI DECISION TR#20031. I Dram Elbe: C1482r"b. ISSUED . 10-06-03 FOR BIDDING SD- 2 A Q CEC 2003 Job Number: C14-M.0 I / t 1 - 1 I \ bS' Q � — r REGRADE AS I REQUIRED AT 1.2`// ` 4 /// •� r f, !, / / MAXIMUM SI,� // //ir6 1 -5�i U D / . E4`TIyN BASIN tdT10FW BASIN ORMATiON _,- — — 4 i m DMH-10 — R=48.00 I --- - � t f// // ////l�//'' / l . I 1 � - l t PROP N�N e PS\N - ' / F•-� -48` �I / / / / /// / / / - , , „,,,., •,,.. / Ir;. S\t�• SOON QOr1C`` �� _, . / / / / / � , W \ I ^44_ _ `II I i it UNO 1 ( o \ \ 11 11 l t © DMH-9 PRIMARY DCB-9 / R=4$.24 ♦ \ \\ \ / 50\� yP�'0 \ CONTAINMENT \ \\*2GP OPRSE R=46,18, TRAP ! \ DMH-7 DUS R-47.00��• ` ` \ \\ ��` \�`- /i i'' .-' / // // ,� J ) ♦ 1 \ / ��p� OPNp R� GOPRNO _ /1. t R't--/ � � -- lam/ \ F �'NC�`F°� vSN NEp P, � ' • / � � '� ou SON 65 u` 4-11 . 'i - --.•_, - .._._ - .._. �� \\•`' \\ \� \\\ \\\ \ 1 . � I I I �� 13`O'` � / \ � L, \ �y SS \,\N F ORF"g � F�� loll DCB-8 R=46.0845 47 �01 Ln N2- DMH-8 } / 64 DCB-7 l R=48.50 o ,� n ' / / / ,6A/ ( / ,! 'I 1 f \ 1 - \ 1 �1 •� DCB-10 DMH-11 ° ,`R=4 .20 _ _ _ - - R—.06' 46- 0001, ON / 1ox +► •/a / Kati / / Ire / f4001* /100 -s14- // \\ \\ \1 0CB-6 �68_ / \\ \ 1 ! !111) ' =46.08 a., / \\ ; - l \ 1 11111 j f / — y - /2 Z W� ~ \ \\ ,4 t I I I I(! 111111 / DMH-4 x / ° �.Gil J�h�' / �_ — 47 // Z -I,- —— — \ \ \ �° / _ \ 1 I i _ R=47.60 F. �,�• / / / '�' / ' / }. / - �,jl7 ( ¢ 1 1 (L''Z to �- \ / ) /•� o j 11( I I l ,f� ' 1 �1` / s eke '� / / / �/ , / / / / / / W 2. �_ In I I j I I i' 44-AI 100, _ 0 / / / _ / Ln -'i , :5 '' iii /// _ - - - -- � // / '� / DMH-3 4� / / ✓ / / / / / m \ ,/ � CV / - - - -50 - / �` I ` / _ r R1 / / �o / / / / , / W Z ZG� 00 -48- - / / R-47.88 � o / - "�/ /' // // / / / � ' / / S1 z DIM -5 �x_ / f� ��. IY d Ln d Z � / _ /' \ J l ►`A �, / / / / / / /`' i // / �P Q ¢ on �' a ' - -/_ �R� / ,' t / // // // // , ' / / / , DMH-6 /k �1 \ J ` / x / / / 812 / / fj U) R=47.40 x 16 �\ I t J �1� O I /� // // / / / / =48.0 / / �Q� 'Ct DCB-5 1 ! I II 11 1 \ \ -`� R=46.08 ° DMH-2 \... - -46- - EXISTING CONTOUR R=47.69 J J / � '� 48 .. 90 48.0 / / ,/ � �/ O � PROPOSED CONTOUR \ / 1 1 I I I ► I 1 i \\ \ ` , \ xk1 \ x / J , CATCH BASIN HAYBALE IKE, I \►� / / // / ! �A +49.5 PROPOSED SPOT GRADE 10 TYPICAL AT ALL CATCH` BASIN o / �`� / 4 \pQ 7 — / 1 / \ \\1 IIII IIIII111 I ► p I / / / / q`° C8�`I4 __ - - / R'=4$,0 I I I I I }I I}I 1 1 1 I %\\ \\ )1 p0'x100' CONSTRUCTION ' ( /\/ 1 � C 4 §TAGING AREA 1 �11� , I j / R= 6.68 CB`�3 \\ / / -48- \ R= 10 // "� \ / i / \ \ ( ` x DMH-1 I / ,� / // / / / / / // / c R=48.85 PLAN \\\ \ \ 1 /// ,•\ \ � / i SCALE 1" = 40' I - � \\X =49. o to 20 40 soMIR I I I is I I , \ \ I I I J /11( \ �\ \ 1 \ ( \ \\\\\ -- (\�\ v\�\\\\\�\ `0 11J - \ \ ` / / /bP Z / .X\\\\�\ I ( I 1 \I \l\\\�� 1\ 1\� \ \\ \ 5 I \ \y\ ` I J / / /r' / /5/ / CURLEX II EROSION CONTROL % ,\1\ \ -01 J /� �'' 1 1 / // / / / / / / BLANKET BY AMERICAN 50- en / 1 1 1 1 1 1 • \ \ I \� �`' - - i\ - \\ EXCELSIOR CO.) OR EQUAL ON _ / 1 1 ► ' ,. \DEE 30 W-c 50 L CRUSHED \\ 11 . / _� ' / / / / / / \ ALL 2H TO 1 V SLOPES TYP S,TOINE ACKING PAD AT '6 GTTION E TRANCE _ / / / / / Jv c7 00 Ilk k I J / / ice \ \ ; \ � \\\ } I I l \\ ( lJ / \ 1\\ \ � \ , . -• / / � � � / / PLAN \ \ •\ � 1 \ \ 1 I 1 1 a \ I \� (51 y � A / \ , -- \ \ , GN J o� , J SCALE 1 = 40 \ \ ` \1 11 1 \ s / \ \�\ \ 5a / l I I I EX. PA MEEII T C] 0 10 20 40 80 REMOVE X. CAP C �`�� - / / / II i 1 BERM ( ) I q LINED RETENTION \ \ \ BASIN \\ \` / I i \ �/5 / I 1 / ', • / \ �` 1 III / �'\�� `�k' ' J J /� � �2 6 ' ' //// //-'_ _._ ' \A ' �d 1 III / \ ✓ / J REGRADE AS �•• _,._ _- REQUIRED AT / ` 'J MAXIMUM Sr( ' B PRO ENZ\0p,S / / /,/ ////// / / AROUND-R 5a BASIN Lj 0 E-�gC' Ca` ` FOR" td"fION BASIN �i\\ \\ \` _ -sa- /1 `GSI bP 19eORMAl10N 58- i 48` 1- 1\ N 60r►5 51 W r i i5 ( ^^ ci PRIMARY R=48.24 DCB-9 / \ CONTAINMENT ,/DMN-7 . ^ R=46�8I •\ TRAP / 4 s VIEW A EXISTING 1H RIM=71.44 I , i/r l SCALE 1„ = 40 INV IN(6")=-1 3.63 / /// o / 0 10 20 40 80 INV IN(6-)- 3.58 / I INV IN(8")= 3.64 / \ Dra> Its C14b. INV 0l1T(8"=63.28 i g/ 2l 10-06 - 03SD- 3 ISSUED: — FOR . BIDDDING / • �� © 0C 2003 a Job.&=bar: C14-8�5.Q a. s i p / 0 / q DMH-10 R-48.00 p f_N 1=42.26 (DMH-9) pMH-9 1-42.22 (36 OUT) R=48 24 I=41.16 (12' OUT) 1-42.55 (DMH-8) i �- oQ �'/ C�� 1-42.55 (ROOF) 1-42.45 (D1H-10) 36' FE NTH RAT GUARD 1=42.10 3</e is ADS �s'wS ® W rc 12' FE-41.10 S=0.01 �j F � / o001 PROPOSED Z o / ® ° - off . 20' x 20' oSE ��� PRIMARY W RIP-RAP QROQ EN N ` O � 0.0 w APRONS TRAP -1 p. 1 gPS�tJ �/ /R=46.tO8 � � t 6 �k�y� 1 INDUSTRIAL I i moo. / 1-43.31 (OUT) \ 1 LOWER WATER MAN TO PROPOSED BUSINESS ° %0 DRAIN 0#0 ((TOCONFLICT WITH ADS BIOFILTRA77ON DMH-7 / \ � � QyG C 1 -8 SWALE i �,� . R=47.O0 ac� ��� \ �• S~ �Q e� t Q 1=43.07 {Dc>3-8} I �oQ, Co) ' / 1-43.07 (DCB-9) /Y 1-4131 (OUT) 1-42.97 -8 3I k ®\ p y R j DMH-8 R50-48. `�`• OC8-10 PQQ` \ - �Q v�, 1 1-42.87 (DMH-4) / /® R-44 MI241.85 / DCB-7 (=4287 (DAM-7) �. NV OUT=41.75 POST INDICATOR 18 FLARED END R-46.08 1-42.87 (ROOF) / `t V,rL* NV-41.10 1;►, j 1-43.29 (OUT) 1-42.77 (DAM-9) 100, sS-QO03 DMH-11 �, G�' ky �++✓ •x12'x12' DI iEE"' R-45.00 ,s• /f,� ',� `9�� 4'•DI C SERWCE 12'xt xt2' Di _,_._ I=41.26 (CB-11) t R-47.60 / 2' ° / DAM-4 � � � � . ® i-41.2s {C8-10} I 1-43.09 (DCB-7) ��� IP/ / 12' a FIRE a �� I-41.16 (18' OUT) . \ i I 1-43.09 (DMH-5) j/ RQ YDRANT W �� � / ® 1=43 09 (DMH-3) / �� /• 1000 GALLON GREASE TRAP-2 �� tt4p� GATE VALVE CC-) c l 1-42.99 (DMH-8) ° / •,. ��G R-48.20 DCB-B / ��Q 00 1 144.50 (INLET) 4, k 'R R=46.t18 I / / Qj� Ckg' 1-44.25 (OUTLET) 4 SCH 40 PVC a Q �� Dc�' `" SEWAGE LJFT STATION _ > I=43 73 (OUT) ! / . O� ® %. 05�.��,�, � ® CLEMIOLITS w COVER ELEV-48.8 o Q , ��"• I / , OQ. (1, �,�. 4 SCH 40 PVC VENT INV IN=38 55 W a L I� / ¢ � / 4 o TO BUILDING ROOF INV OUT-40.55 Z = I / �, to � `7" 40 SCH 40 PVC FOOD AREA SEWER (4• FORCE M� Wj 6' SCH 40 PVC BUI.DNG SEWER 8' SCH 40 PVC ` �3 U) PUMP CONTROL PANEL WITH VISUAL CLEANOUT / f� / ALARM IN LOCKED PEDESTAL MOUNT. • cn Q / 1 / �- VALVE t� Of �t / REMOTE ALARM TO BE LO ATED NSIOL / I z CN PROPOSED 517E LIGHT (REFER / , / / BUILDING AT MANAGER'S OFiCE CH Z m _ L" TO LIGHTING PLAN BY OTHERS) / ® / SMH-3. FaM-4&50 S CB-tt / C� Q Z 'D /DAH-3 ( } W C! Q LA-, .� / E �� INV iN-39.25 SMH-1 . R-48.00 Z R-47.88 SMH-1. RWI=48.60 iNV OUT=39A5 (LIFT STATION) 1-4aO6 (ROOF) <Cjl c.> � z o /� 1-43.40 (DCB-5) A / 3 �' A' INV IN(4'}-44.15 (GREASE TRAP) r Q �� i/ 1-43.06 (CB-12 P��L � Q o c' J us �'� 1=43 49 (DMM-2)/ 1 ! � NV oUT(s7=44.tI5 {SMH 2) 6 SCH 40 PVC SEWER � � c, � �/� I=4296 (a3 `, � I- Z c� O m,- / o. 1=43 39 (DAM-4)r /`� / Q��''►. SMH-2. F&f-48.50 ' ROPOSED GAS SERVICE BY INV 0(6')-43.80 (BUILDING) -12 KEYSPAN ENERGY DELIVERY CAP END OF STUB AND MARK `�' 7 / / � / ® 4�ANW40 PVC INV N{4"�•4380 (SMHt)- S .' R-41LOO P�0 Q p t WITH VERTICAL 2 BY 4 BOARD I / / WV 0UT(6'�43 70 (SMH 3) Q f=43 54 (ROOF) a tr �1 i-43.44 CB-11 ` AT END OF 30' ADS 0 ® =43 N (DA ) l / R �►y° ,, 1-43.54 (CB-13) �P U 5f0 43.34 (DMH-4) I R-46. / / S ,' TTAAPPM EVE AND�GATUE VALVE DMM-6 i�4808(oul� ' DAH-2 ' ,� �� NOTE: INSTALL 45' D.I. BENDS AS � R-47.40 ® ` / R-47.69 a t�1 REQUIRED TO ADJUST VERTICAL �J FORCE MAW ALIGNMENT BETWEEN HADAWAY i I-43.62 (OUT) f ° I-43.74 (DC8-4) 13 CLEANOUT MANHOLE ROAD AND SiTE GRADE. 1=43.52 INLET STUB) 1-43.741(DMH-1) R=4a00 ' RIM-48 7 1-4&7 (DAH-3) \ / 1-44.02 (ROOF) �PQ 4' FM INV-42.O± 1000 GALLON GREASE TRAP-t , I=44,02 (C8-14) 1` '� ® / �'1cr• J R-48.50 \ I=43 92 (CB-1 P�P / r 44.50 (INLM12 �12x6 TE 1=4425 (oUET) �4 PVC FORCE X 5. CONTINUOUSLY�w w CB-14 ��� AT MINIMUM 0.5% SLOPE, EXCEPT / CROSSING R=48.00 � AT WATER \ ' / �y0 / / 46,68 PR HYDRANT ® 1-44,90 (ROOF) °QP� ! ' -3 / j' /® 44.02 (OUT) CB WTH GAT VAL�DE VE =44.40 (CB-t3) 5�`� L!�! Y P 100 x100' CONSTRUCTION R=48 0 / DMH_1 t / OWER FORCE MAN TO PROPOSED CONCRETE i STAGING AREA \ I-44 (tx1T) ° ° R-48.85 / / / A MINIMUM OF 18' HEADWALL SCALE 1" = 40' `-"µ 1-44.75 (CB-2) / / BELOW WATER MAN TO (TV.) P 1-44.75 (CB-3) AVOID CONFLICT ..tea \ I=44.65 (OHM-2) / / 4' FM HIV-41.35 W HIGH FORCE MAIN 0 10 20 40 80 POINT MATH AR I A1NP FBEASE VALVE MANHOLE i \ , FORM MAIM / ® z RIM=48.4 \ ' MEANOUT PAN40LE 4 FM WV-43.8f � � 4' FM NV=44.5t 1 \ ® I RIM=49.5 �- PROPOSD 12' DUCTILE IRON WATER 4 FM IN 45 5t MAIN LOOPED AROUNID BUILDING •� TIE INTO EXISTING MAiN WIN �•� / j z \ CB-1 TAPPING SIRW AND GATE VALVE ' 2 R-51.50 NOTE' INSTALL 4T DJ. BENDS AS , � 49.50 I=48./0 (OUT) / / , REQUIRED TO ADJUST VERTICAL .\ a, 1- 30 ( ) ! / / • ALIGNMENT BETWEEN HADAWAY I= 20 (OUT) `r� / /� ® ROAD AND SITE GRADE 1 O � A AA 0 2' PVC W� I CONDUIT FOR FORCE MAN Low POINT AND ®/ / PYLON SIGN! CLEA14WT MANHOLE RIM-49.0 �( JP � � Fi / ELECTRIC 4' FM INV=41,Ot F-- 0 a 0 G H Q � EX. MOWTOFIING WELLS TO BE ABANDONED IN Ov\ A A ACCORDANCE NTH DEP STANDARD REFERRENC£S FOR MONITORING WEI.lS, DEP PUBLICATION \ / a fNSC-310-91 (TYP) GUARDRAIL TO I o BE REMOVED AND / o M a REPLACED AS OPO -w SHOWN CD A C 4' FM INV.520t'--may 40 FM WV-49.0t Pp x / CONS7RUG?1a1V NOTE � .. FORCE MAN � ' PLAN 1. SITE LIES N FLOOD ZONE C, PER BARNSTABLE FIRM MAP. CLEANOUT MANHOLE / I / 2. SITE CONTRACTOR TO VERIFY EXISTING SITE CONDITIONS AS SHOWN AND BRING ANY INCONSISTENCY RI'JF)1 NV=55.Ot / ' l SCALE 1� = 4�' TO THE ATiEN110N OF THE OWNER PRIOR TO BIDDING. 4 l I 3 IT iS THE CONTRACTOR'S RESPONSIBILITY TO NOTIFY DIGSAFE. THE TOWN OF BARNSTABLE DPW. AND ALL UTILITY LEGEND �° COMPANIES A MINIMUM OF 72 HOURS PRIOR TO CONSTRUCTION ACiPATIES FOR LOCATION OF ALL UNDERGROUND 0 10 20 40 80 UTILITIES AND UTILITY COMPANY AND DPW APPROVALSARE TRA TOR SHALL4. ALL BE RESPON W FORATER. AND VERIFiCATION OFAGE ALL LOCACTIONS�D AND MOT SHOW ELEVATIONS. ONLATE Y THE INFORMATION CON\SY�P��tE / SHOWN ON THIS PLAN IS APPROXIMATE ONLY, IS NOT WARRANTED BY THE OWFIER AND ENGINEER TO BE CORRECT, NOR DOES THE 0*0 AND ENGINEER WARRANT THAT ALL UNDERGROUM U71JTIES ARE SHOWN. HYDRANT 5. ALL SEWER SYSTEM COMPONENTS SHALL BE N5TALIID W COMPLIANCE WITH THE STATE AND TOWN OF BARNSTABLE REQURDJENTS AND REGULATIONS ALL SEINER AND DRAINAGE COMPONENTS SHALL BE ® LIGHTING c ' J REQUIRED TO WA'MSTAND HEAVY DUTY H-20 LOADINGS f 4' FM INV=58 0t .' \�c / 6. TIGHT JOINT (T.J.) SEINER PIPING SHALL CONSIST OF POLYViWtt C2•FiMK (PVC) SCHEDULE 40- ALL PIPES TO BE LAD ON FIRM BASE AND TO BE WATERTIGHT. ALL CONNECTIONS AND JOINTS SHALL. BE MECHANICALLY SOUND �I�' / AND TIGHT. SLOPES ON ALL SEWER AND DRAIN LINES ARE APPROXIMATE CONTRACTOR TO HOLD INVERTS FOR � SEWER MANHOLE UJ 1 CONSTRUCTION. -w- WATER LINE 7. BEFOG BACKFLLING THE SEWER SYSTEM, A CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER AND THE TOWN OF 2>S �� BARIWA3LE DIVISION OF WATER POLLUTION CONTROL FOR INSPECTION. -E ELECTRIC LINE W • PROPOSED 4 FORCE MAN FOR i /./ ��F 0� 8. ALL WATER, SM AND DRAINAGE UTILITY CONSTRUCTION SHALL CONFORM TO THE RECU LATM AND T~-�•1 N 0 1 . ..� POSSIBLE FUTURE BUILWG, FROM 1 4P ��� N�5.Ot WITH DROP INCMWCTiC)tR INSIDE EXISTING SMH TO TERMfN1ATE ' ° SPECFTCATIONS OF THE TOWN OF BARNSTABI.E WATER COMPANY. TOWN OF BARNSTABLE DIVISION OF WATER -G- GAS LINE [-•-4 � WITH TEE AND 90'ELBOW FACING ``l POLLUTION CONTROL, AND TOWN OF BARNSTABLE DPW RESPECTIVELY. OUTLET AT EX TROUGH AT INSIDE �MOAUTCN 4 F' ORC,'E MAIN ,�'� of �\� `,v' 9. REFER TO ARCHITECTURAL PLANS BY �GNEI L, W A11�. HASSER iTECTS FOR BUILDING PLANS. °A G`` P ELEVATIONS. IIECTRICAI. 11NG, -T- TELEPHONE LINE INVERT=83:6t. SECURE FORCE (CAP BOTH L7� / ' �0 a4 �1� 0--q MAN TO INSIDE MANHOLE WALL FORCE MAN 10. FINAL DESIGNAND LAYOUT OF GAS AND UNDERGROUND U11UTO TO BE DESIGNED BY UTILITY COMPANIES -S- SEWER LINE CLEANOUT MANHOLE ' �O�`' SiTE CONTRACTOR IS RESPONSIBLE FOR COORDINATION NTH UTILITY COMPANIES D ALL UTILITY INSTALLATIONS �-- R4'IMFM INV-59.Bt .'/ g91 111.. ELECTRIC. TELEPHONF, CABLE AND FIRE ALARM SY'STIEMS SHALL PLACED 1NDERGROUNN 70 BE IN FULL COMPLIANCE WTH ALL THE UTILITY COMPANIES' DESIGN A14D D N ACCORDANCE NTH -' SEWER FORCE MAIN (SFTri) '� ass I � � THE REQURDJENIS OF THE UTILITY COMPANIES AND THE TOWN iRE AND BARNSTABLE F PUBLIC WORKSDRAINAGE LINE AO DEPARTMENTS, REFER TO PUNS BY UTILITY COMPANIES FOR LAYOUT OF RESPECTIVE UTILITY SYSTEMS. 9 DOUBLE CATCH BASIN (DCB) 12. CONTRACTOR SHAM PROVIDE TRAFFIC CONTROL MEASURES IN ACCORDANCE WTH THE MANUAL OF UNIFORM su TRAFFIC CONTROL DE41tES FOR ALL WORK WTH1N TC}MN LAYOUTS O CATCH BASIN (CB) P,V`P 11 CONTRACTOR SHALL OVEREXCAVATE DETENTION POND AREAS, AS REQUIRED, DOWN TO THE TOP OF MEDIUM O MANHOLE (DMH) hi / �AO SAND LAYM AND REPu10E WTH CLEAN, COARSE. 2 MN SAND. DRAINAGE SA . DRAVNAGE � Exls INtG SVH / INV IN(6�s3.63 QP����� Drams 1Nlle C14825rgvbl= INV IN(81=63.64 :¢ 4' FM INV-58 _ A10. SD -4 .i.��'�• t •...,..,.. FORCE MANS TO BE SLEEVED W - LARGER DIAMETER PPE MATH ENDS IN CONCRETE 4' FM NV-fi20f SEATED OR ENCASED �C CEC ,2�.3 Job NumbeQ: C14-825.a WiFERE CLOSER THAN 10 FM M EXISTM WATER MAIN TYP i o WIDTH AND SLOPE VARIES WIDTH AND SLOPE VAPoLS (SEE SITE PLANS) (SEE SiTE PLANS) FINISH ROAD GRADE •----1' BITUMINOUS SURFACE COURSE CLASS i, TYPE 1-1 ..__2. BITUMINOUS SURFACE COURSE CLASS i, TYPE i-1 2' BITUMINOUS BINDER COURSE 2' BITUMINOUS BINDER COURSE - w i CLASS 1, TYPE 1-1 ,-uxocsTURBEn CAST IRCN SIDE OF TRENCH LASS i, TYPE I-1 SOX j CLASS TYPE I 1 �T CONCRETE A�GONER - .. .__ 2 C_Y CF STONE 6" SHED ABOVE DRAIN '� o o c c CONCRETE 0 FINISH GRADE THRUST 2LOCK U 12' PROCESSED GRAVEL BASE COURSE o o .... p • o 0 12" PROCESSED GRAVEL BASE COURSE U o • 18' SIiOUIDER ^ ti a�_ �?'0 {COMPACTED) o"�; 0 o 0 0 o (COMPACTED) 0• 0 � BITUMINOUS SURFACE COURSE �.../ �o: oQ (M1.03.1) �U s' o�. PIPE wATER MAIN ' BITUMINOUS BASE COURSE S 7 - I` '�..� v .� .' CO COMPACTED SUBGRADE COMPACTED SUBGRADE BAT' TE RODS (T EA SLOE) SUBGRADE TO BE SAME OIAAI. AS VALVE ANCHORING Tc'E BITUMINOUS CONCRETE PAVEMENT HEAVY BITUMINOUS BERM M.aBaTS DUTY BITUMINOUS CONCRETE PAVEMENT CONCRETE ROViDE 12" SQ BY (NOT T'0 SCALE) NOT TO SCALE) THRUST 4' THICK CONCRETE (NOT TO SCALE} BLOCK HYDRANT INSTALLATION NO SCALE uNIASTURSO SDE of TPENCH SOIL COMPACTION NOTES: :.'.'. CONCRETE 8 24 i THRUST eio« ' . LY I PRECAST CONCRETEZ 24' SQUARE CAST IRO!! FRAME !k GRATE TWO 24' SQUARE CAST �tON FRAME GRATES FINISH GRADE :y,' ,}+RUST 1. SOILS WITHIN BUILDING ENVELOPE AND BELOW PARKING Q« 64 OPENNGS 0 2-1/4' SQUARE , f ti ti, •�. W AREAS, DRIVEWAYS, SIIDEWALKS, AND EQUIPMENT PADS SHALL / � 64 OPENINGS 0 2-1/4 SQUARE PER GRATE MORTAR MANHOLE FRAME AND COVER _.;.�:•,'� R� r�ENo ,,•, `� > BE COMPACTED TO 95% MAXIMUM DRY DENSITY AS DETERMINED BY ASTM 01557. - ADJUST TO GRADE WiTH BRICK = }- > +' COURSES AS REQUIRED O Q Q r� 2. SOILS WITHIN LANDSCAPE AREAS SHAH BE COMPACTED TO _ CID ADJUST TO GRADE WITH BRICKL1J N 90% MAXIMUM DRY DMM AS DETERMINED BY ASTM D1557. " -- -"�-i' TOP SLAB ECCENTRIC Z UCD j 8 MIN. N TOP SLAB 8' MIN. t-� 224"x1 • 1--0'i , • r , • CONE SECTION ti uNOfSTURSM SiQE of T 2£TtCM 3. FILL SHlW. BE PLACED iN LIFTS NOT EXCEEDING 12 a A -0 i +$or •q• (2 THRU 4) (.� � UNCOMPACIED THICKNESS IN AREAS TO BE COMPLETED WITH DISCHARGE � HEAVY MECHANICk EQUIPMENT AND 6 UNCOMPACTED • BLOCK THRUST w m ELBOW r __ 1_ T C�+ � z � N 12 O.C. (TYP) �: THRUST w THICKNESS IN AREAS TO BE COMPACTED BY WALK-BEHIND RISER SECTION eLocx �` " W z Zvi c RISER SECTION COMPACTORS. (OPt1o17NA(.) (OPTIONAL) m �� cIfQ Z o B1TYI. JOINT 5FAAUWT (TYP) NOWAft TEE ` --J uj Z 4 `n c� w a: �J " RISER SECTION _ O cv BUTYL JOINT SEALANT TOTAL WIDTH BUTYL JOINT SEALANT TOTAL WIDTH 4-0 i 5 (f') ., OF WALL AND PIPE OPENINGS (TYP) OF WALL AND PIPE OPENINGS (TYP) WL CRA� A. ' 12. O.C. (TYP) ' ; "' 12" O.C. (TYP) SEC O Q < 0 1T N BASE SECTION BASE SECTION U PIPE TEES •B• . . DIAMETER DEAD ENS 90' 45' 22 1/2 11 1/4' a, 3 TOPSOIL dt SEED 3 B BASE SECTION (INCHES) VALVES BENDS BENDS BENDS BEINOS " 1/2-/� PIPE OPENINGS CAST TO PLAN SEE NOTE 2 SEE NOTE 2 t 4 2.0 2.0 20 2A 20 6•�--� �. 2.5 3.6 20 20 2. 0 ,. 6' 8 4.4 8.2 13 20 2.0 � '�••"�K•--_'sk -�e '>'-'ems'.' .-�--mac^^�c'_•--$c-•--•s0.^ � y d k'< 1k� � tF ;••'' fy.:Al ilt .2 'r' ��� - _ ---- SEE NOTE 2 7 �`� - 1�2 DiA OF PiPE 10 6 5 9.2 5.0 2.6 20 12 &9 12.6 6.8 3.4 20 GENERAL NOTES: L 6' FIRST CLASS BEDDING ' NOTES: GENERAL NOTES: 1. L3FARtING AREAS, BASED ON SOIL BEARING CAPACITY of 4,000 PST. MINIMUM BEARING AREA GENERAL NOTES: IS 2.0 SQUARE �' I. ALL REINFORCING STEEL MUSE CONFORM TO THE LATEST ASTM A185 AND/OR A$15 (MADE 60. 1. ALL REINFORCING STEEL MUST CONFORM TO THE LATEST ASTM A185 AND/OR A615 GRADE 60. 2. SOIL HAS DIFFERENT BEARING CAPACITY THAN NOTED, NEW BEARING CAN BE TED BY , 1. TEMPORARY EROSION Nk SED�NENT CONTROLS SFNAIL BE UTILIZED DURING CONSTRUCTION. THE SEE TABU 1 FOR STEEL REINFORCEMENT REQUIREMENT. SEE TABLE 1 FOR STEEL. REINFORCEMENT REQUIREMENT. RATIO I.E., SOIL HAS BEARING OF 2,000 PST, MULTIPLY TABULATED VALVE BY 4 2. , SWALE SHALL BE KEPT OFF LINE UNTIL THE VEGETATION HAS BEEN ESTABLISHED. 1. ALL REINFORCING STEEL MUST CONFORM TO THE LATEST ASTM A185 AND/OR A615 GRADE 60, 2. STEEL REINF9WJENT FOR BASE SECTION BOTTOM SHALL BE A MIN. OF 0.12 SO. IN/LINEAL FT. (BOTH WAYS) 2 STEEL REINFORCEMENT FOR BASE SECTION BOTTOM SHALL BE A MIN. OF 0.12 SO. IN/LINEAL FT. (BOTH WAYS) SPECIFICATION 0.12 SO. IN/LIiEAL FT. 3. TABLE iS FOR HORIZONTAL RESTRAINT.ONLY. �--- 2 THE FIRST TWENTY FEET OF SWALE AT THE INLET PiPE OUTFALL SHALL BE UNED WITH 3' TO 6' 3. CATCH BASIN SPECS. CONFORM TO THE LATEST ASTM C478 SPEC. FOR 'PRECAST REINFORCED CONCRETE 3. CATCH BASIN SPECS. CONFORM TO THE LATEST ASTM C478 SPEC. FOR 'PRECAST REINFORCED CONCRETE 2. STEEL REINFORCEMENT FOR BASE SECTION BOTTOM SHALL BE A MIN. OF 0.12 SO. tN/LINEN. FT, (BOTH WAYS) 4. VALUES SHOWN ARE FOR TEST PRESSURE OF 150 PSI WITH A 100 PSI SURGE ALLOWANCE. STONES PLACED ON A 6` BED OF HARDENING (COMPACTED SILTY SAND)] MANHOLE SECTIONS'. MANHOLE SECTIONS'. 3. MANHOLE SPECS. CONFORM TO TF� LATEST ASTM C478 SPEC. FOR 'PRECAST REINFORCED CONCRETE 5. THRUST BLACK SHAD_ NOT BE PLACED AGAINST THE FOLLOWING SOS,: A PEAT ORGANIC SILT AND ORGANIC SOILS; �-- 4. MORTAR SHALL CONFORM TO SECTION M4.0215 OF THE MASSACHUSETTS D.P.W. STANDARD SPECS. 4. MORTAR SHALL CONFORM TO SECTION M4.02.15 OF THE MASSACHUSETTS D.P.W. STANDARD SPECS. MANHOLE SECTIONS". I 3. THE FOLLOWING SEED MIX (OR APPROVED EQUAL) SHALL BE PLANTED iN THE SWALE' FOR HIGHWAYS AND BRIDGES. FOR HIGHWAYS AND BRIDGES. B SOFT CLAY; C) RUBBISH FILL AND OTHER UNSU(TAROE NaTE1ClAl. • D) S�FUTTi:RED SHARE; 4. MORTAR SHALL CONFORM TO SECTION M4.02.15 OF THE MASSACHUSETTS D.P.W. STANDARD SPECS. E) INORGANIC SILT AND VERY FINE SANDS. 50% 5. STEPS SHALL_ BE MA INDUSTRIES TYPE, STEEL. REINFORCED COPOLYMER POLYPROPYI.ENE PLASTIC. 5. STEPS SHALL BE MA INDUSTRIES TYPE, STEEL REINFORCED COPOLYMER POLYPROPYLENE PLASTIC. FOR HIGHWAYS AND MIDGES. 6. WHERE POSSiBIE, POUR CONCRETE ANCHOR BLOCKS AGAINST UNDISTURBED EARTH. OTHERVNSE, PLACE COMPACTED 1 35% CREEPING RED FESCUE 6. ONE POUR MONOLITHIC BASE SECTION. 6. ONE POUR MONOLITHIC BASE SECTION. 5. ONE POUR MONOLITHIC BASE SECTION. BACKFILL USING GRAVEL AND WELL GRADED SAND AFTER REMOVING FORMS. 35X K-31 TALL FESCUE 10% ANNUAL RYE GRASS 7. ANY NECESSARY ADJUSTMENTS DURING CONSTRUCTION WILL BE DONE BY SAW-CUTTING AND/OR CORING ONLY. 7. ANY NECESSARY ADJUSTMENTS DURING CONSTRUCTION WILL BE DONE 1 Y SAW-CUTTING AND/OR CORING ONLY. 6. ANY NECESSARY ADJUSTMENT'S DURING CONSTRUCTION WiLL BE DONE BY SAW-CUTTING MD/OR CORING ONLY. CHISELS OR PNEUMATIC TOOLS WILL BE ALLOWED. 7. BACKFILL SHOULD BE COMPACTED TO AT LEAST 90 PERCENT OF MAXMUM DRY UNIT WEIGHT DETERMINED BY ASTM 5X RED TOP NO JACKHAMMERS, WWMERS, CHISELS OR PNEUMATIC TOOLS WILL BE ALLOWED. NO JACKHAMMERS, HAMMERS, CHISELS OR PNEUMATIC TOOLS WILL BE ALLOWED. NO JACKHAMMERS, HAMMERS, TEST DESIGNATION 0-1557. �. & RED CLAY BRICK SHALL CONFORM WITH SECTION M4.05.2 CLAY DICK OF MASSACHUSETTS D.P.W. STANDARD 8. RED CLAY BRICK SHALL CONFORM WITH SECTION M4.05.2 CLAY BRICK OF MASSACHUSETTS D.P.W. STANDARD 7. STEPS SHAM BE MA INDUSTRIES TYPE, STEEL REINFORCED COPOLYMER POLYPROPYLENE RAS!TIC. SPECS. FOR HIGHWAY AND BRIDGES. SPECS. FOR HIGHWAY AND BRIDGES. n 8. RED CLAY BR" SHALL CONFORM WITH SECTION M4.05.2 CLAY BRICK OF MASSACHUSETiS D.P.W. STANDARD NOTE: ALL FITTINGS TO BE PLACED ON WELL CONSOLIDATED GRAVEL SPECS. FOR HIGHWAY AND . TYPICAL THRUST BLOCK PLACEMENT B10FILTRATION SWALE PRECAST CONCRETE CATCH BASIN PRECAST CONCRETE DOUBLE GRATE CATCH BASIN DRAINAGE MANHOLE - 4' DIAMETER ON BENDS, TEES AND PLUGS (NOT TO SCALE) (NOT TO SCALE) (NOT TO SOLE) NOT TO SCALE j {NOT TO SCALE) { ) I MODIFIED ROCKFILL: t MOM ROCKFILL SHALL CONSIST OF HARD, DURABLE ANGULAR S CAP SHAPED STONES YM04 ARE THE PRODUCT OF THE PRIMARY CRUSHING OF A STONE CRUSHER. ROUNDED STONE, BOULDERS, SANDSTONE AND SIMILAR SOFT STONE OR RELATIVELY THiN SLABS WiLL NOT BE ACCEPTABLE. PAY LINE AN STONE SHALL BE FREE FROM OVERBURDEN, SPOIL. SHALE, ORGANIC UM OF K EXCAVATOR- NEW _ a 6" DEPTH OF MODIFIED ROCK FILL MATTER, AND MEET THE FOLLOWING GRADATION �: NEW 6' I.D. STEEL PiPE FILLED SIZE STONE PASSING PERCENTAGESSUBGRADE .: 8 INCH 95-100 _ 23-5/8' v,r . s tir.• ..r " - 40% OPEN APERTIM FOR PUNT MATERIAL 4 INCH 0-25 t s7.2.' �;r�s ,,�a•� ti T:,,v'r •,'a! a 4.0' 2-1/2 INCH 0-5 t1 r y`a ?. .°;«: _Y: 7;:fi_=-�'i; ,t ,,,:� ;,, rR M. DAIENSiM 3-9/16' X 3-911C SQUAIEr VARIES . O.. VARIES y� „�..p,,;. r l.+s'Y.�.✓' r '��`+,��,.+ ) ! .�, , :�' Ir .,• /r- r ELEV=39.5 - .� , �f ; r - p COMMON FILL .,, , rdr ' FxiID WITH 5Q/50 N�( OF SAND AND z .r...•J'K+.• .1 RJR•�II `.�••' �2 '. ' f�. •'�� �J+ .'�•. 'u �. iS` --COMPACT TO 95% MAX DRY DENSITY UNDER ROADS "'' •"�; '"s� ORGW SEED FREE COMPOST. do DRIVEWAYS & 90% MAX DRY DENSITY ELSEWHERE r �1tWr ,rl��'�, ' • .r �'•' ' �° '{' �''t 'k• PRECAST TURFSTONE GM PAVER I -MIN 6 DEPTH OF 1-1/2 WASHED, CRUSHED STONE + a BY EIEAL BRICK( OR APPROVED EQUAL 1 MIRAFI 14O NC FILTER FABRIC '1` r h CLEM SAND FILL PLACED & TAMPED BY HANDAIL l" 'F r GRASS-UNED FOREBAY BOTTOM ELEV=38.8 3 COMPACTED CLEAN FILL BOTTOM BASIN ELEV=38.0 N r,r " HYDROSfEDEED RMTED SQUARE TINED WITH FINISH GRADE ' ' 73 PIPE ;/ 50/50 MR OF SAID AND ORGANC FREE DIA N COAPOSTAS NOTED N SITNrATLONS. BEDDING VARIES 1/2 PIPE OIA (HAUNCHING AREA) "° •= 'I .• MIRAFI 140 NC FILTER FABRIC TIIRFSTOFE GRID PAVER . • 4 MIN. 4 FEET DEPTH OF CLEAN COARSE SANG VARIES 6' IN EARTH � ! CONCRETE FOOTING MODIFIED ROCKFILL BERM DETAIL 12- IN ROCK _J@ ;. r1 , N„ wr 1-1/2' COMPACTED WLTNE SAND (NOT TO SCALE) 12' TYP 12' TYP t'1/2• 0 .. 1O' Ct5(rpom CRUSTED STONE, TO MET -� i GRADES FOR PAVDA NT, SEE GRAM RAN. r,.>! �. C�"4 UNDISTURBED FIRM ANTERIOR. ni #L:r. w o BASIN BOTTOM TO BE LINED WITH 8' COI,pACTED SUBGRADE �" Q DEPTH LAYER OF 1-1/2- WASHED, r, CRUSHED STONE 1 GENERAL NOTE: SECTION 1 a 1. FINISH GRADE MATERIAL. VARIES (SEE SiTE PLAN) E- 4 2 BASIN ELEV=38.00 ``� 2 2. COMPACT SOIL IN HAUNCHING ZONE TO 85% MAX DRY DENSITY 6 LAYER OF MODIFIED ROCK FILL ON SiDESLOPES TO U� MIN 4 �=44.0 MINIMUM FEET DEPTH OF CLEAN, COARSE SAND GEOTEXTILE FILTER FABRIC, MIRAFI 140"° OR EQUALUTILITY TRENCH tjVERAL NOTE: TURFSTONE GRiD PAVERS CONCRETE FILLED BOLLARD 1. D fQNS MAY BE MODIFIED BY QNGINEER TO MEET FIELD COND(MNS (NOT TO SCALE) (NOT TO SCALE) (NOT TO SCALE) De+i*g Mmkbw CL481IIINMf m SECTION THROUGH STONE- LINED DETENTION BASIN (NOT TO SCALE) SD._._5 ISSUED: � 0 -06 -03 - FOR . B,IDDDING' ... CEN: zNx�3 o _7 .; ..;;,. ..t'.3.. 0 C14--M.0 I i i DESIGN CALCULA TIONS SEWAGE LIFT STA TION AND PUMP SPECIFICATIONS DESIGN FLOW: W 1. PUMPS TO BE TWO MYERS WG50-2325 f 6. PUMP CONTROL PANEL SHALL BE PROVIDED WITH 11MER RETAIL 70,000E S.F. X 50 GPD/1,000 S.F. = 3,500 GPD SUBMERSIBLE GRINDER SEWAGE PUMPS W/5.25' TO PUMP SEWAGE AFTER MIDNIGHT. LAG PUMP ON SWITCH IMPELLAR, 5.0 HP, THREE PHASE, 230 VOLTS SHALL OVERRIDE TIMER. GASKETS SINGLE LEAF ALUMINUM ACCESS DOOR- TOTAL DESIGN FLOW = 3,500 GPD PUMP RATE = 150 GPM 0 61 TDH. 7. 3' x 4' CLEAR SING IN CONCRETE SLAB TOP GREASE TRAP 1: 28 SEATS x 15 GPD/SEAT = 140 GPD x 200%2: = 280 GPD 2. CONTROLS SHALL BE FOR A DUPLEX, INSTALLATION SHALL INCLUDE ALL ELECTRICAL GREASE TRAP 6,000 SF x 50 GPD/1,000 SF = 300 GPD x 200X = 600 GPD WORK REQUIRED TO OPERATE THE PUMPS, ALTERNATING PUMP SYSTEM AND SHALL INCLUDE SWITCHES, ALARMS, AND CONTROLS UNDER LIFT STATION. 3,500 GPD + 1,000 GAL ADDITIONAL CAPACITY BELOW INLET NORMAL OPERATING CONDITIONS AND UNDER HANDS-OFF-AUTOMATIC SWITCHES, AUTOMATIC �-+ 4, DIA, SCH 40 PVC VENT WITH BNRD � TIMER TO START PUMP AFTER MIDNIGHT, POWER. CY OPERATING CONDITIONS WITH BACKUP E--+ VENT UP ALONG BUILDINGAUTOMATIC ALTERNATOR TO CHANGE THE LEADw �� �. PUMP, RUNNING LIGHTS, AUTO RESET FOR NIGH 8. ENTIRE INTERIOR OF LIFT STATION SHALL BE COATED WITHTMA ABOVE GRADE PRECAST CONCRETE RISER INSTALL BITUMASTIC WATER ALARM, WEATHERPROOF FLASHING LIGHT #50 COAL TAR OR APPROVED EQUIVALENT. COAL AND HORN, LOCKING HASP, NEMA 4X ENCLOSURE, TAR SHALL BE APPLIED ACCORDING TO MANUFACTURER'S AND BE MOUNTED ON THE REAR OF THE BUILDING. RECQMENDATIONS AND SPECIFICATIONS. THICKNESS OF COAL .eL' TWO (2) - f,000 GALLON GREASE TRAPS FINISH GRADE = 46.8t TAR SHALL BE 16 MILS (TWO GOATS). ---I I; ; .- .I, ONE (1) - 8' DIA. SEWAGE LIFT STATION 3. FORCE MAINS TO BE 4' DIA. SCHEDULE 40 I± 1 9. BJ S ELECTRICAL CONTRACTOR SHALL CONSULT I '4i MAINTAIN 4.0 FEET ON (f) - VALVE CHAMBER PVC PRESSURE PIPE WITH A MIN. OF 4' OF E€ j { _ ; l - MINIMUM COVER OVER TWO (2) - CONCRETE SANITARY SEWER MANHOLES COVER. i.5 C.F. POURED CONCRETE THRUST WITH THE GENERAL CONTRACTOR FOR INSTALLATION04 FORCE 11NN (TYP) ONE 1 AIR RELEASE VALVE MANHOLE BLOCKS ARE TO BE PROVIDED AT ALL FORCE EL ELECTRICAL POWER CONNECTIONS. �-+�-+ � = ELECTRICAL PERMIT WILL BE REQUIRED FOR PUMP ELE�I 44.9E N FIVE (5) - FORCE MAIN CLEANOUT MANHOLES MAIN ANGLE POINTS. FORCE MAINS SHALL REMAIN CHARGED. INSTALLATION. E-� ca (2) 4" DIA. FORCE MAINS 4. FORCE MAIN SHALL BE SLOPED CONTINUOUSLY UPWARD, <C EXCEPT AT WATER MAIN CROSSING, AT A MINIMUM SLOPE OF FTOUT RILL (TYP) 0.5% WITH A MINIMUM OF 4.0 FEET OF COVER SOILS. 5. THE PUMPS SHALL BE INSTALLED ON A STAINLESS MERCURY FLOAT NLET PIPES 4' FTrI NNV OUT=40.;55 STEEL UFTOUT RAIL SYSTEM. THE RAILS SHALL BE 2FR�AME AND COVER TO GRADE* DIA. HEAVY DUTY CAST ON INVERTa�i8.55 SUPPORTED AT THE LIFT STATION BASE, THE ACCESS SWITCHES AND OPENING, AND AN INTERMEDIATE POINT. REMOVAL OF FINISH GRADE CABLES (SECURE THE PUMPS SHALL NOT REQUIRE ENTRANCE INTO THE f TO MANHOLE wain) , MANHOLE. PUMPS SHALL AUTOMATICALLY ENGAGE WITH rAS THE DISCHARGE CONNECTION WHEN LOWERED INTO PLACE. -- �ES �IREDe BRICK ALARM AND BOTH PUMPS ON 4 " ECCENTRIC ' ELEV-37.39 00(1E S'ECTIQN , 1+ (2 THRU 4) j LEAD PUMP ON (TIMER OVERRIDES 12' O.C. (TYP) ELEV=36.39 ,+ -��', •, ' 6' R A BUTYL JOINT ao ELEV=35.89 A 26' DIA. HEAVY DUTY CAST IRON " >"� a RISER SECTION 4-0 0 -5" (�2 > r PROVIDE ADJUSTMENT FRAME AND COVER TO GRADE 8 DIA. PRECAST CONCRETE t a H-20 RATED PUMP CHAMBER FINISH GRADE Z SECTIONS TO MATCH ' � L ,�- TERNATING PIPE SUPPORTS APPROX. GRADE •; `� N GRIN PUMPS Z n 1/2'/FT v MEYERS UFTOUT RAIL SYSTEM S ; BASE SECTION ry w < N PUMPS OFF WITH CHECK VALVE FOR EACH PIPE OPENINGS CAST TO PLAN Z ELEV=26.58 g" PUMP , z J' .^ 4' INSIDE DIAMETER PRECAST , , 6. W ct� t L CONCRETE MANHOLE (SEE SEWER' •' `J ' r - MANHOLE DETAIL) 4' PVC CROSS WITH ¢ o .'s 1 3' X 3' OPENING------,,,,,, I CLEANOUT SEE NOTE h N ��Owoi AL TO PIPE DIAMETER _,, (D C Q N 6' CRUSHED STONE ° BOTTOM EL=24.41 �' 4• PVC GENERAL NOTES: w I 1. Ail. REINFORCING STEEL MUST CONFORM TO THE LATEST ASIM A185 AND/OR A615 GRADE 60, � SPECIFICATION 0.12 SO. IN/UNEALa- 2'--0` COMPACTED BASE W/ 6' " 2. STEEL REINFORCEMENT FOR BASE SECTION BOTTOM SHALL BE A MIN. OF 0.12 SO. IN/LINEAL FT. (BOTH WAYS) CONCRETE FILL LAYER OF CRUSHED STONE 4 PVC FORCE WW I I � � 3. MANHOLE SPECS. CONFORM TO THE LATEST ASTM C478 SPEC. FOR "PRECAST REINFORCED CONCRETE "`--- - - ---' c>FANo� (m') VARIES MANHOLE SECTIONS'. VARIES 4. MORTAR SHALL CONFORM TO SECT�N M4.02.15 OF THE MASSACHUSETTS D.P.W. STANDARD SPECS. � 8'-T INSIDE DRER N FOR HIGHWAYS AND BRIDGES. ;.r,; " 12*SUMP A. x 12 DEEP 5. ONE POUR MONOLITHIC BASE SECTION. 5��. 6. ANY NECESSARY ADJUSTMENTS DURING CONSTRUCTION WILL BE DONE BY SAW-CUTTING AND/OR CORING ONLY. PROVIDE SECURE BRACING AGAINST VAULT 6' GROUT NO JACKHAMMERS, HAMMERS, CHISELS OR PNEUMATIC TOOLS WILL BE ALLOWED. s ►AIL M 7. STEPS SHALL BE STEEL REINFORCED COPOLYMER POLYPROPYLENE PLASTIC. SLOPE TO DRAIN , '':%'i 6' GRAVEL BORROW 8. RED CLAY BRICK SHALL CONFORM WITH SECTION M4.05.2 CLAY BRICK OF MASSACHUSETTS D.P.W. STANDARD (TYP.) ; , ' SPECS. FOR HIGHWAY AND BRIDGES. r .. EXTENDED BASE 9. PIPE TO MANHOLE CONNECTIONS SHALL MADE USING PSX PQSITTVE SEAL CONNECTIONS AS I A MANUFACTURED BY PRESS-SEAL GASKET CORPORATION, OR EQUAL. COMPACTED BASE W/ 6' A-A PLAN VIEWLAYER OF CRUSHED STONE SECTI0N SEWER MANHOLE-4' DIAMETERSEWAGE LIFT STATION VALVE CHAMBER FORCE MAIN CL EANOUT DETAIL (NOT TO SCALE) (NOT TO SCALE) NOT TO SCALE (NOT TO SCALE) , i i C I i A 4Y• 4' DIA, VW PPE 0 i4 8' DIA. PRECAST CONCRETE H-20 RATED PUMP CHAMBER VENTED RIM 26' DW VY DUTY IRON o FRAME AN TO GRADE a PROVIDE ADJUSTMENT KOR-N-SM RUBBER SECTIONS TO MATCH W FINISH GRADE MANHOLE 800T (Tl'P) GASKETTED SINGLE-LEAF aLUMN+IUM APPROX. GRADE ACCESS DOOR (3' x 3' CLEAR OPENING) E l aa. POLYPROPUIJat£ FINISH GRADE=47.2t E]VCAPSUATED RE9AR 6' SCH 40 STEP, 12 O.C. ) UNISTRUT BRACING oi PVC M LET PPE BUTTERFLY VALVE G OR EQUAL f/ / SEE TRENCH DETAIL FOR �? FROM BUIiM EACH l r. BACKFILL AND COMPACTION 4 REQUIREMENTS x 0 d V INSIDE DIAMETER PRECAST ' •', 26" DIA, HEAVY DUTY CAST IRON " VALVE CONCRETE MANHOLE (SEE SEWER i CRISPIN SL20B' SEWER AIR FINISH GRADE-1 CLEANOUT EACH LINE ' MANHOLE DETAIL) 'r RELEASE VALVE WMIPPLE AND FRAME AND COVER TO GRADE (1YP) ' p, COMPANION FLANGE. a ALTERNATING SEWAGE GRINDER PLI PS 4 INLET VALVELit ' ON LIFTOUT RAIL SYSTEM c FLU 4' PVC FM CONCRETE ..a i •WITH SOFT SEATING MATERIAL (�'•) e 4" FOR LOW PRESSURE 24' DIA, ACCESS OPENING (TYP.) 6' SCH 40 a �' Lu OPERATION PPE HANGER (TYP.) PVC MEET PPE ELEV=39st FROM SW a a. � 43.8 f 3' DROP FLOW L� i R 12' DNA. DRAINAGE SUMP 43.8 l FILLED WITH 3/4' DIA 4 SEE UTILITY PLAN FOR INVERTS PIPE SUPPORTS WASHED STONE a INLET 3' z 4` OPENING COMPACTED BASE W 6' � . TEE if � � 12 DIA. x 12 DEEP SUMP 0�T 4' DNA. FORCE MAIN (TYP) LAYER OF CRUSHED STONE 6' GROUT - t>iii TEE �' i 6' GRAVEL BORROW E� SLOPE TO DRAIN (TYP.) AA EXTENDED BASE COMPACTED BASE W/ 6' LAYER OF CRUSHED STONE o �aaQati�or�o� oaoo�z��c+mac>�c� r>�fc� �, c,{ .. 6 LAYER OF 1/8 TO 1/2 STONE PLAN VI EW SECTION A-A AIR RELEASE VALVE DETAIL w NOT TO SCALE 1000 GALLON GREASE TRAP T SEWAGE LIFT STATION VALVE CHAMBER � III (NOT TO SCALE) (NOT TO SCALE) (NOT TO SCALE) I Ili ai �t hmbw C140MOLM 7 SD-- 6 ISSUED; 10-06 - 03 - FOR BIDDDING QM200.3 Job xumtw. c14-M.0 i 4,4' ---- • SOLID INW'titlE UNES(TYP.) HANDICAP PARKING SIGN MOUNTED IN ISLAND , 4' HANDICAP GRAPHIC SYMBOL CENTERED IN SPACE (SEE DETAIL) NOTE: SYMBOL TO BE PAINTED IN ALL 1,27' PAINTED %�SE UEM HANW PPID SPACESSYMBOL TO BE ON BLU 4' WIDE PAINTED 4'R NON—SKID BACKGROUND WHITE LINES (TYP) oll 2.0' 5.5 ( 1,1' 8' MIN ._L_ 4' SOLID YELLOW STRIPE SCORE LINES AT HEAD do TOE OF RAMP 1.78' -� NOTE. SEE ARCHITECTURAL DWGS. 4' UP—RAMP FOR FINISH REQUIREMENTS '.—Q• ' 4. O 1:12 SLOPE UP—RAMP —'+ z �'�' O 1.12 SLOPE �+ 12' :� 4' MAX. w ARROW0. - SOLID WHITE LINES 12' WIDE, 12' APART 0 WHITE PAINTED CROSS WALK DETAIL \ 6 MIN. 4 MIN. 6 MIN. p LETTERS O o 4 6 ►�1 LIMIT OF STRUCTURAL FILL (D FOR FROST PROTECTION TYPICAL PAVEMENT MARKINGS HANDICAP SPACE 5'�• HANDICAP SPADE �n 7,-9, PAINTED HANDICAPPED SPACE STRIPING HANDICAP SYMBOL HANDICAP RAMP/DUSTPAN PAINTED STOP DETAIL (NOT TO SCALE) N 12" X 18" STEEL SIGN; BOLTED TO (NOT TO SCALE) (NOT TO SCALE) H STEEL COLUMN IN TWO LOCATIONS; TEXT PAINT BOLTS TO MATCH SIGN 3" SQUARE GALVANIZED STEEL TUBE PER OKCVL PtAV �� COLUMN POST; TYPICAL AS NOTED ON noauwm UMMIMM C1.4 PARKING PLAN Yi111=WY K BOLTED SLEEVE CONNECTION ( TWO BOLTS ) FOR REPLACEMENT OF SIGN 50-0' POST BASE IF DAMAGED CHAMFERED EDGE NOTE: SEE ARCHTECTLFAL DWGS. GRADE LINE FOR F � � AS SHOWN ON PLANS o V 0 r GALVANIZED STEEL PLUG WELDED PANT CURB ' z Z M c " � j TO BASE PIPE SECTION ( 2 BOLTS ) a WED. BROO� BITLIMIM CONCRE� �2 � >- WIDTH OF FLARED END I°l �" .. FIaLSFI PAVEMENT W Oa.. < i fj to SECTION PLUS 10'-0"t �� Z = ,�.. I 11 n Lit ca Im r I �� �� PRECAST CONCRETE -- a' d Z t _ coo 0 CURB W/6" REVEAL VERTICAL GRANITE CURB 4' ca+C wAtx ca+C CQ 4000 t�- (� U) NTH 6" R P.S.L NTH RA110 OF a:45 .. Q REVEAL < N 3--0 MIN. Ly J m .�J' 3 SLEEVE SET IN BITUMINOUS SURFACE W.W.F. MM,, #nG 0 a . Y CONC. PIER a " ti �---- STONE FOR PIPE ENDS 5'-0' M� � -EXPOSED 0 LOAM AND SEED TOP COURSE LOAM SEED ' Z c o �1 M2.02.03 MASS DPW STD. SPECS. I I I I A A s' fir.' 12 -0 t �., } CONCRETE T a 4 CHA1IFfR z I uT FACE OF (3UA.DM�IG {� y �7 L J I HAVE BRUSH BITUMINOUS BINDER ) uj U BLAST FINISH I 1 \ ' `' �' BINDER COURSE A 6' cOrPAchn -' Git1SHED GRAVEL (SASE co CD CN COMPACTED SLIBWAX FLARED END SECTION lLn HC-SIGN 8' CONC. SONOTUBE FOUNDATION »»» DIY 4� �Yj 1/4' TO 1/2' PFOAMDED '� (SEE FLARED END DETAIL FOR SIZE) ' j, � Fri 0 SECTION o COMPACTED OM CTED -- . HANDICAP PARKING SIGN GRANULAR r, e Uckf (NOT TO SCALE) x BASE J PLAN -, AT FACE OF . USE EXPANSION JOINT 8 TROWELED CONTROL. JOINT WIDTH OF FLARED END SECTION PLUS 2'-0" t / f CONCRETE FILL TO x ��/'� . � w CONCRETE FILL TO PROVIDE KEY•CONSMXTION -UMIT OF EXCAVATION JOINTS UMIT OF EXCAVATION � CONCRETE FILL TO fc=2,500 psi p CLASS 1, TYPE 1-1 BIT. CONCRETE UMIT OF EXCAVATION ( ) CONCRETE FILL TO fc=2,500 psi BARS 0. 3 .P, CONSTRUCTION CONTROL JOINT C fc-2,500 psi LIMIT OF EXCAVATION j 6" BEDDING FOR RIP-RAP FINISH GRADE SEE PAVEMENT SECTION f c�2.500 psi 12' SHOULDER BITUMINOUS SURFACE COURSE SECTION A-A PRECAST CONCRETE CURB BITUMINOUS BASE COURSE SLOPE-VMES VERTICAL GRANITE CURB CONCRETE WALKWAY WITH CONCRETE CURB GENERAL NOTE: • "d NOT TO SCALE NOT TO SCALE NOT TO SCALE 1. DIMENSIONS MAY BE MODIFIED BY ENGINEER TO MEET FIELD CONDITIONS SUBGRADE V t,r < � RIP--RAP AT FLARED END SECTION BITUMINOUS BERM (NOT TO SCALE) (NOT TO SCALE) �I No u' tt• STAKE HAYBAtFS CAST IRON FRAME AND GRATE °"1i1° r R7 awr ro�mo 3/4» C�I/1A�IIt ALL TOP EDGES � ` we lnr.c .ae u,a MESH GEOTEXTILE FILTER FABRIC Y TYP. BITUW NOUS PAVEMENT —x— x--x x— x g• I I„ OR wikDima — _ 12 —X— X— X—X—�X �' 2 DIA. CRUSHED STONE %A - +b 4W a 'p COMPACTED GRANULAR S NOTES: j 1 BASE (12" MIN). UNLESS OTHERWISE SPECIFIED: DIMENSIONS ARE IN INCHES PRECAST CONCRETE /� -.- �F�. _..._ „ REMOVE BURRS A', BREAK SHARP rn/� \ ',�y 4 " 15 p REMOVE ALL BURR$ AND BREAK 'Jf7I1RI" LLVGS. �� CATCH t7�7�N / S1/TIE — Ywwrf H IMTEEas a GAOUN+ w COMPACTED SUBGRADE NOTES: 108 � AeTiFws- MYNTF. CH r�rrrE awKOTaouHO •"""' tr I UNLESS OTHERWISE SPECIFIED: DIMENSIONS ARE IN INCHES TOLERANCES ON DIMENSIONS LOCATING BOLT HOLES AND TYPICAL FIRE LANE LAYOUT I REMOVE ALL BURRS AND BREAK SHARP EDGES. FINISHED SURFACES SHALL NOT BE CUMULATIVE. \\ FOR EACH 50 FT. LENGTH TOLERANCES ON DIMENSIONS LOCATING BOLT HOLES AND BUILD NGS TH ANDAT HAVE No C 0 M PACTO R AND LANDING PAD Q FINISHED SURFACES SHALL NOT BE CUMULATIVE CURB OR SIDEWALK NOT TO SCALE z k 15' CART CORRAL VON -T 30 CART CORRAL CATCH BASIN HAYBALE DIKE DETAIL ,� � (NOT TO SCALE) (NOT TO SCALE) y NO SCALE NOTES: ALL CONCRETE TO BE 4,000 psi WITH FIRE LANE DLP-71AIL MAXIMUM WATER CEMENT RATIO OF 0.45 AND AIR ENTRAINMENT.1.66" DIAL GALVANIZED STEEL RAIL (NOT TO SCALE) 2875' DIA. GALVANIZED STEEL POST 9 GAGE MESH D PIPE DIMENSIONS IN.) DIA. H --�-- W TOP 1-� CONNECTOR (IN.) tt" MAX t ' f 1 1�68' DIAL GALVANIZED STEEL SECTI 12 6.5 10 6.5 25 29 1 TYP. 15 6.5 10 6.5 25 29 38 7.5 15 6.5 32 35 - - - k' - NOTES: ONE LENGTH WATER MAIN L9S CROSS 4' BERM • 4a.o 4' BERM o 48.0 24 7.5 18 6.5 38 2 a75' DIA GALVANIZED STEEL Post t. YrfETr 5frIER AND COW 00N=IE FOOM(TIP.) 10.5 NA 7 t, 1 30 .0 53 68 SK{RT 18 WQIE•S Of 11ERTK;At'.Ip^ Hif 36 10.5 NA 7.0 53 68 CLEARANCE fs tD BE44 W VVVV L 1, TYP.STEEL. RAT GUARD J 9 GAGE 2" DIAMOND MESH 1 2 LENGTH PWRABTVEDD LINES OVUED , ,• .• , �g��� , a! 1 '.• 1 6' LOAM AND SEED t CLEW t .. COMPACTED I ( 1 HOPE THE SEWER LINE. SANITARY SEWER �E 4 1.es6' DIA. GALVANIZED 5lEfl. 2 A Mkt HORIZONTAL '' • y COMP CtfrW SDI BACKHIW t 2 I FLARED END STEEL RAT GUARD - SEPARATION OF 10 MEET ' a FILL R �RAIL r •r SUMP AT a.Ev-e.o olo 222 TO BE MAINTAINED • BETWEEN WATER NO � o.� . (.A I A W ��..A...� VERTICA� SEPARATION 3,000 PSI CONCRETE PPE CRADLE " ; 5 18" MIN. , �, . ' . LINED RETENTION BASIN SECTION A-A 12 DIA. . THE WATEIM SHALLBE SUMM PER ,• •. —�- — —.. REQt t�alE,tre�s (NOT TO SCALE) 8'-a• ' I. I. {. AM TK SEWS ENCASED NOTE' IN CONCRETE WHEN THE REQUIRED FOR WATER/SEWER CROSSINGS WITH LESS THAN fit.Nmortbe amosm ANITARY FORCE MAIN SEPARATION rnlTs 18" VERTICAL. SEPARATION. SEWER PIPE To BE ENCASED IN ELEVAllQNCANNOT I3E I�Ef. CONCRETE 10' TO EACH SIDE OF WATER MAIN. ADS FLARED END DETAIL CHAIN I WATER - SEWER CROSSING DETAIL SD--7 (NOT TO SCALE) LINK FENCE DETAIL CONCRETE ENCASEMENT DETAIL I NO SCALE NOT TD'SCALE (NOT TO SCALE): ISSUED : 10 -06 - 03 —" FOR BIDDD-ING C 0C 200J 14* ftMbW. Oi4•-8?. o. A Alm w