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285 DERBY STREET - BUILDING JACKET '285 DERBY :STREET T Certificate Number: B-14-793 Permit Number: B-14-793 Commonwealth of Massachusetts City of Salem This is to Certify that the Small Retail Building located at --------— Building Type 283 DERBY STREET in the City of Salem Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY BROTHER"S TAVERNA 283 DERBY STREET TIMOTHY CLARKE This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires .............Not Applicable unless sooner suspended or revoked. Expiration Dale m Issued On: Monday, June 23, 2014 �� coNnr2�d, Cofir; onWi of Massachusetts — z f s City o Salem o _ 20 31.31d Fbbor m,MA 01970(978)745-9595 x5641 - -'n — t9diM cArd W A8 Ulvis n for Certificate of Occupancy Permit B_14-793 PERMIT T O BUILD FEE PAID:: $2$2,320.00 DATE ISSUED: 4/25/2014 This certifies that SOUTH HARBOR HOLDINGS LLC has permission to erect, alter, or demolish a building_ 283 DERBY STREET Map/Lot: 340439-0 as follows: Renovation 762-14 RENOVATE BROTHER'S RESTAURANT=PER PLANS SUBMITTED (ON FILE).-SEE COMMENTS BELOW Contractor Name: MATTHEW GENZALEL DBA: MRGCONSTRUCTION MGMTINC�--Md Contractor License No: CS-78126 $ f 4/25/2014 �.... . * ®/ , uild Icl � " Date B 4'- AOL'F This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Oficial ' may grant one or more extensions not to exceed six months each upon written request All work authorized by this permit shall conform to the approved application and the approved construction docu hts for which this permit has been granted. , 4N All construction,alterations and changes of use of any b riding and structures shall be in compliance with the local ion ng by-lawsand codes., At This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ` 1' -v �" The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.-` HIC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Restrictions: v Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. 'O°NDMU �0MMO s f sachusetts CI lem r n 120 Washington S1C¢Y' 70(978)745-9595 x5641 n - - Return card to B rtificate of Occupancy - structure CITY OFW'ED UILDING PERMIT Excavation PERMIT TOB IN THE WINDOW b ' q R Footing INSPECTION RECORD Foundation FramingVe S ' Mechanical Insulation INSPECTION: I r""° ,. BY_ , >: > DATE Chimney/Smoke Chamber .® ' = , Final !� 'L a _o Ng Yt Plumbing/Gas ` < Rough:Plumbing a // ,/,(/it -- Rough:Gas ��/ .,�q g4#1 Final ElectricalAL Lj 1, 4.° Service t a Rough Final Fire Department .u < Preliminary � tc Heal Department -- 1 Prelimina ^ r - Final Certificate No: 157-08 Building Permit No.: 157-08 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the BUSINESS located at -------------------- lin m-li-g--Type---------------------- -- Dwel 0285 DERBY STREET in the CITY OF SALEM --- --- ----------------- -- --- --------------- ------------------- ------- ---- ----------------------------------- -- --------------- -- -- ----- Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR NIGHTMARE PRODUCTIONS,LLC This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires unless sooner suspended or revoked. Expiration Date ------------------------ - ---------------__ ----- --- -------------------- Issued On: Tue Sep 25,2007 -------------- - ---- - GeoTMS02007 Des Lauriers Municipal Solutions,Inc. -------------- _ ________--_----------------_____________----_--- b COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast Regional Office JANE SWIFT Governor - BOB DURAND Secretary LAUREN A.LISS DEC 3 12001 Commissioner Clarke Brothers Fuel Oil Co. Re: Salem—285 Derby St. P.O. Box 677 RTN 3-1359 &3-13216 Salem,MA 01970 Response Action Outcome Activity and Use Limitation Attn: Donald Clarke, Owner Interim Deadline RAO SCREENING REVIEW AUL SUMMARY COMPLIANCE REVIEW Dear Mr. Clarke: On June 22, 1995, the Department of Environmental Protection(the Department)received a Class A-3 Response Action Outcome(RAO) Statement and Activity and Use Limitation(AUL) for RTN 3-1359. On November 10, 1997, the Department received a Class A-3 RAO Statement for RTN 3-13216 and Amendment to Activity and Use Limitation adding RTN 3-13216 to the original AUL for RTN 3-1359. On August 5, 1998, the Legislature enacted the`Brownfields Act" which called on the Department to conduct a targeted audit of all sites at which AULs have been implemented in order to ensure that these actions are meeting the requirements of Massachusetts' laws and regulations, including Massachusetts General Law chapter 2 1 E and the Massachusetts. Contingency Plan(MCP). The Department's audit of this site consisted of an RAO Screening Review and an AUL Summary Compliance Review. RESPONSE ACTION OUTCOME (RAO) SCREENING REVIEW A screening review of the RAO was performed using a standard Department checklist. Examples of the Department's checklists are available on the Internet at http://www.state.ma.us/depibwsc/audits.htm. The Department is not directing you to undertake further response actions at this time. Please note, however, that the review conducted by the Department was not a comprehensive audit,and the Department reserves the right to conduct a comprehensive audit of the RAO at any time in the future. If is possible that a future audit, if one occurs,may identify deficiencies and/or violations of applicable laws and regulations, and may require you to undertake further response actions at the site. This Information is available in alternate format by calling our ADA Coordinator.at(617)574-6872. 205A Lowell St. Wilmington,MA 01887 . Phone(978)661-7600 . Fax(978)661-7615 . TTD#(978)661-7679 �� Printed on Recycled Paper Salem,RTN 3-1359 2 AUL SUMMARY COMPLIANCE REVIEW Chapter 206 of the Acts of 1998 (The Brownfields Act)requires that the Department conduct an audit of all sites with AULs. In carrying out this mandate, the Department has established special procedures for reviewing AULs recorded on or before October 29, 1999, including the AUL submitted as part of the RAO for your site. Please note that these procedures do not apply to AULs recorded on or after October 30, 1999, and this Summary of AUL Compliance Review should not be relied upon to predict audit results for such AULs. Applying the procedures described above, the Department has identified errors in the AUL that require correction. Specifically: 1. The original AUL recorded June 20, 1995 does not include the AUL Opinion prepared by an LSP, or completed Form BWSC-114,both of which are required by the MCP. 2. The AUL does not adequately define what uses and activities are permitted at the site, what uses and activities are restricted, or what obligations and conditions must be maintained at the site- (a) ite-(a) The AUL does not clearly identify what categories of use may occur at the site(i.e. commercial, industrial, residential, day care, school, recreational, etc.). The AUL must be more specific in this regard. While the AUL addresses permitted and restricted activities, it does not address uses at the site. (b) The AUL requires maintenance of the pavement and concrete floor,without identifying the location of the paved areas. The location of the building is identified on the sketch plan attached to the AUL. To assist with compliance of the obligations of the AUL, the sketch plan must delineate areas which must be covered by pavement or building to maintain a condition of No Significant Risk. The language describing the obligation to maintain the pavement and concrete floor must refer to an attached sketch plan for delineation of these areas (i.e. maintain the pavement and concrete floor in the areas identified on the attached sketch plan). To correct these errors, an Amendment and Ratification of Notice of Activity and Use Limitation must be implemented within 180 days of the date of this Notice, using the enclosed form and instructions. The revised sketch plan may be attached as Exhibit C to the Amendment and Ratification Form. Please note that the AUL Opinion must be prepared and attached to the Amendment and Ratification Form using Form 1145. Alternatively, you may submit a new RAO Statement within 180 days of the date of this Notice, documenting the achievement of a Class A-1, A-2, or B-1 RAO at the site (i.e. an RAO that does not rely on an AUL to maintain a level of No Significant Risk). This is an enforceable interim Deadline issued pursuant to M.G.L. c.21E, 310 CMR 40.0167 and 310 CMR 40.1140. If you do not meet this deadline you will be subject to enforcement action by the Department. The Department has prepared forms and detailed instructions for implementing the required AUL corrections. Copies of the forms and instructions are attached, and are available on the Department's AUL Audit Project web page, http://www.state.ma.us./dei)/bwsc/files/audits/ Salem,RTN 3-1359 3 aulfix.htm. This web page will be updated periodically to address any commonly asked questions that arise as a result of AUL audits. The Department is also offering several training workshops in the next few months. The Department recommends that you(and/or the Licensed Site Professional (LSP)/attorney preparing your AUL corrections) attend one of these workshops if you have questions on how to proceed. The training schedule is also available on the Department's AUL Audit Project web page. To obtain a schedule and/or register for the workshops, contact Thomas Potter,DEP's Statewide Audit Coordinator at (617)292-5628. POST AUDIT COMPLETION STATEMENT REQUIRED When the AUL Errors are corrected, you should submit to the Department(attention: BWSC Audit Section) a Post-Audit Completion Statement in accordance with 310 CMR 40.1170, a copy of which is attached. LICENSED SITE PROFESSIONAL A copy of this letter has been sent to Allen Walker, LSP#6894, the LSP-of-Record for the Disposal site associated with RTN 3-1359, and a copy of this letter has been sent to Stephen Ransom, LSP #4601,the LSP-of-Record for the Disposal site associated with RTN 3-13216. LIMITATIONS & RESERVATION OF RIGHTS Please note that the screening review conducted by the Department on the RAO was not a comprehensive audit,and the Department reserves the right to conduct a comprehensive audit of the RAO at any time in the fixture. It is possible that a future comprehensive audit, if one occurs, may identify deficiencies and/or violations o�applicable laws and regulations, may require you to undertake further response actions at the site, and may invalidate the AUL. The screening review is not a representation by the Dep,artx I ent that the RAO complies with M.G.L. c. 21E, 310 CMR 40.0000, or any other laws,regulation), or requirements. The Department's findings were based upon the accuracy and certainty of the information reviewed during the audit. These findings do not: (1)preclude future audits of past, current, or future actions at the site; (2)apply to actions or other aspects of the site that were not reviewed in the audit; (3)in any way constitute a release from any liability, obligation, action or penalty under M.G.L. c. 21E,310 CMR 40.0000, or any other laws, regulations, or requirements. The Department retains authority to take or arrange,or to require any Responsible Party or Potentially Responsible Party to perform any response action authorized by M.G.L. c. 21E,which the Department deems necessary to protect health, safety, public welfare,or the environment. /4 Salem,RTN 3-1359 4 Sincerely, ' l Patricia M. Dons ue Chief, Audit Section Bureau of Waste Site Cleanup Filename: N1howes/P:/Letters/scnnof3-1359 Scnoafv6_[05_31_01] Attachments: Audit Follow-Up Plan Transmittal Form&Post-Audit Completion Statement(BWSC-111) AUL Amendment and Ratification Form and Instructions Activity&Use Limitation(AUL) Opinion Form(BWSC-114S) cc: Salem Chief Municipal Officer Salem Health Department Salem Zoning Code Enforcement Official Salem Building Inspector Allen Walker, LSP-of-Record(LSP#6894) LFR Levine-Fricke, 194 Forbes Rd., Braintree,MA 02184 Stephen Ransom, LSP-of-Record(LSP#4601) Ransom Environmental Consultants, Brown's Wharf,Newburyport, MA 01950 Thomas M.Potter,Audit Coordinator, DEP-Boston NERO/Data Entry/RAO/TSAUD W �T�� (�nmmnnnr�ttl#� of l�tt�ttrl�u�ri#s CITY OF SALEM In accordance with the Massachusetts State Building Code, Section 108. 15, this yew. CERTIFICATE OF INSPECTION is issued to SALEM ACCESS TELEVISION CORP. i tIIertifg that 1 have inspected the premises known as SALEM ACCESS T. V. located at 0285 DERBY STREET in the city of Salem County of Essex Commonwealth of Massachusetts. .The means of egress are sufficient for the following number of persons: BYSTORY zxxzzzzxzzir zrzyzzxx z�pzxSzzxxzzxzx�zxzxxx Story Caja xc:� xxzxzz 7Fx7Kxx Capaci[y Story Ca%�7R�i$%SSs$*4Ws%$x Capacity BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location or Structure Capacity Location RECEPTION ROOM 25 IST FLOOR STUDIO 35 1ST FLOOR E 0137-1998 09/01/1990 09/01/1999 VadAo � Certificate Number Date Certificate Issued Date Certificate Expires Building Officia The building official shall be notified within (10) days of any changes in the above information. 1 kS REM i'— C0.'^:oNHF_ALTD OF "_LSSAC3IIS:TS CITY OF SALE.': APPLICATION FOR C=IFICI= OF INSFECTION Date ( vrFee Required S ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code. Secti 108. 1S. I heresy apply for a Certificate of Insnecrion for the below-named premises located at the following address: (n� Street 6 Number— � .36� I J Name of Premises_ 0 n Ylrl l i� � t iI_- Purpose for which Premises is used tt\G "i GV3 License(s) or Permit(s) required for the pr s by other Governmental Ageaeies: - License or Permit A¢encv it" Certificate to be issued co-n�\Py,\ Poce�S }V'eITUI.J�.( �eV2N- O � Address: C-1) Owner of Record of Building: � (1aLy� Address: 07$ � 5S eM '✓� a -•l Name of Present Holder of Certificate: 1 Name of Agent. if any.. . 141 Signa am ure c Perso to w Cerr_:icare TI= is i ued r hislb authorized agent p' IR� Date ff,�,.,-,�� I r q� INSTRUCTIONS: Day time phone &M L0 ✓"z 1. Make check payable to: The City of Salem 2. Return this application with your check to: Insnecror of Buildinzs. City of Salam Butldine Deaartment. one Sales Green. Salem. MA. 01970. PLEASE NOTE: 1. Application farm with required fee must be submitted for each building or srraeture of part thereof to be cert1fied- 2. Application 6 fee must be received before the cerrificate will be issued. J. The building official shall be notified within ren (10) days of anv change in the above informarion. CERMTI= I ' - / =IEATION DATE: PERIODIC INSPECTION REPORT This form is to be completed each time a Periodic Inspection is made. At the time a new Certificate of Inspection is issued, a notation indicating that the fee has been paid will be made to Application Form prior to the new Certificate of Inspection being issued. Any changes since the last inspection are to be added to the file card of the premises. c Street 6 Number 0 5 Q 'r Name of Premises SCt (,e PF Certificate to be issued to: �� (�(n/� c C e C n-v Address Owner of Record of Building ( (5 Q ( Q l a/Y Address U Purpose for which premises are used yl i V-1 G &/ cla �CE)�4 Changes since last Inspection (required on file card also) i • R ) U C OYICP 2. 3. 4. S. Date Order Issued: Order Issued To: Address Date Violations Corrected: REMARKS: I have this day inspected the above premises, and the same conforms to the pertinent requirements ofthe Massachusetts State Building Code and the rules and regulations o. pursuant thereto. l o _ Date Building Offic 1 Certificate A Date Issued: Date Expires: Recommended Next 1�6'-a 9 � c�i�P (�nmmnnurrttl#t� pf �tt,���r�n�ri#s x a CITY/TOWN OF i In accordance with the Massachusetts State Building Code, Section 108. 15, this CE��/R� TIFICATcE OF INSPECTION is issued to . . . . . . . .�.�1I :!.\ . . . . . � �. ?.5 . . . e.IUB.7. .n ✓ti. .� . . . . . . . . . . . . . . . . . . . . . . . . ]I TPrtitU that I have inspected the. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .known as. . -. {< 1�11V� .RCCeS�. .��J located at. . . . . . . . . �. . . . . . .1J. .�.�. . Cj.�in the. . . . . . . . . . . . .of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County of. . . . . . . . . . . . . . . . .Commonwealth of Massachusetts. The means of egress are sufficient for the following number of persons: BY STORY Story Capacity Story Capacity Story Capacity Story Capacity BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location or Structure Capacity Location ke�e pp4 on `�� IST 471 . . VZ do ✓r Certificate Number Atte Certificate Issued Late Certificate Expires Building Offici Z The building official shall be notified within (10) days of any changes in the above information. �� Business Certificate UP of batem, JIasgarbusetts ��'•� ,`o% Gro 9BiY,yiNg�P DATE FILED Type: ,f$ New Expiration Date 7, 1 / 1 '04 ❑ Renewal, no change Number /03 El Renewal with change In conformity with the provisions of Chapter one hundred and ten, Section five of the Massachusetts General Laws, as amended, the undersigned hereby declare(s) that a business is conducted under the title of: rA,rr PA ,c Zcj �v,e at ZR� �'�/+� n0rby ST Tel .# S79 /7y/ yyy7 type of business a S6. D Fir ms/{ r c ole c -6 le by the following named person(s): (Include corporate name and title if corporate officer) Full Name Residence �,JAr�fU (3a✓i It-c 27 Z 2.vs7- Tel . # OeVerL, m� a/y,s �lo�sz�-zzy5 Signatures/ --------- 4�/l'`� --- ----------- ----------------------------------------------------- ------------------- ------------------- --------------------=-------------------------- -- on 4a 'z '1t9Othe above named person(s) personally appeared before me and made an oath that the foregoing statement is true. -------------------------------------- --- _ CITY CLERK -----------------------------------------------------Notary Public (seal) Date Commission Expires Identification Presented State Tax I.D. # S.S. # O Z 7 (if available) In accordance with the provision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5, of Mass. General Laws, business certificates shall be in effect for four(4) years from the date of issue and shall be renewed each four vears thereafter. A statement under oath must be filed with the town clerk upon discontinuing, retiring, or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be famished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars ($300.00) for each month during which such violation continues. - RANSOM Environmental Consultants,Inc. September 25,2002 Project 961147 Public Property Department ATTN: Zoning One Salem Green Salem, Massachusetts 01970 RE: Filing of Amendment and Ratification to Activity and Use Limitation(AUL) Clarke Brothers Fuel Oil Company 285 Derby Street Salem, Massachusetts MA DEP Release Tracking No. 3-1359& 3-13216 To Whom It May Concern: On behalf of Clarke Brothers Fuel Oil Company, Ransom Environmental Consultants, Inc. (Ransom)has prepared this letter to inform you that on September 5, 2002, an Amendment and Ratification to Notice of Activity and Use Limitation (AUL), a copy of which is enclosed,was recorded with the Essex County Registry of Deeds in Book 19183,Page 242. The AUL affects a portion of the property located at 285 Derby Street, in Salem, Massachusetts. It identifies certain activities and uses which are inconsistent with maintaining a condition of No Significant Risk at the subject property. Such activities and uses are so identified in order to prevent exposures to residual petroleum-contaminated soil at a portion of the subject property. The Amendment and Ratification to the AUL identifies changes in the specific activities and uses which are consistent with maintaining a condition of No Significant Risk and those obligations and conditions necessary to ensure that a condition of No Significant Risk continues to exist at the property for the foreseeable future. This public notification is being provided pursuant to the Massachusetts Contingency Plan, 310 CMR 40.1090 and 310 CMR 40.1403(7)(a). If you have any questions,please contact Stephen B. Ransom,LSP, at(978)465-1822. Sincerely, Stephen B. Ransom Licensed Site Professional AMB/TJS/SBR:sh Enclosure cc: Donald J. Clarke (letter only) MA DEP,Northeast Regional Office(letter only) ■ Brown's Wharf,Newburyport,Massachusetts 01950,Tel(978)465.1822, Fax(978)465-2986 200 High Street,Portland,Maine 04101,Tel(207)772-2891 195 Commerce Way,Portsmouth, New Hampshire 03801,Tel(603)436-1490 9K Princess Road, Lawrenceville,New Jersey 08648,Tel (609)620-0700 1445 Wampanoag Trail,Suite 108A, Fast Providence,Rhode Island 02915,Tel(401)433-2160 www.ransomenv.com 2002090509109: 8k 19193 P9:24242:00 OTHER Ps 0 AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIMITATION (for amending and ratifying a Notice of Activity and Use Limitation recorded on or before October 29, 1999) WITNESSETH: This Amendment and Ratification of Notice of Activity and Use Limitation ("Amendment and Ratification")is made as of this 31 day of July, 2002,by South Harbor Holdings LLC(Donald J. Clarke,Manager) of Salem,Essex County,Massachusetts together with his/her/its/their successors and assigns(collectively"Owner"). WITNESSETH: v WHEREAS, Owner is the owner in fee simple of a certain parcel of land located in Salem, Essex County, M Massachusetts ("Property"), pursuant to a deed recorded with the Essex County Registry of Deeds in Book 6459 Page 699; Y v WHEREAS,the Property comprises a disposal site, or part of a disposal site, as the result of a release of oil y and/or hazardous material ("the Disposal Site"). Response actions have been selected for the Disposal Site in U3 accordance with M.G.L. 0.21E ("Chapter 21E") and the Massachusetts Contingency Plan, 310 CMR 40.0000 ("the o MCP"). Said response actions are based upon (a) the restriction of human access to and contact with oil and/or m hazardous material in soil and/or groundwater, and/or (b) the restriction of certain activities occurring in, on, Q through,over or under the Property or a portion thereof The Department of Environmental Protection has identified m the Disposal Site as Release Tracking Numbers 3-13216 and 3-1359; N WHEREAS, on June 19, 1995, Donald J. Clarke filed a Notice of Activity and Use Limitation with the a Essex County Registry of Deeds in Book 13064, Page 228 imposing an activity and use limitation on a portion of o the Property("the Original AUL"). The portion of the Property affected by the Original AUL and this Amendment cand.Ratification is hereinafter referred to as "the AUL Area." The AUL describes activities and uses that are N permitted within the AUL Area, and defines obligations and conditions that must be maintained within the AUL Area. The AUL also describes uses and activities which, if carried out within the AUL Area, could result in Significant Risk to health, safety, public welfare or the environment due to potential exposure to residual contamination. b rn WHEREAS,the following amendments to the Original AUL are necessary to ensure that a condition of No Significant Risk is maintained at the Disposal Site. NOW,THEREFORE,Owner hereby amends the Original AUL as follows: AUL Opinion iEn Il t The basis of the Original AUL, as amended herein, is an Activity and Use Limitation g ty Opinion ("AUL } C Opinion"),prepared by a Licensed Site Professional and attached hereto as Exhibit B. Said AUL Opinion t, L", replaces and supercedes any AUL Opinion contained or referenced in the Original AUL. Ci E S us !•W Site Activities and Uses 8 ii � E The following descriptions of Permitted Activities and Uses,Activities and Uses Inconsistent with the AUL Opinion, and Obligations and Conditions replace and supercede those contained in the Original AUL. 1. Permitted Activities and Uses. A condition of No Significant Risk to health, safety,public welfare or the environment exists for any foreseeable period of time so long as any of the following activities and L 0 uses occur within the AUL Area: i. Commercial and industrial uses of the property and activities consistent therewith c.? which do not involve soil disturbance; ii. Construction-related excavation such as those associated with underground utility service activities, provided that it is conducted with a Soil Management Plan and Health and Safety Plan in accordance with Obligations (3) and (4) of this Opinion; and involves the repair and/or replacement of the asphalt pavement or concrete floor with a comparable barrier immediately following the completion of the project such that a condition of No Significant Risk is maintained; and iii. Such other activities and/or uses which, in the Opinion of an LSP, shall present no greater risk of harm to health, safety, public welfare, or the environment than the activities and uses set forth in this paragraph. 2. Activities and Uses Inconsistent with the AUL Opinion. The following activities and uses, if implemented within the AUL Area, may result in a Significant Risk of harm to health, safety, public welfare or the environment: i. Activities and/or uses which may cause physical or chemical deterioration,breakage or structural damage to the asphalt pavement in the AUL area or concrete floor in the Site building located in the AUL area or the removal of the asphalt pavement or concrete floor in the AUL area; ii. Activities and/or uses which are likely to involve the removal and/or disturbance of the soil located beneath the asphalt pavement and concrete floor in the AUL area including excavation or digging, unless such activities are performed in accordance with a Soil Management Plan and a Health and Safety Plan, approved by a Licensed Site Professional(LSP);and iii. Use of the property as a residence, school, daycare facility and/or other use at which a child's presence is likely. 3. Obligations and Conditions. The following obligations and/or conditions must be maintained within the AUL Area in order to maintain a condition of No Significant Risk: i. The asphalt pavement and concrete floor areas, as shown on the attached sketch plan, provided as Exhibit C,must be maintained in good condition at the Site such that the contaminated soil beneath the pavement and floor remains inaccessible; ii. Semi-annual inspections must be performed to confirm that the asphalt pavement and concrete floor is being properly maintained to prevent exposure to the contaminated soil at the Site; iii. Prior to the commencement of activities likely to disturb the soil at the Site, a Soil Management Plan must be prepared by an LSP. The Soil Management Plan should describe appropriate soil excavation handling, storage, transport, and disposal procedures and include a description of the engineering controls and air monitoring procedures necessary to ensure that workers and receptors in the vicinity are not affected by fugitive dust. Also, should excavation and digging of soils below the asphalt pavement and/or concrete floor be required at the Site, such work must be performed in accordance with MCP criteria; iv. A Health and Safety Plan must be prepared prior to the commencement of any activity which involves the removal and/or disturbance of the asphalt pavement and/or concrete floor and/or is likely to disturb the underlying contaminated soil in the AUL area. This plan should clearly describe the location.of the contaminated soil and identify the types of personal protective equipment and monitoring devices necessary to ensure that workers are not exposed to the contaminated soils in at the Site;and 7/26/00 v. The asphalt pavement and/or concrete floor at the AUL area must be repaired and/or replaced with a comparable barrier following the completion of any activity which involves its removal or disturbance, such that future exposures to the underlying contaminated soil is prevented. Except as expressly amended herein,the Original AUL is hereby ratified and confirmed. Owner authorizes and consents to the recordation and/or registration of this Amendment, which shall be deemed to be effective as of the date the Original AUL was recorded and/or registered. WITNESS the execution hereof under seal this Vis) day o /R V 20 o L Donald larke,Manager South Harbor Holdings,LLC [COMMONWEALTH MASSACHUSETTS] [STATE OF ss Xv�120Ov Then personally appeared the above-named Donald J. Clarke and acknowledged the foregoing instrument to be his free act and deed before me, o Publics. oy Commission Expires: MY COMMISSION EXPIRES DECEMBER 3, 2004 7/26/00 The undersigned Waste Site Cleanup Professional certifies that, in his opinion, the terms of the Original AUL, as amended herein, are consistent with the AUL Opinion attached to the Original AUL hereto as Exhibit B, and are appropriate to maintain a condition of No Significant Risk at the Disposal Site. IStephen .Ransom,LSP [LSP SEAL j [COMMONWEALTH OF MASSACHUSETTS] [STATE OF ] esc as 20b Then personally appeared the above-named Stephen B. Ransom and acknowledged the foregoing instrument to be his free act and deed before me, Notary Publi My Commission Expires: Upon recording,return to: Donald J.Clarke P.O.Box 677 Salem,Massachusetts 01970 7/26/00 The undersigned Waste Site Cleanup Professional certifies that, in his opinion, the terms of the Original AUL, as amended herein, are consistent with the AUL Opinion attached to the Original AUL hereto as Exhibit B, and are appropriate to maintain a condition of No Significant Risk at the Disposal Site. Date: S 0 LSP e [LSP S A ] [COMMONWEALTH OF MASSACHUSETTS] [STATE OF C. ,ss 1200&, Then personally appeared the above-named Stephen B. RaniMyCo9mmiExpires: ged the foregoing instrument to be his free act and deed before me, 51( 5'k)3 Upon recording,return to: Donald J.Clarke P.O.Box 677 Salem,Massachusetts 01970 7/26/00 Exhibit B Activity and Use Limitation Opinion In accordance with the requirements of 310 CMR 40.1074,this Activity and Use Limitation Opinion has been prepared for a portion of land owned by South Harbor Holdings LLC, and located at 285 Derby Street in Salem,Massachusetts. As of the date of this Activity and Use Limitation(AUL) Opinion, the property is zoned for commercial and industrial use. Site History Historically the Site has been utilized for commercial and industrial purposes;since at least 1928. Activities at the Site have included use as a roofing company,television headquarters; and a warehouse. According to the MA DEP 1993 Transition List of Confirmed Disposal Sites and Locations to be Investigated,the 285 Derby Street property was first listed as a location to be investigated on October 15, 1988. On October 23, 1991,the property was issued a Waiver of Approvals by the MA DEP. The Release Tracking Number(RTN)for the release at the property was 3-1359. Environmental assessments conducted by Ransom Environmental Consultants,Inc. (Ransom) and Kurz Associates Inc. (KAI), of Bridgewater,Massachusetts between 1987 and 1995 detected petroleum- impacted soil and ground water in the southern portion of the Site. Laboratory analyses indicated that the petroleum product present was No. 2 fuel oil. Response actions taken to remediate the release included removal of approximately 150 to 200 gallons of petroleum product/ground water and excavation of 18 cubic yards of petroleum-impacted soil. Between February and April, 1995 Ransom performed a subsurface investigation that indicated concentrations of petroleum hydrocarbons were below the Method 1 S-3 standards in soil samples and below the Method 1 GW-2 and GW-3 standards in ground water. On June 20, 1995 a Class A-3 Response Action Outcome (RAO) Statement was prepared!for RTN 3-1359 and submitted to the MA DEP and AUL was placed on the property to maintain a condition of "No Significant Risk"of harm to human health, safety, public welfare, and the environment. On December 2, 1995, a release of approximately 100 gallons of No. 2 fuel oil occurred in the boiler room located at the south end of the Site building. Immediate response actions were performed at the Site and the MA DEP assigned RTN 3-13216 to the incident. As a result of the December 2, 1995, fuel oil release, Ransom also performed a Release Abatement Measure(RAM) consisting of the removal of the upper concrete floor in the boiler room and excavation of 15.45 tons of petroleum-impacted fill material. Following the excavation of contaminated soil,the lower concrete floor of the boiler room was cleaned to remove residual fuel oil. In addition, 382 gallons of water were removed from the boiler room floor. A RAM Completion Statement was filed with the MA DEP. As part of the RAM Completion Statement, Ransom performed a Method 3 Risk Characterization to evaluate site-specific risks to human health from contaminants in soils and ground water at the Site. The Method 3 Risk Characterization included a characterization of the risk of harm to human health,safety, public welfare,and the environment as described in the Massachusetts Contingency Plan(MCP). Based on the results of the Method 3 Risk Characterization, it was Ransom's opinion that conditions at the Site represent a condition of"No Significant Risk"of harm to human health, safety, public welfare, and the environment. However, the Method 3 Risk Characterization indicated restrictions previously placed on the Site through the AUL must remain in place in order to maintain this condition. As such, an AUL First Amendment was recorded at the Essex County Registry of Deeds on November 3, 1997. Page 1 of 3 Reason for Activity and Use Limitation A Method 3 Risk Characterization was conducted to evaluate the risk posed by the contamination remaining in soil at the Site. As described above,Ransom performed a Method 3 Risk Characterization for the Site which demonstrated that an AUL is necessary to maintain a condition of"No Significant Risk"of harm to human health, safety,public welfare, and the environment Prohibited Site Activities and Uses This AUL area is approximately 4,530-square feet and is located in an asphalt paved parking area on the southern portion of the Site as well as the southern portion of the Site building including the boiler room area. The AUL will apply to this area only and is shown on Exhibit C. Site activities and uses that are prohibited at the AUL portion of the Site are as follows: 1. Activities and/or uses which may cause physical or chemical deterioration, breakage or structural damage to the asphalt pavement in the AUL area or concrete floor in the Site building located in the AUL area or the removal of the asphalt pavement or concrete floor in the AUL area; 2. Activities and/or uses which are likely to involve the removal and/or disturbance of the soil located beneath the asphalt pavement and concrete floor in the AUL area including excavation or digging,,unless such activities are performed in accordance with a Soil Management Plan and a Health and Safety Plan, approved by a Licensed Site Professional(LSP); and 3. Use of the property as a residence, school, daycare facility and/or other use at which a child's presence is likely. Should either of these activities become necessary to perform construction or utility activities at the Site, certain obligations are required as described in the AUL and the MCP. Permitted Site Activities and Uses Site activities and uses that are permitted at the AUL portion of the Site are as follows: 1. Commercial and industrial uses of the property and activities consistent therewith which do not involve soil disturbance; 2. Construction related excavation such as those associated with underground utility service activities, provided that it is conducted with a Soil Management Plan'and Health and Safety Plan in accordance with Obligations(3) and(4) of this Opinion; and involves the repair and/or replacement of the asphalt pavement or concrete floor with a comparable barrier immediately following the completion of the project such that'.a condition of No Significant Risk is maintained; and Page 2 of 3 3. Such other activities and/or uses which, in the Opinion of an LSP, shall present no greater risk of harm to health, safety,public welfare,or the environment than the activities and uses set forth in this paragraph. Obligations Required to be Undertaken and/or Maintained Certain obligations are required to be undertaken and/or maintained in the AUL area to maintain a condition of No Significant Risk. These obligations are as follows: 1. The asphalt pavement and concrete floor areas, as shown on the attached sketch plan, provided as Exhibit C, must be maintained in good condition at the Site such that the contaminated soil beneath the pavement and floor remains inaccessible; 2. Semi-annual inspections must be performed to confirm that the asphalt pavement and concrete floor is being properly maintained to prevent exposure to the contaminated soil at the Site; 3. Prior to the commencement of activities likely to disturb the soil at the Site, a Soil Management Plan must be prepared by an LSP. The Soil Management Plan should describe appropriate soil excavation handling, storage,transport, and disposal procedures and include a description of the engineering controls and air monitoring procedures necessary to ensure that workers and receptors in the vicinity are not affected by fugitive dust. Also, should excavation and digging of soils below the asphalt pavement and/or concrete floor be required in the AUL area, such work must be performed in accordance with MCP criteria; 4. A Health and Safety Plan must be prepared prior to the commencement of any activity which involves the removal and/or disturbance of the asphalt pavement and/or concrete floor and/or is likely to disturb the underlying contaminated soil. Thi's plan should clearly describe the location of the contaminated soil and identify the,types of personal protective equipment and monitoring devices necessary to ensure that workers are not exposed to the contaminated soils in at the Site; and 5. The asphalt pavement and/or concrete floor at the Site must be repaired and/or replaced with a comparable barrier following the completion of any activity which involves its removal or disturbance, such that future exposures to the underlying contaminated soil are prevented. LSP: Cl�c2nR tep B. Beryom,Licensed Ne Professional Date: Page 3 of 3 Massachusetts Department of Environmental Protection BWSC-1145 Bureau of Waste Site Cleanup Release Tracking Number ACTIVITY& USE LIMITATION (AUL) OPINION FORM 3�- 1359 COMPLETE THIS FORM AND ATTACH AS AN EXHIBIT TO THE AUL DOCUMENT TO BE RECORDED AND/OR REGISTERED wrrH THE REGISTRY OF DEEDS AND/OR LAND REGISTRATION OFFICE. _ A. LOCATION OF DISPOSAL SITE AND PROPERTY SUBJECT TO AUL: Disposal Site Name: 285 Derby Street Street: 285 Derby Street Location Aid: City/Town: Salem ZIP Code: 01970-0000 Address of property subject to AUL,if different than above. Street: City/Town: ZIP Code: B. THIS FORM IS BEING USED TO: Provide the LSP Opinion for an Amendment and Ratification of a Notice of Activity and Use Limitation,pursuant to instructions provided by DEP in a Notice of Audit Findings issued to: South Harbor Holdings, LLC (Donald J. Clarke, Manager) Name of Organization or person: Date issued: 12/31/2002 C. LSP OPINION: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this submittal,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(1)the standard of care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge, information and belief. The Amendment and Ratification of the Activity and Use Limitation that is the subject of this submittal is being provided in accordance with instructions provided by the Department of Environmental Protection in a Notice of Audit Findings Issued to: Name of Organization or person: South Harbor Holdings, LLC (Donald J. Clarke, Manager) Date issued: 12/31/2002 1 am aware that significant penalties may result, including,but not limited to, possible fines and imprisonment,if I submit information which I know to be false,inaccurate or materially incomplete. Check here if the Response Action(s)on which this opinion is based,if any,aro(were)subject to any order(s),permit(s)and/or approval(s) issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. Stephen B. Ransom 4601 LSP Name: LSP#: Stamp: Telephone: (978)465-1822 Ext.: 25 FAX: (978) 465-2986 LSP Signature, Date: /�� YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY FIND THE DOCUMENT TO BE INCOMPLETE. Revised 4/2/2001 Page 1 of 1 TEXACO GASOLINE STATION (north approximate) BL/MW-5 A I 1. FIGURE BASED ON OBSERVATIONS I I I ( MADE BY RANSOM ENVIRONMENTAL I i CONSULTANTS ON FEBRUARY 21, 1995 AND APRIL 28, 1995. 285 DERBY STREET - 2. MONITORING WELLS MW-1, MW-2, MW2 I i (283) AND K-1 INSTALLED BY KURZ BUILDING ASSOCIATES INC. IN DECEMBER 1987. ~ I �`�� / 3. MWA, MWB, AND STA ARE 1—INCH B�M'N-4 BM/MW-6 I PIEZOMETERS INSTALLED BY RANSOM /'� TAA'' LOADING j I 0 ON FEBRUARY 21, 1995 / DOCK I �. A 4. MONITORING WELLS MW-3 THROUGH O� / M BJ/MW-3 y 04 MW-6 INSTALLED BY RANSOM ON -trY { APRIL 27 AND 28, 1995. H I $ ti GJ / BOILER ROOM MW-2 m + I m ASPHALT—PAVED / REOLLRYV BM PARKING AREA WE — — D LEGENDMWE MONITORING WELL SOIL BORING ® CATCH BASIN 283 DERBY STREET BUILDING ------- PROPERTY BOUNDARY AUL AREA BM= BENCHMARK OF ASSUMED ELEVATION = 100.00 FEET. MW2 (283) K—T .. .-_.. ........__ _ .._--_._.. ..� _ . . _ . . .. Environmental EXHIBIT C — Consultants, Inc. SITE PLAN PREPARED FOR: SITE: 285 DERBY STREET DATE: AUGUST 2002 SOUTH HARBOR HOLDINGS, LLC. SALEM, MASSACHUSETTS PROJECT: 961147 FIGURE: 2 eener rojecls 199fi 9fi114] DRAWINGS 95114]02A.DWG Aug 09. 2002 — Z33pm COMMONWEALTH OF MASSACHUSETTS ESSEX REGISTRY OF DEEDS, SO.DIST,SALEM,MASS ESSEX SS apt r 200`.1 A TRUE COP OF RECORD: 00Kf91l3PAGE l ATTES REGISTER J The Salem News, Salem,Mass.,Wednesday,September 18,2002 C9 t airs. its way Legal Notice tpply, Legal Notice ° NOTICE OF AMENDMtNT AND RATIFICATION NOTICE OF AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIMITATION OF NOTICE OF ACTIVITY AND USE LIMITATION q* Site Address 285 Derby Street,Salem Massachusetts Site Address:24-26 Congress Street,Salem,MA 01970 MA DEP Release Tracking Numbers 3-1359 and 3-13216 MA DEP Release TruckingNumbers 3-2084 Property Owner;Donald J.Clarke Property Owner;Donld J.Clarke Pursuant to the Massachusetts Contingency Plan (310 CMR 40.1073).an Pursuant to the Massachusetts Contingency Plan(310 CMR 40.1073),an Amendment and Ratfliation of Notice of Activity and Use Limitation on the Amendment and Ratification of Notice of Activity and Use Limitation(AUL) above disposal site was recorded with the Essex County Registry of Deeds on - on the above disposal site was recorded with the Essex County Registry of Deeds ,ravy, September 5,2002,at Book 19183,Page 242.The purpose of the Amendment on September 5, 2002,at Book 19183,Page 280.The purpose-of the Amend-+_ roll or and Ratification was to modify the original Notice of Activity end Use Limba. ment and Ratification was to modify the original Notice of Activity and Use ears tion which was recorded with the Essex County Registry of Deeds on June 19, Limitation which was recorded at the Essex County Registry of Deeds on Novem-4 erican 1995,at Book 13064,Page 228. - her 3,1997,at Book 14409,Page 49. -' egg The modifications to the Notice.of Activity and Use Limitation are as fol- The modifications to the Notice of Activity and Use Limitation are as fol- atahiee lows: lows: Prohibited Site Activities and Uses - Prohibited Site Activities and Uses This AUL area is approximately 4,530 square feet and is located in an asphalt- The AUL area is approximately 1,484 square feet and is located in an asphalt- ggets, paved parking area on the southern portion of the Site as well as the southern por- paved parking area on the northern portion of the Site.The entire AUL area is hash tion of the Site building including the holler room area.The AOL will apply to this asphalt paved. d. area only. Site activities and uses that are prohibited at the portion of the Site are as fol- r ham Site activities and uses that are prohibited at the AUL portion of the Site are as lows: follows: 1.Activities and/or uses which may cause physical or chemical deterioration,. :Voice, 1.Activities and/or uses which may cause physical or chemical deterioration, breakage or structural damage to the asphalt pavement or the removal of the breakage or structural damage to the asphalt pavement in the AUL.area or con- asphalt pavement or the portion of e AUL area; the Site identified as th French trete floor in the.Site building located in the AUL area or the removal of the2.Activities and/or uses which are likely to involve the removal and/or distur- asphalt pavement or concrete floor in the AUL area: bance of the petroleum hydrocarbon contaminated soil located beneath the pave- ® 2.Activities and/or uses which are likely to involve the removal and/or distur- ment,including excavation or digging,at the portion of the Site identified as the bance of the soil located beneath the asphalt pavement and concrete floor in the AUL area unless such activities are performed in accordance with a Soil Manage- AUL area including excavation or digging,unless such activities are performed in ment Plan and a Health and Safety Plan,approved by a Licensed Site Professional accordance with a Soil Management Plan and a Health and Safety Plan,approved (ISP)and; by a Licensed Site Professional(LSP);and 3. property as a residence,school,daycare facility and/or other use at nortgge 3.Use of the property as a residence,school,daycare facility and/or other use at which a of presence is likely. C01p0- which a child's prensence is likely. �uthern Should it become necessary to perform construction or utility activities at the ;e New Should either of these activities become necessary to perform construction or Site,certain obligations are required as described in the AUL and the MCP. condi- utility activities at the Site,certain obligations are required as described in the Permitted Site Activities and Uses sold at AUL and the MCP. Site activities and uses that are permitted at the AUL portion of the Site are as remises Permitted Site Activities and Uses follows: �em� Site activities and uses that are permitted at the AUL portion of the Site are as 1.Activities and/or uses including,but not limited to,vehicular parking,pedes- im in follows: man and vehicular traffic which do not compromise the structural integrity of the a.Commercial and industrial uses of the property and activities consistent pavement; therewith which do not involve soil disturbance; ' 2.Commercial activities and/or uses which do not disturb the petroleum usuant b.Construction-related excavation such as that associated with underground hydrocarbon contaminated soil located beneath the asphalt pavement in the AUL r Deed utility service activities,provided that it is conducted with a Soil Management area; stry of Plan and Health and Safety Plan in accordance with Obligations(3)and(4)below; 3.Construction related excavation such as those associated with underground t (a) and involves the repair and/or replacement of the asphalt pavement or concrete utility service activities,provided that it is conducted with a Soil Management is Con- Iloor with a comparable barrier immediately following the completion of the pro- Plan and Health and Safety Plan in accordance with Obligations(3)and(4)below ject such that a condition of No Significant Risk is maintained;and and involves the repair and/or replacement of the asphalt�uuum e.Such other activities and/or uses which,in the P pavement with a at a 'ace or Opinion of th LSP,shall pre- parable barrier immediately following the completion of the project such that a sent no greater risk of harm to health,safety,public welfare or the environment condition of No Significant Risk is maintained;and and(c) than the activities and uses set forth in thisparagraph. i basis Obligations R 4.Such other activities and/or uses which,in the Opinion of an e en shall pre- 4 on arequired to be Undertaken and/or ke Maintained sent no greater risk of harm to health,safety,public welfare,or the environment 9 on a Certain obligations are required to be undertaken and/or maintained in the than the activities and uses set forth in this paragraph AUL area to maintain a condition of No Signicant Risk,These obligations are as Obligations Required to be Undertaken and/or Maintained ments follows: Certain obligations are required to be undertaken and/or maintained at the Is an1.The asphalt pavement and concrete floor areas,as shown on the sketch plan, Site to maintain a condition of No Significant Risk.These obligations are as fol- invent y provided as Exhibit C to the Amendment and Ratification,must be maintained in lows: good condition at the Site such that the contaminated soil beneath the p p g reds in pavement 1.The asphalt pavement must be maintained good condition at the portion of and floor remains inaccessible; the Site identified as the AUL area such that the petroleum hydrocarbon contami-. strict) 2.Semi-annual inspections must be performed to confirm that the asphalt pave- nated soil,beneath the pavement remains inaccessible; ment and concrete floor is being property maintained to prevent exposure to the 2.Semi-annual inspections must be performed to confirm that the pavement is t of all contaminated soil at the Site; being properly maintained to prevent exposure to petroleum hydrocarbon conta- in the 3.Prior to the commencement of activities likely to disturb the soil at the Site a minated soil in the AUL area; as,tax Soil Management Plan must be prepared by an LSP..The Soil Management Plan 3.Prior to the commencement of activities likely to disturb the petroleum ants or should describe appropriate soil excavationhandling,storage,transport,and dis- hydrocarbon contaminated soil located in the AUL area,a Soil Management Plan [cable, posal procedures and include a description of the engineering controls and air must be prepared by an ISP,The Soil Management Plan should describe appropri- :Lions, monitoring procedures necessary to ensure that workers and receptors in the ate soil excavation handling,storage,transport,and disposal procedures and vicinity are not affected by fugitive dust.Also,should excavation and digging of. include a description of the engineering controls and air monitoring procedures soils below the asphalt pavement and/or concrete floor be required in the AUL necessary to ensure that workers and receptors in the vicinity are not affected by check area,such work must be performed in accordance with MCP criteria; fugitive dust.Also,should excavation and digging of soils below the asphalt pave- .The 4.A Health and Safety Plan must be prepared prior to the commencement of ment be required in the AUL area,such work must be performed in accordance P.C., any activity which involves the removal and/or disturbance of the asphalt pave- with MCP criteria; Box ment and/or concrete floor and/or is likely to disturb the underlying contaminat- 4.A Health and Safety Plan must be prepared prior to the commencement of (30) ed sell This plan should clearly describe the location of the contaminated soil and any activity which involves the removal and/or disturbance of the pavement upon identify the types of personal protective equipment and monitoring devices nett- and/or is likely to disturb the underlying petroleum hydrocarbon contaminated led in to ensure that workers are not exposed to the contaminated soils in at the Site;and soil.This plan should clearly describe the location of the petroleum hydrocarbon Site; contaminated soils and identify the and 5.The asphalt pavement and/or concrete floor at the Site must be repaired monitoring devices necessary o ensure that that wes of orkers arrsonal e not exposotective ed to the petro- and/or replaced with a comparable barrier following the completion of any activi- leum hydrocarbon contaminated soils in the AUL area;and ty which involves its removal or disturbance,such that future exposures to the 5.The pavement within the AUL area must be repaired an/or replaces with a •nunderlying contaminated soil are prevented, comparable barrier following the completion of any activity which involves its P.C.CAny person interested in obtaining additional information or reviewing the removal or disturbance,such that future exposures to the underlying petroleum quire AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIM- hydrocarbon contaminated soil is prevented, itreet ITATION and the disposal site file may contact Stephen B.Ransom,Ransom. Any person interested in obtaining additional information or reviewing the 02458 Environmental Consultants, Inc., Brown's Wharf;Newwburyport, MA Amendment and Ratification of Notice of Activity and Use Limitation and the dis- W500 01950,(978)465-1822. posal site file may contact Stephen B.Ransom,Ransom Environmental Con- (9/18/02) sultants,Inc.,Brown's Wharf;Newburyport„MA 01950,tel.(918)465-1822. (9/18/02) �ANSOM N. vironmental Consultants,Inc. September 25,2002 Project 961147 Code Enforcement Salem Building Inspector One Salem Green Salem, Massachusetts 01970 RE: Filing of Amendment and Ratification to Activity and Use Limitation(AUL) Clarke Brothers Fuel Oil Company 285 Derby Street Salem,Massachusetts MA DEP Release Tracking No. 3-1359& 3-13216 To Whom It May Concern: On behalf of Clarke Brothers Fuel Oil Company, Ransom Environmental Consultants,hic. (Ransom)has prepared this letter to inform you that on September 5, 2002, an Amendment and Ratification to Notice of Activity and Use Limitation(AUL), a copy of which is enclosed, was recorded with the Essex County Registry of Deeds in Book 19183, Page 242. The AUL affects a portion of the property located at 285 Derby Street, in Salem,Massachusetts. It identifies certain activities and uses which are inconsistent with maintaining a condition of No Significant Risk at the subject property. Such activities and uses are so identified in order to prevent exposures to residual petroleum-contaminated soil at a portion of the subject property. The Amendment and Ratification to the AUL identifies changes in the specific activities and uses which are consistent with maintaining a condition of No Significant Risk and those obligations and conditions necessary to ensure that a condition of No Significant Risk continues to exist at the property for the foreseeable future. This public notification is being provided pursuant to the Massachusetts Contingency Plan, 310 CMR 40.1090 and 310 CMR 40.1403(7)(a). If you have any questions, please contact Stephen B. Ransom, LSP, at(978)465-1822. Sincerely, XStephenB. Ransom Licensed Site Professional AMB/TJS/SBR:sh Enclosure cc: Donald J. Clarke (letter only) MA DEP,Northeast Regional Office (letter only) ■ Brown's Wharf, Newburyport, Massachusetts 01950,Tel(978)465-1822, Fax(978)465-2986 200 High Street,Portland,Maine 04101,Tel(207)772-2891 195 Commerce Way, Portsmouth,New Hampshire 03801,Tel(603)436-1490 .9K Princess Road, Lawrenceville,New Jersey 08648,Tel (609)620-0700 1445 Wampanoag Trail,Suite 108A,East Providence,Rhode Island 02915,Tel(401)433-2160 www.ransomenv.com 2002090500146 Sk,19183 P9;242 09/05/2002 09:42;00 OTHER Pe 1/10 Il h� AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIMITATION (for amending and ratifying a Notice of Activity and Use Limitation recorded on or before October 29, 1999) WITNESSETH: This Amendment and Ratification of Notice of Activity and Use Limitation ("Amendment and Ratification') is made as of this 31 day of July, 2002,by South Harbor Holdings LLC(Donald J. Clarke,Manager) of Salem,Essex County,Massachusetts together with his/her/its/their successors and assigns(collectively"Owner"). WITNESSETH: v WHEREAS, Owner is the owner in fee simple of a certain parcel of land located in Salem, Essex County, U) Massachusetts ("Property"), pursuant to a deed recorded with the Essex County Registry of Deeds in Book 6459 Page 699; v WHEREAS,the Property comprises a disposal site,or part of a disposal site, as the result of a release of oil -P and/or hazardous material ("the Disposal Site"). Response actions have been selected for the Disposal Site in m accordance with M.G.L. c.21E ("Chapter 21E") and the Massachusetts Contingency Plan, 310 CMR 40.0000 ("the o MCP"). Said response actions are based upon (a) the restriction of human access to and contact with oil and/or w hazardous material in soil and/or groundwater, and/or (b) the restriction of certain activities occurring in, on, ca through,over or under the Property or a portion thereof The Department of Environmental Protection has identified the Disposal Site as Release Tracking Numbers 343216 and 3-1359; N WHEREAS, on June 19, 1995, Donald J. Clarke filed a Notice of Activity and Use Limitation with the a Essex County Registry of Deeds in Book 13064, Page 228 imposing an activity and use limitation on a portion of the Property("the Original AUL"). The portion of the Property affected by the Original AUL and this Amendment o and Ratification is hereinafter referred to as "the AUL Area." The AUL describes activities and uses that are permitted within the AUL Area, and defines obligations and conditions that must be maintained within the AUL N Area. The AUL also describes uses and activities which, if carried out within the AUL Area, could result in Significant Risk to health, safety, public welfare or the environment due to potential exposure to residual v contamination. m b WHEREAS,the following amendments to the Original AUL are necessary to ensure that a condition of No Significant Risk is maintained at the Disposal Site. NOW,THEREFORE, Owner hereby amends the Original AUL as follows: AUL Opinion The basis of the Original AUL, as amended herein, is an Activity and Use Limitation Opinion ("AUL Opinion'),prepared by a Licensed Site Professional and attached hereto as Exhibit B. Said AUL Opinion replaces and supercedes any AUL Opinion contained or referenced in the Original AUL. " w4 C) f ISite Activities and Uses € The following descriptions of Permitted Activities and Uses,Activities and Uses Inconsistent with the AUL a Opinion,and Obligations and Conditions replace and supercede those contained in the Original AUL. 1. Permitted Activities and Uses. A condition of No Significant Risk to health, safety,public welfare or the environment exists for any foreseeable period of time so long as any of the following activities and uses occur within the AUL Area: i. Commercial and industrial uses of the property and activities,consistent therewith c;t } which do not involve soil disturbance; ii. Construction-related excayation such as those associated with underground utility service activities, provided that it is conducted with a Soil Management Plan and Health and Safety Plan in accordance with Obligations (3) and (4) of this Opinion; and involves the repair and/or replacement of the asphalt pavement or concrete floor with a comparable barrier immediately following the completion of the project such that a condition of No Significant Risk is maintained; and in. Such other activities and/or uses which, in the Opinion of an LSP, shall present no greater risk of harm to health, safety, public welfare, or the environment than the activities and uses set forth in this paragraph. 2. Activities and Uses Inconsistent with the AUL Opinion. The following activities and uses, if implemented within the AUL Area, may result in a Significant Risk of harm to health, safety, public welfare or the environment: i. Activities and/or uses which may cause physical or chemical deterioration,breakage or structural damage to the asphalt pavement in the AUL area or concrete floor in the Site building located in the AUL area or the removal of the asphalt pavement or concrete floor in the AUL area; ii. Activities and/or uses which are likely to involve the removal and/or disturbance of the soil located beneath the asphalt pavement and concrete floor in the AUL area including excavation or digging, unless such activities are performed in accordance with a Soil Management Plan and a Health and Safety Plan, approved by a Licensed Site Professional(LSP);and iii. Use of the property as a residence, school, daycare facility and/or other use at which a child's presence is likely. 3. Obligations and Conditions. The following obligations and/or conditions must be maintained within the AUL Area in order to maintain a condition of No Significant Risk: i. The asphalt pavement and concrete floor areas,as shown on the attached sketch plan, provided as Exhibit C,must be maintained in good condition at the Site such that the contaminated soil beneath the pavement and floor remains inaccessible; ii. Semi-annual inspections must be performed to confirm that the asphalt pavement and concrete floor is being properly maintained to prevent exposure to the contaminated soil at the Site; iii. Prior to the commencement of activities likely to disturb the soil at the Site, a Soil Management Plan must be prepared by an LSP. The Soil Management Plan should describe appropriate soil excavation handling, storage, transport, and disposal procedures and include a description of the engineering controls and air monitoring procedures necessary to ensure that workers and receptors in the vicinity are not affected by fugitive dust. Also, should excavation and digging of soils below the asphalt pavement and/or concrete floor be required at the Site, such work must be performed in accordance with MCP criteria; iv. A Health and Safety Plan must be prepared prior to the commencement of any activity which involves the removal and/or disturbance of the asphalt pavement and/or concrete floor and/or is likely to disturb the underlying contaminated soil in the AUL area. This plan should clearly describe the location of the contaminated soil and identify the types of personal protective equipment and monitoring devices necessary to ensure that workers are not exposed to the contaminated soils in at the Site;and 7/26/00 v. The asphalt pavement and/or concrete floor at the AUL area must be repaired and/or replaced with a comparable barrier following the completion of any activity which involves its removal or disturbance, such that future exposures to the underlying contaminated soil is prevented. Except as expressly amended herein,the Original AUL is hereby ratified and confirmed. Owner authorizes and consents to the recordation and/or registration of this Amendment, which shall be deemed to be effective as of the date the Original AUL was recorded and/or registered. WITNESS the execution hereof under seal this _day o 20 o L- Donald. larke,Manager South Harbor Holdings,LLC [COMMONWEALTH W MASSACHUSETTS] [STATE OF F55Si'y as AV_-tj 1-020 01-- Then 'vThen personally appeared the above-named Donald J. Clarke and acknowledged the foregoing instrument to be his free act and deed before me, o ry Publics y Commission Expires: MY COMMISSION EXPIRES DECEMBER 3, 2004 7/26/00 The undersigned Waste Site Cleanup Professional certifies that, in his opinion, the terms of the Original AUL, as amended herein, are consistent with the AUL Opinion attached to the Original AUL hereto as Exhibit B, and are,appropnate to maintain a condition of No Significant Risk at the Disposal Site. ' Date 3��a_ ,/ ` fStephen .Ransom,LSP [LSP SEAL [COMMONWEALTH OF MASSACHUSETTS] [STATE OF ss 1 l 1200_ — Then 200_ — Then personally appeared the above-named Stephen B. Ransom and acknowledged the foregoing instrument to be his free act and deed before me, Notary Pubh :. My Commission Expires: Upon recording,return to: Donald I Clarke P.O.Box 677 Salem,Massachusetts 01970 7/26/00 The undersigned Waste Site Cleanup Professional certifies that, in his opinion, the terms of the Original AUL, as amended herein, are consistent with the AUL Opinion attached to the Original AUL hereto as Exhibit B, and are appropriate to maintain a condition of No Significant Risk at the Disposal Site. Date: ,� Q LSP [LSP S A ] [COMMONWEALTH OF MASSACHUSETTS] [STATE OF �c ss cqc ,ss `'i I �S ,206 Then personally appeared the above-named Stephen B. imyicgo - - dged the foregoing instrument to be his free act and deed before me, Expires: 5 l S O3 Upon recording,return to: Donald J. Clarke P.O.Box 677 Salem,Massachusetts 01970 7/26/00 Exhibit B Activity and Use Limitation Opinion In accordance with the requirements of 310 CMR 40.1074,this Activity and Use Limitation Opinion has been prepared for a portion of land owned by South Harbor Holdings LLC, and located at 285 Derby Street in Salem,Massachusetts. As of the date of this Activity and Use Limitation(AUL) Opinion,the property is zoned for commercial and industrial use. Site History Historically the Site has been utilized for commercial and industrial purposes 'since at least 1928. Activities at the Site have included use as a roofing company,television headquarters; and a warehouse. According to the MA DEP 1993 Transition List of Confirmed Disposal Sites and Locations to be Investigated,the 285 Derby Street property was first listed as a location to be investigated on October 15, 1988. On October 23, 1991,the property was issued a Waiver of Approvals by the MA DEP. The Release Tracking Number(RTN)for the release at the property was 3-1359. Environmental assessments conducted by Ransom Environmental Consultants,Inc. (Ransom)and Kurz Associates Inc. (KAI), of Bridgewater,Massachusetts between 1987 and 1995 detected petroleum- impacted soil and ground water in the southern portion of the Site. Laboratory analyses indicated that the petroleum product present was No. 2 fuel oil. Response actions taken to remediate the release included removal of approximately 150 to 200 gallons of petroleum product/ground water and excavation of 18 cubic yards of petroleum-impacted soil. Between February and April, 1995 Ransom performed a subsurface investigation that indicated concentrations of petroleum hydrocarbons were below the Method 1 S-3 standards in soil samples and below the Method 1 GW-2 and GW-3 standards in ground water. On June 20, 1995 a Class A-3 Response Action Outcome(RAO) Statement was prepared:,for RTN 3-1359 and submitted to the MA DEP and AUL was placed on the property to maintain a condition of "No Significant Risk"of harm to human health, safety, public welfare, and the environment. On December 2, 1995, a release of approximately 100 gallons of No. 2 fuel oil occurred in the boiler room located at the south end of the Site building. Immediate response actions were performed at the Site and the NIA DEP assigned RTN 3-13216 to the incident. As a result of the December 2, 1995, fuel oil release,Ransom also performed a Release Abatement Measure (RAM) consisting of the removal of the upper concrete floor in the boiler room and excavation of 15.45 tons of petroleum-impacted fill material. Following the excavation of contaminated soil,the lower concrete floor of the boiler room was cleaned to remove residual fuel oil. In addition, 382 gallons of water were removed from the boiler room floor. A RAM Completion Statement was filed with the MA DEP. As part of the RAM Completion Statement, Ransom performed a Method 3 Risk Characterization to evaluate site-specific risks to human health from contaminants in soils and ground water at the Site. The Method 3 Risk Characterization included a characterization of the risk of harm to human health, safety, public welfare,and the environment as described in the Massachusetts Contingency Plan(MCP). Based on the results of the Method 3 Risk Characterization, it was Ransom's opinion that conditions at the Site represent a condition of"No Significant Risk" of harm to human health, safety,public welfare, and the environment. However, the Method 3 Risk Characterization indicated restrictions previously placed on the Site through the AUL must remain in place in order to maintain this condition. As such,an AUL First Amendment was recorded at the Essex County Registry of Deeds on November 3, 1997. Page 1 of 3 Reason for Activity and Use Limitation A Method 3 Risk Characterization was conducted to evaluate the risk posed by the contamination remaining in soil at the Site. As described above,Ransom performed a Method 3 Risk Characterization for the Site which demonstrated that an AUL is necessary to maintain a condition of"No Significant Risk"of harm to human health, safety, public welfare, and the environment Prohibited Site Activities and Uses This AUL area is approximately 4,530-square feet and is located in an asphalt paved parking area on the southern portion of the Site as well as the southern portion of the Site building including the boiler room area. The AUL will apply to this area only and is shown on Exhibit C. Site activities and uses that are prohibited at the AUL portion of the Site are as follows: 1. Activities and/or uses which may cause physical or chemical deterioration,breakage or structural damage to the asphalt pavement in the AUL area or concrete floor in the Site building located in the AUL area or the removal of the asphalt pavement or concrete floor in the AUL area; 2. Activities and/or uses which are likely to involve the removal and/or disturbance of the soil located beneath the asphalt pavement and concrete floor in the AUL area including excavation or digging, unless such activities are performed in accordance with a Soil Management Plan and a Health and Safety Plan, approved by a Licensed Site Professional(LSP); and 3. Use of the property as a residence, school, daycare facility and/or other use at which a child's presence is likely. Should either of these activities become necessary to perform construction or utility activities at the Site, certain obligations are required as described in the AUL and the MCP. Permitted Site Activities and Uses Site activities and uses that are permitted at the AUL portion of the Site are as follows: 1. Commercial and industrial uses of the property and activities consistent therewith which do not involve soil disturbance; 2. Construction related excavation such as those associated with underground utility service activities, provided that it is conducted with a Soil Management Plan and Health and Safety Plan in accordance with Obligations (3) and(4)of this Opinion; and involves the repair and/or replacement of the asphalt pavement or concrete floor with a comparable barrier immediately following the completion of the project such that'.a condition of No Significant Risk is maintained; and Page 2 of 3 3. Such other activities and/or uses which, in the Opinion of an LSP, shall present no greater risk of harm to health, safety, public welfare,or the environment than the activities and uses set forth in this paragraph. Obligations Required to be Undertaken and/or Maintained Certain obligations are required to be undertaken and/or maintained in the AUL area to maintain a condition of No Significant Risk. These obligations are as follows: 1. The asphalt pavement and concrete floor areas, as shown on the attached sketch plan, provided as Exhibit C, must be maintained in good condition at the Site such that the contaminated soil beneath the pavement and floor remains inaccessible; 2. Semi-annual inspections must be performed to confirm that the asphalt pavement and concrete floor is being properly maintained to prevent exposure to the contaminated soil at the Site; 3. Prior to the commencement of activities likely to disturb the soil at the Site, a Soil Management Plan must be prepared by an LSP. The Soil Management Plan should describe appropriate soil excavation handling, storage,transport, and disposal procedures and include a description of the engineering controls and air monitoring procedures necessary to ensure that workers and receptors in the vicinity are not affected by fugitive dust. Also, should excavation and digging of soils below the asphalt pavement and/or concrete floor be required in the AUL area, such work must be performed in accordance with MCP criteria; I 4. A Health and Safety Plan must be prepared prior to the commencement of any activity which involves the removal and/or disturbance of the asphalt pavement and/or concrete floor and/or is likely to disturb the underlying contaminated soil. This plan should clearly describe the location of the coptaminated soil and identify the types of personal protective equipment and monitoring,devices necessary to ensure that workers are not exposed to the contaminated soils in at the Site; and 5. The asphalt pavement and/or concrete floor at the Site must be repaired and/or replaced with a comparable barrier following the completion of any activity which involves its removal or disturbance, such that future exposures to the underlying contaminated soil are prevented. LSP: (J I_gfepB. Veniaom, Licensed i e Professional Date: Page ') of 3 Massachusetts Department of Environmental Protection gWSC-114S Bureau of Waste Site Cleanup L17 ' Release Tracking Number ACTIVITY& USE LIMITATION (AUL) OPINION FORM 1- 1359 COMPLETE THIS FORM AND ATTACH AS AN EXHIBIT TO THE AUL DOCUMENT TO BE RECORDED AND/OR REGISTERED WITH THE REGISTRY OF DEEDS ANDIOR LAND REGISTRATION OFFICE. A. LOCATION OF DISPOSAL SITE AND PROPERTY SUBJECT TO AUL: Disposal Site Name: 285 Derby Street Street: 285 Derby Street Location Aid: Cityrrown: Salem ZIP Code: 01970-0000 . Address of property subject to AUL,if different than above. Street: Cityrrown: _ ZIP Code: B. THIS FORM IS BEING USED TO: Provide the LSP Opinion for an Amendment and Ratification of a Notice of Activity and Use Limitation,pursuant to instructions provided by DEP in a Notice of Audit Findings issued to: South Harbor Holdings, LLC (Donald J. Clarke, Manager) Name of Organization or person: Date Issued: 12/31/2002 C. LSP OPINION: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this submittal,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1),(Ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge, information and belief. The Amendment and Ratification of the Activity and Use Limitation that is the subject of this submittal is being provided in accordance with instructions provided by the Department of Environmental Protection in a Notice of Audit Findings Issued to: Name of organization or person: South Harbor Holdings, LLC (Donald J. Clarke, Manager) Date issued: 12/31/2002 I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false,Inaccurate or materially incomplete. Check here If the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s)and/or approval(s) issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. Stephen B. Ransom 4601 LSP Name: LSP#: Stamp: Telephone: (978)465-1822 Ext.: 25 FAX: (978) 465-2986 LSP Signature: _ Date: �'/O, YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY FIND THE DOCUMENT TO BE INCOMPLETE Revised 4/2/2001 Page 1 of 1 TEXACO GASOLINE STATION (north approximate) II - _----� - - - - - - - � NOTES. BL/MW-5 1 FIGURE BASED ON OBSERVATIONS I I MADE BY RANSOM ENVIRONMENTAL I i 1 1 CONSULTANTS ON FEBRUARY 21, 1995 AND APRIL 28, 1995. ( 1 285 DERBY STREET I 2. MONITORING WELLS MW-1, MW-2, MW2 0,!41 / 1 i (283) AND K-1 INSTALLED BY KURZ BUILDING ASSOCIATES INC. IN DECEMBER 1987. �1�� 3. MWA, MWB, AND MWE ARE 1-INCH / / VIV-4 BM/MW-6 PIEZOMETERS INSTALLED BY RANSOM /� !bb'"'.• LOADING j ( a ON FEBRUARY 21, 1995 / �i / DOCK 4. MONITORING WELLS MW-3 THROUGH O / BJ/MW-3 ARIL 27 ANDS 81995. ON N GJ / BOILER R800M H I MW-2 rn / {� m * 1 CT -�.�-0 G ASPHALT-PAVED ® ' / RECOVERY +MWB BM PARKING AREA — IFQEND — MWE MONITORING WELL SOIL BORING ® CATCH BASIN 283 DERBY STREET BUILDING ------ PROPERTY BOUNDARY AUL AREA BM= BENCHMARK OF ASSUMED LLL ELEVATION - 100.00 FEET. MW2 (283) K—T Environmental EXHIBIT C — Consultants, Inc. SITE PLAN PREPARED FOR: SITE: 285 DERBY STREET DATE: AUGUST 2002 SOUTH HARBOR HOLDINGS, LLC SALEM, MASSACHUSETTS PROJECT:. . 961147 FIGURE: 2 server rojecls 1996 96114] DRAPING$ 96114]02A.DW Avg 09. 2002 — Z33pm COMMONWEALTH OF MASSACHUSETTS ESSEX REGISTRY OF DEEDS;SO.DIST,SALEM,MASS ESSEX SS JZ 16 5 200 A TRUE COP OF RECORD: OOKr9ff3l`AGE � A7TES REGISTER ams. The Salem News, Salem,Mass.,Wednesday,September 18,2002 C9: - - its way legal Notice ipply," l eg al Notice - NOTICE OF AMENDMtNT AND RATIFICATION NOTICE OF AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIMITATION •OF NOTICE OF ACTIVITY AND USE LEarATION ; ' Site Address 285 Derby Street,Salem Massachusetts MA DEP Release Tracking Numbers 31359 and 3-13216 Site Address:24-26 Congress Street,Salem,MA 01970 MA DEP Release Tracking Numbers 3.2084 Property Owner;Donald J.Clarke Property Owner;Donald J.Clarke Pursuant to the Massachusetts Contingency Plan (310CMR 40.1073):an Pursuant to the Massachusetts Contingency Plan (310 CMR 40.1073),an Amendment and Ratifiation of Notice of Activity and Use Limitation on the Amendment and Ratification of Notice of Activity and Use Limitation(AUL) above disposal site was recorded with the Essex County Registry of Deeds on on the above disposal site was recorded with the Essex County Registry of Deeds; ;ravy, September 5, 2002,at Book 19183,Page 242.The purpose of the Amendment on September 5,2002,at Book 19183,Page 280.The purpose of the Amend- roll or and Ratification was to modify the original Notice of Activity end Use Limita. ment and Ratification was to modify the original Notice of Activity and Use ears. tion which was recorded with the Essex County Registry of Deeds on June 19, Limitation which was recorded at the Essex County Registry of Deeds on Novem- erican 1995,at Book 13064,Page 228. - ber 3,1997,at Book 14409,Page 49. kThe modifications to the Notice,of Activity and Use Limitation are as fol- The modifications to the Notice of Activity and Use Limitation are as fol- ,egg lows: atable Prohibited Site Activities and Uses lows: Prohitedses This AUL area is approximately 4,530 square feet and is located in an asphalt- The AUL areatis approximately Activities and111,484 square feet and is located in an asphalt- ggets, paved parking area on the southern portion of the Site as well as the southern por- paved parking area on the northern portion of the Site.The entire AUL area is hash tion of the Site building including the boiler room area.The.AUL will apply to this asphalt paved. area only. Site activities and uses that are prohibited at the portion of the Site are as fol. r ham Site activities and uses that are prohibited at the AUL portion of the Site are as lows: follows: 1.Activities and/or uses which may cause physical or chemical deterioration, hoice, 1.Activities and/or uses which may cause physical or chemical deteriootion, breakage or structural damage to the asphalt pavement or the removal of the breakage or structural damage to the asphalt pavement in the AUL.area or com asphalt pavement or the portion of the Site identified as the AUL area; Meth trete floor in the.Site building located in the AUL area or the removal of the 2.Activities and/or uses which are likely to involve the removal and/or distur. asphalt pavement or concrete floor in the AUL area: bance of the petroleum hydrocarbon contaminated soil located beneath the pave- 2.Activities and/or uses which are likely to involve the removal and/or distur- ment,including excavation or digging,at the portion of the Site identified as the bance of the soil located beneath the asphalt pavement and concrete floor in the AUL area unless such activities are performed in accordance with a Soil Manage- AUL area including excavation or digging,unless such activities are performed in ment Plan and a Health and Safety Plan,approved by a Licensed Site Professional accordance with a Soil Management Plan and a Health and Safety Plan,approved (ISP)and; by a Licensed Site Professional(LSP);and 3.Use of the io rpo-tgge 3.Use of the property as a residence,school,daycare facility and/or other use at which a child's presenceproperty s likely. uthem s prensence is likely. entre,school,daycare facility and/or other use at which a child's - Should it become necessary to perform construction or utility activities at the ;e New Should either of these activities become necessary to perform construction or Site,certain obligations are required as described in the AUL and the MCP. condi- utility activities at the Site,certain obligations are required as described in the Permitted Site Activities and Uses sold at AUL and the MCP. Site activities and uses that are permitted at the AUL portion of the Site are as Permitted Site Activities and Uses follows: causes Site activities and uses that are permitted at the AUL portion of Site aro as 1.Activities and/or uses including,but not limited to,vehicular parking,pedes anum, follows: riled in a.Commercial man and vehicular traffic which do not compromise the structural integrity of the mnercial and industrial uses of the property and activities consistent pavement; therewith which do not involve soil disturbance; 2.Commercial activities and/or uses which do not disturb the petroleum rsuant b.Construction-related excavation such as that associated with underground hydrocarbon contaminated soli located beneath the asphalt pavement in the AUL utility service ti r Deed acvities,provided that it is conducted with a Sell Management area; Ary of Plan and Health and Safety Plan in accordance with Obligations(3)and(4)below; 3.Construction related excavation such as those associated with'underground pith(a) and involves the repair and/or replacement of the asphalt pavement or concrete utility service activities,provided that it is conducted with a Soil Management �e Con- floor with a comparable barrier immediately following the completion of the pro- Plan and Health and Safety Plan in accordance with Obligations(3)an cSuch other d(4)below iindum lett such that a condition of No Significant Risk is maintained;and - - and involves the repair and/or replacement of the asphalt pavement with a com- ace or . activities uses which,in the Opinion of an ISP,shall pre parable barrier immediately following the completion of the project such that a sent no greater risk of harm to health,safety,public welfare or the environment condition of No Significant Risk is maintained;and and(c) than the activities and uses set forth in thisparagraph. l basis 4.Such other activities and/or uses which,in the Opinion of an LSP,shall pro vfaster Obligations Required to be Undertaken and/or Maintained sent no greater risk of harm to health,safety,public welfare,or the environment 9 on a Certain obligations are required to be undertaken and/or maintained in the than the activities and uses set forth in this paragraph AUL area to maintain a condition of No Signicant Risk,These obligations are as Obligations Required to be Undertaken and/or Maintained nents follows: - 1Certain obligations are required to be undertaken and/or maintained at the s y an .The asphalt pavement and concrete floor areas,as shown on the sketch plan, : Site to maintain a condition of No Significant Risk.These obligations are as fol- ment provided as Exhibit C to the Amendment and Ratification,must be maintained in lows: good condition at the Site such that the contaminated sell beneath the p p g reds in pavement 1.The halt pavement A must be maintained rood condition at the portion of and floor remains inaccessible; the Site identified as the AUL area such that the petroleum hydrocarbon contami-. strict) 2.Semi-annual inspections must be performed to confirm that the asphalt pave- noted soil,beneath the pavement remains inaccessible; ment and concrete floor is being property maintained to prevent exposure to the 2.Semiannual inspections must be performed to confirm that the pavement is t of all contaminated sell at the Site; being properly maintained to prevent exposure to petroleum hydrocarbon conta- in the 3.Prior to the commencement of activities likely to disturb the soil at the Site a urinated soil in the AUL area; s tax Soil Management Plan must be prepared by an LSP..The Soil Management Plan 3. Prior to the commencement of activities likely to disturb the petroleum nts or should describe appropriate soil excavaflon.handling,storage,transport,and dis- hydrocarbon contaminated soil located in the AUL area,a Soil Management Plan cable, posal procedures and include a description of the engineering controls and air must be prepared by an ISP,The Soil Management Plan should describe appropri- tions, monitoring procedures necessary to ensure that workers and receptors in the ate soil excavation handling,storage,transport,and disposal procedures and vicinity are not affected by fugitive dust.Also,should excavation and digging of, include a description of the engineering controls and air monitoring procedures soils below the asphalt pavement and/or concrete floor be required in the AUL necessary to ensure that workers and receptors in the vicinity are not affected by heck area,such work must be performed in accordance with MCF criteria; fugitive dust.Alsoshould excavation and digging gging of soils below the asphalt pave- The 4.A Health and Safety Plan must be prepared prior to the commencement of ment be required n the AUL area,such work must be performed in accordance P C any activity which involves the removal and/or disturbance of the asphalt pave- with MCP criteria; Box ment and/or concrete floor and/or is likely to disturb the underlying contaminat- 4.A Health and Safety Plan must be prepared prior to the commencement of (30) ed soil,This plan should clearly describe the location of the contaminated soil and any activity which involves the removal and/or disturbance of the pavement Trace- upon identify the types of personal protective equipment and monitoring devices nett- and/or is likely to disturb the underlying petroleum hydrocarbon contaminated ied in ssary to ensure that workers are not exposed to the contaminated soils in at the soil.This plan should clearly describe the location of the petroleum hydrocarbon Site;and - contaminated soils and identify the types of personal protective equipment,and 5.The asphalt pavement and/or concrete floor at the Site must be y oared monitoring devices necessary to ensure that workers are not exposed to the petro and/or replaced with a comparable barrier following the completion of any octroi-. learn hydrocarbon contaminated soils in the AUL area;and ry which involves its removal or disturbance,such that future exposures to the 5.The pavement within the AUL area must be repaired an/or replaces with a underlying contaminated soil are prevented, comparable barrier following the completion of any activity which involves its neys, Any person interested in obtaining additional information or reviewing the removal or disturbance,such that future exposures to the underlying petroleum 'quire AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIM- hydrocarbon contaminated soil is prevented, Street ITATION and the disposal site file may contact Stephen B.Ransom,Ransom. Any person interested in obtaining additional information or reviewing the 02958 Environmental Consultants, Inc., Brown's Wharf; Newwbaryport,MA Amendment and Ratification of Notice of Activity and Use Limitation and the dis- 01950,(978)465-1822. 3-0500 (g/18/02) - posal site file may contact Stephen B.Ransom,Ransom Environmental Con- sultants,Inc.,Brown's Wharf;Newburyport„MA 01950,tel.(918)465-1822. (9/18/02) - Ctv of '5alvnl, { ttssarljuertts nttrb of eal Hn 19 2 09 �� °�'1� e ` CtiY ni ',ALI M, MASS Ctf RK'S O'rfICF DECISION ON THE PETITION OF LOUIS-J.—KARLBERG,REQHSTING A SPECIAL PERMIT FOR THE PROPERTY LOCATED AT 285 DERBY STREET ---�l A hearing on this petition was held March 18, 1998 with the following Board Members were present: Gary Barrett, Chairman, Nina Cohen, Albert Hill , Richard Dionne and Paul Valaskagis . Notice of the hearing was sent to abutters and others and notices of the hearing were properly published in the Salem Evening News in accordance with Massachusetts General Laws Chapter 40A. At the request of the petitioner, the Salem Board of Appeal voted 5-0, to grant leave to withdraw this petition without prejudice for a Special Permit to allow a natural discovery museum-"Micro Zoo" for the property located at 285 Derby Street. Granted leave to withdraw without prejudice. GRANTED LEAVE TO WITHDRAW WITHOUT PREJUDICE March 18, 1998 c5c, Gary Barrett, Chairman Board of Appeal A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK. Appeal from this decision,if any, shall be made pursuant to Section 17 of the Massachusetts General Laws Chapter 40A, and shall be filed within 20 days after the date of filing of this decision in the office of the City Clerk. Pursuant to Massachusetts General Laws Chapter 40A, Section 11, the Variance or Special Permit granted herein shall not take effect until a copy of the decision bearing the certification of the City Clerk that 20 days have elapsed and no appeal has been filed, or that, if such appeal has been filed, that it has been dismissed or denied is recorded in the South Essex Registry of Deeds and indexed under the name of the owner of record or is recorded and noted on the owner's Certificate of Title. Board of Appeal 0 PyConsulting 2ANS0M Engineering Environmental Hydrogeology Consultants, i C. Applied Sciences ovember 20, 1997 Project 961147 The Honorable Neil J. Harrington Mayor 93 Washington Street Salem, Massachusetts 01970 RE: Response Action Outcome (RAO) Statement and Activity and Use Limitation (AUL) Opinion 285 Derby Street Salem, Massachusetts MA DEP Release Tracking Number: 3-13216 Dear Mayor Harrington: In accordance with the Massachusetts Contingency Plan(MCP), Ransom Environmental Consultants, Inc. (Ransom) has submitted.a Response Action Outcome (RAO) Statement to the Massachusetts Department of Environmental Protection(MA DEP) for the above-referenced site. The MCP requires that the local chief municipal officer and board of health be notified when an RAO Statement has been prepared for a disposal site. In support of the RAO, an Activity and Use Limitation (AUL) amendment was recorded to indicate that a release occurred at the property. The MCP also requires that the local chief municipal officer, board of health, zoning official, and building code enforcement official be provided with a copy of the recorded AUL amendment. As such a copy of the recorded AUL amendment is attached. Based on the results of a Release Abatement Measure (RAM) as presented in the RAM Completion Report and RAO Statement, dated May 28, 1997, it is Ransom's opinion that a condition of "No Significant Risk" of harm to human health, safety, public welfare, and the environment exists at this property. Site conditions, as determined by Ransom, meet the requirements for attaining a Class A-3 RAO. Copies of the RAM Completion Report and RAO Statement are available for public viewing at the MA DEP Northeast Regional Office located at 10 Commerce Way in Woburn, Massachusetts. MA DEP files are open for public viewing by appointment only. You may contact the MA DEP Northeast Regional Office at (617) 932-7600 for more information on reviewing MA DEP files. A copy of the legal notice for the AUL to be published in the Salem Evening News on November 26, 1997, is enclosed. Brown's Wharf 56 Court Street 1273 Bound Brook Road,Suite 13 120 Shea Lane Newburyport,MA 01950 Bristol,RI 02809 Middlesex,NI 08846.1490 Glenmoore,PA 19343 Tel (508)465-1822 Tel (401)254.5070 Tel (908)356.6655 Tel (610)458-7628 Fax(508)465-2986 Fax(401)253-9508 Fax(908)356-4898 Fax(610)458.7629 The Honorable Neil J. Harrington Mayor, City of Salem If you have any questions regarding the Site or the attached documents, please do not hesitate to call. Sincerely, /RA/NSOM ENVIRONMENTAL CONSULTANTS, INC. /W ' �/v"9`II W. Scott Hoppe Project Geologist of y ay Regional hectorew England WSH/TJS:sh Enclosure cc: Salem Board of Health Salem Zoning Officer Salem Building Inspector Massachusetts Department of Environmental Protection, Northeast Regional Office Tim Clarke, Clarke Brothers, Inc. Ransom Project 961147 Page 2 ram\cmo.not November 20, 1997 (FORM#9) NOTICE OF AN AMENDMENT OF AN ACTIVITY AND USE LIMITATION NO. 2 FUEL OIL RELEASE 285 DERBY STREET SALEM, MASSACHUSETTS RELEASE TRACKING NUMBER 3-13216 Pursuant to the Massachusetts Contingency Plan (310 CMR 40.1073), the Notice of Activity and Use Limitation on the above disposal site recorded/registered with the Essex Registry of Deeds on June 19, 1995, was amended on November 3, 1997. The modification to the Notice of Activity and Use Limitation is as follows: 1. Said Notice is amended to indicate that a subsequent release occurred at the Portion of the Property for which the existing AUL applies. Appropriate response actions have been conducted to achieve site closure with regard to M.G.L. c. 21E and the Massachusetts Contingency Plan. Any person interested in obtaining additional information or reviewing the Amended Notice of Activity and Use Limitation and the disposal site file may contact Stephen B. Ransom, LSP, President, Ransom Environmental, Inc., Brown's Wharf, Newburyport, Massachusetts 01950; at (508)465-1822. 961147\ram\au1-1ega.not NS®M V ® L F CO P 1� Consulting 11 Engineering Environmental Hydrogeology Consultants, Inc. Applied Sciences November 6, 1997 Project 961147 Massachusetts Department of Environmental Protection Northeast Region 10 Commerce Way Woburn, Massachusetts 01801 RE: Transmittal of First Amendment to Notice of Activity and Use Limitation 285 Derby Street Salem, Massachusetts MA DEP Release Tracking Number 3-13216 To Whom It May Concern: Ransom Environmental Consultants, Inc. (Ransom) has prepared the attached First Amendment to Notice of an Activity and Use Limitation (AUL amendment) for the above-referenced site. This AUL amendment is being transmitted to support the Release Abatement Measure (RAM) Completion Report and Response Action Outcome (RAO) Statement prepared by Ransom and dated May 28, 1997. The RAM Completion Report and RAO Statement were transmitted to the Massachusetts Department of Environmental Protection (MA DEP) ori May 29, 1997. On June 2, 1997, the MA DEP issued a letter stating that the RAM Completion Report and RAO Statement submittal was administratively deficient since an Activity and Use Limitation (AUL) Transmittal Form (BWSC-113) and Activity and Use Limitation (AUL) Opinion Form (BWSC-114) were not included with the submittal. Forms BWSC-113 and BWSC-114 were not submitted by Ransom because an AUL was previously recorded on the property and the risk characterization performed by Ransom indicated that the existing AUL was protective of the subsequent release associated with Release Tracking Number (RTN) 3-13216. Following receipt of the MA DEP letter dated June 2, 1997, Ransom contacted Dorothy Montores of the MA DEP to clarify the requirements for the AUL. Ms. Montores stated that an AUL amendment was required to reflect that a subsequent release occurred and that the previously recorded AUL is protective of the release associated with RTN 3-13216. The AUL amendment was recorded at the Essex County Registry of Deeds on November 3, 1997. A true copy of the AUL amendment, including an Activity and Use Limitation (AUL) Opinion Form (BWSC-114), is attached. Ransom has also attached an Activity and Use Limitation (AUL) Transmittal Form (BWSC-113) and an updated Response Action Outcome (RAO) Statement and Downgradient Property Status Transmittal Form (BWSC-104). Brown's Wharf 56 Court Street 1273 Bound Brook Road,Suite 13 120 Shea lane Newburyport,MA 01950 Bristol,RI 02809 Middlesex,NI 08846-1490 Glenmoore,PA 19343 Tel (508)465-1822 Tel (401)254-5070 Tel (908)356-6655 Tel (610)458-7628 Fax(508)465-2986 Fax(4ol)253-9508 Fax(908)356-4898 Fax(610)458.7629 Massachusetts Department of Environmental Protection Should you have any questions regarding enclosed documents, please do not hesitate to contact us. Sincerely, //RANSOM ENVIRONMENTAL CONSULTANTS, INC. W. , 9/06tt pe Project Geologist Stephen B. Ransom, LSP President WSH/TJS/SBR:sh Attachments cc: Clarke Brothers, Inc. Ransom Project 961147 Page 2 ram/rao-aul.ltr November 6, 1997 ATTACHMENT A First Amendment to Notice of An Activity and Use Limitation (Form 108213) and Activity and Use Limitation(AUL) Transmittal Form (BWSC-13) Transmittal of First Amendment to Notice of Activity and Use Limitation 285 Derby Street Salem, Massachusetts MA DEP Release Tracking Number 3-13216 Ransom Environmental Consultants, Inc. Project 961147 Massachusetts Department of Environmental Protection BWSC-113 Bureau of Waste Site Cleanup Release Tracking Number ACTIVITY & USE LIMITATION (AUL) TRANSMITTAL FORM Pursuant to 310 CMR 40.1056 and 40.1070-40.1084 (Subpart J) �' 13216 A. LOCATION OF DISPOSAL SITE AND PROPERTY SUBJECT TO AUL: Disposal She Name: Clarke Brothers Inc. Street: 285 Derby Street Location Aid: chyrrown: Salem ZIP Code: 01970 Address of property subject to AUL,if different than above. Street: chyrrown: .. _ ZIP Code: .. FX Check here if this Disposal Site is Tier Classified. If the Disposal Site subject to the AUL is also subject to a Ter I Permit,provide the Permit Number: Related Release Tracking Numbers affected by this AUL: B. THIS FORM IS BEING USED TO: (check one) Submit a certified copy of a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1074(complete all sections of this form). ❑ Submit a certified copy of an Amended Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1081(4) (complete all sections of this form). Submit a certified copy of a Termination of a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1083(3) . (complete all sections of this form). Submit a certified copy of a Grant of Environmental Restriction,pursuant to 310 CMR 40.1071,(complete all sections of this form). . Submit a certified copy of an Amendment of Environmental Restriction,pursuant to 310 CMR 40.1081(3)(complete all sections of this form). Submit a certified copy of a Release of Environmental Restriction,pursuant to 310 CMR 40.1083(2)(complete all sections of this form). You must attach all supporting documentation for the use of-form Indicated,Including copies of any Legal Notices and Notices to Public Officials required by 310 CMR 40.1400. C. AUL INFORMATION: Date AUL was recorded and/or registered with Registry of Deeds and/or Land Registration Office: Name of Registry of Deeds and/or Land Registration Office where AUL was recorded and/or registered: Book and Page Number and/or Document Number of recorded and/or registered AUL: D. PERSON SUBMITTING AUL TRANSMITTAL FORM: Name of Organization: Clarke Brothers Inc. Name of Contact: Timothy Clarke Title: Manager Street: P.O. Box 677 Chyrrown: Salem State: MA ZIP Code: 01976 Telephone: (978) 745-1007 Exl.: FA):(optionat) (978) 745-4309 E. OWNER OF PROPERTY, IF NOT PERSON SUBMITTING AUL TRANSMITTAL FORM: Provide a mailing address for the owner of the property if that person is not submitting the AUL Transmittal Forth Provide addresses for additional owners on an attachment. Name or Organization: Name of Contact: Title: Street: Chyrrown: State: ZIP Code: Telephone: - Ext: FAX(optional) Revised 518/95 Do Not Alfer This Form - Page 1 of 2 Massachusetts Department of Environmental Protection BWSC-113 Bureau of Waste Site Cleanup ACTIVITY & USE LIMITATION (AUL) TRANSMITTAL FORM Release Tracking Number Pursuant to 310 CMR 40.1056 and 40.1070_-40.1084(Subpart J). 13216 F. RELATIONSHIP TO DISPOSAL SITE OF PERSON SUBMITTING AUL TRANSMITTAL FORM: (check one) QX RP or PRP- Specify. (a Owner O Operator j Generator 0 Transporter Other RP or PRP: Fidudiary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E.s.2) Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E.s.50)) E] Any Other Person Submitting AUL Specify Relationship: G. rCEERTIFICATION OF /PERSON SUBMITTING AUL TRANSMITTAL FORM: I. _1�O^E)a - 1v r �. ,attest under the pains and penalties of perjury(i)that I have personally examined and am fam�harU the information contained in this submittal,including any and all documents accompanying this transmittal form,(ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(i)that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. [the person or entity on whose behalf this submittal is made amts aware that there are significant penalties,including, but not limited to ossible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. - By Title: Yf S rAn (signakre)� U For. C1or1cc. )J 1-oia.s, Date: II'-3 (print name of person or entity recorded in Section D) Enter address of person providing certification.If different from address recorded in Section D: Street: Cityn`own: - . . - State: ' ZIP Code: r Telephone: - - Ext.: - FAX(optional) YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU--MAYBE PENALIZED FOR MISSING.; A REQUIRED DEADLINE,AND YOU MAY INCUR ADDITIONAL COMPLIANCE FEES. Revised 5/3/95 Do Not After This Form Page 2 of 2 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION Form 1082B FIRST AMENDMENT TO NOTICE OF AN ACTRM-Y AND USF T IMITAnON M.G.L. C. 21E§6 and 310 CMR 40.0000 Disposal Site Name: 285 Derby Street 1 I i l_�a- lr: [ ?t)5?. 261. DEP n.tDEP Release Tracking No.(s): 3-13216. 3-1359 R�+ '44 a a WHEREAS,a Notice of Activity and Use Limitation(AUL)has been recorded with the Essex County Registry of Deeds in Book 13064,Page 228 (said Notice of Activity and Use Limitation and any amendments thereto are collectively referred to herein as"Notice"); WHEREAS,said Notice sets forth limitations on use and activities,conditions and obligations affecting certain parcel(s)of land situated in Salem, Essex County,Massachusetts,with the buildings and improvements thereon,said land being more particularly bounded and described in Exhibit A attached hereto and made a part hereof("Property'D. Said limitations on use and activities are consistent with the terms of an Activity and Use Limitation Opinion C AUL Opinion')dated June 19, 1995, signed and sealed by Allen R. Walker of Ransom Environmental Consultants,holder of a valid license issued by the Board of Registration of Waste Site Cleanup Professionals,pursuant to Massachusetts General Laws Chapter 21A, Sections 19-19J (the holder being referred to as"LSP')attached to the Notice of Activity and Use Limitation as Exhibit D and made a part thereof,in order to maintain at the Property a condition of No Significant Risk;and WHEREAS,the undersigned LSP, in accordance with M.G.L. c. 21E and the MCP, has issued and signed an AUL Opinion,dated October 29, 1997,filed with DEP at its Northeast Regional Office under Release Tracking No.(s)3-13216,and attached hereto as Exhibit B and made a part hereof. Said AUL Opinion explains that the implementation of the following proposed changes in Site Activities and Uses at the Property will maintain a condition of No Significant Risk at the Property, and that no additional response actions are necessary; NOW THEREFORE, in accordance with M.G.L. c. 21E and the MCP, the undersigned Clarke Brothers, Inc., of Salem, Essex County, Massachusetts,being the owner of the Property, hereby amends said Notice as follows: Said Notice is amended to indicate that a subsequent release occurred at the Portion of the Property for which the existing AUL applies. Appropriate response actions have been conducted to achieve site closure with regard to M.G.L. c. 21E and the MCP, following recordation of this AUL. In all other respects the provisions of said Notice remain unchanged. fit, 0�=1�0 7/2R/95 iin rreu - 1711) 310 CMR DEPARTMENT OF ENVIRONMENTAL PROTECTION 1082B: continued Clarke Brothers,Inc-_authorizes and consents to the filing and recordation and/or registration of this Fust Amendment to Notice of Activity and Use Limitation,said Amendment to become effective when executed under seal by the undersigned LSP and recorded and/or registered with the appropriate Registry of Deeds and/or Land Registration Office. WITNESS the execution hereof under seal this -3 day of Nw 19_� wner COMMONWEALTH OF MASSACHUSETTS / 55r� , ss 19 l Then personally appeared the above named n tT /l�d acknowledged the foregoing to be his/her free act and deed before me, Public: Commission Expires: 1 Yki�% The undersigned LSP hereby certifies that he/she executed the AUL Opinion dated October 29, 1997, filed with DEP at its Northeast Regional Office under Release Tracking No.(s) 3-13216, attached hereto as Exhrbit B and made a part hereof,and that, in his Opinion, this Fust Amendment to Notice of Activity and Use Limitation is consistent therewith. Date/!/(/GO -- LSP.._ SEALj `; COMMONWEALTH OF MASSACHUSETTS ass�X ss Then personally appeared the above named and acknowledged the foregoing to be his/her free act and deed before me, Notary Public: My Commission Expires: I a�o3 Upon recording, return to: Clarke Brothers,Inc. P.O.Box 677 Salem,MA 01970 ,;` 7/28195 310 CMR- 1711 Massachusetts De artment of.Environmental Protection BWSC-114' Bureau of Waste Site"Cleanup Release Tracking Number ACTIVITY & USE LIMITATION (AUL) OPINION FORM a Pursuant to 310 CMR 40.1070-40.1084(Subpart J) 3 - 132I6 COMPLETE THIS FORM AND ATTACH AS AN EXHIBIT TO THE AUL DOCUMENT TO BE RECORDED AND/OR REGISTERED WITH THE REGISTRY OF DEEDS ANDIOR LAND REGISTRATION OFFICE A. LOCATION OF DISPOSAL SITE AND PROPERTY SUBJECT TO AUL: Disposal Site Name: Clarke Brothers Inc. - Street: 285 Derby Street Location Aid: cityrrom: Salem ZIP Code: 01970 Address of property subject to AUL,if different than above. Street: Cdyrrcwn: ZIP Code: B. THIS FORM IS BEING USED TO: (check one) Provide the LSP Opinion for a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1074(complete all sections of this form). ® Provide the LSP Opinion for an Amended Notice of Activity and Use Limitation;pursuant to 310 CMR 40.1081(4) (complete all sections of this form). Provide the LSP Opinion for a Termination of a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1083(3) (complete all sections of this form). Provide the LSP Opinion for a Grant of Environmental Restriction,pursuant to 310 CMR 40.1071,(complete all sections of this form). Provide the LSP Opinion for an Amendment of Environmental Restriction,pursuant to 310 CMR 40.1081(3)(complete all sections of this form). Provide the LSP Opinion for a Release of Environmental Restriction,pursuant to 310 CMR 40.1083(2)(complete all sections of this form). C. LSP OPINION: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this submittal,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of()the standard of care in 309 CMR 4.02(1),Q)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge,information and belief, > Ysection B indicates that a Notice of Activity and Use Llmhation is being registered anci/orrecorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1074(i)(b); > If Section B indicates that an Amended Notice ofActivtty and Use Limitation is being registered and/orrecorded,the Activity and Use Limitation that is the subject of this submittal()is being provided in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(i) complies with 310 CMR 40.1080(1)and 40.1081(1); > ff Section B indicates that a Termination of a Notice of Ac Wily and Use Limitation is being regstered and/or recorded,the Activity and Use Limitation that is the subject of this submittal()is being prcvided in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(i)complies with 310 CMR 40.1083(3)(a); > if Section B indicates that a Grant of Environmental Restriction is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal()is being provided in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(i)complies with 310 CMR 40.1071(1)(b); > ff Section B indicates that an Amendment to a Grant of Environmental Restriction is being registered and/orrecorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(i)complies with 310 CMR 40.1080(1)and 40.1081(1); - > if Section B indicates that a Refuse of Grant of Environmental Restriction is being regstered andror recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and (ii)complies with 310 CMR 40.1083(3)(a). I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false,inaccurate or materially incomplete. Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permlt(s)and/or approval(s) issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. SECTION C IS CONTINUED ON THE NEXT PAGE. Revised 51855 Do Not Alter This Form Page 1 of 2 _ - PLAN BW;k�99 Pt.A11�3 .ESSEX HEG61RY 1.F UEE03. b / 10 TE : �,�- h/ M kJ 8 O DENOTES k r-1 L CAPIZ30E/AIG fitcRL3�4�U S SO.O o h / Attest: / V p i 4 0 ` ii re Qly= w O. 7 m - �S3p0/ FOR IPEG/STRY USE OAII-Y 7.56i� / CERTIFY THAT TN/S PLAA/ �, COMFORWS THE RUL ES C. 15. TO/ 1r AND RECULATIOIJS OF THE REGISTRY OF DEEDS. s APE s�•3� A � x-530 s F. r � �p i-��, ����.� H b - -_ , 7'111SPLAN ALAS DRA1./�t/ f-RO/`f DEEDS, 5, 7o �z zp LOT 44/ RECORDS, ic;Y-A IS OF OTNERS AAW ACTZIAL FIELD AAORe. LOT 439 1 i l2EFERE/VCES W I ESSEX COUNTY REG/3TA?Y OF oEEaS 0 � 0 DE,EDS: 8004 PAGE 6433 42/ STOF2Y Bit/GK 1 NL 9464 ¢/5 .285 0 i 70Z/ 283 /0 74.5 390 LOT 440 � ' " ' ASSES50l2S PLs1T ` 34 LOTS -939 -442 LOT AREA = 253gZ S.F CITY EVC1�VEEPS PL" OF pERBY STREET IMPROVEMENTS - NAY 7, /99/- RIZZO,[SSOCIATES PLAN OF LANGMA/D *.5oz OF /94-¢ BOOK S.Z/9 PAGE -`F60 / CE,eT/FY THAT THE PROPERTY LIMES -SNOk/AI ARE THE LINES L7/VIO/NG EX/ST1 1c7 OA/NL:/�SN�P ,QND THE L/ti/ES OF STREETS ANO AIA YS <51-10A it/ A2E THOSE OF PUBLIC 0 2 PR/(TATE STREETS 0,2 MAYS ,AL eE.dDY 1 san EST'AQL/S/NEO, AAID 7-,4/47- A/0 A/ElJ L/NES �CsnY�° F-OR O/V/.5'/OAI OF EX/STING OLJlERSN/I OA? AlAYS /1 QE SI-10AI .. .BU/LOi,t/G Q .i F - C 30 r�E�/3 r sT��F�r ��A /_ F/ l, Met olz o io zo 30 40 �o j/IE /" TENT OF TN/S PLAM /S Tv /? A/Al_ D J. CZAIleKE DEL /"FATE THC ACT/V/TYAA-D USE L /M ITAT/OA/ AREA (A . U. L.) A-c S//O/./A/. SCALE : / _ ?_O" DATE: JunIE co loi ��r or w_assseg Ll - --} cFGISiFY CF s%uS y.0 P:<T �.eL•= •Ce >.S S. TSP COM AA1Y 0,, 2 / ,, r tJ1 i Ci' 1G.;RRL- . .. O. r5OX /3/ 5,4 Massachusetts Department of Environmental Protection SWSC-114 -Bureau`of.Waste Site Cleanup ACTIVITY & USE LIMITATION (AUL) OPINION FORM ReleaseTraekng Number Pursuant to 310 CMR 40.1070-40.1084(Subpart J) ❑3 - i 32 ib C. LSP OPINION. . (continued) ' LSP Name: Stephen B-. "Ransom _. ., LSP 9: '4601 'Stamp) - Telephone:' (978) 465-1822 ExL; .crr..N �' r FAX: 78) 46%-9qJq6 LSP Signature: � � - e"JA Date: f YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY FIND THE DOCUMENT TO BE INCOMPLETE. CCOAMONWEALfH OF MASSACHUSETTS ESSEX REGISTRY OF DEEDS,SO DIST.SALEM MASS ESSEX SS A)Q" 3 19 97 A TRUE COPY OF RECORD. 11 SOOK " �� PAGER ATTEST; p"^ _ ATTACHMENT B Response Action Outcome (RAO) Statement & Downgradient Property Status Transmittal Form (Form BWSC-104) Transmittal of First Amendment to Notice of Activity and Use Limitation 285 Derby Street Salem, Massachusetts MA DEP Release Tracking Number 3-13216 Ransom Environmental Consultants, Inc. Project 961147 Massachusetts Department of Environmental Protection BWSC-104 Bureau of Waste .Site Cleanup RESPONSE ACTION OUTCOME (RAO) STATEMENT& Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM a _ 13216 Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) A. SITE OR DOWNGRADIENT PROPERTY LOCATION: Site Name:(optionan Cl arkp Rroi-hprc Tnr Street: 285 Derby Street Location Aid: Cityrfown: Salem ZIP Code: 01970 ® Check here if this Site location is Tier Classified. If a Tier I Permit has been issued,state the Permit Number. Related Release Tracking Numbers that this Form Addresses: If submitting an RAO Statement,you must document the location of the Site or the location and boundaries of the Disposal Site subject to this Statement. If submitting an RAO Statement for a PORTION of a Disposal Site,you must document the location and boundaries for both the portion subject to this submittal and,to the extent defined,the entire Disposal Site. If submitting a Downgradient Property Status Submittal, you must provide a site plan of the property subject to the submittal and,to the extent defined,the Disposal Site. B. THIS FORM IS.BEING USED TO: (check all that apply) X(�} Submit a Response Action Outcome(RAO)Statement(complete Sections A,B,C.D,E,F.H.1,J and L). ❑ Check here if this is a revised RAO Statement. Date of Prior Submittal: Check here if any Response Actions remain to be taken to address conditions associated with any of the Releases whose Release Tracking Numbers are listed above. This RAO Statement will record only an RAO-Partial Statement for those Release Tracking Numbers. Specify Affected Release Tracking Numbers: Submit an optional Phase I Completion Statement supporting an RAO Statement or Downgradient Property Status Submittal (complete Sed:,)ns A,B.H,I,J,and Q. ❑ Submit a Downgradient Property Status Submittal(complete Sections A,B,G.H,I,J and IQ. Check here If this is a revised Downgradient Property Status Submittal. Date of Prior Submittal: E] Submit a Termination of a Downgradient Property Status Submittal(complete Sections A,B.I,J and Q. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution(complete Sections A,B,H,I,J and Q. Specify one: F-1 Fora Class C RAO [-] For a Waiver Completion Statement indicating a Temporary Solution Provide Submittal Date of RAO Statement or Waiver Completion Statement: You must attach all supporting documentation required for each use of form indicated,including copies of any Legal Notices and Notices to Public Officials required by 310 CMR 40.1400. C. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply) ❑ Assessment and/or Monitoring Only Deployment of Absorbant or Contaminant Materials FX] Removal of Contaminated Soils Temporary Covers or Caps Re-use,Recycling or Treatment ❑ Bioremediation O On Site ® Off Site Est.Vol.: 12 cubic yards E] Soil Vapor Extraction Describe: 15.45 tons of soil recycled E] Structure Venting System Landfill O Cover O Disposal Est.Vol.: cubic yards EJ Product or NAPL Recovery E] Removal or Drums,Tanks or Containers Groundwater Treatment Systems Describe: Air Sparging ® Removal of Other Contaminated Media Temporary Water Supplies Specify Type and Volume: Temporary Evacuation or Relocation of Residents ❑ Other Response Actions Fencing and Sign Posting Describe: SECTION C IS CONTINUED ON THE NEXT PAGE. Revised 47195 Supersedes Forms BWSC-004 and 010 Cln part) Page 1 of 4 Do Not Alter This Form Massachusetts Department of Environmental Protection BWSC-1U4 Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME (RAO) STATEMENT& ReleaseTrack,g Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)8 40.1050'(Subpart J) _E:13:2 13216 C. DESCRIPTION OF RESPONSE ACTIONS: (continued) Check here if any Response Action(s)that serve as the basis for this RAO Statement involve the use of Innovative Technologies. (DEP is interested in using this Information to create an Innovative Technologies Clearinghouse.) Describe Technologies: D. TRANSPORT OF REMEDIATION WASTE: (if Remediation Waste was sent to an off-stte facility,answer the following questions) Name of Facility: AMREC / ECC TovnandState: Charlton, MA / Stoughton, MA Quantity of Remediation Waste Transported to Date: 15.45 tons ✓ 382 gallons - E. RESPONSE ACTION OUTCOME CLASS: Specify the Class of Response Action Outcome that applies to the Site or Disposal Site. Select ONLY one Class: Class A-1 RAO: Specify one of the following: O Contamination has been reduced to background levels. O A Threat of Release has been eliminated. Class A-2 RAO: You MUST provide justification that reducing contamination to background levels is infeasible. ® Class A3 RAO: You MUST provide both an implemented Activity and Use Limitation(AUL)and justification that reducing contamination to background levels is infeasible. If applicable,provide the earlier of the AUL expiration date or date the design life of the remedy will end: Class B-1 RAO: Specify one of the following: - 0 Contamination is consistent with background levels O Contamination is NOT consistent with background levels. ❑ Class B-2 RAO: You MUST provide an implemented AUL. If applicable,provide the AUL expiration date ❑ Class C RAO: ❑ Check here if you will conduct post-RAO Operation,Maintenance and Monitoring at the Site. Specify One: O Passive Operation and Maintenance O Monitoring Only O Active Operation and Maintenance(defined at 310 CMR 40.0006) F. RESPONSE ACTION OUTCOME INFORMATION: ® if an RAO Compliance Fee is required,check here to certify that the fee has been submitted. You MUST attach a photocopy of the payment. ❑X Check here if submitting one or more AULs. You must attach an AUL Transmittal Form(BWSC-113)and a copy of each implemented AUL related to this RAO Statement. Specify the type of AUL(s)below: (required for all Class A-3 RAOs and Class B-2 RAOs) ® Notice of Activity and Use Limitation O Grant of Environmental Restriction Number of AULs attached: 1 Specify the Risk Characterization Method(s)used to achieve the RAO described above and all Soil and Groundwater Categories applicable to the Site. More than one Soil Category and more than one Groundwater Category may apply at a Site. Be sure to check off all APPLICABLE categories,even if more stringent soil and groundwater standards were met. Risk Characterization Method(s)Used: Method 1 ❑ Method 2 © Method 3 Soil Category(ies)Applicable: S_7 F g_2 ® S-3 Groundwater Category(ies)Applicable: GW-1 Q GW-2 Q GW-3 > When submitting any Class A-1 RAO or a Class 8-1 RAO where contamination is consistent with background levels,do NOT specify a Risk Characterization Method. > When submitting any Class A-2 RAO or a Class B-1 RAO where contamination is NOT consistent with background levels,you cannot use an AUL to maintain a level of no significant risk. Therefore,you must meet S-1 Soil Standards,if using Risk Characterization Method 1. Revised 47!85 Supersedes Forms BWSC-004 and 010 rnaR P Page 2 of 4 Do Not Alter This Form Massachusetts Department of Environmental Protection BWSC-104 Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME (RAO) STATEMENT& Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM _ 13216 Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)8 40.1056(Subpart J) G. DOWNGRADIENT PROPERTY STATUS SUBMITTAL: If a Downgradient Property Status Submittal Compliance Fee is required,check here to certify that the fee has been submitted. You MUST attach a photocopy of the payment. . Check here if a Release(s)of Oil or Hazardous Material(s),other'han that which is the subject of this submittal,has occurred at this property. Release Tracking Number(s): O Check here if the Releases identified above require further Response Actions pursuant to 310 CMR 40.0000. Required documentation for a Downgradient Property Status Submittal Includes,but is not limited to,copies of notices provided to owners and operators of both upgradient and downgradient abutting properties and of any known or suspected source properties. H. LSP OPINION: I attest under the pains and penalties of perjury that 1 have personally examined and am familiar with this transmittal form,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge,information and belief, > it Section B Indicates that a Downgradient Property Status Submht3/is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented In accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii) is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in 310 CMR 40.0183(2)(b),and(iii)complies(y) with the identified provisions of all orders,permits,and approvals identified in this submittal; > ifSection B indicates that either an RAO Statemen4 Phase I Completion Statement and/or Periodic Review Opinion is being provided,the response action(s)that is(are)the subject of this submittal()has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,and(iii)complies(y)with the identified provisions of all orders,permits,and approvals identified in this submittal. I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit Information which I know to be false,inaccurate or materially incomplete. Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s)and/or approval(s) Issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. LSP Name: Stephen B. Ransom LSP#; 4601 Stamp: i Telephone: (978)465-1822 Ext.: FAX:(optional) (978.)465-2986 Signature: q r Date: /L`�''�"J G / ! 7 I. PERSON MAkING SUBMITTAL: Name of Organization: Clarke Brothers, Inc. Name of Contact: Donald Clarke Title: President Street: P.O. Box 677 City/Town: Salem State: MA ZIP Code: 01970 Telephone: (978) 745-1007 Ext.: FAX:(optional) J. RELATIONSHIP TO SITE OF PERSON MAKING SUBMITTAL: (check one) I ® RP or PRP Specify: (3 Owner O Operator O Generator O Transporter Other RP or PRP: Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21E,s.2) Agency or Public Utility on a Right of Way(as defined by M.G.I.c.21 E,s.50)) Any Other Person Submitting This Form Specify Relationship: Revised 417/95 Supersedes Forms BWSC-004 and 010(in part) Page 3 of 4 Do Not After This Form kiMassachusetts Department of Environmental Protection BWSC-%4" Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME (RAO) STATEMENT& Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM _ 13216 Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)8 40.1056(Subpart J) K. CERTIFICATION OF PERSON SUBMITTING DOWNGRADIENT PROPERTY STATUS SUBMITTAL: 1, ,attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form;(i)that,based on my Inquiry or the/those individual(s)immediately responsible for obtaining the information,the material information contained herein is,to the best of my knowledge, information and belief,true,accurate and complete;(ii)that,to the bust of my knowledge,information and belief,Me person(s)or entity(ies)on whose behalf this submittal is made satisfy(ies)the criteria in 310 CMR 40.0183(2);IN)that 1/the person(s)or entilyCies)on whose behalf this submittal is made have provided notice in accordance with 310 CMR 40.0183(5);and(v)that I am fully authorized to make this attestation on behalf of the person(s)or entity(ies)legally responsible for this submittal. IAhe person(s)or entlty(jes)on whose behalf this submittal is made is/are aware that there are significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. BY Title: (signature) For: Date: (print name of person or entity recorded in Section I) Enter address of the person providing certification,if different from address recorded in Section 1: Street: Clt1'Rown: State: ZIP Code: Telephone: Ext.: FAX:(optional) L. CERTIFICATION OF PERSON MAKING SUBMITTAL: If you are completing only a Downgradient Property Status Submittal,you do not nee: to complete this section of the form. I, - Dona 1 d J. `Clarke ,attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form,(ii)that,based on my Inquiry of those individuals immediately responsible for obtaining the Information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii)that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. IAhe person or entity on whose behalf this submittal is made amts aware that there are significant penalties,including,but not limited to, possible fines/andiim1/prisonment,for willfully submitting false,inaccurate,or incomplete information. By: -42-e'G p„LG(��- Title: President (signature) Donald J. Clarke- For: Cic,)t,, Date: tl' 3-54 (print name of person or entity recorded in Section 1) Enter address of the person providing certification,if different from address recorded in Section 1: . . Street: Cdy/iown: State: ZIP Code: Telephone: Ext.: FAX:(optional) YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE,AND YOU MAY INCUR ADDITIONAL COMPLIANCE FEES. Revised 417/95 Supersedes Forms BWSC-004 and 010(n part) Page 4 of 4 Do Not Atter This Form Eawo)q_ CERTIFI AT I E y DATE Mcarch�3� ,9994 CITY OF SALEM A s SALEM, MASSACHUSETTS 01970 BUILDING. PERMIT-- .;�, , YQ4CRma CERTIFICATE OF OCCUPANCY t. DATE -'.0 P112DE'C 4'H •19 19� PERMIT NO. -07-93.. APPLICANT l,:".[.g ':,%;ch ADDRESS 27 Con;;- J3 Sale?.r...i:ass J 4A7 IN0.1 �STRECTI (FONT R'S LICENSE) NUMBER OF PERMIT TO - Tns (_1 STORY T=Wn­n DWELLING UNITS (TPF OF IMPROVEMENT( 'N0. (PROPOSED USE) ZONING ' D• S AT (LOC>TIONI - it I - T'FIDISTRICT IND.) - (STREETI BETWEEN- AND 'CROSS STREET) - (CROSS STREET);_: LOT" SUBDIVISION' " LOT BLOCK SIZE BUILDING IS +D'BE; FT. W'IOE.P.,� FT. LONG BY ' ':FT. IN HEIGHT AND SHALL.:CONFORM-1IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION _ - IivPEI REMARKS:. - Altera_;.Dns sce SS. _L I e"'71aiGIi AREA OR - 7Y_Y114NNv iWY VOLUME �T]I C:BIU S011t9E FEET' _'SCC@BB 1•C'.1StlLE'anC ve�loinsrrwerrElornoe+lsrns'nbriloellvrEl oetlPe�n SPens�roe�nla OWNER TO BE POSTED:ON PREMISES ADDRESS 1 * `-L'ri L'LCEL iS�i':�L:: 't:15d.- SEE_AE VEI�$E SIQE?f QR)-E=O�NDIT IONS:OF CERTIFICATE DEPARTMENTAL�APPROVAL FOR CERTIFICATE •_ of OCCUPANCY and COMPLIANCE" ; '.r To Pe tilled in by each division indicated hereon ■ ; dpbh cort�pletipnj of its �inaliinspection. BUILDINGS Permit No. 557-93 i Approved b Jb'Zn J.' Jennings 1 �/3�/94 PP Y Date Remarks i I , PLUMBING I Permit No. Approved by Dennis Ross; Date 3/23/94 Remarks ELECTRICAL Permit No. Approved by 1 Johnrd..i i Date 3/22/94 r u Remarks fFire OTHER Permit No. ! , Approved by N rman ?aPoi.nte'' Date 3/30/94 j j Remarks iOTHER Permit No. . A pproved by' Date ' I Remarks BUILDING PERMIT Y�#) JOB WEATHER CARD ,, DATE December )h 19 $3 PERMIT NO. LPPLICANT .t P,.,f e!B We!ch,. :- ADDRESS __�7 (-,u7f4resw 467 4 IND.)" (STREET) ICONTR•S LICENSEI t[^ +n PERMIT TO '�ITPT:IC",dnA (_I STORY ?sdra NUMBER OF DWELLING UNITS (TYPE 01 IMPROVEMENT) N0. (PROPOSED USE) AT (LOCAT�pN) lbj i)Arb'F Nrrear. Ward ZONING DIST CT X(NO.) 13TREETI - i BETWEEN AND - - - _ - - (CROSS STREET) ICROSS STREETI LOT ...• '. SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY - FT. LONG BV FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION a - TO TYPE USE GROUP - BASEMENT WALLS OR FOUNOAT I ON (TYPE) iEMARKS: Altevrt]r.ns Madel $L Pccess .fA .ft&iuu Likillcias Call for Permit to C.ccu y /�REA OR GLUME ESTIMATED COST }��LV(JG� PER S yLLgy i' ICUOICISOUARE FEET) )WNER Access ContaltanC � � �Z� - '•DDRESS til Bard Strzot AluarOe • ilasa. BYILDII ..I1EP:' i�C-8P1Sbj:A) a �? 4 V,Ya%91/.,yA rHII ERM'NRMIT CONVEYS C RIGHT TO OCCUPY ANY STREET. ALLEY 09 SIDEWALK OR ANY PORTER THEREOF. EITHER TEMPORA ,H 'ERMAN EBY THE ENCROACHMENTS ON PUBLIC PROPERTY. NOT. SPECIFICALLY PERMITTED UNDER THE LIC BUILDING COO E,•I.IY✓! •ROVED BY THE JURISDICTION. STREET S. ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY:'BH'O.Q. - =ROM THE DEPARTMENT OF PUBLIC WORKS. THEISSUANCEOF THIS PERMIT DOES NOTRELEASETHE APPLICANT FROM E_ S-E 3FANYAPPLICABLE SUBDIVISION RESTRICTIONS. EINIMUM OF THREE CALL .. App ROVED PLANS MUST BE RETAINEO ON JOBANDTHIS WHERE APPLICABLEBE'PI�_ NSPECTION5 REOUIR ED F.O R PFRMI TS ARE REQUIRE +u CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECT ION HAS BEEN ELECTRICAL PL UM BIND rA' I. FOUNDATIONS OR FOOTINGS. MADE, WHERE A CERTIFICATE OF"OCCUPANCY IS EEE- MECHANICAL IN STALLAGO !. PRIOR TO COVERING STRUCTURAL QUIRED,S UCH BUILDING SHALL NOT BE OCCUPIED UNTIL " t M EMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MAGE. 1. PENAL INSPECTION BEFORE - OCCUPANCY. - �,4:. .r, - ...''I ^T'( i POST THIS CARD SO IT IS VISIBLEFROM STREET ; BUILDING INSPECTION APPROV?LS' PLUMBING INSPECTIONAPPROVALS ELECTRICAL HySPECTIONAPPROV:AL'6:�i'. !. y .�-- ,., T 2. 3-:-43-1p/L/ BOARD OF HEALTH r - GAS INSPECTION APPROVALS FIRE QLPT.INSPECTING APPROVSI�LSI OTHER CITY ENGINEER 2 - /J _ /�J/ 2,. 71 " " /� ` Y �. g YY YORK SMALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION. INSPECTIONS INOICATED,ON XIS CARD NSPECTOR HAS APPROVED THE VARIOUS . WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE. CAN.BE"ARRANGED FOR BY TELEPHONE I ; STAGES OF CONSTRUCTION. >',OR WRITTEN NOTIFICATION PERMIT 15 ISSUED AS NOTED-ABOVE. d 1. ,•i t''tt"hir - +� M, •SENDER:Complete items 1,2,3,and 4. Add your address In the"RETURN TO"space _ on reverse. (CONSULT POSTMASTER FOR FEES) i.The following service is requested(check one). Show to whom and date delivered....................60c ❑ Show to whom,date,and address of delivery.. —6 2.0 RESTRICTED DELIVERY —G (The restricted deliveryfee is charged in addition to the return receipt fee.) TOTAL ¢_ a.AARTIICLEADDRESSEDTo- 17 e- 2L drt-![/U/f Bti f z 5;1 �7C/ In 0:'TYPE OF SERVICE: AIITCLE NUM�EA In EI REGISTERED ❑INSURED 12 1-17',z y L.ycERTIFIED ❑COD y .El EXPRXI ESS MAIL �r In (Always obtain signature of addressee or agent) 53 I have received the article described above. X! SIGN TUBE ElAddrgyee 11 u 'zed a C 5. ATE OF DELIVERY POSTMARK In In 0 = S. ADDRESSEEV MR&S(O quesred) O n M a 1 r7. UNABLE TO DELIVER BECAUSE: m 0 i s r UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS PENALTY FOR PRIVATE SENW INSTRUCTIONS USE TO AVOID PAYMENT Print your name,eddms%and LP Code In the apace below. OF POSTAGE,$300 • Coat" M%be,and O an the reverse. sL Attach to Rant of eNtle U spam permits, ��p othenew star to bats of article. • Endorse v.0*-Retum Receipt Requested' adjacent to number. RETURN TO Q (Name-,df Sender) (Street or P.O. Box) � d/ (Ci'ty, State, and ZIP Code) P 474 720 632 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED- NOT FOR INTERNATIONAL MAIL (See Reverse) Sant o d--A 1 . Street and N� � t _ P.O.,Sta a end ZIP C C Postage $ Certified Fee kyecial Delivery Fee Re tricted Delivery Fee Return Receipt Showing to whom and Date Delivered - Return Receipt Showing towhom, N Date,and Address of Delivery m TOTAL Postage and Fees $ a ly Postmark or Dere " o' 0 m 0 li rn a STICK POSTAGE STAMPS TO ARTICLE TO COYER FIRST CLASS POSTAGE CERTIFIED NAIL FEE AND CHARGES TOR ANWEIrCTED OPTIONAL SERVICES.(leelraaQ 1.Ifywwannhisrecelptpostmarkedsnckthegommedstubcntheleftlrartionoflheaddmssstde of the article leaving the receipt attached and present the article at a post office aervicewincrow or hand h to your rural cagier.Ino extra charge) r 2 If you do not want this receipt postmarked,stick the gummed stub on the left portion of the -.address sideof-the article,date,detach and retain the receipt,and mall the ardcte. 3.If you want-a return receipt,write the certifiedmait wrtiber and-your name and address on a return reooilitCard;Form 3811,and attach it to the fronfofthe erficle by mea naSfthe gammedends N space permits.Otherwise,affix to track of an-idle.Endorse front of article RETURN RECELPT REQUESTED adjacent to the number. 4.if you:want delivery restricted to the addressee,or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY an the front of the article. S.Enter fees for the services requested in the appropriate spaces on the front of this receipt.If rotum receipt Is requested,check the applicable blocks In Rem 1 of Form 3811. 6.Save thls receipt and present it if you make inquiry. i ��, r _ �3uhlit �rn�Px#fir �P�tcr#n1Pn# S��mE�� �Ili�t111$ �BP�IMT#I11PIlf j Richard T. McIntosh One Salem Green 1 745-0213 i I June 23, 1.983 Harvey Lazarus X285 Derby St.__ . Salem, Massachusetts RE: Lrving_TaxQ Certificate of Occupancy Dear Mr. Lazarus: You are hereby notified of the following Building Code violations iregarding the above referenced occupancy: i 1 . The two walls that are framed with exposed studs must be covered with at least two layers of 5/8 fire code sheetrock (or equivalent fire rated material) ; I - 2. There must be a floor drain and gasoline trap installed in accordance with-the requirement of Secion 414.2.5 of the Massachusetts State Building Code. I Until the above has been accomplished, inspected and accepted, no Certificate of Occupancy will be issued, and any and all prior Certificates that may have been issued are hereby revoked. 1 Your immediate attention to the above is solicited. 1 jj Very truly yours,, I � . I 1r: Richard T. McIntosh Inspector of Buildings RTM:bms cc: Fire Dept. Irving Taxi, 285 Derby St. , Salem I i - qW INSPECTION CODE ENFORCEMENT MEMO s ( its ofttlem, ttssttcljusetts AT 4 23� Prl ' `r dlrpartmrnt �IeuDquartrrs U� 40 lafttgette 6Irert QJllief ClTrOFSALIN,.4ASS. Date May 3, 1983 To% Code Enforcement Officer City Departments Building Inspector In compliance with the provisions of Chapter 1480 Section 28As of the General Laws of the Commonwealth of Massachusetts, you are hereby notified of the following apparent defects or code violations, which may require furthur action by your department. Locations Rear 285 Derby Street Type of Oecupancys Garage (Repair and Storage ) Name of Occupant or Business Irvings Taxi Nature of apparent defect or code violations Apparent occupancy in violation of 527CMR5. 02( 1) 9 527CMR5. 02(3) , of the Massachusetts Fire Prevention Regulations; and Sections 414. 2. 3, and 414, 2. 5 of the Mass. State Building Code. Please advise of action to be taken by your office, with regards to required partitions...and gas traps required , under above sections of the Mass: Codes. Original complaint made bys Capt. David J. Goggin, Salem Fire Marshal Respectfully submitteds c Capt David J. Gog n ccs file Salem Fire Marshal C1 S-Q Form #57 (Rev. 12/78) / 0 527 CMR: BOARD OF,FIRE PREVENTION. REGULATIONS 5.01: `continued Gasoline. A volatile flammable liquid that will emit a flammable vapor at a� temperature of less than one hundred (100) .degrees Fahrenheit, to be ascertained: by. any standard closed-cup instru- ment. - Height. Of a garage in stories :does not include a basement or, cellar. , Marshal. . The State Fire Marshal Mill-constructed roof. A roof constructed with steel or wood true- sea, or wood beams of sufficient,strength for the load carried, but in no case less than six. (6) inches by six (6) inches in cross section, with roof planking not less than one and three-quarters (1 3/4) of an inch in thickness. . Motor vehicle. Any vehicle containing or using gasoline or any ' o er petro euro' product for fuel or power, excluding vehicles having fuel tanks of one gallon or less capacity.' Self-closing. Closing automatically or mechanically after opening. Service station: Any building or premises wherein or upon which ' gasoline orother motor'fuel.is sold at retail. - Full self-service facility. A service station where all the pumps are self-service. Self-service type business. As used in these regulations, shall mean at type o siness wherein the licensed motor vehicle = operator dispenses his. own motor fuel. Split-island facility A motor fuel dispensinginstallation where partes the facility is used as self-service and part.is used for attendant service.> Service stationo erator. The person responsibile for the service Ration operatUon or his duly authorized ;representative. A duly. authorized.,representative shall be a person 16, years of age or older. Sprinklers and sprinkler alarms. An adequate system of automatic sprinklers sprin e-&T r alarms shall be one that meets the generally accepted standards of engineering practice. 5.02: Location and Construction (1) Garages hereafter erected or altered shall conform to the require- ments of these rules and regulations. Any existing building or other structure hereafter converted foruse as a garage, and'any alteration or addition to an existing.garage shall conform to the requirements of these rules and,regulations as they would apply to a'new building for such use at the same location. . (2) Every garage hereafter erected shall have a fire-resisting roof covering, and shall have a floor ,of concrete or of some approved fire-resisting material. In' municipalities where local building codes permit the use of wooden shingles on dwellings, garages constructed in conjunction with such residences may also be roofed' with wooden shingles: (3) No portion of a building or` other structure shall be used as a. garage unless the portion so used is separated from the rest of the building by .a fire wall, fireproof. floor and fireproof ceiling, in a ev manner .necessary in a given case, provided that if the garage has a .,net floor areaof not more. than two thousand (2,000) square feet such 51 . 527 CMR: BOARD OF FIRE PREVENTION REGULATIONS 5.02: continued separation may be made with a fire partition or a fire protected parti- tion and fire protected ceiling, and. the garage shall otherwise conform to the requirements of these rules and regulations as they would apply to an independent building at the same location. #^_ .(4) A garage,, having -a net floor area- of more than five thousand (5,000) square feet, or more than one story in height, hereafter erected within the fire limits, shall be a first=class building: if the net floor area is not more than five thousand (5;000) square feet and the building is not over one story in'height, 'it may be a second-class building; and if the net floor area isnot more than six hundred.(600) t±* square feet, it may be's metal building, No third-class building shall be erected for._use as:a,garage within the.fire limits. h (5) Every garage hereafter erected - in excess, of ten' thousand .` (10,000)_ square feet on an p one floor shall be so divided by fire walls that no space therein shall exceed ten thousand (10,000) square feet' in area, unless the garage is a first-class building and equipped ' throughout with an adequate system of automatic 'sprinklers and sprinkler alarm. (6) Any garage hereafter erected of five (5) or more stories in height L and in excess of ten.thousand (10,000) square feet in area on any one floor shall have for each ten thousand (30,000). square feet of floor area one four-inch (411) standpipe, connected separately to the service main, extending from the lowest story up to and through the roof, and located within the enclosing walls of a stairway; Each standpipe shall be provided with a two and one-half (2h) inch Fire Department Standard hose connection and gate valve -for each story, located not over five (5) feet'above' the.level of the floor, and two (2), two and one-half (2' ) inch Fire Department Standard hose connections and gate tib. valves located on the roof, with a controlling gate valve under the roof arranged to operate from below and above the roof, with a three- quarter (3/4) inch drain pipe and valve to prevent freezing. Each. standpipe shall also be provided with a Fire Department Standard Siamese steamer connection located'outside the building not less than two (2) feet nor more than four' (4) feet above the street level. 1 (7) Any garage hereafter erected of three (3) or more stories in f —height shall be equipped"throughout with an adequate system of auto- matic sprinklers and sprinkler alarm: (8) The .operation of standpipes and/or sprinkler systems mandatory in this regulation may be inspected by the marshal or head of the fire department at any time, and shall be tested in the presence of the <head,of the fire department at least once each year. (9) A special structure may be, constructed without exterior walls, - provided that in other respects it is constructed as a first-class build- king, and provided that no part of the building is located nearer than fifteen (15) feet to any building or interior lot ,line, and further provided: r (a) that' any permanent right of way may be considered as a part of the .fifteen (15) foot distance from any adjoining interior lot line; (b) that the space between the building and the lot line is main- tained free and unobstructed at all times; (c) that if the structure does not exceed four (4) stories in height and if the roof is to be. used-for the parking of motor vehicles, it shall be constructed of noncombustible continuous concrete slab construction; (d) that the floor and roof shall have a:continuous curb not less than twelve (12) inches in height, securely anchored to the floor, 12/31/81 . 52R' , friavviitti Page No. of Pages WILLIAM WILLIS �yf;il! iNtr!iCF Drywall • Plastering Contractor 16 Taft Street Marblehead, Mass. 01945 AAp p Phone 631.3323 JoA �� 07 M1 t0q PROPOSAL SUBMITTED TO PHONE t\ltc+�G�Yi�ko 0 Harvey Lazarus Q JW�'-l" 5.1 84 STREET JOB NAME work at 285 Derby St. Salem MA CITY, STATE AND ZIP CODE ^ .� xf ' JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: To whom it may concerns ..... Mr. Harvey Lazarus has contracted me to put two layers of 5/8 fire code on each side wall in the garage area now being used by Irving Taxi Co. He contracted me in Nov. of 1983 to do this work , and has been waiting for me to fit this work into my schedule. We plan on completing this work during the month of January 1984. .... .... ........... .. Thank you. I WP proposP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: ). Payment to be made as follows: dollars ($ All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica Authorized tions involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Arrrpttmrr of f rapasal—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified.Payment will be made as outlined above. Date of Acceptance: Signature FORM 118-3 COPYRIGHT 196o-Aveilable from Inc..Townsend,Maes.01069 �^� �, � 5 �l1ILp(�di#���� �ttlPTtt, `'�{iT85tICI11I5Ptt5 ' Nirt ilrpartment Nnibynarttre All 7 e �amea IlfnnNn R� '� ?� Al //5 Ili of �f 'fe•1� � - C17y 4r SAt �H,MASS, August 18, 1975 9 Mr. Harvey Lazarus Re: 285 Derby St. 37 Puritan Ave. Salem, Mass. 01970 Swampscott, Mass. 01907 Sir: ri As a result of an inspection this date of the premises located at I 285 Derby Street, Salem, Mass, owned by you, the following recommenda- tions are submitted which should receive serious consideration. These recommendations are made in the interest of fire prevention and to correct conditions that are or may become dangerous as a fire hazard or are in violation of law. 1. The gasoline storage tank situated on your premises and out of service for apparently several years, shall be removed from. the ground by an approved contractor, and delivered to a waste depot which will accept old gasoline storage tanks. A permit shall be required under Chapter 148 Section 38A, for removal of said tank. 2. It is hereby advised that you file with the Inspector of Buildings ? Mr. John Powers, 5 Broad Street, Salem, Mass. for a Certificate of Occupancy for this structure. j. You are hereby notified that the license for storage of flammables has expired for this location and a new application and hearing 1 , < are required for consideration for storage of any flammables. _ 4. A test was conducted of your sprinkler system and your- installers letter of August 15, 1975 on Weinstein & Weinstein letterhead has been approved. All tests were found satisfactory. 5. It has been found that apparently the previous occupants had sub-divided a large section of the structure in the rear of the building, to provide for a lower room and an open storage area above. \ It has been determined that they failed to provide for dropping the sprinkler piping into this new area, and have thusly 'created a. large unsprinklered area. This area shall therefor be provided with proper sprinkler protection. 6. Permits are being duplicated for two oil burner units and Mr. t Goldberg has been contacted regarding a third oil burner which has no permit. t cc: Building Inspector R E fully Jis m tted, Wire Inspector ieut. David . Go in all . _ �l _-- it - -� �, Yf"t, -. ������� No. Z City of Salem Ward I X °�crwRc� APPLICATION ` FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to completes an items in sections:1, 11, /it, IV, and IX- I. AT(LOCATION) 1 1 Ql EJ 0{ 1 QCT ZONING D STRICT 7 LOCATION OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE 11. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ❑ Addition(It residential,enter number o/new 12 ❑ One family 18 ❑ Amusement recreational housing units added,it any,in part D,13) 19 ❑ Chwch,other religious 13 ❑ Two or more family-Enter number 3 Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial 21 E] Parking garage 4 ❑ Repair replacement - 14 ❑ Transient hotel,motel,or dormitory- 22 E] Service station,repair garage Enter number of units ........................... 5 ❑ Wracking(it mulh'familyresidenfie,enter number23 E] Hospital,institutional E]of units in building in Part D,13) 15 Garage 24 ® Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School,library,other educational 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP 28 ❑ Tanks,towers 8 E4 Private(individual,corporation,nonprofit institution,eta) 29 ❑ Other-Specify 9 ❑ Public(Federal,State,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, e machine shop,laundry building at hospital,elementary school,secondary school,college, 10. Cost of improvement/13.0. 0. parochial school,parking garage for department store,rental office building,office building """�..."""' $ at industrial plant If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost SQ�cM /aCCYJC 7elc�ulo,> Tactlthy aElectrical........................................................................... b. Plumbing.......................................................................... c. Heating,air conditioning............................................. d. Other(elevator,etc.)..................................................... 11. TOTAL COST OF IMPROVEMENT $ III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J&M,all others skip to IV E. PRINC.IPI1t TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 rLry,/Masonry(wall bearing) 35 ❑ Gas 40 ublic or private company Will there be central air 31 ❑ Wood frame 36 it 41 ❑ private(septic tank,eta) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44,g yes 45 ❑ No 33 Reinforced concrete 38 Coal H. TYPE OFF l ER SUPPLY ❑ ❑ Lr�✓ Will there by an elevator? 34 ❑ Other-Specify 39 ❑ Other-Specify 42 Public or private company 46 ❑ yes 47 ❑ No .T 43 ❑^Private(well,cistern) J.DIMENSIONS MDEMOLITION OF STRUCTURES 48. Number of stones ..........._�.t�_�..................... M. : ' 49. Total square feet of floor area, Approval all floors,based on exterior Has pp oval from Historical Commission been received dimensions ....-................................................................. for any structure over fifty(50)years? Yes_ No 50. Total land area,sq.it..................................................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed.............................. ...................................... i HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 52. Outdoors....................._ .......................................... Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed•..... ............................................_..._ Electric: Gas: 54. Number of Full........................................... Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial.----................... BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No_K, (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No---K (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yeses No_ Is property located in the S.R.A. district? Yes_ No X Comply with Zoning? Yes-1 No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes,submit documentation/if no,submit Board of Appeal decision) If new construction,has the proper Routing Slip been enclosed? Yes_ No_ Is Architectural Access Board approval required? Yes_ No—K (If yes,submit documentation) Massachusetts State Contractor License # 00 12 4 9 Salem License# 7R 7 Home Improvement Contractor # Homeowners Exempt form(if applicable) Yes_ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX (6) MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary,please submit CONSTRUCTION IS TO BE COMPLETED BY: mA� in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. I. i Owner or Lessee �j/04 z. Rw ( �.W Co 7 /46 rc-r S]-. 7y ori Contractor � Builder's ((0,46(a4srt C it/IH ni cr-76License No. )12411 3. 0 S elle l Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to Conform to all applicable laws of this jurisdiction. Signature of applicant Address Application date �iCT -7 CodbC, r S*• So leiMA. 0 - 2�9S DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building / _ n FOR DEPARTMENT USE ONLY Permit number 7 Building use Group Permit issued 11JK - e V 19 Fire Grading Building (/ Permit Fee $ //J �• Live Loading ' Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ Plan Review Fee $ TITL NOTES AND Data- (For department use) PERMIT TO BE MAILED TO: DATE MAILED: A;—c?l0 _ Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN -For Applicant Use O N 0285 DERBY STREET 587-07 GIs#: 973 COMMONWEALTH OF MASSACHUSETTS Map: 34 Block: CITY OF SALEM Lot-. 0440 Category: REPAIl2/REPLACE Pelmit# . 587-07 BUILDING PERMIT Project# JS-2007-000856 Est. Cost: $1,500.00 Fee Charged: $26.00 Balance Due $.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Expires Use Group: ACE CONTRACTING CONSTRUCTIO SUPERVISOR-086016 Lot Slze(sq.ft.): 25382 Owner: SOUTH HARBOR HOLDINGS LLC Zoning: . B5 Units Gained: Applicant: SOUTH HARBOR HOLDINGS LLC Units Lost: AT: 0285 DERBY STREET Dig Safe#: ISSUED ON: 09-Ian-2007 AMENDED ON: EXPIRES ON: 09-Jun-2007 TO PERFORM THE FOLLOWING WORK. REMOVE PARTITIONS AND REPAINT J.B. POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final: House# Smoke: Treasury: Water: Alarm: Sewer: Sprinklers: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2007-001077 09-Jan-07 CASH $26.00 GeoTMS©2007 Des Lauriers Municipal Solutions,Inc. � a�� . �� � �� .� �.��,� - - - _ - � , .� , �� �� , . . r wo�n,t�w r► r�oe.cs�. �t��,� D.EsaB�.rr �Mdo�b OIIIMal7 Y«v No� �iLLi :• OoirM�i�AwN Y�_No,�, Y�MLOMlO PdMMT APPLICAt10N �Of� P«mit to: (Grol�wMiiolwwr apply) lioof. RNoof. InM�ll 8fdY�p. Co1iMn�ot D�ok. SIw4 Pcol� �o., an.r' wrd►se wLLour«Y a ca�t�rTo�vo�oeu►rs w vwoc��wNa TO THE INSP6CTOR OF BUILDINt3S: 1fw und�r�iprNd t��bl► applMt ia s v� ro buud aooadinp to 1t� foYowirq �� • , Ow�rr'a N�rt� -S�` r/7`v! ��'�r'r2 �0�I� i��y. � � �'. llddn..a W+on. p°b�X �Z S'A� r 17Y, 7 5�.�1" - /od ,� MdWWx's N�nN �ddr.ss a Pnon. , j ) � M.a�nics N.m. f/?'�1/ � Addt�ss 6 P11ort� /l T' •"�/�r 7� tV �`�.y j f 7� 1 7�1` o � �'� wn��n.pupo..d burorq� wYMd a eu�dYp9 M a O�MMq,�a how�r MmWw�T�_ MI�4ii�q o01ron11 b Yw9 Ew�w�d ooM�d,�pN uorw r ►� p` ilw O S ,-7 7 3 3 � 7�ew�t � rse. t ' �un of � �� �n c�ac� c��� � � of�r _��ti� f �� �,o �� ��o� s7`�w� 7� !`ip� � JCh o� S/��3�I-- -- — I�t/A/?��..� L , ,, r_�� L f. C — � ,� �'- �Ll�' - b(a C� � MNL �iMIT'id: F� l/v t9rr'R� �,�,��nt��' `r�'. � �'c. E'v; /�/1�9 � /9 �3f� . � . . . � � � ^ \ � .� � . . ,.: _ � �` 1 � � ' . d � N � � . � � • .. �. . . . . . ,. _.,� I� � . �• .r __ __ ____ _ _ _ _ _ _ __ . ' Ted Warren 5 Hardy Street Salcm,MA 01970 � � 97R-744-0693 � FMAII, twarren�C,alam.mitedu afety Railing,3001b rating . 111" x12 Deck Joist I Masonry Anchored FO�': 3.0' W�rren Light Craft, LLC 283 Derby Strect, Rear Sal�.em, MA 01970 1 Hr. Steel Framed Wall 33.5" ` ' Stud 362S125-27 � II �5/8" Type"X" Wallboard outside 2x12 Deck Rim Jois� i 1 Hr..Steel Framed Wali over existing wall 1/2" Sheetrock inside la screwed to " ' Stud 362S125-27 9 . 5/8" Type "X" Waliboard intside existing wall 'I 1/2" Sheetrock ouside _ B"T&G - _ Over Mezanine III � d2 Rim Joist 12 Doug�as Fir 16"O.C. , �Iny A�ea .. � . S� . � . 5!8"T& . .�" P �� I� Trim Roo � stee�Trec ' , , ' 500 CFM Upb18St � 2g' g.6" cerrF;aa�,No�s: . Roof Ventilator !iD • I �? � � � ' Shop � s .s� � Tr�m � Cold Rolled Steel Stud 3625125-2 D � s�e-Ty�xwaii� ��� � 3/4" CDX T&G � �� � 10 11 1/4 ,�sh�� /4"T8G Plywood Undedayment � j Steel Tiac 12"Sheetrock . . � 1/2"Sheetmdc j� 2z6 trimmed ta Ievel fl �. I � �� 3/4"T8G Plywood Undedayme • Fire Hazard Safety Cabinet �— tnmmedtolevelfloo� ; I Section Through South Wall ° X �2 X2o� �s� o.�. � I of Tnm Room � �"' � � °�� r.t��r a�;,�s�ays: SCALE: 1" — 1'-0" • • Industrial Curtain ' — 10 high Section Through East Wall �_--- - ---"' ' of Trim Room ; . _._--- - I I19.7' _ 19'43/8" . SCf�L�: 1�� = 1�-��� I I , . � � - � � 3 I i i SD � SD . , , To Flre Detectors . . 1 . . < i �I _ 2ss nerby stre�t i � ,. SALEM,MA � � . . � ' �i�ll/� �) /`'1 �L���U/�d� .. i � To Cantrol Panei in Sprinkler Room I . , . , -� � [ssc�enare: . , , --� �i. Dx¢TM1er.lO 2005 , .. 706 VCMBER: i � FI RE nanwry nv; i � �:����� � , Cf1EC[C¢DRC: � I � 3uild Out �X/� rren Li � ht Graf-t � � APPRO��D FOR 01iNF.R: emsa : a:'r��.ii:'C:'..i � �CALE: 1/4" = 1'-0" � .- . ` , �.:�T i � , ___.___,. � � � �' . BLYD[NG ORDL�R: 1 � �, .. _ �. . . __._..,. . � . . . �Yi - �.�'J= -�PF� , � , ' "..� ..__ J. ._. . SCALF: 1/4':._1�_�.r ' � �� o� ....,. _ '_ _..� . .O.,.JP � � . . _ _. . , J=S . , _ ..- :'i�'i0 f � , ,r �_� ,, .. ;� � _ . . . , �,�F: A- 1 ! ` Spvih�t-�w .S�S�� t l�e fied int� F��-�Sr�s .i'evt� � �� � . . � 0:1TEOIWARRENII�NTCRAFTDarty98.VG0 fY90le005 ' � t p/�- � y� � . . � � � � �.O.Q� T'D' �' YiJI-t^ `,VDo�— �ctS S . � � ; - ��s�..�-� b� ��, ��..i�y ���;�,,�� � ��-) � _.__.�.__ _.__-- --- _ _ ___ . _ . _ .�...� _ ____ _ _ �. _ --- - - � � -____.�_ � _ � � � � . . __ _ REW ENVIRONMENTAL CONSULTANTS, INC. September 24, 2019 Mayor Kimberley Driscoll Salem City Hall 93 Washington Street Salem, Massachusetts 01970 Re: Notice of Activity and Use Limitation (RTN 3-35138) 285 Derby Street, Salem, Massachusetts Dear Mayor Driscoll: The purpose of this letter is to inform you that in August 2019, a Notice of Activity and Use Limitation ("AUL"), a copy of which is appended to this letter, was recorded with the Essex County Registry of Deeds (Southern District) in Book 37793, Page 534. The AUL applies and affects the entire parcel at the subject location, assessor's identification is 34-0440-0. The AUL identifies certain activities and uses which are inconsistent with maintaining a condition of No Significant Risk at the property. Such activities and uses are identified in order to prevent exposures to contaminated soil located beneath impervious surfaces. The AUL also identifies those activities and uses which are consistent with maintaining a condition of No Significant Risk and those obligations and conditions necessary to ensure that a condition of No Significant Risk continues to exist at the property for the foreseeable future. This notification is being provided pursuant to the MCP, 310 CMR 40.1090 and 310 CMR 40.1403(7)(a). If you have any questions, please contact Mr. Timothy Clarke at 978-745-1020. Sincerely, Richard Warren, LSP, cc: Salem Health Department, Building Code Enforcement Official, Zoning Official, and Massachusetts Department of Environmental Protection Northeast Regional Office A.R.S. REW ENVIRONMENTAL CONSULTANTS, INC. MOLD ASSESSING AND REMEDIATION SERVICES, LLC 500 Maple Street, Danvers, Massachusetts 18402 Royal Hammock Blvd.Naples, Florida (Primary)978-375-7086(Alternative)239-825-4424 'a/J./ SI�O 377 3 4 O8/28/2019 02:32 NOTC RUL Pg 1/12R4191411\k1,1.11191111-g1,--53- FSS Form 1075 Note: Pursuant to 310 CMR 40.1074(5),upon transfer of any interest in or a right to use the property or a portion thereof that is subject to this Notice of Activity and Use Limitation,the Notice of Activity and Use Limitation shall be incorporated either in full or by reference into all future deeds,easements, mortgages,leases,licenses,occupancy agreements or any other instrument of transfer.Within 30 days of so incorporating the Notice of Activity and Use Limitation in a deed that is recorded or registered,a copy of such deed shall be submitted to the Department of Environmental Protection. NOTICE OF ACTIVITY AND USE LIMITATION M.G.L.c.21 E,§6 and 310 CMR 40.0000 Disposal Site Name:285 Derby Street DEP Release Tracking No.(s):3-35138 This Notice of Activity and Use Limitation("Notice") is made as of this 49,Q'i'"day of August, 2019, by South Harbor Holdings, LLC, a Limited Liability Company organized under the laws of the State of Massachusetts, having its principal office at 281 Derby Street, Salem, together with successors and assigns(collectively"Owner"). WITNESSETH: • WHEREAS, South Harbor Holdings, LLC is the owner in fee simple of that certain parcel of land located in Salem, Essex County, Massachusetts with the buildings and improvements thereon, pursuant to a deed recorded with the South Essex Registry of Deeds in Book 14166, Page 215; WHEREAS, said parcel of land, which is more particularly bounded and described in Exhibit A, attached hereto and made a part hereof ("Property") is subject to this Notice of Activity and Use Limitation. The Property is shown on a plan recorded in the South Essex Registry of Deeds in Plan Book 6459,Plan 699; WHEREAS,the Property comprises all of a disposal site as the result of a release of oil and/or hazardous material. Exhibit B is a sketch plan showing the relationship of the Property subject to this Notice of Activity and Use Limitation to the boundaries of said disposal site existing within the limits of the Property and to the extent such boundaries have been established. Exhibit B is attached hereto and made a part hereof;and WHEREAS, one or more response actions have been selected for the Disposal Site in accordance with M.G.L. c.21E("Chapter 21E")and the Massachusetts Contingency Plan,310 CMR 40.0000("MCP"). Said response actions are based upon the restriction of human access to and contact with oil and/or hazardous material in soil and/or (b) the restriction of certain activities occurring in, on, through, over or under the Property. A description of the basis for such restrictions, and the oil and/or hazardous material release event(s) or site history that resulted in the contaminated media subject to the Notice of Activity and Use Limitation is attached hereto as Exhibit C and made a part hereof; 1 Form 1075: continued NOW,THEREFORE,notice is hereby given that the activity and use limitations set forth in this Notice of Activity and Use Limitation are as follows: 1. Activities and Uses Consistent with Maintaining No Significant Risk Conditions. The following Activities and Uses are consistent with maintaining a Permanent Solution and a condition of No Significant Risk and,as such,may occur on the Property pursuant to 310 CMR 40.0000: (i) Any commercial,retail,business, manufacturing, and industrial or other use which is not prohibited by or inconsistent with those allowed under this limitation; (ii) Restricted residential uses, including condominium and apartment housing, daycare center or children's nursery, school, playground, or playing field recreational area provided access to soils is restricted by surface cover consisting of pavement, concrete or the emplacement of three feet of clean fill; (iii)The cultivation of fruits and vegetables for human consumption in aboveground containers or raised beds without the use of soils at the Property; (iv) Landscaping and routine maintenance of landscaped areas as long as such activities do not involve excavation of subsurface soils; (v) Use as an undeveloped(vacant) parcel as long as access to soils is restricted by surface cover consisting of pavement,concrete or the emplacement of three feet of clean fill,or by surrounding the Property with a secure fence restricting access to the Property by surrounding receptors; (vi) Excavation activities associated with subsurface utility repairs and/or construction work that are likely to disturb site soil provided that these activities are conducted in accordance with a Health and Safety Plan and Soil Management Plan; (vii)Emergency subsurface utility repairs; (viii) Such other activities or uses that, in the Opinion of a Licensed Site Professional, shall present no greater risk of harm to health, safety, public welfare or the environment than the activities and uses set forth in this Paragraph;and (ix) Such other activities and uses not identified in Paragraph 2 as being Activities and Uses Inconsistent with maintaining No Significant Risk Conditions. 2. Activities and Uses Inconsistent with Maintaining No Significant Risk Conditions. The following Activities and Uses are inconsistent with maintaining a Permanent Solution and a condition of No Significant Risk pursuant to 310 CMR 40.0000, and, as such, may not occur on the Property: (i)Use of the Property as a single-family residence; (ii)Use of soils at the Property for agricultural purposes including the cultivation of fruits and vegetables for human consumption; (iii)Construction,planned utility repairs,or other invasive activities involving excavation of subsurface soils without a Soil Management Plan and a Health and Safety Plan approved by a Licensed Site Professional; (iv) Excavation or removal of any loam, peat, gravel, sand, rock, or other mineral or natural resource except as provided in Paragraph I; 2 (v)Removal of pavement, concrete or buildings specified in Exhibit B unless a Licensed Site Professional Opinion, as required in Paragraph 3 (ii), indicates that such activity is consistent with maintaining a condition of No Significant Risk;and (vi)Other activities that result in direct exposure of site workers or visitors to subsurface soil, unless such exposure is determined to constitute a condition of No Significant Risk in the Opinion of a Licensed Site Professional. 3. Obligations and Conditions. The following obligations and/or conditions are necessary and shall be undertaken and/or maintained at the Property to maintain a Permanent Solution and a condition of No Significant Risk: (i) Access to soil within the Activity and Use Limitation Area must be restricted for all receptors other than emergency utility workers; (ii) Excavation associated with non-emergency utility repairs or longer-term construction work that will involve the excavation of subsurface soils, significant modification of buildings or construction of new buildings shall be conducted in accordance with the applicable performance standards for Permanent Solution subject to Activity and Use Limitations at 310 CMR 40.1067. In addition, a Soil Management Plan and a Health and Safety Plan shall be prepared and approved of by a Licensed Site Professional before such construction activities are initiated,as provided by Paragraph 2(iii).The Soil Management Plan shall describe appropriate soil excavation, handling, storage, transport, treatment and/or disposal approaches in accordance with soil management protocols as approved by the Licensed Site Professional; (iii)A Health and Safety Plan shall be prepared by an individual qualified sufficiently trained in worker health and safety requirements and implemented before any such construction activities that are likely to disturb oil and/or hazardous material contaminated soil are initiated, as provided by Paragraph 2(iii). The Health and Safety Plan should specify the type of personal protective equipment (PPE), engineering controls, and environmental monitoring necessary to prevent workers from exposure to OHM-contaminated soils through dermal contact, ingestion, and/or inhalation. Workers must be informed of the requirements of the Health and Safety Plan and the Health and Safety Plan must be available on-site throughout the construction project period; (iv) If future construction activities are anticipated with building modification, demolition, soil excavation or new building construction that will alter or disturb the barriers identified in Paragraph 3(v) below, the provisions of Paragraph 3(ii) and Paragraph 3(iii)of this Activity and Use Limitation will be followed and a Licensed Site Professional is required to review the plans for such activities prior to initiation; (v) The buildings,asphalt pavement,concrete and other impermeable barriers shall be maintained in the area shown on Exhibit B. These barriers shall be maintained to prevent exposure to site workers, visitors and trespassers. If impermeable barriers are removed and not replaced with a similar impervious barrier, emplacement of a cap consisting of three feet of clean fill is required;and (vi)As described in Paragraph 2(ii), cultivation of produce for human consumption shall be restricted to growth in containers or raised beds without the use of soils at the Property. 3 Form 1075: continued 4. Proposed Changes in Activities and Uses. Any proposed changes in activities and uses at the Property which may result in higher levels of exposure to oil and/or hazardous material than currently exist shall be evaluated by a Licensed Site Professional who shall render an Opinion, in accordance with 310 CMR 40.1080, as to whether the proposed changes are inconsistent with maintaining a Permanent Solution and a condition of No Significant Risk.Any and all requirements set forth in the Opinion to meet the objective of this Notice shall be satisfied before any such activity or use is commenced. 5. Violation of a Permanent or Temporary Solution. The activities,uses and/or exposures upon which this Notice is based shall not change at any time to cause a significant risk of harm to health, safety, public welfare, or the environment or to create substantial hazards due to exposure to oil and/or hazardous material without the prior evaluation by a Licensed Site Professional in accordance with 310 CMR 40.1080, and without additional response actions,if necessary,to maintain a condition of No Significant Risk. If the activities, uses,and/or exposures upon which this Notice is based change without the prior evaluation and additional response actions determined to be necessary by a Licensed Site Professional in accordance with 310 CMR 40.1080, the owner or operator of the Property subject to this Notice at the time that the activities, uses and/or exposures change, shall comply with the requirements set forth in 310 CMR 40.0020. 6. Incorporation into Deeds,Mortgages,Leases, and Instruments of Transfer. This Notice shall be incorporated either in full or by reference into all future deeds, easements, mortgages, leases, licenses, occupancy agreements or any other instrument of transfer, whereby an interest in and/or a right to use the Property or a portion thereof is conveyed in accordance with 310 CMR 40.1074(5). 4 Form 1075: continued Owner hereby authorizes and consents to the filing and recordation and/or registration of this Notice, said Notice to become effective when executed under seal by the undersigned Licensed Site Professional, and recorded and/or registered with the appropriate Registry(ies)of Deeds and/or Land Registration Office(s). eg- WITNESS the execution hereof under seal this .�� day of August,2019. uth Harb Holdings,L aura A.Murphy, ember COMMONWEALTH OF MASSACHUSETTS Essex,ss August ,2019 On this day of August, 2019, before me,the undersigned notary public, personally appeared Maura A. Murphy, proved to me through satisfactory evidence of identification, which were &Suna/ ,c./2f4'/uj�e , to be the person whose name is signed on the preceding or attached document,and acknowYedged to me that(he)(she)signed it voluntarily for its stated purpose. tmane (as r for South Harbor Holdings,LLC,a partnership) (as for ,a corporation) (as attorney in fact for ,the principal) (as (a)(the) ) icia signature and seal of notary) & GEORGE W. ATKINS, III 1 COMMONWEALTHNotary OFPublic MASSACHUSETTS 1 ' My Commission Expires I February 20, 2026 5 The undersigned Licensed Site Professional hereby certifies that in his Opinion this Notice of Activity and Use Limitation is consistent with a Permanent Solution and maintaining a condition of No Significant Risk. Date: /.ega/P 'chard OFA,4 , • 461 '149P� RICHAFiD �, �YF�RREN NO.6501 • ^ S'1E PR°� 1 Licensed Site Pro essio a SEAL COMMONWEALTH OF MASSACHUSETTS Essex,ss August IF",2019 On this ay of August,2019,before me, the undersigned notary public, personally appeared Richard Warren (name of document signer), proved to me through satisfactory evidence of identification,which were Drivers License,to be the person whose name is signed on the preceding or attached document, and acknowledged to me that(he) (she) signed it voluntarily for its stated purpose. (as partner for ,a partnership) (as for ,a corporation) (as attorney in fact for ,the principal) ( for ,(a)(the) o ficial signature and seal of notary) GEORGE W. ATKINS, Ill Notary Public t J COMMONWEALTH OF MASSACHUSETTS Upon recording,return to: I \ J My Commission Expires February 20, 2028 South Harbor Holdings,LLC C/O Timothy Clarke 281 Derby Street,PO Box 829 Salem,Massachusetts 01970 6 • • / 06,18'97 1s06 fort. 310 •r Ij DK 14166 P(3 215 QUITCLAIM OEED I, DO)ALD J. CI.AR2CB of Salem, Essex County, Massachusette, for nominal consideration paid, grant to SOUTH HARBOR HOLDINGS LLC, a Massachusetts limited liability company of 281 Derby Street, P. 0. Box 677, Salem, Essex County, Massachusetts, with QUITCLAIM COVENANTS the following described real estates Tho land on the southerly aide of Derby Street in (said Salem, containing about twenty-five thousand four hundred and fifty-throo (25,453) square feet of land bounded and described as follows: EASTERLY: by land of Almy, Bigelow i Washburn, Inc., two hundred forty-eight and twenty-seven hundredths (248.27) foot, SOUTHERLY, by the South River, ono hundred ten and seven tenths (110.7) foot, WESTERLYr by land now or late of Baldwin, two hundred ten and eighty-two hundredths (210.82) foot, and NORTHERLY: by said Derby Street one hundred fourteen and eight hundredths (.114.08) foot. Doing the same promisee convoyed to me by Harvey E. Lazarus, individually and as Trustee of New Derby Street Realty Trust, by deed dated April 6, 1988, recorded in Easex South District Registry of Deeds, Book 9464, Page 415. GRANTED PREMISES: 283 Derby Street, Salem, Hassachusettu 01970 WITNESS the execution hereof under peal this ,L day of Juno, 1997. Witness DON= J. C E Commonwealth of Masaachueett6 Essex, as. June ,4 , 1997 Then personally appeared the above named DONALD J. CLARHE and acknowledged his execution of the foregoing to be his free act and deed, before me, 1� 2441J Notary Public My commission expires: 0-mope EXHIBIT B Sketch Plan Illustration Boundaries of the Property Subject to Activity and Use Limitations Boundary of AUL (Entire Property as Described by Exhibit A) 285 Derby Street Derby Street '281 ( I 1 Site , (Otherwise cited as the , 283 Property) 1 285 1 • 1 1 South River _tZY PRJ EXHIBIT C LSP Opinion 285 Derby Street Salem, Massachusetts 01970 Purpose On behalf of South Harbor Holdings, LLC, owner of property situated at 285 Derby Street in Salem,this Activity and Use Limitation(AUL)Opinion has been prepared by Richard Warren, Licensed Site Professional (LSP 6501) of REW Environmental Consultants, Inc. This AUL Opinion is applicable to the Property as defined and further described in the Notice of AUL Form 1075 to which this Exhibit C is attached. Property and Disposal Site Description The subject site is somewhat rectangular shaped, physically situated at 285 Derby Street in the City of Salem,consisting of approximately 0.58 acres(or 25,264 square feet) of land. Storm water is controlled naturally and via city controlled and managed storm drains. The site is improved with a single story, steel framed and brick façade structure-built slab-on- grade. The overall footprint is approximately 16,173 sf and occupies approximately 64% of site land.The structure was built about 1915. The unimproved portion of land lies east of the structure and is used for parking and occupant deliveries. The surface area consists primarily of concrete and asphalt. Bordering east is a similar building of near similar proportions and construction. Bordering west is vacant land owned by the City of Salem. Use is for limited parking and as a public park. Derby Street borders the site to the north beyond which there are several commercial buildings. Bordering south is the South River. The site is principally located in a commercial settlement. Zoning is Business (B5). Site access is direct from Derby Street and is relatively flat. A Phase 1 Environmental Site Assessment (ESA) identified past use as an automotive sales and service center since from 1920 to 1976. Sales of leather products and other miscellaneous uses are reported for the 1980's, 1990's and to the present. Historic Fill material was used to reclaim land at the Property. The Property is currently developed with multiple tenants. Release History The property was previously listed with the MassDEP under two separate Release Tracking Numbers (RTNs 3-1359 and 3-13216). Both RTNs were associated with releases of fuel oil identified within the southeastern portion of the Site. Remedial activities were performed to remove impacted soil and groundwater from the release areas. Response Action Outcome Statements (RAOs) were submitted for each RTN. The RAOs rely on an AUL, which restricts use of the southeastern portion of the Site (see MassDEP Waste Site & Reportable Releases Information). An amendment to the AUL was filed and recorded on September 5, 2002. Specifically, the AUL permits commercial and industrial uses of the site provided the asphalt pavement, concrete and tiled floor in the AUL area are maintained. Conversely,the AUL restricts activities which may damage the asphalt pavement,concrete and tiled floor in the area and requires upkeep of the pavement, concrete and tiled floor; no removal of soil from the area unless done under approval from a Licensed Site Professional (LSP), or use of the property as a residence, school, day care facility, and/or other use where children are likely to be present. Other than the placement of an overlapping AUL under RTN 3-35138, there is no further relationship with RTNs 3-1359 and 3-13216. Given the overall application of the new AUL, it can be interpreted that RTNs 3-1359 and 3-13216 are somewhat subordinate Disposal Site Boundary Based upon the historical placement of fill material at the Property,distribution of OHM levels in Disposal Site soils varies. Because of the this, the Disposal Site comprises the entire property as described in Exhibit A and illustrated in Exhibit B of this Notice of AUL. This AUL applies to the entire Disposal Site (i.e., the entire property). Current and Proposed Future Use The property is currently a commercial facility occupied with multiple tenants.The reasonably anticipated future use of the property is continued use as commercial retail and storage. The potential exists that the property can be developed in the future for other commercial and/or restricted residential uses. Provisions of this Notice of AUL prohibit development of the property for single family residential use and prohibit the use of soils at the Property for the cultivation of fruits or vegetables for human consumption. However, development of the property for restricted residential, day care or children's nursery, school, playground, or playing field recreational area uses is permitted provided access to soils is restricted by surface cover consisting of concrete and pavement or three feet of clean fill. Cultivation of fruits or vegetables for human consumption is permitted if such cultivation is in raised beds or containers containing soil not obtained from the property. Restricted residential use is differentiated from single family residential use because restricted residential uses, for the purposes of this AUL, are defined as those uses such as a condominium or apartment building whereby a future owner(s) is an entity that has legal and operation control of the property, is bound by the provisions of this AUL, and has authority and capacity to enforce this AUL such that a condition of No Significant Risk is maintained under any future uses of the Property. If restricted residential use or development as a day care or children's nursery, school, playground, or playing field recreational area is proposed,an LSP will render an opinion based upon the specific development plans without requiring an AUL Amendment. Risk Characterization The results of a Method 3 Risk Characterization performed for the Disposal Site concluded that a condition of No Significant Risk of harm to human health, safety, public welfare and the environment, as defined in the MCP, has been achieved provided an AUL is recorded for the Property to restrict use. A condition of No Significant Risk will be maintained provided the permitted and prohibited activities and uses and obligations set forth in this Ngttce,pf AUL that precede this LSP Opinion are complied with. of P� p � 0.*' .:ZICHAF �%H "'ass . D NS w RREN I NO.6501 and Warren �'� srrE aa.° // W Environmental Consultants, Inc. 'v Danvers, Massachusetts 01923 LSP SEAL i � � " P�1tA11T # ih 7 �J� ; � � � ; � , �, � � � � � � � � � � s '�PP�twu tor permi w• $ � � � M � s . �,��°— �,<'—d�, � � a ' « � � Z � Z � � � � � � � � � � � � � _ � � � � � � �,Q`"2�,.��.� �� �. � ; ' � � � � �� r' � � e M � S � s' �qr�uit rauted g � c 20� 8 � pd � s � � � � m � � � � � oved by: o �' � G ' � �° G� � C ctor ot BuiWiu�c � � � � m� C� x � � � a m � � � z I � x 8 � 3 = n � � I a: � � • s a v � � � � p � � � G� � � �" b+ • O � V � � O � y N ; � � - � a M � O �� 2 � � O � � C Z i �i � . � S � � � � � � � � i � � . .. .C����S1�,�V _'_ '!� .. PUBLIC PROPERTY DEPt1R'ItiIE1VT �i.a�usr�.K.-.,.� �I.�ro� 130 WwvurwTcx��`n�,7�e',.,.�y�an:stris 01970 1t7:9.'�.7ii959S 1 FNC 97L7�0.9CN APPI,ICATION FOR TAE REpAiR, REIVOVATI N ON TRUCTION DEVIOLITI N O CAAN E �� Lrcr �� OCCrrp,�CY FOR ��NY F.�USTINc'� STR��� OR BUR nnv� —� • 1.0 SITE INFORINATION �' .. . _ Locatlon Nartr: ���a _ _. . Addr°sr_ . _28� -�E2�Y 5 r2EE o— - . _ _ - . 5f}�EM, MR- Prop�rtY M►oeated in a:Ca�s�vatbn Aro�YM M�Obtrkt YM 2.0 OWNERSHIP iNFORMATION - 4.1 Ownor W Lsnd ' N�rns: �ONRLD �, Ct.R.2eCE 7JL3A Soi.tTN Ffff,Q4�P �D N S LLc-� I Addreas: p 1 . o . i3o� �z5� sftc.EM, M� 0l9�0 _ C�� Z� Te�ePtwn�: GI'l8- '1�-E S'� 1 U o'7 3.0 COMPLETE THIB SECTION FOR WORK IN ���T�un BUILDING8 ONLY I Addition Existing UM� Renovation Number ot Stories Renovated — Change in Use N� DemoliUon ExisUng 2/6 6 �� Approximate yeaa ot r��5� Area per flaor (s� Renovated � ca�struction or renovation '—' of existing building New 9�iet Description ot Proposed Work:�--� /� ! C�S�1j,'� y �/ �/;'nr J�� �r� �� �� � .�rP�� � ( �� tisP�r, Pw /— �� ,,,, �p �/K� . // - - - ----- ---- -Mail Permit to: -_ -- --- - - — --- . � m BUILDING CODE REVIEW � • ' • ° 0 1. General Project Data Project Name: 285 Derby Street Salem, Massachusetts 5. Number of Exits= 2 per section 1017.2 z � Description: Tenant Improvements in existing 1 story Multi-Tenant Building, work consists of Maximum length of exit access travei = 250'where fully sprinklered -Table 1006.5 � f— m 'j instailation of new partitions, and improvement of ineans of egress. 6. HVAC Shaft (table 602) 1 hour 4s" LL w 2. General Building Data- Corridors (table 1011.4) 1 hour, with sprinkler - 0 hour : vwqt`�£dAAc�,T � ~ � �;� Building Use Group Classification: B (Business), f-1 (Moderate Hazard factory), A3 (Assembly) 7. Tenant Separations: (table 602) 0 hrs - Note 1 hour is provided �.`� �p,P��Gq���� �r U o Fire Suppression System Provided: Yes, per NFPA 13 8. Finishes and Roofing Classifications o �� 7814 z � Q � Construction Type: 36 - Exterior masonry Bearing Wall, Interior- Approved Materials per Section 606.3 Roofing fire classification (1506.1.3): Class C roof covering (min.) � Total Gross Building Area (Existing) = 12,180 Building Height(Existing) = 22'-0" Interior Finish Requirements: � � w 3. Building Area Tabulation Vertical Exits & Passageways: Class I � r � �C ra w �� Allowable Tabular Area and Height (table 503) = 8,400 sf, 2 stories, 30' Exit Access Corridors: Class II, Enclosed Rooms: Class III � � W (For most restrictive of B, F1, and A3 per sec 313.1.1) 9. Handicap Accessibility 521 CMR �' Q � ¢ • If the value of the work costs less than $100,000, then only the work being performed ne d = � � with Sprinklers allowed area increases 200%to 25,200 SF/floor per section 506.3 for one story buildings. w � 4. Means of Egress comply with 521 CMR U OC W Occupant Load for Tenancy (table 1008.12): 10. Energy Code - Prescriptive requirements for renovations per Chapter 13 of 780 CMR: � z Occupancy -A3 Assembly Occupants per SF Table 1008.1.2 Area ` Climate Zone: 13A refer to table 13042.7 (Glazing area 25%-40%) F Occupant Load: for Assembly area (unconcentrated) 15 per 100 sf for 1500 SF = 100 persons Exterior Masonry Wall improvements (i.e. furred our areas) provide R11 insulation M Siorage, and support areas 1 per 100 sf for 600 SF = 6 persons W�ndow Replacements: Provide Maximum U-value of .5 (Max), SHGC=.5 (Max) Totai Area& Occupancy of Tenancy = 2,100 SF Occupancy= 10G persons � �'�.� . _.�JLI3 __ � U"___1_..a �,, -,�3 u'�urov:_� � � � - - ' O O � O , __: _ . • _ O Z . _._ ,�. �.::c� � o m N _ :=a. Q �- �o a - - -.' -,_.. „ �� . '�-n � w W �.i � .� F;.RI-�'R:iTE'..'�._ -��icC(�t,1F6,S- �Lf � m W J - O �F- Q � ,_. ..._._ ... .........� . . _ _, J � �Q U W d Z 0 N nnnnnnnnnnn TENANT SIGNAGE TENANT SIGNACE TENANT SICNAGB E--I U W a =Q =Q . � v� � �: � �, _ �, � � � E-� z ' m ' � U� Q SALEM ACCESS TELEVISION 0 _ - �_2, �M x z�- RE ES E � 2�� 2" ��yy P'+ � _ " IDT � I'-10' 3'-OY2� 3'-OY2° � w � O W _ _ � 0 0 � W � � i i � Qx � F � � . 13 O' Q L� E- � r w � � d DWG N0. NEW RECESSED ENTRYWAY EXISTING REGESSED ENTRYWAY EXISTING STOREFRONT TO REMAiN A � NEW STOREFRONT GLA55 AND ALUM. FRAI'IE TO I'IATCN /� DERBY STREET (SOUTH) ELEVATION ADJACENT STOREFRONT AT 'SALEM ACGESS TELEVISION' � 1/4" = 1'-0�� 0 m � � . , CLQSET CLOS� � � . ' p� O n ' EXISTING EXISTING ts�`'����'�'rF, Z � KITCHENETTE BATHROOM � ;�v� �it �', � � � .. , �f EXISTING I ADJOINING � � �iO-��Q L' �' � w NOIUR wALL � o TENANT � Sa'Ek`' J."', �R = rn ► SPACE � BUILT-IN STORAGE i (• ' � O c -! � ..,�-=:r � � Q ` Q � � � w w ELECTRIC Q � Q PANELS � W � exisT. � � ELECTRIC V I'TI Q � W Roon _� 7'-7�'4�� ('� aF[ EXIST. � = W � EMERG. U � � LIGHT w 0 4,_9„ NOTE: BUILDING IS SPRINKLERED � � (p �ry PER NFPA 13. MOST NEW � i PARTITIONS ARE 5'-10"+ BELOW n � EXISTING GEILING, NEW � GONDITIONS wILL BE VERIFIED EXISTiNG I FOR SPRINKLER GODE z NOIUR WALL � GOMPLIANGE. Q ov J \ � � SYMBOL KEY a �` P 4�-O�� TENANT SPACE �" Q 2� OO SF Q � NORN STROBE ALARI'1 O p o O p � _� M� PULL STATION � O � N �o ¢ b � I� in � OS 51"IOKE DETEGTOR w W w w - ADJOINING TENANT SPACE 6- � mw � � :s I'-8" °' v m � ILLUI"IiNATED EXIT SIGN � O �r a (SALEM ACCE55 TELEVISION) N — � �a v i �6'-0' E EMERGENGY LIGHTS � a Z� N . 6. �i� �i �o `p,� in in _� ... _ . . ...... � „�,Q 59"x6�8" ���� 3'0"x6'8 4'-O" i �nu m � �ry o � a EXISTiNG WALL TO REI'IAiN r l U ; =Q � NEW 0' uIGN wALL w "� � � ,�ry N `��- - NEW 12' NIGH WALL FL� (� 0 � ' � z � NEW FULL EXIS ING � " DIIIENSIONING NOTES � � NEIGNT ENTR � I. INTERIOR DIMENSIONS ARE TO CL OF STUD AT NEw � STOREFRONT =Q TO REMAI � o.� WALLS, AND FACE OF FINISFI AT IXIST. WALLS p �� ENTRY � � UNLE55 OTNERWISE NOTED x O i � 2X4 STUD WALL - 0 2. EXTERIOR DiMEN510N5 ARE TO FACE OF Q� W/SHEET 'AZEK' � MASONRY OR TO CLEAR OPENING OF ENTRY � � O O n UNLE55 OTNERw15E NOTED AT EXTERIOR x =Q 16'-6Y4" " 8'-OJ�° � �-`i W OVER 3/8"CDX � ���� � FIN.TO GL GL TO FIN. H W �"' Q DIE FLUSN WTO M I; Q 5"x4" � � Q � � ALUM. POST ALUM.POST � � � QLCJ F � �� � 2 CONG. 5�� EXISTWG STEPS, ENTRY, SITE/FLOOR PLAN �zj.J � p Q RISERS � � NEW STOREFRONT GL 5 qND STOREFRONT TO AND ALUI"I. FRAf'IE � �' C� U� U] TREAD AT 11° REMAIN 3/16�� = 1�-O�� 4, �„ DWG NO. EW EGRES � ^ 13�_On 2�_�n �3�_On 2�_�n �3�_pn .1�_�n �3�_�i� 2'-I" �J (..+ 62'-2" � � BUILDING CODE REVIEW • � ' ' o ,y � 1. General Project Data Project Name: 285 Derby Street Salem, Massachusetts 5. Number of Exits= 2 per section 1017.2 z � Description: Tenant Improvements in existing 1 story Multi-Tenant Building, work consists of Maximum length of exit access travel = 250'where fully sprinklered - Table 1006.5 � H m � installation of new partitions, and improvement of ineans of egress. 6. HVAC Shaft (table 602) 1 hour ,,,� ' LL w 2. General Building Data- Corridors (table 1011.4) 1 hour, with sprinkler- 0 hour y��EDnq� � � � Building Use Group Classification: B (Business), f-1 (Moderate Hazard factory), A-3 (Assembly) 7. Tenant Separations: (table 602) 0 hrs - Note 1 hour is provided Q.�,�' _qp tec�1�,+ � U o Fire Suppression System Provided: Yes, per NFPA 13 8. Finishes and Roofing Classifications � .g�T ,. , Q a Construction Type: 3B - Exterior masonry Bearing Wall, Interior-Approved Materials per Section 606.3 Roofing fire classification (1506.1.3): Class C roof covering (min.) � `" � �'at � '� � Q � Total Gross Building Area (Existing) = 12,180 Building Height(Existing) = 22'-0" Interior Finish Requirements: � w 3. Buildin Area Tabulation Vertical Exits & Passageways: Class I F � oC a Allowab e Tabular Area and Hei ght (table 503) = 8,400 sf, 2 stories, 30' Exit Access Corridors: Class II, Enclosed Rooms: Class III ��T F� � � � F (For most restrictive of B, F1, and A3 per sec 313.1.1) 9. Handicap Accessibility 521 CMR Q � W with Sprinklers ailowed area increases 200%to 25,200 SF/floor per section 506.3 for one story buildings. � If the value of the work costs less than $100,000, then only the work being performed need = w � 4. Means of Egress comply with 521 CMR V oC W Occupant Load for Tenancy (table 1008.1.2): 10. Energy Code - Prescriptive requirements for renovations per Chapter 13 of 780 CMR: � Z Occupancy-A3 Assembly Occupants per SF Table 1008.1.2 Area Climate Zone: 13A refer to table 1304.2.7 (Glazing area 25%-40%) � Occupant Load: for Assembly area (unconcentrated) 15 per 100 sf for 1500 SF = 100 persons Exterior Masonry Wali improvements (i.e. furred our areas) provide R11 insulation � Storage, and support areas 1 per 100 sf for 600 SF = 6 persons �Nindow Replacements: Provide Maximum U-value of .5 (Max), SHGC=.5 (Max) Total Area & Occupancy of Tenancy = 2,100 SF Occupancy= 106 persons �p"�' ,'.i1 _ r.;,_,=mv.1 by r s .tty: '_ z _ - ----_ - � po0 .... , , — z _, . , ,., � � o m N . . . . _ _�. .�..Cr _ ;_; �` ' _ ' _ 170A Q V �O Q ,": :: .� " ' ' � W W W . a..' .- ,i'� �T�' .._�..,�� �_ ....�. w O �H Q � J � �aV W aZON _ _ P_ _Rfl fl fl fl R_ �, TENANT SIGNAGE TENANT SICNAGE T6NANT SIGNACE E-I U W a �Q � � . � � � � � Hz SALEM ACCESS TELEVISION m � m � � 0 _ - ,_2, �M x � RE ES E 2� 2" I�-y'-I fZ � _- IDT I'-10' 3'-OY2' 3'-OYp° � w � O 0 0 � Q � � � i � � I3' O" Z � � � � � O Q ' DWG N0. NEW RECESSED ENTRYWAY � EXISTING REGESSED ENTRYWAY EXISTING STOREFRONT TO REI"IAIN p � NEW STOREFRONT GLASS AND ALUM. FRAf'IE TO MATGN � DERBY STREET (SOUTH) ELEVATION � ADJACENT STOREFRONT AT 'SALEI"I ACCE55 TELEVISION' � � 1/4" = 1'-0�� - � � � . 0 � CLQSET CLOS p� O 1 EXISTING EXISTING �" ` z n KITCHENETTE BATHROOM � ��y�c���yr � � � � EXISTING I � � ����Cr,��`�'!, � w NoIUR waLL ADJOINING . TENANT o � 7��4 Y �+ � ~ rn SPACE � BUILT-IN STORAGE ; S 9 � � U O a A� � � a � �T p A Q � w ELEC7RIC . � Q PnNELS K w N LL EXIST. � � F- ELECTRIC I V I�7 Q Cn w Roon _ � 7'-7�'q" _ � ¢ EXIST. �J,J �' EMERG. U � N LIGHT w � 4, q„ NOTE: BUILDING IS SPRINKLERED � � � �N PER NFPA 13. I"lOST NEw � i PARTITIONS ARE 5'-10"+ BELOW � ^ EXISTING GEILING, NEW M CONDITIONS wILL BE VERIFIED EXISTiNG I FOR SPRINKLER GODE z NDIUR wnLL S. GOnPLIANGE. Q `o„ _ J � , SYMBOL KEY � � 4�-O� TENANT SPACE �" o 2100 SF Q � '� W � NORN STROBE ALARI"I O p o O z p � _� M� PULL STATION J O � N o� � � �oQ �0 �v I� in � OS 51"IOKE DETEGTOR � W w w - ADJOINING TENANT SPACE � . , o� � p- w � m W � . (SALEM ACCESS TELEVISION) `9 ��-8� N Q m � ILLUf'IINATED EXIT SIGN I— o �� a � I K �a U 6'-0' E EMERGENGY LIGHTS � � Z� N \ 8, o � o � � \o m� m � � 0., . ..:.... 5 9_x6 8 _..... .. 3 O xs 8 . _::- 4�_�n � J io Q... � ��. � V � J �ry 0 EXISTING wALL TO REMAIN � a u o a : =Q _� NEW B' NIGH WALL r l O �� � �fv N 0 NEW I2' HIGH WALL w � � . ^' , w NEw FULL EXIS iNG � ^ DIIIENSIONING NOTES � Z NEIGNT ENTR `,°� I. iNTERIOR DinEN510N5 ARE TO CL OF SND AT NEW � Q � STOREFRONT =Q TO REI"IAI � o� WALLS, AND FACE OF FINISN AT D115T. WALLS p �� ENTRY � � � � UNLE55 OTNERWISE NOTED '� x O 2X4 STUD WALL - o � - 2. IXTERIOR DIIIENSIONS ARE TO FACE OF �y-� Q� MASONRY OR TO CLEAR OPENING OF ENTRY F1-1 �+ .� W/SHEET� 'AZEK' � UNLE55 OTHERWISE NOTED d � O O AT EXTERIOR " =Q 16'-6Y4" 8'-OYe" � PG OVER 3/8"GDX � �' �' FIN.TO CL GL TO FIN. H w p' � DIE FLUSN INTO "� '.�; Q 5"x4" a � Q d�.. � ALUM. POST ALUI"I.POST H ' � Q LC� E-� w � 2 CONC. 5�� NEW STOREFRONT GLA 5 �— EXISTiNG STEPS, ENTRY, . SITE/FLOOR PLAN W � O d RISERS @ ° AND ALUM. FRAME AND STOREFRONT TO 1 �� � �� � � � � TREAD AT II" REI"IAiN 3/16 = 1 -0 4�_��� DWG N0. EW EGRES � � ^ 13�_pn .2�_�° �3�_On 2�_�n �3�_pii 2�_�n �3�_��i 2i_��i •� �..d 62'-2" F cr,- The Commonwealth of Massachusetts Department of Public Safety Y� y Massachusetts State Building Code(780,CMR) Boildifig Permit Application'for.any Building other than*a One-or Two-Family Dwelling . \ (This Section For Official Use Only) ' Building Permit Number: Date Applied: Building Of pl: SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for whi a str e a ress is not available) a23 d e l y S1 Ste, fen' , fit No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2•PROPOSED WORK Edition of MA State Code used If New Construction check here❑ w or check all that apply in the two rows below Existing Building❑ Repair❑ Alter,itioh ❑"" :\ddition❑ Demolition ❑ (Please fill out and submit Appendix I) Change of Use ❑ Change Of Occupancy ❑ Other Specify: / r Lrd.J GT -.Z 3 Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 4Sr Is an Independent Structural Engmeer.n,Peer Review required? i Ni Z/D✓criptionoTo/oTBrief W) kk: Walw2l d /lgxof;nt 21S- e/•by - J7 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ Existing Use Gnmp(s): Proposed Use Grou p(s): SECTION 4:BUILDING HEIGHT AND AREA Existing E, ,'o No.of Floors/Stories(include basement levels)&Area Per Floo (si.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:U GR Chec s pp • a le) \: Assembly r\=1 ❑ .4-2❑ Nightclub ❑ A-3 ❑ A-! ' r\o❑ B: Business ❑ FE. F: Facto! acto F-1 ❑ F2❑ IL• FIi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ 1-1-5❑ l: Institutional I-I ❑ 1-2❑ 1-3❑ 1-4❑ hh iblercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ 5-2 Cl U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check asap lieable) IA ❑ IB ❑ IIA ❑ IfB ❑ IIIA ❑ IfIB ❑ ry ❑ VA ❑ VB ❑ SECTION 7:SITE INFOMMATION(refer to 780 Cb1R 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: "Trench Permit: Debris Removal: PP Y� Public� Check if outside Flood Zone h licate municipal Cl A trench will not be Licensed Disposal Site❑ Private❑, or indentify Zone:', or on site system❑ required ❑-or trench or specify: 1 1 , permit is enclosed O. Railroad right-of-way: Hazards to Air Navigation: \I\„I li I r < ,.;innn s� n I Ojc.! I r. Nut Appllcablti ..Is Stritclure xvilhill airport tp roach area? Is their r•view completed? Of Consent to Build enclosed ❑ Yes❑ or No Yc. No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Fdition of Code:. Use Group(s):. -I)•pe of Construction: Ocnipant Load per Flour: Does the building contain,m S IninklerS stem? Special Slipulatiuns:_ e F SECTION CI: I'ItOI'EI1TY OWNI?R AUTIIORIZA'rION Name and Address of Property Owner (tr „' ��(� 27 /, O ,&, , Tao S FooK `//` CW�Q Name(Print) No.and Street City/Town .Lip a Property Owner Contact Infornwlion: y1,2 "Pine Telephone No. (business) Telephone No. (cell) a-mail ah i ress If applicable, the property owner hereby authorizes Name Street Address _ City/Town State Zip t to act on the property owner's behalf, in all nmlrors relative to work authorized by this building ermit ae2iillioll., SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If builtWig is less than 33,000 cu.ft.of enclosed.c .ce end or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Nome(Registrant) Telephone No. e-nuaiLaddress Registration Number Street Address City/Town State Zip Discipline Expiration Dale 10.2 General Contractor Company Name Name of Person Responsible for Construction License NO. and Type if Applicable Street Address City/Town State Zip "fete hone No. business Telephone No. cell e-mail address SECTIONIl:\V'OI:I:F.IS'Cl)\IPI;NS,\fk?NIN:;IJN.\NCI;;\Irllr;\VPI' M.G.L.c.152. 25C6 A Workers'Compensation Insurance Affidavit from the i•[A Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:,CONSTRUCTION COSTS AND PERMIT FEE ^ Estimated Costs:(Labor i, Item and Materials) Total Construction Cast(from Item 6) 1. Building 'S e200 Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical appropriate municipal factor)-$ 3. Plumbing S— Note: blininuun fee (contact nmuhici Wilit Y) I. Mechanical (f1VAC) S O S, \iechanical Oth Enclose check payable to 6. Pula!Cos[ Sj0 ^— (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I her-by attest under the pains and penalties of perjury that all of the information contained in this Application is true and accurate t ti e.best of my nowledge and understanding. ,y Pclepl®he Date PlVyle Print 41,1 Sign n me Title a 9c jtroet Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: l Name Date