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Home My WebLink About0048 LAUREL ROAD - Health 48 LAUREL RD., CENTERVILLE A = 230 047 l l i i l NORFOLK RAM GROUP ENGINEERING : ENVIRONMENT February 11, 2004 MA Department of Environmental Protection Southeast Regional Office— Bureau of Waste Site Cleanup 20 Riverside Drive Lakeville, MA 02347 Re: Phase I Initial Site Investigation Report & Tier Classification Submittal Ryan Residence 48 Laurel Road -Centerville, MA RTN: 4-17618 NRG Ref. No. 779.1.1 To the Department: On behalf of Cape Cod Oil Services;Inc..(d.b.a. Scudder-Taylor Oil Co.) Norfolk Ram Group, LLC, submits to the Massachusetts Department of Environmental Protection the enclosed documents for the above-referenced Site: ' • Phase I Initial Site Investigation Report and Numerical Ranking System Scoresheet e Tier Classification Transmittal Form (BWSC-107 and BWSC-107A) • Comprehensive Response Action Transmittal Form & Phase I Completion Statement (BWSC-108) Pursuant to 310 CMR 40.1403(3)(e), by copy of this letter to the municipal officials referenced below, NRG is providing notice of availability of these documents at the DEP office in Lakeville, Massachusetts. The original BWSC forms are attached to this cover letterwith copies bound into the Phase I Report. Following your review of the attached, please do not hesitate to call with any questions. Very truly yours, Nojfolk Ram Gr IL J se h Salvetti LSP P Senior Associate NAProjects\779 Scudder\779.1.1 Centerville\04rep\Phase 1\DEPPH1.D0C Enclosures cc: Thomas Walsh, Cape'Cod Oil Company (With Attachments) Edward Ryan., Home Owner (With Attachments) Chris Morley, Vertex (Without Attachments) CB arnstable.136ard of Health (Without Attachments) 1 Barnstable Board of'Selectmen (Without Attachments) ONE ROBERTS ROAD o PLYMOUTH,MASSACHUSETTS 02360 a (508)747-7900 PHONE• (508)747-3658 FAx 100 KUNIHOLM e HOLLISTON,MASSACHUSETTS 01746• (508)822-5500 PHONE Y (508)822-1611 FAx W W W.NORFOLKRAM.COM .:i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 508-946-2700 MITT ROMNEY ELLEN ROY HERZFELDER Governor Secretary KERRY HEALEY EDWARD P.KUNCE Lieutenant Governor Acting Commissioner URGENT LEGAL PROMPT ACTION NECESSARY RECEIVED Ca L M M CERTIFIED MAIL February 26,2003 FFEB 2 8 2003 Scudder Taylor Oil Co. RE: BARNSTABLE-BWSC TOWN Uf BARNSTABLE HEALTH DEPT. P.O.Box 1210 48 Laurel Road, Centerville Hyannis,MA 02601 Residential property RTN#4-17618 NOTICE OF RESPONSIBILITY M.G.L. c. 21E,310 CMR 40.0000 ATTENTION: Tom Walsh On February 13,,2003 at 8.20 pm the Department of Environmental Protection (the'"Department") received oral notification of a release and/or threat.of.release of oil and/or hazardous material at the above referenced property which requires one or more response actions. A delivery of 263 gallons of#2 fuel oil was made to the wrong residence. The aboveground storage tank (AST) at the above referenced address had been removed but the vent and fill piping was left in place. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c.21E, and the Massachusetts Contingency Plan (the "MCP"), 310 CMR 40.0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal"responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. The Department has reason to believe that the release and/or threat of release which has been reported is or may be a disposal site as defined by the M.C.P. The Department also has reason to believe that you (as used in this letter, "you" refers to Scudder Taylor.Oil Co.,) are a Potentially Responsible Party (a "PRP")with liability under M.G.L. c.21E §5, for response action costs. This liability is."strict",meaning that it is not based on fault, but solely on your status as owner, operator, generator, transporter, disposer or other person specified in M:G.L. c.21E §5. This liability is also "joint and several",meaning that you may be liable for all response,action costs incurred at a disposal.site regardless of the existence of any other liable-parties. This information is available in alternate format.Call Aprel McCabe,ADA Coordinator at 1-617-556-1171.TDD Service-1-800-298-2207. DEP on the World Wide Web: http://www.mass.gov/dep Zia Printed on Recycled Paper 2 be liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties. The Department encourages parties with liabilities under M.G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials.By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the Department in taking such actions. You may also avoid the imposition of,the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L.c.21E is attached to this notice. You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. The Department encourages you ,to take any action necessary to protect any such claims you may have against third parties. At the time of oral notification to the Department,the following response actions were approved as an Immediate Response Action(IRA): • Assessment. • Deployment of Absorbent/Containment Materials. • Excavation and disposal of up to 50 cubic yards of contaminated soil. • Vacuum removal of #2 Fuel oil from the basement. • All Remediation Waste must be properly stored/handled and disposed of within 120 days from the date of generation per 310 CMR 40.0030. ACTIONS REQUIRED Additional submittals are necessary with regard to this notification including,but not limited to,the filing of a written IRA Plan, IRA Completion Statement and/or an RAO statement. The'MCP requires that a fee of$750.00 be submitted to the Department when an ICAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the Department for the implementation of all IRAs, and Release Abatement Measures (RAMS) pursuant to 310 CMR 40.0420 and 310 CMR 40.0443, respectively. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. In addition to oral notification, 310 CMR 40.0333 requires that a completed Release Notification Form (BWSC-103, attached) be submitted to the Department within sixty(60) calendar days of February 13,2003 You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary.response actions at this site. The Department has Glenn.Goral of Response Environmental listed as the LSP of record. a 3 (2) a Response Action Outcome Statement or, if applicable, (3) a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is February 13,2004. If-required by the MCP,a completed Tier I Permit Application must also accompany a Tier Classification Submittal. This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c.21E and the MCP. If you have any questions relative to this Notice, please contact Tyson Rose at the letterhead address or at (508) 946-2743. All future communications regarding this release must reference the following Release Tracking Number: 4-17618. Very truly yours, Richard F.Packard, Chief Emergency Response/Release Notification Section P/TLR/re CERTIFIED MAIL#7002 2030 0006 4996 8718 Attachments: Release Notification Form;BWSC-103 and Instructions Summary of Liability under M.G.L. c.21E cc: Board of Health Board of Selectmen Fire Dept Response Environmental,Inc. 563 Main Street—Suite 211 Worcester,MA 01608 ATTN: Glenn Ga-ol Health Complaints 26-Feb-03 Time: 8:19:35 PM Date: 2/14/1903 Complaint Number: 3923 Referred To: THOMAS MCKEAN Taken By: THOMAS MCKEAN Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: Number: 48 Street: Laurel Road Village: CENTERVILLE Assessors Map_Parcel: Complainant's Name: C-O-MM Fire Dsitrict r Address: Telephone Number: Complaint Description: Dispather Jeff Gifford of the C-O-MM Fire Dept. called TM at home the evening of 2/13/03 at approx. 8:15. Scudder and Taylor pumped 263 gallons of oil into the basement of a vacant home at 48 Laurel Road. Actions Taken/Results: TM responded immediately and observed the multiple gallons of oil on the basement floor. C- O-MM Fire Captain Eldredge and the General Manager of were both onsite(phone 775-0474). The Police Department had just left. Envirosafe Environmental Services (Sandwich 508 888- 5478)was called-in to vacuum up the oil. Mr. Nick Christiani arrived 35 minutes later with a vacuum truck and two other employes. The spill was also reported to DEP (Tyson Rose 946-2743). At 9:30 p.m., TM called the homeowner, Ed Ryan, in Quincy at(617) 543- 2415 and assured him the oil spill clean-up will continue to be handled properly and professionally. On 2/25, neighbor Grace Sweeney called to obtain information. TM called her back. On 2/26/03, TM called David Bennet to obtain updated information, & Insurance Company hired their own 1 0 Y� Health Complaints 26-Feb-03 LSP-Glen Goral of Response Environmental (508 795-0110 ext. 2). TM called Heather Atwood of Envirosafe(888-5478 or cell 508 737- 4109). The basement floor is being dug-up today along with 2-3 feet beneath over an area most of the basement floor. Resampling will be conducted tomorrow. Only 22 gallons of product was recovered from the top of the basement floor out of 263). At least 100 gallons has made it to the ground. Shoring-up will be conducted with the installation of piers so that excavation could be accomplished closer to the foundation wall. Nothing found outside the footprinted of the home. This is a substantial release according to Heather Atwood 2/26/03. Investigation Date: 2/13/1903 Investigation Time: 8:30:00 PM 2 CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508)790-23801FAX#(508)790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A.# 03- F- /(2 7 LOCATION: DRESS OF RELEASE: 73 ��✓ f I A 103 DATE OF RELEASE: `2. 1 3 / 0-3 _ PRODUCT RELEASED: _*2 vP I off ESTIMATED QUANTITY: Zed t I Crty; f r CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: C ✓t4zr L+rc( A�t f ktcyvt#G NOTIFICATIONS: FIRE DEPARTMENT: YES( NO( ) DATE:�2 f TIME: f L� NATIONAL RESPONSE CENTER YES(vNO( ) DATE: Z 13 Q TI E: 2 0 DEPT.OF ENVIRONMENTAL PROTECTION YES(v,f NO( ) DATE:Z 6TIME:Zd OIL SPILL COORDINATOR: YES( ) NO(vr DATE: TIME: TOWN BOARD OF HEALTH: YES( '"NO( ) DATE:r / TIME: Zd 16, TOWN HARBORMASTER: YES( ) NO(-'f DATE: 71ME: OTHER AGENCIES: COMMENTS: � /C �, luv - UGC Ch,3 � ,r<, a t u ,- . ( f � l REPORTED BY: L DATE: WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH C-0-MM FORM#58 N � Health Complaints 14-Feb-03 Time: 8:19:35 PM Date: 2/14/1903 Complaint Number: 3923 Referred To: THOMAS MCKEAN Taken By: THOMAS MCKEAN Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: Number: 48 Street: Laurel Road Village: CENTERVILLE Assessors Map_Parcel: Complainant's Name: C-O-MM Fire Dsitrict Address: Telephone Number: Complaint Description: Dispather Jeff Gifford of the C-O-MM Fire Dept. called TM at home the evening of 2/13/03 at approx. 8:15. pumped 263 gallons of oil into the basement of a vacant home at 48 Laurel Road. Actions Taken/Results: TM responded immediately and observed the multiple gallons of oil on the basement floor. C- O-MM Fire Captain Eldredge and the General Manager of were both onsite (phone 775-0474). The Police Department had just left. Envirosafe Environmental Services (Sandwich)was called- in to vacuum up the oil. Mr. Nick Christinson arrived 35 minutes later with a vacumm truck and two other employes. The spill was also reported to DEP (Tyson Rose). David Bennet of Bennet and O'Reilly will be hired as the LSP. At 9:30 p.m., TM called the homeowner, Ed Ryan; in Quincy at(617) 543-2415 and assured him the oil spill clean-up will continue to be handled properly and professionally. Investigation Date: 2/13/1903 Investigation Time: 8:30:00 PM 1 d-- �7 L •. '�-� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 8� PART A / di CERTIFICATION Property Address: 48 LAUREL RD. CENTERVILLE MAP 230 LOT 047 ' Name of Owner MACHPERSON Address of Owner: C/O BILL TILLO;70 JOYCE ANN RD.CENTERVILLE Date of Inspection: 3123199 D j`99 Name of Inspector:(Please Print)JOHN GRACI p ,9 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) �j Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 t Telephone Number: (608)664-6813 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evaluat'on By the Local Approving Authority performing at the time of the Inspection.My Inspection does Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:3124199 The System Inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.THE SYSTEM HAS BEEN PUMPED WITHIN THE LAST MONTHS,THE TANK WAS EMPTY revised 9/2/98 Page 1 of 11 ' 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3/23/99. INSPECTION SUMMARY: Check A, B, C, 0/D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: na One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. na The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiitration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. na Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced na The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass Inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed I revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3123/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n/a-(approximation not valid). 3) OTHER n/a revised 912198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3/23/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No, X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n(a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the Invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system Is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3/23199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 pan.S of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3123199 FLOW CONDITIONS RES113ENITIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):n/a Total DESIGN flow: n& Number of current residents:f! Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):..NO Seasonal use(yes or no):AQ Water meter readings,if available(last two year's usage(gpd): n& Sump Pump(yes or no): NQ Last date of occupancy: 311199 COMMERCIAL/INDUSTRIAL Type of establishment: nla Design flow: n(a gpd(Based on 15.203) Basis of design flow: nla Grease trap present:(yes or no):JM Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n(a Last date of occupancy: nla OTHER: (Describe) nfa Last date of occupancy: nla GENERAL INFORMATION PUMPING RECORDS and source of information: WITHIN THE LAST MONTH System pumped as part of inspection:(yes or no):NO If yes,volume pumped n&- gallons Reason for pumping: nla TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLa APPROXIMATE AGE of all components,date installed(if known)and source of information: SEPTIC TANK ORIGINAL WITH A PIT INSTALLED IN 1993 PEMIT#93-61 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3/23/99 BUILDING SEWER: (Locate on site plan) Depth below grade: JILE Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nLa Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: 1 Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No n/A Dimensions: L 8'6"H 6'7"W 4'10"-EMPTY Sludge depth: n& Distance from top of sludge to bottom of outlet tee or baffle: n(a Scum thickness:jVA Distance from top of scum to top of outlet tee or baffle:x& Distance from bottom of scum to bottom of outlet tee or baffle: nLa How dimensions were determined: n& Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nLa Dimensions: n& Scum thickness: Wa Distance from top of scum to top of outlet tee or baffle:_n(a Distance from bottom of scum to bottom of outlet tee or baffle nLa Date of last pumping: nla Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nLa revised 9/2J98 Page 7 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3/23/99 TIGHT OR HOLDING TANK: MQ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n(a Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) Dimensions: n/a Capacity: n!a gallons Design flow: n& gallons/day Alarm present: NQ Alarm level:jiL& Alarm In working order:Yes_No_ NQ Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:Wit Comments: (note if level and distribution Is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nla revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3/23/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Na Type: leaching pits,number: 6'X4'LEACH PIT leaching chambers,number: ji& leaching galleries,number: _WA leaching trenches,number,length: Wa leaching fields,number,dimensions: E& overflow cesspool,number: WA Alternative system: nla Name of Technology: -n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE EACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT WAS EMPTY AT THE TIME OF THE INSPECTION-NEVER MORE THAN V IN CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: nla Depth of solids layer: n(a Depth of scum layer. n/a Dimensions of cesspool: n& Materials of construction: n/a Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: _ (locate on site plan) Materials of construction:nla Dimensions:n/a Depth of solids: nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa revised 912/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 LAUREL RD.CENTERVILLE MAP 230 LOT 047 Owner: MACHPERSON Date of Inspection:3123199 NRCS Report name: n[a Soil Type: n& Typical depth to groundwater: nLa USGS Date website visited: n/a Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 Page 11 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 404 BRASSIE WAY MASHPEE Owner: ELEANOR ROSS Date of Inspection:3/23/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a 97heC QGb N [60 AC41 revised 9/2/98 Page 10 of 11 TOWN OF B RNSTABLE LOCATION vd SEWAGE .# r f VILLAGE L�u��5- ASSESSOR'S MAP & LOT ®, 6 , 7 INSTALLER'S NAME & PHONE NO. tffip:!�_(.-{(,uo Sec_ SEPTIC TANK CAPACITY �Zo`vSYCNc JC�u LEACHING FACILITY:(type) NO. OF BEDROOMS.PRIVATE WELL OR<f L1C WA-TER BUILDER OR OWNER yWl V�ejy-1 DATE PERMIT ISSUED: 'h DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No toes No...f 3.... 3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , TOWN OF �rR� Jv Appliratiun for Disposal Works Tonstrur#ion rud Application is hereby made for a Permit to Construct ( ) or Repair ( 1.1 an Individual Sewage Disposal System at: ................_�(.0_..4=4LV. .-....fk- .........._........... ......................_................. ....................--••--............•.. Locat on Address ••.-.(L_ot�HNo. ............. .....t�!'1....� ro✓" .............._.... ..........,�.. T ........................................... Ow er dross a --••...........-•- hxP: .L °! ... T........................ ....... c:D:. .: . ........th.�-.�dli................ Installer Address Type of Building Size Lot............:...............Sq. feet aDwelling—No. of Bedrooms...5...................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ..--••--•---•----------------------•--------..-_.._.._ W Design Flow........... t�....................gallons per person pen day. Total dail flow....�.........._............gallons. WSeptic Tank Liquid ca.pacity` .�.�..gallons Length......�_f........ Width... -----.... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No.._.].............. Diametev...ID......... Depth below inlet....(......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►." Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2.................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 0 Description of Soil.....................................................................................•-•-------........-----.......---....................-••-••-••••••................. TlNature of Re airs or Alterations—Answer when a licable....-. 1l.S,_1'1a, ..............�.20�.........,1.OM....�:.z�=4 �0.�7......................-•----....................................................----•---.................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'AM 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b. • of li lth. Signed. .......... .... ---•............ .......... ......................... .... Date �y Application Approved By---- ;-moo . .t.t .,. - .......................................... ........... -�s�-.:.,[.�2� . Date Application Disapproved for the f ollowing reasons:......................................................................................... ................_ ...........-•-•-•............................................•-----....---••--••-----.....................--•--...--•---•--.......................-•-•-•---•-------...................•-•-............... . Date PermitNo...... ....�_�......................... Issued......................................................_ Date .. 'ram. '•e•''i• C t, .r .r i-_ «7"'r,3-. t^ •+..• � 1,u:;'art X\r-��:••✓7 ,�r.. _,s---f�'r h.. ':! :i- .�a�,t�a.�'r r.y i"< . r THE COMMONWEALTH OF MASSACHUSETTS, r BOARD OF � HEALTH � TOWN OF Y'A�R�+Ir®H<W4:?0, 45-j _ Appl ration for Disposal Works Toustrnrtiun Permit 9 , Application is hereby made for a Permit to Construct ( ) or Repair ( (f,)0"aen Individual Sewage. Disposal System at: - ..................`.(A ..IA Q'Ety ..... ....................... ...._....... ..._........---------...-- ..° -- •-------..........._..---•-..........._.. •-••••-••-•-_ .....l .Local Address •_•_-•••••_--••. ........... .o.Y.` ...................................• .......... 94 Owner ................:...... .o. .. Address j.. Installer Type of Building � Size Lot............................Sq. feet Dwelling—No. of Bedrooms.._. ,,1 ' ..... ...........:.......Expansion Attu(t ) Garbage Grinder ( ) p.t Other—Type of Building ............................ No. of _ersons .~► Showers ( ) — Cafeteria ( ) �W Q Other fixtures ............................. ._.:.... ' �... r ...................... ...................... Desi Flow............. ... .. ..1 rd �i1��-' -r t U �" W gn . ...................gallons pe�pers<onl pe day. Total'!darlx flow__._ _ ...........----......--gallons. WSeptic Tank-� Liquid capacity�� '�gallons Length_.�a,. .... idth....�� _..___ Diameter................ Depth................ Disposal Trench—No.................... Widtl��.........�.. Totarl�,Length.................... Total leaching area...................sq. ft. Seepage Pit No.--__4------------ Diameter.__... -.--.....�tDeptli elow inlet.....�f......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dd sing tarik`( ) a Percolation Test Results Performed by.......................................... .......................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.... ... Depth to ground water........................ C3, Test Pit No. 2................minutes per inch Depth of Test Pit_.&.1'�."�............ Depth to ground water......................... a ................................. ................. .........• -...--•........ . ..........._.........••--------------------------------•.............................................. 0 Description of Soil...............................................................:.............................•---......................... ............................................ U .................................................. -- -____- ...... ......... -.____........ �....... ......- --••• ..--•--•-•---------------------------------•--•---...-•---••--------..._.._...._.........:_......----•-•-:_......---......---•-....•••__ _........•-•........ -.._•--__•....---••••_-- U Nature of Repairs or Alterations—Answer when.applicable__. ( C:'1=r,-,_t.-.. 1_/�11-�_ r .J�—_. if- a0h . .0..K_........za..D...I..e.4.6t�.._ 1.a3.--•----------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL' 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of he th S P r i .f. n M-y-�•� J•^.. Date ignd yr z k Application Approved By...... . r .. :�.�. �1----------------------------------------- y c�=-:-��-� Date Application Disapproved for the following reasons:.........-•____-_____•____________________________________•__.....-_-________•__........_..................._ ........................................................................................... .....••--......._..-----•--..........._.......__.........._.._............._.....•... _..--•--•.... . Date Gj PermitNo........1 .................. Issued..................................................... Date ., '. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of dbM0 H r�dSCavj\e. f�rrtif utttr ,�f tom littnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( t.a by..............•--•....................�..1.-..J ! .- .. T. .,. , ,.................................................................................. In taller at...................................... ....��h:�a�! C':�-.... .: ................. ....................._._........ ...........__...... has'been installed in accordance with the provisions of TITq-,, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... ��..-- ........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................................................` .�..�............ Inspector............... ..................................... . ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of Y-A•R-IOI�ITH No.....I . .. 'aaYr.►�TocSol-e Fa��.��. ...-::... 3iisposalr orks Q116,onstrurtion Permit Permission is hereby granted...............1—,q_l4fJ__t°_-L4. �4z. to Construct ( ) or Repair ( L),.�an-lrldividual Sewage rsposal System Street as shown on the application for Disposal Works Construction Permit Ni �__9-______. Dated.......................................... .............•••........ .,e.. ........................................................ DATE............ .............................. Board of Health - TOWN OF BARNSTnnABLE LOCATION �-� � L.Ccu ,/g k �&,; SEWAGE # VILLAGE C-CA�ev v-N \`10 ASS-E-SSOR'S MAP & LOT 3 v -vL INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY i O O O G 4\\o X^-� LEACHING FACILITY:(type) ?Q f (size) NO. OF BEDROOMS PRIVATE WELL PUBL�WATE—R-_-) BUILDER OR OWNER I �� $_, 1M ?A ZS is� DATE PERMIT ISSUED: ��- DATE .COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,j ii s 1000 P,T W, 57Te C I -3�/oy7 Fins......2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -U /j/1.:.....-.OF.. .ems � '- . Appliratiun for Disposal Warks Tonotrurfion 1hrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( - n Fndividual Sewage Disposal System at: ................ ....�rn. \J 2:�` - :........_..... ........------- �ev� ��.1.._ ........................._..._.. a - •ocation- d ess •••-or Lot No. 4 .. ' ..__............................................ Owner Address Installer Address Type of Building Size Lot................ ____________Sq. feet U Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) p�1, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------- s�`4. _Y......_............................_..............................................-................. WWDesign Flow..........:.................................gallons per person day: Total flow................................_...........gallons. WSeptic Tank=Liquid capacity/ Length____ __________ Width.__ ......... Diameter-................ Depth................ x Disposal Trench—. o_____________________ Width_....`............. Total Length............ Total leaching area...................sq. ft. r_.._. 3 Seepage Pit No____________________ Diameter.....��_......... Depth below inlet......... ......... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '" Percolation Test Results Performed by........................... -----••------------• Date........................................ 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x --------------------------- ------ ------------------_..................................................................... 0 Description of Soil................................•-------------•-----..___-------••-------....----.•-..-•------•--•---•------------.......---•---._...----------.......•••--••-••--•--_.. x x ........... / ...... .......... U Nature of Repairs or Alterations-Answer when applicable.---4��-l�d�_�(- � _...?�� ........ •-1�v Agreement: 1SA The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT1.L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliaee-b he bo of Signed..--...-•- �by ---....---•--•. ................. --•- ............. Date Application Approved B PP PP y ... ~ Date Application Disapproved for the f ollouring reasons:...............:..•---•--.......---......-----•--•--•-••---•--...-•-----._...--=------••-•• ---............::.. -............................._..................................................•....................................................................................................................- Date Permit No.----9.7._'_. QG..................._.... Issued-.....................................................- Date - FEs..... o Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � � =.......OF........t �..ik.R� , �.,-i.c � ?�..�................................... �.......... ................. Appliratiun for Disposal Works don' strurtion rrrmit Application is hereby made for a Permit t pp y t to Construct ( ) or Repair ( ),Y,an,.Indlvidual Sewage Disposal System at -.- Location Address or Lot No ............ .iS._�- 1 r , P1n-e 2.,C ✓``•- .. .................. - -V L.--' ............... Owner Address a ....................... = .. ......... ....�. ............................ .. �:. .: ...... ---------....... Installer Address Type of Building Size.Lot............................Sq. feet -tea Dwell ng Grinder p., Otherl—Typeoof Building di gms......................... No. of personsnsion Attic (•-__)Showers (Gajbag Cafeteria, ( ) P4 Other fixtures ...............k.......... :....`-..(- ............. '. d WW Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity!! gallons Length...f�......... Width... ......... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length._............................... Total leaching area...................sq. ft. 3 Seepage Pit No.......t........... Diameter....... ......... Depth below inlet......:......... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------------- --------------- ------ ----..... •--------- -..... •----- .--•-•-----•--•--------:.................................................................... 0 Description of Soil................................................................................................... ................................................................... UI"1 ......••---••--•--•---------- -----------------------------------------•----•-•-----......---•------------•------------------------•-•-•--------•--.....-----.......= --.-------_--•----- Nature of Repairs or Alterations-Answer when applicable...__ / t 4 ......-•-•••--•-•----••-........ 4 ... Agreement: 1 S The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T M 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance-has-been-issued by the board of health.1 _ Signed..----•--- __ --•-.� .. ....._ �.� .� � = _. Date _ Application Approved B .......:'��} -� Date Application Disapproved for the following reasons:-----•--•----------•---------•---------------•---......-----.......--••----...........----•..............--- ................................••--.......--•--•----...-•------•---.........-------------•-•-------..._.--•---•--------...-------•----...--=--------------._......-------------•--•----•-•-••----•-.._ Date Permit No......S-.z..--.3 0a-----------•-------- Issued----....--••--. ..............................._ Date -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OFHEALTH C /l{l/�-...OF........f` u t/`- ............................ ........................ 01rrtif rate of Tnmplittnrr THIS IS TO CERTIFY. That the Individual Sewage Disposal System constructed ( ) or Repaired bY........................................... .........................�� .I. ,r....---------•-•----------------------...---••---•---.......•---•-.......-•-............. Installer" at.....-•---•......-----•.......: �_ 1 C 1, � t a V -, 1 Ga-�-----_ C`- rah-�''--v---------------•-------------------- ...............•-- ..i...-----.....--•---------...--•-------•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...:2-:-<lcna.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 0 DATE................... . 1 - - Inspector -4� - •----- ••-•-• .............................. iJ a- ------............................................. -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (�........OF....... C' NO... FEE---. �.�.......... �ts�rn��tl= urk�-�nn�trnrtaan �rrmit Permission is hereby granted.......... .--.-----P-•- -_�,�-+�-----•------------•-----•---------------------------------------------------- to Construct ( ) or Repair (�)aii Individual Sewage Disposal System at No U Y t ,,�. r I C`., (_ _e t_ \ ^r?%_. I -� ..----•---------•--•--•-•------•-•--------.............----•-•---.......------------...-----•--•-------------------------------•--------................................................... Street \ ..................... as shown on the application for Disposal Works Construction Permit No.517,,�- __ Dated..................... DATE. t` ` J ward of Health �, .� �'� ,,`-�., e f ��'. E � ' ♦ �_i � i � i • � I � - , � , �` ' Y