Loading...
HomeMy WebLinkAbout0038 MAGNOLIA AVENUE - Health 38 MAGNOLIA AVENUE F Centerville A= 225 — 013 .: _ UK T01 ,rd. N0. 152 1/3 ORA 10%XALA n TOWN OF BARNSTABLE LOCATION SEWAGE# g U 1�- Off Z VILLAGE ASSESSOR'S MAP&PARCEL 01 INSTALLER'S NAME&PHONE NO. �� 5�qd' 907 V SEPTIC TANK CAPACITY 2-0 U V LEACHING FACILITY: (type) At- (size) NO.OF BEDROOMS (I OWNER A tool leaf v� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet' FURNISHED BY I A-C 15.92' A-D 25.75' A-E 36.39' B-C 44.38' B-D. 53.82' i B-E 67.30' B - Da Do Da Do 93 Ya l I O m No. Fee /C;O r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plieation for Disposal *pstrm Construction 30ermit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System NJ Individual C?nponents Location Address or Lot No. /l?O ! Owner's Namfc Address an el. / o A A�NOI( y�Cf1 /f USA Assessor's Map/Parcel Ov I a�1. ?Nane,Addres d Tel.No. (T'�pg� 0 b� Designer's Nara Address, d Te,No. �$ o�S v cam. ��� Beo*dVc� C> ell a�� l'c. a� r- A Type of Building: j4G4r. Dwelling No.of Bedrooms �Q Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 106 gpd Design flow provided ' �d gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 0. 7 QQ Type of S.A.S. C Description of Soil Nature of Rep, s or�ter 'ons(Answ when applicable) D e last insp ted: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title r ent 1 ode and not to place the system in operation until a Certificate of Compliance has been issued by this oard of He ` Sin Date �(r Application Approved by �r to L G Application Disapproved by Date for the following reasons ..r Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,11A the On-site Se age Dispgaal system Constructed( ) Repaired( ) Upgraded Abandoned( )by H U C� at -m has been con cted in acc ce with the provisions f Title 5 and t e for Dispos System Construction Permit No - ated C Installer C(" d 5 /`fl r D Designer #bedrooms Approved d flow 7 gp The issuance of this p it not b construed as a guarantee that the system cti d 'g d. ® e' Date Inspector SY No. ( 'v / ' Fee 00r , 1 THE COMMONWEALTH OF MASSACHUSETTS -Entered in computer: Yes �1r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 3pplifatlon. for VspoSal 6pstem tonstrUction Permit r Application for a Permit to Construct( ) Repair( ) Upgrade( ) ^Abandon( ) ❑Complete System Individual Components r Location Address or Lot No. AS/V® A / Owner's Nam ,Addre and Tel.Nn_= _ Assessor's Map/Parcel � ®� _ a ikr ll�r' N do� ( � Na Address, T eCISNo.,A , ' : 7 a o t ,, f,4/p pd ( rr Type of Building: Q`a Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons %1 Showers( ) Cafeteria( ) Other Fixtures , Design Flow(min.required) / f`O 6 ' gpd Design flow provided k � ri gpd Plan Date Number of sheets Revision Date Title 1 i Size of Septic Tank "p Q �Q Type of S.A.S. 2 ` Description'of Soil P 1 »ib Nature of Rep 'rs or,Alter tions(Answer"when applicable) r�iPA De last insp ted: Agreement: 1 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title d-oft he it nmental ode and not to place the system in operation until a Certificate of Co'mpliance'has been issued by this dl oard of He -- g Date 4" Application Approved by 1 , �,� ir� / pO ➢ate / Application Disapproved by Date for the following reasons Permit No. C7 Date Issued I ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE' MASSACHUSETTS y Certificate,of Compliance THIS IS TO CERTIFY,t at the On-site Sewage Dis sal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ''/ T ( n�u �C, c 6�t7 at�Zl !/r 1 •C, (/ t, (�'. has been con ucte in cc d�ce with the provisioktA) and�e for Dispo al System Construction Permit No r `dated < Installer JJ r c/ , nJ Designer rc.1 #bedrooms �d Approved design flow �/ �1 / /� gp The issuance of thi#e,- it h 1 not be construed as a guarantee that the system wifl ction,as des gn / V 1f/I ,!� Date Inspector >f�/��I, s19 r'/rig i -------------------- - -- - - - - --------- - - - _ -- �. No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS MispoBal 6pstem Construction Permit Permission is hereby granted to Coon truct( ) Repair( Upgrade( ) A ndon( ) System located at J D /' 1.4 �c t/ Arl Z and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru it t b ompleted within three years of the date of this permit. Date Approved by ' v I c,�m ;r`�a of Bat"s-0--aL te ]Is�Ftm�� F. !Ceffer,,Dr�-ector 3SYrW5SR BEE I $ it h Di-visioni Thomas McKearn, Director 2.00 Main Stn-eet,Hyanimis,MA 02601 Office: 508-962-4644 Fax: 508-740-6304 mtaljUer &Desig r Certification Foam Date- Sew2gc Permnne Assessor's 1MapTarcelt Desng,p"era 1�6 W vim- f Installer: V��"� l.�(0_�r Dv\ Address- Address: On (W� 61-,, was issued a permit to install a (date) (installer) septic system.at 3" D I a based on a design drawn by ( ddress) 0,►1,t Q,( jg'. dated (design _ZI certify'that the septic system referenced above was installed substantially according to the design, which may include.minor approved changes such as lateral relocation of lie distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any componcnt of the septic system) but in accordance with State & Local Regulations. plan revision or certified as-built by desi er to follow. DANIELA. yGs o 01, _A Si e) a,v Ci IL c" , I o.46502 �0 C� "ONAL esigaer's Sigaatule) (Affx Designer's Stamp Here) p,—,E,,As— -ET-a-N O BHMiSTABLE NOTLIO HEA:IJE DUVISION. CERTIFICATE OF CG1v,—eLIA!dLt f I L NOT. !E fsRMED _Gr I—M BOTH MS FORM AND AS-BUILT CARD AREA RECEIVED BY THE BAIMISTABLE PU B- LIC=5 ALTI DIVISION.N. THA-14IK YOU, 0:Fieahb/septic/Designer Certi ucaiiou Fo-im 3-26-04_doc i r i E III L � III 3S A- C 15.9 2' A- D 25. 75' A- E 36. 39' ! B-C 44. 38' LO � , B-D 53. 82 � , B - E 67. 30' A B - Date: May 28,2014 Dome by: Daniel A. Ojala Down Cape Engineering, Inc. 939 Main Street Yarmouthport, MA Property Address: 38 Magnolia Avenue Centerville,MA `a t'S \ O to GAR. Aye \ . i 225/1 a6-00J e v@; \ 1 � KURIQR LDWARDT0. q� G/OHYANNISI3 NR I 1 WILIAW STREET HYANNI3,MA.02a1 225/035\ DB 11332Po 159 /38 9 32 < \ 1 I M 225 PCL 012 ' / BURWICIL \A7 I NontuekJet lacut .I R Dm �'m� ` FALKF3A'f1AM, SOI{n mcumI m / WPSTON,MA AVBLRRY LA\� 54a, /` JB .193 \ DFRRY,NH03039 ISE—Y.Lu I\o DB I'19B]PG ssz ' LOCUS MAP o ctb690e TRusr \ \ i( I SCALE I'-20DO'S: ASSESSORS MAP 225 PARCEL 13 LOCUS IS MTIHIN FEMA FLOOD ZONE A13 (EL.12) ZONE B&ZONE C..V16 AS o SHOWN ON COMMUNITY PANEL#250001 OOOBD DATED 7/2/1992-HOUSE AREA 163 MAPPED ZONE C&B M1 �A ZONING SUMMARY E Snxc O TAnP PF T ZONING DISTRICT:RD-1 DISTRICT /I----- -------- \�O \ MIN.LOT SIZE 43.560 S.F. M 20' IN.LOT FRONTAGE NIN.LOT WIDTH 125' Xb MIN.FRONT SETBACK 30, RFx09F 42 SF f �'------__ --+-T; 4 MIN.SIDE SETBACK 10' a D9rnxD I �-T)) \ NIN.REAR SETBACK 10' IFAONIO - __ \ MAX.BUILDING HEIGHT 30' 6.1 CrF DF Ew5nx0 CAAVFL 0 'AY aen � S pROPDSm KOUSE 1 I r_______________- 4 s �r 225/018-002 SITE IS LOCATED WITHIN AP AQUIFER I'y LARGAY,vINCETRB& \ PROTECTION DISTRICT ENw O' A—EN.V BIR&P&A \ OWNER OF RECORD i i0 RERAw 1 9 �i �y SOP, -_---- ATE P/C `2° OODB RY.G% 8 STEPHEN DAVID.TR. --' I t\\ \, _ WOODBURY,CP 06'/9R \ MAGNOLIA AVE REALTY TRUST O '1Vj 55-92 \ 30 EASTBROOK ROAD,SUITE 203 \ II DEDHAM.MA ARMOY ODSf.MIIVEWAY n nev IN , _ \ I' REFERENCES DEED BOOK 24079 PACE 33 PLAN BOOK 216 PAGE 248 LCP 15774 A,B, NOTES: J 34 1� w E NOTE:HOUSE LOCATION i• A °Y O y I BDATUM:1.PLANE U.S.SURVEY FOOT M HORIZONTAL NETWO STALE APPROX.FROM G.I.S. PLANE U.S.SURVEY FOOT FROM MI5 RTI(NETWORK �\,) ^•Z•�L i / O I 2t9 S,."GAT.(m—1.) � CONTRACTOR TO NOTIFY OIGSAEE PRIOR TO ANY 'EXCAVATION.AND COORDINATE AL.-UTILITY CONNECTIONS /JB� h%! / _KYAMN c ro NARW P ANTS) WITH APPROPRIATE VENDORS CONTRACTOR TO VERIFY Jy�L- 3 yTT.� LOCATION OF ALL UNDERGROUND UTILITIES. 225/DFI ST j I 2 ENSONO_AR ro Bf RFTNNm / /PRaoF o ONIA ROOK EL 14 z A I PROPDsm 1REE'rLM•NERroxE 3.EXISTING HOUSE TO BE RAISED UP ONTO NEW HIGHER TCP Dc FwNOAR EL I52 a Tn BL S FAN' / AD D InON ON,GRADE AROUND HOVE AS INDICATED.SMALL SN GRADE AROUND NSE I4 �,r'OlF ADDITIONS AS INDICATED.RELOCATE SEPTIC COMPONENTS It 34 MAGNOLIA d DF Ens we xaug—It /�V_ IF REQUIRED,VERIFY LOCATION IN FIELD. 225/011\\ Sq� 8' \ `,% RAISED HOUSE ITIR t� !R �-� / 4.EXISTING SEPTIC SYSTEM TO REMAIN-1995 BURWICB, C /I A�3� RELOO�IE ) / INSTALLATION.NO INCREASE IN DESIGN FLOW PLANNED. JERALD DTR 2 ,i\ / i;Po BS ff.TFKAnON(N 51100 ao Cl1KER ](El Q) tiB' / I -_ _ .. fca34ERr uwx NOTE:MOVE AND RAISE SEPTIC TANK AND REMOVE PUMP Sa` id MNrS) CHAMBER.UTILIZE EXISTING LEACHING.ALL COMPONENTS WEST ON,MA. hWpl Iy \ 225/D6-001 / ARE GREATER THAN 100'FROM DUNE OEUNEATION UNE. OMAGNOLIA _l 9 W'0.'N•J<xew3LG I REALTY TRUST .yd' n P4 \ -- 3JO 5.GUTTERS AND DOWNSPOUTS ALL ROOF SURFACES OR / '.X 3JONA5 STONE CDL GRAVEL DRIP EDGES AROUND ALL ROOF SURFACES C166908 I ,.p - �� f �LCIRJOTON,MA 021 TJ/ REQUIRED. REIDLAIE �'fi7 S xV ro RE RrPu�im �T WTX N nce SPEq RDIOVF ANY\ I 6.DUNE LINE DELINEATION BY WOODS ROLE GROUP. RATIO 43 S' QATKIXNI . ""•` OF NAII15 0 zwrs4TR­i— I \ x S ARE00Is \ 7.SITE TO BE RAISED TO MATCH NEW HOUSE GRADES. HARNE PLW15)• '{'' ROPE _ TMj�p' A CLEAN FILL ONLY(I.E.CLEAN DREDGED FILL,CLEAN SAND, STRUCTURAL GRAVEL,ETC.) ALL SLOPED AREAS J CURRENLTY CONTAINING INVASIVE SPECIES TO BE REVEGETATED WITH NATIVE SPECIES,SEE NOI FILING FOR N �24Y VI9 I'z BBUUO.16 FFTEE)RPuNTING LISTS AND INVASIVES CONTROL 1 - ' .70.NVARVss 0 '� _6 X x(e� 0-- Q\ ..�,-,,,..,�,,,. ----++ w,x�NFA�n°19iLwx,w� �'"=• w 1. nv2 �,e 5� _ _ HuxBERm Tuc ro .f \ p PRIOR APPROVED HARDSCAPE SE3-5118 - - orvA99ES&lttlrs'wRT •�\ BOOK 27762 PAGE 25 NWEY91pRF i you El NEW PROPOSED HARDSCA E AM9 Np6Y5OOgL e gIFS µ qDE uST OF PATH H� \/ \ \ SYSTEM DESIGN: NOnVE PCISON IOU ro SWnI \ WOODS RpL 0P we.(TYP.) 0 r '\ EXISTING: NA INVA—AREA —- DESIGN FLOW.10 BEDROOMS O 110 GPD 1100 GPD ro RE RVLADEn wTH HAmE EnsnxD_AR ro az EIAu® \ HAnnXcs W1TIR3 ADRK a9r � waosD IRlEIr41L 1 I \ - N WDOcS OR EOUA\ \ EXISTING 2000 GALLON SEPTIC TANK LEACHING: 54'X 30'LEACHING FIELD \\I I 54'X 30'(.74) 1198 GPD>110D GPD \ COASTAL DIME. \ 225/017 PROPOSED: �I DESIGN FLOW:10 BEDROOMS O 110 GPD=110D GPD MAP 225 °°�9`' i \ WG R9U,G VABeTH \ EXISTING 2000 GALLON SEPTIC TANK TO BE RE-LOCATED \\ \ PCL 13 -__) I KX SMIGBAVB \ AND RE-USED 1..31 AREALTYTR LEACHING: C+/- \` III \ 5 PROCTOR�'I" REMOVE 42 SF 2 OF EXISTING LEACHING FIELD CHELMSFORDNIA It LOCUS- _ I \01821 95 5.1'OFF OF PROPOSED HOUSE 42 SF(.74) 31 GPD 125156250 NOTE:HOUSE LOCATION 1198-31 1167 GPD>1100 GPD OK J APPROX.FROM G.I.S. LEGEND PRO m oLxraw\\\ •\ `\__% /�� ®89 I 7 PROPcsm Lswr D..f9AA 225/014 I \ F -��IESt IroLf LE AL LIM K / \ u 3 BAYS Naas l01[OGRgIP DEDIIG O3LA _ . M DB`MM 257 I '-a, urc POLE I O 225/015 _x—%-MRK UOIE KURKM LD ARD TR J OV fIECIwL ('lO1LYA �E NNIS- -— D[IELIwc -TWUNA I\ TEa SE.PnC ZONE We 1 v\: SITE PLAN OF LAND \' \ IN a- I -- - WEST HYANNISPORT, MA p 86 2M15 AG01Y6 0EMB& #38 MAGNOLIA AVE EeOEAN,SL\ PREPARED FOR 135 RAIL TREE HIaRD \��\� WOODBiRtV,Cr06798 53=d \' MAGNOLIA AVE REALTY TRUST ---- DATE: 8-27-2D13 REVISED: 9-17-13(ADD'L LAWN REMOVAL, INVASNE PLANT NOTES) REVISED: 10-29-13 FOOTPRINT.REVERT TO ORIGINAL HOUSE ROTATION \�- REVISED: 1-14-19 FOOTPRINT, REVISED SEPTIC �''W1���� I[A� N soe-wz-45u itl '� � \` AgIEL '�J.lo SDR-Sfit-eB80 I ao.N�oro.�om a D xl6u d S'Qy�_ � °J^ s OM'O COO LT _`gym _ o•amep�,' civil engineers xs� /and surveyors SCOlO:1'=20' I aum� v v,11 SHE'LOF2" 0J9 MP;n SI-1(Rtw 6A) YARMDU3HPORT MA 02675 0 10 20 a 40 30 rEEI DATE DANIEL A.OJALA,P.LS..P.E. +R AL60 560 I\XI-7 A'i3oenmw.n(6Hv-ET'2 or'>_� 'IS-04p 845E,DwG No. Fee f BOARD OF HEALTH TOWN OF BARNSTABLE 2pplication jfor Vern Construction Permit Application is hereby made for a permit to Construct(1/j, Alter( ), or Repair( ) an individual well at: a �a tee. C � 225 I ation-Address Assessors Map and Parcel Owner Address 2z1 n MA o 2(`3i Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well —1�t S W-q o Py C) / Capacity Purpose of Well /— Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certi cate of Compliance has been issued by the Board of Health. Signed ��Vx its Da Application Approved By / � 1. Date Application Disapproved for the following reason Date Permit No. Issued V� ate BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( by Installer at has been installed in accordance with the provisions of the Town of Barnstab ar f He I Private Well Protection Regulation as described in the application for Well Construction Permit No. r` ted THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector 100 .. . No. � / Fee BOARD OF HEALTH TOWN OF BARNSTABLE 0(ppYicatton _for Yell Construction p ernuit Application is hereby made for a permit to Construct(4, Alter( ), or Repair( an individual well at: bobation-Address Assessors Map and Parcel Owner T J Address Installer-Driller Address 1 Type of Building Dwelling Other-Type of Building No. of Persons Type of Well S C�1ti l o C'�l C. Capacity Purpose of Well t Agreement: r; The undersigned agrees to install the afore described individual ell in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certi cate of Compliance has been issued by the Board of Health. Signed I J J/ / Da Application Approved By U U1� / Date Application Disapproved for the following reason . Date Permit No. p Issued /ate BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) by Installer at has been installed in accordance with the provisions of the Town of Barnstabl oard He t• Private Well Protection Regulation as described in the application for Well Construction Permit No. / r rated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Veil coon,5truction Permit No. ov, Fee t Permission is hereby granted to ox L.L� ns aller to Construct( Alter( ), or Repair O an individual well at: C? No. 1 i Stieet as shown on the a o pl'cation for Well Construction Per�t No. /794 ted 3 Date MApproved By / f //V � 11 s I P 9 -Sv L=A 725/011— Is 2OAIDDM wav� Woll MAP 225 A. pa_I 13 t3l AC-/ LOCUS WELL LOCATION SKETCH PLAN WEST HYANNISPORT, M it,I #38 MAGNOLIA AVE MAGNOLIA AVE REALTY TRUST GATE: 3-14-2014 wo cap*to imdq.iK 13.8' P 14 ST E GE P, OPT, \ / LA 02 03 x _/ � - x 150' SETBACK TO SEPTIC (TYP.) #4 x X �-'#7 �UNF 5�„ �"' NUM RED FL '�- - - OF DUNE GROUP DUNE IE G - Byy EDGE HOLE (TYP.) PROPOSED WELL' LOCATION AUGER HOLE WOODS HOLE GR U I (TYP.) x •v 9 COASTAL DUNE �v Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at welll Location: New Well —� tree umber: Street Name: 38 MAGNOLIA AVENUE Please specify well type: Building Lot#: Assessor's Map#: Domestic Assessor's Lot#: ZIP Code: Number Of Wells: 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS Yes C No North: West: 41.63547 70.33111 Subdivision/Property/Description: Mailing Address: r click here if same as well location addres Property Owner: Street Number: Street Name: KU RKER 38 MAGNOLIA AVENUE City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETfS ZIP Code: 02668 Board of health permit obtained: �-,Yes (•Not Required Permit Number: Date Issued: W2014 012 4/23/2014 Massachusetts Department of Environmental Protection ti}. Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock �ger (--Choose Bedrock-- 1 WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition of (ft) stem drill rate fluid 0 20 Fine To Coarse Sand Brown r YES r NO r Fast 0 Slow r Loss r Addition 20 21 Fine To Coarse Sand I Brown YES r tJ� GOFast Slow Loss®�Addition WELL LOG BEDROCK LITHOLOGY Visible Extra From To(ft) Code Comment Drop in drill Extra fast or slow Loss or addition of Rust Large (ft) stem drill rate fluid Staining Chips Choose Code ;YES r NO Fast Slow r Loss C�;Addition F]Ye �Ye ADDITIONAL WELL INFORMATION Developed Yes No Disinfected t:� Yes G No Total Well Depth 21 Depth to Bedrock Fracture -- ........................................................................ t,Yes r Pb Surface Seal Type (None Enhancement CASING I r.!Is Casing above ground. From: 1 To: 0 From To Type Thickness Diameter Driveshoe 0 18 Polyvinyl Chloride Schedule 40 4 :Ye SCREEN r No Scree - - From To Type Slot Size Diameter 18 21 Stainless Steel Well Point 0.012 4 WATER-BEARING ZONES r DRY WELT From To Yield (gpm) 12 21 15 PERMANENT PUMP(IF AVAILABLE) --Choose Pump --Choose Pump Description Horsepower Description--- lHorsepower--- Pump Intake Depth(ft) Nominal Pump Capacity(gpm) ANNULAR SEAL/FILTER PACK Massachusetts Department of Environmental Protection s Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) From To Material 1 Weight Material 2 Weight Water Batches Method Of Placement Choose (gal) Material Choose Material Choose One WELL TEST DATA Time Pumping Time To Recovery (ft Date Method Yield(gpm) Pumped Level (ft Recover BGS) (HH:MM) BGS) (HH:MM) 6/2/2014 Constant Rate Pump-� 15 1:30 16.5 0:01 12 WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate (gpm) 6/2/2014 12 15 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. PATRICK Supervising Driller DESMON Driller DESMOND Registration# 877 Monitoring[M] g Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 024 Date Job Complete 6/2/2014 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. CERTIFICATE OF ANALYSIS Page: I of 1 Barnstable County Health Laboratory (M-MA009) Report Prepared For: Report Dated: 5/1/2014 Sally Desmond Desmond Well Drilling Order No.: G1479661 P 0 Box 2783 Orleans, MA 02653 Laboratory ID#: 1,479561-01 Description: Water-Drinking Water Sample#: Sample Location: '38.-Magnolia Avenue, Collected: 04/28/2014 Collected by: Customer Received: 04/29/2014 AoutineM ITEM RESULT UNITS RL MCL METHOD TESTED Nitrate as Nitrogen 4.5 mg/L 0.10 10 EPA 300.0 4/2912014 Iron 0.48 mg/L 0.01 01 EPA.200.7 5/1/2014 Manganese 0.080, mg/L 0.008, EPA 200.7 . 51112014 pH 6.3 PH AT 25C NA 6.5-8.5 SM 4500-HwB 4/29/2014 Sodium 29 mg/L 1.0 20 EPA 200.7 5/1/2014 Total-eColiform Absent P/A 0 0 SM 9223 4129/2014 Conductance 340 umohs/cm 2.0 SM 2510B 4/29/2014 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a Physician. The watermay present aesthetic problems(taste, odor,staining)due to Iron. Attached please find the laboratory certified parameter list. Approved By: Q_ (Lab Director) ND None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, P.O.Box 427, Barnstable, MA 02630 Ph:508-376-6605 Commonwealth of MassachUsefts. Title 5 Official 1ns: ,`pect10.ft.1Form Su bsttrface Se rage:Disposal System IForr N6t"for Voluntary Assessments 38 Magnoila Ave. 11 P�roperty Address.:: - _ ........... Willie,.Goldwasser _..._... ...... r .. Owner Owner's Blame -information is required.foreuery 1A�etH �rt . V)�QK�(� G Ma (32672 5/16/2C113' .... page .. City/Town: . State Zip Code Date of Inspecfiion 22�5 O 13' inspection"resu is Must tae subrvtitfed oft this form. lnspecti ari forivas spay'Writ be>alteret in airy way. Please see complet6ness checklist at tho:end of the focfrt. `. important,When - -- - fll �tl��� j1lmg:outforms CtihY on-ttie computer, use only the tab' - key Co mbve your 1. Inspector: cursor •do not Sean M., �dtle5 use'the,return key. - Name:of lnspector Capewlde E nterpnses Company Name 153 Gomm.erclal St; Mash............pee _ - Ma 0269 City/Town State Ztp Code ...: 508-477-6877 S14522 Telephone Number. License Number �cificalen` i•certify that i have personally inspected the sewage disposal system at this address and that the information reported below is titoe, accurate and complete as of the time of the inspection. The inspection was performed based on my frainmg and experience In tiie.proper function and maintenance of on site sewage disposal systems,l arrt,a•[3EP approved system:inspector pursuantto Section 1. ,34Q of Title 5(3 Q C lIR 1414., The system ® Passes;; Conditionally=Passes Fails ❑. Needs Further Evaluafion by the Local Appraving Authority 571:6/2013 _ Inspectors Signature Date. H The,system inspector shall submit a cagy of this inspection report to the.Apr g Author (i3ol of Health or'DEP)within,:3U days;of corripieting this inspection. If the:systern i shared rem: has a design flow of 1 000 gpd.cjr greater, the inspector and the system ovine shall stabt�lt tli report to the;appropriate regional office c the E EP The original should be sen to the s #em ti ler and copies sent to the buyer, if applicable and the approving<auth'orty n **k*Thts.report cn0y de.scribe"s Condittans;at the'#ante dt inspection and unsl r the ccan$itiof use at'hat time 1"his inspection does ricat'address hove the systern ut+ilt pe rrn in t futu,��un€ter the.saavte or different conditions of lase: �J t5ins.r 3113 Tine-S:Oft c6al s ec form;Subsudme Sewage Disposal System•Page.1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Magnoila Ave. Property Address Willie Goldwasser ` Owner Owner's Name information is required for every West H Yannis port Ma 02672 5/16/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 38 Magnoila is served by a Title V septic system consisting of a 2000 gallon septic tank, 2000 gallon pump chamber, distribution box and a leach field 54'x30' with 9 laterals. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy P annis ort Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y N ND (Explain below): P ❑ ❑ ( P ) ❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 5/16/2013 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 10 Number of bedrooms (actual): 10 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1198 gpd provided t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2012— 186,000G &2011 —98,000G Sump pump? ❑ Yes ❑ No Last date of occupancy: vacantDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is p required for every y West H annis ort Ma 02672 5/16/2013 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hyannisport Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 2005 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 gallons Sludge depth: 6" l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Magnoila Ave. M Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hyannisport Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hyannisport Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons . Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber was in good condition, pump cycled when float was manually activated. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 5/16/2013 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 54'x30' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field is located in stone driveway Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is p required for every y West H annis ort Ma 02672 5/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 .... Commonwealth.of essachusetts lag Subsurface Sewage Disposal•;System Form =•Not for Voluhtary�Assessments f a 38 Magnoila Ave ....... _ __.. _ __ _ ..__ . .... Property Address: Willie Goldwasser. Owner Owner's Name; information is.. West Fi annis ort 14'la . 02672 511612013: required for every p a e CityfPown State• Zip Code Date of In dtlon P9 e Systezi ,'9nfsrrnatotl (coat} Sketch Of Sewage'Do mPe 'vewofthei sewage disposal system',.includinguties to at l"east two permanent'reference.landmarks or benchmarks: Locate:ail wells within 100 feet.,Locate where public water supply enters the btaWing Gbeck one of the boxes below: Z. hand-sketch in'the area below, ❑ .drawing.attached separately:: "N' ....... t $ Z C -2. i ;; t5ins•3113 Tale'5Official Inspection Form:Subsurface Sewage Disposal Sy%arh•Page l5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for every West Hy p annis ort Ma 02672 5/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 8 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 4/11/1995 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Design plan dated 4/11/1995 indicates that groundwater was encountered at 93"and system is designed to have a seperation of 5' between bottom of s.a.s. and adjusted water elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 38 Magnoila Ave. Property Address Willie Goldwasser Owner Owner's Name information is p required for every y West H annis ort Ma 02672 5/16/2013 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 50ffiaI Inspection ection Form c p _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name . information is CCV)fttV required for VIII�i Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. F Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name f� P.O.Box 763 Company Address Centerville Ma. 02632 ream City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the, ; information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on'site sewage disposal systems. I am a DEP approved system inspector pursuant to Section"15.346of Title 5 (310 CMR 15.000). The system: s ® Passes ElConditionally Passes El Falls ❑ Needs Further Evaluation by the Local Approving Authority 7/13/2010 Insp ctor's ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ALI- 11 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dis al System•Page 1 of Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is p required for y W.H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C Further Evaluation is Required b the Board of Health: q Y ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for y p W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 10 Number of bedrooms (actual): 11 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1198 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for y p W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2008:98,000 g ( y g (gpd)): 2009:93,000 Detail: 2008:268 gpd 2009:255 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 7/13/2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 , J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for Y P W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for y p W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appeat tight.No evidence of Ieakage.System vented through the leaching field. Septic Tank(locate on site plan): 1' Depth below grade: . feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 gallon Sludge depth: 4" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for y p W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from�top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle I Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for y p W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has 9 outlet Iaterals.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 2000 Gallon pump chamber appears structurally sound.Pump floats and alarm in proper working order. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for y p W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 54'x30'x6" ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.Leaching was dry at time of inspection. .Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Ir Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for y p W H annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 r t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 0 4 M,4,8 n b1,ill t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 e Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is W H annis ort Ma. 02672 7/13/2010 required for y p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leachfield 4' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1995 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Magnolia Ave. Property Address Willie Goldwasser Owner Owner's Name information is required for yannp W H is ort Ma. 02672 7/13/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 flA V-P or � 5 I � i CENT ERVILLE-03TERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 I CENTERVILLE,MA. 02632 (508) 7 I 90-23801FAX* (508) 790-2385 OILtHAZARDOUS MATERIAL RELEASE FORM I I F,A *: 0121 LOCATION: ADDRESS OF RELEASE: '19 Maonal i a Aran„a _rent-e—ri l 1 p MA Narvcw Rraaidanro II ' I I DATE OF RELEASE: 28/95 PRODUCT RELEASED: Gasol i ne 1 EST B'•IAfED QUANTITY._Unknown CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: Proper Nnti f i rati nnc I � I I NOTIFICATIONS: FIRE DEPARTMENT:YES ) NO( ) DATE: 2/-- ° TIME: inog NATIONAL RESPONSE CENTER:YES( ) NO W D ATE: TIME: DEPT.OF ENV IFONMENTAL PROTECTION:YES NO( ) DATE:T aztpr TIME: � 1JIL SPILL COORDINATOR. YES( ) NO W DATE: TIME.- TOWN BOARD OF HEALTH: YES 00 NO( ) DATE: 2/ /,T__ TIME: Tu'v;'N HARBORPtASTER: YES O NO(g) DATE: TIME: OTHER AGENCIES: I I ' COMMENTS: Upon remnval of 110 ga11nn fuel nil t nk frnm ahnira lar t-i nn Ia aernnd tank wag found Tt ajna»rod to he g approximately �aallon gaaoline tan Tan ran f fi l l Prl rf t-h , t-or Lii�t}i a�annrnx �~ I 4 inch i n d f amatar hole i n top of tank wbpr Fait ni na ,iapd to ie attached_ Upon remnval of rank additional rar3r small pin holes found in the bottom tank_ Th k an found to ha in n vary corn roded condition, Barnsr _ .ahle Board of Health nnrifin.l and -.-. i Ior ion nrinr to remn,%ral Additinn 7 follow—up to by rmm letad I by tl.n_H_ 3/1 /95 Roil aamnlea frrnn i-ndpr tank r Mind t-n h VR— to be leaking. REPORT FILED BY: ! I / w_ ' DATE: 311I i Martin MacNeely, Fire Xrevention OQficer WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINY.COPY-BOARD OF HEALTH C.O.M.M.FORM #58 I f COASTLAND TANKS, INC. ANKS 14 Nye Road Falmouth, MA 02540 (508) 457-4600 FAX (508) 548-7495 Apn,i.e 24 , 1995 M-s. Donna Z . KLon and-i. He.a.Pth Department Town 04 BaAn4tabte 367 Ma-La S#.;r,eet Hyammi,6, MA 02601 RE : 38 Magnotia Avenue, We6t Hyann "poet, MA Dean M-s. M-ion.a nd L; I ways recentty Z"on.med of an Incident Report Jrom you')c oj4Zce on 4-4.P.e wi th the DEP. The Au.b ject og the report way the nemovat od a 55 gatton gasotLme tank, brom 38 Magnot.i.a. Avenue on Febru my 28 duAin.g a heavy rain. The nepont Mated that due to the ra-i.n., the tank, o v u"towed, -&pit Lmg .i t.,& conten ,6 and that Coasttan.d Tan" appeared to be un re aped p p and without the nece-e-sary equ.Zpment to p&e$o un the remo vat. In gact the ex i.3tenee o4 the g"oLi me tank was a comptete ,sun.pri,6e, Coa-sttand Tan" waz onty contracted to remove a heating o Lt tank. The heating oit tank, wa's removed w.i thout amy probtem, the tank way in. pretty good cond-a t-i,on and thew, wa,s no evidence o4 any retea-se. Fonta atety , whUe ,Lemov-i.ng the oit tank I j"t saw what Looked ta.k.e another tank. When the d-i,�t way cteared 4rom around the -second tank, it ways -seen to have a hote in the top where the 4ZUer pipe had %"ted through and 4aUen into the tank wh-ieh he.P.d a mixtune o{ mo-stty water with some g"otLme. The owner w" not home that day , we Later tea.,rned that the tank. had -stored g" j on a backup ge.nenator. 14 some water and gam oven.6towed 4rom the tank, that -shoutd have been av o-i.ded. I am awaAe o{ the Zmportanee 04 preverrtLng any and a42 %etead" and I regn.et that the b ew m-in te.s o4 detay r"u Pt ed in the o v er4 tow. However, witAout my uneoven,i.ng o{ the gay tank an underground rete"e would have continued into the tutu-,Le every t.i.me. it nain.ed and water worked Zt--s way into the tank Note. I own and d-i.d have my HNU with, me but with the heavy ra Ln and ezpecti.ng onP.y heating oit I did not have it opena.�:ng . I COAST AND TANKS, INC. ANKg 14 Nye Road Falmouth, MA 02540 (508) 457-4600 - FAX (508) 548-7495 a.?,-s o n etunned Paten. -La the day and co v eked the temo v ed di At wi th poly and made aAUrangement-s 4 on an env4Aonmenta-2 con sultan t to come to the hou,6e ean2y the next day to pe4.4 onan aU needed mom4 ton i.n.g , actLon and noti4,i.cat.Lon. The con-suttan t, Compt Lance Env-vconme-nAat. Inc. zupenvi-,&ed addit4-onat AoZZ n.emovafi- can ey the next day. A4ten. tab to st.i.ng the eon.eu tart pn.odueed a jcepon t which cone tuded that accond.i.ng to the Lequ,ULt-tons att contam4jw.ted -sow had been removed. I 'm told that a copy o4 the ,Lepomt. was Aent to you'. o44-i.ee and the DEP. I have wonh.ed " an env4,,Lonmen ta.2 eomt aeto L bon, oven, 5 yea,". We have made a ta,Lge Zmve- tment o4 money and comm, tment to the bcusin"-b. I enjoy my wonh and ass a na tute .oven, and 4i,6hexman I t ke pn,i.de .i n doing my panes to cf-ea.n the envi,&on.ment. I wound hope that my yean-s o4 expen i.ence and my e64ont,s to do a t work, comptetety by the negueati_on,s and a eons--deAa Zon o4 what is night ham nesuR.ted Ln, Co"tP-and Tanlvs hav Lng a good nepu to ti.on. I tnu.L'y Leg Let that you -6aw my eb6o4AA o4 Febn.uxmy 28 ,Ln a pooh. tLght. I hope that thug .letter, cta ,-%"-i,e s 4 on you and the DE P that C oa-6t-lCand Tanks d-i.d a good job and that 4 on tu.nate ty an abandoned, appan.entty 4on.gotten tank. was Le-moved 4n.om the env-vconme.nt. Shouk.d you have any quest i.on,& on comments -ega.,Ld-i,ng thus matter, do not hes- tote to ca-U me. S4-mcen.e.2y ; Kenneth T.,ojano Pn.oject Manager. C o"t-tand Tanh s Inc. Title S.- Draft Printed September 20, 1993 Appendix 4 Page I No.. -p_ eA Date - Commonwealth of Massachusetts Massachusetts Site Suitability Assessment for-01 On-site Sewage Disposal ..... Certification Number: . .......... ......Performed By: ... ........ WitnessedBy: ....................ED.............1.5AP-Z..................y...............................................................:........................................................................................ Location Address or Lot No. Owner's Name, Address and Tel. 8 36 MA614(01-IA 1=-70 -T'i:37C:;;A-P- 14yAjiu(,sfba:r, M c/,, Xz,.4 a V- 4 4 A,e y jib OLD LILVGe-, WAY 60T U.I-r 02&&5' New Construction El Repair Office Review Published Soil Survey Available: No ❑ Yes Year Published ... 1113 Publication Scale Soil Map Unit Drainage Class . `..... Soil Limitations .. ...................................... .......... ..................... ........... Surficial Geologic Report Available: No ;K Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) . ........ Landform .. ......... . . .... .............. . ...... Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes ❑ Within 500 year flood boundary No ❑ Yes Within 100 year flood boundary 'No ❑ Yes EZI Wetland Area: National Wetland Inventory Map (map unit) . . . ........... .......... ........... ..................... . ....... Wetlands Conservancy Program Map map unit) ... ... ...... Current Water Resource Conditions (US'GS): Month IAPF11— Range Above Normal D Normal llul ul Below Normal D Other References Reviewed: .. . ...... . . .. .... ..... .......I...... ............. .. ...................... ........... ............. ...... . ..... .......................... .... ................. ................. ................... .......... .. ......... a 71110 S. Draft Printed September 20, 1993 Appendix 4 Page 2 On-site Review Deep Hole Number .. ..... .... Date: Time:.... ...... w Weather Gcaa(- Y Location (identify on site plan) ............ Land Use Slope 1%) .....�...• Surface Stones ... fit Vegetation Si`t- P(.dal (MoD E-::-eA-TE) Landform F1.XT- Position on landscape (sketch on the back) ............� Distances from: SEF SAP I (L Open Water Body .... feet Drainageway . ........ feet Possible Wet Area .... ... .... feet Property Line .... . . ...... feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure,Stones, Boulders, Consistent % Gravel) A 6"d(C �. �- Flw.l!✓ A _ 41, dip . Parent Material (geologic) .... - Depth to Bedrock: Deoth to Groundwater: Standing Water in the Hole: • C5 Weeping from Pit Face: i,240 Estimated Seasonal High Ground Water: + 2.7j Fe';DK �.�i�l�1�►C� kl�Tt:C. ?Title S: Draft Printed September 20, 1993 Appendix 4 Page 2 On-site-Review Deep Hole Number .. ... Date:......474-- `' Time:.... .Jo` c--'r- Weather CaaL-- - 5LJL""N/ Location (identify on site plan) ...•.......... - Land Use .... Slope 1%) ....,� Surface Stones ... �.b Vegetation Ko -FEAT C Landform FLAT Position on landscape (sketch on the back) ...... X 07...•.....SiF-p-rtc, PLk Ll . Distances from: - CC tflA" Open Water Body feet . Drainageway ...... feet Possible Wet Area .... ... ... feet Property Line . feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) )Structure, Stones, Boulders, Consistent %Gravel) SAla0 2Cv �t 3' C MCDictNt - - �S(t t.Y Parent Material (geologic) Depth to Bedrock: .?- Joe,' Death to Groundwater: Standing Water in the Hole: V1(eeping from Pit Face: Estimated Seasonal High Ground Water: + Z.3 rr rl'-o( (1 WAI e Title S: Draft Printed September 20, 1993 Appendix 4 Page 3 Determination for Seasonal High Water Table Method Used:' 'T,�ST pi T- Z. ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole i2 inches ❑ Depth to soil mottles inches ❑ Ground water adjustment Z,-3 feet Index Well Number ...MNY-ri Reading Date Index well level Adjustment factor .....K°A' Adjusted ground water level T.5 Percolation Test Date: -.CD -�i' Time: ........ Observation Hole # Z Depth of Perc - Start Pre-soak End Pre-soak Time at 12" �b Time at 9" Time at 6"Time W-61 14 llJ Rate Min./Inch M� _40 51=c Site Suitability Assessment: Site Passed r Site Failed ❑ Additional Testing Needed: I� Performed By:. M . ait.�.y Certification Number: �-- Witnessed By:...... ......FD... .... ..AW—Y........... ..._..... .. Comments: JOHN V. H RVEY AT romY AT LAiff 116 OLD KINEiS ROAD 00TUM MASS 02635 (506-4E26-8017) April13,1995 Board of Health Town of Barnstable Town Hall Offices Hyannis, Mass 02601 Teczar Property 38 Magnolia Avenue,.West Hyannisport Gentlemen, Please find attached an Application for Disposal Works Construction Permit to repair an individual sewage disposal system at the above address. I am also enclosing two copies of the "Site Suitability Assessment for On-Site Sewage Disposal" performed by John O'Reilly , P.E. and four blueprints of the Sewage Disposal System prepared by Bennett and O'Reilly, Inc., Engineering and Environmental Services. Ve o ru JVH/sam V , TOWN OF BARNSTABLE ` 1 LG;CA ON J? M kj AM Ii�FJA OF SEWAGE #IV �r/S VILLAGE�� Per ASSESSOR'S MAP Cz LOT 1� j INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY c� D 00 LEACHING FACILITY:(type) 80Xd-r (size) NO. OF BEDROOMS 16 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 9� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No At 0 q 4 MA A)O �'� ASSESSORS MAP NO. -� PARCEL NO. No..�:�...� �I THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiou for Di-nVniiul lVarkri Tattitrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 36 i"1�1J0L_1A vr`. 1� f ► �S 1' Z3 Z ........................................- ..... -- -•-----•------ ------- W itio_n-:Add D - -11 _ � ! 0 Ei ........ -- .... wncr �_Addres 1�1 � Addres Type of ildi g Size Lot_______- _.............. .-. Dwelling— No. of Bedrooms___________________Vb_________________-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ----------------------------------- W Design Flow.....................5'15-.--__--___----gallons per person per day. Total daily flow-.------_-___--____---lbC�_--_-_____gallons. WSeptic Tank—Liquid ca acity_ ?_gallons ength.-J 'B____ Width.4_'-4__. Diameter.._------------ Depth.......5 x Disposal T-reneh—No. : 9ZO.... Width.._. --- Total Length....... ...... Total leaching area---- ____ PD Seepage Pit No--------_---_-.---. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (X) Dosin ta��nk �( t '-' Percolation Test Results Performed by. _1!__..�_0-`?_11,J],R_-_ Z.4 Date----_ d �� 1 - ......... cl Test Pit No. 1__ _ ___ininutes per inch Depth of Test Pit.___1' ".______ Depth to ground water..........1._.._...... G14 Test Pit No. 2_-.�-.____minutes per inch Depth of Test Pit-----1W ----- Depth to ground water......A Z.0... _ P+ ------------------- ---------- ----•------••....--•-----•------•-------•---•-•-----------------••---•------••-•-----------------.......---....._--•-••...... 0 Description of Soil------- .... ..... C -----�?lL------ ?............ x v ---------------------•---------------dam . - ...... ��---------- --- x ----------------------------------- --------------------------------- - -- �-��- �� ! �,�'�. ee�� U Nature of Repairs or Alterations—Answer when applicable---------/.A ' Xlerwz......PF-__OeFxi V6. ------------------------ -.......... �L. Agreement: ` The undersigned agrees to install the aforedescribed Individual Sewage D osal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The ersigned rther agrees not to place the system in operation until a Certificate of Co.mpiiance en issue y the oard health. Signed .. -----. .. .......... ... .. Application.Approved By-. ................... . ....... ---....... - - - . .. ........ -r Due Application Disapproved for the following rearons: ......_............._......................_..._._..._....__-------------- - _...... ----------- - - _ - ------------------------------------- -------- ---------- . --V ace Permit No. � .- T/--- --------------_ Issued .`.. Date N. - 1 THE COMMONWEALTH OF/1JlASSACHUSETTS BOARD OF HEALTH i TOWN OF BARNSTABLE 2�kppIirafion for Diti-Vniiul Workii Towitrurtion rumit } Application is hereby made for a Permit kto Const_ruct or Repair (x) an Individual Sewage Disposal System at: M� r�. r .................................................C�1. li ..................... --•--------LTS----Z-3 --=-z42"---._�.__..�o� ................... atiou• \dd cs or Lot No. ............ D -T -.... o_ ou>J. .. ..�(��Y�Y_ I.l� O1�_Y�e�Y�S_..Pr_4D teener ---- ------ �T �J _ Addres ►.a Iust le Address Type of ilding Size Lot._______`z ___.__._..S� Dwelling—No. of Bedrooms._................1 __.______-_-__.-_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons---------------------------- Showers — Cafeteria a' Other fixtures _______________________________ _ _ W Design Flow..................... .'.............gallons per person per day. Total daily flow..----._____--______..-ttoQ-----------gallons. l� WSeptic Tank—Liquid capacity-9�_gal Ions ength...14-o---- Width_& �.- --__ Diameter_............ . Depth.....5�...--.4 x Disposal T-remli—No.f ELJ�___. Width....�4....... Total-Length......-a�.... Total leaching pd Seepage Pit No_................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box o) Dosing tank ( I Percolation Test Results Performed by. �I.._.._ ..olp_.�t�,�, .._ S� Date.........'... ..�.............. a Test Pit No. I. �_ ��.-.minutes per inch Depth of Test Pit-----q5 . Depth to ground water..........9"- ....... Test Pit No. 2.'4._ '___minutes per inch Depth of Test Pit_-_ ............. Depth to ground l^ Cs+ water_._-__-l�rc-_-_--. ---- ------------------••--- x ------•-----••-••--•------•........----------•-------------------.••----------------------•-------------..........---.----- DDescription of Soil-------..... --- A;?%em...--- �---- � ...... M --•-------- ......................................QF----� ---- I% ---- ---- -----------------------------------------------•------------ W --- ......... `!E ---- PGA/--- --- 04 i s........................... UNature of Repairs or Altgratio s---Answer when applicable.-.-__-- 4AA o 9,='rC/7......0 ......................................... .............................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage D' posal System in accordance with the provisions of TITLE 5f the State Environmental Code—Thtderstgned trher agrees not to place the system in"operation until a Certificyate of Compliance en issue y the board 0f healih� ,� E� A , - -- - - Signed - _ v .f-- .-....! ��G+ ------- i torte^ Application Approved By^ �� 2 .i`.- .-._..........._. „" t/ -�J . .. .. ....... .... ........ . Dare Application Disapproved for the following reasons: ......................................................-- ..--............ - - .....................- Permit No. �`J..... C�'il-- ---------------- Issued /�........ ............ Date THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifirate of Tompliartrie S 1S 90ERT4 at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by - _...... . - --------------- - -.............. - -------...._...---..-._.. --------------- ----------------------- n''}}�rdlcr at ..........................-............................................................ t------ - has been installed in accordance with the provisions of TITL 5 of The State Environmental Code as described in,1,, the application for Disposal Works Construction Permit No ,;� ���,.7C�r-� - dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........-_�..._���.....-_.S............................... _ ......... Inspector . .---_----------:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a TOWN OF BARNSTABLE rr or�blio �. #ru#ilan "amit gr_C Permission is hereby granted • <a l(...--- l -%--, � ys, =-•---.-_-_---• -------------•----------------- ...-.------.._. to Construct agair n Indi 'dual eta,g� ,Dis-os/a1�Systerrt I at No..... ................ UE...a......!tiC�...- — f Stree ,�/ as shown on the application for Disposal Works Construction Permi .... ��Dated....?"... � �� .......................... r DATE...................... ------------•--_----. �J Board of Health ----- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 1/9/14 AsBuilt t C ,TOWN OF BARNSTABLE LOCATION J? M�¢�1 9 A ug SEWAGE t! VILLAGE � N�7lS Pa2T ASSESSOR'S HAP & LOT INSTALLER'S NAME & PHONE NO.��, sEp� �, ►� 5. 0 -s���a59y SEPTIC TANK CAPACITY "4 D 00 r tt � LEACHING FACILITY:(Cype) (size) NO. OF BEDROOMS _)L) PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 9� DATE C011PLIANCE ISSUED• VARIANCE GRANTED: Yes No i' 0 4 f yQ�o A)O i ssq 12/i ntranet/propdata/prebui It.as pC?mappar=225013&seq=1 1/2 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE SYSTEM P rI;y F'L r„t,r•.��; \ TOP FOUND. EL 15.2' (NOT MAs y : aaFS�t�N� MINIMUM J OF COVER OVER PRECAST ' ti\. DANIEL A. yJ o OJALA , PRECAST H-10 JA RISERS (TYP.) 2'0 4"OSCH40 PVC kNo.4650 PIPES LEVEL 1 EXISTING C� s E R� c''� *10.62 10" 2000 GAL H-10JE t�= qc 4 L ti, 9 02' TEE SEPTIC TANK o AN{ELA. A. m $.77 000pop000000, U OJA!A OJALA co GAS BAFFLE °o�oo�o^o^pS CIVIL o No.40980 • 8.47' 8.30' pN0.46502 o �opesstiO�P a : 4' LIQ. LEVEL (ACME OR EQUAL) s�� a`` �qN o�;,} U00 O O O O O O O O O O O O O O O O O O SU O O {. • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 �•-• / ppp0OipOOpOOnO�Onp00�0'OOOOOpO�OnOCpnp�p�p�p7pop10. \ •Y.' ' 6" CRUSHED STONE OR MECHANICAL '\ COMPACTION. (15.221 [2]) ( % SLOPE) ( 2 %d SLOPE) EXISTING 5 1 FOUNDATION 32' SEPTIC TANK 15' D' BOX LEACHING **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 1000 GALLONS AND ITS SUITABILITY FOR RE—USE. REPLACE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE — _ J.-\ yv r CILITY - P — — 09g6� /(/, A *. i ne\N It I S = T/ 7_/T/r71�' I 2 •°� FE 'C 5 I Z-Z C� 4 / w DECK I � T/ ion . o , PROPOSED SEPTIC ADDENDUM TO ACCOMPANY "= n � SITE PLAIN OF LAND Scale:1 10' IN 0 5 10 15 20 v25 FE WEST I-IYANNISPORT, MA off 508-362-4541 fax 508-362-9880 #38 MAGNOLIA AVE I downcape.com PREPARED FOR NOW/1 A1,0e eagllleefill. /AC. MAGNOLIA_ AVE REALTY TRUST civil engineers land surveyors ������ eL� 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 13-040 KURKER.DWG DCE # 13-040 1p?SS�Tp N 3 ,S 07 26° w � o � N •— .No y 3 N 7 e 011e .— CV 0 V) 3 EASE GG Nantucket S AVE. OLIA TO Sound o�9 tI r [I 00.04' vT N 86'4643° w LOCUS MAP ` NOT TO SCALE ----__ ASSESSORS MAP 225 PARCEL 13 ---__ INV. OUT ----- fit 9.33 LOCUS IS WITHIN FEMA FLOOD ZONE A13 '----- r (EL.12) ZONE B. & ZONE C, V16 AS _ - SHOWN ON COMMUNITY PANEL #250001 .4,W a 0008D DATED 7/2/1992- HOUSE AREA �� 3 MAPPED ZONE C & B INV, IN 9.65 z ZONING SUMMARY 3 O U M W Z ZONING DISTRICT: RD-1 DISTRICT `�`' o CONCRETE o o f w MIN. LOT SIZE 43,560 S.F. FOUNDATION o ;) MIN. LOT FRONTAGE 20' T.O.F. MIN. LOT WIDTH 125' EL. 15.3 z N MIN. FRONT SETBACK 30' z MIN. SIDE SETBACK 10' o MIN. REAR SETBACK 10' z MAX. BUILDING HEIGHT 30' J SITE IS LOCATED WITHIN AP AQUIFER PROTECTION DISTRICT ~ EDGE OF DUNE 3OJALA Cp ` Qn 10 NDATE DANIEL A. OJALA, P.L.S. o z v> vi. 0 o: 0 0 3 AS—BUILT SEPTIC SYSTEM LOCATED AT #38 MAGNOLIA AVE WEST HYANNISPORT, MA PREPARED FOR 3 MAGNOLIA AVE REALTY TRUST 0 �f MAY 22, 2014 c off 508-362-4541 fox 508-362--9880 downcope.com down cape g111eerh7,g 7C.. civil engineers Scale:1"= 40.' land surveyors Ti0 939 Main Street ( Rte 6A) q( YARMOUTHPORT MA 02675 D CE # 1 3-0 4 0 0 20 40 60 80 100 FEET 13-040 BASE.DWG rip r Lo�t� q) +•'Pace -To Pts+c�ME7..1rr .��_ stt.�f �Ef1 �=oK- /Q � �6 ;'7?y 9\�C. ./ 1 _ -- — _ _ r:I Cw 5��1 SNALt_t3f MI, u,u, ' (fix ► } , ^ �EA�'� A 1.11-7) RA IGEL> L E VG:L. STd.lir E'<l"'TG +-iCFAizZA{lCaE -7RT IT •F-ST P1T 2 ►o) �!V�- WAY �,L(� L _�? R IiM,41u (aQA CL --- _ _....___.____ " W WA i �= Q.(ot FL= I/ r,,t (PE-evinL�� 43Ll ' ►.17T RE: FAVep. L ►�CNMAQIL / 1 !F{E �, _ - --__-. x (5eADE oVFe » �. �uaLl_ e,E AS -v� �� , EY-t 1© 1 yr ►� - L ��. AT }' .;:�eTN ✓rAli:v '` ^��Aal �zYrLdr�IL �I,ICt-t ds R> �.u,r .i LL N CAM " + ►? �LAT'ICA--I ATE :E61, T�-I4-t 1 '5 .n•;i ;yctt D- 4-;r Aij )tkk, vATnt. j D4T+.Ltti: LAB M'�t •on2� ai>. �/` 1 � � �' <ul> ;�adP►1tT�.P,� : !•��::,. > t7 1.1 SILTY �JA�U C' Y.1C►7t1A1TE1?ETj a-� DCl�TC �rPA �f i IZ T '17o GAL_2 S.t��Ic► �!i �'r l�Wa _M L oAMY 1 D �'`� M I r t 4 0 �.Ec� !+~tC�t� �_-�__ cr IC - �" +vf 1 toY - hArr1P 3ca Tb :ovr`V- F-I EL-, •To A DEYTu of ._ "'�. _.- - ! - + o� lL N TAUk WASPS 33 aAL/14CI1 DF '1 WII!I� 454 X r yEet �Z _— C' 3e" - - DE?'T►•t. uM �YGLF Z.� N FL \ � -' �a?rA ____ ti/IT1.lE�-�E;� �3Y• T t7' F P VILL A �� --.�AC � Via. MEDiut/ F rA 4,b�ly pley �AEAUn-1 -�T L TiMF� A DaY �MAu�. T i �Ih1w�u, � ! warErz , 4A7>Eg.Atf, (Tyt� / r w,,-r PIT If �!r 6wp I ! !3) PUMP c►1AMe� NA�7 24 Ne(11 �iaL) �' _ . I I too gToeA a>< Ay v FbC Pbx, Er /Purhr r EDGC opi61 ' _ •� _ /¢ . �'' v ; (i�c)rJL7 YIATY-12- GoL��S.�F�,�1] FA t�_u / " - `_ Ee e►¢I. r xrgi WATF_f� -- NlE??!UM o 1,�t<.�Ch E<�"T �'1,47C �!�'E• = Z.'�- � '�. 'S�tb'v �-. e� ��� __ --- __ __... __ - t tOLA)( T` �2'! - - -.Z)oc^. l�X�T tL{C� - - 14 :.--VEIL ' TE��t" P+T z MWIMAL 64AD!►e. FRDF'u�EP Tc y �Trsrs}, \ BOO GPD A 54 x �' LF-Acp Fib LD NAS A LoAD1►.�6 G4PAclTY OF' C r Uh_F��_ �_r Ya'r Typ) Y-r `54 Y, 5e) x 7`tit a v%* I 1`3 F� �Pp ( PEPG !�,5 6LASS t + ) ► 3� f „� too' Fo4t-k pU►d l= ►� 'TALL. o►J� ► - mac GAL <.�t�c. -'�4►.tK !!<�o ,�Pv 15o°e = i(�o GAL czFt� 4 to QL- PU `lp Dr-r--sJ a k,. oVCe PUMP EFF, Pl.[MP w/ Ai-AQM, t! UI E7 MYF V-�� WHR 5 NP PUM og ,4PC�4ovEC, EQ"AG> Dis i E.12>(.t T IC41 e4X DIL;l, - H-Zo VA—t CD) OWE (1) - S4�x � fEAr _i, �'ik:"� Vr = l ', aPD > 11C� 6PP 2E61I� N'JT'Ch_: t) �iAl E DIG�R��L. l�1aT �L.�icJl-"7.) w/ T111S DEst�-• ►•.1 , LOTS 2 36-"r4 Z) TOPSoI L (0P_GA0IC✓ , F Ej I.OAKY �,��.1 n•� E'I.jG0LA07I 1 F-1� T.ilA.V- ►A6- i'4-STALL 4Ttvi.1 OF- F-tF'L.D hHA -L-L GE l2FMovE'ID !AF, Tt:) A ZlA;,TAMcC OC- S AROULJD MqFE4P,� i 'rrsrk� JI FELLS ALID De>wid TO H -!�-;1L7Y '"iEPlUPS 6aA1,1D (l'-L = In.i-)7 AWO jza-PL.AC-jE:-D w/ A GLEAE.i ��Qe�E <„A►.1L u IPACTEU Tb MI►.11M IZ't7' _F'tTL_FME1.AT. (6e7c Qon ��A I._.L. e� W O-r I F I IE-D l F -I L ^^I.1 L,!Tlnti l S CN A 1 1(_a E FQaP'L E`u L.TS �F�. -- h�+ 1�.1 t4P��1E . �u%I�i'F"P_ F l►�SYi=CT!���1 IS klE,-QED; AAA[-i- EE Oe7rnFtE� FIrL.1) �HAL-.L LE �!c= TA!�t% Y �M�' tA M►31=1� <-,h4 Ll 1?5E H--&-) RA77 FoMX - °tom t) QI.ID ecxtu 'fA�J{C�, LNA{_L t?>C t�!dOt�:. tr1aTE"�TIGNT w�' -rNn�U41r dl �If3+�WF;LI� A 9fkl7-n"t7V- PLuI =f� SEANtS., r r r + , ALL '� - P(�G1`(J �!J :_�ME'AC T!✓!7 MATEe1�L. . u►A fz I z:Z!I""i<��1 p- N � Al-L LA TELA L-� \ _ '7) ALAeYi, ✓,�4A LL 1-IEZ' ')F G'wELL I►s: L PJWIZt >3y ,c SFPA•tATE u i i `✓1� �� C t ec u rr Fvcr-1 TI ic Pt.a tom'P. J to . $, k/dTt--2 Ulir �,04LL eC �?-ELnc-47 0 To la F-Wk-/'t •Y TF7�f i�/Nf~fzF `�FIn�EtZ `F"e�E'eE� � Wi114, �T�� ' '- �PLE DI-: J7A !CE- FtZOM --kNklT-c, To W MAOMItr-1 �b ) ..i►.J�� G � ra•! a _; - A�1D �oT!••t L1�1�� To � �L.��. i so r 1 P E• � PG,oPo"C T Taint,! WdTE pIA �,Cs1 qo "('ERA° ALL DI-,' L.1f1E4;,Lo i ozx-A ,� v f � PtTi✓4(ED f Toe �Dl l r.l DA i k�► ALL CoY��s Tc Iv'I T 1 i i�1 _ !�1 L ET TrE ,12 2 LAYM JF El-- (4.(v + ^' I'-o" c� FIrJI��+•-t . � �pF?,_•,-_u_Z'> Ye'�. �1~`'°T8►tE ���isfi` 3o r t o Y Z 2.t' II.°>1J� f ! o� PROJECT / 14 R�i�E' l T 1 I " DPl�P TASE Yll_VE *`K$L `./ o - v �IEA�!- Mam .A�r;, }e fir! w k:a6oLlA AVe 1^� N�A�I►1}<> Q"� M4 • I gE14 „ Z4 '/av ��cradF" {; s�.4P,o ''I ' ► ` N�c« ,okvF I al _ ALAOM .�tl' TNrIJ�s� f3LaC1C1►�a �- Abow'E E'67 4L � �°,`� - - � TITLE _ oD Au- r��}ll�� MAX. Gi'oLL►1vW�tEt � � � � Lj C���Gk: �I�F `�=-<'� ._. `jY�T E i"L Rthl!' ALL GPbV1T L1LlEh �" �o" --Surl� h. 1c , . \ N T �_L I F4` ° lo,c LIL1E� ExfTr►Y D l`.oX MUD>T ' = o ,J � B E N N ET T 1� 'R E I L LY, Inc. LI`'�L 1-0e- Z-.. PPIo _, M e� <'. _ / �FT M1t� Z�[y, �a� ��,�^ //`` �t.314 Engineering 8. Environmental Service. - !L.JI_.[_� C71�� To PI'lZ 1 r�t , Dt W'�.t r' E^!C L � s O - ---_ -- --- ---___ ALIBI IN W �C^rrr-� �UK.. B Underpas% Road o '' f3r(wstc titA 026i1 P.O. Box 166, •r, 508-896-6630 Office 508-896-4687 Fax - (N DATE: SCALE: BY: CHECK: JOB NUMBER: 3 ALL !��jTLSLLQTI'�1� 'G"AL--L e F I0- tjC 111 LiTL'lCT ;_:cSMT'Llst CMS 1S.00 (T TLE � - ' :r� 1�C' X�P� ( � ;__. •r' W I `,i I Commonwealth of Massachusetts Executive Office of Environmental Affairs Dep a rtment of Environmental Protection ' Southeast Regional Office William F.Weld Governor Trudy Coxe Secretary,EOEA Thomas B. Powers. Acting Commissioner URGENT LEGAL MATTER: PROMPT ACTION NECESSARY o o0 TRTIFIED MAIL: RETURN RECEIPT RE UESTED i o ® March 2 , 1995 Thomas Teezar RE: BARNSTABLE--BWSC 38 Magnolia Way 8 Magnolia Way 1 Centerville, Massachusetts 0263,2 RTN: 4-11167 NOTICE OF RESPONSIBILITY M.G.L. c . 21E, 310 CMR 40 . 0000 ATTENTION: John V. Harvey, Esq. , Agent for Thomas Teezar On March 1, 1995, at 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 . In addition to oral notification, 310 CMR 40 . 0333 requires that a completed Release Notification Form (BWSC- 003 , attached) be "submitted to the Department within sixty (60) calendar days of the date of the oral notification. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c . 21E, and the Massachusetts Contingency Plan (the "MCPtt ) , 310 CMR 40 . 0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result front 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 11 : 30 a.m. ) is/are a Potentially Responsible Party (a "PRPtt ) 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 20 Riverside Drive • Lakeville,Massachusetts 02347 9 FAX(508)947-6557 • Telephone (508) 946-2700 ,r -2- 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 . 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) : • Excavation of 6 cubic yards of Contaminated Soil . • Proper, Storage/Disposal/Recycling of all Contaminated Media. • All Remediation Waste must be properly handled and disposed of within 120 days from the date of generation per 310 CMR 40 . 0030 . Specific approval is required from the Department for the implementation of all IRAs, with the exception of assessment activities, the construction of a fence and/or the posting of signs . This site shall not be deemed to have had all the necessary and required response actions taken for it 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. Additional submittals are necessary with regard to this notification including, but not limited to, the filing of an IRA Completion Statement and/or a Response Action Outcome (RAO) k -3- statement . The MCP requires that a fee of $750 .00 be submitted to the Department when an RAO statement is filed greater than 120 days from the date of initial notification. You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at this site . You may obtain a list of the names and addresses , of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1145 . If you have any questions relative to this notice, please contact Michael Moran at the letterhead address or at (508) 946- 2855 . All future communications regarding this release must reference the following .Release Tracking Number: 4-11167 . Very truly yours, Richard F. Packard, Chief Emergency Response / Release Notification Section P/MM/jt CERTIFIED MAIL #P656 826 576 RETURN RECEIPT REQUESTED Attachments : Release Notification Form; BWSC-003 and Instructions Summary of Liability under M.G.L. c .21E cc : Warren J. Rutherford Town Manager Town of Barnstable 367 Main Street Hyannis, MA 02601 Board of Health Town of Barnstable Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Brian R. Grady, R.S . Board of Fire Commissioners Hyannis, MA 02601 DEP _ SERO ATTN: Andrea Papadopoulos, Deputy Regional Director 4 COMPLIANCE ENVIRONMENTAL, INC. 31 Fremont Street Needham, MA 02194 617-444-5950 ENVIRONMENTAL ASSESSMENT AND RESPONSE ACTION OUTCOME STATEMENT RELATIVE TO A RELEASE OF HEATING OIL AT W 38 MAGNOLIA AVE., , v DEP RTN. 4-111 f 7 -' C Prepared for: Coastland Tanks, Inc. clo .John V. Harvey, Esq. clo Thomas H. Teczar 14 Nye Road Falmouth, MA 02540 Prepared by: Compliance Environmental, Inc. 31 Fremont Street Needham, MA 02194 April 10, 1995 .. e s TABLE OF CONTENTS Page 1.0 INTRODUCTION 1 2.0 UNDERGROUND STORAGE TANK EXCAVATION 1 3.0 SUBSURFACE SOIL ASSESSMENT 2 4.0 RECYCLING OF THE EXCAVATED SOIL STOCKPILE 7 5.0 RESPONSE ACTION OUTCOME STATEMENT 7 6.0 FINDINGS, OPINIONS AND RECOMMENDATIONS 8 7.0 LIMITATIONS 10 ATTACHMENTS Figure 1 Site Locus Map Figure 2 Schematic Site Plan Appendix A DEP Forms (RNF, IRA & RAO) Appendix B Laboratory Analytical Reports Appendix C Bill of Lading • Thomas H.Teczar Property Page 1 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 1.0 INTRODUCTION This Report concerns an environmental assessment related to the excavation of a 55-gallon, underground, gasoline storage tank associated with a residential property located at 38 Magnolia Avenue, West Hyannisport, Massachusetts (hereinafter, the "Site"). Hyannisport is a village located within the Town of Barnstable on Cape Cod, Massachusetts. Refer to Figure 1, the Site Locus Map for the approximate location of the Site. Refer to Figure 2,the Schematic Site Plan for the approximate location of the discussed Site features. According to the Town of Barnstable Assessor's records the Site comprises approximately 1.09 acres of land. The Assessor's designation is Map 225, Parcel 013 and Lots 238 - 242. Also according to Assessor's records, the current Site owners are listed as;Edward P. and Thomas H. Teczar and Patricia Ernitz. As shown on the attached Schematic Site Plan, the Site is occupied by a single family home. According to Mr. Thomas H. Teczar, Site owner and present occupant, ..."since its development, in circa 1895, the Site has always been utilized as a private residence, with no commercial or industrial activities ever taking place." The Site is connected to the municipal water service. According to Mr. Teczar,. Site observations and information supplied by the Town of Barnstable Health Inspector, Ms. Donna Z. Miorandi there are no on-Site or abutting property drinking water supply wells. According to Ms. Miorandi, the Site is not located in any Zone of Contribution (ZOC) to any municipal water supply wells. Based on the above and the Site's close proximity to the ocean (an average of approximately 175 feet) it appears that the groundwater beneath the Site is not a source of drinking water nor would it be expected to be a drinking water source in the future. The house is two-story, wood frame, shingle sided, cape style structure at grade with no underlying basement. The northwest corner of the house has an attached garage. The outside area of the Site is occupied by a gravel driveway in the north, a lawn, and a sandy beach area in the south which abuts the ocean. Sanitary sewage is conveyed to an on-Site septic system located out from the southeast corner of the house. All improved properties in the near vicinity are used in a manner similar to the Site. The properties north, east and west of the Site are occupied by single family, private residences. The south border of the Site abuts Centerville Harbor,Nantucket Sound and the Atlantic Ocean. 2.0 UNDERGROUND STORAGE TANK EXCAVATION The house is heated by oil stored in a recently installed, 275-gallon, above ground, oil storage tank situated in the garage. Prior to installation of the above ground storage tank the heating oil had been stored in an approximate 300-gallon, underground, storage tank which had been located adjacent to the west wall of the garage. Pursuant to regulations, the discontinued underground u - ' Thomas H.Teczar Property Page 2 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 storage tank was scheduled for excavation and removal. On a rainy February 28, 1995 Coastland Tanks, Inc. of Falmouth, Massachusetts excavated the approximate 300-gallon, underground, oil storage tank. Upon removal, the oil storage tank was observed to be in relatively good condition with no holes, weak areas or evidence of a release of oil to the adjacent subsurface environment. Observations of the tank excavation revealed what appeared to be the wall of a second, adjacent underground storage tank. Additional soil removal revealed an approximate 55-gallon, underground, gasoline storage tank which according to Mr. Teczar stored gasoline to power the previously existing back up electric generator. Mr. Teczar was unaware of any prior environmental incident or leak or loss of oil and/or gasoline associated with either of the two storage tanks. Upon exposure, the approximate 55-gallon, underground, gasoline storage tank appeared rusted, the filler pipe had rusted loose and fallen through the top of the tank resulting in an opening of about four inches in diameter. This opening which apparently has existed for some time prior to the uncovering of the tank is evidence of the potential threat of a release of gasoline to the adjacent environment via precipitation inflow over time. According to Mr. Ken Trojano of Coastland Tanks, Inc. observations through this hole indicated that the tank was full of what appeared to be a mixture of mostly water with some residual gasoline. Mr. Trojano pumped the water and gasoline mixture from the tank and transferred it to a 55-gallon drum which was sealed and transported under Uniform Hazardous Waste Manifest to an appropriate recycling/disposal facility. Ms. Miorandi was on Site during much of the February 28, 1995 above described activities. According to Ms. Miorandi,the heavy rain falling into the exposed tank opening caused an unspecified volume of the water/gasoline mixture to overflow from the tank prior to pumping. The two removed storage tanks were cleaned and transported to the Mid-City Scrap Disposal facility in Westport,MA (Permit No. 12889). 3.0 SUBSURFACE SOIL ASSESSMENT In response to the apparent release of gasoline an environmental consultant(the author, Mr. Joseph S. Hobin) from Compliance Environmental, Inc. (CEI) arrived on Site on March 1, 1995 in order to assess the soils within the tank excavation and to determine the extent of the gasoline release (if any). The weather on March 1, 1995 was overcast but not raining with a temperature of approximately 35 degrees Fahrenheit. The excavation immediately adjacent to the west wall of the garage was measured to be approximately five by six feet by four feet deep. The subsurface soil was a course to fine sand with a trace amount of silt. There was no visual evidence of any oil or gasoline on the soils within the excavation or on the stockpiled soils removed from the excavation on February 28, 1995. There was however a moderate smell of gasoline emanating from the excavation and the stockpiled soils. I Thomas H.Teczar Property Page 3 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 Representative composite soil samples were taken from the four walls and floor of the excavation. The soil samples were obtained by digging into the walls and floor of the excavation approximately nine inches to obtain the soil sample. This procedure insured that the soil sample was representative of actual conditions and not soil which had fallen or slumped into the excavation. The soil samples were placed about two-thirds full in clean,approximate eight ounce, soil jars with aluminum foil sheet covers followed by screw on caps. During the soil sampling procedure which disturbed the soils in the excavation there a moderate odor of gasoline. The soil sample jars were allowed to warm in a heated truck for a minimum of 15 minutes. After passage of the warming period, the jars were lightly shaken and the headspace above each soil sample was field screened for the presence of volatile organics with a HNu photoionization detector referenced to an isobutylene standard read as benzene. The HNu photoionization detector measures the relative concentration of volatile organics in the headspace of sealed soil jars, these readings cannot be directly translated to quantitative concentrations of volatile organics present, but are indicative of the presence and relative concentration of volatile organics in the soil sample. The results of the HNu photoionization detector screening of the soils collected from the excavation are summarized below in Table 1. TABLE 1 HNu Photoionization Headspace ScreeningResults Performed on Soil Samples Collected from the Tank Excavation Location HNu Photolomzatlon Headspace in ppm (1) east wall 3 ppm south wall 130 ppm west wall 4 ppm north wall 3 ppm floor 120 ppm Note: (1) ppm=parts per million In the opinion of CEI, the above observations and HNu photoionization detector headspace screening results are indicative of a release of volatile organic compounds (VOCs) to the soils of the south wall and floor of the excavation. It is the further opinion of CEI, that the VOC contamination is from a release of gasoline from the former, adjacent ,underground, storage tank. This opinion is confirmed by Section 40.0313 of the Massachusetts Contingency Plan (MCP, 310 CMR 40.0000) which requires notification to the Massachusetts Department of Environmental r Thomas H.Teczar Property Page 4 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 Protection (DEP) within 72 hours of any release of oil and/or hazardous material adjacent to an underground storage tank,as established by measurement of equal to or greater than 100 parts per million by volume of total organic vapors "as benzene" in the headspace of a soil sample obtained greater than two feet below the ground surface, using a headspace screening method. In an effort to remove the above identified VOC or gasoline contamination the excavation was extended by removal of approximately two feet of soil from the south wall and floor of the excavation. This resulted in an increase of the excavation dimensions to approximately 5.5 by eight feet by six feet deep and a soil stockpile of approximately six cubic yards. Prior to leaving the Site on March 2, 1995, the heavy weight, plastic sheeting placed under and over the excavation soil stockpile was secured in place. In order to assess the results of the above second soil removal, representative composite soil samples were taken from the south wall and floor of the excavation. Two representative composite soil samples(samples; stockpile 1 and 2) were also collected from the stockpile resulting from the two soil excavations. The four soil samples were field screened for the presence of volatile organics with the HNu photoionization detector. The results of the HNu photoionization detector screening of the soils collected from the excavation and soil stockpile are summarized below in Table 2. TABLE 2 HNu Photoionization Headspace ScreeningResults Performed on Soil Samples Collected from the Tank Excavation and Soil Stockpile Location HNu Photoionization Headspace in ppm south wall BDL floor 1 ppm stockpile 1 3 ppm stockpile 2 3 ppm Note: (1) BDL=Below the photoionization Detector Limit of 0.1 ppm. Pursuant to Section 40.0313 of the MCP(see above), it is the opinion of CEI, that the above HNu photoionization detector headspace screening results indicate that there is no significant VOC or gasoline contaminated soil remaining in the excavation. Thomas H.Teczar Property Page 5 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 Pursuant to the above described MCP required 72 hour notification, on March 1, 1995 after completion of the above excavation, soil sampling and field screening activities a phone call from the Site was placed to Mr. Michael Moran of the Southeast Office of the DEP. Within that conversation, Mr. Moran was made aware of the above assessment data and informed that confirmation of the observations and field screening data would be provided by laboratory analysis of composite soil samples to be collected from the walls and floor of the excavation. Based on the March 1, 1995 conversation the DEP sent a March 2, 1995 Notice of Responsibility to Thomas Teczar. A copy of the NOR is included in Appendix A, DEP Forms. A summary of the more pertinent information in the NOR is listed below: the March 1, 1995 initial, oral notification of the release was acknowledged; Mr. Teczar was informed that the DEP considered him to be the potentially responsible parry (PRP); a requirement to perform response actions to prevent harm to health, safety, public welfare and the environment which may result from the release; at the time of the oral notification, the following response actions were approved by the DEP as an Immediate Response Action (IRA): the excavation of six cubic yards of contaminated soil and the proper storage and disposal/recycling of all contaminated media and remediation waste; a requirement to submit to the DEP the following completed DEP forms and supporting documents (ie, this report and attached appendices): Release Notification Form (RNF), IRA Completion Statement and/or a Response Action Outcome (RAO) Statement (completed copies of which are included in Appendix A); a statement that the Site shall not be deemed to have had all the necessary and required response actions taken for it unless and until all substantial hazards presented by the release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. 21E and the MCP;and a requirement to engage a Licensed Site Professional (LSP, Dr. Steven L. Kurz, No. 6324). After the phone call with Mr. Moran, all discussed issues, opinions and information were reported to Ms. Miorandi who had just arrived on Site. Ms. Miorandi concurred with the expressed opinions and the days assessment and excavation activities. Thomas H.Teczar Property Page 6 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 As referenced above, in order to further confirm the above observations and HNu photoionization detector headspace screening results; a representative, five point, composite soil sample (designated EX-COMP) was obtained from the four walls and floor of the excavation. In addition, another representative composite soil sample (designated "stockpile") was collected from the soil stockpile for purposes of recycling the excavated soil at a DEP approved asphalt hatching facility. Upon collection the soil samples were placed in appropriate glass jars which were stored in an ice filled cooler for transport to a DEP approved laboratory under appropriate chain-of custody protocol. The soil samples from the excavation were analyzed for VOCs via EPA Method 8260, total lead and total petroleum hydrocarbon (TPH) content via modified ASTM Method D3328-78. The soil samples from the soil stockpile were analyzed for VOCs and total lead. The laboratory reports,laboratory QA/QC documentation and the chain-of custodies are attached as Appendix B. A summary of the laboratory analytical results is provided below in Table 3. TABLE 3 Laboratory VOC,Total Lead and TPH Results Performed on Soil Samples Collected from the Tank Excavation and Excavation Stockpile Sample Location VOC Result Total Lead TPH Result EX-COMP Excavation BRL(1) 5.1 mg/Kg (2) 21 mg/Kg Stockpile Stockpile BRL 4.5 mg/Kg NA (3) Notes: (1) BRL=Below the instrument ReportingLimit of 0.5 or 2.5 m for all EPA Method pP compounds, see Appendix B. (2) mg/KG=milligrams per kilogram, roughly equivalent to ppm. (3) NA =Not Analyzed, it was not necessary to analyze the soil stockpile for TPH in order to transport it for asphalt hatching. In the opinion of CEI, the above Table 3 laboratory results confirm the on Site observations and headspace field screening results indicating that there is no significant total lead, TPH or VOC or gasoline contaminated soil remaining in the excavation. This opinion is confirmed by Section 40.1600 of the MCP, which lists minimum Reporting Concentrations (RCs). There were no identified VOC concentrations and the MCP Soil Category S 1 RC for total lead is 300 ppm and the S 1 RC for TPH is 500 ppm. Thomas H.Teczar Property Page 7 of 10 38 Magnolia Avenue,West Hyannisport, MA April 10, 1995 4.0 RECYCLING OF THE EXCAVATED SOIL STOCKPILE On April 7, 1995 the approximate, six cubic yard, excavation soil stockpile was transported for recycling to the Bardon-Trimount Asphalt Batching Facility in Stoughton, Massachusetts. The DEP Bill of Lading and related documents necessary to transport and recycle the excavated soil is attached as Appendix C. After removal of the soil stockpile, the tank excavation was backfilled with clean soil transported to the Site. 5.0 RESPONSE ACTION OUTCOME STATEMENT The March 1, 1995 DEP approved IRA of excavating approximately six cubic yards of contaminated soil and the appropriate off Site disposal/recycling of the two underground storage tanks and all contaminated media resulted in no identified oil or hazardous material concentrations in remaining on Site soils which exceed the MCP RCs pursuant to 40.1600 or the MCP Method 1, Risk Characterization, Soil Category S-1 Standards pursuant to 40.0975 (6) (a). Based on the above and pursuant to the Class A-2, Response Action Outcome (RAO) as described in 40.1036, it is the opinion of CEI that a permanent solution has been achieved in response to the gasoline release and that a level of no significant risk exists without the need for any Activity and Use Limitations. Support and documentation for this Class A-2 RAO opinion is provided by this report and the completed IRA completion Statement and RAO Statement, copies of which are included in Appendix B. The above Class A-2 RAO Statement is based on remaining soil concentrations which are below MCP regulatory RCs and Risk Characterization Standards but may be above background concentrations. Consequently, a Feasibility Evaluation is required which evaluates the feasibility of reducing the concentration of oil and hazardous material in the environment to levels that achieve or approach background. In the opinion of CEI, the identified total lead concentration of 5.1 ppm and the TPH concentration of 21 ppm in the soil remaining on the Site does in fact approach background levels. It is the further opinion of CEI, that the incremental increased cost to continue the excavation until reducing soil concentrations to background or BRL is disproportionate to the incremental benefit to the environment. This second opinion is based on the following: the remaining soil concentrations do approach background levels, the groundwater beneath the Site is not a source of drinking water nor is it expected to be a future source of drinking water and further excavation would be very costly due to structural considerations relative to the immediately adjacent garage which would have to be either moved or adequately braced before performing any additional excavation. Thomas H.Teczar Property Page 8 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 6.0 FINDINGS, OPINIONS AND RECOMMENDATIONS Based on the above observations and field screening and laboratory analytical results, CEI offers the following findings, opinions and recommendations: The approximate 1.09 acre Site is occupied by a single family residence. The present and past use of the Site has always been residential with no history of commercial or industrial activities. North, East and west of the Site are improved properties also occupied by similar single family residences. Directly south of the Site is Nantucket Sound, the Atlantic Ocean. Based on observations and research at the Town of Barnstable municipal offices there are no known drinking water supply wells on the Site or any near vicinity properties. In addition, the Site is not located in any Zone of Contribution (ZOC) to any municipal water supply wells. Based on the above and the Site's close proximity to the ocean (an average of approximately 175 feet) it appears that the groundwater beneath the Site is not a source of drinking water nor would it be expected to be a drinking water source in the future. The house is heated b oil stored in a recently installed y y , 275-gallon, above ground, 011 storage tank situated in the garage. Prior to installation of the above ground storage tank the heating oil had been stored in an approximate 300-gallon, underground, storage tank which had been located immediately adjacent to the west wall of the attached garage. Pursuant to regulations, the discontinued, underground storage tank was scheduled for excavation and removal on February 28, 1995. Upon-removal, the approximate 300-gallon, oil storage tank was observed to be in relatively good condition with no holes, weak areas or evidence of a release of oil to the adjacent subsurface environment. Observations of the tank excavation revealed what appeared to be the wall of a second, adjacent underground storage tank. Additional soil removal revealed an approximate 55- gallon, underground, gasoline storage tank which according to Mr. Teczar stored gasoline to power the previously existing back up electric generator. Mr. Teczar was unaware of any prior environmental incident or leak or loss of oil and/or gasoline associated with either of the two storage tanks. Upon exposure, the approximate 55-gallon, underground, gasoline storage tank appeared rusted, the filler pipe had rusted loose and fallen through the top of the tank resulting in an opening of about four inches in diameter. This opening which apparently has existed for some time prior to the uncovering of the tank is evidence of the potential threat of a release of gasoline to the adjacent environment via precipitation inflow over time. According to Mr. Ken Trojano of Coastland Tanks, Inc. observations through this hole indicated that the tank was full of what appeared to be a mixture of mostly water with some residual gasoline. Mr. Trojano pumped the Thomas H.Teczar Property Page 9 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 water and gasoline mixture from the tank and transferred it to a 55-gallon drum which was sealed and transported under Uniform Hazardous Waste Manifest to an appropriate recycling/disposal facility. Ms. Miorandi of the Town of Barnstable Health was on Site during much of the February 28, 1995 activities. According to Ms. Miorandi, the heavy rain falling into the exposed tank opening caused an unspecified volume of the water/gasoline mixture to overflow from the tank prior to pumping. The two removed storage tanks were cleaned and transported to the Mid-City Scrap Disposal facility in Westport, MA. On March 1, 1995 observations and HNu photoionization detector headspace field screening of soil in the excavation adjacent to the former 55-gallon, gasoline storage tank identified volatile organic compound (VOC) or gasoline contamination of the soil at the south wall and floor of the excavation. After additional excavation of the south wall and floor of the excavation it was determined via photoionization headspace field screening that the significant VOC or gasoline contaminated soil had been excavated. Pursuant to the Massachusetts Contingency Plan (MCP,310 CMR 40.0000) 72 Hour Notification requirements, a March 1, 1995 phone call was placed from the Site to Mr. Michael Moran of the DEP's Southeast Regional Office. After becoming aware of the excavation activities and assessment data Mr. Moran gave approval for an Immediate Response Action (IRA) which involved the excavation of approximately six cubic yards of contaminated soil and the appropriate off Site disposal/recycling of all contaminated media. Based on the phone conversation the DEP sent a Notice of Responsibility(NOR) to the Site owner and occupant, Mr. Thomas H. Teczar. In addition to Mr. Moran, Ms. Miorandi was also made aware of the excavation and assessment activities and data. In order to further confirm the above observations and HNu photoionization detector headspace field screening results;a representative, five point, composite soil sample (designated EX-COMP) was obtained from the four walls and floor of the excavation. The composite soil sample from the excavation was analyzed for VOCs, total lead and total petroleum hydrocarbon (TPH) or oil. There were no identified VOC, total lead or TPH concentrations which exceeded the MCP Soil Category S 1 Reporting Concentrations. On April 7, 1995 the approximate, six cubic yard, excavation soil stockpile was transported for recycling to the Bardon-Trimount Asphalt Batching Facility in Stoughton, Massachusetts via the Bill of Lading included in Appendix C. After removal of the soil stockpile, the tank excavation was backfilled with clean soil transported to the Site. The March 1, 1995 DEP approved IRA of excavating approximately six cubic yards of contaminated soil and the appropriate off Site disposal/recycling of the two underground storage Thomas H.Teczar Property Page 10 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 tanks and all contaminated media resulted in no identified oil or hazardous material concentrations in remaining on Site soils which exceed the MCP RCs pursuant to 40.1600 or the MCP Method 1, Risk Characterization, Soil Category S-1 Standards pursuant to 40.0975 (6) (a). Based on the above and pursuant to the Class A-2, Response Action Outcome(RAO) as described in 40.1036, it is the opinion of CEI that a permanent solution has been achieved in response to the gasoline release and that a level of no significant risk exists without the need for any Activity and Use Limitations. Support and documentation for this Class A-2 RAO opinion is provided by this report and the completed IRA completion Statement and RAO Statement, copies of which are included in Appendix B. Pursuant to the NOR requirements, CEI recommends that a copy of this Environment Assessment Report along with the original RNF, IRA Completion Statement and the RAO Statement be forwarded to Mr. Michael Moran at the Southeast Regional Office of the DEP in Lakeville, MA. on or before April 28, 1995. 7.0 LIMITATIONS This Report is not a complete environmental audit. No attempt was made to determine the regulatory compliance of the present or the past owners or operators of the Site with any federal, state or local environmental or land use laws and regulations. The observations made during Compliance's inspection and research of the Site, and the conclusions drawn therefrom, were made on the date(s) and under the conditions stated herein. No inferences regarding other conditions, locations and materials at a later or earlier time may be made based on the contents of this Report. Where subsurface examinations and associated laboratory analyses of samples were not performed, Compliance makes no representations concerning soil, surface water or groundwater quality. Unless otherwise noted herein, the assessment activities did not include an evaluation of the presence of. asbestos, radioactive materials, radon, infectious waste, lead paint and/or pesticides and herbicides. Unless otherwise noted, any map, figure or schematic plan contained in this Report is not meant to be an accurate engineering drawing, but is provided to present the relative locations of buildings and Site features. This Report was prepared for the sole use of our Client. The use of this Report by anyone other than our Client or Compliance is strictly prohibited without the express prior written consent of Compliance. Portions of the Report may not be used independent of the entire Report. r FIGURES RVrw ��� �-�'�': - f � off, ��- %��,��� • �� ,�Jl 10 5 10 � / \��) a� '�'-� ��s a e_ •I Public Beach� Landing 13 20 ice' ® _ _ _. , ►.. _ �: �� ,� o�„1 1 .- �� ill f VILL ARBGannet • Rocks FIGURE I SITE LOCUS MAP. 38 o i Magnolia West Hyann.isportg MA ,,, ' `�AC`VOLIA 4 vE FIGURE 7 PROPER?-Y LINE SCHEMATIC SITE PLAN w ; 38 MAGNOLIA AVENUE WEST HYANNISPOkT, &1A FORMER LOCATION OF TWO y APPROX. SCALE:1 INCH - SO FEI UNDERGROUND.,STORAGE TANKS q DATE: 4/9/95 V ' Site Plan Derived From V_ Town of Barnstable G.I.S. ill,,,'[ cAR 4/1/93 ACE HOUSE A :N ,o 4 . ATLANTIC OCEAN V . APPENDIX A DEP FORMS (RNF, IRA & RAO) THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Massachusetts of En tal rotection BWSC-�u� Qureau of Wasted ' l �. ;� � ► �i� Release Tracking Number RELEASE NOTI :` ` SNOT TRACTION E] -111167 FORM Pursuantto `; 4 5 and 31 ;CI�t `. All „ubpart C) If assigned by DEP A. RELEASE OR THREAT OF RELEASE;' Street: of n i ;i1tr, ��, 'Crai9V►ile Beach R�:�� RIZ t r a n Atdr Citylrown: Wesf H ann i:s Po �A �w IPicex � 0 B. THIS FORM IS BEING USED TO: (ch j4 r S R Submit a Release Notification(comple44 t Submit a Retraction of a Previously R Ion of ar l r elease(complete Sections A,B,E,F and G or tn,s form). You MUST attach the suppor ing doc j' I by 310 i I C. INFORMATION DESCRIBING THE P4. I r TOO OR r{ OC Date and time you obtained knowledge of the Rel" �3"�I - i � Specify: Ed AM ❑ PM to : The date you obtained knowledge is always re ou obta i of required it reporting only 120 Day.Conditions. � i M � � tr e�, r�, AM P IF KNOWN,record date and time release or TOR; Ip-r r Spec N ❑ ❑ Check here if you previously provided an Oran t 4 �(2 Hour.a �in g Conditions only). Provide date and time of Oral Notification. D 1 F I i i ia: O * Specityy ✓�AM ❑ P M Check all Notification Thresholds that apply to the ; f Relea Infom�ation see 310 CMR 40.0310.40.0315) 2 HOUR REPORTING CONDITIONS 72 t G CoN DAY REPORTING CONDITIONS tl Ir- a�P, N:,i� 111� 1�t:• ❑ Sudden Release , I queou ;i � i 18 Release of Hazardous.Materials)to Soil or 1: a„! , ] ual to or, Groundwater Exceeding Exceeding Reportable ❑ Threat of Sudden Release } fConopntration(s) ❑ Oil Sheen on.Surface Water l '`( i r,ge Tan ,F j r lease of Oil to Soil Exceeding''Reportable ff l 1F(� +Eoncentration(s)and Affecting More than 2 Cubic ❑ Poses Imminent HazardE, ' I lrrYards ,y ❑, lease❑ t` 7R.e�elease of Oil to Groundwater Exceeding Reponaolc Could Pose Imminent Hazard Aor ntration(s) ❑ l r ter Release Detected in Private Well ❑�1 `� � � � ,4 S4bsurface Non-Aqueous Phase Liquid(NAPL) ❑ Release to Storm Drain Lter �Ec)ual to or Greater than 1/8 Inch and Less than 1 i2 ❑ }In h I ❑ Sanitary Sewer Release �� i 1 �(i s ET (Imminent Hazard Only) , Y t& List below the Oils or Hazardous Materials that excr � r; Concentratir n yRportable Quantity by the greatest amount. If necessary,attach a list of additional Oil and Hazy $ i tancesu i' rle ilt s t t#' sad. i� )�r� y. . Name and Quantities of Oils(0)and Hazardous M t i��+ Reportable Concentrations it �o"tin oc ;r (Units Exceeded,if Applicable Q F 5� 4 Sat?I'48� x t O or HM Released k � n in # its (RCS-1,RCS-2,RCGW-1,RCGNV-:2) aSol h I ra s+�il� r D. ADDITIONAL INVOLVED PARTIES dr as aff 3 zl Threat of Release,other than an owner who is here if atta ching names and ad sr, Check 9 f ❑ I submitting this Release Notification(requir Check here if attaching licensed Site Profe add You nay write In n on a r e lsec�P�!d page of this form. 065 FOl` : W. rj t page 1 of 2 Revised 3/1/95 of AIte�Y, ( Irk ;k1' e o y} TI';it + Massachusetts of Ena, '"I ,j I.Protection BW ¢ureau of Waste! k ,`� Alp" , it � ' # i P i d Release Tracking Nunlr,,r � �1 RELEASE NOTIF { NOTIF ET. CTION0 OM FORM Pursuant to3;�1f( ubpart C) If assigned by DEP IF 14 � PERSON REQUIRED TO NOTIFY: Name of Organization:: fir. 3+ t f '.}"� Name of Contact: I)70 a Street: 3 Ina 9 Ylo :a I• `�� ,�. d, : , 3+ Cityrrown: GUeSIA d hh%S 'r 1 �, 1=:!"ZIP Code: Oa6 70�` Telephone: F. RELATIONSHIP OF PERSON REQUIR ;O RE L + O,F'RELEASE: (check one) RP or PRP Specify: e Owner Q O I , 'tor �: - ! Ugg�er Poor PRP: Fiduciary,Secured Lender or Municipality'vAt I alined b. ^ s 3 ' Agency or Public Utility on a Right of Way(asi ! s c 21 E s '))� (�I Hi Any Person Otherwise Required to Notify S.I G. SWqIkICATION the in.s df rlury.(();that I have personally examined and am : 1 6a ( Pa }ram' � �'(x l h � xtp��. w t familiar with the information contain in this m,,i all doeu n artyrn rthis transmittal form,(ii)that,based on my inquiry n tt; a: u5 �"r+ �1 xI I of those individuals immediately responsible ob the m � t n lined In this submittal is,to the best of my i' ton on behalf of the entity legally responsible for knowledge and belief,true,accurate and complete ly,autho , 3,, g y p this submittal. Uthe person or entity on whose behal de amr R 4 �f a�re, g decant penalties,including,but not limited to, possible fines and imprisonment,for willfully subm i a " ) �1 "` s t 9 BY (signature) 1 r¢ �• : � to,� 1 w'd:t For: , It III (print name of person or entity recorded in Se ( B Enter address of the person providing certification,��, i i ss t{� 1 1 ,Pd '. Street: ZIP Code: City/Town: + N tA Telephone: :.I R; f r Nlr #Y; Ili; � _ ►` ' W R DttiN THE DOCUMENT AS OFT YOU MUST COMPLETE ALL RELE, ��r a ns' ,fJIAY RETUR INCOMPLETE. IF YOU SUB LETE� N;' t �r� E P,,ENALIZED FOR MISSING IRED,.� , 01 31 I ft !Y `K71�a�• I{. .{ �' 7'� i �l �fI as Sfj i { N', 4 + s,3a •_' Page 2 of 2 s Form' Revised 3I1/95 After. x Massachuse t of It iiProtection Bureau of T , Release Tracking Nun,c.r —, IMMEDIATE R� TIO z I 't� _ l TRANS MITTAK want to24A `=40,0427(Subpart D) • rr iR tFiq , ,,•t it� . A. RELEASE OR THREAT OF RELEAS ( ' Release Name:(optional) I 1 I.�, I 1 Street: 3 n'1�3 n I is {, � , ' I lP� d i(�e tack, ��,;;14 City/Tom: Cve5l H a nni 5 JA 4 e d a(0 701 Check here if a Tier Classification Submilw ,DEP`' 1 e ' Mang iNumber. , Check here If this location is Adequately R i 310 C I ( ;1 Specify Program: CERCLA H ion I agement Q RCRA State Program(21 C Faciiir,.Z�) Related Release Tracking Numbers That This IRAi B.THIS FORM IS BEING USED TO: Submit an IRA Plan(complete Sections A,'i d b wtf i Check here if this IRA Plan is an upda f,a prevw � en 1 Plan. Date Submitted: Submit an Imminent Hazard Evaluation B,C,E..". Submit an IRA Status Report(complete Submit a Request to Temunate n AcU vet andlorl a arCo r Uni ing Response Action(s)Taken to Address on a I krrrdnent Hazard(complete Sections A,Bi EeSubmit an IRA Completion Statement ,.C,D: 11 IC1U You must attach all suppo n regw �6 �� lof f rm indicated,including copies of any Legal N� wo Public sNi • � ft 010 CMR 40.1400. C. RELEASE OR THREAT OF RELEAS~i HAT Identify Media and Receptors Affected: (check at Air r er 'i3110 Surface Water 0 Sediments ✓USoil ' " IPu } Water Supply [� Zone 2 ! Resicience Wetland Q Storrs Drain p r f School Q Unknown !� 2:,. ch' II t� 4 i ' -2 Hour Reporting Condition(s) Identify Conditions That Require IRA,Pursuant (,I � , , e 72 Hour Reporting Cond•Rion(s) Release g i '� ,rr Other Condition(s) Describe: a �k USl ex�af/a� % ' fllt/ ' aY ales Q4 /a0 7 /3C t r. � 1� Identify Oils and Hazardous Materials Released i ply) I9 rif' i;s 'I !IChbrinated Solvents Heavy Mcrae Others Specify: a �n• � :;, i " cl$O1/, a' a�I` � vc+n d ' `t��,r � of , �r,, a�,f,a•s D. DESCRIPTION OF RESPONSE ACTT II that a Onlyf ) '� Dep I> loyment of Absorbent or Containment Matenais Assessment and/or Monitoring ( I +I t , rr �Excavabon of Contaminated Soils ,: I I: ( ) { ; Temporary Covers or Caps I%' Re-use,Recycling or Treatment t ' ¢ a ?•. Bwremediation 44 ��" f 'i'ftSoil.Vapor Extraction / O On Site L/J " Site Est9 f r I ( D/ IF I I,Structure Venting System � Describe: P�a Product or NAP.Recovery Store Q On Site 0 OK S Is ti 'Groundwater Treatment Systems LandfillLandfillQ Cover 0 D ( AT) ^a f frr/1'I Removal of Drums,Tanks or ContainersiA+r,Sparging SS !•_..��wm-d F ih'temporary Water Supplies Describe• '" It f r q rr,w�r, r ... ONTWU r e E, . Str00 spa` sand 011 Page 1 of 3 Revised 2/24195 Sype,�S p { .gt `,il + f1,�C f t � ��1 tl �jyFa�� Massachusetts D ; f Envy P ptectlon Bureau of Waste I „ Release Tracking Numu,! IMMEDIATE RESF'� lON L TRANSMITTA 'to 310i t!i �40g0441 (Subpart D) FDESCfR IPTION OF RESPONSE ACTIO er Contaminated Media I impry Evacuation or Relocation of Residents l of Oth ) �Type and Volume: G�vb+t i I! f'_.": ' '4 I Fenang and Sign Posting 4{ a: Other Response Actions Describe: th n[ormation to aid in creating an Innovative Check here If this IRA involves the use of Irmo DEP is Technologies Clearinghouse). Describe Technologies: x ( I� t �Wast o srte facility,answer the following questions) E. TRANSPORT OF REMEDIATION WAS Ir + �3„i, Name of Facility. Town and State: �t t. 11.1[; t.�/J 5 Ic Y!! Quantity of Remediation Waste Transported to Dat�1 '. , r,! ri i,u a wrr F. IMMINENT HAZARD EVALUATION SO' �k one of k with IN'., a t` e. Based upon an evaluation,an Imminent Hazall `,} f l �� 4 f2eleas� f f 7 Based u an evaluation,an Imminent Hazer necGong_ Yil7 syey!�or?hreat of Release. rd ews h,this Release or Threat of Release,and furtncr Based upon an evaluation,it is unknown whet kr, it { assessment activities will be undertaken. t Based upon an evaluation,lt is unknown wheth *ja and ews, j.G.• i is Release or Threat of Release. However, -lmmine�l II i i response actions will address those condiUonli!: 'i ft y: I G. IRA COMPLETION STATEMENT: ! I ) ,' I i nducted as part of the Response Actions planned Threat o ar`a Sit` Check here if future response actions address ( + e that is identified on the Transition List as for a Site that has already been Tier Classifieid ' demos ST , , +"givers):,These additional response actions must described in 310 CMR 40.0600(i.e.,a Transr ; Trackin . . i r I ' Number). occur accordingto the deadlines applicable State Release Tracking Number Q.e.,Site ID + i �i� tssified -- ec clad, site-Nitowing submission of the IRA Completion If any Remediation Waste will be stored,tr ' � Y . , ,r q ,e N Rerr►edy Implementation Plan,along with tn- Statement,you must submit either a Releasri ' s re r� II� 'pletion Statement. appropriate tranrt l 1 4.:..; rr_. r Fi .tt rttg�r :.. . H. LSP OPINION: I �! mine ) � Ih tsitransmittal form,Including any and all I attest under the pains and penalties of perjury that la M gild judgm t� y !"j o i�apPl cation of(i)the standard of care in 309 CMR n this submittal In my pro �,, � f C "4"03 5 to the best of my knowledge, documents accompanying }'' m the O. 4.02(1),(ii)the applicable provisions of 309 CMR 4 ( (...) information and belief, �) ��, t tion pla�„ b u pM red,tkiesresponse action(s)that is(are)the subject of . ff Secdon B of this form indicates that.an Imme�( i ,p. �d; i c721 E and 310 CMR 40.0000,(ii)is(are) Ucable this submittal(i)has(have)been developed in acap .e* r F "�" actin thg applicable provisions of M.G.L.c.21 E and 310 appropriate and reasonable to accomplish the pu i I I ders ?lu i+ C o "is!'entifiied in this submittal; with the identifi (jV tfi!I' Ii CMR 40.0000 and(iii)complies(y) ice ' � �s Ir>nmment Hazard Evaluation was developed in N +ution is bg " undertaken to support this •,jf Section 8 of this brm indicates that an tmmiQ, } ,;: -AAR +}a ibl� rttladlvjties(Y) accordance with the applicable provisions of M G1 of M.G ti C!M�',40 DODO; Imminent Hazard Evaluation complies(y)with the �, � �r�t Get+ . $' tus Re a� tq.he response action(s)that is(are)the subl�ct . !f Section B of this brtn indicates that an Imm. PPlicab P kG�X.G-i21 E and 310 CMR 40.0000,(ii)is(are) of this submittal(i)is(are)being implemented in n 9 !applicable provisions of M.G.L.c.21 E and 310 appropriate and reasonable to accomplish the pu r ;, (��actibr ` °I s entified in this submittal; CMR appropriate 0 and(pi)complies(y)with the data, < .:. Y I ') aRequest to Terminate an Acute Rem em l � ' • bSec6on B of this tom►In that an Itnm to A . , ti.i ,aril is being submitted,the response action() System andlor Terminate a Continuing Res + and Im I_ r with the applicable provisions of M.G.L.c.21 E of this submittal(i)has(h �, p, f I 'i "ir xporise action(s)as set forth in the applicable that is(are)the subject an` plish t r ,,,,"' ,' permits and approvals identified in and 310 CMR 40.0000,(ii)is(are)appropriatea ). i rasfiall orders,. provisions of M.G.L.c.21 E and 310 CMR 40. ,E this submittal. it� " i -;�,.. ,� ,;ilk „'• � �=)�hi'� • Page 2 ci 3 and it' Su SC V' Revise 2124195 ( t fllteh 3 t y .,,.a�n�r , a�d.�;_.. x+��ffit��`�Al�d: k11!�dM1�i �li<,`.Y:�r• _ Massachusetts � FI � of Ens � ' 1 f or;otection !,I�161 ��w4 , �' 1 ,i Bureau of Waste° Release Tracking wunw�r I .-ION ( ' i i �1', i �. �� _ IMMEDIATE REST �� -to 31, 4 �' ± 4p 0427(Subpart D) TRANSMITTAL r'I 1 a _ .: . LSP Opinion(continued): � i ,; � ,± �.A,�^ I am aware that significant penalties may result,inc I to,possa fi r� nsonment,if,I submit information which I know to ij tk I Ntl s ° inaccurate or materially incomplete. 1• ' !' 'I � r PR rmit(s)and/or approvals)i��Wca�, ( io any or qks Check here if the Response Action(s)on whi „ �eltf iU nyl ;eil(a► 'iovsi° lei DEP or EPA. If the box is Checked,you MU I r E ( ��ti�e�. r 6,,wq � LSP Name: . ';;BEEN 6 t'� It*C j_ c g �• hi ±il ' 7�y i; L Telephone: ti0nal 17 �W 4 '7— Sb FAX(op ) h�Fm yr. Oro,- �j, . Signature aWh { Date: I. PERSON UNDERTAKING IRA: Name of Organization: i �latx Name of Contact: /1dmj5 R '' Il qi}' 'II 1'j2 V rS � �I ��xl�17�"9��� Street: 3S Ina n�I a gl r ;, �� I . h oa67:L 06 3 Cityrrown: i er r e 1 y4 ZIP Code' f l II i uq' 1 4b r Telephone:13 Check here If there has been a change in th ! x a" "DE TAKING IRA: (check one) J. RELATIONSHIP TO RELEASE OR T �: i SE ��•' �Oth"r,RP or PRP: rator +�' i eRP or PRP • Specify: �6wner Q �� {,. 1 �# � (err.' defin : 1 t ' Fiduciary,Secured Lender or Municipality jI ±oily Agency or Public Utility on a Right of Way a 21 Et 1 � 1 �1, Any Other Person Undertaking IRA Specit I r au. r t+ r K. C ION OF PER�DAI-IdNG � �� i� � I riper' r�er i ¢oil,pequry(i)that I have personally examined and arm ulf 1 and all l i pa�y�ng this transmittal form,(ii)that,based on my 9 familiar with the information contain n this s "� )� " 'A1ciW ined in this submittal is,to the best of my fully a ,FFN !^ f} 3s attdstation on behalf of the entity legally responsible for of those individuals immediately responsible to tion,the " a nificant penalties,including,but not limited to, knowledge and belief,true,accurate and complet , k s made a` �r ¢ l �ere I'fl ` this submittal. Ilthe person or entity on whose b� . ( rate,o< �irtfx o .11 possible fines and imprisonment,for willfully su 11 l I Ir T 7) gy; signal ## 'I9 For' (print name of person or entity recorded m 1 �tl f ��t • - '� ddress� "• r I n• on,aa ,�f •Enter address of the person providing certtfx;aU Street ` (�� i�: � fi„ . Zip Code: i, CitylTown: Telephone: II It I Of�DEP MAY RETURN THE DOCUMENT AS ±�ONSi y�il �Ffi 'h Y BE PENALIZED FOR MISSING YOU MUST COMPLETE ALL Rt r. V rOMPL Lfll, e 1INCOMPLETE. IF YOU QUI 1 r Page 3 of 3 Lofj BWSG= anL1 s $(F r T ' fi i Revised 2R4195 Not i ip f E ' t#f Protection.: 16c'IntS�C-Gt� i f�assachusetts D� ! i Bureau of Waste Situ Paissi Y Trac-i i%hu.i..,..r. RESPONSE ACTIN' I E ( '� �AENT It I a (pursuant to 310 CUR } r r l ' A. RELEASE OR THREAT OF RELEA Name if Previously Assig d(classified Release a Street: D isAd �2 f H ae pp Additional Release Tracking Numbers Addressed f recto the disposal site or portion of the dtspot;al Provide a clear and accurate description of the I ��i ! f(' ,the local;'�� y # site to which the RAO applies,as specified in 310� this r � # # nc? {1 tl �S�'.e e Fa�rt Fr 5. Is a site or disposal site map or survey attached toy '.�I Ye ilk a f h a statement regarding the relationship of the Rr0 Does this RAO apply to a portion of a disposal stte o` Ibfe'�to ether.with a statement as to whether any Statement to any other RAO Statements that ha ' disposal 9 1 response actions are needed for any otlj additional po B. PERSON SUBMITTING RAO STAT Name of Organization:-TIT A19 Name of Contact: ` M Street: ° i r7 ° 67 - ' �! N p code — City/Town: State iif Telephone: r - d ` UBMITTING RAO STATttltriftiEr�'f: C. RELATIONSHIP TO RELEASE O s EL �� f I ifri 1 (check one/specify) r , RP Specify(circle one): Owner O ?' Trans M $E #{g ❑ PRP Specify(circle one): Owner Op4 Trans I ' ❑ Fiduciary/Secured Lender I f , C] Agency/Public Utility on a Right Way j � ' .❑ Other Person: a YFn.. .�' r , • � Pa RESPONSE INFORMATION: Ievised i . 9S. RAQ status: 1�eS D •i�!Rq r( ((Kt4���.e�p �f-_ s. Was initial notificat ion oral? )i. Is a Release Notification Form(RNF)attached? ies s j�; Yes 0 d I f M' Was a RNF previously submitted? dj Is a RAO Compliance Fee attached? Yes A ��s r c� d days after Release Notification and prior to Tier Crass, ffl �I'6{I I d!l !t ��x c, " { 'CHARA� 'I T1Q '96UNDWATER SOIL E. RAO INFORMATION: $ r'" ( CATEGORY: MET OR I is CATEGORY: a. RAOC � ' �q ����, lr ,taGW-1 ��S-1 I I � I iial l ,: l_�JA-2 � �{ S-3 'f f ti Was contamination reduced to background lev i iie? I asp ( f,ry�M� b, i Y s , �'Limrtau Is this RAO based upon the implementation off I l )plemen �t III f'!�I Ifsii , If yes.indicate the type of Activity q j I1.,�4 al Ill1 � l, . 3 at Date filed with Registry of Deeds: BooWPaga Number(or other idenufi" rch have been implemented under 310 criit, 1{ Attach to this RAO Statement a Her 40.1070 and an Activity and Use I t ,' t!t,- ���t, �f at the sr :'0a !40 0896(for Class C RAOs only)? Will Post-RAO Operation and Maintenance(0 ��1 9 1 ' pp 44 _. �No ❑ Yes .If yesye�r r I five 0 I fj! ill of that i ,lt be regarred to,confirm and/or matraa t ,ntenan Attach to this RAO Statement a description i f t � �r those conditions at the disposal site Upon whrc ' Page Wit Revised 10/1/93 i4 # ! #:; `A` � f of E G,� � Protection �1W5�C-OOa Massachusetts ; � 1, , Bureau of Was Site, 4 11h!r (''dfzr ka ReleaseTrarJunp Nwnt , RESPONSE ACT T ' i E ( TI�NENT -[I�i6�7 � t to 310 CUR � (P1+K1iiiD prp i t i�h S� r F. RESPONSE ACTIONS COUPLETii: I M 4df8'i C , Q EMENTr (Check all that apply)' IOUSLY h TYPE OF w, f k t RESPONSE ACTION. ATT MITTED DATE OF Immediate Response Action' r+ r Release Abatement Measure' ��— ment Measure' Utility Related Abate �— Phase If'— � t Phase II Phase III �— z I j IR Phase IV r — / M j Phase V for each. 4 1 +tt8chme st �+ ' �► t ,e Completion01 statement. for multiple actions were completed at a dis � ide de t s warranted G. DESCRIPTION OF RESPONSE ` w " (Check all that apply) 11i ' � NSE'ACTIONS REMOVAL OF REMEDIATION WAS I o , nage Couols. ❑ Contaminated Water Ii ),f l.: t i� ;lip r7 Contaminated Soils r i d '1fil /Dikes/lmpoundments (check all that apply): T orary, overs/Caps Y nzr� '� r 'I, te/Fioduct Recovery Q"Excavate ' ' — al - �' ti �1�f�+r I� a ((ova `E! Uation/Relocation of Residents SlG` [store �2' i Di�f Pjfi..fyf> ,�- a r ovary Water Supplies ❑Treat . � r' � vr�� t�; t systemf ❑ Re-use �, . i �.: tt�irrfl: �, ri '11` M;i .,• ..� .= ��ds ��, i�; o' nd�rater Treatment Systems eRecycle Actuar Volume: s, � I ,. rds ❑Landfill Actual Volume t j d ❑ 141 Drums/Tanks/Containers I� Flit ' PLi9. �V f If{6.ks"i SY.Fri ❑ NA // �z, m /:: '; ESSMENT ONLY other: d i ie±� !'`f! SIIII;(I'" 'ril,j H. FINDINGS AND CONCLUSION' d I r+ en�1 rf 4 r x15+ la nd/or reports necessary to support the RAO to u,� Except where previously submitted and spy 1,. ocum Department,including,without limitation,the, {' I 1 � '' ° ��r or.hazardous material in the environment have I� i4 �, �!it to �, r� ,3 ♦ For all Class A RAOs,information d, d A-3 h jai fe k�of�rt+' feasibility evaluation conducted pursuant t been reduced to background,and '(' of back: b et�t�t 310 CMR 40.0860 demonstrating th :, t leve6of,No Significant Risk has been achieved or ng the g f ♦ For all.Class A and Class B RAOs, I ��o p' exists. i' I ��� f ��ti ,It'' ncontrolled,sources,as specified in 310 fall ru For all Class A RAOs and where r CMR 40.1003(5)have been eluruna 1 Ih dsEtemarn at the disposal.site. r h fusion tha s s bazar For all Class C RAO$.information sp:< , I is �r �tri which presents defin. and enterprising steps 31 9 .., 6 ♦ For'all Class C RAOs,acopy-of Itie "a dispo si e 3i� to be taken toward achieving a Per s '• _. � f� a a ,�l .� •aq 3 uw� , r. ._ .. rimed f "; IY Revised 10/1/93 Massachusetts De f E �11Pro#action OVi15iC-00 i Bureau of Waste I # # y Bottom Tr&Mng NU,1,Lf RESPONSE ACTIOI �l'ip(pursuant to 310 CMR 1. LW OPINION: Name of Organization: 195� L .t U LSP Name: Telephone: )7 j i( " �' {, 1 attest that I have personally examined and #' formaU fi ri ubmrttal, including any and all documern� accompanying this attestation,and in my prole. jrespon r c t tsublect':of this submittal complies with th, provisions of M.G.L.c.21A, §§ 19-19J, 309 C 90 C �, g fy@vlaws, regulations, orders, permits, dnc � approvals applicable to such response actions) # nrfican , '' � �t }+t cluding,but not limited to,possible i nes , a r .. and imprisonment,if I wilfully submit info ation se,,lna t ',c Of Signature ; t' t �`�'� a—- • ��G M { Date: _ # t f ' 1#{ .;. L :^c License Number: JIM r 1�� ��' ' KiJii.Z H . No.632h. w � 'l1 rn i qq P I� � pp 13p 1 ° jig al �51 J. CERTIFICATION OF PERSON SU®I 'i STAT { }' certify under penalties of law that I have personl' am famirrnaUon conta#ned in this submittal,includ' any Pe r, ion m m u 1 ihdwrduals immediately responsible for obtaining and all documents accompanying this cenificau „ y ,! �' , klx the information,the material information contains st of my a do Lef true,accurate and complete. I am aware k r ; that there are significant penalties,including,bu��• i,' ible fin ntnior�wrlfully submitting false, inaccurate, or incomplete iFF ) sr Signature: A t / 1 Name of Person(print):, {`k It 1 tx 3' it 'i k 8�77••• n9�X` ' � • t � I ,' ,�(y art �'�t ry r I x* lA f M1: P r f Page 3 of 3 Revised 1011/93 1 APPENDIX B LABORATORY ANALYTICAL REPORTS APPENDIX C BILL OF LADING s. i�36FS!✓�w vl uvFr i �iOY ° 1$ 03/16/95 15:27 BAR��i &,ZINC 6 7444 g�� �' NO.261 FW2iu02 Ff li$�fx x �l IRO�T � RVICBS 11 n �i 1 FOR L. FANAL iTS The following is requi' y way € � ' anal;ytical testing based on ` Department of Environme tlOM nd'I'p,alicies. 1. The source of the i `! the o tsmination must be known. 2. The petroleum and nst Lhe petroleum released must be known. : � 3. The below items are � i `` and + ' Icert�fied� by the generator. I, the generator, have i � ` dt' , . Ldefeimined that there is no reason to suspect or be , �5the c ataeaiaated soil has been a �i� , impacted by any releases` haza ^eri;als other than that of the known source or I have z Abe a � 1o }l and hazardous materials that are suspected or �Ppres 1 Nfisoi1, in addition. to those associated with the Teas;" u�d' g : any anthropogenetic contaminants. «; I, the generator reali �' Ie ,dil .' ' °� bal;lx consist of a search of information and recor '{�Q�7(, :bl y {' t Sh' {1b,' 'the generator of the contaminated soil Buff, ke a € t�rminatxon. Such records and information may include not "those of the generator, Y � , �iM� location of generation Y' �fltyegf aerator) the Departments Bureau of Waste Site Cite mu RUINe. Board of Health, Fire Department) within whie GIs' i , the generator have 1 frf,ici� " tiion justifying the limits of the analytical regy { :; 4 as p she°tSite History Information accompanying . the 21E B 1" i1nq , real "Shipping Record. This includes as a minimum, the analytical paramet € ed, i - any screening analytic` € . it r TCLP, headspace data) ; , g - the laboratory analytf` - a description of the a physical descriptil soil' gj�;t�he classification method used; a description of th tion ' "€' � ' ga d9 to current and former usage• p 14 v. Cenerator - Printed H r� � � e A dress / A4 Signature of Genera or " ' }F t Date �,$RON Uf W,RN I C R S PETROLEUM` ' JE;D E CYCLING SUBX1TTAL P t HIC This cover sheet � ' �� �Comp;c � , ' r, quests and submittals . tf r � ,F concerning the tra "" � i � re W betroleum contaminated soils , as governed f lici' � !t Ia '� SITE LOCATIOAT �. CITY/TOWN: 3 I d , +i a z , I_F KNOWN: G Y1 C,DEP SPILL # : ADDRESS: C2 zF Yr .s 1.y1 . ! 6 DEP CASE TM CONTACT PERSON FOR TAL NAME: .10 5 2 ii �" " ��.o I Y1 i"'�' QNEro. . B s THE FOLLOWING ARE 'OR �h , J.' r 1 _ A Comple 2. A Comple ti Las zginal Signatures o 3 Ana ytic m a> , fy�;ed Laboratory TE PitOF `.., .AT ;a 'A !Dr�KlC RT I F I CATION S LICENSED SI _ , '3f�e b , All soil 'sampl$ ,' tain , manner<• that accurately and "; � !' 4t C� g �a� ;tx levers in the adequately ;ize M� ► 3 t on` �' as Spec:;- f j ed by DEP stockpile/soi deY a policies, ands' for r th',U' tandard and accepted industry prac W; A k r lWfi Based upon s . ', on j{ z `'the analytical data �, r�Y 1„ r '=k, other pertinent and obtained, an 1 ! uat i � o �a'e"vidence or reason to available in � � the � dp XX y y 1 believe thatl. 0 `�' is with anything other than virgin p., h i 1.5 _ z } 10 G ! ' OOj J that I have personally i I certify put< ;, � � �� , � � , " '°, examined this s anJ , ,l , ;1�Ai 1 with the information contained in nt Ed 1 ,t fg&hments and that , based r ! + edaately responsible for on my inquiry ndivx obtaining thei n, _ � u �pffi'hat the information is true, accurafiP1m aware that there are sigriificrsnt '_ fort f( 'E It, 9 fr�13e information, including pos s I J,. ,� �[ j� SP'' G AATURE <. A �1 � yy r g y}{ I i f H 0 t U�IC7�S` Petro'_. �J in ! rofile x f a R1 Generator's Name/Add F ; � ar ffil {: r V i l e 1`� o a 6 3 a: Site Name/Address: I h W! t � Y Current Use of Prope°� i I S► ► '� t.,, :' (home, factory, etc . � ` I t � •, � , � fast Use of Property, G S I , 'iTRY ` � (site history) i ' n Consultant's Name/Ad e P� ,' a Jh s`L l�'1 i i All �tF{ Soil Contaminant: a: 2 No. 4, Vo. 5, No. G, other, p 'bl `crik� . .r>a to Estimate of Quantity., " :° t;'` k" § & cubic yards . : � � a Source of Contaminate, Unde. t iS,tor`age Tank, If other Please describe: Mill r C " ; race o�' S T Grd Ise Soil Type: SA Q P :..d (sand, gravel . etc. )` jr a Prim SignatureAf f -11 nTES/15 y� 5Y• 9 0 RMassachusett . , enIt ®ifs m� � � ion �lM1isC-0' I 4 I ,1 On�a retect Bureau of Waste ' tic Reie BILL OF LADI 10 CM ❑ ;� 710111 la 111 - , ,A. LOCATION OF SITE OR DISP ERE R PI - iAJASTE WAS GENERATED: Felease Name(optional): Street: �s M a haid Lt1 k i l�` i' �I � iyyypppat i, f'yisto�b/e Co c(il IL 1 I City/Town: G e il �. • t i / ll N6 t Date/Period of Generation: a9 /_ � l Additional Release Tracking Numbers Asso a • f:Ladin ( ifstip ' ,,1�. IG 'II PFeI� Note: It this DJIJ of; �u/t oPn au i Action(LPsa)taken prior to PlotiF ! J�asa �ra� u I let Is reot'needed. B. PERSON CONDUCTING RE S 11 ; � ASSO< � 0T&9 BILL OF LADING: Name of Organization: 7*h0 Name of Contact: lO!?'! a ! Street: 3 /�d Lill, t4 � t / a !! Ciryffown: C I �. S� f,� �•, s a xi . '.,,,Zip Code: Telephone: C. RELATIONSHIP TO RELEAS ,i f f®F REL ��' t ° Pr�68S®1+9 CONDiICTIl�9G RESS�OtdSE ACTtC)fd ASSOCIATED WITH BILL OF (check one/specify) ator 1! te e one): RP Specify(circle Owner r r o �I �r a l �, II.I ElPRP Specify(circle one): Owner t rftor ns rI hertPRP ❑ Fiduciary/Secured Lender Agency/Public Utility on a Right of Way.t' ! ' 4. ua i r i.s Other Person: fan owner and/or o erator is not conducUri ton assoct ; Bu of.lkading,provide on an attachment the name, P 1, k ,.. f won ct person,address and telephone nu MI N area co for,-each,if known. , D. TRANSPORTER/COMMON CAI I j I AT1 0 Transporter/Common Carrier Name: Co •; i {I '�% f u ` Contact Person: Jai I Ilia Street: l4� y f ,� I St %eh�' a ` , 9r ;Zip Code: — P T.ele hone: SO$ - S7 5�d o of E. RECEIVING FACILITY/TEMP ING EL F�� � 4 Jperatcr,Facility Name: i ri, ��i ' � f ear, Contact Person: Tltle: City/Tc.:n: S>to si :;firf ;i ,t)f st Zip Code. ada7t "eleprz:ne: (1 lit � I AL, , ' -ype cf=acuity: Asphalt BatchlCl ' ; andfilll _#a� �1 1`f;� Incinerator check :-e) � ❑ Asphalt Batch/HI andfill/andflll/ rM, Temporary Storage Thermal Processl ❑ 9 • � � � �� Qther: � Fvlslc"of HazardousWa'rast2;ass A Permit a: Q OAO nt1 Permltl' EPA Identification#:' f -�:;tua -nticipated Period of Temporary Storm t.; `If`apphca V �_— =.east-is r Temporary Storage(If applicable R {{ ttpp }{}{ p))p xlFrd„� �ap•a�,�aketa,.,;.,•„ printed Peru Page t cf 2 i + iY � �� f'�'(r�� s � r i�:•s •i. � 1 (� i� .i ( Pb��� r, i,:� I ��`((r p! I l�h>�� . pro Massachusett nt `ntal Protection BWSC-C � " Bureau of Waste' �� r gat"a r x� ^r Vase Trachn_-, BILL OF LAD16V 3,50 cIIR ' E41-1® � :l.;s _ . . ..... art E. RECEIVING FACILITY/TEMP EL IY hued): Temporary Storage Address: sF i a treat: C:ty/Town: St aC`_; ` i i Zip"Code: F. DESCRIPTION OF RENIEDIAT (check all that apply) Contaminated Media(circle all that appl undwat far t E Ctner• _ Contaminated Debris(circle all that app; nstruc, �f tV� etation/Organic Materials Inorganic Absorbant Material f IV,I _ CJ Non-hazardous Uncontainerized Waste(-!, fy).; N• se liquid Other: i�� i 1 ❑ Non-hazardous Containerized Waste(cir` Tank 1, +it ,l # Cgntainers gums Engineered Impoundments _ Ali • Tape of Contamination(circle all that apply) + t Diesel #4 Oil #6 Oil Waste Oil Kerosene. Jet Fuel Estimated Volume of Materials: Cubic Yar' { ) li hl 1 Other: 3 } F Contaminant Source(check one/specify): ��ti t ccident ! n'.�'r rid Storage Tank ❑Other: 1 f i 7 4�It.. «�P�ce 1 Response Action Associated with Bill of Lad l 1 I +v Imrti a ' ton.' Release Abatement Measure Utility-Related Abatement Me I lted Reg a „ ;; Comprehensive Response Action Other(specify): 10 ' ) ��t �� � ilk Ra-nediation Waste Characterization Support, ached: s g ❑ Site History Information ❑ Samplin thods a ,aboratory Data ❑ Field Screening Data If supporting documentation is not a en+! ' I.,lachm e taieiand in connection with what document sucPP 9 PPjj irrtrmation was previously submitted to DE h P Y tl, ,�• i �� , u�', �1'f� t �� �'�:t� / C. LICENSED SITE PROFESSIION: VVV time of Organization: f LS?Name:g Ste. L ^'• ,i.",�t4 ,; .N €` ' I, llel lephone: t u} `" 4 i � � !��i+} IYR��t F} ' —:ave personally examined and am familiar dt o eontarn �: ds,trnrtted,with this form. Based on this information, it is my i �.., t • N i«i a C�rnion that the testing and assessment acU ere ad e enze the'Remediation Waste, in accordance with 3 i 0 �'✓R 40.0030,and that the facility or locatloci I I�diatlon w�� it �) Mara "tenstics des submittal. I am ao:are i,a �rlt r. .=_t significant p ies including,but not Ii f"nes an tI a ayiresult!f'I.wl a I itm n which I knc.v to ce false,inac rate r mat i/al�yin pletet 5' ( ' ! , S � `' �Cy S: natur tti I i VA al: STsv t� X _3;3: _+sense Number: �3a.� ! u i�l at1; a � .; i�15 t+ V Zt&r';V. t tdo•632 f� ufTC ;!n3 • t T (� r'�9d'�'7P K CERTIFICATION OF PERSON C , f RESP r6Vi!AsSOCIATED WITH THIS BILL OF LADING: r � � { anity under penalties of law that I have pe ° and am; ioation contained in this submittal, including any c all Cccuments accompanyingthis certlfi� i' ped on j hos- F�dividuals immediate) responsible for obta+n:ng , :nferrration,the material information contc"'` Ie best gd'I+ 1f I nd elief,true,accurate and complete. I am aware there are slgn,hcant pena::{es. lncludln� f r f posse " nent. for wilfully submitting false, inaccurate. or t•=- t at ..t.. ..4-0Ifi�iifl}+AYe by t.1-H 'k�x.-.,. .. _ .. • ,._.,.... .. sad tC,ti93 l printed®, f�( Page 2 of 2 - COMPLIANCE ENVIRONMENTAL, INC. 31 Fremont Street Needham, MA 02194 617-444-5950 Ms. Donna Miorandi. April 21, 1995 Health Department Town of Barnstable 367 Main Street Hyannis, MA 02601 Neal Dear Ms. Miorandi: Find enclosed, a copy of our Environmen 1 Assessment and Response Action Outcome Report relative to the removal of an approximate 55 gallon, underground, gasoline, storage tank formerly located at 38 Magnolia Avenue, West Hyan 'sport, Massachusetts(DEP Release Tracking Number 4-11167). Refer to Section 6.0 of the Report for our findings, opinions and recommendations. Refer to the attached appendices for copies of the completed, appropriate Massachusetts Department of Environmental Protection(DEP) forms. As recommended in Section 6.0 of the Report a copy of this Report and the enclosed original Release Notification Form (RNF), Immediate Response Action (IRA) Completion Statement and the Response Action Outcome (RAO) Statement is being forwarded to Mr. Michael Moran at the Southeast Regional Office of the DEP in Lakeville,MA. We appreciate your interest in the project and your assistance with the municipal research. If you have any questions or comments at any time do not hesitate to call us. Sincerely, COMPLIANCE ENVIRONMENTAL, INC. . Jose S. Hobin - President cc: John V. Harvey; Esq. APPENDIX A DEP FORMS (RNF, IRA & RAO) I Commonwealth of Massachusetts Executive Office of Environmental Affairs Dep a rtment of Environmental Protection ' Southeast Regional Office William F.Weld Governor Trudy Coxe Secretary,EOEA Thomas B. Powers. Acting Commissioner URGENT LEGAL MATTER: PROMPT ACTION NECESSARY o o0 TRTIFIED MAIL: RETURN RECEIPT RE UESTED i o ® March 2 , 1995 Thomas Teezar RE: BARNSTABLE--BWSC 38 Magnolia Way 8 Magnolia Way 1 Centerville, Massachusetts 0263,2 RTN: 4-11167 NOTICE OF RESPONSIBILITY M.G.L. c . 21E, 310 CMR 40 . 0000 ATTENTION: John V. Harvey, Esq. , Agent for Thomas Teezar On March 1, 1995, at 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 . In addition to oral notification, 310 CMR 40 . 0333 requires that a completed Release Notification Form (BWSC- 003 , attached) be "submitted to the Department within sixty (60) calendar days of the date of the oral notification. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c . 21E, and the Massachusetts Contingency Plan (the "MCPtt ) , 310 CMR 40 . 0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result front 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 11 : 30 a.m. ) is/are a Potentially Responsible Party (a "PRPtt ) 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 20 Riverside Drive • Lakeville,Massachusetts 02347 9 FAX(508)947-6557 • Telephone (508) 946-2700 ,r -2- 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 . 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) : • Excavation of 6 cubic yards of Contaminated Soil . • Proper, Storage/Disposal/Recycling of all Contaminated Media. • All Remediation Waste must be properly handled and disposed of within 120 days from the date of generation per 310 CMR 40 . 0030 . Specific approval is required from the Department for the implementation of all IRAs, with the exception of assessment activities, the construction of a fence and/or the posting of signs . This site shall not be deemed to have had all the necessary and required response actions taken for it 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. Additional submittals are necessary with regard to this notification including, but not limited to, the filing of an IRA Completion Statement and/or a Response Action Outcome (RAO) k -3- statement . The MCP requires that a fee of $750 .00 be submitted to the Department when an RAO statement is filed greater than 120 days from the date of initial notification. You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at this site . You may obtain a list of the names and addresses , of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1145 . If you have any questions relative to this notice, please contact Michael Moran at the letterhead address or at (508) 946- 2855 . All future communications regarding this release must reference the following .Release Tracking Number: 4-11167 . Very truly yours, Richard F. Packard, Chief Emergency Response / Release Notification Section P/MM/jt CERTIFIED MAIL #P656 826 576 RETURN RECEIPT REQUESTED Attachments : Release Notification Form; BWSC-003 and Instructions Summary of Liability under M.G.L. c .21E cc : Warren J. Rutherford Town Manager Town of Barnstable 367 Main Street Hyannis, MA 02601 Board of Health Town of Barnstable Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Brian R. Grady, R.S . Board of Fire Commissioners Hyannis, MA 02601 DEP _ SERO ATTN: Andrea Papadopoulos, Deputy Regional Director 4 COMPLIANCE ENVIRONMENTAL, INC. 31 Fremont Street Needham, MA 02194 617-444-5950 ENVIRONMENTAL ASSESSMENT AND RESPONSE ACTION OUTCOME STATEMENT RELATIVE TO A RELEASE OF HEATING OIL AT W 38 MAGNOLIA AVE., , v DEP RTN. 4-111 f 7 -' C Prepared for: Coastland Tanks, Inc. clo .John V. Harvey, Esq. clo Thomas H. Teczar 14 Nye Road Falmouth, MA 02540 Prepared by: Compliance Environmental, Inc. 31 Fremont Street Needham, MA 02194 April 10, 1995 .. e s TABLE OF CONTENTS Page 1.0 INTRODUCTION 1 2.0 UNDERGROUND STORAGE TANK EXCAVATION 1 3.0 SUBSURFACE SOIL ASSESSMENT 2 4.0 RECYCLING OF THE EXCAVATED SOIL STOCKPILE 7 5.0 RESPONSE ACTION OUTCOME STATEMENT 7 6.0 FINDINGS, OPINIONS AND RECOMMENDATIONS 8 7.0 LIMITATIONS 10 ATTACHMENTS Figure 1 Site Locus Map Figure 2 Schematic Site Plan Appendix A DEP Forms (RNF, IRA & RAO) Appendix B Laboratory Analytical Reports Appendix C Bill of Lading • Thomas H.Teczar Property Page 1 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 1.0 INTRODUCTION This Report concerns an environmental assessment related to the excavation of a 55-gallon, underground, gasoline storage tank associated with a residential property located at 38 Magnolia Avenue, West Hyannisport, Massachusetts (hereinafter, the "Site"). Hyannisport is a village located within the Town of Barnstable on Cape Cod, Massachusetts. Refer to Figure 1, the Site Locus Map for the approximate location of the Site. Refer to Figure 2,the Schematic Site Plan for the approximate location of the discussed Site features. According to the Town of Barnstable Assessor's records the Site comprises approximately 1.09 acres of land. The Assessor's designation is Map 225, Parcel 013 and Lots 238 - 242. Also according to Assessor's records, the current Site owners are listed as;Edward P. and Thomas H. Teczar and Patricia Ernitz. As shown on the attached Schematic Site Plan, the Site is occupied by a single family home. According to Mr. Thomas H. Teczar, Site owner and present occupant, ..."since its development, in circa 1895, the Site has always been utilized as a private residence, with no commercial or industrial activities ever taking place." The Site is connected to the municipal water service. According to Mr. Teczar,. Site observations and information supplied by the Town of Barnstable Health Inspector, Ms. Donna Z. Miorandi there are no on-Site or abutting property drinking water supply wells. According to Ms. Miorandi, the Site is not located in any Zone of Contribution (ZOC) to any municipal water supply wells. Based on the above and the Site's close proximity to the ocean (an average of approximately 175 feet) it appears that the groundwater beneath the Site is not a source of drinking water nor would it be expected to be a drinking water source in the future. The house is two-story, wood frame, shingle sided, cape style structure at grade with no underlying basement. The northwest corner of the house has an attached garage. The outside area of the Site is occupied by a gravel driveway in the north, a lawn, and a sandy beach area in the south which abuts the ocean. Sanitary sewage is conveyed to an on-Site septic system located out from the southeast corner of the house. All improved properties in the near vicinity are used in a manner similar to the Site. The properties north, east and west of the Site are occupied by single family, private residences. The south border of the Site abuts Centerville Harbor,Nantucket Sound and the Atlantic Ocean. 2.0 UNDERGROUND STORAGE TANK EXCAVATION The house is heated by oil stored in a recently installed, 275-gallon, above ground, oil storage tank situated in the garage. Prior to installation of the above ground storage tank the heating oil had been stored in an approximate 300-gallon, underground, storage tank which had been located adjacent to the west wall of the garage. Pursuant to regulations, the discontinued underground u - ' Thomas H.Teczar Property Page 2 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 storage tank was scheduled for excavation and removal. On a rainy February 28, 1995 Coastland Tanks, Inc. of Falmouth, Massachusetts excavated the approximate 300-gallon, underground, oil storage tank. Upon removal, the oil storage tank was observed to be in relatively good condition with no holes, weak areas or evidence of a release of oil to the adjacent subsurface environment. Observations of the tank excavation revealed what appeared to be the wall of a second, adjacent underground storage tank. Additional soil removal revealed an approximate 55-gallon, underground, gasoline storage tank which according to Mr. Teczar stored gasoline to power the previously existing back up electric generator. Mr. Teczar was unaware of any prior environmental incident or leak or loss of oil and/or gasoline associated with either of the two storage tanks. Upon exposure, the approximate 55-gallon, underground, gasoline storage tank appeared rusted, the filler pipe had rusted loose and fallen through the top of the tank resulting in an opening of about four inches in diameter. This opening which apparently has existed for some time prior to the uncovering of the tank is evidence of the potential threat of a release of gasoline to the adjacent environment via precipitation inflow over time. According to Mr. Ken Trojano of Coastland Tanks, Inc. observations through this hole indicated that the tank was full of what appeared to be a mixture of mostly water with some residual gasoline. Mr. Trojano pumped the water and gasoline mixture from the tank and transferred it to a 55-gallon drum which was sealed and transported under Uniform Hazardous Waste Manifest to an appropriate recycling/disposal facility. Ms. Miorandi was on Site during much of the February 28, 1995 above described activities. According to Ms. Miorandi,the heavy rain falling into the exposed tank opening caused an unspecified volume of the water/gasoline mixture to overflow from the tank prior to pumping. The two removed storage tanks were cleaned and transported to the Mid-City Scrap Disposal facility in Westport,MA (Permit No. 12889). 3.0 SUBSURFACE SOIL ASSESSMENT In response to the apparent release of gasoline an environmental consultant(the author, Mr. Joseph S. Hobin) from Compliance Environmental, Inc. (CEI) arrived on Site on March 1, 1995 in order to assess the soils within the tank excavation and to determine the extent of the gasoline release (if any). The weather on March 1, 1995 was overcast but not raining with a temperature of approximately 35 degrees Fahrenheit. The excavation immediately adjacent to the west wall of the garage was measured to be approximately five by six feet by four feet deep. The subsurface soil was a course to fine sand with a trace amount of silt. There was no visual evidence of any oil or gasoline on the soils within the excavation or on the stockpiled soils removed from the excavation on February 28, 1995. There was however a moderate smell of gasoline emanating from the excavation and the stockpiled soils. I Thomas H.Teczar Property Page 3 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 Representative composite soil samples were taken from the four walls and floor of the excavation. The soil samples were obtained by digging into the walls and floor of the excavation approximately nine inches to obtain the soil sample. This procedure insured that the soil sample was representative of actual conditions and not soil which had fallen or slumped into the excavation. The soil samples were placed about two-thirds full in clean,approximate eight ounce, soil jars with aluminum foil sheet covers followed by screw on caps. During the soil sampling procedure which disturbed the soils in the excavation there a moderate odor of gasoline. The soil sample jars were allowed to warm in a heated truck for a minimum of 15 minutes. After passage of the warming period, the jars were lightly shaken and the headspace above each soil sample was field screened for the presence of volatile organics with a HNu photoionization detector referenced to an isobutylene standard read as benzene. The HNu photoionization detector measures the relative concentration of volatile organics in the headspace of sealed soil jars, these readings cannot be directly translated to quantitative concentrations of volatile organics present, but are indicative of the presence and relative concentration of volatile organics in the soil sample. The results of the HNu photoionization detector screening of the soils collected from the excavation are summarized below in Table 1. TABLE 1 HNu Photoionization Headspace ScreeningResults Performed on Soil Samples Collected from the Tank Excavation Location HNu Photolomzatlon Headspace in ppm (1) east wall 3 ppm south wall 130 ppm west wall 4 ppm north wall 3 ppm floor 120 ppm Note: (1) ppm=parts per million In the opinion of CEI, the above observations and HNu photoionization detector headspace screening results are indicative of a release of volatile organic compounds (VOCs) to the soils of the south wall and floor of the excavation. It is the further opinion of CEI, that the VOC contamination is from a release of gasoline from the former, adjacent ,underground, storage tank. This opinion is confirmed by Section 40.0313 of the Massachusetts Contingency Plan (MCP, 310 CMR 40.0000) which requires notification to the Massachusetts Department of Environmental r Thomas H.Teczar Property Page 4 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 Protection (DEP) within 72 hours of any release of oil and/or hazardous material adjacent to an underground storage tank,as established by measurement of equal to or greater than 100 parts per million by volume of total organic vapors "as benzene" in the headspace of a soil sample obtained greater than two feet below the ground surface, using a headspace screening method. In an effort to remove the above identified VOC or gasoline contamination the excavation was extended by removal of approximately two feet of soil from the south wall and floor of the excavation. This resulted in an increase of the excavation dimensions to approximately 5.5 by eight feet by six feet deep and a soil stockpile of approximately six cubic yards. Prior to leaving the Site on March 2, 1995, the heavy weight, plastic sheeting placed under and over the excavation soil stockpile was secured in place. In order to assess the results of the above second soil removal, representative composite soil samples were taken from the south wall and floor of the excavation. Two representative composite soil samples(samples; stockpile 1 and 2) were also collected from the stockpile resulting from the two soil excavations. The four soil samples were field screened for the presence of volatile organics with the HNu photoionization detector. The results of the HNu photoionization detector screening of the soils collected from the excavation and soil stockpile are summarized below in Table 2. TABLE 2 HNu Photoionization Headspace ScreeningResults Performed on Soil Samples Collected from the Tank Excavation and Soil Stockpile Location HNu Photoionization Headspace in ppm south wall BDL floor 1 ppm stockpile 1 3 ppm stockpile 2 3 ppm Note: (1) BDL=Below the photoionization Detector Limit of 0.1 ppm. Pursuant to Section 40.0313 of the MCP(see above), it is the opinion of CEI, that the above HNu photoionization detector headspace screening results indicate that there is no significant VOC or gasoline contaminated soil remaining in the excavation. Thomas H.Teczar Property Page 5 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 Pursuant to the above described MCP required 72 hour notification, on March 1, 1995 after completion of the above excavation, soil sampling and field screening activities a phone call from the Site was placed to Mr. Michael Moran of the Southeast Office of the DEP. Within that conversation, Mr. Moran was made aware of the above assessment data and informed that confirmation of the observations and field screening data would be provided by laboratory analysis of composite soil samples to be collected from the walls and floor of the excavation. Based on the March 1, 1995 conversation the DEP sent a March 2, 1995 Notice of Responsibility to Thomas Teczar. A copy of the NOR is included in Appendix A, DEP Forms. A summary of the more pertinent information in the NOR is listed below: the March 1, 1995 initial, oral notification of the release was acknowledged; Mr. Teczar was informed that the DEP considered him to be the potentially responsible parry (PRP); a requirement to perform response actions to prevent harm to health, safety, public welfare and the environment which may result from the release; at the time of the oral notification, the following response actions were approved by the DEP as an Immediate Response Action (IRA): the excavation of six cubic yards of contaminated soil and the proper storage and disposal/recycling of all contaminated media and remediation waste; a requirement to submit to the DEP the following completed DEP forms and supporting documents (ie, this report and attached appendices): Release Notification Form (RNF), IRA Completion Statement and/or a Response Action Outcome (RAO) Statement (completed copies of which are included in Appendix A); a statement that the Site shall not be deemed to have had all the necessary and required response actions taken for it unless and until all substantial hazards presented by the release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. 21E and the MCP;and a requirement to engage a Licensed Site Professional (LSP, Dr. Steven L. Kurz, No. 6324). After the phone call with Mr. Moran, all discussed issues, opinions and information were reported to Ms. Miorandi who had just arrived on Site. Ms. Miorandi concurred with the expressed opinions and the days assessment and excavation activities. Thomas H.Teczar Property Page 6 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 As referenced above, in order to further confirm the above observations and HNu photoionization detector headspace screening results; a representative, five point, composite soil sample (designated EX-COMP) was obtained from the four walls and floor of the excavation. In addition, another representative composite soil sample (designated "stockpile") was collected from the soil stockpile for purposes of recycling the excavated soil at a DEP approved asphalt hatching facility. Upon collection the soil samples were placed in appropriate glass jars which were stored in an ice filled cooler for transport to a DEP approved laboratory under appropriate chain-of custody protocol. The soil samples from the excavation were analyzed for VOCs via EPA Method 8260, total lead and total petroleum hydrocarbon (TPH) content via modified ASTM Method D3328-78. The soil samples from the soil stockpile were analyzed for VOCs and total lead. The laboratory reports,laboratory QA/QC documentation and the chain-of custodies are attached as Appendix B. A summary of the laboratory analytical results is provided below in Table 3. TABLE 3 Laboratory VOC,Total Lead and TPH Results Performed on Soil Samples Collected from the Tank Excavation and Excavation Stockpile Sample Location VOC Result Total Lead TPH Result EX-COMP Excavation BRL(1) 5.1 mg/Kg (2) 21 mg/Kg Stockpile Stockpile BRL 4.5 mg/Kg NA (3) Notes: (1) BRL=Below the instrument ReportingLimit of 0.5 or 2.5 m for all EPA Method pP compounds, see Appendix B. (2) mg/KG=milligrams per kilogram, roughly equivalent to ppm. (3) NA =Not Analyzed, it was not necessary to analyze the soil stockpile for TPH in order to transport it for asphalt hatching. In the opinion of CEI, the above Table 3 laboratory results confirm the on Site observations and headspace field screening results indicating that there is no significant total lead, TPH or VOC or gasoline contaminated soil remaining in the excavation. This opinion is confirmed by Section 40.1600 of the MCP, which lists minimum Reporting Concentrations (RCs). There were no identified VOC concentrations and the MCP Soil Category S 1 RC for total lead is 300 ppm and the S 1 RC for TPH is 500 ppm. Thomas H.Teczar Property Page 7 of 10 38 Magnolia Avenue,West Hyannisport, MA April 10, 1995 4.0 RECYCLING OF THE EXCAVATED SOIL STOCKPILE On April 7, 1995 the approximate, six cubic yard, excavation soil stockpile was transported for recycling to the Bardon-Trimount Asphalt Batching Facility in Stoughton, Massachusetts. The DEP Bill of Lading and related documents necessary to transport and recycle the excavated soil is attached as Appendix C. After removal of the soil stockpile, the tank excavation was backfilled with clean soil transported to the Site. 5.0 RESPONSE ACTION OUTCOME STATEMENT The March 1, 1995 DEP approved IRA of excavating approximately six cubic yards of contaminated soil and the appropriate off Site disposal/recycling of the two underground storage tanks and all contaminated media resulted in no identified oil or hazardous material concentrations in remaining on Site soils which exceed the MCP RCs pursuant to 40.1600 or the MCP Method 1, Risk Characterization, Soil Category S-1 Standards pursuant to 40.0975 (6) (a). Based on the above and pursuant to the Class A-2, Response Action Outcome (RAO) as described in 40.1036, it is the opinion of CEI that a permanent solution has been achieved in response to the gasoline release and that a level of no significant risk exists without the need for any Activity and Use Limitations. Support and documentation for this Class A-2 RAO opinion is provided by this report and the completed IRA completion Statement and RAO Statement, copies of which are included in Appendix B. The above Class A-2 RAO Statement is based on remaining soil concentrations which are below MCP regulatory RCs and Risk Characterization Standards but may be above background concentrations. Consequently, a Feasibility Evaluation is required which evaluates the feasibility of reducing the concentration of oil and hazardous material in the environment to levels that achieve or approach background. In the opinion of CEI, the identified total lead concentration of 5.1 ppm and the TPH concentration of 21 ppm in the soil remaining on the Site does in fact approach background levels. It is the further opinion of CEI, that the incremental increased cost to continue the excavation until reducing soil concentrations to background or BRL is disproportionate to the incremental benefit to the environment. This second opinion is based on the following: the remaining soil concentrations do approach background levels, the groundwater beneath the Site is not a source of drinking water nor is it expected to be a future source of drinking water and further excavation would be very costly due to structural considerations relative to the immediately adjacent garage which would have to be either moved or adequately braced before performing any additional excavation. Thomas H.Teczar Property Page 8 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 6.0 FINDINGS, OPINIONS AND RECOMMENDATIONS Based on the above observations and field screening and laboratory analytical results, CEI offers the following findings, opinions and recommendations: The approximate 1.09 acre Site is occupied by a single family residence. The present and past use of the Site has always been residential with no history of commercial or industrial activities. North, East and west of the Site are improved properties also occupied by similar single family residences. Directly south of the Site is Nantucket Sound, the Atlantic Ocean. Based on observations and research at the Town of Barnstable municipal offices there are no known drinking water supply wells on the Site or any near vicinity properties. In addition, the Site is not located in any Zone of Contribution (ZOC) to any municipal water supply wells. Based on the above and the Site's close proximity to the ocean (an average of approximately 175 feet) it appears that the groundwater beneath the Site is not a source of drinking water nor would it be expected to be a drinking water source in the future. The house is heated b oil stored in a recently installed y y , 275-gallon, above ground, 011 storage tank situated in the garage. Prior to installation of the above ground storage tank the heating oil had been stored in an approximate 300-gallon, underground, storage tank which had been located immediately adjacent to the west wall of the attached garage. Pursuant to regulations, the discontinued, underground storage tank was scheduled for excavation and removal on February 28, 1995. Upon-removal, the approximate 300-gallon, oil storage tank was observed to be in relatively good condition with no holes, weak areas or evidence of a release of oil to the adjacent subsurface environment. Observations of the tank excavation revealed what appeared to be the wall of a second, adjacent underground storage tank. Additional soil removal revealed an approximate 55- gallon, underground, gasoline storage tank which according to Mr. Teczar stored gasoline to power the previously existing back up electric generator. Mr. Teczar was unaware of any prior environmental incident or leak or loss of oil and/or gasoline associated with either of the two storage tanks. Upon exposure, the approximate 55-gallon, underground, gasoline storage tank appeared rusted, the filler pipe had rusted loose and fallen through the top of the tank resulting in an opening of about four inches in diameter. This opening which apparently has existed for some time prior to the uncovering of the tank is evidence of the potential threat of a release of gasoline to the adjacent environment via precipitation inflow over time. According to Mr. Ken Trojano of Coastland Tanks, Inc. observations through this hole indicated that the tank was full of what appeared to be a mixture of mostly water with some residual gasoline. Mr. Trojano pumped the Thomas H.Teczar Property Page 9 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 water and gasoline mixture from the tank and transferred it to a 55-gallon drum which was sealed and transported under Uniform Hazardous Waste Manifest to an appropriate recycling/disposal facility. Ms. Miorandi of the Town of Barnstable Health was on Site during much of the February 28, 1995 activities. According to Ms. Miorandi, the heavy rain falling into the exposed tank opening caused an unspecified volume of the water/gasoline mixture to overflow from the tank prior to pumping. The two removed storage tanks were cleaned and transported to the Mid-City Scrap Disposal facility in Westport, MA. On March 1, 1995 observations and HNu photoionization detector headspace field screening of soil in the excavation adjacent to the former 55-gallon, gasoline storage tank identified volatile organic compound (VOC) or gasoline contamination of the soil at the south wall and floor of the excavation. After additional excavation of the south wall and floor of the excavation it was determined via photoionization headspace field screening that the significant VOC or gasoline contaminated soil had been excavated. Pursuant to the Massachusetts Contingency Plan (MCP,310 CMR 40.0000) 72 Hour Notification requirements, a March 1, 1995 phone call was placed from the Site to Mr. Michael Moran of the DEP's Southeast Regional Office. After becoming aware of the excavation activities and assessment data Mr. Moran gave approval for an Immediate Response Action (IRA) which involved the excavation of approximately six cubic yards of contaminated soil and the appropriate off Site disposal/recycling of all contaminated media. Based on the phone conversation the DEP sent a Notice of Responsibility(NOR) to the Site owner and occupant, Mr. Thomas H. Teczar. In addition to Mr. Moran, Ms. Miorandi was also made aware of the excavation and assessment activities and data. In order to further confirm the above observations and HNu photoionization detector headspace field screening results;a representative, five point, composite soil sample (designated EX-COMP) was obtained from the four walls and floor of the excavation. The composite soil sample from the excavation was analyzed for VOCs, total lead and total petroleum hydrocarbon (TPH) or oil. There were no identified VOC, total lead or TPH concentrations which exceeded the MCP Soil Category S 1 Reporting Concentrations. On April 7, 1995 the approximate, six cubic yard, excavation soil stockpile was transported for recycling to the Bardon-Trimount Asphalt Batching Facility in Stoughton, Massachusetts via the Bill of Lading included in Appendix C. After removal of the soil stockpile, the tank excavation was backfilled with clean soil transported to the Site. The March 1, 1995 DEP approved IRA of excavating approximately six cubic yards of contaminated soil and the appropriate off Site disposal/recycling of the two underground storage Thomas H.Teczar Property Page 10 of 10 38 Magnolia Avenue, West Hyannisport, MA April 10, 1995 tanks and all contaminated media resulted in no identified oil or hazardous material concentrations in remaining on Site soils which exceed the MCP RCs pursuant to 40.1600 or the MCP Method 1, Risk Characterization, Soil Category S-1 Standards pursuant to 40.0975 (6) (a). Based on the above and pursuant to the Class A-2, Response Action Outcome(RAO) as described in 40.1036, it is the opinion of CEI that a permanent solution has been achieved in response to the gasoline release and that a level of no significant risk exists without the need for any Activity and Use Limitations. Support and documentation for this Class A-2 RAO opinion is provided by this report and the completed IRA completion Statement and RAO Statement, copies of which are included in Appendix B. Pursuant to the NOR requirements, CEI recommends that a copy of this Environment Assessment Report along with the original RNF, IRA Completion Statement and the RAO Statement be forwarded to Mr. Michael Moran at the Southeast Regional Office of the DEP in Lakeville, MA. on or before April 28, 1995. 7.0 LIMITATIONS This Report is not a complete environmental audit. No attempt was made to determine the regulatory compliance of the present or the past owners or operators of the Site with any federal, state or local environmental or land use laws and regulations. The observations made during Compliance's inspection and research of the Site, and the conclusions drawn therefrom, were made on the date(s) and under the conditions stated herein. No inferences regarding other conditions, locations and materials at a later or earlier time may be made based on the contents of this Report. Where subsurface examinations and associated laboratory analyses of samples were not performed, Compliance makes no representations concerning soil, surface water or groundwater quality. Unless otherwise noted herein, the assessment activities did not include an evaluation of the presence of. asbestos, radioactive materials, radon, infectious waste, lead paint and/or pesticides and herbicides. Unless otherwise noted, any map, figure or schematic plan contained in this Report is not meant to be an accurate engineering drawing, but is provided to present the relative locations of buildings and Site features. This Report was prepared for the sole use of our Client. The use of this Report by anyone other than our Client or Compliance is strictly prohibited without the express prior written consent of Compliance. Portions of the Report may not be used independent of the entire Report. r FIGURES RVrw ��� �-�'�': - f � off, ��- %��,��� • �� ,�Jl 10 5 10 � / \��) a� '�'-� ��s a e_ •I Public Beach� Landing 13 20 ice' ® _ _ _. , ►.. _ �: �� ,� o�„1 1 .- �� ill f VILL ARBGannet • Rocks FIGURE I SITE LOCUS MAP. 38 o i Magnolia West Hyann.isportg MA ,,, ' `�AC`VOLIA 4 vE FIGURE 7 PROPER?-Y LINE SCHEMATIC SITE PLAN w ; 38 MAGNOLIA AVENUE WEST HYANNISPOkT, &1A FORMER LOCATION OF TWO y APPROX. SCALE:1 INCH - SO FEI UNDERGROUND.,STORAGE TANKS q DATE: 4/9/95 V ' Site Plan Derived From V_ Town of Barnstable G.I.S. ill,,,'[ cAR 4/1/93 ACE HOUSE A :N ,o 4 . ATLANTIC OCEAN V . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Massachusetts of En tal rotection BWSC-�u� Qureau of Wasted ' l �. ;� � ► �i� Release Tracking Number RELEASE NOTI :` ` SNOT TRACTION E] -111167 FORM Pursuantto `; 4 5 and 31 ;CI�t `. All „ubpart C) If assigned by DEP A. RELEASE OR THREAT OF RELEASE;' Street: of n i ;i1tr, ��, 'Crai9V►ile Beach R�:�� RIZ t r a n Atdr Citylrown: Wesf H ann i:s Po �A �w IPicex � 0 B. THIS FORM IS BEING USED TO: (ch j4 r S R Submit a Release Notification(comple44 t Submit a Retraction of a Previously R Ion of ar l r elease(complete Sections A,B,E,F and G or tn,s form). You MUST attach the suppor ing doc j' I by 310 i I C. INFORMATION DESCRIBING THE P4. I r TOO OR r{ OC Date and time you obtained knowledge of the Rel" �3"�I - i � Specify: Ed AM ❑ PM to : The date you obtained knowledge is always re ou obta i of required it reporting only 120 Day.Conditions. � i M � � tr e�, r�, AM P IF KNOWN,record date and time release or TOR; Ip-r r Spec N ❑ ❑ Check here if you previously provided an Oran t 4 �(2 Hour.a �in g Conditions only). Provide date and time of Oral Notification. D 1 F I i i ia: O * Specityy ✓�AM ❑ P M Check all Notification Thresholds that apply to the ; f Relea Infom�ation see 310 CMR 40.0310.40.0315) 2 HOUR REPORTING CONDITIONS 72 t G CoN DAY REPORTING CONDITIONS tl Ir- a�P, N:,i� 111� 1�t:• ❑ Sudden Release , I queou ;i � i 18 Release of Hazardous.Materials)to Soil or 1: a„! , ] ual to or, Groundwater Exceeding Exceeding Reportable ❑ Threat of Sudden Release } fConopntration(s) ❑ Oil Sheen on.Surface Water l '`( i r,ge Tan ,F j r lease of Oil to Soil Exceeding''Reportable ff l 1F(� +Eoncentration(s)and Affecting More than 2 Cubic ❑ Poses Imminent HazardE, ' I lrrYards ,y ❑, lease❑ t` 7R.e�elease of Oil to Groundwater Exceeding Reponaolc Could Pose Imminent Hazard Aor ntration(s) ❑ l r ter Release Detected in Private Well ❑�1 `� � � � ,4 S4bsurface Non-Aqueous Phase Liquid(NAPL) ❑ Release to Storm Drain Lter �Ec)ual to or Greater than 1/8 Inch and Less than 1 i2 ❑ }In h I ❑ Sanitary Sewer Release �� i 1 �(i s ET (Imminent Hazard Only) , Y t& List below the Oils or Hazardous Materials that excr � r; Concentratir n yRportable Quantity by the greatest amount. If necessary,attach a list of additional Oil and Hazy $ i tancesu i' rle ilt s t t#' sad. i� )�r� y. . Name and Quantities of Oils(0)and Hazardous M t i��+ Reportable Concentrations it �o"tin oc ;r (Units Exceeded,if Applicable Q F 5� 4 Sat?I'48� x t O or HM Released k � n in # its (RCS-1,RCS-2,RCGW-1,RCGNV-:2) aSol h I ra s+�il� r D. ADDITIONAL INVOLVED PARTIES dr as aff 3 zl Threat of Release,other than an owner who is here if atta ching names and ad sr, Check 9 f ❑ I submitting this Release Notification(requir Check here if attaching licensed Site Profe add You nay write In n on a r e lsec�P�!d page of this form. 065 FOl` : W. rj t page 1 of 2 Revised 3/1/95 of AIte�Y, ( Irk ;k1' e o y} TI';it + Massachusetts of Ena, '"I ,j I.Protection BW ¢ureau of Waste! k ,`� Alp" , it � ' # i P i d Release Tracking Nunlr,,r � �1 RELEASE NOTIF { NOTIF ET. CTION0 OM FORM Pursuant to3;�1f( ubpart C) If assigned by DEP IF 14 � PERSON REQUIRED TO NOTIFY: Name of Organization:: fir. 3+ t f '.}"� Name of Contact: I)70 a Street: 3 Ina 9 Ylo :a I• `�� ,�. d, : , 3+ Cityrrown: GUeSIA d hh%S 'r 1 �, 1=:!"ZIP Code: Oa6 70�` Telephone: F. RELATIONSHIP OF PERSON REQUIR ;O RE L + O,F'RELEASE: (check one) RP or PRP Specify: e Owner Q O I , 'tor �: - ! Ugg�er Poor PRP: Fiduciary,Secured Lender or Municipality'vAt I alined b. ^ s 3 ' Agency or Public Utility on a Right of Way(asi ! s c 21 E s '))� (�I Hi Any Person Otherwise Required to Notify S.I G. SWqIkICATION the in.s df rlury.(();that I have personally examined and am : 1 6a ( Pa }ram' � �'(x l h � xtp��. w t familiar with the information contain in this m,,i all doeu n artyrn rthis transmittal form,(ii)that,based on my inquiry n tt; a: u5 �"r+ �1 xI I of those individuals immediately responsible ob the m � t n lined In this submittal is,to the best of my i' ton on behalf of the entity legally responsible for knowledge and belief,true,accurate and complete ly,autho , 3,, g y p this submittal. Uthe person or entity on whose behal de amr R 4 �f a�re, g decant penalties,including,but not limited to, possible fines and imprisonment,for willfully subm i a " ) �1 "` s t 9 BY (signature) 1 r¢ �• : � to,� 1 w'd:t For: , It III (print name of person or entity recorded in Se ( B Enter address of the person providing certification,��, i i ss t{� 1 1 ,Pd '. Street: ZIP Code: City/Town: + N tA Telephone: :.I R; f r Nlr #Y; Ili; � _ ►` ' W R DttiN THE DOCUMENT AS OFT YOU MUST COMPLETE ALL RELE, ��r a ns' ,fJIAY RETUR INCOMPLETE. IF YOU SUB LETE� N;' t �r� E P,,ENALIZED FOR MISSING IRED,.� , 01 31 I ft !Y `K71�a�• I{. .{ �' 7'� i �l �fI as Sfj i { N', 4 + s,3a •_' Page 2 of 2 s Form' Revised 3I1/95 After. x Massachuse t of It iiProtection Bureau of T , Release Tracking Nun,c.r —, IMMEDIATE R� TIO z I 't� _ l TRANS MITTAK want to24A `=40,0427(Subpart D) • rr iR tFiq , ,,•t it� . A. RELEASE OR THREAT OF RELEAS ( ' Release Name:(optional) I 1 I.�, I 1 Street: 3 n'1�3 n I is {, � , ' I lP� d i(�e tack, ��,;;14 City/Tom: Cve5l H a nni 5 JA 4 e d a(0 701 Check here if a Tier Classification Submilw ,DEP`' 1 e ' Mang iNumber. , Check here If this location is Adequately R i 310 C I ( ;1 Specify Program: CERCLA H ion I agement Q RCRA State Program(21 C Faciiir,.Z�) Related Release Tracking Numbers That This IRAi B.THIS FORM IS BEING USED TO: Submit an IRA Plan(complete Sections A,'i d b wtf i Check here if this IRA Plan is an upda f,a prevw � en 1 Plan. Date Submitted: Submit an Imminent Hazard Evaluation B,C,E..". Submit an IRA Status Report(complete Submit a Request to Temunate n AcU vet andlorl a arCo r Uni ing Response Action(s)Taken to Address on a I krrrdnent Hazard(complete Sections A,Bi EeSubmit an IRA Completion Statement ,.C,D: 11 IC1U You must attach all suppo n regw �6 �� lof f rm indicated,including copies of any Legal N� wo Public sNi • � ft 010 CMR 40.1400. C. RELEASE OR THREAT OF RELEAS~i HAT Identify Media and Receptors Affected: (check at Air r er 'i3110 Surface Water 0 Sediments ✓USoil ' " IPu } Water Supply [� Zone 2 ! Resicience Wetland Q Storrs Drain p r f School Q Unknown !� 2:,. ch' II t� 4 i ' -2 Hour Reporting Condition(s) Identify Conditions That Require IRA,Pursuant (,I � , , e 72 Hour Reporting Cond•Rion(s) Release g i '� ,rr Other Condition(s) Describe: a �k USl ex�af/a� % ' fllt/ ' aY ales Q4 /a0 7 /3C t r. � 1� Identify Oils and Hazardous Materials Released i ply) I9 rif' i;s 'I !IChbrinated Solvents Heavy Mcrae Others Specify: a �n• � :;, i " cl$O1/, a' a�I` � vc+n d ' `t��,r � of , �r,, a�,f,a•s D. DESCRIPTION OF RESPONSE ACTT II that a Onlyf ) '� Dep I> loyment of Absorbent or Containment Matenais Assessment and/or Monitoring ( I +I t , rr �Excavabon of Contaminated Soils ,: I I: ( ) { ; Temporary Covers or Caps I%' Re-use,Recycling or Treatment t ' ¢ a ?•. Bwremediation 44 ��" f 'i'ftSoil.Vapor Extraction / O On Site L/J " Site Est9 f r I ( D/ IF I I,Structure Venting System � Describe: P�a Product or NAP.Recovery Store Q On Site 0 OK S Is ti 'Groundwater Treatment Systems LandfillLandfillQ Cover 0 D ( AT) ^a f frr/1'I Removal of Drums,Tanks or ContainersiA+r,Sparging SS !•_..��wm-d F ih'temporary Water Supplies Describe• '" It f r q rr,w�r, r ... ONTWU r e E, . Str00 spa` sand 011 Page 1 of 3 Revised 2/24195 Sype,�S p { .gt `,il + f1,�C f t � ��1 tl �jyFa�� Massachusetts D ; f Envy P ptectlon Bureau of Waste I „ Release Tracking Numu,! IMMEDIATE RESF'� lON L TRANSMITTA 'to 310i t!i �40g0441 (Subpart D) FDESCfR IPTION OF RESPONSE ACTIO er Contaminated Media I impry Evacuation or Relocation of Residents l of Oth ) �Type and Volume: G�vb+t i I! f'_.": ' '4 I Fenang and Sign Posting 4{ a: Other Response Actions Describe: th n[ormation to aid in creating an Innovative Check here If this IRA involves the use of Irmo DEP is Technologies Clearinghouse). Describe Technologies: x ( I� t �Wast o srte facility,answer the following questions) E. TRANSPORT OF REMEDIATION WAS Ir + �3„i, Name of Facility. Town and State: �t t. 11.1[; t.�/J 5 Ic Y!! Quantity of Remediation Waste Transported to Dat�1 '. , r,! ri i,u a wrr F. IMMINENT HAZARD EVALUATION SO' �k one of k with IN'., a t` e. Based upon an evaluation,an Imminent Hazall `,} f l �� 4 f2eleas� f f 7 Based u an evaluation,an Imminent Hazer necGong_ Yil7 syey!�or?hreat of Release. rd ews h,this Release or Threat of Release,and furtncr Based upon an evaluation,it is unknown whet kr, it { assessment activities will be undertaken. t Based upon an evaluation,lt is unknown wheth *ja and ews, j.G.• i is Release or Threat of Release. However, -lmmine�l II i i response actions will address those condiUonli!: 'i ft y: I G. IRA COMPLETION STATEMENT: ! I ) ,' I i nducted as part of the Response Actions planned Threat o ar`a Sit` Check here if future response actions address ( + e that is identified on the Transition List as for a Site that has already been Tier Classifieid ' demos ST , , +"givers):,These additional response actions must described in 310 CMR 40.0600(i.e.,a Transr ; Trackin . . i r I ' Number). occur accordingto the deadlines applicable State Release Tracking Number Q.e.,Site ID + i �i� tssified -- ec clad, site-Nitowing submission of the IRA Completion If any Remediation Waste will be stored,tr ' � Y . , ,r q ,e N Rerr►edy Implementation Plan,along with tn- Statement,you must submit either a Releasri ' s re r� II� 'pletion Statement. appropriate tranrt l 1 4.:..; rr_. r Fi .tt rttg�r :.. . H. LSP OPINION: I �! mine ) � Ih tsitransmittal form,Including any and all I attest under the pains and penalties of perjury that la M gild judgm t� y !"j o i�apPl cation of(i)the standard of care in 309 CMR n this submittal In my pro �,, � f C "4"03 5 to the best of my knowledge, documents accompanying }'' m the O. 4.02(1),(ii)the applicable provisions of 309 CMR 4 ( (...) information and belief, �) ��, t tion pla�„ b u pM red,tkiesresponse action(s)that is(are)the subject of . ff Secdon B of this form indicates that.an Imme�( i ,p. �d; i c721 E and 310 CMR 40.0000,(ii)is(are) Ucable this submittal(i)has(have)been developed in acap .e* r F "�" actin thg applicable provisions of M.G.L.c.21 E and 310 appropriate and reasonable to accomplish the pu i I I ders ?lu i+ C o "is!'entifiied in this submittal; with the identifi (jV tfi!I' Ii CMR 40.0000 and(iii)complies(y) ice ' � �s Ir>nmment Hazard Evaluation was developed in N +ution is bg " undertaken to support this •,jf Section 8 of this brm indicates that an tmmiQ, } ,;: -AAR +}a ibl� rttladlvjties(Y) accordance with the applicable provisions of M G1 of M.G ti C!M�',40 DODO; Imminent Hazard Evaluation complies(y)with the �, � �r�t Get+ . $' tus Re a� tq.he response action(s)that is(are)the subl�ct . !f Section B of this brtn indicates that an Imm. PPlicab P kG�X.G-i21 E and 310 CMR 40.0000,(ii)is(are) of this submittal(i)is(are)being implemented in n 9 !applicable provisions of M.G.L.c.21 E and 310 appropriate and reasonable to accomplish the pu r ;, (��actibr ` °I s entified in this submittal; CMR appropriate 0 and(pi)complies(y)with the data, < .:. Y I ') aRequest to Terminate an Acute Rem em l � ' • bSec6on B of this tom►In that an Itnm to A . , ti.i ,aril is being submitted,the response action() System andlor Terminate a Continuing Res + and Im I_ r with the applicable provisions of M.G.L.c.21 E of this submittal(i)has(h �, p, f I 'i "ir xporise action(s)as set forth in the applicable that is(are)the subject an` plish t r ,,,,"' ,' permits and approvals identified in and 310 CMR 40.0000,(ii)is(are)appropriatea ). i rasfiall orders,. provisions of M.G.L.c.21 E and 310 CMR 40. ,E this submittal. it� " i -;�,.. ,� ,;ilk „'• � �=)�hi'� • Page 2 ci 3 and it' Su SC V' Revise 2124195 ( t fllteh 3 t y .,,.a�n�r , a�d.�;_.. x+��ffit��`�Al�d: k11!�dM1�i �li<,`.Y:�r• _ Massachusetts � FI � of Ens � ' 1 f or;otection !,I�161 ��w4 , �' 1 ,i Bureau of Waste° Release Tracking wunw�r I .-ION ( ' i i �1', i �. �� _ IMMEDIATE REST �� -to 31, 4 �' ± 4p 0427(Subpart D) TRANSMITTAL r'I 1 a _ .: . LSP Opinion(continued): � i ,; � ,± �.A,�^ I am aware that significant penalties may result,inc I to,possa fi r� nsonment,if,I submit information which I know to ij tk I Ntl s ° inaccurate or materially incomplete. 1• ' !' 'I � r PR rmit(s)and/or approvals)i��Wca�, ( io any or qks Check here if the Response Action(s)on whi „ �eltf iU nyl ;eil(a► 'iovsi° lei DEP or EPA. If the box is Checked,you MU I r E ( ��ti�e�. r 6,,wq � LSP Name: . ';;BEEN 6 t'� It*C j_ c g �• hi ±il ' 7�y i; L Telephone: ti0nal 17 �W 4 '7— Sb FAX(op ) h�Fm yr. Oro,- �j, . Signature aWh { Date: I. PERSON UNDERTAKING IRA: Name of Organization: i �latx Name of Contact: /1dmj5 R '' Il qi}' 'II 1'j2 V rS � �I ��xl�17�"9��� Street: 3S Ina n�I a gl r ;, �� I . h oa67:L 06 3 Cityrrown: i er r e 1 y4 ZIP Code' f l II i uq' 1 4b r Telephone:13 Check here If there has been a change in th ! x a" "DE TAKING IRA: (check one) J. RELATIONSHIP TO RELEASE OR T �: i SE ��•' �Oth"r,RP or PRP: rator +�' i eRP or PRP • Specify: �6wner Q �� {,. 1 �# � (err.' defin : 1 t ' Fiduciary,Secured Lender or Municipality jI ±oily Agency or Public Utility on a Right of Way a 21 Et 1 � 1 �1, Any Other Person Undertaking IRA Specit I r au. r t+ r K. C ION OF PER�DAI-IdNG � �� i� � I riper' r�er i ¢oil,pequry(i)that I have personally examined and arm ulf 1 and all l i pa�y�ng this transmittal form,(ii)that,based on my 9 familiar with the information contain n this s "� )� " 'A1ciW ined in this submittal is,to the best of my fully a ,FFN !^ f} 3s attdstation on behalf of the entity legally responsible for of those individuals immediately responsible to tion,the " a nificant penalties,including,but not limited to, knowledge and belief,true,accurate and complet , k s made a` �r ¢ l �ere I'fl ` this submittal. Ilthe person or entity on whose b� . ( rate,o< �irtfx o .11 possible fines and imprisonment,for willfully su 11 l I Ir T 7) gy; signal ## 'I9 For' (print name of person or entity recorded m 1 �tl f ��t • - '� ddress� "• r I n• on,aa ,�f •Enter address of the person providing certtfx;aU Street ` (�� i�: � fi„ . Zip Code: i, CitylTown: Telephone: II It I Of�DEP MAY RETURN THE DOCUMENT AS ±�ONSi y�il �Ffi 'h Y BE PENALIZED FOR MISSING YOU MUST COMPLETE ALL Rt r. V rOMPL Lfll, e 1INCOMPLETE. IF YOU QUI 1 r Page 3 of 3 Lofj BWSG= anL1 s $(F r T ' fi i Revised 2R4195 Not i ip f E ' t#f Protection.: 16c'IntS�C-Gt� i f�assachusetts D� ! i Bureau of Waste Situ Paissi Y Trac-i i%hu.i..,..r. RESPONSE ACTIN' I E ( '� �AENT It I a (pursuant to 310 CUR } r r l ' A. RELEASE OR THREAT OF RELEA Name if Previously Assig d(classified Release a Street: D isAd �2 f H ae pp Additional Release Tracking Numbers Addressed f recto the disposal site or portion of the dtspot;al Provide a clear and accurate description of the I ��i ! f(' ,the local;'�� y # site to which the RAO applies,as specified in 310� this r � # # nc? {1 tl �S�'.e e Fa�rt Fr 5. Is a site or disposal site map or survey attached toy '.�I Ye ilk a f h a statement regarding the relationship of the Rr0 Does this RAO apply to a portion of a disposal stte o` Ibfe'�to ether.with a statement as to whether any Statement to any other RAO Statements that ha ' disposal 9 1 response actions are needed for any otlj additional po B. PERSON SUBMITTING RAO STAT Name of Organization:-TIT A19 Name of Contact: ` M Street: ° i r7 ° 67 - ' �! N p code — City/Town: State iif Telephone: r - d ` UBMITTING RAO STATttltriftiEr�'f: C. RELATIONSHIP TO RELEASE O s EL �� f I ifri 1 (check one/specify) r , RP Specify(circle one): Owner O ?' Trans M $E #{g ❑ PRP Specify(circle one): Owner Op4 Trans I ' ❑ Fiduciary/Secured Lender I f , C] Agency/Public Utility on a Right Way j � ' .❑ Other Person: a YFn.. .�' r , • � Pa RESPONSE INFORMATION: Ievised i . 9S. RAQ status: 1�eS D •i�!Rq r( ((Kt4���.e�p �f-_ s. Was initial notificat ion oral? )i. Is a Release Notification Form(RNF)attached? ies s j�; Yes 0 d I f M' Was a RNF previously submitted? dj Is a RAO Compliance Fee attached? Yes A ��s r c� d days after Release Notification and prior to Tier Crass, ffl �I'6{I I d!l !t ��x c, " { 'CHARA� 'I T1Q '96UNDWATER SOIL E. RAO INFORMATION: $ r'" ( CATEGORY: MET OR I is CATEGORY: a. RAOC � ' �q ����, lr ,taGW-1 ��S-1 I I � I iial l ,: l_�JA-2 � �{ S-3 'f f ti Was contamination reduced to background lev i iie? I asp ( f,ry�M� b, i Y s , �'Limrtau Is this RAO based upon the implementation off I l )plemen �t III f'!�I Ifsii , If yes.indicate the type of Activity q j I1.,�4 al Ill1 � l, . 3 at Date filed with Registry of Deeds: BooWPaga Number(or other idenufi" rch have been implemented under 310 criit, 1{ Attach to this RAO Statement a Her 40.1070 and an Activity and Use I t ,' t!t,- ���t, �f at the sr :'0a !40 0896(for Class C RAOs only)? Will Post-RAO Operation and Maintenance(0 ��1 9 1 ' pp 44 _. �No ❑ Yes .If yesye�r r I five 0 I fj! ill of that i ,lt be regarred to,confirm and/or matraa t ,ntenan Attach to this RAO Statement a description i f t � �r those conditions at the disposal site Upon whrc ' Page Wit Revised 10/1/93 i4 # ! #:; `A` � f of E G,� � Protection �1W5�C-OOa Massachusetts ; � 1, , Bureau of Was Site, 4 11h!r (''dfzr ka ReleaseTrarJunp Nwnt , RESPONSE ACT T ' i E ( TI�NENT -[I�i6�7 � t to 310 CUR � (P1+K1iiiD prp i t i�h S� r F. RESPONSE ACTIONS COUPLETii: I M 4df8'i C , Q EMENTr (Check all that apply)' IOUSLY h TYPE OF w, f k t RESPONSE ACTION. ATT MITTED DATE OF Immediate Response Action' r+ r Release Abatement Measure' ��— ment Measure' Utility Related Abate �— Phase If'— � t Phase II Phase III �— z I j IR Phase IV r — / M j Phase V for each. 4 1 +tt8chme st �+ ' �► t ,e Completion01 statement. for multiple actions were completed at a dis � ide de t s warranted G. DESCRIPTION OF RESPONSE ` w " (Check all that apply) 11i ' � NSE'ACTIONS REMOVAL OF REMEDIATION WAS I o , nage Couols. ❑ Contaminated Water Ii ),f l.: t i� ;lip r7 Contaminated Soils r i d '1fil /Dikes/lmpoundments (check all that apply): T orary, overs/Caps Y nzr� '� r 'I, te/Fioduct Recovery Q"Excavate ' ' — al - �' ti �1�f�+r I� a ((ova `E! Uation/Relocation of Residents SlG` [store �2' i Di�f Pjfi..fyf> ,�- a r ovary Water Supplies ❑Treat . � r' � vr�� t�; t systemf ❑ Re-use �, . i �.: tt�irrfl: �, ri '11` M;i .,• ..� .= ��ds ��, i�; o' nd�rater Treatment Systems eRecycle Actuar Volume: s, � I ,. rds ❑Landfill Actual Volume t j d ❑ 141 Drums/Tanks/Containers I� Flit ' PLi9. �V f If{6.ks"i SY.Fri ❑ NA // �z, m /:: '; ESSMENT ONLY other: d i ie±� !'`f! SIIII;(I'" 'ril,j H. FINDINGS AND CONCLUSION' d I r+ en�1 rf 4 r x15+ la nd/or reports necessary to support the RAO to u,� Except where previously submitted and spy 1,. ocum Department,including,without limitation,the, {' I 1 � '' ° ��r or.hazardous material in the environment have I� i4 �, �!it to �, r� ,3 ♦ For all Class A RAOs,information d, d A-3 h jai fe k�of�rt+' feasibility evaluation conducted pursuant t been reduced to background,and '(' of back: b et�t�t 310 CMR 40.0860 demonstrating th :, t leve6of,No Significant Risk has been achieved or ng the g f ♦ For all.Class A and Class B RAOs, I ��o p' exists. i' I ��� f ��ti ,It'' ncontrolled,sources,as specified in 310 fall ru For all Class A RAOs and where r CMR 40.1003(5)have been eluruna 1 Ih dsEtemarn at the disposal.site. r h fusion tha s s bazar For all Class C RAO$.information sp:< , I is �r �tri which presents defin. and enterprising steps 31 9 .., 6 ♦ For'all Class C RAOs,acopy-of Itie "a dispo si e 3i� to be taken toward achieving a Per s '• _. � f� a a ,�l .� •aq 3 uw� , r. ._ .. rimed f "; IY Revised 10/1/93 Massachusetts De f E �11Pro#action OVi15iC-00 i Bureau of Waste I # # y Bottom Tr&Mng NU,1,Lf RESPONSE ACTIOI �l'ip(pursuant to 310 CMR 1. LW OPINION: Name of Organization: 195� L .t U LSP Name: Telephone: )7 j i( " �' {, 1 attest that I have personally examined and #' formaU fi ri ubmrttal, including any and all documern� accompanying this attestation,and in my prole. jrespon r c t tsublect':of this submittal complies with th, provisions of M.G.L.c.21A, §§ 19-19J, 309 C 90 C �, g fy@vlaws, regulations, orders, permits, dnc � approvals applicable to such response actions) # nrfican , '' � �t }+t cluding,but not limited to,possible i nes , a r .. and imprisonment,if I wilfully submit info ation se,,lna t ',c Of Signature ; t' t �`�'� a—- • ��G M { Date: _ # t f ' 1#{ .;. L :^c License Number: JIM r 1�� ��' ' KiJii.Z H . No.632h. w � 'l1 rn i qq P I� � pp 13p 1 ° jig al �51 J. CERTIFICATION OF PERSON SU®I 'i STAT { }' certify under penalties of law that I have personl' am famirrnaUon conta#ned in this submittal,includ' any Pe r, ion m m u 1 ihdwrduals immediately responsible for obtaining and all documents accompanying this cenificau „ y ,! �' , klx the information,the material information contains st of my a do Lef true,accurate and complete. I am aware k r ; that there are significant penalties,including,bu��• i,' ible fin ntnior�wrlfully submitting false, inaccurate, or incomplete iFF ) sr Signature: A t / 1 Name of Person(print):, {`k It 1 tx 3' it 'i k 8�77••• n9�X` ' � • t � I ,' ,�(y art �'�t ry r I x* lA f M1: P r f Page 3 of 3 Revised 1011/93 1 APPENDIX B LABORATORY ANALYTICAL REPORTS APPENDIX C BILL OF LADING s. i�36FS!✓�w vl uvFr i �iOY ° 1$ 03/16/95 15:27 BAR��i &,ZINC 6 7444 g�� �' NO.261 FW2iu02 Ff li$�fx x �l IRO�T � RVICBS 11 n �i 1 FOR L. FANAL iTS The following is requi' y way € � ' anal;ytical testing based on ` Department of Environme tlOM nd'I'p,alicies. 1. The source of the i `! the o tsmination must be known. 2. The petroleum and nst Lhe petroleum released must be known. : � 3. The below items are � i `` and + ' Icert�fied� by the generator. I, the generator, have i � ` dt' , . Ldefeimined that there is no reason to suspect or be , �5the c ataeaiaated soil has been a �i� , impacted by any releases` haza ^eri;als other than that of the known source or I have z Abe a � 1o }l and hazardous materials that are suspected or �Ppres 1 Nfisoi1, in addition. to those associated with the Teas;" u�d' g : any anthropogenetic contaminants. «; I, the generator reali �' Ie ,dil .' ' °� bal;lx consist of a search of information and recor '{�Q�7(, :bl y {' t Sh' {1b,' 'the generator of the contaminated soil Buff, ke a € t�rminatxon. Such records and information may include not "those of the generator, Y � , �iM� location of generation Y' �fltyegf aerator) the Departments Bureau of Waste Site Cite mu RUINe. Board of Health, Fire Department) within whie GIs' i , the generator have 1 frf,ici� " tiion justifying the limits of the analytical regy { :; 4 as p she°tSite History Information accompanying . the 21E B 1" i1nq , real "Shipping Record. This includes as a minimum, the analytical paramet € ed, i - any screening analytic` € . it r TCLP, headspace data) ; , g - the laboratory analytf` - a description of the a physical descriptil soil' gj�;t�he classification method used; a description of th tion ' "€' � ' ga d9 to current and former usage• p 14 v. Cenerator - Printed H r� � � e A dress / A4 Signature of Genera or " ' }F t Date �,$RON Uf W,RN I C R S PETROLEUM` ' JE;D E CYCLING SUBX1TTAL P t HIC This cover sheet � ' �� �Comp;c � , ' r, quests and submittals . tf r � ,F concerning the tra "" � i � re W betroleum contaminated soils , as governed f lici' � !t Ia '� SITE LOCATIOAT �. CITY/TOWN: 3 I d , +i a z , I_F KNOWN: G Y1 C,DEP SPILL # : ADDRESS: C2 zF Yr .s 1.y1 . ! 6 DEP CASE TM CONTACT PERSON FOR TAL NAME: .10 5 2 ii �" " ��.o I Y1 i"'�' QNEro. . B s THE FOLLOWING ARE 'OR �h , J.' r 1 _ A Comple 2. A Comple ti Las zginal Signatures o 3 Ana ytic m a> , fy�;ed Laboratory TE PitOF `.., .AT ;a 'A !Dr�KlC RT I F I CATION S LICENSED SI _ , '3f�e b , All soil 'sampl$ ,' tain , manner<• that accurately and "; � !' 4t C� g �a� ;tx levers in the adequately ;ize M� ► 3 t on` �' as Spec:;- f j ed by DEP stockpile/soi deY a policies, ands' for r th',U' tandard and accepted industry prac W; A k r lWfi Based upon s . ', on j{ z `'the analytical data �, r�Y 1„ r '=k, other pertinent and obtained, an 1 ! uat i � o �a'e"vidence or reason to available in � � the � dp XX y y 1 believe thatl. 0 `�' is with anything other than virgin p., h i 1.5 _ z } 10 G ! ' OOj J that I have personally i I certify put< ;, � � �� , � � , " '°, examined this s anJ , ,l , ;1�Ai 1 with the information contained in nt Ed 1 ,t fg&hments and that , based r ! + edaately responsible for on my inquiry ndivx obtaining thei n, _ � u �pffi'hat the information is true, accurafiP1m aware that there are sigriificrsnt '_ fort f( 'E It, 9 fr�13e information, including pos s I J,. ,� �[ j� SP'' G AATURE <. A �1 � yy r g y}{ I i f H 0 t U�IC7�S` Petro'_. �J in ! rofile x f a R1 Generator's Name/Add F ; � ar ffil {: r V i l e 1`� o a 6 3 a: Site Name/Address: I h W! t � Y Current Use of Prope°� i I S► ► '� t.,, :' (home, factory, etc . � ` I t � •, � , � fast Use of Property, G S I , 'iTRY ` � (site history) i ' n Consultant's Name/Ad e P� ,' a Jh s`L l�'1 i i All �tF{ Soil Contaminant: a: 2 No. 4, Vo. 5, No. G, other, p 'bl `crik� . .r>a to Estimate of Quantity., " :° t;'` k" § & cubic yards . : � � a Source of Contaminate, Unde. t iS,tor`age Tank, If other Please describe: Mill r C " ; race o�' S T Grd Ise Soil Type: SA Q P :..d (sand, gravel . etc. )` jr a Prim SignatureAf f -11 nTES/15 y� 5Y• 9 0 RMassachusett . , enIt ®ifs m� � � ion �lM1isC-0' I 4 I ,1 On�a retect Bureau of Waste ' tic Reie BILL OF LADI 10 CM ❑ ;� 710111 la 111 - , ,A. LOCATION OF SITE OR DISP ERE R PI - iAJASTE WAS GENERATED: Felease Name(optional): Street: �s M a haid Lt1 k i l�` i' �I � iyyypppat i, f'yisto�b/e Co c(il IL 1 I City/Town: G e il �. • t i / ll N6 t Date/Period of Generation: a9 /_ � l Additional Release Tracking Numbers Asso a • f:Ladin ( ifstip ' ,,1�. IG 'II PFeI� Note: It this DJIJ of; �u/t oPn au i Action(LPsa)taken prior to PlotiF ! J�asa �ra� u I let Is reot'needed. B. PERSON CONDUCTING RE S 11 ; � ASSO< � 0T&9 BILL OF LADING: Name of Organization: 7*h0 Name of Contact: lO!?'! a ! Street: 3 /�d Lill, t4 � t / a !! Ciryffown: C I �. S� f,� �•, s a xi . '.,,,Zip Code: Telephone: C. RELATIONSHIP TO RELEAS ,i f f®F REL ��' t ° Pr�68S®1+9 CONDiICTIl�9G RESS�OtdSE ACTtC)fd ASSOCIATED WITH BILL OF (check one/specify) ator 1! te e one): RP Specify(circle Owner r r o �I �r a l �, II.I ElPRP Specify(circle one): Owner t rftor ns rI hertPRP ❑ Fiduciary/Secured Lender Agency/Public Utility on a Right of Way.t' ! ' 4. ua i r i.s Other Person: fan owner and/or o erator is not conducUri ton assoct ; Bu of.lkading,provide on an attachment the name, P 1, k ,.. f won ct person,address and telephone nu MI N area co for,-each,if known. , D. TRANSPORTER/COMMON CAI I j I AT1 0 Transporter/Common Carrier Name: Co •; i {I '�% f u ` Contact Person: Jai I Ilia Street: l4� y f ,� I St %eh�' a ` , 9r ;Zip Code: — P T.ele hone: SO$ - S7 5�d o of E. RECEIVING FACILITY/TEMP ING EL F�� � 4 Jperatcr,Facility Name: i ri, ��i ' � f ear, Contact Person: Tltle: City/Tc.:n: S>to si :;firf ;i ,t)f st Zip Code. ada7t "eleprz:ne: (1 lit � I AL, , ' -ype cf=acuity: Asphalt BatchlCl ' ; andfilll _#a� �1 1`f;� Incinerator check :-e) � ❑ Asphalt Batch/HI andfill/andflll/ rM, Temporary Storage Thermal Processl ❑ 9 • � � � �� Qther: � Fvlslc"of HazardousWa'rast2;ass A Permit a: Q OAO nt1 Permltl' EPA Identification#:' f -�:;tua -nticipated Period of Temporary Storm t.; `If`apphca V �_— =.east-is r Temporary Storage(If applicable R {{ ttpp }{}{ p))p xlFrd„� �ap•a�,�aketa,.,;.,•„ printed Peru Page t cf 2 i + iY � �� f'�'(r�� s � r i�:•s •i. � 1 (� i� .i ( Pb��� r, i,:� I ��`((r p! I l�h>�� . pro Massachusett nt `ntal Protection BWSC-C � " Bureau of Waste' �� r gat"a r x� ^r Vase Trachn_-, BILL OF LAD16V 3,50 cIIR ' E41-1® � :l.;s _ . . ..... art E. RECEIVING FACILITY/TEMP EL IY hued): Temporary Storage Address: sF i a treat: C:ty/Town: St aC`_; ` i i Zip"Code: F. DESCRIPTION OF RENIEDIAT (check all that apply) Contaminated Media(circle all that appl undwat far t E Ctner• _ Contaminated Debris(circle all that app; nstruc, �f tV� etation/Organic Materials Inorganic Absorbant Material f IV,I _ CJ Non-hazardous Uncontainerized Waste(-!, fy).; N• se liquid Other: i�� i 1 ❑ Non-hazardous Containerized Waste(cir` Tank 1, +it ,l # Cgntainers gums Engineered Impoundments _ Ali • Tape of Contamination(circle all that apply) + t Diesel #4 Oil #6 Oil Waste Oil Kerosene. Jet Fuel Estimated Volume of Materials: Cubic Yar' { ) li hl 1 Other: 3 } F Contaminant Source(check one/specify): ��ti t ccident ! n'.�'r rid Storage Tank ❑Other: 1 f i 7 4�It.. «�P�ce 1 Response Action Associated with Bill of Lad l 1 I +v Imrti a ' ton.' Release Abatement Measure Utility-Related Abatement Me I lted Reg a „ ;; Comprehensive Response Action Other(specify): 10 ' ) ��t �� � ilk Ra-nediation Waste Characterization Support, ached: s g ❑ Site History Information ❑ Samplin thods a ,aboratory Data ❑ Field Screening Data If supporting documentation is not a en+! ' I.,lachm e taieiand in connection with what document sucPP 9 PPjj irrtrmation was previously submitted to DE h P Y tl, ,�• i �� , u�', �1'f� t �� �'�:t� / C. LICENSED SITE PROFESSIION: VVV time of Organization: f LS?Name:g Ste. L ^'• ,i.",�t4 ,; .N €` ' I, llel lephone: t u} `" 4 i � � !��i+} IYR��t F} ' —:ave personally examined and am familiar dt o eontarn �: ds,trnrtted,with this form. Based on this information, it is my i �.., t • N i«i a C�rnion that the testing and assessment acU ere ad e enze the'Remediation Waste, in accordance with 3 i 0 �'✓R 40.0030,and that the facility or locatloci I I�diatlon w�� it �) Mara "tenstics des submittal. I am ao:are i,a �rlt r. .=_t significant p ies including,but not Ii f"nes an tI a ayiresult!f'I.wl a I itm n which I knc.v to ce false,inac rate r mat i/al�yin pletet 5' ( ' ! , S � `' �Cy S: natur tti I i VA al: STsv t� X _3;3: _+sense Number: �3a.� ! u i�l at1; a � .; i�15 t+ V Zt&r';V. t tdo•632 f� ufTC ;!n3 • t T (� r'�9d'�'7P K CERTIFICATION OF PERSON C , f RESP r6Vi!AsSOCIATED WITH THIS BILL OF LADING: r � � { anity under penalties of law that I have pe ° and am; ioation contained in this submittal, including any c all Cccuments accompanyingthis certlfi� i' ped on j hos- F�dividuals immediate) responsible for obta+n:ng , :nferrration,the material information contc"'` Ie best gd'I+ 1f I nd elief,true,accurate and complete. I am aware there are slgn,hcant pena::{es. lncludln� f r f posse " nent. for wilfully submitting false, inaccurate. or t•=- t at ..t.. ..4-0Ifi�iifl}+AYe by t.1-H 'k�x.-.,. .. _ .. • ,._.,.... .. sad tC,ti93 l printed®, f�( Page 2 of 2 - COMPLIANCE ENVIRONMENTAL, INC. 31 Fremont Street Needham, MA 02194 617-444-5950 Ms. Donna Miorandi. April 21, 1995 Health Department Town of Barnstable 367 Main Street Hyannis, MA 02601 Neal Dear Ms. Miorandi: Find enclosed, a copy of our Environmen 1 Assessment and Response Action Outcome Report relative to the removal of an approximate 55 gallon, underground, gasoline, storage tank formerly located at 38 Magnolia Avenue, West Hyan 'sport, Massachusetts(DEP Release Tracking Number 4-11167). Refer to Section 6.0 of the Report for our findings, opinions and recommendations. Refer to the attached appendices for copies of the completed, appropriate Massachusetts Department of Environmental Protection(DEP) forms. As recommended in Section 6.0 of the Report a copy of this Report and the enclosed original Release Notification Form (RNF), Immediate Response Action (IRA) Completion Statement and the Response Action Outcome (RAO) Statement is being forwarded to Mr. Michael Moran at the Southeast Regional Office of the DEP in Lakeville,MA. We appreciate your interest in the project and your assistance with the municipal research. If you have any questions or comments at any time do not hesitate to call us. Sincerely, COMPLIANCE ENVIRONMENTAL, INC. . Jose S. Hobin - President cc: John V. Harvey; Esq.