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HomeMy WebLinkAbout0364 MAIN STREET (CENT.) - Health (2) 364 Main Street (Cent.) Centerville P == 208 042 r I No. 42101/3 O A 10% 0& 0 0 0 0 1 BENNETT AlO'REILLY, Inc. - 0 Engineering, Environmental & Surveying Services 1573 Main Street Sanitary 21E/Site Remediation Property Line PO Box 1667 Site Development Hydrogeologic Survey Subdivision Brewster,MA 02631 Waste Water Treatment Water Quality Monitoring Land Court 508-896-6630 Water Supply Licensed Site Professional Trial Court Witness 508-896-4687 Fax B003-3668 ' April 4, 2003 Mr. Robert Sulzman 235 Golfer's Crossing Drive Penhook, VA 24137 RE: LIMITED,.REMOVAL ACTION COMPLETION STATEMENT ' N/F Sulzinan Residence 364 Main Street - Centerville, MA 02632 ' Dear Mr. Sulzman, BENNETT & O'REILLY, INC., has prepared the following Limited Removal Action ' Completion Report and Supporting Documentation as representing remedial response actions and environmental assessment activities conducted at the above referenced property in accordance with the provision of 310 CMR 40.0318. Remedial response actions were conducted to mitigate ' environmental and human health hazards associated with the historic release of an unknown amount of#2 fuel oil from a former 500-gallon underground storage tank(UST) at the subject residential property. Initial assessment activities as associated with attempted in place abandonment included soil sampling beneath the ends of the UST. Supplemental assessment included a hand boring in an area of identified impact beneath the north-eastern (hereinafter"north" or"northern") end of the tank. Soil contamination identified in the supplemental assessment defined an apparent 4' x 4' x 6' (D) volume beneath the tank for the LRA. Laboratory analysis of fractional extractible petroleum ' hydrocarbons (EPH) reported petroleum impacted .soil above applicable RCS-1 Reportable Concentrations to approximately 12' below ground surface (bgs) in the area beneath the northern section of the UST. A Limited Removal Action(LRA) was conducted for the excavation of some 6.36 tons of contaminated soil as followed by confirmatory soil sampling and analysis at the extent of excavation . in all sidewall (SW) and bottom of hole (BOH) areas. The contaminated soils generated were transported to the Aggregate Industries facility in South Dennis, MA, for recycling on March 18, ' 2003 under an approved Bill of Lading. ' 1 APRIL 4,2003 N/F SULZMAN RESIDENCEB003-3668 PAGE 2 OF 8 LIMITED REMOVAL ACTION COMPLETION tSubsequent to soil removal, laboratory analysis identified no residual petroleum contamination within the excavation as background conditions significantly below the applicable RCS-1 Reportable Concentration standards. As such, this report represents the rationale and technical justification to document a condition of "No Significant Risk" without "Notification Requirements" in support or regulatory compliance, pursuant to the requirements of the ' Massachusetts Contingency Plan(MCP), as regulated under 310 CMR 40.0318. The work conducted by BENNETT&O'REILLY,INC.,represented herein,has proceeded ' under my supervision in a manner consistent with the MCP Response Action Performance Standards,pursuant to 310 CMR 40.0919 and QA/QC policies of BENNETT& O'REILLY, INC. The facts and statements herein are,to the best of our knowledge,a true and accurate representation of the site activities, remedial response actions and environmental conditions associated with the project at the time of reporting. ' ENVIRONMENTAL CONDITIONS [Refer to Appendix A] The subject property, identified on Barnstable Assessor's Map 208 as Parcel 42, is located ' approximately 100 yards northeast of the Main Street/Old Stage Road/Park Avenue intersection [Refer to Figure 1]. The parcel contains some 0.33 acres of residentially developed land with a two- story dwelling, constructed in the 1800's, and a detached garage. Access to the area of the former UST and underlying release is restricted as the impact occurred from approximately 6- 12'beneath an enclosed brick patio located on the southern side of the dwelling. The surrounding neighborhood is moderately developed with similar residential dwellings. The site is entirely upland with nearby wetlands within 300 yards to the east. Regional groundwater contours indicate a southeasterly flow direction towards Scutter Bay,with groundwater at 20'+/-NGVD as was discovered at 13'+/-below grade in the area of release.The aforementioned wetlands may influence local flow direction. Therefore, Scutter Bay and the nearby wetlands are ' identified as potential environmental receptors [Refer to Figure 2]. The subject property and surrounding area are serviced by municipal water supply with no ' known private wells within 500' of the release area. The site is not located within the Zone II - Protective Radius of any public water supply or within 200' of any surface water 'reservoir. According to MA DEP BWSC GIS mapping, the subject site is located within the Sole Source Aquifer designation of Cape Cod. Based on this mapping and the proximity of groundwater, the -RCGW-1 Reportable Concentration standards are applicable. Furthermore, the GW-1,GW-2,and GW-3 groundwater categories are applicable in review of exposure and Method 1 - Risk ' Characterization. Based upon frequency and intensity of use for soils beneath the footprint of the brick patio,the S-3/GW-1 soil category would be applied in review of exposure risks. However,in a Limited Removal Action the more restrictive RCS-1 Reportable Concentration soil category is 1 applicable in review of response action performance,as based upon the proximity of the release to residential dwellings. [Refer to Figure 3]. I ' APRIL 4,2003 N/F SULZMAN RESIDENCEB003-3668 PAGE 3 OF 8 LIMITED REMOVAL ACTION COMPLETION ' BACKGROUND/PRELIMINARY ASSESSMENT [Refer to Appendix B] On Friday, February 21, 2003, BENNETT & O'REILLY, INC., personnel traveled to the ' subject property to witness and document UST abandonment procedures as performed by EnviroSafe Corporation. According to the property owner,the UST was taken out of service several years ago ' as coinciding with the installation of a natural gas line and associated heating and hot water equipment. To access the tank,EnviroSafe Corp.personnel cut a 2'x Thole in the brick and mortar patio,removed the brick,concrete and soil cover,and cut a second 2'x Thole in the top of the 500 ' gallon steel UST(approximately 6 long x 4'diameter). No fuel oil was discovered in the abandoned vessel. Following the cleaning of the vessel,EnviroSafe Corporation personnel cut one hole in each end of the bottom of the tank in order to access the underlying soils. BENNETT & O'REILLY, ' INC., noted no significant corrosion on the inside of the vessel.. However, olfactory evidence indicated petroleum impact with a distinct weathered fuel oil odor in soils beneath the bottom of the vessel. ' Representative soil samples were collected from beneath either end of the UST to qualify P P q fy potential environmental impact as associated with the historic storage of home heating oil. The soil ' samples were collected in 250-milliliter glass jars with aluminum septa,agitated to develop organic vapors, and screened with a photoionization detector (PID) [HNU PI 101, 10.2 eV lamp] by"jar headspace"method for total organic volatiles(TOV),as consistent with the MA DEP"Interim Soils Policy..."WSC 94-400. PID screening indicated significant impact to underlying soils at both ends of the UST. BENNETT & O'REILLY, INC., field preserved the samples with ice in a cooler and departed the site. Later that day,BENNETT&O'REILLY,INC.,submitted the"worst case"sample from the ' northern end of the vessel,BOT@6'(N-2)for EPH analysis with target analytes,as consistent with the MA DEP VPH/EPH Guidance Policy[#WSC-02-411]under a Rush 3 Business Day turnaround to a Massachusetts Certified Laboratory, Groundwater Analytical, Inc. BENNETT&O'REILLY, ' INC., received the laboratory analytical on Wednesday, February 26, 2003, as reporting fractional EPH concentrations significantly above the applicable RCS-1 thresholds. As such, further environmental assessment was proposed to qualify the lateral and vertical extent of such significant ' soil impact. ENVIRONMENTAL ASSESSMENT [Refer to Appendix B] ' On March 3, 2003, BENNETT& O'REILLY, INC., personnel returned to the subject site to perform hand borings(HB)through the bottom of the UST. HB-1 was advanced through the hole in the northern end of the UST. Composite soil samples were collected in two-foot intervals from 6-10'bgs. The samples were collected in 250-milliliter glass jars with aluminum septa,agitated,and screened for TOV. Results of field screening indicated elevated PID readings (13.2, 6.4 ppm) for soil samples from HB-1:6-8'bgs(0-2'below tank)to HB-1:8-10'bgs(24 below tank),respectively. A Dexsil PetroFlag TPH field analysis[EPA SW-824/Method 9074]was performed on the HB-1:8- 10' bgs sample reporting a TPH concentration greater than 1000 ppmv. ' APRIL 4,2003 N/F SULZMAN RESIDENCE/8003-3668 PAGE 4 OF 8 LIMITED REMOVAL ACTION COMPLETION ' While waiting for the Dexsil test to develop,BENNETT&O'REILLY,INC.,advanced HB- 2 through the hole in the southern end of the tank, as offset approximately 4' southwest of HB-1. Two composite soil samples, HB-2:6-8' bgs and HB-2:8-10' bgs, were collected in glass jars and ' screened for TOV. PID readings indicated jar headspace TOV concentrations of 1.0 and 0.6 ppm, respectively. A Dexsil PetroFlag field analysis of HB-2:6-8'bgs reported a TPH concentration of ' less than 10 ppmv. As such,it was determined that significant petroleum impact was limited to the northerly end of the tank, and HB-2 was not further advanced beyond 10' bgs. ' Subsequent to the Dexsil PetroFlag test reporting a TPH concentration greater than 1000 ppmv for the 8-10' bgs sample, HB-1 was advanced to 12' bgs and a 2' composite soil sample collected to qualify potential impact beyond 10'bgs. PID screening of HB-1:10-12' bgs reported a ' jar headspace TOV concentration of 3.6 ppm with a Dexsil TPH concentration report greater than 1000 ppmv. As such,HB-1 was advanced to 13'bgs,as corresponding to the groundwater interface, and a one-foot composite sample collected from 12-13'bgs. Due to equipment malfunctions,no PID screening of jar headspace was performed;however a Dexsil field test reported a TPH concentration of 133 ppmv for the HB-1:12-13'bgs sample, apparently defining the vertical limit of significant petroleum impact to 12' +/- bgs as above the groundwater interface. ' BENNETT & O'REILLY, INC., personnel then advanced HB-3 through the dwelling's basement slab as angled towards the northern end of the UST, offset approximately 5' northeast of ' HB-1 [Refer to Site Plan]. Two foot composite soil samples were collected in 250 milliliter glass jars from T bgs(basement slab)to 13'+/-bgs(6'below basement slab). PID screening reported all jar headspace TOV concentrations as BRL(Below Reportable Limit)and thus it was determined that no significant petroleum contamination was present at the HB-3 location. BENNETT&O'REILLY, INC., personnel secured the site and departed with all soil samples field preserved with ice in a ' cooler. On March 4,2003, BENNETT&O'REILLY,INC., submitted HB-1:8-12'bgs(composite of HB-1:8-10'and HB-1:10-12')and HB-1:12-13'bgs for EPH analysis to Groundwater Analytical tunder a Rush 24 Hour turnaround at the home owner's request. Based on the original laboratory analysis of BOT@6'(N-2)as reporting all target analytes below the applicable RCS-1 standards,the ' HB-1 soil samples were forwarded for Carbon Range Only EPH analysis. BENNETT&O'REILLY, INC.,received the laboratory analysis on March 5,2003,as reporting fractional EPH concentrations substantially greater than the RCS-1 standards for the HB-1:8-12'bgs sample. EPH concentrations for HB-1:12-13' bgs were reported as significantly below the RCS-1 thresholds as approaching ' - background conditions. Therefore, based on acquired field and laboratory data, it was determined that an approximate 4'x 4' x6' (D) volume of soil was significantly impacted from 6' to 12' bgs as ' situated beneath the northern end of the UST [Refer to Site Plan]. REMEDIAL RESPONSE/LIMITED REMOVAL ACTION [Refer to Appendices C and D] Subsequent to the solicitation of proposals by three independent environmental contractors, EnviroSafe Corporation personnel returned to the subject site on Monday, March 17, 2003, to ' prepare the work area for the removal of contaminated soils beneath the UST. EnviroSafe began by cutting and removing an approximate 4' x 6' area of the brick patio as situated above the vessel. I i ' APRIL 4,2003 N/F SULZMAN RESIDENCEB003-3668 PAGE 5 OF 8 LIMITED REMOVAL ACTION COMPLETION EnviroSafe then removed the approximate 1.5' of concrete and soil cover above the UST as clean overburden. EnviroSafe,having cleaned the UST on February 21,2003,then cut the UST in several pieces and removed it from beneath the patio. On March 18, 2003, BENNETT & O'REILLY, INC., returned to the site with EnviroSafe ' to remove contaminated soils within the identified area as assisted by Allstate Power-Vac Environmental Services. Contaminated soils from around the UST were removed and the bottom of hole (BOH) was advanced to 8' bgs throughout the 4' x 6' excavation. After reaching 8' bgs, EnviroSafe personnel began the construction of an in-place shoring box. While preparing the ' necessary materials,BENNETT&O'REILLY,INC.,personnel collected sidewall samples by way of a 3" bucket hand auger in order to avoid the safety risks posed by entering the excavation. The ' sidewall samples were collected in such a way that the boreholes corresponded with the placement of the trench box. BENNETT&O'REILLY,INC.,personnel collected representative north sidewall and Clean Overburden Stockpile samples in 250 milliliter glass jars with aluminum septa. The samples were agitated to develop organic vapors and field PID screened for TOV by"jar head space" method. ' Low-level PID readings(0.4,0.6 ppm)indicated that the S W-N:6-12'and Clean Overburden samples did not exceed the RCS-1 standards for petroleum hydrocarbon concentrations. The PID screening was further substantiated by a Dexsil PetroFlag field analysis for the SW-N:6-12' sample as ' reporting a TPH concentration of 0 (zero)ppmv. Subsequent to the collection of the north sidewall sample, EnviroSafe personnel began the ' installation of the shoring box. BENNETT & O'REILLY, INC., personnel documented the construction of the shoring box and,when pauses in construction allowed,collected the remaining sidewall samples. PID screening of the SW-S:6-12'sample reported a 2.0 ppm TOV concentration of the jar headspace. Though the sample exhibited trace olfactory evidence of petroleum impact,a Dexsil TPH analysis reported a concentration of 0 (zero) ppmv, indicating that SW-S:6-12' represented the southern extent of petroleum impact. Slightly elevated PID readings for the SW- ' W:6-12' and SW-E:6-12' samples (4.4, 9.2 ppm) indicated potential significant impact for those locations. However,with no olfactory evidence of petroleum impact for the west sidewall sample, ' it was determined that natural organic debris was the cause of the elevated PID response,and SW- W:6-12'was determined to represent the western extent of impact. ' SW-E:6-12'produced a distinct petroleum odor with a PID response of 9.2 ppm and as such was determined to-likely be above RCS-1 standards. As such, BENNETT & O'REILLY, INC., personnel offset the SW-E sample approximately 3/4'to the east and collected SW-E:6-12'xl. Due to the potential risk to the integrity of the east sidewall,it was decided by BENNETT&O'REILLY, INC.,and EnviroSafe personnel that the excavation could not be extended any further east until the shoring was in place. This sample revealed low-level olfactory evidence of impact with a PID reading of 1.4 ppm. In consideration of the 0 (zero) ppmv TPH concentration established for the south sidewall sample as reporting a 2.0 ppm PID response, the SW-E:6-12' xl sample was determined to likely be significantly below the applicable RCS-1 standards as representing the east ' sidewall. After such interpolation, the soil.samples were preserved with ice in a cooler. ' APRIL 4,2003 N/F SULZMAN RESIDENCEB003-3668 PAGE 6 OF 8 LIMITED REMOVAL ACTION COMPLETION ' As EnviroSafe personnel continued install the shoring box,BENNETT&O'REILLY,INC., personnel instructed EnviroSafe to remove additional impacted soils and to position the east sidewall to correspond with the SW-E:6-12'xl borehole location. After setting the trench box, EnviroSafe ' personnel advanced the BOH to approximately 10' bgs, at which point the shoring system was advanced to the same depth. Finally,the BOH was advanced to 12'throughout the excavation,and ' the BOH@12'collected. PID screening of the BOH@12' sample registered a response of 1.6 ppm as indicating removal of significant impact from the bottom of hole. Confirmatory Dexsil TPH analysis revealed a concentration of 0 (zero) ppmv for the BOH, as establishing 12' bgs as the ' vertical extent of significant#2 fuel oil impact. The BOH sample was field preserved with ice in a cooler. The soil samples were submitted to Groundwater Analytical, Inc., on March 19, 2003, under a Standard turnaround for EPH analysis, Carbon Range Only, with target analytes for the ' "worst case" areas (SW-W:6-12', BOH@12') to qualify�fractional and targeted risk based com ounds. TABLE ' SUMMARY OF•EPH LABORATORY ANALYSIS METHOD 1-RISK CHARACTERIZATION: SOIL LOCATION EPH RESULTS RCS-1 S-1 SOIL S-2 SOIL S-3 SOIL ' [mg/Kg=ppm] STANDARD STANDARD STANDARD STANDARD [µg/g=ppm] WgIg=ppm] [llg/g=ppm] 310 CMR 310 CMR 310 CMR' 40.975(6)(a) 40.975(6)(b) 40.975(6)(c) ' GW-1/GW-2/GW-3 GW-I/GW-2/GW-3 GW-1/GW-2/GW-3 SW-W:6-12' C9 to C1S BRL(<31) 1,000 1,000/1,000/1,000 2,500/2,500/2,500 5,00015,00015,000 C1,to C76 BRL(<31) 2,500 2,500/2,500/2,500 5,00015,00015,000 5,000/5,000/5,000 ' C11toC22 BRL(<31) 200 200/800/800 200/2,000/2,000 200/5,000/5,000 AIITargets BRL(<0.51) >4 >4/100/100 >4/1,000/100 >4/1,000/100 BOH@ 12' C9 to CIS BRL(<30) 1,000 1,000/1,000/1,000 2,500/2,500/2,500 5,000/5,000/5,000 C19 to C36. BRL(<30) 2,500 2,500/2,500/2,500 5,000/5,000/5,000 5,00015,00015,000 C11 to C22 BRL(<30) 200 200/800/800 200/2,000/2,000 200/5,000/5,000 All Targets BRL(<0.50) >4 >4/100/100 >4/1,000/100 >4/1,000/100 SW-N:6-12' C9 to C1S BRL(<31) 1,000 1,000/1,000/1,000 2,500/2,500/2,500 5,00015,00015,000 C19 to C76 BRL(<31) 2,500 2,500/2,500/2,500 5,00015,00015,000 5,00015,00015,000 C11 to CS2 BRL(<31) 200 200/800/800 200/2,000/2,000 200/5,000/5,000 SW-S:6-12' C9 to CIS BRL(<31) 1,000 1,000/1,000/1,000 2,500/2,500/2,500 5,000/5,000/5,000 C19 to C16 BRL(<31) 2,500 2,500/2,500/2,500 5,000/5,000/5,000 5,000/5,000/5,000 CIItoC22 BRL(<31) 200 200/800/800 200/2,000/2,000 200/5,000/5,000 ' SW-E:6-12' C9 to C1S BRL(<31) 1,000 1,000/1,000/1,000 2,500/2,500/2,500 5,00015,00015,600 x 1 C19 to C76 BRL(<31) 2,500 2,500/2,500/2,500 5,000/5,000/5,000 5,00015,00015,000 ' C11toC22 BRL(<31) 200 200/800/800 200/2,000/2,000 200/5,000/5,000 Clean C9 to C1S BRL(<31) 1,000 1,000/1,000/1,000 2,500/2,500/2,500 5,00015,00015,000 Overburden C19 to C76 BRL(<31) 2,500 2,500/2,500/2,500 5,00015,00015,000 5,000/5,000/5,000 ' Stockpile C11 to C22 BRL(<31) 200 200/800/800 200/2,000/2,000 200/5,000/5,000 ' EPH=Extractible Petroleum Hydrocarbons BRL=Below Reportable Limit Shaded areas designates appropriate soil category(s) 1 APRIL 4,2003 N/F SULZMAN RESIDENCEB003-3668 PAGE 7 OF 8 LIMITED REMOVAL ACTION COMPLETION Laboratory analytical received April 2,2003,reported the fractional EPH concentrations of all exposure points representing the extent of the excavation, as well as the Clean Overburden Stockpile,as BRL wherein the reporting limits were significantly lower than the applicable RCS-1 criteria developed in review of LRA performance standards. Based on laboratory analytical received, BENNETT&O'REILLY,INC.,determined that the significant petroleum contaminated soils had ' been removed from the subject property as successful mitigation of potential human and environmental health hazards. Based on the lab analysis documenting the extent of soil contamination to 12' bgs as above the capillary fringe and groundwater interface, and field testing of the BOH sample,it was determined that there was no significant impact to groundwater in the area of the release. Therefore, no groundwater assessment was deemed necessary nor was conducted. . ' BENNETT& O'REILLY, INC., contacted EnviroSafe Corporation to report the results of the lab analyses and instruct the contractor to backfill the area of excavation with flowable fill pursuant to the authorized proposal. EnviroSafe informed BENNETT & O'REILLY, INC., that backfill operations would occur on April3, 2003. A summary of the laboratory analytical results is presented in Table I with the RCS-1 and Method 1 - Risk Characterization Standards. r RISK CHARACTERIZATION [Refer to Appendix D] Soil As previously represented, the RCS-1 soil category was considered in review of LRA performance criteria, in accordance with the provisions of 310 CMR 40.0318. This criteria is the ' same as the most stringent S-1/GW-1 Method 1 - Risk Characterization standards. Laboratory analysis reported the EPH concentrations for all soil samples submitted as BRL wherein the reporting limit concentrations were significantly below the applicable and most restrictive RCS-1 thresholds. Furthermore,the Method 1 -Risk Characterization standards were used in the evaluation of soils for concentrations of fractional EPH and target analytes with regard to potential human and environmental exposures. Lab results indicate the EPH concentrations in all discrete sidewall(SW) and bottom of hole(BOH)areas are substantially lower than the S-3/GW-1,GW-2,GW-3 Method 1 - Risk Characterization standards, as well as the most stringent S-1, S-2/GW-1, GW-2, GW-3 ' criteria for consideration of all human exposures related to potential ingestion,inhalation and dermal contact. As such, laboratory analysis of EPH with target analytes concentrations at the extent of excavation represent a condition of"No Significant Risk"for all foreseeable activities and uses in ' support of project closure. Groundwater ' Groundwater impact was considered for this project. Groundwater is established as within 13'below grade surface and a discrete vertical extent of significant soil impact was defined within ' 12' of grade surface with background levels observed in the bottom of hole area. The BRL concentrations are significantly below the applicable RCS-1 standards, as well as the S-1, S-2, S- 3/GW-1,GW-2,GW-3 Method 1 -Risk Characterization standards as a measure ofpotential leaching ' to groundwater. As such,no groundwater analysis was conducted nor deemed necessary in support of the Limited Removal Action Completion without any activity or use limitations for the protection of public health safety and the environment. tAPRIL 4,2003 N/F SULZMAN RESIDENCE/13003-3668 PAGE 8 OF 8 LIMITED REMOVAL ACTION COMPLETION The remedial completed response actions at the Sulzman Residence are represented by the P ' excavation and recycling via asphalt batchin of some 6.36 tons of contaminated soil beneath the 4' Y g P g (+/-) diameter x 6' (+/-) long former UST. Laboratory analysis was used to qualify the limit of contamination and the effectiveness of remedial response activities in the area of the release as consistent with the VPH/EPH Guidance Policy and 310 CMR 40.0318. This information was applied to RCS-1 Reportable Concentrations for soil and Method 1 - Risk Characterization as technical justification for the Limited Removal Action Completion to support project closure. Method 1 - Risk Characterization, as applied to EPH and target analyte concentrations demonstrate a condition of"No Significant Risk"with no significant residual impact within the area of excavation beneath the footprint of the brick patio. As such, a permanent solution has been achieved and a Limited Removal Action Completion Statement is applicable for the closure of the area of excavation, as noted on the Site Plan; with no restriction to activities or use of the site. The findings of this investigation, as represented herein, set forth the rationale and technical justifications for project closure, as established by the Limited Removal Action Completion Statement. The LRA report is based upon the available data and regulations in effect at the time of ' this reporting. Should you have any questions or need additional information, please contact myself or David Bennett at your convenience. ' Sincerely, B TT ILLY, INC. S ennett, LSP Todd M. Ev rson, ES ' Direc nvironmental Services Project M ager ' cc: Mr. Bernie Klotz -BK Real Estate Mr. Eric and Mrs. Margaret Weber- prospective property buyers ' Inspector Wilcox - Centerville, Osterville, Marstons Mills Fire Department Mr. Thomas McKean -Barnstable Health Department Mr. John Minim -Barnstable Town Manager LIMITED REMOVAL ACTION COMPLETION STATEMENT SUPPORTING DOCUMENTATION N/F Sulzman Residence 364 Main Street- Centerville, MA 02632 Project#13003-3668 APRIL 4,2002 ' Prepared By: BENNETT& O'REILLY, INC. 1573 Main Street- P.O. Box 1667 Brewster, MA 02631 David C. Bennett, LSP. ' Prepared For: Mr. Bernie Klotz BK Real Estate, Inc. Bayberry Square 1 B 1645 Route 28 Centerville, MA 02632 ' On Behalf Of: Mr. Robert Sulzman ' 235 Golfer's Crossing Drive Penhook, VA 24137 APPENDIX A: Reference Plans -Figure 1: Site Locus Plan(USGS Topographic Quad., Barnstable, MA) - Figure 2: Hydrologic Map (CCPEDC, 1993) -Figure 3: MA DEP BWSC GIS Map (1997) - Site Plan"Fuel Oil Release Investigation, Limited Removal Action...", Prepared by BENNETT& O'REILLY, INC., Dated 3/20/03 APPENDIX B: Field Reports - Field Response Log -Photo Documentation APPENDIX C: Environmental Records/Permits - Tank Removal Application and Permit -Receipt of Disposal of Underground Steel Storage Tank ' - Certification of Tank Removal/Disposal [EnviroSafe Corporation] -Aggregate Industries Receipts: Soil Recycling Submittal/Bill of Lading, BWSC 12A,B,C APPENDIX D: Laboratory Analysis ' - Laboratory Analyses (2/26/03, 3/5/03,4/2/03) [Groundwater Analytical, Inc.] APPENDIX E: Quality Assurance/Quality Control Plan 1 1 1 1 � APPENDIX A 1 1 1 1 1 1 1 1 1 1 1 ' NJF Sulzman Residence, 364 Main Street - Centerville, MA ' 1. f L�••r`'. `� f if. ' j b, f4�pt-'s- J. f '•_� ,':1 Hay" Wry ' I ./ ..,�_.._. �' ' �.•.'�, apt � .___. '�'^'— r' � • _ •. '•. 90 VI rk Flo �l I_ f �, .jam• +f r .. .f J} f'�' �/ �+ r f tom "' —1� a •� t �r,! •%'j •x • •?J i � III t �, r (�• ` �� �• 1��5 �_•••i:• + ��'• � �, • ''tip tit z • v.�` r S- � may" ` � 'r • r r Public Bet4 - � !• i� ey CENTERVrLr,E RARBOR \ f y l 0 1/2 1 MILE ' 16o Om 1000m Printed from TOPO! @1999 Wildflower Productions(www.topo.com) ' FIGURE 1: The subject property,364 Main Street in Centerville,is identified on Barnstable Assessor's Map 208 as Parcel 42 and is located approximately 100 yards northeast of the Main Street/Old Stage Road/Park Avenue intersection. The parcel contains some 0.33 acres of residentially developed land with a two- story dwelling,constructed in the 1800's,and a detached garage. The surrounding area is moderately developed with similar residential dwellings. o , 32.5 � � 3t 18.1 ' A1W 314'1&, \ 1 3. ti.�` S. A! �.' �l .r -r* - GS ✓tin �! 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'Ililf^►�1�= � .�•,,,, ifit.ri�IN4f +' _ 4V t b,�l r��u;,lhiili■ r II�" r� � t.:ayr �• •� 41 '`'II'�II• �,� 1.,■� pig qN1II .I '(E , , ���' i �11 I `� Ijr• ok "Sill 11 gill (�► , ' 1� �� f rr Fr r::;f 'III► III ._ ,.yy lirr. �►�� � ' r.l� fl�1�1! r I �n t p I ,1�11F' IE A1111 _ 1 1 1 1 � APPENDIX B 1 1 1 1 1 1 1 1 1 1 1 ' Sulzman-13003-3668 ' FIELD RESPONSE LOG Sulzman ' B003-3668 ' Responsible Party: Mr. Robert Sulzman 235 Golfer's Crossing Dr. ' Penhook, VA 24137 Property Location: N/F Sulzman Residence Bernie Klotz ' 364 Main.Street BK Real Estate, Inc. Centerville, MA Bayberry Square 1B 1645 Route 28 ' Centerville, MA 02632 Background Conditions: ' Contacted by EnviroSafe to perform soil field testing and collection of representative soil samples as associated with in-place underground storage tank(UST) abandonment. • 500 gallon UST as situated beneath enclosed brick patio. Environmental Conditions: '. • Moderate residential development: RCS-1, S-1, S-2, S-3. • BWSC GIS overlay lists area as part of Sole Source Aquifer of Cape Cod with groundwater ' at 25'+/-NGVD and topographic elevation of 40'+/-NGVD. • Groundwater projected as with in 15'of ground surface throughout majority of site: RCGW- ' 1, GW-1, GW-2, GW-3 apply. Remedial Response: ' Date Time ' 2/21/03 12:35 pm ' BENNETT&O'REILLY,INC.personnel arrive on site. Discover UST within footprint of patio-500 gal.UST.Bottom of tank at approximately 6'bgs(cylinder shaped UST,4'dia., ' Page 1 of 7 1 Sulzman-BO03-3668 6' long). Discover fill and vent lines cut off below ground surface. UST pumped and cleaned. Two triangular holes,approximately 5"across,cut into bottom of tank at north and south ends. 12:45 pm 1 Collect 2 soil samples (GRAB) at south end. Collect 2 soil samples(GRAB) at north end. Field screen with PID (HNU PI 101, 10.2 eV lamp) for TOV of headspace as follows: LOCATION PID DESCRIPTION SS-South 1 13.4 Clean, medium sand SS-South 2 7.2 Clean, medium sand SS-North 1 17.0 Clean, medium sand SS-North 2 20.0 Clean, medium sand 1:15 pm ' Create sketch. 1:30 pm tSecure and depart site. 2:30 pm ' -2 to Groundwater Analytical as 3-4 day Rush #672 for EPH with Forward BOT at 6 (N ) yt y ( ) ' targets. 3/3/03 1:35 pm BENNETT&O REILLY,INC.personnel(Todd Everson, Scott Kraihanzel)arrive on site. Homeowner signs budget addendum. Boring to be conducted through holes from initial in ' place abandonment. Advance HB-1 and HB-2 for PID screening as follows: ' Page 2 of 7 Sulzman-BO03-3668 HB-1 HB-2 ' Depth PID TPH Depth PID TPH ' 0-2' (6-8'bgs) 13.2 N/A 0-2'(6-8'bgs) 1.0 1 2-4' (8-10'bgs) 6.4(EPH) Over cal 2-4'(8-10'bgs) 0.6 N/A STD(>1000 ppm) 4-6' (10-12'bgs) 3.6(EPH) Over cal STD(>1000 ppm) 6-7' (12-13'bgs) N/A(EPH)- 133 ppm 4:00 pm Consult with LSP. Attempt to advance HB-3 through basement slab to qualify northern extent of impact. Collect 2' composite soil samples from slab (T bgs) to groundwater interface (13'bgs) for field PID screening as follows: ' HB-3: Depth PID TPH 0-2' (7-9'bgs) BDL -N/A ' 2-4' (9-11'bgs) BDL N/A 4-6' (11-13'bgs) BDL N/A ' 6-61/2' (13-13'/Z'bgs) BDL N/A ' 5:15 pm Secure and depart site. ' Page 3 of 7 Sulzman-BO03-3668 ' 3/4/03 8:30 am Discuss environmental assessment with LSP. Decide to submit HB-I: 8-12'bgs (2-6)and HB-1: 12-13' bgs (6-7') for EPH analysis (CRO) Note: At request of property owner in verbal conversation on 3/3/03, will submit soil ' samples under 24-48 hour turnaround, Rush#684. Groundwater Analytical to pick up samples on morning of 3/4/03. ' 3/18/03 8:30 am BENNETT&O REILLY,INC.personnel(Todd Everson)arrives on site to find EnviroSafe crew (Rob Fratus - Forman, Jack, Billy - Laborers) on site with Allstate Power-Vac Environmental Services (1 800 794-2243). EnviroSafe in tank grave vacuuming contaminated soils from sidewalls. ' Former UST has been cut up and removed from grave and photodocumented. Significant corrosion and staining of tank adjacent to hole used for HB-I (north). This is the likely cause of petroleum impact to underlying soils. 9:00 am ' EnviroSafe advances BOH to T bgs(I'beneath former tank bottom). Bernie Klotz(BK Real Estate) arrives on site to inspect work progress. 9:20 am BOH at 8'. EnviroSafe crew breaks. Will install trench box (sidewall shoring) prior to advancing BOH. Collect SW-N: 6-12' bgs (as corresponding to the depths identified as petroleum contaminated soils during environmental assessment activities)to qualify potential ' residual petroleum impact remaining after initial excavation activities. Field PID screen S W- N: 6-12' for TOV (by jar headspace) as follows [HNU PI 101, 10.2eV lamp]: LOCATION DEPTH PID DEXSIL DESCRIPTION SW-N 6-12' 0.4 0 Tan, fine to medium sand, trace fine gravel ' Page 4 of 7 Sulzman-BO03-3668 . ' Clean overburden 0.6 Brown, fine sand stockpile 9:40 am EnviroSafe crew begins installation of shoring system. 10:15 am Collect remaining sidewall samples (6-12') to quality lateral extent of impact, while EnviroSafe crew cuts wood components for shoring system. Field screen SW samples for TOV (by jar headspace) as follows: LOCATION DEPTH PID DEXSIL DESCRIPTION ' SW-N 6-12 4.4 Brown to tan, fine to medium sand SW-E 6-12' 9.2 As Above SW-S 6-12' 2.0 0 As Above ' Notice m evidence f petroleum - 'o ce moderate to strong olfactory e de e o pet o eum impact at SW-E: 6 12. Extend SW-E: 6-12'approximately 3/4'and collect sidewall sample. NOTE: Cannot extend SW-E: 6-12'any further east without risking integrity of excavation;i.e. SW-E: 6-12'x 1 is eastern extent of excavation. SW-E:6-12' x 1 1.4 11:15 am EnviroSafe crew continues to install shorebox. ' 1.2:00 pm ' EnviroSafe crew nearing completion of shore box. Begin to advance BOH to 12'bgs. I � Page 5 of 7 I ' Sulzman-BO03-3668 ' 1:00 pm EnviroSafe crew reaches 12' bgs. Collect BOH at 12' for PID screening as follows: LOCATION DEPTH PID DEXSIL DESCRIPTION ' BOH at 12' 1.6 0 Grey-brown, medium sand 1:20 pm Release truck#1 to Aggregate Industries. Break for lunch. 1:50 pm,: Secure site with Caution Tape. Suggest to EnviroSafe crew to install termite control around trench box prior to backfill with Flowable Fill. 2:15 pm Site secure. Depart site. ' NOTE: 4' x 6' (+/-) excavation to approximately 9'bgs. ; 4' x 4' (+/-) excavation @ 9-12' bgs (trench box approximately 4'x 4') ' 3:40 pm Prep samples to submit under Standard Turnaround to Groundwater Analytical for EPH with targets (SW-W, BOH at 12') and EPH without targets (Clean Overburden, SW-N, SW-E, SW-S). Soil samples will be picked up by Groundwater Analytical courier on morning of ' 3/19/03. 4/2/03 ' 10:00 am ' Receive laboratory analytical as reporting EPH concentrations for all sidewall and bottom of hole areas from the extent of excavation as BRL. Notify BK Real Estate and EnviroSafe Corp. ' Page 6 of 7 Sulzman-BO03-3668 Submitted by: BENNETT& O'REILLY, INC.. Todd M. Everson, ES Project Manager ' This Field Response Log is a compilation offreld observations, interviews with individuals familiar with the project and a review of public record. As such, it is intended to be an accurate and complete record of pertinent information. However, based on the reliance on third party and hearsay information included, no guarantee or warranties of the accuracy and completeness of that information is expressed or implied. Page 7 of 7 1 ' View,from south,of subject dwelling. Note that approximately two feet below the screened-in brick patio exists the subject 500 gallon UST. I' 1 - _ r YT 41. l boom ' View,from west,of subject dwelling and screened-in brick patio. 1 1 1 1 y. 1 View, from east as within the enclosed brick patio,of approximate 2'x 2'hole cut to access UST. i i 1 r r 1 .. rView, from above,of bottom of former UST with hole cut in southern end. r i r View,from southeast,of former UST as cut into several pieces to facilitate removal. 1 View of corrosion and petroleum staining on outside of vessel,former northern end. View,from southeast,of vactor truck(Allstate Power-Vac Environmental Services)used for contaminated soil removal. y��JJ s Views of shoring box as constructed in place by EnviroSafe Corporation. 1 � 1 1 1 � APPENDIX C 1 1 1 1 1 1 1 1 1 1 1 ' Make application to local Fire Department. Fire Department retains original application and issues duplicate as Permit. Aa6 .-09 �: !/XPi E'/, 1LC2Q VOL f/1tP 9432�e4y�GO�Z C^t `-'t__ - r 1 APPLICATION and 'PERMIT 25.00 for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00,.application is hereby made by: ' Tank Owner Name(please print) Robert Sulzman X gnarure tr y,wPermu Address 364'Main Street Centerville, MA ' Street city � Stare �P ' 17companyName. Enviro Safe Corporation Co.or Individual Bennett & O'Reilly Print Print Address 14B Tan Sebastian Dr Sandwich, MA Address PO Roy IF67 Brewster, MA Pnnr PnY Signature (if applying for permit) Signature(if applying for permit) V2 17�(f2�t ,, a ' IN IFCI'Certified Other ❑ IFCI'Certified ® LSP# Other ' Tank Location 9F,4 Main StrPPt renf-py-vi 11 P. ma Sleet Address C. Tank Capacity(gallons) _ 1 ,nnn Substance Last Stored — #2 Oil ' Tank Dimensions (diameter x length) Remarks: Tank was cut up into pieces and removed in order to facilitate remedial activities . Firm transporting waste_Enviro-Safe corporation State Lic.# 329 ' Hazardous waste manifest# MAM799516 E.P.A.# MAD985269323 Approved tank disposal yard ' Turner Salvage Tank yard# 002 ' Type of inert gas Tank yard address 235 Commercial Street, Lynn, MA ' T*jConservation Dept. : Centerville Date: City or Town FDID# Permit# ' Date of issue February 21, 2003 Date of expiration March 7, 2003 Dig safe approval number. 20030603121 Dig Safe Toll Free Tel. Number-800-322-4844 ' Signature/Title of Officer granting permit Q After removal(s) ("Consumptive Use"fuel oil tanks exempted)send Form FP-29OR signed by Local Fire Department to Office of the ' State Fire Marshal, UST Regulatory Compliance Unit, P.O.Box 1025, Stow,MA 01775. 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'��+ '` �� µ"g"''tY�`*�': �� �,,.' e..� � m ,y�,'+s. * �'C�� �1,�.'w.��y����� �a �x. •�7 Yam..` ae=, ;�n ri•�,���'��i���x.::. �:•.. r.-, ,� ,�,�. a.s .'9`� .F°k .,�'sC� .is�.��t-� .�-,v. T.� ��"""?e'�i ��'� ''�'.?.4�� art. tf t '. �;s', : ''; _ �attk;I.b # orm�'1'�Z90��, .> � �. a;�•'y-'� ,�; � t,,..`��,�'��.��. '�4 ��,� '���.� `,.��`� otiGcadon sF rm 90iraFP 90 ) o ? vpdphance,, 0v�ner/Qperato ;o matl>.revtsed cb�p n 2y, Y a E P -pera ree _ f Sr5 O4- Al=�02 fa � y .. �� � ?� mow." �`,�' � �"S Y-r '�: •,•�r'�.�s r�. d�`s^4,y'S4�`st�����;� B�S�. i�� �xm,£`',',��' .e�{.'�':w.� ,.t• RECEIVED MAR 2 6 2003 ' Enviro-Safe Corporation Environmental Services ' March 19, 2003 ' Inspector Wilcox Centerville, Osterville, Marstons Mills Fire District 1875 Route 28 ' Centerville, MA 02632-3117 RE: Certification of Tank Removal/Disposal 364 Main Street Centerville, MA Dear Inspector Wilcox: This letter serves as confirmation that on February 24, 2003, Enviro-Safe Corporation of Sandwich, Massachusetts (ENVIRo-SAFE) uncovered, pumped and cleaned (1) 1,000 gallon 1 underground heating oil storage tank (UST) in preparation to abandon this tank in place at the above referenced site in Centerville, MA. A representative of the COMM Fire District was on-site during this tank abandonment as well as Mr. Dave Bennett of Bennett & O'Reilly from Brewster Massachusetts, Licensed Site Professional (LSP). ' On March 17, 2003, the tank was cut up into pieces and removed in order to facilitate to remedial activities which took place on March 18, 2003. The cut up tank was cleaned and properly disposed of at Turner Trucking and Salvage Scrap yard (Massachusetts tank yard # 002) by ENVIRo-SAFE. Please contact Dave Bennett of Bennett & O'Reilly if you have any further questions regarding the tank closure. If you have any questions regarding these matters, please do not hesitate to contact me at (508) 888-5478. Thank you. Sincerely, HeatheM�M. A ood Enviro-Safe Corporation CC: Robert Sulzman CC: Dave Bennett, Bennett&O'Reilly Sulzman/miscOldc 14B Jan Sebastian Drive Sandwich, MA 02563 • PH (508) 888-5478 • FX (508) 888-9093 IREC U z. knit J March 25, 2003 AGGREGATE ' INDUSTRIES HEATHER ATWOOD. ENVIRO-SAFE CORP. 14B JAN SEBASTIAN ROAD tSANDWICH, MA 02563 Re: Soil, Sulzman Residence 364 Main Street Centerville, MA Release Tracking#: LRA Recyclable soil from the above address was received at our facility or. March 181, ' 2003. Attached is the shipper's log of soil receipts totaling 6.36 tons along c .th the Bill of Lading and other receipt documentation. ' We will issue a"Certificate of Recycling"upon request after processing. Thank you for recycling soil at our So. Dennis facility. Yours truly, William R. Reinhardt Manager, Soil Division AGGREGATE INDUSTRIES ' Northeast Region 1101 Turnpike Street Stoughton, Massachusetts 02072 ' Telephone 781-344-1100 Facsimile 781-341-5523 AGGREGATE INDUSTRIES ENVIRONMENTAL SERVICES ' 1101 TURNPIKE STREET, STOUGHTON, MA 02072 ' PHONE (781) 341-5500 FAX (781) 341-2440 ' SOIL RECYCLING SUBMITTAL (Revised 4/1/00) ' Site Information: Name: N/F Sulzman Residence Contact: Robert Sulzman Street: 364 Main Street Phone,#: 508-778-5198 City/Town: Centerville State/Zip: MA, 02632 Generator Inforration: Name: Robert Sulzman Contact: Robert Sulzman ' Street: 364 Main Street Phone,,,-`: 508-778-5198 City/Town: Centerville State,Zip: MA, 02632 ' Consultant Info r-inatiori: Name: BENNEIT & O'REILLY, INC. Contact: Todd Everson Street: 1573 Main St. ; P.O. Box 1667Phonee: 508-896-6630 City/Town: Brewster State/Zip: MA, 02631 Estimated Soil Quantity 6 Tons 4 Cubic Yards Soil Contaminants i ' (gasoline, diesel fuel, motor oil, etc.) #2 Fuel Oil Analyses Performed (check all that apply) TPH, VOCs, Flash, pH, Reactivity (S, CN), PCBs As, Cd, Cr, Hg, Pb, TCLP (metals), if required based on total levels All the above tests were performed Other EPH ' Laboratory Analytical Data Attached x Screening Data Attached x Instrument Used and Constituents Found HNU PI 101 phtoionization detector (PTn), 10 2 Pv lama- ' calibrated to benzene standard t Description/Source of Release x UST, Other, Describe i Date of Release Unknown (historic) Soil Description Physical Description (sand, gravel, silt, etc.) ' Fine to medium sand Classification Method Unified Soil classification System Check if the following materials are present: clay, construction debris, vegetative matter, ash, coal, other deleterious materials (list) ' Soil Characterization Methodology Samulinsz tilethod Grab x Composite Biased samples (e.g. headsoace screened, visually contaminated) Constinites of Concern 42 Fuel Oil Site History (check if exara sheets attached) Current Use Residential ' past Use BeccirlanH g1 Vacant woodland ' Ir the generator, having used due diligence, determined that there is no reason to suspect or believe that the petroleum contaminated soil has been impacted by any releases of oil or hazardous materials other than that of the known source or I have identified the additional oil and hazardous materials that are suspected or known to be present in the soil, in addition to those associated with the known release, including any ar_thropogenic contaminants. I, the generator, realize that due diligence shall consist of a search of information and records reasonably available to the generator of the contaminated soil and sufficient to make the determination. Such records and information may include, but are not limited to, those of the generator, location of generation (i.e. facility if not the generator), the Department's Bureau of Waste Site Cleanup and the municipality (i.e.Board of Health, Fire Department) within which the site is located. All samples for VOC analysis were collected according to DEP policy C #99-415. 1 r — Signature of GeneratoP. Date ' Robert Sulzman Generator - Printed Name 2 A site diagram is required indicating any major structures or roads, excavation areas and stockpile locations. All sampling locations must be noted. x Check if diagram attached. SITE DIAGRAM i ' 1 Name of Individual preparing diagram: ' BIIVIVEZT & O REILLY, INC. BTES/900 ' 4/1/00 3 Massachusetts Department of Environmental Protection BWSC-012A Bureau of Waste Site Cleanup Release Tracking Number' P BILL OF LADING (pursuant to 310 CMR 40.0030) ❑ _ A. LOCATION OF SITE OR DISPOSAL SITE WHERE REMEDIATION WASTE WAS GENERATED: ' Release Name(optional): Street: 364 Main Street Location Aid: parcel 42 1 City/Town: Centerville ZIP Code: _ ' Date/Period of Generation: 03/14/2003 to: 03/70/2003 Additional Release Tracking Numbers Associated with this Bill of Lading: Note: If this Bill of Lading is the result of a Limited Removal Action(LRA) taken prior to Notification, a Release Tracking Number is not needed. B. PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH BILL OF LADING: ' Name of Organization: Name of Contact: Robert Sul,man Title: ' Street: 364 Main Street Cityrrown: Centerville State: MA ZIP Code: Telephone: Ext.: C. RELATIONSHIP TO RELEASE OF PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH BILL OF LADING: ' ® RP or PRP Specify: ® Owner Operator Generator ❑ Transporter Other RP or PRP: Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) ' ❑ Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) ❑ Other Person: If an owner and/or operator is not conducting the response action associated with the Bill of Lading,provide on an attachment the name,contact person,address and telephone number,including any area code and extension,for each,if known. D. TRANSPORTER OR COMMON CARRIER INFORMATION: Transporter/Common Carrier Name: FnyirnSafe Corporation ' Contact Person: Heather Atwood Title: Operatinng Manager Street: 14R Ian Sehactian Drive Cityrrown: gandwich State: MA ZIP Code: _ Telephone: Ext.: F RECEIVING FACILITY/TEMPORARY STORAGE LOCATION: Operator/Facility Name: Contact Person: William Reinhardt Title: Snils Manager Street 230 Great Western Rnad City/Town: CnLth T)ennic State: MA ZIP Code: 0,2660-0000 Telephone: 7R 1_341-5500 Ext.: Type of Facility: Asphalt Batch/Cold Mix Landfill/Disposal ❑ Incinerator Temporary Storage (check one) ® Asphalt Batch/Hot Mix Landfill/Daily Cover 0 Other: ❑ Thermal Processing Landfill/Structural Fill EPA Identification#: ' Division of Hazardous Waste/Class A Permit#: Division of Solid Waste Management Permit#: Actual/Anticipated Period of Temporary Storage(specify dates if applicable): to: Reason for Temporary Storage: Revised 10/3/94 Page 1 of 3 ' Massachusetts Department of Environmental Protection BWSC-012A Bureau of Waste Site Cleanup Release Tracking Number* 1 BILL OF LADING (pursuant to 310 CMR 40.0030) ❑ LRA E. RECEIVING FACILITYITEMPORARY STORAGE LOCATION(continued): ' Temporary Storage Address: Street: City/Town: State: ZIP Code: ' F. DESCRIPTION OF REMEDIATION WASTE: (check all that apply) ® Contaminated Media(check all that apply): ® Soil O Groundwater O Surface Water O Other: Contaminated Debris(check all that apply): O Vegetation or Organic Debris O Demolition/Construction Waste OInorganic Absorbant Materials O Other: ' EJ Non-hazardous Uncontainerized Waste(check all that apply): O Non-aqueous Phase Liquid O Other: Non-hazardous Containerized Waste(check all that apply): O Tank Bottoms/Sludges O Containers O Drums OEngineered Impoundments O Other: ' Type of Contamination(check all that apply): ❑ Gasoline ❑ Diesel Fuel ® #2 Oil #4 Oil #6 Oil Waste Oil ❑ Kerosene Jet Fuel ❑ Other: Estimated Volume of Materials: Cubic Yards: 4 Tons: 6 Other: Contaminant Source(check one/specify): ❑ Transportation Accident ® Underground Storage Tank Other: ' Response Action Associated with Bill of Lading(check one): ElImmediate Response Action Release Abatement Measure EJ Utility-Related Abatement Measure ® Limited Removal Action ,Comprehensive Response Action Other Remediation Waste Charcerization Support Documentation attached: ® Site History Information ® Sampling and Analytical Methods and Procedures ® Laboratory Data ® Field Screening Data If supporting documentation is not appended,provide an attachment stating the date and in connection with what ' document such information was previously submitted to DEP. G. LICENSED SITE PROFESSIONAL(LSP)OPINION: ' Name of Organization: RENNFTT&()'RFii.i.Y INC LSP Name: David C_Kennett Title: Directnr of Fnvironmental qervives Telephone: 508-896-6630 Ext.: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this submittal,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of (i)the standard of care in 309 CMR 4.02(1), (ii)the applicable provisions of 309 CMR 4.02(2)and(3),and (iii)the provisions of 309 CMR 4.03(5), ' to the best of my knowledge,information and belief,the assessment actions undertaken to characterize the Remediation Waste which is(are)the subject of this submittal for acceptance at the facility identified in this submittal comply with the applicabl rovisions of 310 CMR 40.0000,and such facility is permitted to accept Remediation Waste having the characteristics described in this submi that significant penalties may result, including,but not li to,possible fines and imprisonment,if I submit information which I kno to or materially incomplete. ' D MD a a. LSP Signature: Seal: BENNETT` ' Date: 0/t3TS . License Number. 4303 ' Revised 10/3/94 Page 2 of 3 ' Massachusetts Department of Environmental Protection BWSC-012A Bureau of Waste Site Cleanup Release Tracking Number ' BILL OF LADING (pursuant to 310 CMR 40.0030) ❑ LRA H. CERTIFICATION OF PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH THIS BILL OF LADING: I certify under penalties of law that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this certification,and that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained herein is,to the best of my knowledge and belief,true,accurate and complete. I am aware that there are si i n pen ties,includin ,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete ' information. Signature: "t? t'� Date: Name of Person(print): Robert Sulzrnan 1 1 Revised 10/3/94 Page 3 of 3 Massachusetts Department of Environmental Protection BWSC-012B Bureau of Waste Site Cleanup j ' BILL OF LADING(pursuant to 310 CMR 40.0030) Release Tracking Number SUMMARY SH OF LRA I. LOAD INFORMATION: rgnTrans tative: . i Signature f Rece' 'ng Fa 'ity/Temporary Storage Representative: Load 1: ��Date of S ' m t pm t a i Date of ReceiQt �3 Time of R t f! AAA PM AM g-ppf' TruckfTractor Registration: Trailer Registration(if any): El tv toad Size(cu.yd Aons: Load 2: Signature of Transporter Representative: Signature of Receiving Facilityfremporary Storage Representative: Date of Shipment rime of Shipment Time of Receipt , Date of Receipt AM PM AM PM i ' Truckfrractor Registration Trailer Registration(if any): ' Load Size(cu.ydsJtons): i ' Load-3: Signature of Transporter Representative;. Signature of Receiving Facilitylremporary Storage Representative: , Date of Shipment Time of Shipment i AM PM i Date of Receipt Time of Receipt- ' i � AM [] PM i Truck/Tractor Registration: Trailer Registration(if any): Load Size(cu.ydsJtons): ' Load 4: Signature of Transporter Representative: , Signature of Receiving Facility/Temporary Storage Representative: ' Date of Shipment Time of Shipment � I Date of Receipt Time of Receipt AM PM AM PM , TruddTractor Registration: Trailer Registration(if any): I Load Size(cu.ydsJtons): Load 5: Signature of Transporter Representative: I Signature of Receiving Facility/Temporary Storage Representative: Date of Shipment Time of Shipment I Date of Receipt Time of Receipt AM PM I AM PM ' - TrucluTractor Registration: Trailer Registration(d anyx I I Load Size(w.ydsJtorus): I Load 6: Signature of Transporter Rgwr sentaadve i Signature of Receiving FaciiitylremporarySuorage Representative: I Date of Shipment Time of Shipment i P� I Date of Receipt Time of Receipt AM Q PM I AM PM I TrudclTractor Registration: Trailer Registration Cf anyX Load Size(cu.ydsJtons): J. LOG SHEET VOLUME INFORMATION: Total Volume Recorded This Page(cu.ydsJtons) Total Carried Forward(cu.ydsJtons): ' Total Canned Forward and This Page(cu.ydsJtons): Revised 1043194 Page 1 of 1 I f 1 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC-012C BILL OF LADING(pursuant to 310 CMR 40.0030) Release Tracking Number SUMMARY SHEET OF 11 - � 1 K. SUMMARY OF SHIPMENTS: Daily Volume Shipped Date of Shipment: Date of Receipt: Number of Loads Shipped: (cu.yds./tons): 1 1 1 1 1 1 1 1 1 1 1 i Summary Sheet Total Shipped: 1 Bill of Lading Total Shipped (only if different): Revised 10/3/94 Page 1 of 2 i i i Massachusetts Department of Environmental Protection BWSC-012C Bureau of Waste Site Cleanup BILL OF LADING(pursuant to 310 CMR 40.0030 Release Tracking Number SUMMARY SHEET ' ONLY COMPLETE ONE COPY OF THIS PAGE AND ATTACH TO THE FINAL COPY OF THE SUMMARY SHEET. L. ACKNOWLEDGMENT OF RECEIPT OF REMEDIATION WASTE AT RECEIVING FACILITY OR TEMPORARY STORAGE: iReceiving Facility/Temporary Storage Representative(print): William R. Reinhardt Title: Manager Signature: V��l� �wv�� -`'G�—, "��► z, ' ��L Date: ' M. ACKNOWLEDGMENT OF SHIPMENT AND RECEIPT OF REMEDIATION WASTE BY PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH THIS BILL OF LADING: I certify under.penalties of law that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this certification,and that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material informatigWesqlained in herein is,to the best of my knowledge and belief,true,accurate and complete, I am aware that there are significant penalties,includi g,but o,possible fines.and imprisonment,for willfully submitting false,inaccurate,or incomplete information. Signature: Date: iName of Person(print): David C. Bennett, LSP Director ot Environmentaiervices ' BENNEIT & O'REILLY, INC. P.O. Box 1667 1573 Main Street iBrewster, MA 02631 As agent for Robert Sulzman i 1 i i i 1 Revised 1013194 Page 2 of: i i i i i 1 APPENDIX D 1 1 1 � I 1 1 1 1 1 1 1 -s 'f ii�iC l ii.a 1 D Fi_J ' �� Groundwater Analytical,Inc. OUNDWATER P.O. Box 1200 ANALYTICAL Buzzards Main Street Buzzards Bay,MA 02532 Telephone(508)759-4441 February26 2003 FAX(508)759-4475 ' www.groundwateranalytical.com Mr. David Bennett ' Bennett & O'Reilly, Inc. P.O. Box 1667 Brewster, MA 02631 LABORATORY REPORT ' Project: Sulzman/13003-3668 Lab ID: 58464 Received: 02-21-03 Dear Dave: Enclosed are the analytical results for the:above referenced project. The project was processed for Rush 3 Business Day turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a sample receipt report detailing the samples received, a project narrative indicating project changes and non-contormances, a quality control report, and a ' statement of our state certitications. The analytical results contained in this report meet all applicable NELAC standards, except as may ' be specitically noted, or described in the project narrative. This report may only be used or reproduced in its entirety. I attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the information, the material contained in this report is, to the best of my knowledge and beliet, accurate and complete. ' Should you have any questions concerning this report, please do not hesitate to contact me. ' Sincerely, ' Eric H. 1 en en Operatio Man er ' EHJ/smd Enclosures GROUNDWATER ANALYTICAL Sample Receipt Report Project: Sulzman/BO03-3668 Delivery: GWA Courier Temperature: 4.8'C ' Client: Bennett&O'Reilly, Inc. Airbill: n/a Chain of Custody: Present Lab ID: 58464 Lab Receipt: 02-21-03 Custody Seal(s): n/a Lab ID field ID Matrix Sampled ` .Method Notes 58464-1 BOT®6'(N-2) Soil 2/21/03 13:00 IMA DEP EPH with PAHs Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C257798� 250 mL Glass Proline ! BX6122 None i n/a n/a n/a 1 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 ANALY I ALTER ' Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GGFI D Field ID: BOT06'(N-21 Laboratory ID: 58464-01 ' Project: Sulzman/BO03-3668 QC Batch ID: EP-1623-M Client: Bennett&O'Reilly, Inc. Sampled: 02-21-03 Container: 250 mL Glass Received: 02-21-03 Preservation: Cool Extracted: 02-24-03 Matrix: Soil Analyzed: 02-25-03 %Moisture: 2 Dilution Factor: Aliphatic: 1 Aromatic:1 •EPH'Ranges Concentration Units° ;.I Reporting.limit n-C9 to n-C18 Aliphatic Hydrocarbons 390 mg/Kg 30 ! n-C19 to n-C36 Aliphatic Hydrocarbons 200 mg/Kg 30 n-Cl1 to n-C22 Aromatic Hydrocarbons 350 — j mg/Kg j 30 J Unadjusted n-C11 to n-C22 Aromatic Hydrocarbons' ! 360 mg/Kg 30 I CAS Number Target Analytes Concentration Units` Reporting Limit 91-20-3 Naphthalene _ _ BR_L _; mg/Kg � 0.50_ 91_57-6 2=lvtethylnaphthalene - _- - — 2.5 �Kg_1 0.50 85-01-8 j Phenanthrene _— 0.72 —� mg/Kg�_ 0.50 83-32-9 Acena hthene BRL mg/Kg 0.50 208-96-8 Acenaphthylene - - 0.94 mg/Kg 0.50 I ------- T ------ -- - -- - -------- ------ _86 73-7--_--.___Fl uorene -— -- - 1.3 mg/Kg --- 0_50 120-12-7 Anthracene BRL mg/Kg 0.50 206-44-0 Fluoranthene BRL j mg/Kg j 0.50 129-00-0 Pyrene BRL mg/Kg i 0.50 56-55-3 Benzo[a]anthracene BRL ; mgLKg 0.50 j .- - .._..._._._ - - •----.. . . . 218-0.-9 Chrysene - BRL .I _ mg/Kg j 0.50 205 99-2 Benzo[b]fluoranthene BRL i - mg/Kg ! - 0.50 - 207 08-9 Benzo[k]fluoranthene BRL 1 mg/Kg 0.50 i 50 32 8 Benzo[a]pyrene BRL mg/Kg 0.50 193 39 5 Indeno[1,2,3-c,d]pyrene BRL ( mg/Kg j 0.50 53-70-3 Dibenzo[a,hjanthracene BRL mg/Kg 0.50 191-24 2 Be I 1 -nz--o-[g-,-h,i - _ — ]perylene _-- BRL__ mg/Kg 0.50 QC Surrogate Compounds Recovery QC Limits Fractionation: i 2=Fluorobiphenyl 79 % 40- 140 % _ 2-Bromonaphthalene 80 % ! 40- 140% —� Extraction. I Chloro-octadecane ! 78 % 40- 140 % —ortho-Terphenyl 103 % j 40- 140% _ QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performancelacceptance standards for the required QA/QC procedures achieved? Yes j 1 t 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. ' Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest ' concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. ' 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL ' Project Narrative Project: Sulzman/BO03-3668 Lab ID: 58464 ' Client: Bennett&O'Reilly, Inc. Received: 02-21-03 15:50 A.-Documentation and Client Communication The following documentation discrepancies,and client changes or amendments were noted for this project: ' 1 . No discrepancies,changes, or amendments were noted. B.Method Non-Conformances ' The following method non-conformances were noted for this project: 1 . No method non-conformances were noted. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Buz Street,P.O.Box 1200 GROUNDWATER Buzzards Bay,MA 02532 CHAIN-OF-CUSTODY RECORD ANALYTICAL Telephone(508)759-4441•FAX(508)759-4475 AND WORK ORDER No 069359 www.groundwateranalytical.com Project Name: Firm: TURNAROUND ANALYSIS REQUEST f i ❑ STANDARD(10 Business Days) Volatile. So Written Pee ;re CBs Metals Petroleum"..,be. Nat. General Chemistry other Project Number: Address: g waste ❑ PRIORITY(5 Business Days) ",; •.�rLI..S.• [�y v"l.� (? "7•.� %i�.:J I f RUSH(RAN- /_>7� a ) RR a a (Rush requires Rush Authorization Number a c o j a ❑ ❑ ❑ ❑ ❑ Sampler Name: City State Zip: - _ � r , ? U Please Email to: ❑ T01ease FAX to: ` ^n. a• _. 4 r_c. 3 m g � x ❑ Project Manager. Telephone: BILLING Q = ° - - ° 13 GNIV_ �,/ of '-�^ - a- �•r `="^-�`� Purchase I'_'^ �".` ' ❑ Third Parry Billing: g o g a o INSTRUCTIONS:Use separate line for each container(except replicates). ❑ GWA Quote: o g u Samlln $ s a � g3 e g eS a ❑ e E P 9 Matrix Type Containers) Preservation Fine ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 8 ❑ ❑ ❑ o Z SAMPLE o ' LABORATORY B e ° a' g ❑ IDENTIFICATION 3 < — s $ a $ a: NUMBER F3 f6 m g° a ❑ ❑ w w z W 5 5 5 a .j (Lab Use Only S e" o o x a o ~ � 3H � aniati � r � 3IY q 11 us � s = � -3> � � € m a = sm HIM FTTI REMARKS/SPECIAL INSTRUCTIONS DATA QUALITY OBJECTIVES CHAIN-OF-CUSTODY RECORD Regulatory g story Program Project Specific O� 1 p C NOTE:All samples submitted subject to Standard Terms and Conditions on reverse hereof. State Stand ard Deliverables Man regulatory programs and EPA Y 9 ry P 9 methods require project Relinquished dV Sampler: Date Time Received by. �,;C.!:;•., Receipt Temperature: specific OC.Project specific OC includes Sample Duplicates. . ^ OCT )�MCPGW-1/S-1 `\ "^'''y' / ❑PWS Form Matrix Spikes,and/or Matrix Spike Duplicates.Laboratory QC is l,�r r n'^ �•,��"(?' ❑me eamVereree '/,� not pro ect s ecific unl �•4`' z.e•C eemmmeeeea ME M P ass rearran r❑ ❑ C GW-2/S, ❑ I P P gad.P ojed specilic OC samples are charged on a per sample basis.Each MS,MSD Relinquish6d by: 0 Tlme Recei by: Container Count: p MA ❑NV STARS C. and Sample Duplicate requires an additional sample aliquot. ❑NH ID Drinking Water Fry'd,C . d' /3-/0 �y / ❑NV LI Wastewater Project Speellle OC Required Selection of OC Semple 4opment: Date Time gceN y boratory: Shlpping/Airbill ! �u% ^/t Number: ❑RI ❑Waste Disposal Sample Duplicate ❑Please use sample: 2/ 0 1.J Jl E,K/G JJ ❑uT ❑Dredge Materiai ❑Matrix Spike 1 ❑_ ❑ Jr GWA Courier O E ress Mail❑Federal Express Custody Seal ;]Matrix Spike Duplicate El UPS 0Hand❑ Number; ' GROUNDWATER NALY DW d�ANALYTICAL ' Quality Assurance/Quality Control a° 'A.Program Overview . x A Groundwater Analytical conducts an active Quality Assurance program to ensure the production of high ' quality, valid data. This program closely follows the guidance provided by Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans, US EPA QAMS-005/80 (1980), and Test Methods for Evalutaing Solid Waste, US EPA, SW-846, Update III (1996). ' Quality Control protocols include written Standard Operating Procedures (SOPS) developed for each analytical method. SOPs are derived from US EPA methodologies and other established references. Standards are prepared from commercially obtained reference materials of certified purity, and documented for traceability. Quality Assessment protocols for most organic analyses include a minimum of one laboratory control sample, one method blank,,.one matrix spike sample, and one sample duplicate for each sample preparation batch. All samples, standards, blanks, laboratory control samples, matrix spikes and sample duplicates are spiked ' with internal standards and surrogate compounds. All instrument sequenc es begin with an initial calibration verification standard and a blank; and excepting GC/MS sequences, all sequences close with a continuing calibration standard. GC/MS systems are tuned to appropriate ion abundance criteria daily, or for each 12 hour operating period, whichever is more frequent. Quality Assessment protocols for most inorganic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. Standard curves are derived from one reagent blank and four concentration levels. Curve validity is ' verified by standard recoveries within plus or minus ten percent of the curve. B. Definitions Batches are used as the basic unit for Quality Assessment. A Batch is defined as twenty or fewer samples of the same matrix which are prepared together for the same analysis, using the same lots of reagents and the II ' same techniques or manipulations, all within the same continuum of time, up to but not exceeding 24 hours. Laboratory Control Samples are used to assess the accuracy of the analytical method. A Laboratory Control Sample consists of reagent water or sodium sulfate spiked with a group of target analytes representative of the ' method analytes. Accuracy is defined as the degree of agreement.of the measured value with the true or expected value. Perent Recoveries for the Laboratory Control Samples are calculated to assess accuracy. ' Method Blanks are used to assess the level of contamination present in the analytical system. Method Blanks consist of reagent water or an aliquot of sodium sulfate. Method Blanks are taken through all the appropriate steps of an analytical method. Sample data reported is not corrected for blank contamination. ' Surrogate Compounds are used to assess the effectiveness of an analytical method in dealing with each sample matrix. Surrogate Compounds are organic compounds which are similar to the target analytes of interest in chemical behavior, but which are not normally found in environmental samples. Percent ' Recoveries are calculated for each Surrogate Compound. IGroundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 ANO4LY�ALTER Quality Control Report Laboratory Control Sample Category: MA DEP EPH Method QC Batch ID: EP-1623-M Matrix: Soil Units: mg/Kg ;CAS Number Analyte 7_::Spiked =Measured Recovery QC Limits. -: 111-84-2 n-Nonane(C9) 3.3 2.0 61 % 40- 140% j 629-59 4 i n-Tetradecane(C14) 3.3 2.4 72 % 40-140% 629-92-5 n-Nonadecane(C19) 3.3 j 2.8 j 83% 40- 140% 112-95-8 i n-Eicosane(C20) 1 3.3 2.8 84% 40-140 % 630-02-4 n-Octacosane(C28) _ j 3.3 2.9 88% 40-140 % j 91-20-3 Naphthalene 3.3 j 2.4 71 % j 40- 140 % 83-32-9 i Acenaphthene I 3.3 j 2.6 i 78% j 40- 140 120-12-7__ Anthracene I 3.3 j _2.9 _ 86% 40- 140 129-00-0 Pyrene i 3.3 _ 3.0 89% 40- 140% r218-01-9— Chrysene -_ --- 3.3 _ j_- 3.1 93% 40-140 QC Surrogate Compounds Recovery _ QC Limits Fractionation: 2-Fluorobi hen I_ 90 % --- ! 40- 140 % - — --- r na t al - ---- --- -------- 40-140 2-Bromona hthalene j 92 % I _ Extraction: Chloro-octadecane 85 % _ 40-140% ortho-Terphenyl 89 % 40-140 Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 ' I ALTER ANALYQuality Control Report Method Blank ' Category: MA DEP EPH Method QC Batch ID: EP-1623-M Matrix: Soil I - EPH Ranges � `Concentration r ; Units" Reporting Limit n-C9 to n-C18 Aliphatic Hydrocarbons BRL mg/Kg 30 j nn--C19 to n-C36 Aliphatic Hydrocarbons j _ BRL j mg/Kg 30 I n-C11 to n-C22 Aromatic Hydrocarbons i BRL_ mg/Kg 30 ' I Unadjusted n-Cl1 to n_C22 Aromatic Hydrocarbons T BRL mg/Kg 30 CAS Number _ Target Analytes Concentration Units Reporting Limit 191-20-3 --; Naphthalene � -- --- — BRL — j mg/Kg 0.50 I 91-57-6 2-Methyl naphthalene BRL j mg/Kg j 0.50__ 85-01-8 TPhenanthrene _ BRL mg/Kg 0.50 83-32-9 _ Acenaphthene _ _ _ _ BRL mg/Kg _0.50 208-96-8 - Acenaphthylene - _ BRL _ -T_mg/Kg j 0.50 86-73-7 TFluorene BRL mg/Kg 0.50 120-12-7 Anthracene _ _ _ BRL mg/Kg 0.50 ' —-...-------------- -- ------ - 206-4. 4-0--- - Fluoranthene----- --- -_ .. ------- BRL--------= --mg/Kg g---- 0.50- 129-00-0 Pyrene BRL m K 0.50 56-55-3 Benzo[a]anthra_cene BRL mg/Kg 0.50- 218-01-9 Chrysene BRL mg/Kg 1 0.50 205-99-2 Benzo[b]fluoranthene BRL mg/Kg 10.50 207-08-9 Benzo[k]fluoranthene BRL mg/Kg 0.50 50-32-8 Benzo[a]pyrene BRL mg/Kg I 0.50 193-39-5 Indeno[1,2,3-c,d]pyrene BRL mg/Kg 0.50 53-70-3 Dibenzo[a,h]anthracene _-.-_._- ... _.- ---..--.-_---BRL --(-0-50 -- __.... 191-24-2 Benzo[g,h,i]perylene---- — _..._:_. ------_—_--BRL ----- --mg/Kg -- 0.50 QC Surrogate Compounds Recovery QC Limits Fractionation: 2-Fluorobiphenyl 83 % 40-140 2-Bromonaphthalene _ 82 % ; _ 40- 140% Extraction: Chloro-octadecane _ 82 % _ 40-140% _ ' ortho-Terphenyl 81 % I 40- 140% Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it ' that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. P.O. Box 12 0 Buzzards Bay, MA 02532 Groundwater Analytical, Inc., 0 , 228 Main Street, y, ' ANALY ICALTER ' Certifications and Approvals Groundwater Analytical maintains environmental laboratory certification in a variety of states. ' Copies of our current certificates may be obtained from our website: http://www.groundwateranalytical.com/qualifications.htm ' CONNECTICUT, Department of Health;Services, PH-0586 d . xr X. Categories: Potable Water,Wastewater,Solid Waste and Soil ' http://www.dph.state.ct.us/B RS/Envi ron mental_Lab/OutStateLabLi st.htm FLORIDA, Department of Health, Bureau of Laboratories, E87643 Categories:SDWA,CWA, RCRA/CERCLA http://www.floridadep.org/labs/qa/dohforms.htm MAINE, Department of Human Services, MA103 Categories: Drinking Water and Wastewater http://www.state.me.us/dhs/eng/water/Compiiance.htm MASSACHUSETTS, Department of Environmental Protection, M-MA-103 Categories: Potable Water and Non-Potable Water ' http:Hwww.state.ma.us/dep/bspt/wes/fi Ies/certI abs.pdf NEW HAMPSHIRE, Department of Environmental Services, 202703 ' Categories: Drinking Water and Wastewater http://www.des.state.nh.us/asp/NHELAP/Iabsview.asp NEW YORK, Department of Health, 11754 ' Categories: Potable Water, Non-Potable Water and Solid Waste http://www.wadsworth.org/labcert/elap/comm.html PENNSYLVANIA, Department of Environmental Protection, 68-665 Environmental Laboratory Registration(Non-drinking water and Non-wastewater) http://www.dep.state.pa.us/Labs/Registered/ RHODE ISLAND, Department of Health, 54 Categories:Surface Water,Air,Wastewater, Potable Water,Sewage http://www.healthri.org/labs/labsCT—MA.htm U.S. Department of Agriculture,Soil Permit, 5-53921 Foreign soil import permit VERMONT, Department of Environmental Conservation,Water Supply Division ' Category: Drinking Water http://www.vermontdrinkingwater.org/wsops/labtable.PDF ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 RE VILE D LIAR 0 6 2003 1 Groundwater Analytical, Inc. GROUNDWATER ANALYTICAL228 Box 1 28 Main Street ' Buzzards Bay, MA 02532 Telephone(508)759-4441 FAX(508)759-4475 ' March 5, 2003 ' Mr. David Bennett Bennett & O'Reilly, Inc. P.O. Box 1667 Brewster, MA 02631 LABORATORY REPORT ' Project: Sulzman/13003-3668 Lab ID: 58712 Received: 03-04-03 Dear Dave: 1 Enclosed are the analytical results for the above referenced project. The project was processed for Rush 24 Hour turnaround. ' This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a sample receipt report detailing the samples received, a project narrative Indicating project changes and non-conformances, a quality control report, and a ' statement of our state certifications. The analytical results contained in this report meet all applicable NELAC standards, except as may ' be specitically noted, or described in the project narrative. This report may only be used or reproduced in its entirety. I attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the intormation, the material contained in this report is, to the best of my knowledge and beliet, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sincerely, Eric H.J nsen ' Operati ns Ma ager EHJ/smd Enclosures - --_---- - --- --- GROUNDWATER ANALYTICAL Sample Receipt Report Project: Sulzman/BO03-3668 Delivery: GWA Courier Temperature: 6.7'C Client: Bennett&O'Reilly, Inc. Airbill: n/a Chain of Custody: Present Lab ID: 58712 Lab Receipt: 03-04-03 Custody Seal(s): n/a Lab.ID Fi ld ID -Matrix Sampled Method - Notes- :- 58712-1 HB-1:8-12'bgs Soil 3/3/03 14:00 MA DEP EPH Carbon Ranges Only Con ID Container Vendor —IQ—C--L.t—F Presery QC Lot Prep Ship C212746 250 mL Glass Proline BX6399 None n/a n/a n/a ' Lab ID Field ID Matrix Sampled Method " ,, Notes 58712-2 I HB-1:12-13'bgs Soil 3/3/03 14:30 'MA DEP EPH Carbon Ranges Only Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C212750 250 ml Glass Proline BX6399 None n/a n/a n/a Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL t Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GC/FID Field ID: HB-1:8-12'bgs Laboratory ID: 58712-01 Project: Sulzman/BO03-3668 QC Batch ID: EP-1626-M Client: Bennett&O'Reilly, Inc. Sampled: 03-03-03 Container: 250 mL Glass Received: 03-04-03 Preservation: Cool Extracted: 03-04-03 ' Matrix: Soil Analyzed: 03-05-03 %Moisture: 4 Dilution Factor: Aliphatic:1 Aromatic:1 I` EPH Ranges - :Concentration Units Reporting Limit n-C9 to n-C18 Aliphatic Hydrocarbons 690 mg/Kg 30 n-C19 to n-C36 Aliphatic Hydrocarbons' ! 350 mg/Kg 30 n-C11 to n-C22 Aromatic Hydrocarbons' 630 mg/Kg 30 J Unadjusted n-C11 to n-C22 Aromatic Hydrocarbons r 630 mg/Kg 30 QC Surrogate Compounds Recovery QC Limits Fractionation: ;_ 2-Fluorobiphenyl _ 121 % _ 40-140 2 B"romonaphthalene j 115 % _I 40-140% —� ' Extraction: - Chloro-octadecane 64 % j 40-140% J ortho-Terphenyl _ 83 % _40-140% _ QA/QC Certification 1 ' 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes ' Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated ' on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration,if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. ' t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. ' Groundwater Analytical, Inc. P.O. Box 1200 228 Main Street Buzzards Bay, MA 02532 Yt Y, GROUNDWATER ' ANALYTICAL ' Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GGFID Field ID: HB-1:12-13'bgs Laboratory ID: 58712-02 Project: Sulzman/6003-3668 QC Batch ID: EP-1626-M Client: Bennett&O'Reilly, Inc. Sampled: 03-03-03 Container: 250 mL Glass Received: 03-04-03 Preservation: Cool Extracted: 03-04-03 Matrix: Soil Analyzed: 03-05-03 %Moisture: 6 Dilution Factor: Aliphatic:1 Aromatic:1 'EPH Ranges Concentration Units.:s-: Reporting Limit 11 n-C9 to n-C18 Aliphatic Hydrocarbons j 55 mg/Kg 32 L ' C1n 9 to n-C36 Aliphatic Hydrocarbons 55 mg/Kg 32 n-C11 to n-C22 Aromatic Hydrocarbons 68 mg/Kg 32 ' Unad usted n-CI1 to n-C22 Aromatic Hydrocarbons t 68 mg/Kg 32 f _ QC Surrogate Compounds Recovery QC Limits Fractionation: ! 2-Fluorobiphenyl 80 % 40- 140 % 2-Btomonaphthalene— j 91 % 40140 % Extraction: i Chloro-octadecane 66 % 40-140% ortho-Terphenyl _ _ 75 % - 40- 140% ' QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes ' Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter, project narrative and quality control report are considered part of this data report. i Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP 119181. Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Project Narrative Project: Sulzman/B003-3668 Lab ID: 58712 ' Client: Bennett&O'Reilly, Inc. Received: 03-04-03 10:50 `A. Documentation and Client Communication ' The following documentation discrepancies,and client changes or amendments were noted for this project: 1 . No discrepancies, changes,or amendments were noted. i B.Method Non-Conformances ' The following method non-conformances were noted for this project: 1 . Project 58712 was received at a temperature of 6.7'C. This measurement is outside the recommended range of 2- �I ' 6'C. 1 ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 MMM GROUNDWATER Buz Main Street,P.O.Box 1200 Buzzards Bay,MA02532 CHAIN-OF-CUSTODY RECORD N� 069362 ANALYTICAL Telephone(508)769-4441 a FAX(508)759.44-15 AND WORK ORDER www.groundwateranstylleal.com Project Name: Firm: q.. ,�;/L�. �. TURNAROUND ANALYSIS REQUEST ❑ STANDARD(10 Business Days) Valatlles U.N.I.M.s Pas t erb Css Metals Petrolavm dmnrban Raz. General Chemistry Other Project Number: Address: D PRIORITY(5 Business Days) � : waste _,'-�>��_�`� 7 7 �c.,. rice; �RUSH(RAN• G�� (Rush requires Rush Authorization Number) Sampler Name: City/State/Zip: i ` ❑Please Email to: ' �J ,^? .�' 07i,73/I XPlease FAX to: rob 99iD-;-Iilf_i 3` tg 3 Project Manager: ❑ " - = $ o Telephone: BILLING o g = g0 s ,rim, 7 ❑ ❑ ❑ ..-_�:'��•. z,,•....'F•fr Lr?,.Y.- ..F,- ,M'PurchaseOrderNo.:grly. -2C-) o ❑ ❑ v g g g ❑ Third Party Billing: ' S S - >< _ p ❑ INSTRUCTIONS:Use separate line for each container(except replicates). p GWAOuote: _ at a ° o a Sampling s S e = ^d a g 4 o 3 € P 9 Matrix Type C�ontalner(s) Preservation Fi ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ 0 0 0 k c e 2 3 I g a . - € SAMPLE W-� e- W LABORATORY -' ¢ 8 ' 0 0 IDENTIFICATION 5 o g NUMBER12 ❑ ❑ (Lab Use Only) e 6 e a ao ❑❑ ❑0❑ ❑❑ o ❑ o o ao❑o ❑ ❑ o a ❑ ❑ 6 ❑ ❑ 0 0 ❑ 0 0 0 0 0 0 0 0 0 IT_1_FFFF_* REMARKS/SPECIAL INSTRUCTIONS DATA QUALITY OBJECTIVES CHAIN-OF-CUSTODY RECORD Regulatory Program Protect Specific QC NOTE:All samples submitted subject to Standard Terms and Conditions on reverse hereof. Or r State Standard Deliverables Many regulatory programs and EPA methods require project Relinquished by Sampler: Date Time Received by:g 1 YS Receipt Temperatu specific OC.Project specific OC includes Sample Duplicates, l ❑CT �,rMCP GW-1/S-1 ❑PWS Form /� rr r ie Ox"F1G= / y+; Matrix Spikes,and/or Matrix Spike Duplicates.Laboratory QC is ��G Tr >��3 y'�1$- _ `,,,_. r_,I;Ar. oiva❑Ramgam,,d („ 7 D ME D MCP GW-2/S-1 ❑ not project specific unless prearranged.Project specific OC - - z-s•c Revemmended ❑MA D NY STARS D samples are charged on a per sample basis.Each MS,MS[, Relinquis d b)f: at Time ved by: Container Count: and Sample Duplicate requires an additional sample alirLot. 4 ❑NH ❑Drinking Water D NY ❑Wastewater Prolecl Specific OC Requlrad Selection of OC Semple ingwshed 1 to Time R o a,py Lt r ry: ShipphtglAii hill 1 Number: ❑RI D Waste Disposal O Sample Duplicate ❑Please use sample: 'C r,..' .qN I :T:! O VT ❑Dredge Material O Matrix Spike ❑_ D _ Method of hip nt: (6wA Courier❑Express Mail❑Federal Express Custody Seal p Matrix Spike Duplicate O UPS❑Hand❑ Number: I f GROUNDWATER ANALYTICAL ' Quality Assurance/Quality Control A Program Overview Groundwater Analytical conducts an active Quality Assurance program to ensure the production of high quality, valid data. This program closely follows the guidance provided by Interim Guidelines and ' Specifications for Preparing Quality Assurance Project Plans, US EPA QAMS-005/80 (1980), and Test Methods for Evalutaing Solid Waste, US EPA, SW-846, Update III (1996). Quality Control protocols include written Standard Operating Procedures (SOPS) developed for each analytical method. SOPS are derived from US EPA methodologies and other established references. Standards are prepared from commercially obtained reference materials of certified purity, and documented for traceability. Quality Assessment protocols for most organic analyses include a minimum of one laboratory control sample, one method blank, :one matrix spike sample, and one sample duplicate for each sample preparation batch. All samples, standards, blanks, laboratory control samples, matrix spikes and sample duplicates are spiked with internal standards and surrogate compounds. All instrument sequences begin with an initial calibration verification standard and a blank; and excepting GUMS sequences, all sequences close with a continuing ' calibration standard. GUMS systems are tuned to appropriate ion abundance criteria daily, or for each 12 hour operating period, whichever is more frequent. ' Quality Assessment protocols for most inorganic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. Standard curves are derived from one reagent blank and four concentration levels. Curve validity is verified by standard recoveries within plus or minus ten percent of the curve. I B. Definitions Batches are used as the basic unit for Quality Assessment. A Batch is defined as twenty or fewer samples of the same matrix which are prepared together for the same analysis, using the same lots of reagents and the same techniques or manipulations, all within the same continuum of time, up to but not exceeding 24 hours. ' Laboratory Control Samples are used to assess the accuracy of the analytical method. A Laboratory Control Sample consists of reagent water or sodium sulfate spiked with a group of target analytes representative of the method analytes. Accuracy is defined as the degree of agreement of the measured value with the true or expected value. Perent Recoveries for the Laboratory Control Samples are calculated to assess accuracy. Method Blanks are used to assess the level of contamination present in the analytical system. Method Blanks ' consist of reagent water or an aliquot of sodium sulfate. Method Blanks are taken through all the appropriate steps of an analytical method. Sample data reported is not corrected for blank contamination. Surrogate Compounds are used to assess the effectiveness of an analytical method in dealing with each sample matrix. Surrogate Compounds are organic compounds which are similar to the target analytes of interest in chemical behavior, but which are not normally found in environmental samples. Percent Recoveries are calculated for each Surrogate Compound. ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 r GROUNDWATER ANALYTICAL r Quality Control Report Laboratory Control Sample Category: MA DEP EPH Method QC Batch ID: EP-1626-M Matrix: Soil r Units mg/Kg CAS Number. Analyte �lSpiked ilAeasured Recovery-` w QC Limits 111-84-2 n-Nonane(C9) ( 3.3 1.9 56% 40- 140 629-59-4 i n-Tetradecane(C14) 3.3 2.2 67% 40- 140 629-92-5 n-Nonadecane(C19) i 3.3 2.4 72 % 40-140 112-95-8 n-Eicosane(C20) 3.3 2.6 77% 40-140 630-02 4 n-Octacosane(C28) i 3.3 2.4 i 71 % 40- 140 ' QC Surrogate Compounds Recovery QC Limits Fractionation: 1 2-F!uorobiphenyl 79 % j 40- 140 2-Bromonaphthalene 74 % 40- 140 r i Extraction: Chloro-octadecane 70 % ; 40- 140 %_ ortho-Terphenyl_ 74 % 40- 140 % Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. 1 r 1 1 I r ' Groundwater Analytical, Inc. P.O. Box 1200 228 Main Street Buzzards Bay, MA 02532 Yt Y, GROUNDWATER ANALYTICAL ' Quality Control Report Method Blank ' Category: MA DEP EPH Method QC Batch ID: EP-1626-M Matrix: Soil EPH Ranges Concentration Units Reporting Limit n-C9 to n-C18 Aliphatic Hydrocarbons I BRL mg/Kg 30 n-C19 to n-C36 Aliphatic Hydrocarbons BRL mg/Kg 30 n-C11 to n-C22 Aromatic Hydrocarbons t BRL mg/Kg 30 ' Unadjusted n-CI1 to n-C22 Aromatic Hydrocarbons BRL mg/Kg 30 QC Surrogate Compounds Recovery QC Limits ' Fractionation: 2-Fluorobiphenyl 76 % 40- 140 % 2-Bromonaphthalene 75 %_ _r 40- 140 %— Extraction Chloro-octadecane _ 63 %_ 40- 140 %_ ortho-Terphenyl 73 % I _ 40- 140 % _ ' Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest ' concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-CI1 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. I II Groundwater Anal .O. B 22 Analytical, Inc.,Inc Box 1200, 8 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL ' Certifications and Approvals Groundwater Analytical maintains environmental laboratory certification in a variety of states. ' Copies of our current certificates may be obtained from our website: http://www.groundwateranalyticaI.com/quaIifications.htm - -' fCONNECTICUT Depart ment oHealth Services, PH-0586 Categories: Potable Water,Wastewater,Solid Waste and Soil ' http://www.dph.state.ct.us/BRS/Environmental Lab/OutStateLabList.htm FLORIDA, Department of Health,Bureau of Laboratories,'E87643 Categories:SDWA,CWA, RCRA/CERCLA http://www.floridadep.org/labs/ga/dohforms.htm j MAINE, Department.of Human Services, MA103 Categories: Drinking Water and Wastewater http://www.state.me.usldhs/eng/water/Compliance.htm MASSACHUSETTS, Department of Environmental Protection, M-MA-103 Categories: Potable Water and Non-Potable Water http://www.state.ma.us/dep/bspt/wes/files/certlabs.pdf __- - - --- NEW HAMPSHIRE, Department of Environmental Services, 202703 Categories: Drinking Water and Wastewater http://www.des.state.nh.us/asp/NHELAP/Iabsview.asp --- ---- rNEW YORK, Department of Health, 11754 Categories: Potable Water, Non-Potable Water and Solid Waste http://www.wadsworth.org/labcert/elap/comm.html PENNSYLVANIA,Department of Environmental Protection, 68-665 Environmental Laboratory Registration (Non-drinking water and Non-wastewater) http://www.dep.state.pa.us/Labs/Registered/ ' RHODE ISLAND, Department of Health, 54 Categories:Surface Water,Air,Wastewater, Potable Water,Sewage ' http://www.healthri.org/labs/labsCT—MA.htm U.S. Department of Agriculture,Soil Permit, S-53921 Foreign soil import permit VERMONT,Department of Environmental-Conservation,Water Supply Division- ' Category: Drinking Water http://www.vermontdrinkingwater.orglwsops/labtable.PDF + I ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 $ �ad � APR 4 2003 ' Groundwater Analytical, Inc. GROUNDWATER P.O.Box 1200 ANALYTICAL Buz Main Street ' Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 ' April 2, 2003 Mr. Todd Everson Bennett & O'Reilly, Inc. P.O. Box 1667 Brewster, MA 02631 LABORATORY REPORT ' Project: Sulzman/13003-3668 Lab ID: 59199 Received: 03-19-03 Dear Todd: Enclosed are the analytical resu.lts for the above referenced project. The project was processed for ' Standard turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a sample receipt report detailing the samples received, a project narrative indicating project changes and non-contormances, a quality control report, and a ' statement of our state certitications. The analytical results contained in this report meet all applicable NELAC standards, except as may be.specitically noted, or described in the project narrative. This report may only be used or reproduced in its entirety. ' I attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the intormation, the material contained in this report is, to the best of my knowledge and beliet, accurate and complete. ' Should you have any questions concerning this report, please do not hesitate to contact me. ' Sincerely, Eric H.J risen ' Operatio n age r EHJ/smd ' Enclosures GROUNDWATER ANALYTICAL Sample Receipt Report Project: Sulzman/8003-3668 Delivery: GWA Courier Temperature: 4.31C ' Client: Bennett&O'Reilly, Inc. Airbill: n/a Chain of Custody: Present Lab ID: 59199 Lab Receipt: 03-19-03 Custody Seal(s): n/a Lab ID Field ID Matrix Sampled , Method Notes ' 59199-1 _SW-W:6-12'BGS Soil 3/18/03 10:15 jMA DEP EPH with PAHs j Con ID t Container _Vendor QC Lot Presery j QC Lot Prep _Ship _ C257789 250 mL Glass Proline BX6110 None n/a _ n/a-- , n/a ' Lab ID Field ID Matrix Sampled Method Notes 59199-2 BOHQ12'BGS Soil 3/18/03 13:00 MA DEP EPH with PAHs Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C257786 250 mL Glass Proline BX6110 None n/a n/a n/a - - -- ----- __ Lab ID Feld ID _ Matrix 1 Sampled Method (Notes -� 59199.3 SW-N:6-12'BGS Soil 3/18/03 9:20 :MA DEP EPH Carbon Ranges Only ' Con ID-_ Container - Vendor- BX- Lot -Presery QC-Lot - Prep- - Ship — - ---- C257788 2500mt.mL Glass_'_____ ss Proline BX6110 None n/a n/a n/a - Lab I- Field ID �Matrix� Sampled Method _ _ Notes 59199-4 Clean Overburden Stockpile Soil 3/18/03 9:30 MA DEP EPH Carbon Ranges Only Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C257790 250 mL Glass Proline BX6110 None n/a n/a n/a Lab ID Field ID Matrix Sampled Method Notes _I . _ . _ -- (-- 59199-5 SW-S:6-12'BGS Soil 3/18/03 10:35 MA DEP EPH Carbon Ranges Only Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C257785 250 mL Glass Proline BX6110 None n/a n/a n/a - - -- ' tab ID Field ID Matrix Sampled Method Notes 59199-6 SW-E:6 12'x 1 Soil 3/18/03 10:50 MA DEP EPH Carbon Ranges Only Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C257781 250 mL Glass Proline BX6110 None n/a n/a n/a Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 ■ GROUNDWATER NALY�C LTE14 Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GC/FID Field ID: SW-W:6-12' BGS Laboratory ID: 59199-01 ' Project: Sulzman/8003-3668 QC Batch ID: EP-1636-M Client: Bennett&O'Reilly, Inc. Sampled: 03-18-03 Container: 250 mL Glass Received: 03-19-03 Preservation: Cool Extracted: 03-24-03 ' Matrix: Soil Analyzed: 03-27-03 % Moisture: 3 Dilution Factor: Aliphatic:1 Aromatic:1 EPH Ranges C Concentration Units Reporting Limitl n-C9 to n-C18 Aliphatic Hydrocarbons ' t _ BRL _ mg/Kg 31 • - - _ - - -- - ----- ---- - —------------- - n-C19 t to n-C36 Aliphatic_Hydrocarbons_ _B_RL_ mg/Kg 31 n-C1 1 to n-C22 Aromatic Hydrocarbons'° BRL mg/Kg 31 Unadjusted n C11 to n-C22 Aromatic Hydrocarbons t BRL mg/Kg 31 __CAS Number - Target Analytes Concentration Units Reporting Limit! 91-20-3 Naphthalene BRL mg/Kg 0.51 91-57-6 2-Methyl naphthalene BRL mg/Kg 0.51 85-01-8 Phenanthrene BRL mg/Kg 0.51 83-32-9 Acenaphthene BRL mg/Kg 0.51 208-96-8 Acenaphthylene BRL mg/Kg 0.51 86-73-7 Fluorene BR_ L _ _ mg/Kg 0.51 120-12-7 Anthracene BRL mg/Kg 0.51 206-44-0 Fluoranthene BRL mg/Kg 0.51 129-00-0 Pyrene BRL mg/Kg 0.51 56-55-3 Benzo[a]anthracene BRL mg/Kg 0.51 218-01-9 Chrysene BRL mg/Kg 0.51 205-99-2 Benzo[b]fluoranthene BRL mg/Kg 0.51 ' 207-08-9 Benzo[k]fluoranthene BRL mg/Kg 0.51 50-32-8 Benzo[a]pyrene BRL mg/Kg 0.51 193-39-5 Indeno[1,2,3-c,d]pyrene BRL mg/Kg 0.51 53-70-3 Dibenzo[a,h]anthracene BRL mg/Kg 0.51 191-24-2 _ Benzo[g,h,i]perylene BRL mg/Kg 0.51 QC Surrogate Compounds _ Recovery-- �— QC Limits Fractionation: 2-Fluorobiphenyl 86 % 40- 140% 2-Bromonaphthalene 87 % 40-140 % Extraction: _Chloro-octadecane _ _ 69 % _ 40- 140 % ortho-Terphenyl 77 % 40-140% QA/QC Certification - - -- 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. j Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. ' 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Massachusetts DEP EPH Method ' Extractable Petroleum Hydrocarbons by GC/FID Field ID: BOH®12' BGS Laboratory ID: 59199-02 ' Project: Sulzman/BO03-3668 QC Batch ID: EP-1636-M - Client: Bennett&O'Reilly, Inc. Sampled: 03-18-03 Container: 250 mL Glass Received: 03-19-03 Preservation: Cool Extracted: 03-24-03 Matrix: Soil Analyzed: 03-27-03 % Moisture: 4 Dilution Factor: Aliphatic:1 Aromatic: 1 E Hanges' Concentration Units Reporting Limitl n-C9 to n_C18 Aliphatic Hydrocarbons t BRL j mg/Kg 30 n-C19 to n-C36 Aliphatic Hydrocarbons+ BRL mg/Kg 30 n-Cl1 to n-C22 Aromatic Hydrocarbons i° _ BRL mg/Kg -_ 30 _Unadjusted-n-Cl l to n-C22 Aromatic Hydrocarbons r -- _- -_-BRL - — mg/Kg _ 30 ' CAS Number F Target Analytes Concentration — — Units Reporting Limit, 91-20-3 Naphthalene BRL mg/Kg 0.50 91-57-6 2-Methyl naphthalene BRL mg/Kg 0.50 85-01-8 Phenanthrene BRL mg/Kg 0.50 83-32-9 Acena hthene BRL mg/Kg 0.50 208-96-8 Acenaphthylene BRL mg/Kg 0.50 86-73-7 Fluorene BRL mg/Kg 0.50 120-12-7 Anthracene BRL mg/Kg 0.50 206-44-0 Fluoranthene BRL mg/Kg 0.50 129-00-0 Pyrene BRL mg/Kg 0.50 56-55-3 Benzo[a]anthracene BRL mg/Kg 0.50 218-01-9 Chrysene BRL mg/Kg 0.50 205-99-2 Benzo[b]fluoranthene BRL mg/Kg 0.50 207-08-9 Benzo(k]fluoranthene BRL mg/Kg 0.50 ' 50-32-8 Benzo[a]pyrene BRL mg/Kg 0.50 193-39-5 Indeno(1,2,3-c,d]pyrene BRL mg/Kg 0.50 53-70-3 Dibenzo[a,h]anthracene BRL mg/Kg - 0.50 - 191-24-2 Benzo[g h,i]perylene BRL mg/Kg 0.50 QC Surrogate Compounds _- Recovery QC Limits Fractionation: 2-Fluorobiphenyl 76 % 40- 140% 2-Bromonaphthalene 78 % 40- 140% Extraction: _C_hloro-_octadecane 75 %_ 40- 140% ortho-Terphenyl -- - _74 % ----- 40- 140 % ' - ------ -------- QA/QC Certification- ---_----- - 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all perform ance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in' Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-CI1 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. l ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GGFID Field ID: SW-N:6-12' BGS Laboratory ID: 59199-03 Project: Sulzman/BO03-3668 QC Batch ID: EP-1636-M Client: Bennett&O'Reilly, Inc. Sampled: 03-18-03 Container: 250 mL Glass Received: 03-19-03 Preservation: Cool Extracted: 03-24-03 ' Matrix: Soil Analyzed: 03-28-03 Moisture: 4 Dilution Factor: Aliphatic:1 Aromatic: 1 EPH Ranges Concentration Units Reporting Limit; n-C9 to n-C18 Aliphatic Hydrocarbons' t __ BRL mg/Kg ! 31 _n-C19 to n-C36 Aliphatic Hydrocarbons r_ - BRL -_ mg/Kg 31 n-C11 to n-C22 Aromatic Hydrocarbons t° BRL mg/Kg 31 Unadjusted n-C11 to n-C22 Aromatic Hydrocarbons BRL mg/Kg 1 31 QC Surrogate Compounds—_ - Recovery _- QC Limits Fractionation: 2-Fluorobiphenyl 86 % 40- 140 2-Bromonaphthalene 84 % 40- 140 Extraction: Chloro-octadecane 74 % 40- 140 ortho-Terphenyl 77 % 40- 140 ---------------------------------------------------- _ _ _QA/QC Certification _-_---------__---_-_— _-_-__-_-_---1 ' 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated 1 on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL. Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution, percent moisture and sample size. ' t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-CI1 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 ROUN ANALY D ALTER ' Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GC/FID Field ID: Clean Overburden Stockpile Laboratory ID: 59199-04 ' Project: Sulzman/BO03-3668 QC Batch ID: EP-1636-M Client: Bennett&O'Reilly, Inc. Sampled: 03-18-03 Container: 250 mL Glass Received: 03-19-03 Preservation: Cool Extracted: 03-24-03 ' Matrix: Soil Analyzed: 03-28-03 Moisture: 6 Dilution Factor: Aliphatic: 1 Aromatic:1 EPH Ranges Concentration Units Reporting Limit; n-C9 to n-C18 Aliphatic Hydrocarbons BRL mg/Kg 31 ------ --------- n-C19 to n-C36 Aliphatic Hydrocarbons' _ BRL mg/Kg 31 n-Cl 1 to n-C22 Aromatic Hydrocarbons'° BRL mg/Kg 31 Unadjusted n-C11 to n-C22 Aromatic Hydrocarbons t BRL _ mg/Kg _ 31 QC Surrogate Compounds--- -- r- Recovery _— QC Limits Fractionation: 2-Fluorobiphenyl 83 % 40- 140% 2 Bromona hthalene 86 % 40- 140% -- - Extraction: Chloro-octadecane 67 % _ _ 40- 140% ortho-Terphenyl 76 % 40- 140 ' - -- -- - --QA/QC Certification -- --- - -- ._...-- --- 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all perform an ce/acceptan ce standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated ' on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution, percent moisture and sample size. t Hydrocarbon range data.excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-CI1 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 1 GROUNDWATER NALY®gLTEl4 ' Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GC/FID Field ID: SW-S:6-12' BGS Laboratory ID: 59199-05 Project: Sulzman/BO03-3668 QC Batch ID: EP-1636-M Client: Bennett&O'Reilly, Inc. Sampled: 03-18-03 Container: 250 mL Glass Received: 03-19-03 Preservation: Cool Extracted: 03-24-03 ' Matrix: Soil Analyzed: 03-28-03 % Moisture: 4 Dilution Factor: Aliphatic:1 Aromatic:1 r EPH Ranges Concentration Units Reporting Limit n-C9 to n-C18 Aliphatic Hydrocarbons BRL mg/Kg 31 n-C19 to n-C36 Aliphatic Hydrocarbons' __BRL _ - __mg/Kg 31 - - - --f 0. - n-C11 to n-C22 Aromatic Hydrocarbons BRL mg/Kg 31 Unadjusted n-CI1 to n-C22 Aromatic Hydrocarbons BRL mg_/_K_g_ _ 31 QC Surrogate Compounds Recovery QC Limits Fractionation: 2-Fluorobiphenyl 78 % 40- 140 % 2-Bromonaphthalene 77 % 40- 140 % Extraction: Chloro-octadecane 63 % 40- 140 % ortho-Terphenyl 75 % 40- 140 % - -- -- - - _ - QA/QC Certification --- —— — 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes t Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated 1 on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting ii that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. 1 I Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GC/FI D Field ID: SW-E:6-12'x 1 Laboratory ID: 59199-06 Project: Sulzman/BO03-3668 QC Batch ID: EP-1636-M Client: Bennett&O'Reilly, Inc. Sampled: 03-18-03 Container: 250 mL Glass Received: 03-19-03 Preservation: Cool Extracted: 03-24-03 ' Matrix: Soil Analyzed: 03-28-03 % Moisture: 6 Dilution Factor: Aliphatic:1 Aromatic: 1 f EPH Ranges Concentration Units Reporting limit, n-C9 to n-C18 Aliphatic Hydrocarbons' BRL i mg/Kg i 31 n-C19 to n-C36 Aliphatic Hydrocarbons' BRL mg/Kg 31 n-C11 to n-C22 Aromatic Hydrocarbons'° BRL mg/Kg 31 ----- ---------------- -------- ---- - ---- ---- ---- - ---------- Unadjusted n-C11 to n-C22 Aromatic Hydrocarbons t BRL mg/Kg 31 QC Surrogate Compounds _L— RecoveryI QC Limits Fractionation: 2-Fluorobiphenyl 79 % 40- 140 % 2-Bromonaphthalene 79 % 40- 140 % Extraction: Chloro-octadecane 70 % 40- 140 ----------------------------- ortho-Terphenyl 76 % 40- 140 _ QA/QC Certification j ' 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter, project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL ' Project Narrative Project: Sulzman/BO03-3668 Lab ID: 59199 Client: Bennett&O'Reilly, Inc. Received: 03-19-03 17:00 A. Documentation and Client Communication The following documentation discrepancies,and client changes or amendments were noted for this project: 1 No discrepancies,changes,or amendments were noted. ' B.Method Non-Conformances The following method non-conformances were noted for this project: 1 . No method non-conformances were noted. 1 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GRDUNDWATER Buz Main Street,P.O.Box 1200 Buzzards Bay,MA 02532 CHAIN-OF-CUSTODY RECORD ANALYTICAL Telephone dwat7nalyli1•FAX(508)759-4475 AND WORK ORDER N? 070742 www.groundwateranalylical.com lytical.com Project Name: Firm: / TURNAROUND __ .._.. .. �7r-,::r�:-r7".:= /,.^' •`.?,-.ccv �:'� ANALYSIS REQUEST STANDARD(10 Business Days) Volaliles Semlvolallles PeslMer6/PCes Metals Petroleum omcaman Has. General Chemistry other Project Number: „ n ct al Ext..T V I.PH Wade Address: ❑ PRIORITY(5 Business Days) � !.�•'. 9.'; - l,[:-.'.nFi% 15 r .f--.:-a-- ... I ❑ RUSH(RAN- j $, o = 3 v (Rush requires Rush Authorization Number) Sampler Name: City/State/Zip: a Please Email to . . _..,. .. __:�a:r.;, - ...;. - .. `-.•"c,..-�.: Q Please FAX to:�: = / - ❑ ❑ ❑ ❑ a ❑ @ at R Project Manager: Telephone: ° = - W a' o s BILLING g o 0 0 0 o a o > g SZ )�f Purchase Order No.: INSTRUCTIONS:Use separate line for each container(except replicates). ❑ Third Party Billing:_ m s a f € g o a ❑ 0 ❑ GWA Quote: g f e € s a Sampling Matrix Type Containers a o 0 o n $ '° - 5 d ° t a e €O Preservation Pwere n ❑ ❑ ❑ y� _ o n ❑ _ SAMPLE w LABORATORY W m x a a@ g 9 f o V n F o o IDENTIFICATION 3 < 'a a a $ a NUMBER ? $ 5 :`y .`s, s ° p � a' x o - s o S W 5 > cj 5�a a 5 5 a g 5 m (Lab Use Only) S m m Q ny' g� Q s o € o n O H 3 0 o B i E $ v aS S .i Etl i o s E e m — c Q v B o n R E' < o a '$ ❑ - f � a � � S em s g m- a - s �3n fRs - a = ' °° °°O ❑❑ ❑ ❑ ❑ ❑ o❑❑❑ ❑ o ❑ 0 a o ❑ ❑ ❑ ❑ ❑ a 0 ❑ 0 0 a 0 0 0 IB a3!0.35 sU� 5: to-j a gc�S —— ——————————————————————————— A I IT 1'] 7-1 REMARK S/SPECIAL INSTRUCTIONS DATA QUALITY OBJECTIVES CHAIN-OF-CUSTODY RECORD Regulatory Program Project Specific QC NOTE:All samples submitted subject to Standard Terms and Conditions on reverse hereof. State Standard Deliverables Many regulatory programs and EPA methods require project Reli quished by Sampler: Date Time Received by: Receipt Temperature:. e: OCT MCP GW-1/S-1 ❑PWS Form M specific OC.Project specific OC includes Sample Duplicates, r; c„!atrix Spikes,and/or Matrix Spike Duplicates.Laboratory OC is __-,.,�.�' ,_ , _ ❑me ehiga,-d ❑ME ❑MCP GW-2/S-1 ❑ not project specific unless prearranged.Project specific OC '' /t ae•c-moedad ❑MA p NY STARS ❑ samples are charged on a per sample basis.Each MS,MSD Relinquished by: ;Z//"CI e Time Received�/ Container C!ount: ❑NH p Drinking Water and Sample Duplicate requires an additional sample aliquot. ( 1 y� , !�,,.. I-1 NY LI Waslowulor Project Specific OC Required Selection of OC Sample it°liOq°1§I�d y: Dale Time Hbcely 6 Laboratory: Shipping/Airbill ❑RI ❑Waste Disposal O Sample Duplicate ❑Please use sample: ,� F i c" Number: 'l S• ❑VT ❑Dredge Material O Matrix Spike Method of Shipment:,i.:Q GWA Courier O Express Mail❑Federal Express Custody Seal p— ❑ ❑Matrix Spike Duplicate O UPS❑Hand❑ Number: J GROUNDWATER ANALYTICAL Quality Assurance/Quality Control A. Program Overview Groundwater Analytical conducts an active Quality Assurance program to ensure the production of high quality, valid data. This program closely follows the.guidance provided by Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans, US EPA QAMS-005/80 (1980), and Test Methods for Evalutaing Solid Waste, US EPA, SW-846, Update III (1996). ' Quality Control protocols include written Standard Operating Procedures (SOPS) developed for each analytical method. SOPS are derived from US EPA methodologies and other established references. Standards are prepared from commercially obtained reference materials of certified purity, and documented for traceability. Quality Assessment protocols for most organic analyses include a minimum of one laboratory control sample, one method blank,.:one matrix spike sample, and one sample duplicate for each sample preparation batch. ' All samples, standards, blanks, laboratory control samples, matrix spikes and sample duplicates are spiked with internal standards and surrogate compounds. All instrument sequences begin with an initial calibration verification standard and a blank; and excepting GC/MS sequences, all sequences close with a continuing calibration standard. GC/MS systems are tuned to appropriate ion abundance criteria daily, or for each 12 hour operating period, whichever is more frequent. Quality Assessment protocols for most inorganic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. Standard curves are derived from one reagent blank and four concentration levels. Curve validity is verified by standard recoveries within plus or minus ten percent of the curve. B. Definitions Batches are used as the basic unit for Quality Assessment. A Batch is defined as twenty or fewer samples of the same matrix which are prepared together for the same analysis, using the same lots of reagents and the same techniques or manipulations, all within the same continuum of time, up to but not exceeding 24 hours. laboratory Control Samples are used to assess the accuracy of the analytical method. A Laboratory Control Sample consists of reagent water or sodium sulfate spiked with a group of target analytes representative of the ' method analytes. Accuracy is defined as the degree of agreement of the measured value with the true or expected value. Perent Recoveries for the Laboratory Control Samples are calculated to assess accuracy. Method Blanks are used to assess the level of contamination present in the analytical system. Method Blanks consist of reagent water or an aliquot of sodium sulfate. Method Blanks are taken through all the appropriate steps of an analytical method. Sample data reported is not corrected for blank contamination. Surrogate Compounds are used to assess the effectiveness of an analytical method in dealing with each sample matrix. Surrogate Compounds are organic compounds which are similar to the target analytes of interest in chemical behavior, but which are not normally found in environmental samples. Percent Recoveries are calculated for each Surrogate Compound. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL ' Quality Control Report Laboratory Control Sample ' Category: MA DEP EPH Method QC Batch ID: EP-1636-M Matrix: Soil Units: mg/Kg CAS Number Analyte Spiked Measured Recovery — QC Limits 1 1 1-84-2 _n-_N_onane(C9) ! 3.3 2.2 65 % _ 40- 140 629-59-4 n-Tetradecane(C14) 3.3 2.4 73 % 40-140 %_ 629-92-5 n-Nonadecane(C19) ! 3.3 _ 2.8 _— - - 84-% _40- 140% 112-95-8 n-Eicosane(C20) 3.3 i 3.0 90% 40- 140 630-02-4 n-Octacosane(C28) 3.3 2.5 76% 40- 140 91-20-3 Naphthalene 3.3 2.3 68 % 40- 140 % 83-32-9 - Acenaphthene - 3.3 -2-5 76% 40- 140 120-12-7 Anthracene 3.3 2.7 81 % 40- 140 % 129-00-0 Pyrene _: 3.3 2.9 87% 40- 140 % 218-01-9 - Chrysene - -- -_ — 3.3 - 3.1 -- 92 % 40- 140 QC Surrogate Compounds ! Recovery QC Limits Fractionation: 2-Fluorobiphenyl " 86 % 40- 140 2-Bromonaphthalen_e_ _ 85 % 40- 140 Extraction: Chloro-octadecane 86 % 40- 140 ortho-Terphenyl 85 % 40- 140 Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: MA DEP EPH Method QC Batch ID: EP-1636-M Matrix: Soil EPH Ranges Concentration Units Reporting Limit ' n-C9 to n-C18 Aliphatic Hydrocarbons _ — BRL _ j mg/Kg _ 30 n-C19_to n-C_36_Aliphatic Hydrocarbons r __ _ BRL_ mg/Kg 30 n-C11 to n-C22 Aromatic Hydrocarbons" BRL _ mg/Kg 30 _ Unadjusted n_C1 t to n-C22 Aromatic Hydrocarbons r BRL_ - — mg/Kg CAS Number __ Target Analytes _ - Concentration_ - Units J Reporting Limitl. 91-20-3 Naphthalene BRL mg/Kg 0.50 91-57-6 2=Methyl naphthalene BRL mg/Kg 0.50 85-01-8 Phenanthrene BRL mg/Kg 0.50 83-32-9 Acenaphthene BRL mg/Kg 0.50 208-96-8 Acenaphthylene BRL mg/Kg 0.50 86-73-7 Fluorene BRL mg/Kg 0.50 120-12-7 Anthracene BRL mg/Kg 0.50 - --- - ---- - - -.._._.... . _.. _ 206-44-0 Fluoranthene BRL mg/Kg 0.50 129-00-0 Pyrene BRL mg/Kg 0.50 56-55-3 Benzo[a]anthracene BRL mg/Kg 0.50 218-01-9 Chrysene BRL mgiKg 0.50 205-99-2 Benzo[b]fluoranthene BRL mg/Kg 0.50 207-08-9 Benzo[k]fluoranthene BRL mg/Kg 0:50 50-32-8 Benzo[a]pyrene BRL mg/Kg 0.50 193-39-5 Indeno[1,2,3-c,d]pyrene BRL mg/Kg 0.50 53-70-3 Dibenzo[a,h]anthracene BRL mg/Kg 0.50 191-24-2 Benzo[g,h,i]perylene BRL mg/Kg 0.50 QC Surrogate Compounds_ Recovery J QC Limits Fractionation: 2 Fluorobiphenyl 83 % 40- 140 2-Bromonaphthalene 80 % 40- 140 % Extraction: Chloro-octadecane 80 % 40- 140% —_ ortho-Terphenyl _ _84 % _ _ 40-140% Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it ' that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Certifications and Approvals Groundwater Analytical maintains environmental laboratory certification in a variety of states. ' Copies of our current certificates may be obtained from our website: http://www.groundwateranaIytical.com/quaIifications.htm CONNECTICUT, Department of Health Services, PH-0586 Categories: Potable Water,Wastewater,Solid Waste and Soil http://www.dph.state.ct.us/BRS/Environmental Lab/OutState lab Iist.htm FLORIDA, Department of Health, Bureau of Laboratories, E87643 Categories- SDWA,CWA, RCRA/C .h — — --- — http://www.floridadep.org/labs/ga/dohforohforms.htm MAINE, Department of Human Services, MA103 ' Categories: Drinking Water and Wastewater http://www.state.me.us/dhs/eng/water/CompIiance.htm - --- - ----- - - - ...- -- ----- - -- - MASSACHUSETTS, Department of Environmental Protection, M-MA-103 Categories: Potable Water and Non-Potable Water http://www.state.ma.us/dep/bspt/wes/fiIes/certlabs.pdf ' NEW HAMPSHIRE, Department of Environmental Services, 202703 Categories: Drinking Water and Wastewater ' http://www.des.state.nh.us/asp/NHELAP/labsview.asp NEW YORK,-Department of Health, 1175 ' Categories: Potable Water, Non-Potable Water and Solid Waste http://www.wadsworth.org/labcert/elap/comm.htmi PENNSYLVANIA, Department of Environmental Protection, 68-665 Environmental Laboratory Registration(Non-drinking water and Non-wastewater) http://www.dep.state.pa.us/Labs/Registered/ ' RHODE ISLAND, Department of Health, 54 Categories:Surface Water,Air,Wastewater, Potable Water,Sewage hltp://www.healthri-org/labs/IabsCT—MA.htm U.S. Department of Agriculture,Soil Permit, S-53921 ' Foreign soil import permit , VERMONT,Department of Environmental Conservation,Water Supply Division ' Category: Drinking Water http://www.vermontdrinkingwater.org/wsops/labtable.PDF ' Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 1 1 APPENDIX E 1 1 1 1 1 1 1 1 1 1 1 1 BTENNETT A 'REILLY, Inc.-_ Engineering, Environmental & Surveying Services 1573 Main Street 1 Sanitary 21E/Site Remediation Property Line PO Box 1667 Site Development Hydrogeologic Survey Subdivision Brewster,MA 02631 Waste Water Treatment Water Quality Monitoring Land Court 508-896-6630 1 Water Supply Licensed Site Professional Trial Court Witness 508-896-4687 Fax 1 QUALITY ASSURANCE & QUALITY CONTROL PROGRAM 1 Quality Assurance & Quality Control Program For Soil and Groundwater Sampling 1 INTRODUCTION 1 The QualityAssurance & Quality Control (QA/QC) Program outlines the purpose, policies, tY organization and operations to support sampling work conducted by BENNETT&O'REILLY,INC.. ' The procedures and protocal represented herein are consistent with the MA DEP "Standard References for Monitor Wells" [WSC-310-91], and the recommendations of a MA certified laboratory. Implementation of this program will help to ensure the validity of data used to provide professional engineering and environmental opinions to clients. The following definitions are used in the QA/QC Program: ' Quality Assurance refers to the concepts used in defining a system for verifyingand Q tY P g Y ' maintaining a desired level of quality in a product or process. Quality Control is a specific,step-by-step description of how the Quality Assurance Program ' will be carried out. This QA/QC Program guides field sampling activities. Project specific QA/QC Programs are 1 adopted when warranted. Modifications to the QA/QC Program may be made only after specific approval by the QA/QC Officer(Project Manager). 1 1 i The specific objectives of the QA/QC Program are to: 1. specify the level of quality of each field procedure used in collecting samples; 2. identifydeficiencies in field procedures which might affect the quality of data; and P g q tY , ' 3. require sufficient documentation to verify the credibility of the sampling methods employed. ' PROGRAM ORGANIZATION AND RESPONSIBILITY The Project Manager of BENNETT & O'REILLY, INC., is responsible for the quality of work produced. The Project Manger directs the QA/QC Program to document the control of field efforts and resulting data. ' In this capacity, the Project Manager is expected to do the following: I. prepare detailed QC Plans; 2. obtain analytical and sampling procedures reference materials; 3. ensure that all field test and measurement equipment is maintained and calibrated properly; ' 4. monitor quality assurance activities to ensure conformance with authorizedpolicies, q tY procedures, and sound practices, and recommend improvements as necessary, 5. ensure that all field sampling is conducted in accordance with guidelines'contained ' herein, 6. oversee all field sampling efforts to detect conditions which might directly or ' indirectly jeopardize the utility of resulting analytical data, such as improper calibration of equipment or cross-contamination through improper storage of samples; 7. ensure that sample handling procedures are adequate for the sample types received; ' 8. inspect the quality of purchased sampling materials. 2 SAMPLE MANAGEMENT, COLLECTION, AND PREPARATION Introduction Sample management and stringent documentation are essential for successful quality assurance. The ' procedures in this section are designed to ensure collection of samples which truly represent the matrix being sampled by eliminating trace levels of contaminants from external sources. ' Sample Management The management of samples, up to the point of delivery to the laboratory for analysis, is under the supervision of the Project Manager,who shall ensure that samples are collected,labeled,preserved, stored, and transported according to the prescribed methods. If significant deviations from the sampling protocol occur, resulting in a suspected compromise of the sample integrity, all samples collected during the sampling effort prior to correction of the procedure will be discarded and fresh samples collected. ' Sample Collection Groundwater Monitoring wells will be sampled in accordance with the following sampling procedures: 1. Identify the well and record the well number on the groundwater sampling record an an Monitoring Well Sampling Log (attached). 2. Open the well cap and measure total organic volatile (TOV) concentrations at the wellhead with the use of a portable photoionization detector. Record levels detected. ' 3. Measure groundwater level to the nearest 0.01 foot from the top of the well casing using a water level indicator. Record water level on a Monitoring Well Sampling Log (attached). Water level indicators will be decontaminated between wells. 4. The volume of standing water in the well casing will be calculated and recorded on ' the Monitoring Well Sampling Log. At least three well volumes will be purged either by pump or disposable bailer. Newly installed monitoring wells will be developed by purging at least ten volumes. Purging of wells will be complete when ' either dissolved oxygen, pH, conductivity or temperature has stabilized relative to previous sampling rounds. Once the purging is complete,wells will be screened for each of the above parameters and recorded on the Sampling Log . ' 5. Samples will be collected using either a disposable bailers or pump. Samples will be transferred into appropriately sterilized/preserved containers, taking care to ' minimize agitation of the sample [Refer to attached "Recommended Sample Containers..." Groundwater Analytical]. i ' 3 6. Sample containers will be properly labeled with tags provided by the laboratory. Samples will be logged in on a chain-of-custody form. ' 7. Samples taken for precipitate metal analysis will be acidified to a H of less than 2.0 P P P Y P in the field. When sampling water for volatile compounds, care must be exercised to prevent loss of compound through evaporation, and to control susceptibility to outside contamination. j Precautionary measures include: 1. avoiding engine exhaust,gasoline containers,degreasing solvents,solvent-laden rags and non-compatible decontamination agents; 1 2. sampling bottles will only be opened at the time of sampling and quickly closed after collecting the sample,preventing aeration of the sample with the atmosphere or any other gas; 3. slowlyfilling bottles to capacity with sample and securing cap without entraining air g P tY P g P g bubbles; ' 4. invertingthe bottle while tapping lightly to check for air bubbles; PP g g Y ' 5. adding additional sample to eliminate air bubbles if present,repeating steps 3 and 4; 6. placing samples on ice (approximately 4°C) immediately after collection in a dark, ' dry location; ' 7. segregating samples with a secondary barrier such as zip-lock bags, etc.; and 8. analyzing sample as soon as possible within the specific holding times after collection. Pump tubing will be decontaminated as follows: 1. Pump non-phosphate detergent solution through system for two minutes. 2. Pump clean hot tap water through system for two minutes or until clear, whichever is longer. 3. Pump analyte-free water through system for two minutes. 4. Seal tubing ends; wrap and label with date of cleaning. 4 Soils When collecting and screening soil samples,the procedures to be used are: 1. Prior to sampling surficial locations surface vegetation,rocks leaves and debris will P g g > ' be cleared from the sample point to allow collection of a clean soil sample. If surficial soil samples are to be collected,a hand trowel or shovel and spatula will be used. The sampling equipment will be decontaminated as outlined below. 2. Boring samples will be collected via drilling rig-operated split spoon procedures. Soil samples collected from excavations or test pits will be collected directly with an auger (if necessary) from grade to approximately four feet below grade. Samples collected at deeper depths will be obtained directly from the bucket of the backhoe. A stainless steel spatula will be used to remove soil from the backhoe bucket for ' placement in the appropriate sample containers. 3. Soil samples collected for TOV screening will be placed in glass soil jars with aluminum foil placed under the screw cap. Samples will be allowed to warm to ambient temperature before screening or will be screened in a heated vehicle after warming. The jar will be shaken for fifteen seconds prior to warming and after ' warming to ensure proper headspace development. Total organic vapors will be measured via a portable photoionization detector (PID) and their concentration recorded either on a Geological Borehole Log or field log. 4 ' Soil samples will be stored and shipped in appropriate sealed containers. ' 5. Sample containers will be marked to indicate sampling date, time, location, and depth. Samples will be logged in on chain-of-custody forms (copy attached). 6. The stratigraphy of each soil boring and test pit excavation, and the construction of each monitoring well will be recorded by the on-site geologist on the appropriate Geologic Borehole Log or test pit field log(copies attached). When sampling soils for volatile compounds, care must be exercised to prevent loss of compound and to control susceptibility to outside contamination. Precautionary measures include: 1. avoiding engine exhaust,gasoline containers,degreasing solvents,solvent-laden rags ' and non-compatible decontamination agents; 2. opening sampling bottles only at the time of sampling and quickly closing after collecting the sample; 3. placing samples on ice(approximately 4° Q immediately after collection in a dark, dry location; 5 4. segregatingsam les with a second barrier such as zip-lock bags, etc.; and P �'Y P g , , 5. analyzing sample as soon as possible within the specific holding times after collection. Soil sampling equipment (shovel, auger, etc.) will be decontaminated between each sampling location with a potable water rinse, alconox soap wash, and a final potable water rinse. Drilling and excavating apparatus (augers, rods, casing, core barrels, backhoe bucket, and other equipment coming in contact with the borehole or excavation)will be decontaminated between each boring and excavation via steam cleaning. If necessary,an alconox soap wash followed by a steam cleaning will be included. Sample Preservation To prevent or retard the degradation/modification of chemicals in samples during transit and storage, the samples will be refrigerated at or below 4° C in appropriately preserved containers. Samples will be delivered to the laboratory by courier or by overnight delivery service. DATA MANAGEMENT Logging of Samples The accountability of a sample begins when the sample is taken from its natural environment. Sample handling (chain-of-custody) records must be completed at the time of sampling. The following chain-of-custody procedure must be implemented by the Field Team Leader to assure sample integrity. 1. The samples are under custody of the Field Team Leader if: a. they are in his (or her) possession; b. they are in view after being in possession: c. they are locked up or sealed securely to prevent tampering; or, d. they are in a designated secure area. 2. The"original'of the sample handling form must accompany the samples at all times after collection. A copy of the sample handling form is kept by the Field Team Leader. 3. When samples are transferred in possession, the individuals relinquishing and receiving will sign, date, and note the time on the form. 6 The Sampling Handling Record will contain information to distinguish each sample from any other sample. This information will include: 1. the project for which sampling is being conducted; 2. the matrix being samples (air, groundwater, soil, etc.); j3. the sampling date and time; 4. field sample identification number and chain-of-custody identification number; 5. the number and type of containers and the type of preservative used (if any); and, 6. signature of the person performing the sampling. Each sample will be assigned a unique identification number, which will be marked on the sample container. The sample handling record will be forwarded to the laboratory with the samples. As a precaution against this record being lost or altered,the sampling personnel will retain a copy of the sampling handling record documenting all information up until the first change of sample custody. This record will be filed by the Project Manager. Sample Identification Numbers 1 Reporting of date to the data management system will require the assignment of a unique identification number to each sample collected (including quality control samples). A record will be maintained by the Project Manager to associate the field sample with the various identification numbers used to analyze the field sample. Specific sample identification procedures are developed for each field sampling effort by the Project Manager. ' 7 t J FORM SAMPLES 1 � i r r 1573 Main Street, P.O.Box 1667 BENNETT & O'REILLY, Inc. Brewster,MA 02631 Engineering and Environmental Services (508) 896-6630 r MONITOR WELL SAMPLING LOG ICLIENT DATE(S) LOCATION JOB # MEASURING POINT SAMPLER GROUNDSURFACE OR T.O.C. ' Well Elev. of, '. Total Depth to Standing Water Static Volume HNU Comments Number reference Depth of Water Water Table Volume Purged PI-101 point Well (Feet) Height Elevation (gallons) (gallons) (ppm) (feet) (feet) (feet) (feet) r r NOTES: i i BENNETT & O'REILLY Inc. 1573 Main Street, P.O. Box1667 Brewster, MA 02631 Engineering and Environmental Services (508) 896-6630 1 MONITOR WELL SAMPLING LOG RESPIRATION ANALYSIS CLIENT DATE(S) LOCATION JOB # SAMPLER Well Total Approx. Standins Lenzth of HNU Mcthane Oxyeen Carbon Comments: Number Depth of Depth to Water screen PI-101 (%CH,) (%O_, Dioxide Well Water Heieht above (ppm) (%CO,, (feet) (feet) (feet) SWL 1 i 1 i 1 NOTES: BENNETT & O'R.EILLY, Inc. Sheet of 1573 Main Street 508-896-6630 PO Box 1667 508-8964687 Fax Brewster, MA 02631 ' Job Number: Date: Time: Test Hole Number: Job Name: Witness: Casing I. D.: Ground Elevation: Reference Elevation (TOC): Falling Head ❑ Rising Head ❑ Aquifer Saturation Thickness (If Confined): Depth of Boring (A): Well Screen Length (L): Length of Test Section(L): Depth of Groundwater Table(H): Depth of Top of Test Section (B): Type of Material in Test Zone: ' Notes: 2r TIME ELAPSED WATER ACTIVE (sec.) TIME (sec.) h/Ho DEPTH(e) HEAD(h) -- T X . B STATIC 77 1 A T L —1 2R {— h=H-X(falling head) or h =X-H (rising head) Ho=H-Xo (falling head) or Ho=Xo-H (rising head) Xo=X at t=0 A,B, H&L are defined above. Ir rr irr r r r rr r Ir iirr r it r rr rr r r r rr Job Nam 'Job Num er: Date: Location: Weather_: _ Witness: Start Date_:_ _ Pump & low Rate Location: TOC: Location: TOC: Location: TOC: NOTES: Time Time Depth to Water Static Water Lv. Draw Down Depth to Water Static Water Lv. Draw Down Depth to Water Static Water Lv. Draw Down pH/Cond./Temp. (sec). 0 -- -- - - -- —- - - 2 --- 3 -- -- ----- - --- -- 4 - - -- ------- ---- 5 - - --- - ---- ------------ --- 6 - ---- — -- - -- 8 - - —--- — 15 --- ----- - 30 (sec.) 45 (min) 1 -- _ - - - -- --- 2 - - - - - - ------ 3 - --- -- 4 -- - — - 6 - ----- -- -- -- 8 -- - - ----- ---- - -------- --- - - 9 - -- --- 10 20 - --- - - - ------ 30 40 -- -- — 50 60 - -- --- - - - --- 70 80 -- - - - - - 90 - - --_.--- -- - - 100 _ 19_0 -- - - -- -- --- ---- . --- ------- - _ _280 - - - ---- - ------ 316 460 _550 - 640 _ 730 820 --- — - -__ - 910 1000 BENNETT & O'REILLY, Inc. Sheet of 1573 Main Street 508-896-6630 ' PO Box 1667 508-896-4687 Fax Brewster, MA 02631 Sieve Analysis Data and Computation Sheet Job Number: Date: Job Name: Sample Number: Sample Collected By: Sample Tested By: Notes SIEVE WEIGHT PERCENT CUMULATIVE PROJECT OPENING SIEVE RETAINED RETAINED PERCENT MANUAL ' MILLI- MESH IN GRAMS (Cumulative) FINER SPECIFICATION METERS (Cumulative) I i PASSED MESH SIEVE TOTAL Sample Weight Wet: Sample Weight Dry: ' Percent Moisture: Sample Weight Passed Through Sieves: BENNETT & O'REILLY, Inc. Sheet of 1573 Main Street 508-896-6630 PO Box 1667 508-8964687 Fax Brewster, MA 02631 Job Number: Date: ' Job Name: SAND GRAVEL SILT SAND Test Hole Number: .* Witness: Drilling Contractor: PEAT CLAY Sampling Method: GEOLOGIC BOREHOLE LOG ' Type Well Lithology/Sediment Lithology Depth Blows per %of°t Depth Specification&Remarks Description Sample 6"Drive Recovery PID Response 5 (PPm) 10 II 15 20 25 SWL: 30 35 40 45 50 BENNETT & O'REILLY Inc• REPORT NUMBER: 1573 Main Street 508-896-6630 PO Box 1667 508-896-4687 Fax Brewster,MA 02631 1 INSPECTORS DAILY RECORD OF WORK PROGRESS Job Number: Date: Job Name: Feature: Contractor: ' Type of Work: Weather Conditions: Temperature: Contractor's Work Force(Indicate classification,including Subcontractor personnel) ' Equipment in'.use or idled(identify which) ' Materials or equipment delivered,quantity or pay items placed iNon-conforming materials or work,field problems,inspections of previously reported deficiencies Summary of construction activities 1 M = i M = i i i = M M M M i = M GROUNDWATER Buz Main Street,P.O.Box1200 CHAIN-OF-CUSTODY RECORD Buzzards Bay,MA 02532 0 Telephone(508)759-4441 AND WORK ORDER N_ 04982 ANALYTICAL FAX(508)759-4475 Project Name: Firm: TURNAROUND ANALYSIS REQUEST Volatile$ s.rotvoladl.. PnHH.mNCa. Metals ho.hum roramo. Hu. G.o.nl Cho Wry -Gib., ❑STANDARD(10 Business Days) Fe$.0m. o. west. Project Number: Address: ❑PRIORITY(5 Business Days) — k 0 p ❑RUSH(RAN- ) c (Rush requires Rush Authorization Number) ❑ ❑ ❑ n ❑ ampler Name: City/Slate/Zip: Please FAX ❑ YES ❑ NO 5 ❑ FAX Number: 5 ry � Project Manager: Telephone: BILLING n o o o ono Purchase Order No.: GWA Reference No.: D NSTRUCTIONS:Use separate line for each container(except replicates). ; ; o e ❑ "e os4 § � s" � "s a ❑ ❑ ❑ n ❑ o ❑ n n n ❑ o ❑ ❑ e ❑ > ampling Matrix Type Container(s) Preservation Fill— � � � � � I A � � � ❑ SAMPLE LABORATORY yy 8 E x $ 3g ❑ i 3 NUMBER H !3 5 ❑ 8 o ❑ Is IDENTIFICATION a a 3 a 8 (Lab Use Only) Ido Y t 3 W W ❑ a O a � 5 � � 0s `s 'a § ' doe nn = aTa � a � � 00 00a a8s � € S REMARKS/SPECIAL INSTRUCTIONS DATA QUALITY OBJECTIVES CHAIN-OF-CUSTODY RECORD Regulatory Program Project Specific OC NOTE:All samples submitted subject to Standard Terms and Conditions on reverse hereof. !! ❑Sale Drinking Water Act Man regulatory programs and EPA methods require project Relinquished b Sampler: Dale Time Received b : Receipt Temperature: !� ❑MA DEP Form Y 9 rY e 9 q P I q Y P Y P specific OC.Project specific OC includes Sample Duplicates, ❑NPDES/Clean Water Act Matrix Spikes,and/or Matrix Spike Duplicates.Laboratory OC is !, Specify State: not project specific unless prearranged.Project specific OC ❑RCRA/Haz.Waste Char. samples are charged on a per sample basis.For water samples. Relinquished by: Date Time Received by: Shipping/Airbill ❑MA MCP(310 CMR 40) each MS,MSD and Sample Duplicate requires an additional Number: Reportable Concentrations sample aliquot. ❑RCGW-1 ❑RCS-1 Relinquished by: Date Time Received by Laboratory: Custody Seall Protect Specific OC Required Selection of OC Sample Cooler Serial ❑RCGW-2❑RCS-2 ❑Sample Duplicate ❑Selected by laboratory Number: ❑MA Dredge Disposal p Matrix Spike ❑Please use sample: ❑NH❑RI O CT❑ME Method of Shipment:❑GWA Courier❑Express Mail❑Federal Express Specify Category: ❑Matrix Spike Duplicate 0 UPS CJ Hand 0 ' ENVIRO'= TABCRATCRIFS, INC_ 449 RCUM 130 SAMCWICS, M& 02563 P921E: (508)888-6460 M: (508)888-64-4-6 ' WATER ANALYSIS REQUISITION: DATE: DATE REC. 'D: SAMPLE NO. TIME: NO. COPIES NAME: RUSH-24.1-T. TU`RNAF,OUND (e..-c.chg.) MAIL: 1 PEONE: FAX: WATER LOCATION: ' FAILING ADDRESS: ' PAY'.,',~,1T/A.MT. REC'D. SA1 TLLD EY: BILL TO/Alvr. : SPECS. : ' ANA_LYSIS REQUEST: W?TE?c SAI-fTZE TYPE: COLIFOR..M EACTrRI A. * FF?-HUD/VA CF * NE•ri W[EL ' CONDUCTANCE E:C:STING wNYLL —SO 0iTIM * TOWN WATER NITRATE-N * _FILTEa/CONDITICNL. ' —IRCN * MISC=.NECUS KkNGANESE * — H?dr ESS _POOL SPA C::OLOP,INE SULFATE FOTASSIL COLIFORM BACTERIA _ALKALINITY _FSETi-COMCNAS _CHLORIDE STA.NDA.RD PLATE COUNT _TURD IDITY _COLOR _COPPER OT]ER ANALYSIS REQUESTECr: ' LEAD ODOR FECAL COLIFORM _AMM-ONIA-N VOLATILE ORGANICS SULFIDE M_=OD ' MA.GNESIL�1 METALS CALCIUM METHOD: * INDICATES PARAMETERS, FOR A POTABLE WATER TEST. _ INSTRUCTIONS: BACI'ERI.A SAMPLE - Obtain sterile sample bottle. Remove strainer/airator from faucet. Turn on cold water. Allow it to run (5) five minutes. Fill container. Do not touch the inside of the bottle or the can with anything. F<)TABLE WATER SAMPLE - Follow instructions above. (Bottle size - 500m1) LEAD - Call lab for instructions. VOLATILE ORGANICS/METALS - Call lab for instructions. i 1 1 1 TECHNICAL REFERENCE 1 I r. t Volatile Organic Analyses ' Minimum Recommended Required rofdin Category Methods Oily., Container(S)2 g Aqueous Samples Preservation Time' Volatile Organics 601/8010 40 mL 3 x 40 mL Class Cool to 4°C' 11 Days 602/8020 Vials witeflcn HCl to pH<24 624/8260 septum caps'z Remove Chlorine' 502.2 524.2 Ad',alein and Acrylonithle 603/8030 40 mL 3 x 40 mL Class Cool to 4'C' 4 Days Vials witeflcn Check pH;Adjust 4-51 sactum caps" Remove Chlorine' Solid Samples ' Volatile Organics 8010/8020 log 1 x 125 mL Class Cool to 41C' Days 82e0 Vial w/teflon sec[um c=c;z CF 2 x 4C mL Grass Vials witeflcn _ectum cats Acrolem anc Acrylcnttrile 8030 log 1 x 125 mL Glass C:,ol to 4'C' Days ' Vial witeflcn sep(um cap z CR 2 x,10 mL Class Vials witeflcn ' septum cats 'z " Se-nivoiatile Organic Analyses Minimum Recommended Required Holding Category Methods oiy.' Container(s)Z Preservation ;;mea Aqueous Samples Sem!volatlle Organics 625/8270 i L 2 x 1 L Amcer Cool to 4°C' 7 Days Glass Bottle Remove Chlorne' _ witeflcn liner' Semrvolanle Organics 8270 2 L 3 x 1 L Amcer Cool to 4°C' 7 Days (low-level,0oth Acid Mlooified Glass Bottle Remove C`Icrine' and BaselNeutral Iracnonsl w/teflon liner" Semvolatlle Organics 8270 1 L 2 x 1 L Amcer Cool to 4°C' 7 Days' (Low-level.only one traction Modified Class Bottle Remove Chlorine' Aral or Base/Neutral) witefton liner" Semrvolatile Organics 525.2 1 L 2 x 1 L Amcer Cool to 4°C' 7 Days" (Drinking Water) Glass Bottle HC1 to pH<24 witefton liner" Add Sodium Sulfitej4 2.3.7,8-TCD0(Dioxin) 1613 1 L 2 x 1 L Amber Cool to 4'C' 7 Days' (Drinking Water) Class Bottle w/teflon liner" Polynuclear 610/8100 1 L 2 x1 L Amber Cool to 4°C' 7 Days' Aromatic 8270 Glass Bottle Remove Chlorine' Hydrocarbons witefton liner" ' Solid Samples Semivolatile 8270 30 g Glass Jar Cool to 4°C' 1_Daysi0 Organics witefton liner" Polynuclear 8100 30 g Glass Jar Cool to 4'C' 1=Days'0 ' Aromatic 8270 w/teflon liner" Hydrocarbons GROUNDWATER l ANALYTICAL 27 ' Pesticide and Herbicide Analyses Category Minimum Recommended Required Holding ' 9 ry Methods Oty., Container(s)l Preservation Timea Aqueous Samples Carbamate Pesticides 531.1 60mL 2 x 125 Class Bottle Cool to 4`C' 28 Days (Drinking Water) w/teflon liner" Add Sodium Thicsulfate25 Adjust pH to 3 with MenccNcreacetic Acid Buffer Organochlorine 608/8080 1 L 2 x 1 L Amber Cool to 4°C' 7�Zays9 Pesticides& PCBs Glass Bottle Check pH:Adjust 5-91 -' witeflon liner'- Remove Chlorine- ' Ordanochlonne Pesticides 508 1 L 2 x 1LAmoer Cool to 4°C' 7 Caysz' & PCBs Glass Bottle Add Sodium Thicsuifate" (Drinking Water) witeflon liner ' Polychlonnated Siphenyls 508A 1 L 2 x t LAmber Cool to 1'C' ; �ays a by Perchlonnatton Glass Bottle (Drinklnc Water) w,tc'IOn liner Orcanchaiice=es locos 5 5 T.L a 1C.mL 07ia5_ 'via!5 Cool t0 C _ __`s :=r:.^n recta acs !OnrKir:c Water. .-.cc Sodium T; -r csulfate-° Orcanconcsoncrus 611:8 10 1 L 2 x 1 L Amcer Cool to-=C' ;_ays Pesactces Glass Bottle Check oH:Aciust=-Z w.,teflcn liner- Remove Chlorine- Chlonnatee 61518150 1 L 2 x 1LAmcer Cool to 1°C' 7;,ays�_ Herc�cices Class Bottle Remove Chicnne- witeflon liner'- ' Chtennatec Hercic:ces 315.1 1 L 2 x 1 LAmeer Cool to 1°C' ays== (Cnnkinc Water; Class Battle Add Sodium wttetlon liner Thicsulfate" Givcncsate = 7 10 mL :x 10 mL Class Cool t0 1°C' 1 ays ' iCrnKing Water; Vial witeilen liner Ado Socium Thicsultate-° =ncctnall 518.1 100 mL 2 x 1'75 mL Class Cool to 1°C' 7 cays tCrinkinc water) Ecrle witerlon liner" HCI to pH <21 ' Add Sodium Thicsulfate25 Ciduat and Paracuat 519.t 250 mL 1 x 1 L Amcer Cool to a°C' 7 CaysZ DnnKinc Water) r Glass Bottle H.SO,to pH<2' witeflon liner" Add Sodium Thicsulfatea5 ' EDE and 06CP Cool to 41C' 1-Cays =0a.1 10 mL 3 x 1C mL Glass (Drinkinc Water) Vials w/teflon Add Sodium Thicsu!fate25 secta cans 'z ' EDS ano DBCP 8011 40 mL 3 x 40 mL Class Cool to a`C' 14 Cays Vials witeflon HCI to pH<21 septa cabs 'z " Remove Chlorine Solid Samples Organochlonne 8080 30 g Glass Jar Cool to 41C' 14 Cays'0 Pesticides&PCBs w/teflon liner" Organc phosphorus 8140 30 g Class Jar Cool to 40C3 14%ays10 Pesticides witeflon liner" Herbicides 8150 30 g Class Jar Coal to 4°C' 14 Cays10 w/teflon liner'? EDB and DBCP 8260 log 1 x 125 mL Glass Cool to 40C' 14 Cays Vial w/teflon septa cap 121 OR 2 x 40 mL Class Vials witeflon septa caps 1 ' 28 ' • 1113 i • =' =+ =• • • • i ' Hydrocarbon Analyses Minimum Recommended Required Holding ' Cagegory Methods Cty.' Container(s)2 Preservation Time' Aqueous Samples Hydrocarbon 03328-78 1 L 2 x 1LAmber Coal to 4°C' 7 Days Fingerprint Giass Bottle H,SO,to pH <2 (GC;Fi0) witeflon liner" Total Petroleum 418.1 1 L 2 x 1 L Amcer Cool to 4°C' 22 Days Hydrocarbons Giass Bottle H.SO,to pH<2 (TP:i,IR) witeflon liner Oil and Grease 413.1 1 L 2 x 1 L Amcer Cool to 4°C' 28 Days 413.2 Glass Battle H,SO,to pH<2 wrterlon liner Gasoline Rance 8015/'API 40 mL 2 x 40 mL Giass Cool to 4°C' 1=Days ' - Crcanics Vials w/teflcn HCI to pH <2' secra sacs z Ciesai Rance 3 G/A.F! L _- i L.amcer CCCI to-1 :ays4 Crc_ar,,cs Gas_ �ctt:e HSO. ;o cr <2 ' _ w;tc-lCn iir,Er' _ _ NIA CE?Vc.a-:ie 8G 5:,tvIA.CE.= GM.L :x "L Gar Cool to 'C- Days Petroleum Hycre- Vials wlteilcn HGi or H,SO tc,cH<2 carccns iVFH1 saora cacs NIA 0E. Extractacle 81001NIA DE: 2 L 3 x iLAmcer Cont ro 1=C :=Days Petroleum Hydcecarccns(E=H) 8270 MCC Gass Bott!e H-SO,or HCI;o 0H<2 with!cw-:Evei=A.Hs(GC'MS-SiM1 witeflcn liner` Solid Samples ' Hvcrccarccn 03329•73 X p Gar Jar Ccol to 1°C' _3ays'0 Fircercnnt Mcciiied witericn lin,er'- iGC�Fi01 ictal Fevcieum :;3.i 30 Gass Jar Cool to-t`C' =C,ays;l Hycracarecns tilccrflee witeflon liner i =H•!F1 Cii ano Grease a13.1 30 c_ Giass Jar Coot to 41C' Days ' t13.2 witeilcn liner Mcctriee Gasclinerance 3015:AFI t0 C_ i x ;25 mL Giass Cool to 4L°C7 t= Days Organics Vial wrterlon septa cap Diesel Range 8100/AFI 30 g Giass Jar Cool to 4`C' 1=Days!, Organics witeflon liner' MA DER Volatile Petroleum 8015rMA DEF 50g 1 x 125 mL Glass w/50mL Cool to 40C' 1-Days Hydrocarbons(VPH) Methanol and Giass Jar without Methanol. ' MA DER Extractable 8100/MA 0EF 30g Glass Jar Cool to 4'C' 1 a Days Petroleum Hydrocarbons(EPH) w/teflon liner" Metals Analyses Minimum Recommended Required Holding Category Methods dty.' Container(s)= Preservation Time' 1 Aqueous Samples Total Metals 200s 100 mL Plastic Bottle HNO3 to pH<2 180 Days (except Mercury) 6010 Cool to 4°C' 7000s Dissolved Metals 200s 100 mL Plastic Bottle Filter First" 1a0 Days (except Mercury) 6010 HNO3 to pH<2 7000s Cool to 41C' Total Mercury 245.1 100 mL Plastic Battle HNO,to pH<2 28 Days 7470 Cool to 40C' i ' GRCLJNCWATER ANALYTICAL 29 ' Metals Analyses Minimum Recommended Required Holding ' Category Methods oty. Containers) Preservation Time' Dissolved Mercury 245.1 100 mL Plastic Bottle Filter First" 28 Days 7470 HNO,to pH <2 Cool to 4`C' ' SDWA Lead and 200.4 1 L 1 x 1 L Plastic Cool to 41C' 18C Days Cooper Rule 200.7 Bottle Chromium. 218.1.5 200 mL Plastic Bottle Cool to-`C' 20--ours Hexavelt?nt Solid Samples Total Metals 6010 2 g C2=_s Jar Cool to 4`C' 18C Days (except Mercury) 7000s w ieilon liner Total Mercury 245.5 0.6 c Glass Jar Cool to 4=C' o 2_ _ays 7471 av'tellcn liner Hazardous Waste Characterization Analyses Minimum Recommended Required Hc;cing Category Methods otv.' Container(s)= Preservation Time Solid Samples" TC�P Vclanie t 311 SG c 2 x '25 mL&a=_s Cool to y=C- _ __vs 5 Organics 3280 v;ai mteilon sacrum cao i CLr Metals. 1311 300 C Glass Jar Cool to a`C' 28 Days'' Samivoiaaies• 6010 wreilcn liner 1=D=_vs'g :esttc:ces and 7000s Heroic:ces 8080 8150 0270 ICnrtaC irty 10,10 t occ P!astic or Glass Cool to Nc'3 Mcdiiied Jar Corresiviry 90-15 20 e Plastic or Gass Jar Cool to 1`C' Ncre Feac;ivity SW-8a6 20 c Plastic or Gias Jar;6 Cool to-I-C' Ncre Faint Reiter 9095 100 a Plastic or Glass Jar None Conventional Physical Properties Analyses Minimum Recommended Required Holc°ng ' Category Methods oty.' Container(s)' Preservation Time' Aqueous Samples Color 110.1.3 50 mL Plastic or Glass Bottle Cool to 4°C' 48'.-curs Conductance 120.1 100 mL Plastic or Class Bottle Cool to 40C3 28--=_vs Harcness 130.1-2 100 mL Plastic or Glass Bottle Adjust pH <215 18C Days Cool to 41C3 Odor 140.1 200 mL Class Bottle Only Cool to a°C' 2a Hcurs pH 150.1 25 mL Plastic or Glass Bottle None Anar,,-a ' Immediately Solids,Total 160.1 100 mL Plastic or Glass Bottle Cool to 4°C' 7 Cays Dissolved(TDS) Solids.Total 160.2 100 mL Plastic or Glass Bottle Cool to 4°C' 7 Cays Susoended(TSS) Solids.Total(TS) 160.3 100 mL Plastic or Glass Bottle Cool to 41C3 7 Days Solids,Total 160.4 100 mL Plastic or Glass Bottle Cool to 40C3 7 Days Volatile(TVS) Solids.Settleable 160.5 1 L Plastic or Glass Bottle Cool to 40C' 48 Hcurs (SS) Turbidity 180.1 100 mL Plastic or Glass Bottle Cool to 4°C' 48 Hcurs 1 30 Conventional Inorganic Analyses Minimum Recommended Required Holding Category Methods oty.' Container(s)2 Preservation Timer Aqueous Samples Acidity 305.1 100 mL Plastic or G;ass Bottle Cool to 40C' 1d Days Alkalinity 310.1-2 100 mL Plastic or Grass Bottle Cool to 4°C' 1 Days Bromide 320.1 100 mL Plastic or Grass Bottle None 29 Days Chloride 325.1-3 50 mL Plastic or Grass Bottle None 2= :)ays Chlorjge, 330.1-5 200 mL Plastic or Class Bottle None' A.r.aiyze- Total Residual Immediately 335.1-3 500 mL Plastic or Grass Bottle Remove Sulfide" 14 mays NaOH to pH>12 Cool to d°C' F;uoride 340.1-3 300 mL Plastic Bottle Only None 2c Days Iodide 345.1 100 mL Plastic or Grass Bottle Cool to 1°C' 2,1 —curs Nitrogen,Ammonia 3E0.1.3 100 mt_ Plastic or Glass Sortie H_S0,to cH <2 25 -ays Cool to d'C' _ P vlitrocen, ''E I.I -500 , = H _mL O1astic or Giasortle ,SO, to pH <2 �ays Tctal Kjeldahl Cccl to d°C' Nitrogen. 353.1-3 100 mL -!as* or G:a_s Bottle H SO to pH<2 25 _ays Nitrate plus Nitrite Cool to"'Cl Nitrogen. 353.2-3 100 rnt. Plastic or Grass Battle Cool to 4°C' do 'curs Nitrate(Wastewater) Nitrogen. Nitrate 353.2.3 100 mL Plastic or G;ass Bottle Cool to 4'C' 2E Days (Chlorinated Drinking Water) Nitrceen, Nitrate 3E3.2.3 100 mL Plastc or Glass Bottle Cool to 4'C' 1d 2ays (Ncn-Chlorinated Drinking Water) H-50, to pH<2' Nitrecen. 3E3.2-3 50 mL Plastic or Grass Bettie Cool to d°C' =curs i ' Nitrite Minimum Recommended Required Holding Category Methods oty.1 Container(s)2 Preservation Time, ' Aqueous Samples Crthophcsonate 365.1.3 50 mL Glass Bottle Only Filter(0.,15 um) d8:"curs Cool to 4°C' Oxygen, Qissclved 360.1 300 mL G;ass Bottle Only None Anavze ' Immediately Phosphorous. Total 365.1-4 50 mL Giass Bottle Only H2S0 to pH<2 28 Cays Cool to 4°C' Siiica 270.1 50 mL Plastic Battle Only Cool to 4°C' 28 Cays ' Sulfate 375.1-4 50 mL Plastic or Giass Battle Cool to 4°C' 28 Cays Sulfide 376.1-2 500 mL Plastic or Giass Bottle NaOH to pH>9 7 Days 2 mL Zinc Acetate _ Cool to 4°C' ' Sulfite 377.1 50 mL Plastic or Glass Bottle None Anaivze Immediately Conventional Organic Analyses I ' Minimum Recommended Required Holding Category Methods aty.' Container(s)2 Preservation Time Aqueous Samples Biochemical 405.1 1 L Plastic or Glass Bottle Cool to 4°C' 48 Hours ' Oxygen Demand (5 Day 800) Chemical 410.1-4 50 mL Plastic or Giass Bottle HZSO,to pH<2 28 Days Oxygen Demand Cool to 40C3 (COO) ' GROUNDWATER ANALYTICAL 31 ' Conventional Organic Analyses Minimum Recommended Required Holding Category Methods Qty.' Container(s)' Preservation Time' Aqueous Samples Organic Carbon, 415.1 25 mL Plastic or Glass Bottle H2SO,to pH<2 28 Clays Total(TOC) Cool to 4°C' ' Phenolics 420.1-3 500 mL Glass Bottle Only H2SO,to pH <2 28 Days Cool to 4°C' Surfactants 425.1 250 mL Plastic or Glass Bottle Cool to 4°C' 48 :curs (MBAS) Microbiological Analyses Minimum Recommended Required Halcing Category Methods Qty' Container(s)' Preservation Time' ' Aqueous Samples Coliform, Various 100 mL Sterilized Bottle Cool to 4°C' 6 Hcurs Total(Wastewater) Remove Chlorine Colifcrm. Various 100 mL Steriized Bcttle Cool to 4°C= 5 rc rs ' Fecal (Wastewater) Remove Chlorine' Coliform, Various 100 mL Stenlizec Bottle Cool to 4°C' 30::—:urs Total(Drinking Water) Remove Chlorine Coliform, Various 100 mL Sterilized Bottle Cool to 4°C' 30=curs ' Fecal(Drinking_Water) Remove Chlorine' B.CcIi Various 100 mL Sterilized Bottle Cool to 4°C' 30 Hcurs (prinking Water) Remove Chlorine' Radiological Analyses Minimum Recommended Required Halcing Category Methods Qty.' Container(s), Preservation Time-'— Gress Aloha and Beta 900.0 1 L Plastic or Glass Bcttle HCI or HNO,to pH <2 180 =ays Radium-225 903.1 1 L P!astic or Glass Bottle HCI or HNO,to pH<2 180 =ays Radium-228 904.0 1 L Plastic or Glass Bottle HCI or HNO,to pH <2 180 :ays Strontium-90 905.0 1 L P!astic or Glass 3ottle HCI or HNO,to pH <2 180:ays ' Tritium 906.0 1 L Glass Bottle None 180 Days 1 32 i ' SAMPLING NOTES 1. The minimum quantity specified is the minimum amount of samcle material the vial.The cap should then be gently placed on the vial,taking care not to necessary to perform the analysis.This quantity allows for no margin of disturo the crown of liquid.and firmly rotated tight.The vial should then tie error. examined to verify the absence of all air bubbles. For some analyses,Groundwater Analytical recommends specific types and Solid samples for Volatile Organic Analyses(VOA)must also be collected ' numbers of containers(e.g.,an Aqueous Volatile Organic sample requires 3 with a minimum of headspace or air pockets.Sample vials should be packed x 40 mL Glass Vials witeflon septum caps).In such cases,the recommenced fully and tightly sealed.Vial threads mould be wfbed c!ean prior to capping container(s)allow for an adequate margin of error. for best seal.When packing vials.however,avoid excessive manipulation of the'sample material which may result in a loss of volatile organics.A wide P4other analyses.Groundwater Analytical only recommends a general.type mouth 125 mL Glass Vial witeilon septum cao is the preferred sample con- ' - of container(e.g.,a Solid Semivolatile Organic sample requires a Giass Jar tainer. witeilon liner).In such cases.it is strongly recommended that twice the mini- mum quantity of sample material be collected in the recommended type of 13. Solid samples for Volatile Organic Analyses may be collected in 40 mL Glass container. Vials that have been acidified with Sodiumoisultate(NaHSOJ,Hydrochloric Ac:d(HC:)or Sulfuric Acid(H,SO J.The presence of acid in the container ill For solid samples, in addition to the minimum quantities required for indi- have no detrimental effect on the sample. vidual analyses. each sample also requires 20 g of sample material for a percent solids(or percent moisture)determination. Example:A soil sample :4. Maximum holdina time is 24 hours when Sulfide is present.Samples may be ccilected for TPH-tR(30 g),8 RC RA Metals(2.6 a)and PC Ss(30 a)recutres rested with lead acetate paper before the pH adiustment in order to deter- a minimum of 62.5 g It material for the desired analyses.and 2^c ci material mine it Suifice is present.If Suifice is creseril.it can ce removed by the add- for percent solids(or percent mastwrel,for a total re^_uuec minimum cif 82.4- ;ten of Cacm,um Nitrate powder until a negative scot test:s obtained.The g of material.It is,hen recommenced that this minimum cv ccumec,arc at sarricie is then fiiterea.and NaCH is accec:a adjust:re pH,12. least 165.2 g of sample material be ceifec:ea in a Gass ar witeilon firer. 5 Adjust to pH Q with Nitric Acid(HNO,)or Suifunc Ac:c(H.SO,;.Acidification For solid samoles. all minimum quantities are calculated net of all fore!cn retards biciccical action,reduces acsorpticn erfects arc prevents the forma- objects.such as sticks:leaves and rocks. Lion of precipitates and/or complexes. ' 2. Only sample containers pre-c!eaned according to US EPA pro2bcols are rec. 16. Samples should be collected with a minimum of aeration.The sample battle ommended.Acorconate are-c!eaned and pre-preserved containers are avail- sndula be filled completely,exc!uding all heaescace,and cacped. able from Groundwater Analytical.Pre-c!eaned sample containers shcuic not be prennsed with sample prior to sample collection. Prennsing may cause 17. Extractable organic samples are susceptible to Phthalate ester contamina- ' ' elevated results. tion. Phthalate ester contamination is generally caused by sample contact with a plastic material,parlculany flexible plastics.Use care to avoid sample 3. Samples should be immediately cooled.stored and sn,eced retncerated.1`C contact With any plastic.other than Teilen. is the recbmmer.dea temperature.Refrigeration retards tioicg:col deg- radatlon,reduces the volatility of comocurids.retards:he hvarclysis of non- t 8. Scectied cuantrties of sample material are for only sirc:e onase solid samples ' aqueous comcounds. reduces absorption erfects and prevents continuing (i.e.no free liquids 1.Liquid phase or multiple phase samcies require different chemical reactions. quantities of sample material.Contact laboratory for advice prior to collecting liquid phase or multiple phase samples for TCLP analvses. 1 Adjust to pH<2 with Hydrochloric Acid(HCf).Ac:ai(ic3ticn retards biological action,reduces absorption effects and prevents the formation of prec:oitates 19. Samples ter TCLP Volatile Organics analysis must be leacnect within 14 days and/or complexes.Sulfuric Ac:d(H.SO,)or Sodium Bisuifate(NaHS0 J may of collection.The leach g.ate must then be anaivzed within 14 days of leachin be substituted for HCf in EPA Methods 8010.8011.8020 and 8250. Samples for TCLP.Metals analysis must be leached within 28 days of coiled- _. Adjust to a pH range of 1.0 to 5.0 with Hydrochloric Acid(PC:).Sulfuric Ac:d non.if Mercury is being analyzed.The leachate must then be analyzed within (H.S(:;)or Sodium Hydroxide(NaCH). 28 days of Ieacrling.If Mercury is not being analyzed.:hen samoles torTCLP Metals must be leached within 180 days of CCIIeCacn,and the leachate ana- ' 6. If'samcle will not be received by laboratory within 24 hours of collection.then lyzed within 180 days of leaching. adjust to specified pH range with Sulfuric Acid(H,SO,)or Sodium Hydroxide (NaCH).The pH adjustment may be omitted if it is pertormed ucon receipt at Samples for TCLP Semivolatile Organics,TCLP Peslicdes,and TCLP Her- the laboratory within 24 hours,and may be omitted if the sample is extracted bicldes analyses must be leached within 14 days of colecacn.The leachate within 48 hours of collection, must then be extracted within 7 days of leaching.The extract must then be analyzed within 40 days of extraction. 7. If free chlorine is present in the sample.then Sodium Thiosulfate(Na,S,O,) should be added. Free chlorine can react with organic compounds(o fgrim 20. Samples must be analyzed within 7 days of collection.However,if Heptachlor chlorination by-products. Free chlorine is likely to be found in chlorinated is not being determined,sample holding time to analysis may be extended to municipal drinking waters and treated wastewaters.Sodium Thiosuffate.a 14 days. reducing agent,is added to remove the free chlorine.For most levels of free chlorine,add 4 drops of 10%Sodium Thiosulfate to samples in 40 mL vials, 21. Samples must be extracted within 7 days of collection.Extracts must then be and add 5 mL of 10%Sodium Thidsulfate to samples in 1 L Bottles. analyzed with 14 days of extraction. 8. The listed Holding Time is the maximum of time a sample may be held be- 22, Samples must be extracted within 14 days of collection-Extracts must then tween collection and initiation of analysis or extraction. be analyzed with 30 days of extraction. ' 9. Samples must be extracted within 7 days of collection.Extracts must then be 23. Samples must be extracted within 14 days of collection.Extracts must then analyzed within 40 days of extraction. be analyzed with 28 days of extraction. 10. Samples must be extracted within 14 days of collection.Extracts must then 24. Add 40-50 mg of Sodium Sulfite to each liter of sample to reduce free chlo- ' be analyzed within 40 days of extraction. rine that may be present.Free chlorine can react with organic compounds to form chlorination by-products. Free chlorine is likely to be found in chlori- 11. Samples for dissolved metals must be filtered prior to preservation with Nitric Mated municipal drinking waters and treated wastewaters.Alternatively.use Acid(HNO).Filtration must be done with a 0.45 micron membrane filter. 40-50 mg of Sodium Arsenite.Do not use Sodium Thiosulfate,as it may Pro- Field filtration and preservation is preferred. duce a residue of elemental sulfur which may interfere with the determination ' of some analytes. However,if field filtration is not possible,samples should be drooled to 4°C and shipped to the laboratory for filtration and preservation.Titration must be 25. Samples must be extracted within 7 days of collection.Extracts must then be done as soon as practical after collection.Groundwater Analytical recom- analyzed with 30 days of extraction. mends that filtration be done within 24 hours of collection.If samples are not going to be field filtered,do not preserve samples with Nitric Acid(HNO). 26. Add Sodium Thiosuifate to reduce free chlorine that may be present.Free chlorine can react with organic compounds to forth chlorination by-products. 12- Aqueous samples for Valatile Organic Analyses(VOA)must be collected with- Free chlorine is likely to be found in chlorinated municipal drinking waters. out any headspace or air bubbles.Volatile organics dissolved in water tend to Use approximately 80 mg of Sodium Thiosulfate per liter of sample. volatilize readily and will fill any air bubble available in the vial.Particularly with low level samples,this results in a loss of material upon opening the vial. 27. Samples must be extracted within 7 days of collection.Extracts must then be ' VOA vials must be fi!led slowly until the liquid fortes a meniscus an the rim of analyzed with 21 days of extraction. GROUNDWATER ANALYTICAL 33 i t . t .I i t . Or :`ice:=C11 EN::,; � t t ST iiIDn.�O R===R<=iC=S FOR MGN=OR=:iG WZ:: .S ' S'cC:_ON 1.2 TA-3i.= Or CONTENTS i t t ' section 1.2 Page i January 1991 SECTION 1.2 TABLE OF CON^L'I'"3 1.0 Introduction 1. 1 Foreword 1.2 Table of Contents 1.3 Defi:._ticns 2.0 First Stecs ' 2 .^ Recc.nna_ssan ce Su 7eVs 2 Work and ccst Plans (Reser-zed) 2 .3 Healt and Safety Plans ' 3 .0 Subsurface Investigations 2 . 1 Exlcrat_ry Test Pits 3 Dr;11_nc Technicaes 3 Bcri:cs -n Ccntam'_natec Areas 3 .4 � .. Sam='-ng of So_'_ 3 .5 Sc,l Classification 3 .6 In-s-itu Sasc'_ing c_ Rock 3 .7 Rock Classi_icaticr. 3 .8 Laboratory Tests fcr Scil 3 .9 Plugging Screhcles 4.0 Piezcmeters, obser,aticn Wells and Monitoring Wells ' 4. 1 Monitoring Well Netdcrk Design 4 .2 selection of Well Ccnst_-,cticn Materials 4.3 well Installation Procedures 4 .4 As-built Notes and Records 4.5 well Development 4.6 Decommissioning of Monitoring Wells 5 .0 Interpretation of Ground Water and Aquifer Characteristics ' 5 .1 Water Level Measurements 5.2 In-Situ Hydraulic Conductivity Tests 5 .3 Pumming Tests 5.4 Packeg Tests 5.5 Surveying and Datum Planes 6.0 Sampling of Monitoring wells 6 .1 Quality assurance/Quality Control ' 6.2 Sampling Techniques 6 .3 Sample Handling 6 .4 Chain of Custody 6 .5 Decontamination of Sampling Equipment 1 SecziCQ 1.2 Page ii 1 January 19 91 1 Sect'_cn 1.2 Table cf Ccntents T (ccnti:ued) 1 7.0 ccmcuter Mcdels (Reserved) 1 8.0 Gecpnysical :echnicues (Reserved) 1 1 i 1 1 i 1 " 1 1 i 1 DATE : 12/20/02 PROPERTY ADDRESS: 364 Main Street ----------------------- -- Centerville,Mass_------ ��� ` 02632 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the 'following: 1 . 1 -1500 gallon septic tank. RECEIVED 2. 1 -Distribution box. 3. 2-1000 gallon precast leaching pits. ( 6 'X10 ' ) DEC 26 2002 Based on my inspection, I certify the following conditions: TOWN OFBARNSTABLE 4. This is a title Five Septic System. ( 78 Code ) HEALTH DEPT. 5. The septic system is in proper working order at the present time. 6. #1 pit is dry'-and #2 pit has waste water 59" below the / v invert pipe. SIGNATUR / Name;_ J .- P . -Macomber-Jr . C0 nip any:2g5gpt_p,__Mj gLntpr Son, Inc. Address :__�Qx __CeJLt-erYiU—P, a,_QZ.632-0066 Phone :__508- 775_ 3338 ------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPHrP,. ,�M�A�C(0��MB�ER & SON, INC. T plLeachflelds Pumped & Installed Town Sewer Connectlons P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r i TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:364 Main Street Centerville,Mass. Owner's Name: Bob Sulzmzn Owner's Address: Same Date of Inspection:12/2 0/0 2 Name of Inspector: (please print) Joseph P.Macomber Jr. Company Name: J.P.Macomber & Son inc. Mailing Address: Box 66 rPnt-arvi 1 1 a,MAss.02632 Telephone Number: 5 0 8—7 7 5-3 3 38 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my traiping and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: -/Passes , Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: el The system inspector shall 9mit 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 364 Main Street Centervi e,Mass. Owner: Rob Sulzman Date of Inspection: ]2 12 0/0 2 Inspection Summary: Check A,B,C,D or E/ LA WAYS 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. Answer yes,no or not determined(Y,N,ND)in the. for the following statements. If"not determined"please explain. ESL 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 im System will pass inspection if the imminent. S existing tank is replaced with a complying septic tank as approved by the Board of Health. •A mewl 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. ND explain: 2d 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 364 Main Street Centerville,Mass _ Owoer: Rr)h Rtil 7.man Date of lospectioo:1 2 /20 1n,) C. Further Evaluation is Required by the Board of Health: VO Conditions exist which require funher evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or.the environment. I. 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 wbich will protect public bealtb,safety and the environment: VD Cesspool or privy is within 50 feet ore surface water AM Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 00 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: .460 The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I ore public water supple / The system has a septic tank and SAS and the SAS is within 50 feet ore private water supply well. • 1 The system has a septic tank and SAS and the SAS is less than 1900 feet bui 50 feet or more from a • • prtyate water supple wcll•' Method used to determine distance 1/"GlA6 "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that faciliry and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are rrigeered. A copy of the analysis must be anached to this form. 3. Other: 3 i Page 4 of 1 I el, OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFA CE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:364 Main Street Centerville,Mass. Owner:>3ob Sulzman Date of Inspection: _ 1 2/2 0 /0 2 D. System Failure Criteria applicable to all systems: ' You must indicate"yes"or"no" to each of t}fe following for all inspections: Yes No _ LJ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 4,ZDischarge or ponding of effluent to the surface of the ground or surface waters due to an overloade d or clogged SAS or cesspool Static liquid level in the distribution box love outlet invert due to an overloaded or clogged SAS or /cesspool ; Requirecl squid depth in co%ftee}is less than 6"below invert or available volume is less than f,day flow pumping more than 4 times in the last year NOT due to clogged or obstructed f gg ptpe(s).Number kl�ytimes pumped © . portion of the SAS, cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — water supply. 2//Any portion of a cesspool or privy is within a Zone I of a public well. _ ;; Any portion of a cesspool or privy is within 50 feet of a private water supply well. iAny 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no/ the system is within 400 feet of a surface drinking water supply 4 the system is within 200 feet of a tributary to a surface drinking water supply PY � t e system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well PPe 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. 4 Page 5ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 364 Main Street Centerville,Mass. Owner: Roh Sul zman Date of Inspection: 1 2/2 o /o 2 Check if the following have been done. Yoo must indicate"yes"or"no"as to each of the following: Yes No umping information was provided by the owner, occupant,or Board of Health Were any of the system components pumped out in the previous two weeks' -Z _ 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? _zWere 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,-A luding the SAS, located on site? �_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of tlie baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? Z_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no / !/Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)J 5 Page 6 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 364 Main Street Centerville,Mass . Owner: Rnh qn 1 7,rna n Date of Inspection: 90 n9 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 1{ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x N of bedrooms):qX11,4 —y,43 , Number of current residents: _ Does residence have a garbage grinder(yes or no):/—a Is laundry on a separate sewage system, yes or no):� (if yes separate inspection required) Laundry system inspected (yes or no):/ $ Seasonal use: (yes or no): Water meter readings, if available (last 2 years usage (gpd)):2001 —75, 000 gallons-205. 48 GPD Sump pump(yes or no): 96 2002-76, 000 gallons-208. 22 GPD Last date of occupancy: COMMERCIAL/I DUSTRIAL Type of establishment: �J Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): AM Grease trap present(yes or no): dg Industrial waste holding tank present (yes or no):A Non-sanitary waste discharged to the Title 5 system (yes or no):4! Water meter readings, if available: �l/9 Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records 19� Source of information: Was system pumped as pan of the inspection (yes or no): If yes, volume pumped: _gallons •• How was quantity pumped determined?y}7Q-�•S!// Reason for pumping: 7TYP 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) Vcl Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from syst m owner) /Tight tank IVY.Attach a copy of the DEP approval lookOther(describe): J Approximate age of all compo s, date installed (if known)and source of information: D-� Were sewage odors detected when arriving at the site(yes or no):,ejW 6 i Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 364 Main Street Centerville, Mass . Owner: Bob Sulzman Date of Inspection: 1 2 /2 0/0 2 BUILDING SEWER(locate on site plan) . Depth below grade: 2 � Materials of construction: cast iron �/40 PVCdjother(explain): Distance from private water supply well or suction line: /O't Comments(on condition ofjoints, venting, evidence of leakage,etc.): Joint-, appear tight Nn Pvidpring of 1eakag,e,.,ThP Gyc;{-pm is vented through the house vents. SEPTIC TANK: (locate on site plan) q Depth below grade: 15p, �J Material of construction: i%oncrete,l�metzWd fiberglass polyethylene .t10 other(explain) If tank is metal list age:� Is age confirmed by a Certificate of Compliance(yes or no);! (attach a copy of certificate) /l 1 Dimensions: Sludge depth�'a4f r .� Distance from top of5ludge to bottom of outlet tee or baffle: _` Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee r ba How were dimensions determined: 0�ay , Comments(on pumping recommendations, inlet and outlet to or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage, etc.): j Pump septic tank annually Garbage disposal is pr -, n Tnlet & outlet tees are in place The tank ; s -,truc t-iira 1 1 y -,coned and shows no evidence of leakage.Liquid level at the outlet invert is 51 " GREASE TRAP (locate on site plan) Depth below grade:A Material of consttvctiion�concretwV meta L, fiberglass�t�olyethylene/j&other (explain): tiro Dimensions: A Scum thickness: dfL 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: eo Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Qrpasp trap is not prPsent _ 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 364 Main Street ri-n -rVi 1 1 P _ Ma CS Owner: Bob Sulzman Date of Inspection:12 2 n/n 2 TIGHT or HOLDING TAN ''t-(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 1,14 Material of construction: 1-14 concrete tl,4 metal A fiberglass iY polyethylene4�Lother(explain): Dimensions: Capacity: gallons Design Flow: gallons/day. Alarm present(yes or no): Alarm level: A,'4 Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): _Tight or holding tanks are not present DISTRIBUTION BOX: i (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): Di St-ri but i nn has two 1 atera l G Nc) Pyi dPnc-o of Gn1 i d- rarry nyPr No PvidPnrP .of 1 PakagP i nt-n nr nut- of the hnx PUMP CHAMBERi4y1'e(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): PiiMp rhaMb_Qr s_not pregpnt 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 364 Main Street Centerville,Mass. Owner: Bob Sulzman Date of Inspection: 1 2 /2 0 /0 2 SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required) 2-1000 precast leaching pits hacked in 2 ' of 1 '," stone. 6 'X10 ' If SAS not located explain why: Located- See Pane 1 n Type leaching pits,number:/—C/7 �d r ,d26leaching chambers, number: leaching galleries,number: leaching trenches,number, length: C-, 1126. leaching fields, number, dimensions: ZE overflow cesspool, number: O ,40 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.): T•namV cancl to medli tam f i nP sand No signs of hydraulic failure or P ; na 1 s are dry yP_Pt;:it-i nn i G nnrmal Pit fit i s; clry Pit # Waste water is 59" below the invert pipe. CESSPOOLS,'&,*' (cesspool must be pumped as part of inspection)(locate on site plan) Numbtr and configuration: f� Depth—top of liquid to inlet invert: Depth of solids layer: _ Depth of scum layer: Dimensions of cesspool: X Materials of construction: '1W7 Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): reScz9001 s a,-re nnt—prPq-Pnt PRIVY/(�(locate on site plan) Materials of construction: Dimensions: 41�,9 Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): _ Privy is not present. i Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 364 Main Street Cent .q 11PFMag , Owner: Rob Su zm1 an � Date of Inspection: 12 2 0 0 2 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. s r \� \ L9- \I \ i I 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 364 Main Street Centervillp0maaa. Owner:, Bob Sul7.man Date of Inspection: 1 2/2 0/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high groundwater elevation: NQ_Obtained from system design plans on record -If checked,date of design plan reviewed:—)'4 YES Observed site (abutting property/observation hole within 150 feet of SAS) NQ Checked with local Board of Health-explain: NA YES__Checked with local excavators, installers- (attach documentation) YFS Accessed USGS database-explain:http: / /town-Barnr;table.ma. us. You must describe how you established the high ground water elevation: Jsed: GahrP y g Mi11Pr Mc)c1P1 12/16194 ;r-und Xgater eleuatinn a-bo"zo saa level. Jsed: UG��• Observation well data June 1992 Jsed: USG_S: Technical bulletin 92-000-1 Plate #2 Annual ranges of around water elevation . rouna Leaching pi( eel l`al Groundwater:: / Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the botto of the leaching pit and the adjusted groundwater table is feet. 11 ]•PrtRTr T-..IT�f1T-1m:mrnis'm.s--f.srasn.Isrmr.1.•+t7s.rr•rrRt.-n+n etsTnfans7!►atwt f TOWN OF Barnstable BOAIZU OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I •••TT'1-T•'. ::t—TtIR-.TT'rt.T.i•t*1'tT.TlIT+IIrT'CTIf1T'T7"1:rt•i r'{t1TR1�RTIR�•PTp�Of/tt1�1A�7 AI/1 •lTII'T'T1f•—•.^ -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 364 Main Street Centerville Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # 208-042 OWNER' s NAME Bob Sul.zman. PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc':1r , COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City Stat• LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 1 578 CER'rIFICATION STATEMENT I certify that I have personally inspected the sewage disposa'1 system at this address and that the information reported is true , accurate , and omplete as of the time of +inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one: Systeui PASSED ; The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public llealLll or- the environment as defined in 310 CMR 16 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con Lcted has found that the system fails to protect the v)ublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection for , Inspector Signature Date r/ '.td`�� O�ne copy of this .ification must be provided to the OWNER the BUYER ( where applicable ) and the I30ARD OF HEALTH. � * If the inspection FAILED, the owner or.."operator shall u pgrade ' the system within one yeas• or the date of the inspection, unless allowed or required otherwise as provided in 3,10 CMR 16 . 305 . Partd.doc P , DATE:_--/1/96 . PROPERTY ADDRESS: 164 ELI StLaet, ' ' , Centerville ,Mass e 02632 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 .7 -'=1250' gallon septic tank. 2. 1—Di6tribution box. - . 2-1000 gallon leaching pit. Based bn my Ins.,section, I certify the following conditions:/ 1 . This is a title five septic system. ' ( 78• Code' ) 2. The �s,eptic system is in proper worki"Tig • ordrr_at the present time . 'A 3, No repairs are needed at this ' time �I ;.. ;,. 8 N 11,99 5IGNATM74: 5 Name: J_P _M_acomber Jr_,.• Company:_3. P_Macorr ber. & iSon-`Inc . Address:_-Be�c—bb-----= ----.-- Cente!rvi1l,eLMass__0.2.632 ` Phone:--- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY HIM.,W-90 JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Laachflelds • Pumped & lnstsIled Town Sewer Connectlons P.O. Box 66' Centerville, MA 02632-0066 77.5.3338 775-6412 _ • D Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Trudy Cox@ Govemor "y A��Praul Celluccl e David B.Struhe LL e CoovNniorwt e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAddresa: 364 Main Street Centerville ,Mass . 2�2 9�9 6 Address of Owner. Date of Inspection: (If different) Name of Inspector. Joseph P. Macomber Jr. Company Name,Address and Telephone Number. J.P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: �8sse9 Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails �>l �LG�Inspector's Signature: / Date: - ? L(p The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A) SYSTEM PASSES: _ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 On*Winter Street 9 Boston,Massachusetts 02108 0 FAX(617)55&1049 0 Telephone(617)292.5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddresa: 364 Main Street Centerville ,Mass . 02632 Owner. Job H. Lippincott Date of Inspeotlon:2/2 9/9 6 B)SYSTEM CONDITIONALLY PASSES (continued) • Sewage backup or breakout or h static water level observed in the distrBbution box is due to broken or obstructed pipe(s) en,or duo to a brok settlad or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced 12_6) The system required pumping more than four times a year due to broken or obstructed pips(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N 6. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water �14 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �d The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 364 Main Street Centerville ,Mass . 02632 Owner. Job H. Lippincott Date of Inspection: 2/2 9/9 6 • D) SYSTEM FAILS: • • I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. AD Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. (� Discharge or ponding of silluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. &b Static liquid level in the�tribution box above outlet invert due to an overloaded or clogged SAS or cesspool. /, &A !�7 d� liquid depth inaspcol is less than 6"below invert or available volume is less than U2 day flow. 4' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped A16 Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. 41 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Q[� Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: �Q The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply Q� 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information., (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 364 Main Streiet CEnterville ,Mass , . 02632 Owner. Job H. Lippincbtt Date of Inspection: 2/2 9/9 6 • Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period Large volumes of water have not been introduced into the system recently or as part of this inspection. 2As built plans have been obtained and examined. Note if they are not available with N/A , The facility or dwelling was inspected for signs of sewage back-up. , The system does not receive non-sanitary or industrial waste flow , The site was inspected for signs of breakout. 2A11 system components,4'cluding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baMes or tees,material of construction, dimensions,depth of liquid, depth of sludge,depth of scum. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or ZTha,prox;--ted by non-intrusive methods. e facility owner(and occupants, if different from owner)were provided with information on the proper Surface DisposalP P Pe maintenance of Sub. System. (revised 11/03/95) 4 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address-364 Main Street Centerville ,Mass . 02632 Owner. Job H. Lippincott Date of Inspeotion.2/2 9/9 6 . e FLOW CONDITIONS RESIDENTIAL. s Design flow ns pw d4j s Number of bedrooms: Number of current.residents• Garbage grinder(yes Laundry connected to r no). (yes or no):&C, Seasonal use(yes or ao Water meter reading,if available: 199 4=5 2, 0 0 0 gallons =142. 47 e a l l o n s per day 1995=50,000 gallons= 1_36.Oq gal1nna =Pr suss_ Last date of oocupancy:&U-1la1r COMMERCLkLANDUSIRLA Type of establishment: Design flow: )Qjj__gallons/day Grease trap present: (yes or no)AA Industrial Waste Holding Tank present: (yes or no)-Aft Non-sanitary waste discharged to the Title 6 system: (yes or no)-O Water meter readings, if available: A)A - Last date of oocupancy:-1&L OTHER (Describe) AA Last date of occupancy: GENERAL INFORMATION PUMPINW,CTS and so information: System puzfiped as part of inspection: (yes or n S If yes,volume pumped 1/� ons Reason for pumping: GG4't4l TYPE SYSTEM Septic tank/distribution box/soil absorption system Suigis cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPR TE AGE of all oompone ts, data installed(if known)and source of information:,/el.32g let 7`ZO r�lJ T Sewage odors detected when arriving at the.site: (yes or no)_ (revised 11/03/95) 5 for Disposal Worb Tonstrudion famit - Application Application is hereby made for a Permit to aConstruct or Re it an Individual Sewage Disposal System at: :...... ..... .. . .... ............................. 4 . .......I............................. % ....... ......... ... ........ .. ......C cation-•Ad s or Lot No. ........................ ........................................... n . Address . . . ... ... .............. ............................................................................................... ..... ... Installer ddress Typ of Buildi Size Lot............................Sq. feet Dwelling yKo. of Bedrooms............... ....................Expansion Attic Garbage Grinder ( ) PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) P4Other fixtures ....................................................................................................... ................ ...... .< i��.a..:�... .........gpllons per person per day. Total flow.........._.._ WDesign Flow— i � I p ow_............�-e... gallons. Septic Tan —Liqui capacit/ 4..4allons Length................ Width..- ........ Diameter................ Depth................ Disposal Trench—No..................... Width. ....... Total4migth..... ...... Total leaching area...................sq. f t. Seepage Pit No.....72 ........ Diameter..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................miiiutesperinch Depth of Test Pit.................... Depth to ground water..:..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................................................................................................................................................. 0 Description of Soil.................... ............................................................ ........................................................... ................0.............0..................... ..... ......b......... ......... ...................... W ..... .... ..... *........... ... ... U �o...... .....................I.................................................... .......... .. ... ........... ......... ..... ..... ..... ................ U Nature of Repairs or Alterations—Answer when apDpDl cable.,,;r. ............................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAIT LZE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h6alth. Vigne .. ..... ...................................................................... ............Date. ........... Application Approved By..... Date following �"o r Application Disapproved for t e foUouting reasons:......... ............................................................................. .....**o....7,­*­,­­**­ ................................................................................................................................................................................................... Date Permit No..................._1............................. Issued------q_- 7f- -7............ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH .............. ..... ... .........OF................... ..... ..1110-191---�_ ............................... Tertifiratt of outpliana TH4 I.S'/O CERTJ,FY, T ��e Individual Sewage Disposal System constructed /<01r_"Repaired ( ..). by...,n..... .. ....... ................. ... ... ....; n at..7. .................. .......... ................... .... been installed in accordance with the provisions of T17 'j'k he State Sanitary Co�e as describe&itj the lias 1) al Works Construction Permit No..' dated.... applic. ti for Disposal ..........................4 ......... ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM MALL FUNCTION SATISFACTORY. 14 DATE.......... 7 � ............................... Inspector....../ ........... ........ !t;` .. THE COMMONWEALTH OF MASSACHUSETTS BOARD HE A LTH .............O F.................. . . ................................................ ........ FE ic .... ................ SUBSURFACE SEWAGE D19rc9.kL SYSTEM INSPECTION FORM C SYSTEM INFG,.:i-MON(continued) Property Address: 364 Main Street Centerville ,Mass . 02632 Owner. Job H. Lippincott Date of Inspection: 2/2 9/9 6 _ o ' SEPTIC TANK:,-,:V6.9A41" J (locate on site plan) 'l Depth below grade: Material otconstruction �ooncrete metal_FRP_other(e:^I; ) Dimensions: o Sludge depth Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thkImesa: 72 Distance from top of scum to top of outlet tee or baffle: _ Distance from bottom of scum to bottom of outlet tee or baffle:el Comments: (recommendation for pumping,condition of inlet and outlet tees or bn.Te¢, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.)' r.b. tees are sound and in p ace , Seb ic .tank structurally sound and shows no signs of leakage .No repairs are needed at this time _ Pum_p.Pr3 qP=tic tank at time nf ins Prtinn GREASE TRAP-, (locate on site plan) Depth below grade:/ Material of construction• concrete_metal_FRP_other(e:plain) AIT Dimensions: Scum thic]mess: Distance from top of scum to top of outlet tee or baflle:_14 Diatan from bottom of scum to bottom of outlet toe or baflle: LA- Comments: (recommendation for pumping,co tion of inlet and outlet tees or b&Mes,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) JI 1 a ,ASP H17� _i (revised 11/03/95) 6 SUBSURFACE SEWAGE DISP09AL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 364 Main Street Centerville ,Mass . 02632 Owner. Job H. Lippincott Date of Inspe.otion: 2/2 9/9 6 TIGHT OR HOLDING TAM-/ VW- ' (locate on site plan) ° Depth below puds:AM Material of construction- ooncret•—nww�'�'°ther(exrlain) Dimensions: AM Caladhr. AM 01lons Design flow:. ona/dgy Alarm level: Comments: (condition of inlet tee;co tion of alarm and float switches,etc.) i DISTRIBUTION BOXs-e� (locate on site plan) 1 Depth of liquid level above outlet invert: +•:' Comments: (note if level and distribution is equal,evidence of solids carryover, e%ideace of leakage into or out of boa,etc.) T-box has e ual . flow to the over. o .evi ence o leakage edistribution ox e H—ee-a—e7T-­at this time . PUMP CHAMBER:A yC (locate on site plan) Pumps in working order.(yes or no) IL) Comments: (notecon4ition of pump ,condition of pumps and appurtenances, etc.) • .• , 4.{�t�F•+}if j.�'he•iviv�3'.": 7 (revised.11/03/95) ' SUBSURFACE Sgwnar DISPOSAL SYSTEM INSPECTION FORM SYST=... .. ... . ........:N (oontlnuod) Property Address: 364 Main Street Centerville ,Massa 02632 Owners Job H. Lippincott .. .';.: Date of Inspection: 2/2 9/9 6 ! SOIL ABSORPTION SYSTEM(SA9"/a-/0'z Cl 4aDsf,'1 /7-S (locate an Alto plan,If possible;excavation not requ*but may be approximated by non•intruslw methods)' .: If not determined to be presaat,explain: Type: . Isar pit#,number.'�• leachin number._ - z,t leaching trenches,number,length: 13 leaching fields,number,dime ions: overflow cesspool,number. Comments:(note condition of soil, signs of hydraulic failur-, 1� cond:tion of ve tation,etc.) Soil conditions ;Loamy sand to medium fine sand. �o signs o failure or ponding;Aii vege a ion is normai., No repairs are nee e - this time . -- _--- CESSPOOLS: _ (locate on sits plan) 'f Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer. Dimensions of cesspool: erials Mat of construction: Indication of groundwater: • inflow(osespool must bequmpsd as part of insyrc:: : comments:�udotea condition of soil,signs of hydraulic failorv, 1:-N^1 c' -.''��, condition of vegetation,etc.) PRIVYs�� • (locate on site plan) Materials of oo /!1�/ ---.----- Dimensions: Depth of solids: - Co (note ooadliq:}gt 84 sips of hydraulic faiiu :, :on of vegetation, (revised 11/03/.95)• 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress: 364 Main Street Centerville ,Mass . 02632 Owner. Job H. Lippincott Date of Inspection:2/2 6/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Town Water C. O.M.M. ` DEPTH TO GROUNDWATER �.�- D•1�togroundwater. _feet of determination rap rozimatio:y r y�• (revised 11/03/95) 9 I v 11 •rr.Zrr,-rtlerr--n-zrrrr..•rr.-r-r..r....r.r.:-:r.--!rlr:-rr�-.--ers•—_r-_.—rc-._ .__ _......-,.... _ .. .�.. . .-. -.. .as--rt-Ir=v.rirrrr-r.-.r. .rr.r•.•r TOWN OF Barnstable WARD OF HEALTH ( S1111SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION .....t--, � .. -r—rwz!*c rr�rrrr..rs: rsra r.•mrrnrtss•*srr�rrTr.•..:rrr•r.•1••.•r.� F•••t•t•1-T . .. .11�•!TTTtT�I•R:rTI. ii•.—.T1tS'TTT!T!•t�t.���':Tfr' -TYPE OR PRINT CI.EARL1'- PROPERTY INSPECTED STREET ADDRESS 364 Main Street CenterVillP ,MaGs_ n2t;32 ASSESSORS MAP , BLOCK ANV.PARCEL # OWNER' s NAME Job LippiAco .t PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P. Macomber_ Jr.. COMPANY NAME J.P.Macomber & Son Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City -State LIP COMPANY TELEPHONE ( ) - FAX ( ) - Rasrc7a sa ICs 1. �Og1: 27`�--sa3,��� 5nR 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage diapos67 system at this address and that the information reported is true , accurate , and complete as of the ti.me of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . • n ; ,tl;+tt, Check one : XXXXXXXSystem PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . 1 Inspector Signature ` Date 3/1/96 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF 11EAL'I'll. * If the inspection FAILED, th'vt: owner or"'operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided___ n__3.10 Ch1R 15 . 305 . U rry THE COMMONWEALTH OF MASS.ACHUSETTS : DEPARTNIENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the. Department's qualifications. as required and-is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 9. 1995 T Acting Director of the W-ion of.Water Pollution Control -77 SEWAGE INSPECTIONS -'cOCATTON 364 Main StrPPt DATE 12.120/02 YD-LAGE_Centerville,Mass. 02632 ASSESSOR'S MAP & LOT2nR-n42 ,'INSQECTOR Joseph P.Macomber Jr. d,y SEPTIC TANK CAPACITY 1 -1 500 gallon SeDtI r tank- 1 -Rny LEACHING FACILITY:.(t;ype)2-LP 1 000 ° s (size) '3 n n n qAllnc NO. OF BEDROOMS 4 BUILDER OR OWNER Rob qul 7mAn OWNER MAILING ADDRESS Same �r �e f i I i i i b� LOCATION �(, `�' y s SEWAGE PERMIT NO. r - V'I I, L AVE INSTA LLER'S NAME i ADDRESS Jo 4, A: l BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE . ISSUED 1 / ' 2t ,' No............... � - _... _... THE COMMONWEALTH OF ,MASSACHUSETTS v ti µ BOARD F HEAL H Appliratuan for Disposal Marks tonotrnrtiun ama �� f Application is hereby made for �Pe mit to Construct ( ;) or Repair �) an Individual Sewage Disposal System at: o ........ :.:I ... ... .. ... . - , ---------- - -- - - ------- -----•-- --• .................----......................................... e or-ation-Ad s or Lot No. --- ...- -•• ..... ......... - - • ........................... ........•-•..............•--•------....•-•••-•-•••••••---•. - ----._ ......... n Address (4 •------- - --- -•• •,-•----- -- ;••------••••-•-••...•••••...--• -•••._...-•----..__.._.....---.......---------•---•-........_..-••••••••-•••-•••-••--•----••-••--- a 24 Installer Address d Typ of Buildi � �,/ r/ Size Lot---------------- feet U Dwelling "No. of Bedrooms.............. _/_.__._______.____.......Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building ______________ No. of ersons.__.________________________ Showers a YP g -------------- P ( ) — Cafeteria ( ) a' Other fixtures ________________ Design Flow _________________ _____ ____________gallons per person per day. Total daily flow_.__________.' ......l�___________:____gallons. 04 Septic Tan —Liquid capacit/,2� __ allons Length................ Width___1............ Diameter................ Depth___:,___________ Disposal Trench—No_____________________ Width I Total-bl-ength_:______ ..__.... Total leaching area....................sq. ft. Seepage Pit No.____� .�.____ Diameter___._l__�J___.___. Depth below inlet__ .......... Total leaching area............_.....sq. ft:" Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by................................ Dat ........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit._________.__._.___. Depth to ground water........:............ __. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water......................... .r Description of Soil ==-----•-- ................................................. x c, ----- ------ = x ----•-----------------------•---•----------------------------------------- .-------•- -- ............ -- ------ U Nature of Repairs or Alterations—Answer when appl cable , __. ____ i�k� g.__>_ --•-----•-----------------------------••--------------•-------•---------------------•----••---------=---•---------------------------•-----•-----•---------------------------------..._...--•-•-•-=----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTLE 5 of the State Sanitary Code=The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. gne _.._. Date r ;, Application Approved By---------- --- .. .........--•--•-••••••. Date Application Disapproved for the following reasons________________________a7 Date ------•---------------------------------------------•-------•-------------------------=-----------------------=-••------------------------------------------------=---------------------------------- Date - PermitNo..................................................._.... Issued.... _'7_...7a.........:...••-- -•-•- Date �-.. 0 4t No........ FR$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ... HEAL H �{ ._....OF..... y ._._ .. .-. - Appliratiun for Diipuial Workii Tuntrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Re it "' ) an Individual Sewage Disposal System at -- ....... ---•= '_... ... :: ............ . . . ----- --- --------------------------------------'----•"-•--- �• ��o•ca�ti�on Ad es ! or Lot No. .. .:: !!fir!. --.................. .................•--••--------.._x_.:.......................................................... lI� (r. •--...__ n -••---•-•---_.__...--•......................Address Installer Address Typ of Buildirlgh - "" ,,.0 Size Lot............................Sq. feet U Dwelling!� No. of Bedrooms.............. . ............Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons................ C4 YP g --•----------•-•--•-•-•---- P ___.._._.... Showers ( ) — Cafeteria ( ) Pa Other fixtures ..... i...........................................................•...... ._... W Design Flow _ � _.__.__ llons per person per day. Total daily flow.............' . gallons. WSeptic Tani; I iquid capacit}�, �.�,allons . Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width__................. Total Length........ ......... Total leaching area....................sq. ft. Seepage Pit No._•--1: __----- Diameter..... 1 ...... Depth below inlet... .......... Total leaching area..................sq. ft. Z Other'Distribution box ( ) ' Dosing tank ( ) PercolationTest Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test.Pit.................... Depth to ground water........................ Q+' .......................................................................................................... D Description of Soil" ----------------- --------------- ..................................................... ..... _ - i .. �_. U Nature of Repairs or Alterations—Answer when appl5cable_ :_ ►f{ _... F�r ___ •-----------------------------------------------------------------•-------------•---.........::......---•--••--=--------------------•---•------. ..................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Date Application Approved BY.......... . .- ...................... lM1. ' " Date Application Disapproved for the following reasons--------.................................................................................................... --•----•--•-••••••-•.......--••-•-•--••.......••----•--•.............•-••.....--•••••-=••-•--•--•-----------•--•------•---- -------------------------------------------------------------------------- Date PermitNo................................................ _______ Issued_............... ................................ r. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF Fj9ALTH .............. ..... -1r<+' ..0F................... ........................... C�rr#ifirtt�. of um�li�nr�e TH IS O CERT J'Y, T e Individual Sewage Disposal System constructed ( or Repaired iL/ Y by..- = - . at..!.........*h. ...... ..f4......e^. - __------a..... has been installed in accordance wits the provisions of TITj7 > he State Sanitary Coe as desl^�M�,,��.//�1edri rj the .. application for Disposal Works Construction Permit No........................___�___...__.._ da.ted.._. . ._...__._...._..______. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........:` ................................. Inspector---- -- .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Py HEALTH 1. ' ..... ....OF..... 4.a...................................... No.. .?.c�...._ FEE....jy1._ .......... ru I urku un tirtion rrmit Permission is hereby grante _.. 0. to Constru ) or Repair, an I I ua1 Sewage Dis os Sys r at No...... � i¢�" -�`-' 1 t'i' lr•-*_......_._... .r Str et as shown on the application for Disposal Works Construction P No ated._ � ` ............................. Board of Health x ' DATE........... = a •----••-•----------------- . -FORM 1255 HOBBS & WARREN.".INC.. PUBLISHERS - i TE-12 V I Ll -z,13 00 _0 0 loe I/�lr� L C ........................................................... 4'A 2 A t3AS ac A A D*Vr , fl)Q ST!N ......................... 4, )VF 44 1 OF 15014- X 4' yj�L. t PLA 4/, E r500 CAL on PROJECT I TITLE ►t;7!t F-L. rA L- e6A-le-4* LLF- MA Q, V) 7 BENNETT O' C A REILLY Inc. IS Engineering & Environmental Services 1573 Ma Street -in Route 6A P.O. Box 1067 508-896-6630 Office Brewster, MA 02631 508-896-4697 fax DATE: SCALE: BY: ICHECK I JOB NUMBER: TT.