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HomeMy WebLinkAbout0148 PARK AVENUE - Health 148 PARK AVE. CENTERVILLE A-207-148 UN11ford, N0. 152 1/3 ORA Ali TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE (e-r%Wr j.1),e ASSESSOR'S MAP&PARCEL, 'Aftw!HGAM INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY J�,X � � &);A LEACHING FACILITY:(type) Soo ,� o if jo r (size) 12 S j( 5-0, NO.OF BEDROOMS (a OWNER J�v PERMIT DATE: °'H -,C, COMPLIANCE DATE: 14 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r--37 'It - Goo a- 6 - Ar 0 P C l- fvjb OJ p No. U z Fee V U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppfication for h7Upgrade sal *pstrm Construction permit . Application for a Permit to Construct( ) Repair( ( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 148Poll A 'I Owner's Name,Address,and Tel.No Assessor's Map/Parcel — —GIWA ot-i T � 1�"�/ 9 AV1 Installer`Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. efr e �ve �0Ov„k 5 M ij �ws �. f f� q )uSj W cN `a_ Type of Building: r Dwelling No.of Bedrooms Lot Size 6 2 -f sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 1.) _26 4011 Number of sheets Revision Date Title Size of Septic Tank _ A j Jkq Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar ealth. Si d Date ".2,� Application Approved by P Date Application Disapproved by Date for the following reasons Permit No. 2 0 /� V 0 2 Date Issued --------------------------- — ----------- -- - ------- ---- - - t_ V i- o. Fee ✓)U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for Disposal *pstrm Construction Permit Application for a Permit to o s n ct( ) Repair(/grade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. I LI 8 Pork ho Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel ) — t,L/ f'6WN,/ 4n)turj , ���T� � �,✓� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 170\),sl q 1'�ro WN �.c -�« +1� �o S - WWCl jkr ( -L/ - 3 s6 L Type of Building: Dwelling No.of Bedrooms 6j� Lot Size b y sq.ft. Garbage Grinder( ) _ Other{ Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) �, Q gpd Design flow provided gpd Plan- Date f) _ C1 _)pt�[ Number of sheets Revision Date Title / Size of Septic Tank Type of S.A.S. (/ Uu U /U•, C �n.�,l Description of Soil Nature of Repairs or Alterations(Answer when applicable) e�� 1 i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si d Date �� C Application Approved by Date 1 Application Disapproved by Date - for the following reasons Permit No. 2 U J( — go Date Issued � q /6 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( `� Upgraded( ) Abandoned( )by IG.S C/©wN TN at ( , P P �� f1 P has been constructed in accordance with the provisio s of Title 5 and the for Disposal System Construction Permit No. -��1 dated 1 InstalleQ Designer #bedrooms Approved design flow (/ and The issuance of,this permit shall not be construed as a guarantee that the system will func 'on .esigned. Date /�/J, Inspector Ll --------------------------------------------------------------------------------------------------------------------------------------- No. 00. Fee 1 dd THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MI8po aY * stem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at !����3 , �( A Vp r p n ,hi � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. 4 Provided:Construction must be completed within three years of the date of this permi Date l /(1, Approved by No. /W/1 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF H�A/L/T_ H — OF ✓V1 7�%t b(� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (V) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components ' n 207 �U g Z Loc do Owner's Name 3 07- 776, Zoe-- t � ,.-:, Map Pa rce Address /Llj p`. ,Za Lot# / / Tel one# / andr Installer's Name esigner's e _0 S c r- VFe Address Telephone# Telephone# Type of Building: *DOle Ill ✓LCi Lot Size (OV S Z.:� Sq.feet Dwelling—No.of Bedrooms (�2 Garbage Grinder (/) Other—Type of Building. No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required (060 gpd Calculated design flow (60 gpd Design flow provided gpd Plan: Date 2C, Z Z.D Number of sheets 2- Revision Date Title Plan (0 F-7 Description ofSoil(s) �DFILLQ �Nt , �� /bf� ��S.Loa►y) Soil Evaluator Form No. Name of Soil Evaluator Date"of f Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS In-5 e G Et' w v / / OU o �-� 'V / w The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM S/96 - - --- - -------- ---- -- - ---- - ---- --- - - - ------ - - - --- - -- ---- No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM S/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARRENrM PUBLISHERS- BOSTON ' Town of Barnstable �t r Regulatory Services Thomas F. Geiler,Director • MAn Public Health Division �`I'ArE039.p Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit# 2016-0C)J__Assessor's Map/Parcel o?D? —03$ Installer& Designer Certification Form lyb ._I L-6 Designer: /Ta( p3 o-.id e ChuA, /K C Installer: Dem.�w,�-�_&m Address: o?c)S(.force s k,/- G o r+ Address: On .:.JA was issued a permit to install a (date) 7 (installer) septic system at loark five, CeA4trw f If- based on a design drawn by (addres Holmos a-id /&Gna,14 , IhG dated De e. 2-9) ZO I S_ A44J reNt bZd 3/27-A b (d esigner) X I 4hat the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. i ot:4i,, fiAUL Si r•� ': S LIZARD I- {vi:RA t„ (Install is Signature) ciii 1 aryl%, RTV signer's Signature) (Affix D8ikne s tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAofce fomisidesignercertification fomi.doc Ib puZ n d ryI Li Li ,y� ) �3I I a 0 10 20 30 40 ster Da Bedroom 4 O 1 Master Bedroom I o i �GJ CO \ / v 626 SF addition 1 J 1 Bedroom 3`J O Bedroom 2 Oathro Second Floor Plan 148 Park Avenue, Centerville, MA Daniel Lewis AIA, Architect Scale: I^ = I a-o^ August 24, 20 15 02015 &D6 outbind:H2-0000000OD29B6432901 CDB49B30FFF776DBODF8507008249EAC50E 1D794ABA69DC2D 1D 147BDC0000... Flynn, Judith From: McKean, Thomas on behalf of Health Sent: Tuesday, August 25, 2015 10:50 AM To: Flynn, Judith Subject: FW: #148 Park Avenue, Centerville Judith, Please call Mr. Roche and let him know what we have for a septic system at the property. -----Original Message----- From: Patrick]. Roche [ma i Ito:pjroche@holmesandmcgrath.com] Sent: Tuesday, August 25, 2015 10:26 AM To: Health Subject: #148 Park Avenue, Centerville Good morning, Could you please provide septic information for the above referenced property. Thank you. Patrick J. Roche Holmes and McGrath, Inc. 205 Worcester Court, Suite A4 Falmouth, MA 02540 508-548-3564 * 800-874-7373 Fax 508-548-9672 �- pjroche@holmesandmcgrath.com 0 1 J\ j 8/26/2015 Townkof Barnstable P# �I ( t Deparment ofe R " atory Se rvlces ►�A �—�S �"�� f NAM � 1 Public Health Division Date � � 11 0s�Ja 200 Main Street;Hyannis MA 112601 r /s Date Scheduled �, ` .. . ��;i :�:•1. Tline U d�'►K Pd. Fee r Soil Suitability Assessment or Sewge Disposal ` Perfunmed•By:. i214 1 >a AZ EI)Q b �r i Witnessed By v r 11/ ,LOCATIONA GENEt.AL'QVF�OItMATION,: �� ,��/ -location Address �' -;IJ-16wner'e'Name 'DedkMig, /4/GUe^ Address Assessors Mapipmel: /] /„ -,TOM es•a4d ee f`1,d4 Snglaeer'e Nama NEW CONSTRUCTION ✓ vU�-S REPAIR ]lone(1 �p %CJ" Ind Use 9 i/1"O�) �/a-�- Slopes(96) 3'S °, nf0 AT Surface Stones G Distances fmm: Open Water Body `�Ub011 it ..prosibla WeCArea, r,t?LQ ft Drinking:Vl/aterWall . ft Draihage way —ft :Property 11ne:___ 15 It Other ft S 'TCFI::(Street name,dimensions of tot,exact locations of test holes& eso tests,locale wetlands inpivximity to holes) M14i�L� pV�' .. Tp QA t3 v , p Q 1 J rp Parent material(geologtc) !lG1Q/ t�u,y�1 � Depth to.Bedrock Depth to Oroundwater Standing Water in Hole: Weeping flnm Plt Face Estimated Seasonal High Oroundwater Method Used: DETE ffi RMINATIONFOR SEASONAL- GH WATER TABLE , Depth Observed standing in obs.hole: Id, Depth to soll mottles.Deilth to weeping:from side of obs,,hole: Id. OroundwnWr A�Justment ln. Index Wall 0 Reading Dete-. Index Well level „• _..r._ Ark.ihelor.`,—A�,OroundwatdrLevel,,,, PERC Observation OLATION TEST bt�la„_.„! Thar Hole# Time at 90 _ — Depth of Para } Tithe at b" Start Pre-soak 71me® ,k T Hnd Presoak d 13e. PeI�K-CU i�JFsd /t�7f— Rate MlhJluch .GJC=- /Il!S Site 5ultabllity Assessment Site Passed •9itp Patted: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Cotnpleted,on Back ***If percolation test is to be conducted within 1009 of Wetland,you must:arst notify the Barnstable Conservation Division at least one(1)weelE prior to beginning. Q:1S6PTICIPBRCFORM.DOC s AEEP.OBSERVATION HOLE LOG Hole# t Depth from. :: Soil Horizon Soil Texture_.. Shcl Color .Soil. Other Sucfaca On.): ,(USDA• ) ,(Munaelq Mottling (Structuro,Stones;Boulders. tslatnncy.96'Oravdli �-foZ `BILL W-70 Ab g, LoGm 70-R5 5S. Loam . 1UY� s�b j101�e r'kbe_ . 85- 35 G:: n s4nc1 2,s Sj4 h j�qA1r, DEEP OBSERVATION IIOLE LOG mole# Depth from Soil Horizon Soil Texture Soil Color Soil Oilier: Surface(to.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. d 'Ff LL . �� Loa. : . 71_ 8(o 13 `S, Loam 10f.R q4" f)O/)e rl_,:eb�_ r C. y4, Sa�:ncl •n o h 6e DEEP OBSERVATION HOLE LOG Hole#l2( _ Depth from Soll Horizon Soil Texture Soil Color. Soil Other Surface(lu.) (USDA) (Muuaell) Mottling (Structure,Stones,Boulders. slate . , 0 -':-1 Ab :5., Lo a rr) 31,E 9-13 5S:;:Loavrl : 10y '51b 46;-he• Fr,ti6L�; OOS.2j 5. Grlh DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Solt Texture: SolI Color Soil Other Surface(In): (UPDA) (Munsell) Mottling (Structure,SSoacs.Boulders, 7 Ab Z-aAM 7- lj S. LoG I(Jk S �n�►e f6(� :.140 . C 1Y1� gQ,,�j.. 2�S h 0'�� I �;SQL S� e& )`''load Insurance Rate Matg Above 500 year flood boundary :No— Yes Wil do 500 year boundary No✓ Yen - ' % Within too year flood boundary No., :Yee.,,___ Depth of Naturally Occurring Pervious Ma erial Does at least four feet of naturally occurring poryious matotlal exist in all areas observed.throughout.the area proposed for the soil absorption system? 9 If not,what Is the depth of naturally occurring pe lous matorlall Certlficatlon I cerdfy that on . AnmIn—talProtecdon (date)I have passed the soil evaluator eamination approved-by the DepartinontofEnvir and that the:above analysis was performed by me consistent with :, the required tratnin xpertisc and experience described in p0 CIOR 15.017. Signature Date4d /5' Q;1S13PTI0PRRCP0RM.D0C • - C TowWof Barnstable P# 4. 'ME 3 I I Department of Rejtdato ry Services • Public HeafW`Division „M Dl OII Date r ,. la 200 Main Street,Hyannis MA 03601 yN - Ci Date Scheduled `"mi l - 1 Time v Fee Pd. Soil Suitability Assessment oar Sew ' f ge Disposal Performed By: ' Witnessed By: r'LOCATION& GENE; AI,'; ,ORMATION Location . Address , Ownera Name � O �t�1�^ �� �lvl>l�� Address Assessor's Map/Parcel: /a, D� S a4d A/ /_—Ql i{I Engineer's Name (�/ NEW CONSTRUCTION REPAIR �a Telephone## Slopes(96) �J" e r Surface Stories- &�ArG Distances from: Open Water Body /U00 f ft possible Wet Area I OGt ft Drinking Water Well . ft Draihage Way ft Property Line 25 _{t Other ft ►SIiETCH:(Street name,dimensions of lot,exact locations of test holes& ere tests,locate wetlands proximity to holes) ' QA,�� �- F � Tp IA, i G Parent material(geologic)�QGl g./ l9unt� � Depth to Bedroel( / Depth to Groundwater. Standing Water in Hole: Weeping fl'otn Pit Fnee Ato �^ Estimated Seasonal High Oroundwater Method Used: DETERMINATION FOR SEASONAL•EIGH WATER TABLE Depth Observed standing in obs.hole: hi, Deptil to soli tnoltles: Death to weeping from side of obs.hole:R Index Well ill. ©rnundwater AdJustment g#: eading Date: Index Well level ,_T _ p ,factor—_ Adj. Aro,OroundwuterLeval,,,,_, Dille Thno Observation PERCOLATION TEST b Hole S Tinto at 9" Depth of Pero Time at G" Start Pro-soak T1mo @ /� n Time(9"-G") -� End Pro-soak `y�o ►i!�' Rate Mih./Iuch , •.,`r fil& Site Suitability Assessment: Site Passed -site Fulled: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) Week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG -Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. nsistency.Worayel) 0-CoZ T•1LL — w-70 Ab /3, Loam 1-0�P !>/3 7o-95 5 S, Loam . . 1()`R pVl e Zas S14 V1 o.n G zo e� v4&%L DEEP O13SERVATI0N-I- 6LE LOG Hole# IN Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. o —(o ILL -7 6 L.0a67 id yk V3 71'" Sb 13 S, Loam AR -T/4 17o0)e C o �J� V✓1> Sa r1G� ��S , L! hOh P 1�ea AreL DEEP OBSERVATION HOLE LOG Hole# R(A Depth from Soil Horizon Soil Texture Soil Color Sell 'Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenev. 0 -7 Z L 73-75 Ab 5- , Laura 1-13 13 Loam . 044Z Sb r 0--'-he -1YO- Ci war of 2,5 �� v�oh� oos?: a e DEEP OBSERVATION HOLE LOG Hole# 6 .C3 Depth from Soil Horizon Soil Texture Soil Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consistency. D- ,bid p- 7 'Ab '5 - LoA.m I D bk. of y 7- s.t!ocr Ilk S' ��ne r, R Flood Insurance Rate Map: / Above 500 year flood boundary No— Yes ✓___ Willdn 500 year boundary No Yes ' Within 100 year flood boundary No.. Yes., — Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system?' If not,what is the depth of naturally occurring pe vious material? Certification I certify that on. I� O (date)I have passed the soil evaluator examination approved by the Department of Envlr.nmental Protection and that the above analysis was performed by me consistent with the required trainin xpertise and experience described in 10 CUR 15.017. Signature Date • ' Q:\SBPTiC\PBRCPORM.DOC I OT'[.OVERAGE NOTES CB/DRILLNDE OUND FOUNDN NDy I=1"MAT THE STRUCIURE9 I CERn"THAT MS PUN WAS ORANIN OWS CB/CENTER ATD LOGlL9 ON 111E LOT AS SHOWN, TROY AN ACNAL SmiKY YAOF ON 111E Fm D AND M THEWI AT LOCATIONS CONIO TO mm"IN ACCORDANCE WM 1HE LAND TIE YOR1m S:Y OA IEDAiEY n OP COUR (PUR O T DSTRIICTIDI4 6 200e BETWEEN 'WAPLE TIE BARNSTASU z_G BY-UW Al iV 12,2DIe AND OCT 20.201a r_1 �KIDE) ATeAK.Now HOLMES AND MCGRATH.INC. HOLMES McGRATH.INCH��,AyLAE�� u1�w }9dM1ee If �1 / _.�.�.���.05•E CB/CFNTEA � !•L1TA� )�•RweV S• R I�Tµ T 1 .yam OunD KWIcN R Entered Proleeeland Date 1tt �r eryor Dote L0ttd S Land S.—yor J�1 Ij f -p•J I.N. EPotOH ai Q091RE:N T)-IS-]0 W O.OfIE' PREOSION:I.NK294 LOCUS MAP - ra,N ACCIIRACY aF LTTM.x(SmmNW.V) NOT TO SOME P'p .y ! .� oo ! \ STD�A�' C.O.M.M.FIRE DISTRICT ` B„ ).5 I/ L.xi1A;4�.. a CB/DNILL /� �'� \ ALL YEAS1REL NTS TAKEN 1Wn1 EDY I -ND \ 1 CE m THAT THE 6TINICTDT IS UNMe OTHER NOTD. Q Q)J M1 81 WOEOArL �`b:93. �`y �fIQ � I �' 1` EA-T SNOW On iL00D WSURAN�lE YAP NOTE& NOT TANGENT // LDIYUYTY PANG NO.-CO560J Alm NOTES. I rewD�i // ' \ N (LC.OOC.249.J05) MAT I'LOOD IRNN ZONE X IS NOT A SH,ON L HOUSE MII®Eft 1N PNS(AVDNE eT.zy �A STECIAL RLLO HAZARD AREA. .ON A PUBMC WAY MAT WA9 SN A ON 2 ASSESSOR'B NUIBTER:207-= S 14 rel'Ar ENO LLNOLE'\�� lr ACCCRDANCE M1N11.TIIE 91BDIM90N �ZONNO TAMOT:TRD-1 6 PESOI I HOLMES A McGRATH,INC.' CONTROL UW.w AT LEAST STdI PROTC110N OLQOAY DSTANCE.IF ANY AS IS THEN REWRED A ROD)HAZ.ULO ZDiE:X BY ORDNANCE ON BY-LA.OF SAID CITY x TaPaBeuwc wFa+uAnm BASEII a ON SUCIT LOT.AANO,NO DST."ISO e.R.131E CE LAND INCIURT PLAN9IRY£Y. �i \ csb �s I o d J R.Kublok 9D REW�O,HAS I`RMTACE K AT 19Be1-AAB,1925T-A l \ II�` letered Profeeeland Dote LEAST TILEIrTY FEET. T.WDD EI�OSWE CATGORM B \ I Land Su yor N ANO eCRATH,.'INC.T \\\ 2'� L;q ✓� FORMER LOT 2 ZONING REQUIREMENTS lk WR eT.tm sF.wwa1L 0`P ) ETmNTA¢m'Lmollw a eDM t2S LDaYW R bteradDPrefeabnd Date Iw Y y, Land Survepr RFNt TO IICmAIY l\\ �' y sure EACLOIa NOT TO—22 \yg9i ' � ��RMER PRIER 'FORMER Ty INC LOiTT�mum l hereby eerlify Not the \\\ LOT 1 LOT 50 �� a w a—TT �av:ty Thee ehown m tole mm \ A/ 4• TR2 _� b' Ne I1na MdNWln9 eXlaUtTg \ A ti J2 64,542t S.F. _ erahipe, d the Rnes of the I—FACTOR-1T.0) 'streets anblic m wap shown are thane �sB9 EATReyI,OIE drOf-dy eA.bl shed,and Nat norl,,at,Street.Or ok FouND Q4 FORMER LOT 3 - new IDee mr mdelon of ezMthq Al �\ �e �` R ow mblp or Tor.new Ways me shown. O�'L`YF •'\\ 40�� - HOW AND A1H.INC. NOT J R.Kubick TAxmrt egieterad Profesebnd Date Land Surveyor E DRRL DE 19 9$i FWND I%Q" Ns2•,ya.0'7'w .. [�F'l �ED CB '/DRnLNaE .� r NOT MNO Fowlo � � `r of ,`fie ^ e°AEuixE u�u1"ma1 Y �oOcaE..ane Iwm Yaw a m. ..N,.,�mAni:e uow...a•nw..r.e Lan a+..re .°Y0ele1�e�mm�w m.wa.n a Nam..e E DR LLH Founo DATE DESCRIPTION raw ecke `E/DR1LLH0� R E V I S I O N S FounD NO . \ PLAN OF LAND BONG A REDIMSION OF LOTS 1.2&3 AS SHOWN ON LAND COURT PLAN 19981B 5o/DWILnOtF OWNER/APPLICANT: Fallo ANTHONY FAVA & RYAN HUNT N CENTERMLIE BARNSTABLE. MA C.O.M.M.FIRE DISTRICT SCALE:1'a 20' DATE:DEC.14,2014 holmes and mcgroth, Inc. <Iw eneWeere m1d 1. TR,r.Wyon .. .—E, m IEeT 205 wmtW met.Wate A4 s0e 54e-750401IOE7 fd taut De 02410 503 5+e-9Bn DRAWN: JVB CHECKED: \FAra\2urn9\crrow�rsD Lnna ca.r Sa,�.Owc JOB NO: 215189 DWO.NO.:TTB-5-24 EET 1 v, n Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is September 15, 2015 Centerville MA 02632 Se required for every p page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: L5/ /// / key to move your cursor-do not David D. Coughanowr, IRS use the return key. Name of Inspector Tech Rapid Response Company „b Company Name 155 George Ryder Road South Company Address Chatham MA 02633 CitylTown State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification 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 training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes � �zN OF Mgssgc ❑ Conditionally Passes ❑ Fails o� DAVID tiG ❑ Needs o er Eva�,ation b - Local Approving Authority COUGHANOWR 1 93 R September 15, 2015 Inspector's Signa SgNItARt�� Date The system inspectors a I submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �q�ed Vs t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tarik'{whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure'lis imminent. System will pass inspection if the existing tank is replaced with:a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if.it isstructurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than`20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): ",ikL 'ems t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑. Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue -Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is p required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue -Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is September 15, 2015 Centerville MA 02632 Se required for every p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered opened,® El Were p , and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 400 gpd 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts _z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15,2015 required for every p page. City/Town State Zip Code Date of Inspection D. System Information Description: Two systems were installed at this dwelling.The other system is detailed in another report Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ER No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 0 gpd Detail: 2013: 0 gallons 2014:0 gallons Sump pump? ❑ Yes ® No Last date of occupancy: over 2 years ago Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 L . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owners Was system pumped as part of the inspection? >: ❑ Yes ® No f. If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other (describe): Septic tank and leach pit. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 148 Park Avenue -Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is September 15, 2015 Centerville MA 02632 Se required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: Age:38+ years. Certificate of Compliance for a new system was issued March 1977 (Permit# 126 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 3 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 x 5 x 6-1000 gallon Sludge depth: 4 in t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 148 Park Avenue -Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 8 in Distance from top of scum to top of outlet tee or baffle 6 in Distance from bottom of scum to bottom of outlet tee or baffle 10 in How were dimensions determined? Design Plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. i = Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber,condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is p required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts _ = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue -Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is September 15, 2015 Centerville MA 02632 Se required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately L®CA TINS —OF SEPTIC COMPONENTS —DISTANCES IN DECIMAL FEET f , THIS SKETCH IS A B ^� 1995BEST VIEWED IN o. COLOR FORMAT 1 63.5 18 - _ 2 64.5 22.5 3 67.5 43.5 508 364-0894 k . EXISTING DWELLING Al 148 WATER LINE A B 1 \ 01000 GALLON SEPTIC TANK � 2 NOT LEACH TO PIT \ \ SCALE - t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health- explain: Previous inspection report ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Previous inspection report indicates high groundwater is more than 20 feet below the surface. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue-Assessor's Map 207 Parcel 146 FRONT SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15 2015 required for every p page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file GEOHYDROLOGICAL PROFILE — NOT TO SCALE r r r sgt PRECAST LEACH PIT LO V- N BOTTOM OF LEACHING PIT LEACHING IS ABOVE HIGH OHOUNDWATEH GROUNDWATER ELEVATION PER GIS MAPS t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments va P'r'T '-rqt 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner t°� Owner's Name ry information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection c Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Cou hanowr, IRS use the return key. Name of Inspector Eco-Tech Rapid Response 4-- Ji Company Name 155 George Ryder Road South Company Address Chatham MA 02633 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification 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 training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CM 15.000).The system: ® Passes �M�M S cy ❑ Conditionally Passes ❑ Fails ❑ Needs r ER ion Local Approving Authority UGHA W N No. 093P-1�4F S September 15, 2015 Inspector's Signa Date SgNI TARk The system inspecto a submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 11,9 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Dispo a VS m•Page 1 of 17 a •c f t Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is p required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. Rear system is in disused and degraded driveway which has been rendered inaccessible by a fence. Do not remove fence or resume use of rear driveway for vehicle traffic. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND) for the following statements. If"not determined,"please explain. J 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 failure4is imminent. System will pass inspection if the existing tank is replaced with.a'complying­ eptic tank as approved by the Board of Health. *A metal septic tank will pass inspection if.it is structurally sound, not leaking.and if a Certificate of Compliance indicating that the tank is less than'20 ydars,old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 l I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony'DeDecko Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Arithony DeDecko Tr. Owner Owner's Name information is September 15 MA 02632 Se Centerville p , required for every 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppri, provided that no other failure cr tena`are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ' in information. For example, Ian at the Board of Health . Exist o ® ❑ 9 P P ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 400 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection D. System Information Description: Two systems were installed at this dwelling.The other system is detailed in another report Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? r, I ,. . _ . • � I ❑ Yes Z No Water meter readings, if available (last 2 years usage (gpd)): 0 gpd Detail: 2013:0 gallons 2014: 0 gallons Sump pump? ❑ Yes ® No Last date of occupancy: over 2 years ago Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins 3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15,2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owners Was system pumped as part of the inspection? Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Septic tank and leach pit. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '~ 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every _ _p , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: Age:38+ years. Certificate of Compliance for a new system was issued March 1977(Permit# 126 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: Cover to gradefeet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate Yes No 9 Y p ( PY ) ❑ ❑ Dimensions: 10.5 x 5 x 6-1500 gallon 1 Sludge depth: 5 in t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 in Scum thickness 0 in Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Previous inspection report Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15 2015 required for every p , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: m•P 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syste ag e12of17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system •Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately LOC A POoNNSS LEACH —OF SEPTIC COMPONENTS PIT —DISTANCES IN DECIMAL FEET A 8 2 1 26 26.5 1000 GALLON 2 35.5. 35.5 SEPTIC TANK 3 58 58 1 B A EMS T§ND D WELL L §NG F—] R 148 WATER LINE 0 o T THIS SKETCH IS BEST VIEWED IN COLOR FORMAT NOT 0 TO SCALE 508 364-0894 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 148 Park Avenue- Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is required for every Centerville MA 02632 September 15, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Previous inspection report ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Previous inspection report indicates leaching is above adjusted high groundwater. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 148 Park Avenue-Assessor's Map 207 Parcel 146 REAR SYSTEM Property Address PMMM Realty Trust-Anthony DeDecko,Tr. Owner Owner's Name information is Centerville MA 02632 September 15, 2015 required for every p page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.w 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information formation is Centerville required for MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection Inspection results-must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. r-m i M '9 „1 Important: A. General Information When filling out forms p on the p 1 t"31 computer,use 1. Inspector: only the tab key to move your Darren M. Meyer cursor-do not use the return Name of Inspector key. n/a tja Company Name rab PO Box 981 Company Address East Sandwich MA 02537 re"a" City/Town State Zip Code 781-424-6748 S13920 Telephone Number License Number B. Certification 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 training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �M 0 1( � 210,10 n pector's Signature Date � IF l z The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Lj � 1 V t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 rr Commonwealth of Massachusetts W Title 5 Official Inspection Fora, _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 • ti Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �w 148 Park Avenue-front system Property Address Dedecko. Owner Owner's Name information formation is Centerville squired for MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4(per Asses) DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ,t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is Centerville required for MA 02632 March 9, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2008: 16 gpd Detail 2009: 00 gpd Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: House built in 1976, components 30+years old. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): No signs of leakage. Septic Tank(locate on site plan): Depth below grade: 16 inches feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: typical 1,000G tank Sludge depth: 8 inches t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C�M , 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is Centerville required for MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26 inches Scum thickness 2 inches Distance from top of scum to top of outlet tee or baffle 10 inches Distance from bottom of scum to bottom of outlet tee or baffle 10 inches How were dimensions determined? rods and tapes Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees were present and in good condition, water was level with outlet pipe, no sign of hydraulic failure, integrity of tank looks sound, no signs of leakage. Recommend pumping. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M •'°t 148 Park Avenue -front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc,.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No (Sins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Park Avenue -front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): None present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 L I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 - 6x6 w/1ft ofstone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Concrete pit was 42 inches deep, no riser. Staining level at 30", with approx. 48"of remaining leaching available. No signs of hydraulic failure, soil conditions normal, vegetation normal. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08_ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 t` r. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information formation is Centerville squired for MA 02632 March 9, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of W Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 148 Park Avenue -front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i� 6 A-1Z - A Ftuw,r 0 V IV T-1 Es A - L 61( '3 ' /3 2- 7,2'6 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 9, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >22 feet below grade feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Excavated hole in rear yard, hit water at 13.5 ft. Front yard is 10 feet above rear yard. Bottom of leaching 10 ft. below grade. System is not within adjusted groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 148 Park Avenue-front system Property Address Dedecko Owner Owner's Name i formation is Centerville equired for MA 02632 March 9, 2010 every page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 l Make application to local Fire Department. ,� Fire Department retains original application and issues duplicate as Permit. — -- �fY11'U/'/'liC�'1�GU-GC�/lif/l?� f1�i �7�GliG�d/.yCl'�Ci1'liGGs'lf'/� ��) e�rir�lirrc�>zC a-Jam' rr Cnir�r�icn� ry;G�.e vCcrLC Crir�� >C��air� rr� y �f i— P I I Fee: $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) Anthony DeDeclp X Signature i applying for perntit) Address 148 Park Avenue, Centerylle� MA, 02632 Street - city Stale zip a s • • M11 • Company Name Michael Walker Co.or Individual Print Print Address 2 Cahoon Lane , Harwich, MA Address Print Print re if in permit) Signatur f appi ing for permit) O IFCI`Certified Other ':11 IFCI*Certified C7 L P Other • Tank Location 148 Park Avenue, Centerville Steel Address city Tank Capacity(gallons) 1,000 underground tank Substance Last Stored #2 Fuel Tank Dimensions(diameter x length) Remarks: el AP AA4 231 Firm transporting waste State Lic.# Hazardous waste manifest# E.P.A.# Approved tank disposal yard Tank yard te�J4x—sA�nt,A— i0-e_,ty#o "VL Type of inert gas e Tank yard address City or Town Centerville FDID# 01920 Permit# Date of issue March 15, 2010 Date of expiration March 29, 2010 Dig safe approval number: 20100110823 Dig To e . Number-800-322-4844 f -Signature/Title of Officer granting permit 1. After removal(s)("Consumptive Use"fuel oil tanks exempted)send Form FP-290R signed by Local Fire Dept.to UST Regulatory Compliance Unit, Department of Fire Services, P.O.Box 1025,State Road,Stow,MA 01775. 'International Fire Code Institute FP-292(revised 4/97) r t CENTERVILLE-OSTERVILLE-MARSTONS MILLS.FIRE DISTRICT . 1875 ROUTE 28 CENTERVILLE, MA 02632 (508) 790-2375/FAX#(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A.# 10-0000675 LOCATION: ADDRESS OF RELEASE: 14.8 Park Avenue Centerville, MA 02632 DATE OF RELEASE: ongoing PRODUCT RELEASED: #2 fup1 oil ESTIMATED QUANTITY: Tinknnwn CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: Notified Barnstable BOH NOTIFICATIONS: FIRE DEPARTMENT: YES(X� NO( ) DATE: 3/15/10 TIME: 1059hrs NATIONAL RESPONSE CENTER YES( ) NO(# DATE: TIME: DEPT. OF ENVIRONMENTAL PROTECTION YES(x* NO( ) DATE: 3 15TIME: BOH OIL SPILL COORDINATOR: YES( ) NO(X4 DATE: TIME: TOWN BOARD OF HEALTH: YES" NO( ) DATE: 3/15/10 TIME: T 10nhr� TOWN HARBORMASTER: ' YES( ) NO(xX DATE: TIME: OTHER AGENCIES: COMMENTS: Rep inridpnt #30-0000675 far add;tiopp-1 er ai }ems REPORTED BY: Martin MacNeely,, FPO DATE: 1/1 5/201 0 COPY-FIRE DEPARTMENT COPY-D.E.P. COPY-BOARD OF HEALTH C-O-MM FORM#58 A MM DD YYYY ❑Delete NFIRS -1 • 101920 I U 1 03 1 11512010 11 110-0000675 1 000 Change Basic FDID .A. State* Incident Date * Station Incident Number * Exposure No Activity Check this box. to Indicate that the address for this incident is pzovided on the Wildland Fire Census Tract BLocation* Module in Section B"Alternative Location Specification". Use only for Wildland fires. ��—u ®Street address 148 " IPARK AV ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of I� ❑Rear of I CENTERVILLE I IMAJ 102632 I-1 ❑Adjacent t0 Apt./Suite/Room City State Zip Code I I ❑Directions Cross street or directions as applicable C Incident Type * El Date & Times Midnight is 0000 E2 Shift & Alarms 413 IOil or other combustible liquidl Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required 13 ( 1 0 11 COM1 2 Aid Given or Received* Date. Alarm * ( �a 15 2010 I10:59:57 I I� I I --I D Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received ® I O 151 �� E 3 Arrival * 0 2 010 11.0 0.3 0 2 []Automatic aid racy. Their FDID Their 3 ❑Mutual aid given State CONTROLLED Optional, Except for wildland fires Special Studies 4 ❑Automatic aid given I I ❑Controlled " " I I I I Local option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I I N ❑ Incident Number Last unit 03 15 2010 11:22:35 StudyaID# 1 !Study-Value J None ® Cleared �� U �1I I F Actions Taken* G1 Resources * G2 Estimated Dollar Losses & Values Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional Personnel form is used. for non fires. None Primary Action 86 ( Taken (1)Investigate Apparatus Personnel property $11 , 000 , 0001El I Suppression $f ' ' ,� 84 (Refer to proper I u II '' Contents _ 000 000 Additional Action Taken (2) EMS PRE-INCIDENT VALUE: Optional Othe L 0001 I 0002 u �J Property $1 000 000 El Additional Action Taken (3) El include box if resource counts $1 ' , .include aid received resources. Contents 000 000 Completed Modules .Hl*Casualties❑None A 3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ❑None NN Not Mixed Fire 10 Assembly use Structure-3 1 Natural Gas: -low leak, no evauation or H—Mat actions Service u u ❑ 2 Q Education use ❑Civil Fire Cas.-4 2 ❑Propane gas: <21 lb. tank (as in e,ome use grill) 33 Medical use ❑Eire Serv. Cas.-5 eivilianL ...J 1 � 3 ❑Gasoline: .,enicle feel tank or Portable contain,: 40 Residential use ❑EMS-6 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores Detector 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 nDiesel fuel/fuel oil:,,ehicle fuel tank or portable 58 Bus. & Residential ❑Wildland Fire-8 6 [:]Household solvents: noon/affioa spill, cleanup only 1❑Detector alerted occupants y 59 Office use ©Apparatus-9 7 []Motor oil: from engine or portable container 60 Industrial use QPersonnel-10 2❑Deteotor did not alert then 8 ❑paint• from paint cans,totaling< 55 gallons 63 Military use Arson-11 65 Farm use ❑ uF]unknown 0 ❑Other: �.iuI.a:dac actin-s required or-Pill>55ga1., 00 Other mixed use Plea late the BazMat form J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342 Doctor/dentist office 57 9 Motor vehicle/boat sales/repair 131 ❑Church, place of worship 361❑Prison or jail, not juvenile 571 ❑Gas or service station 161❑Restaurant or cafeteria 419®1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 42 9❑Multi-family dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 4 3 9❑Rooming/boarding house 62 9 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 4 64❑Dormitory/barracks 882 []Non-residential parking garage 331 ❑Hospital 519❑Food and beverage sales 891 Warehouse Outside 936❑Vacant lot 981 ❑Construction site 124 [:]Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river, stream ❑Forest (timberland) ❑ you and enter _ Property Use cock only if 669 951 Railroad right of way have NOT checked a Properly Use box: 807-QOutdoor storage area 960 [:]Other street Property Use 1419 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling I NFIRS-1 Revision 03 11 99 1K1- ~ Person/Entity Involved a~ Local Option Business name (if applicable) Area Cocie Phone Number u I I " I Iu ❑Check This Box if Mt.,Ms., Mrs. First game MI Last Name Suffix same address as incident location. Then skip the three duplicate.address Number Street or Highway Street Type lines. Prefix R Y YP- Suffix Post Office Box Apt./Suite./Room City u I -I State Zip Code El More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner D Same as person involved? Then this h and skip The rest esC o of this se section. Local Option Business name (if Applicable) Area Code Phone Number UI i " I Iu ❑ Check this box .if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I Post office Box. Apt./Suite/Room City u 1 -1 State Zip code _ L Remarks Local Option - 329 on location for removal of 2000 gallon #2 fuel oil tank on side D of property. Upon removal small leak discovered in bottom of tank just left of center. Hole in tank was 1/8" to 1/9" in diameter and in an area of heavy corrosion. Remainder of tank appeared to be intact. Notified Barnstable BOH, Inspector Dave Stanton arrived and requested evaluation of site by an LSP. Dave Stanton unable to reach DEP by phone, so after clearing scene will drive to office on Rt. 132 to notify in person. David Bennett of Bennett Environmental will be evaluating site for contamination. No further issues 329 cleared scene. 03/15/2010 15:20:13 mmacneely I ( L Authorization 18350 IMACNEELY, MARTIN 0. ISR. INSPEC I I 03 LLSJ 1 2010 Officer in charge ID Signature Position or rank Assignment Month Day Year soxcif 8350 I MACNEELY, MARTIN 0. I I SR. INSPEC I 1 1 031 U 2010 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. 3 •�•�. --- �- -- ni oon ni ii s ronl n l n_nnnnFvs Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.� 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. City/Town State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use \ ' - 1. Inspector: only the tab key �--. to move your Darren M. Meyer ,, cursor-do not Name of Inspector use the return key. n/a w Company Name - >= faa PO Box 981 Company Address East Sandwich MA 02537 City/Town State Zip Code 781-424-6748 S 1 3920 Telephone Number License Number B. Certification 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 training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I ID t5ins•09/08 Title 5 Official Inspection Form:Subs L4f wage Disposal System•Page 1 of 17 s r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' M 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑' Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4(per Asses) DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2008: 16 gpd 9 ( Y 9 (gpd)): 2009: 00 gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'M 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,•y''� 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: House built in 1976, components 30+years old. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): No signs of leakage. Septic Tank(locate on site plan): Depth below grade: 12 inches feet Material of construction: 1 ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: typical 1,500G tank Sludge depth: 3 inches t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31 inches Scum thickness 0 inches Distance from top of scum to top of outlet tee or baffle 10 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? rods and tapes Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees were present and in good condition, water was level with outlet pipe, no sign of hydraulic failure, integrity of tank looks sound, no signs of leakage. Recommend pumping. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M ,•'' 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is Centerville required for MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene y El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Park Avenue -rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): None present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM A. 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -6x6 w/1 ft ofstone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Concrete pit was 30 inches deep, with riser in place. Staining level at 36", with approx. 36"of remaining leaching available. No signs of hydraulic failure, soil conditions normal, vegetation normal. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Title 5 Official Ins ect on Form:Subsurface Sewage ge Disposal System•Page 13 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information formation is Centerville required for MA 02632 March 20, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is required for Centerville MA 02632 March 20, 2010 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ob ------------- �C_C : f � !' r I n rl 'ZG l sl - , I �J� Z, 3-5 A � t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c°M 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name information is Centerville required for MA 02632 March 20, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 11.9 feet below grade feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Excavated hole in rear yard, hit water at 13.5 ft. MIW-29, Zone C, Level 7.0, Adj. .1.7' Bottom of leaching 10.5 ft. below grade. System is not within adjusted groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 148 Park Avenue-rear system Property Address Dedecko Owner Owner's Name reformation is Centerville squired for MA 02632 March 20, 2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,SANITARIANS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Compass Realty Development 04/08/2010 BEA10-10195 Mr.Michael DeDecko P.O.Box 2384 Mashpee,MA 02649 REGARDING: UST Closure Assessment&Limited Removal Action Completion Statement 148 Park Street SHIPPING METHOD: Centerville,MA 02633 Regular Mail ❑ Pick Up ❑X Priority Mail ❑ Hand Deliver ❑ Express Mail ❑ Other ❑ Certified Mail ❑ Green Card/RR ❑ COPIES DATE DESCRIPTION 1 04/08/2010 UST Closure Assessment&Limited Removal Action Completion Statement 148 Park Street Centerville,MA 02633 For review and comment: ❑ For approval: ❑ As requested: ❑ For youruse: REMARKS: C.C. Inspector MacNeely,COMM Fire Department Ca � avid`Stanton,Barnstable Health Depa ment Bob N4urphy,MA DEP t rrn FROM: David C.Bennett,LSP/gjb If enclosures are not as noted,kindly notify us at once BENNETTENVMONMENTALAssoCUTES, INC. LICENSED SITE PROFESSIONALS Q ENVIRONMENTAL SCIENTISTS Q GEOLOGISTS Q. ENGINEERS 1573 Main Street-P.O. Box 1743, Brewster, MA 02631 Q 508-896-1706 ® Fax 508-896-5109 ® www.bennett-ea.com BEA10-10195 April 8, 2010 Mr. Michael A. DeDecko Compass Realty Development P.O Box 2384 Mashpee, 02649 RE: UST CLOSURE ASSESSMENT & LIM ITED REMOVAL ACTION COMPLETION STATEMENT Anthony W. DeDecko Trust 148 Park Street Centerville, MA Dear Mr. DeDecko, Pursuant to our agreement dated March 15, 2010, BENNETT ENVIRONMENTAL ASSOCIATES, INC. (BEA) has prepared the following narrative as documenting regulatory compliance and remedial performance. for the excavation of 25 yards of contaminated soil as associated with the removal of a 2,000-gallon underground fuel oil storage tank(UST)at the subject property. This work is consistent with the requirements 527 CMR 9.00 and the MA DEP Policy WSC-401-96. The following narrative,and supporting documentation,absolve any Notification or further Remedial Response liabilities specific to the former UST pursuant to the provisions of 310 CMR 40.0000 as regulated under MGL c. 21 E. BACKGROUND On March 15,2010,BEA received a telephone call from the that a 2,000-gallon oil tank was being removed from the subject property,as inspected by the COMM Fire Department, and a leak was suspected as attributed to corrosion on the bottom of the vessel. During the removal of the vessel, metal scaling had been removed exposing a 1/8"hole that was quickly plugged. The tank was subsequently cleaned and removed under permits issued by the COMM Fire Department. The Fire Department notified the Barnstable Board of Heath (BOH) of the apparent release and BOH officials instructed the property representative of his requirement to contact an environmental professional. As such, BEA was retained to investigate the apparent release and to provide LSP oversight to address regulatory issues of Notification and Remedial performance as related to the Barnstable Health Department and MA Department of Environmental Protection(MA DEP). Upon arrival at the property,BEA inspected and photo-documented the vessel. Soil samples were then collected from within the tank grave as indicating an area of soil contamination in a 1 . EMERGENCY SPILL RESPONSE Q WASTE SITE CLEANUP Q SITEASSESSMENT Q PERMITTING Q SEPTIC DESIGN&INSPECTION WATER SUPPLY DEVELOPMENT,OPERATION&MAINTENANCE Q WASTEWATER TREATMENT,OPERATION&MAINTENANCE APRIL 8,2010 DEDECKO:148 PARK STREET/BEA10-10195 0 PAGE 2 F 4 USTCL-LIMITED REMOVALACTION COMPLETION STATEMENT section of the open excavation consistent with the former position of the tank and noted corrosion of the vessel. Based on the fact that it was raining, further investigation was suspended and the area was capped with polyethylene plastic sheeting to prevent any potential mobilization of contaminants. Bottom-of-hole(BOH)samples were field-tested by the Dexsil Petro-Flag(EPA SW-846,Method 9074) method as indicating significant soil impacts above the applicable RCS-1 Reportable Concentration of 1,000 mg/Kg. As such, a composite BOH: C-W @ 6' sample was submitted to Groundwater Analytical Laboratories in Buzzard Bay, MA on a rush-tumaround for confirmatory total petroleum hydrocarbon (TPH) "fingerprint" analysis to qualify the magnitude of petroleum impacts to underlying soils and toward remedial waste management considerations. ENVIRONMENTAL ASSESSMENT . The following day, BEA returned to the subject property and advanced a series of hand- borings through the bottom-of-hole to establish the vertical and horizontal extent of significant soil impact toward anticipated soil removal operations and any structural considerations. Soil sampling and field-testing indicated that soil impacts were confined to a 10' x 10' area centered around the central and western end(TB-2)of the tank grave to a depth of 12'below grade,which corresponds to 6' below the bottom of the tank grave. Laboratory result received on March 18th and March 22nd confirmed the apparent extent of significant soil impacts identified as related to fuel oil, substantiating a 120-day Reportable Condition. In accordance with the provisions of 310 CMR 40.0318, soil removal activities were scheduled and a Bill of Lading was prepared, executed and approved by Aggregate Industries for the management of remedial waste by asphalt recycling at the licensed facility. LIMITED REMOVAL ACTION On March 24, 2010, BEA returned to the subject property to provide technical support, inspect and document soil removal operations with the direct loading and shipment of contaminated soils from within the identified area of petroleum hydrocarbon impacts to Aggregate Industries in South Dennis,MA. The contractor was instructed to remove and stockpile clean overburben soils in a 10' x 10' area to a depth of 5'. Following the stockpiling and testing of this material,soil removal operations began with the loading of contaminated soils directly into the standing truck. The excavation was in an 8' x 12' area to a depth of 12'below grade.Sidewall(SW)and bottom-of-hole (BOH) samples were then collected and screened with a photoionization detector by the "jar headspace"method for measuring total organic vapors(TOV)as consistent with the MA DEP Policy WSC-02-411. Such screening reported low-level TOV concentrations below 1.5 ppmv in all areas. The highest TOV sample was then field-tested by the Dexsil Petro-Flag method and reported a TPH concentration of 75 mg/Kg,as significantly below the 1,000 mg/Kg RCS-1 standard. Based on the field-testing of a positively biased sample,the excavation was considered complete. As such,the excavator was instructed to clear the sidewall and bottom-of-hole areas of caved soils and endpoint soil samples were collected as field preserved and sent to the laboratory for confirmatory analysis of APRIL 8,2010 DEDECKO:148 PARK STREETBEA10-10195 PAGE 3 OF 4 USTCL-LIMITED REMOVALACTION COMPLETION STATEMENT Total (TPH) and Extractable Petroleum Hydrocarbons (EPH)with target compounds. Receipts from Aggregate Industries report that a total of 27.43 tons of contaminated soils was delivered to the South Dennis,MA facility under a fully executed Bill of Lading for licensed asphalt recycling. This tonnage is consistent with the 25 yards of material removed from an 8' x 12' x 6-7' (D) area as documenting the appropriate management of remedial waste. RISK CHARACTERIZATION The analytical results for endpoint soils samples were reported on March 31,2010. This data was internally validated as reporting all TPH,EPH and target PAH analyte concentrations as Below Reporting Limits (BRL). In all cases, the reporting limits of the analyses conducted were significantly less than the applicable RCS-1 Reportable Concentrations and most restrictive S-1/GW- 1 Method 1 —Risk Characterization standards. The S-1/GW-1,Method 1 —Risk Characterization standards are consistent with the RCS-1 values as a measure of significant risk in consideration of ingestion,inhalation and dermal contact exposures,environmental impacts to sensitive receptors and as a measure of potential leaching to groundwater. As such,the endpoint sampling indicates that background conditions have been achieved and that there is No Significant Risks to humans and the environmental resources inclusive of groundwater beyond the extent of the excavation specific to the area of the former UST. CONCLUSIONS The removal of the former 2,000-gallon fuel oil UST at the subject property,as witnessed by the COMM Fire Department, indicated that a minor release of fuel oil had occurred. BEA was subsequently engaged and identified soil impact within a discrete area of underlying soils above the groundwater interface as representing a 120-day Reportable Condition. In accordance with the provisions of 310 CMR 40.0318,wherein a 120-day Condition exists for impacts strictly to soils(< 100 yards),the excavation and management of remedial waste may proceed as a Limited Removal Action (LRA) within the reporting period if such soil excavation is successful in reducing all soil impacts to concentrations below the RCS concentrations within the reporting period. As such,the removal of some 25 yards of contaminated soils,remedial waste management,and post-excavation environmental testing represented herein, document regulatory compliance and remedial performance in accordance with the governing regulations. Such work absolves any Notification or further Remedial Response liabilities specific to the location of the former UST pursuant to the provisions of 310 CMR 40.0000 as regulated under MGL c. 21E. Copies of this report are being provided to the MA DEP(Hyannis),COMM Fire Department and Barnstable Board of Health as part of the public record towards project closure. If you have any questions or need additional information,please contact me directly at your earliest convenience. APRIL 8,2010 DEDECKO:148 PARK STREETBEA10-10195 PAGE 4 OF 4 USTCL-LIMTTED REMOVAL ACTION COMPLETION STATEMENT Si ely, B IRONMENTAL ASSOCIATES, INC. David ett, LSP nt Encl. -Site Plan entitled "Limited Removal Completion..." prepared by BENNETT ENVIRONMENTAL ASOCIATES, INC.,Dated March 24, 2010. -Environmental Permits and Documentation: Tank removal Permit/Tank Disposal Receipt MA DEP BWSC-100 "Complaint and Inquiry Log Form" Soil Recycling Submittal/BWSC-12 a,b,c Bill of Lading -Laboratory Analytical Reports GWA Lab ID 131856(3/18/10) GWA Lab ID 131925 (3/22/10) GWA Lab ID 132072 (3/31/10) Cc. Inspector MacNeely, COMM Fire Department David Stanton, Barnstable Health Department Bob Murphy, MA DEP (Hyannis) NEW RADIATORS' NEW to TALYTIC CONVERTERS CENTER SSREET•PO BOX 137 SO,DENN15'MA 02660 NATIQNWIDE 508-398 8988::800-698-8988 .PARTS SEARCH -s - 4 * ; jj� f a e _ «a..l lYTi'�.. H- w� *�. 3 o�W tic K - l .] r �t i L ; i1►�t lmralallo TL �(��r V ` ��' - • -.� _ � �."y„ V .GCS..Y' ' [:1 tt/S�SL Rsw��.�?C� ' ��s'lu�} f ir/!'gxrT L//'.iV.F"igcY CASH YtRCaERO R Cf�Ef QAt3i:R$Y . LUE �tflI !C OVER Nf}; i?ISMP±NTLi J R4f7i 'fi1E ' St{l 4']KtE. STOCK • • DESCRIPTIONITEM I .� j )'�T �' '1�'s�J� i}KJ� i�c.� st` a+1.i�r,�' It H �i..,F.• 4 r� n 9 _ a R µ 30'day`guarantee—255ro handing charges—we do not cover r *, • r"f�0'CAt j Please Read Warranty Information on bade before signing, Customer isjFty Aware of Sates Policy i i q Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC100 COMPLAINT AND INQUIRY LOG FORM Complaint ID Number SE - 10 - 22470 L71_1 A.COMPLAINT AND INQUIRY LOCATION: 1. Street Address: 1188 PARK AVENUE 2. City/Town: ICENTERVILLE, BARNSTABLE 3. Caller: JDAVID STANTON 4. Telephone: 5088624644 B.THIS FORM IS BEING USED TO: 1. Date and Time of Complaint, Inquiry or Update: 3/15/2010 Time: 11:00 ❑✓ AM ❑ PM (mm/dd/yyyy) (h h:m m) ❑ 2. Record a New Complaint. 0 3. Record a New Inquiry. ❑ 4. Record an Update of a Previously submitted Complaint or Inquiry. C.DESCRIPTIVE INFORMATION ABOUT COMPLAINT OR INQUIRY: 1. Report Description (Complaint type): Fla.Drum(s) ® b.Bureau of Waste Prevention Matter ❑ c.Dumping ❑ d.Fill Material ❑ e.Odors ❑ f.Bureau of Resource Protection Matter ❑ g.Smoke ❑ h. Vapors ❑ i.Fire [;�j j.Spill or Leak Exempt from Reporting ❑ k. Sheen ❑ I.Fish Kill ❑ m.Sewage Eln.Vehicle Accident ❑ o.Unknown ❑ p.Other 2. Involved Party: JESTATE OF NANCY DEDECKO 3.Comments:(record additional comments in Section F) DAVE STANTON OF BARNSTABLE HEALTH DEPT. REPORTS A POSSIBLE REPORTABLE RELEASE I D.DISPOSITION OF COMPLAINT OR INQUIRY: (check one) ❑ 1.Site Visit ❑ 2.Compliance Site Visit ❑ 3.Field Follow-up Z 4.Further Action Required ® 5.No Action Taken ❑ 6. Release or Threat of Release Exempt from Reporting Requirements(not referred.) ❑ 7. Refer to Other DEP Division:(check one) ❑ a. Air Quality ❑ b.Hazardous Waste ❑ c. Enforce ment/Strike Force ❑ d.Solid Waste ❑ e. Water Supply ❑ f. Industrial Waste Water ❑ g. Water Pollution ❑ h. Other ❑ i. Wetlands and Waterways ❑ 8.Refer to Other Agency: (check one) ❑ a. EPA ❑ b.DPH ❑ c.US DOT ❑ d. US Coast Guard ❑ e. Board of Health ❑ f. Local Fire Dept. ❑ g. Other E. DEP ASSIGNMENT: MURPHY BOB ® 1.DEP Staff: a. Name: b. Check here,if Unassigned.(or staff name not applicable) 2. Preparer Signature: lRobert Murphy 3.Date: 3/15/2010 Revised: 06/16/2004 Page 1 of 2 71 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC100 COMPLAINT AND INQUIRY LOG FORM Complaint ID Number SE - 10 - 22470 F.ADDITIONAL COMMENTS AND DESCRIPTION: ASSOCIATED WITH A 2,000 GALLON UST REMOVED FROM THE 188 PARK AVE RESIDENTIAL PROPERTY.AN LSP HAS BEEN HIRED BY THE ESTATE AND DAVE BENNETT WILL CONDUCT ASSESSMENT ACTIVITIES TO DETERMINE IF A NOTIFIABLE CONDITION EXISTS AND TO ALSO EVALUATE IF AN LRA CAN BE IMPLEMENTED HERE IF NECESSARY. Revised: 06/16/2004 Page 2 of 2 i Massachusetts Department of Environmental Protection L73 Bureau of Waste Site Cleanup BWSC100 COMPLAINT AND INQUIRY LOG FORM Complaint ID Number SE - 10 - 22470 A.COMPLAINT AND INQUIRY LOCATION: 1. Street Address: 1188 PARK AVENUE 2. City/Town: ICENTERVILLE, BARNSTABLE 3. Caller: JDAVID STANTON 4. Telephone: 5088624644 B.THIS FORM IS BEING USED TO: 1. Date and Time of Complaint, Inquiry or Update: 3/1 512 0 1 0 Time: 11:00 0 AM ® PM (mm/dd/yyyy) (h h:m m) ❑ 2. Record a New Complaint. 0 3. Record a New Inquiry. ❑ 4. Record an Update of a Previously submitted Complaint or Inquiry. C.DESCRIPTIVE INFORMATION ABOUT COMPLAINT OR INQUIRY: 1. Report Description (Complaint type): ❑ a.Drum(s) ® b.Bureau of Waste Prevention Matter ❑ c.Dumping ❑ d.Fill Material ❑ e.Odors ❑ f.Bureau of Resource Protection Matter ❑ g.Smoke ❑ h. Vapors ❑ I.Fire Q j.Spill or Leak Exempt from Reporting ❑ k. Sheen ❑ I. Fish Kill ❑ m.Sewage ❑ n.Vehicle Accident ❑ o.Unknown ❑ p.Other 2. Involved Party: JESTATE OF NANCY DEDECKO 3.Comments: (record additional comments in Section F) DAVE STANTON OF BARNSTABLE HEALTH DEPT. REPORTS A POSSIBLE REPORTABLE RELEASE D.DISPOSITION OF COMPLAINT OR INQUIRY:(check one) ❑ 1.Site Visit ❑ 2.Compliance Site Visit ❑ 3.Field Follow-up Z 4.Further Action Required ® 5.No Action Taken ❑ 6. Release or Threat of Release Exempt from Reporting Requirements(not referred.) ❑ 7. Refer to Other DEP Division:(check one) ❑ a. Air Quality ❑ b.Hazardous Waste ❑ c. Enforce ment/Strike Force ❑ d.Solid Waste ❑ e. Water Supply ❑ f. Industrial Waste Water ❑ g. Water Pollution ❑ h. Other ❑ I. Wetlands and Waterways ❑ 8.Refer to Other Agency: (check one) ❑ a. EPA ❑ b.DPH ❑ c.US DOT ❑ d. US Coast Guard ❑ e. Board of Health ❑ f. Local Fire Dept. ❑ g. Other E. DEP ASSIGNMENT: MURPHY BOB b. Check here, if Unassigned. 1.DEP Staff: a. Name: (or staff name not applicable) 2. Preparer Signature: Robert Murphy 3.Date: 3/15/2010 Revised: 06/16/2004 Page 1 of 2 I Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC100 L� L COMPLAINT AND INQUIRY LOG FORM Complaint ID Number 91 - 10 - 22470 F.ADDITIONAL COMMENTS AND DESCRIPTION: ASSOCIATED WITH A 2,000 GALLON UST REMOVED FROM THE 188 PARK AVE RESIDENTIAL PROPERTY.AN LSP HAS BEEN HIRED BY THE ESTATE AND DAVE BENNETT WILL CONDUCT ASSESSMENT ACTIVITIES TO DETERMINE IF A NOTIFIABLE CONDITION EXISTS AND TO ALSO EVALUATE IF AN LRA CAN BE IMPLEMENTED HERE IF NECESSARY. Revised: 06/16/2004 Page 2 of 2 Apr 08 2010 12:26PM p. 1 Marm 30,2010 AGGREGATEINDUSTRIES M1ch kel DeDecko Com ass Realty Devel, 23 C leton Dr Mash Ne,Ma 02649 Re: Sc il, DeDecko Estate 148 Park St Centerville, Ma Release Tracking LRA Recycl ible soil from the above referenced project was last received at our facility on March 4, 2010. A total of 27.43 tons was received. I have since been advised that shipme it is complete and have attached a copy of the BOL,along with an original form 12C to alose out the project. Thank you for recycling with Aggregate Industries. Regards, Willis R Reinhardt Manage r AGGREGATE INDUSTRIES NORTHEAST REGION 1101 Turnpike Street Stoughton,MA 02072 Telephone (781)341-1100 Facsimile 981)341-5523 www.aggregate-w.com An Equal Opportunity Employer An AGGREGATE INDUSTW ES cm WwV SOIL RECYCLING SUBMITTAL Revised 3/12/99 AGGREGATE INDUSTRIES Environmental Services 1101 Turnpike Street, Stoughton, MA 02072 Tel: (781) 341-5500 Fax: (781)341-2440 Site Information: NAME DeDecko Estate CONTACT Michael DeDecko STREET 148 Park Street PHONE (508)221-5003 CITY/TOWN Centerville STATE/ZIP MA 02632 Generator Information: NAME Anthony W. DeDecko Trust CONTACT Michael DeDecko,Trustee STREET 148 Park Street PHONE (508)221-5003 CITY/TOWN Centerville STATE/ZIP MA 02632 Consultant Information: NAME BENNETT ENVIRONMENTAL ASSOCIATES, INC. CONTACT David C. Bennett, President STREET 1573 Main Street-P.O. Box 1743' PHONE (508)896-1706 CITY/TOWN Brewster STATE/ZIP MA02631 Estimated Soil Quantity: TONS 35 CUBIC YARDS 25 Soil Contaminants (gasoline,diesel fuel, motor oil,etc.) #2 Fuel Oil Analyses Performed (check all that apply) FM TPH 0 As pH Reactivity(S,CN) PCBs 0 Flash Cr Pb TCLP(metals)if required VOCS 0 Cd Hg based on total levels other All the above tests Laboratory analytical Screening Data ICI were performed 1 1 data attached I I Attached Instrument Used and Constituents Found Thermoenvironmental FID 10.8 ev TOV Environmental Services.Revised 3/12/99. page 1 of 3 Description / Source of Release: UST 2000 gallons UST DATE OF RELEASE March 15,2010 (discovered) OTHER,DESCRIBE tank removal Soil Description PHYSICAL DESCRIPTION(SAND,GRAVEL,SILT,ETC.) Sand CLASSIFICATION METHOD USDA Check if the following materials are present(check all that apply) ❑CLAY F1 CONSTRUCTION DEBRIS OTHER DELETERIOUS MATERIALS(PLEASE LIST) COAL 13 VEGITATIVE MATTER None ElASH Soil Characterization Methodology Sampling Method GRAB El 13BIASED SAMPLES 13 (E.G.HEA SPACE SCREENED,VISUALLY CONTAMINATED) CONSTITUTES OF CONCERN BOH central/west 6' Site History 11 CHECK IF EXTRA SHEETS ATTACHED CURRENT USE Residentilal PAST USE Residential I,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 anthropogenic contaminants. I,the generator, realize that due diligence shall consisit 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 limmited 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 w col ed a o g to DEP policy#99-415. ISIGNATUREOF GENERATOR DATE t p GENERATOR-PRINTED NAME Michael Dedecko(son)for Anthony W. Dedecko Trust AGGREGATE Environmental Services.Revised 3/12/99. page 2 of 3 INDUSTpES A site diagram is required indicating any major structures or roads,excavation areas and stockpile locations. All sampling locations must be noted. CHECK IF DIAGRAM ATTACHED Site Diagram Site Sketch Plan BENNETT ENVIRONMENTAL ASSOCIATES NAME OF INDIVIDUAL PREPARING DIAGRAM: w AGGREGATE Environmental Services(13TES/900)12/3/97.Revised 3/12/99. page 3 of 3 INOVSTRIES Town of Barnstable Geographic Information System March 18, 2010 207148 #20 207026 #139 �7(/ 4� 207038 #12 207146 #148 187031003 #159 b : 107031002 ' #167 a., { 207147 #76 0 :AIQ�A o .. �'<,y 'goey ymP14G�' o sex 0 c b�d Col N Z�y� 207143 207039 0 16 Fe 111170 #56 DISCLAIMERS:This map Is for planning purposes only. It Is not adequate for legal Map:207 Parcel:146 Selected Parcel boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:DEDECKO,ANTHONY W TR Total Assessed Value'$827000 1"=100'may not meet established map accuracy standards. The parcel lines on this map ' F are only graphic representations of Assessor's tax parcels. They are not true property Co-owner: Acreage:0.54 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:148 PARK AVENUE such as building locations. Buffer 1 ,I Massachusetts Department of Environmental Protection BWSC-012A Bureau of Waste Site Cleanup Release Tracking Number' BILL OF LADING (pursuant to 310 CMR 40.0030) ❑ A. LOCATION OF SITE OR DISPOSAL SITE WHERE REMEDIATION WASTE WAS GENERATED: Release Name(optional): DeDecko Estate Street: 148 Park Street Location Aid: Assessors Map 207, Parcel 146 Cityrrown: Centerville (Barnstable) ZIP Code: 02632 Date/Period of Generation: 0 3/19/2 010 to: 0 3/2 6/2 010 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: Compass Realty Development Name of Contact: Michael DeDecko Title: President Street: 25 Carleton Drive City/Town: Mashpee State: MA ZIP Code: 02649 Telephone: (508) 221-5003 Ext.: C. RELATIUNSHIP TO RELEASE OF PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH BILL OF LADING: ❑ RP or PRP Specify: Owner ® Operator ❑ Generator ❑ Transporter Other RP or PRP: Son: Estate Rep ❑ 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: Compass Realty Development Contact Person: Michael DeDecko Title: President Street: 25 Carleton Drive pee 02649 City/Town: Mash State: MA ZIP Code: Telephone: (508) 221-5003 Ext.: E. RECEIVING FACILITY/TEMPORARY STORAGE LOCATION: Operator/Facility Name: Aggregate Industries Contact Person: Bill Reinhardt Title: General Manager Env. Safety Street: 230 Great Western Road City/Town: South Dennis State: MA ZIP Code: 02660 Telephone: (7 81) 3 41-5 5 0 0 Ext.: Type of Facility: VJ Asphalt Batch/Cold Mix ❑ Landfill/Disposal Incinerator Temporary Storage (check one) Asphalt Batch/Hot Mix Landfill/Daily Cover Other: Thermal Processing Landfill/Structural Fill EPA Identification#: MAD985286384 Division of Hazardous Waste/Class A Permit#: S-01-02 8 Division of Solid Waste Management Permit#: ActuaUAnticipated Period of Temporary Storage(specify dates if applicable): to: Reason for Temporary Storage: Direct load and transport for 148 Park Street Revised 10/3/94 Page 1 of 3 I / -� Massachusetts Department of Environmental Protection BWSC-012A Bureau of Waste Site Cleanup Release Tracking Number* BILL OF LADING (pursuant to 310 CMR40.0030) E. RECEIVING FACILITY/TEMPORARY STORAGE LOCATION(continued): Temporary Storage Address: Street: City/Town: State: ZIP Code: F. DESCRIPTION OF REMEDIATION WASTE: (check all that apply) V1Contaminated Media(check all that apply): Soil O Groundwater O Surface Water O Other:- El Contaminated Debris(check all that apply): O Vegetation or Organic Debris Demolition/Construction Waste OInorganic Absorbent Materials O Other: Non-hazardous Uncontainerized Waste(check all that apply): O Non-aqueous Phase Liquid O Other: ElNon-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): 11 Gasoline 11 Diesel Fuel © #2 Oil ❑ #4 Oil ❑ #6 Oil ❑ Waste Oil ElKerosene ❑ Jet Fuel ❑ Other:- Estimated Volume of Materials: Cubic Yards: 25 Tons: 35 Other: Contaminant Source(check one/specify): ❑ Transportation Accident 10 Underground Storage Tank ❑ Other: Response Action Associated with Bill of Lading(check one): ❑ Immediate Response Action11 Release Abatement Measure ❑ Utility-Related Abatement Measure ® Limited Removal ActionEl Comprehensive Response Action ❑ Other Remediation Waste Charcterization Support Documentation attached:Site History Information V Sampling and Analytical Methods and Procedures 17 Laboratory Data 10 Field Screening Data If supporting documentation is not appended,provide an attachment stating thedate and in connection with what document such information was previously submitted to DEP. G. LICENSED SITE PROFESSIONAL(LSP)OPINION: Name of Organization: BENNETT ENVIRONMENTAL ASSOCIATES.INC. LSPName: David C. Bennett (#4303) Title: President Telephone: , (508) 896-1706 Ext.: 1 02 1 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 a (i)the standard of care in 309 CMR 4.02(1), ii the applicable provisions of 309 CMR 4.02 2 and 3 and t� C�) PP� P O O� t (iii)the provisions of 309 CMR 4.03(5), 'f'rd x 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 acceptan a at the facility identified in this submittal comply with the applicable provisions of 310 CMR 40.0000,and such facility is permitted to ce Remed ati Waste having the characteristics described in thisam aware that significant penalties may result, including,but not limit MbUnd imprisonment,if I submit inbrmation wh' a inaccurate or materially incomplete. LSP Signature: Seal:6"" C v BENN v' Date: - � No.4303" � License Number: _ 4303 c>�y�� G1STS4���`�� S/;E4Y� Revised 10/3/94 Page 2 of 3 iaMassachusetts Department of Environmental Protection BWSC-012A Bureau of Waste Site Cleanup Release Tracking Number' BILL OF LADING (pursuant to 310 CMR 40.0030) ❑ 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 i best of my knowledge and belief,true,accurate and complete. I am aware that there are significant penaltieaindplingjnotlimit to,p sible �andmprisonm�forlfully submitting false,inaccurate,or in mplete information. Signatur Date: Name of Person(print): Michael DeDecko (son)for Anthony W. DeDecko Trust Revised 10/3194 Page 3 of 3 • 'gt� ..3�pf;ry M .u�..li._:v{Yit,c.'¢�a�rra F " i -�x+. 3. y. t::�p61::2.�0•:"i , w;•€.''-�i•';.'?'`�`n- .:�., t,��� i � .,+w�"q�( t'�T��ie`�,�,{�1- .�, c's `��.�. + '$�a�"�'�? � "� 'r�, .- w ,,,�' - r.3 y�..r�,iy��"f�}-,�tt+u l� d'ti:. !�'��S .T ,'+,iu-'£i€`��,Leh r�J all. S � il. �ti; mti��..- �d^•� '`� ?"S��S.N„^. I 'L.v pp�� ;ear6ruik,�*}uams,S�f���M� .-�c�a,.r=as�,.$�e,'�•resr��?��m9 �`afi° ��1:�trr�tso'.�tSy}er,�4a�: o=.r',e�it�kr�., i z..��r=sia:� :s�-- 3�i�-�'r8�:t� �'se''«,+�.�s9�,sa::e':��at��eik'� I _ ��p}a�� cl �I�`5r.'�y��V'�'i5G § d'.� ¢., tew � l:�'� � �a.*,�lt3,i;���nr� �?irv.�}i�.!9. "Yl�� •'1.d�9. A�§�E.��br_r. .°:TI!1��xlstarru'��°flkdi}& :sd >rt i5 x _ N k. -i•^ 5 ;P`---i,i �'tt 4 ' ir lit IhC,hJil.fifi M ' .,j Yj t to 6 � c e n .:;q��. :,�#t�3 s(r'F9 tixteew. ta��r.,,ri�rr2:•�s�d��- �d y. r w�usma.u.r�s�`^�t �:��.-a:r m� !{� 'D!�' I�v�-r^�IL.�i ��"'�``���Cj + ilb31 ' ee �sptii tmisz'"e�,y9�r+lsar'. .u� .gY w to, 0�., !., - �' -:tl I:§} lug ,o p �li'_ _'&I' ; .:} '��W r ,q.�;'rJl�'a�4.. Fx}$s?•�iC�Pst>h�= "„�v a '^c--• 2a Fat ,9rd"a' 9S"A I '-o-'r I'+'• +ad• } ' ,[-•:11'tti�'rR} 9E"n -U�n Is �7� ela - ! J� +i R 'ro��:�r'.�;?,F �f .£��:Ee,k9�El�.fr ry. ¢ §}1 .t (�. OR i,11112t 4 c4+ FUI' e ff7k '1 1 n Iryy ,ea. S s d. tl qd - -1.r o-� 1'L' flll'tte ^si �q .•> �'`� �+.,�.rt�. .{ tz. .. ,... a l �1,.'zVpici}4.`9s f �d ,9r.^:4.�.,d a. _ n (� `�77 1 �,. - � ( �. ��I?y.3,6Gt+Ai1�7'e���9 mEy :.I.7 � J+ �p;t' r r��h .�'d}�Jr !�gr27 }i1!49� '"'�•��adYT.q(,.�iE gT�1,�qlj:: ,Fi"tW�n�eru !} �i!{c1�5j p,ka+LLA�ry +l1 -+�rf P[t�{;a.p811 ''ri��f k11yT.'.�l 7S'd I. ,I Ns:y�i e a. i1 Y,1 ,y ` SYf; IA'4y�t'B�f:I'Pw93r.�:t �Lis:2PLi:f�9ltll :,:t$ 3.s. La A weM =IIe:Sa.c s?: fa6sh is�ii wei sPe Pt1}xa �tr 1m:;5s�ushs ah ua Iia}r 5 SS<IE GHI E�.1,5ROJaI a.ma� x sa _ R '0 i III _ •�,. milli I Apr 08 2010 12: 26PM p• 7 3/2412010 Sca#e Ticket Inquiry J Begin Date 3/2412010 Location 333 End Date 312 010 Ticket Type Scale Sell/Buy/Trans All ARType Ail Ship/Recieve .All Ticket Loc Da Time Customer Order Product Carrier Ve icle 9�L Lint Price 1600786 333 4/2010 11:60 am CASH SLS/SC 64501 RECY SOIL FOB HAULEI 1 27.43 Ton 1,371.50 27.43 1,371.50 Tickets 1 3:18:23PM 3/2412010 Aggregate Industries-NE Region Apr 08 2010 12: 26PM p• 6 Massachusetts Deparirnent of Environmental Protection BWSC-012C uneau of Waste Sine Cleanup ILL OF LADWG(pursuant tQ 310 CMR 40.0030) Release Trmddrno Number SUMMARY SHEET 1 OF 1 - K. SUMMARY OFSHIPMENTS:. Daily Volume Shipped Date of Shl nt: Date of Reoelpt: Number of Loads Shipped: (cu.yds./tons): 3/24/10 1 27_43 Summary Sheet Total Shipped: 1 27.43 0B f ON of Lading Total Shipped (only if difrere": Revised 10J394 Page 1 of Apr 08 2010 12: 26PM P. 6 Massachusetts Department of Environmental Protection BW►SC-012C Bureau of Waste Site Cleanup BILL OF LADING(pursuant b 310 CMR 40.0030 Reba Tracking Number SUMMARY SHEET - L ONLY CO 1PLETE ONE COPY OF THIS PAGE AND ATTACH TO THE FINAL COPY OF THE SUMMARY SHEET. L. ACKNOWILEKX MENT OF RECEIPT OF REMEDIATION WASTE AT RECEMNG FACILITY OR TEMPORARY STORAGE: Recely"l9actiiylie Storage RepmeerrtaMe(w ): William R_ R inhardt Title_ Mng37_ Env. Szvcs. Sfgrature: Dula. 3/30/10 M. ACKNOWLED ENT OF SHIPMENT AND RECEIPT OF RE MEDIATION WASTE BY PERSON CONDUCTING SPONSE ACTION.ASWCUaW WITH THIS BILL OF LADING: Joeftundarpenalli of lawth d I have personally examined and am fa"lar wih the[Mom►ation contained In tfis st&nirial,including any and all documents ac:oompa ng this ceftoetion,and hK based on rry inquiry of those individuals Irmriedialely responsible foroblairiing the k ibmation,the material int nmMon oo ned In herein loje the best of mar Innmiledge and belief,he,accurate and complete, I am aware that there are signdieant penalties,Including, not G b1 p asorownt for veM*aubm enq taker inaccurate or 6rcon'plete kftmetlon. signatum Date: Name of Person(prinl) _ avid C . Bennett , President BENNETT ENVIRONMENTAL ASSOCIATES , INC . for Anthony W. DeDecko Trust Michael DeDecko, Trustee Revised W-4 4 Page 2 of 2 GROUNDWATER Groundwater Analytical,Inc. P.O.Box 1200 ANALYTICAL 228 Main Street Buzzards Bay,MA 02532 Telephone(508)•759-4441 FAX(508)759-4475 www.groundwateranalytical.com March 18, 2010 Mr. David Bennett Bennett Environmental Associates, Inc. P.O. Box 1743 Brewster, MA 02631 LABORATORY REPORT Project: DeDecko/ 148 Park SUBEA10-10195 LAID: 131856 Received: 03-15-10 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-conformances, a quality control report, and a statement of our state certifications. The analytical results contained in this report meet all applicable NELAC or NVLAP standards, except as may be specifically noted, or described in the project narrative. The analytical results relate only to the samples received. 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 belief, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sincerely, Eric H.Je sen Operatio s Ma ager EHJ/ Enclosures Page 1 of 12 GROUNDWATER ANALYTICAL Sample Receipt Report Project: DeDecko/148 Park St./BEA10-10195 Delivery: GWA Courier Temperature: 3.7°C Client: Bennett Environmental Associates,Inc. Airbill: n/a Chain of Custody: Present Lab ID: 131856 Lab Receipt: 03-15-10 Custody Seal(s): n/a Lab ID Field ID _ Matrix Sampled. Method ,`; r _ ` Notes 131856-1 BOH C-W @ 6- Soil 3/15/10 13:45 TPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C415325 250 mL Amber Glass Proline BX34114 None n/a n/a n/a Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 2 of 12 GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: BOH C-W @ 6' Matrix: Soil Project: DeDecko/148 Park St./BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 131856-1 QC Batch ID: HF-3073-M Sampled: 03-15-10 13:45 Instrument ID: GC4 HP 5890 Received: 03-15-10 16:15 Sample Weight: 15 g Extracted: 03-15-10 23:30 Final Volume: 1 mL Analyzed: 03-17-10 01:05 Dilution Factor: 5 Analyst: MB %Solids: 95 ;.Qualitative Identification 5 This sample has GC/FID characteristics that are similar to: 1. Fuel Oil No.2/Diesel Fuel. 2. The Fuel Oil appears to be moderately weathered. / Analyte Concentration 'Notes Units`_ Reporting Limit Total Petroleum Hydrocarbons 1,200 mg/Kg 310 QC Surrogate Compound Spiked Measured .: Recovery. QC Limiti. ortho-Terphenyl 2.7 n/a I d 60-140 Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book ofASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. d Surrogate recovery not measurable due to required sample dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 page 3 of 12 GROUNDWATER ANALYTICAL ASTM METHOD D3328-00(Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 131856-01 Hydrocarbons Laboratory 1.0 0.a 0.s 0.4 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 4 of 12 GROUNDWATER ANALYTICAL Project Narrative Project: DeDecko/148 Park St./BEA10-10195 Lab ID: 131856 Client: Bennett Environmental Associates,Inc. Received: 03-15-10 16:15 A.Documentation and Client Communication The following documentation discrepancies,and client changes or amendments were noted for this project: 1 . No documentation discrepancies,changes,or amendments were noted. B.Method Modifications,Non-Conformances and Observations The sample(s)in this project were analyzed by the references analytical method(s),and no method modifications, non-conformances or analytical issues were noted,except as indicated below: 1 . TPH by GC/FID Non-conformance: Sample 131856-1. Sample did not have measureable surrogate recoveries due to required sample dilution. 2. TPH by GC/FID Note: Sample 131856-1. Sample was diluted prior to analysis. Dilution was required to keep all target analytes within calibration. Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532Page 5 of 12 • :228 Main.Street;P.O.Box 1200 - �• GROUNDWATER' Buzzards Bay.MA02532 CHAIN-OF-CUSTODY;RECORD ANALYT/GAL Telephone(508)759.4441•FAX(508)759.4475 AND-WORK ORDER www.grounoNMeranalybcal.com Project Na a:.. V Firm: TURNAROUND ANALYSIS REQUEST I '^ Ya4ata Erman.®n P xrx Csr 120. MO.. nnfbe Nu. - r z!(3 tB G7V��. ❑STANDARD.(10BuslnessDays) sm°nlCnrmDxt` '.aten it. g, r r Project Number: Address: ❑PRIORITY-.(5 Bu--s�iInnre�ss/ss}Days) HRUS (RAN- ushBee uhAuINtJor lZIA eNumDerlRRA11I)^ 1c)1g5 n J. C.�O 11 Sampler Name: City IState I Zlp: O Please Email to: ° 9: i{ 'A^n El Please FAX to: Protect Manager. Telephone: BILLING $ rR 11 5 u $ Alid, y��� I �? PurrhasaOrderNo.: lL,, tt�+lj/� G Third Party eating: g a X ' INSTRUCTIONS:Use separate line for each container(except replicates). _ ' r ' a - u: ( P P L GWAQuote: �• ;j Sampling Matrix Type Containers) Preservation G ° b r � 9 e� P -( B a LABORATORY 5ti a a (Lab�Use'Only) du 4NUMBER $14 n1sSAMPLE a - IDENTIFCATION e ❑ ❑ L C U ci ❑CU U O€ g v ❑ ❑ R r ana § t� m c o n :rl n 7 n rl %L6 kL'IAj bt X y S Al y M r t:• a P�TH �f 1„'f" r� {k` .IR ' :''R.S "'C :S 19 fy'nt # :;C ''Yj'/ .r.. .o,'• j$'i "fl Y- rib..� fi '+w^7 :i3�, a -_r d w' '' x t Uu '_ s ri ;s.n ?: r ;: ° £:°?I't,r` rs ' +� '4 3 : a -.'y 3 fs ; § . a, y i y *'� ;.- -; t ,; _ •� � A,�..+" �` t, � '.s T w.a>T ear�•'s't"� �' :° h 't%�'it €- ii "_:r : '" •,�' 1'. #� .a > S w REMARKS/SPECIAL INSTRUCTIONS ? DATA QUALITY OBJECTIVES CHAIN-OF-CUSTODY RECORD ni MA DEP MCP Data Enhancement Affirmation Regulatory Program Project Specific aC NOTE:All samples submitted subject to Standard Terms d Conditions on reverse hereof. j �4YES[I NO MCP Data Certification required. Slate Standard Deliverables- Many regulatory programs and EPA methods require project R o Sampler: Dal Time eca ed by: /D R elpt Temperature: /-.. - specilicOC..Project7specifiaOCincludesFSampieDupikales, urmL-Rwrrxaa }• VES O MCP DrMkktg,Waler SampleancNded. O CT ❑MCP GW 1/S-1 ❑PINS Form� �Matriz Spikes,and/orMBMx Spike Duplicates. OC is,' � I _ - )yy ae•crx�mmra.o J R ul col%ctlon of conic icate sa le: not project specific unless prearranged.Project specific ,' ContemerCpunt: ( eq ngant thrpf rrp ]ME ❑MCFGW2/S-2 ❑MWRA tl Dal -Time R by. {; Trip blanks are also required,II VOA sample odleclod). ;samples are charged on a per sample balls. MS,MSD l A ❑NY STAW p. ;and Sample DupllcaW requires anWaddhional'sample aliquot. - e vi/� Signature: ONH ❑Drinking Water a ( O NY ❑Wastewater Pro ect Specific OC Required Selection of OC Sample Rel shed W. - �.D e. Time Received DY Laboratory ShippMglA1�b10 ?�.' J Number. CL] 17 RI ❑Waste Disposal -p Sample Duplicate:. ❑Plesse uss'IMM _ ... ❑Vl• O,DredgeMeterial '❑Matrix Spica Custody seal Method e1�Shipmnnt'. WA Courier EaPreasMeii'u Federal Express ,r4 0_ p ❑Matrix SpNce Duplirale UPS pHand❑ Number: 0 i 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 Evaluating 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 s .. 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. Percent 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. I Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 7 of 12 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: ASTM D3328-00 Mod Hydrocarbon Fingerprint Instrument ID: GC4 HP 5890 QC Batch ID: HF-3073-M Extracted: 03-15-10 14:30 Matrix: Soil Analyzed: 03-16-10 02:53 Units: mg/Kg Analyst: MB Analyte `,Spiked,, 7'Measured,'.; -Recovery' QC Limits , Fuel Oil No.2 130 110 85 % 60-140% QC Surrogate Compound" Spiked Measured Recovery. `;; QC Limits. fi ortho-Terphenyl 2.7 2.4 90 % 30-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5-alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. 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 Page 8 of 12 GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: ASTM D3328-00 Mod Hydrocarbon Fingerprint Instrument ID: GC4 HP 5890 QC Batch ID: HF-3073-M Extracted: 03-15-10 14:30 Matrix: Soil Analyzed: 03-16-10 01:58 Analyst: MB Arialyte_ # "Concentration s'. ' "` Notes _',Units x Reporting Gmlt' Total Petroleum Hydrocarbons BRL mg/Kg 60 QC Surrogate Compound. Spiked .IMeasuredl Recovery_ Y, QC Limits',' r ortho-Terphenyl 2.7 1 2.3 1 87% 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5-alpha-androstane as an internal standard. Sample extraction performed by microwave accelerated solvent 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 9 of 12 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.woundwateranalytical.com/qual ifi cations.htm CONNECTICUT. Department of Health Services,PH-0586 Potable Water,Wastewater,Solid Waste and Soil http://www.ct.gov/dph/I ib/dph/envi ronmental_health/envi ronmental_laboratories/pdf/Out_State.pdf MASSACH USETTS Department of Environmental Protection, M-MA-103 Potable Water and Non-Potable Water http://public.dep.state.ma.us/labcert/labcert.aspx Department of Labor, Asbestos Analytical Services,Class A. Division of Occupational Safety, AA000195 http://www.mass.gov/dos/forms/la-rpt_list—aa.pdf NEW HAMPSHIRE 4 `. . .'- Department of Environmental Services, 202708 Potable Water,Non-Potable Water,Solid and Chemical Materials http://www4.egov.nh.gov/DES/NHE LAP NEW YORK Department of Health, 11754 Potable Water,Non-Potable Water,Solid and Hazardous Waste http://www.wadsworth.org/labcert/elap/Comm.html RHODE ISLAND Department of Health, Potable and Non-Potable Water Microbiology,Organic and Inorganic Chemistry Division of Laboratories, LA000054 http://www.health.ri.govAabs/outofstatelabs.pdf U.S. DEPARTMENT OF AGRICULTURE USDA,Soil Permit, S-53921 Foreign soil import permit VERMONT Department of Health, VT-87643 Potable Water http://healthvermont.gov/enviro/ph_lab/water—test.aspx#cert Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 Page 10 of 12 i GROUNDWATER ANALYTICAL Certifications and Approvals MASSACHUSETrs Department of Environmental Protection, M=MA-103 Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Potable Water(Drinking Water) Non-Potable Water(Wastewater) Analyte Method Analyte Method 1,2-Dibromo-3-Chloropropane EPA 504.1 Antimony EPA 200.7 1,2-Dibromoethane EPA 504.1 Antimony EPA 200.8 Alkalinity,Total SM 2320-B Arsenic EPA 200.7 Antimony EPA 200.8 Arsenic EPA 200.8 Arsenic EPA 200.8 Beryllium EPA 200.7 Barium EPA 200.7 Beryllium EPA 200.8 Barium EPA 200.8 Beta-BHC EPA 608 Beryllium EPA 200.7 Biochemical Oxygen Demand SM 5210-8 Beryllium EPA 200.8 Cadmium EPA 200.7 Cadmium EPA 200.7 Cadmium EPA 200.8 Cadmium EPA 200.8 Calcium EPA 200.7 Calcium EPA 200.7 Chemical Oxygen Demand SM 5220-D Chlorine,Residual Free SM 4500-CL-G Chlordane EPA 608 Chromium EPA 200.7 Chloride EPA 300.0 Copper EPA 200.7 Chlorine,Total Residual SM 4500-CL-G Copper EPA 200.8 Chromium EPA 200.7 Cyanide,Total Lachat 10-204-00-1-A Chromium EPA 200.8 E.Coli(Treatment and Distribution) Enz.Sub.SM 9223 Cobalt EPA 200.7 E.Coli(Treatment and Distribution) NA-MUG SM 9222-G Cobalt EPA 200.8 Fecal Col iform(Source Water) MF SM 9222-D Copper EPA 200.7 Fluoride EPA 300.0 Copper EPA 200.8 Fluoride SM 4500-F-C Cyanide,Total Lachat 10-204-00-1-A Heterotrophic Plate Count SM 9215-B DDD EPA 608 Lead EPA 200.8 DDE EPA 608 Mercury EPA 245.1 DDT EPA 608 Nickel EPA 200.7 Delta-BHC EPA 608 Nickel EPA 200.8 Dieldrin EPA 608 Nitrate-N EPA 300.0 Endosulfan I EPA 608 Nitrate-N Lachat 10-107-04-1-C Endosulfan II EPA 608 Nitrite-N EPA 300.0 Endosulfan Sulfate EPA 608 Nitrite-N Lachat 10-107-04-1-C Endrin EPA 608 pH SM 4500-H-B Endrin Aldehyde EPA 608 Selenium EPA 200.8 Fluoride EPA 300.0 Silver EPA 200.7 Gamma-BHC EPA 608 Silver EPA 200.8 Hardness(CaCO3),Total EPA 200.7 Sodium EPA 200.7 Hardness(CaCO3),Total SM 2340-B Sulfate EPA 300.0 Heptachlor EPA 608 Thallium EPA 200.8 Heptachlor Epoxide EPA 608 Total Colifonn(Treatment and Distribution) Enz.Sub.SM 9223 Iron EPA 200.7 Total Coliform(Treatment and Distribution) MF SM 9222-B Kjeldahl-N Lachat 10-107-06-02-D Total Dissolved Solids SM 2540-C Lead EPA 200.7 Trihalomethanes EPA 524.2 Magnesium EPA 200.7 Turbidity SM 2130-8 Manganese EPA 200.7 Volatile Organic Compounds EPA 524.2 Manganese EPA 200.8 Mercury EPA 245.1 Non-Potable Water(Wastewater) Molybdenum EPA 200.7 Analyte Method Molybdenum EPA 200.8 Nickel EPA 200.7 Aldrin EPA 608 Nickel EPA 200.8 Alkalinity,Total SM 2320-B Nitrate-N EPA 300.0 Alpha-BHC EPA 608 Nitrate-N Lachat 10-107-04-1-C Aluminum EPA 200.7 Non-Filterable Residue SM 2540-D. Ammonia-N Lachat 10-107-06-1-B Oil and Grease EPA 1664 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 Page 11 of 12 GROUNDWATER ANALYTICAL Certifications and Approvals MASSACHUSETTS Department of,Enyironmental Protection,,,M-MA=103 Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Non-Potable Water(Wastewater) Analyte Method Orthophosphate Lachat 10-115-01-1-A pH SM 4500-H-13 Phenolics,Total EPA 420.4 Phenolics,Total Lachat 10-210-00-1-13 Phosphorus,Total Lachat 10-115-01-1-C Phosphorus,Total SM 4500-P-B,E Polychlorinated Biphenyls(Oil) EPA 600/4-81-045 Polychlorinated Biphenyls(Water) EPA 608 Potassium EPA 200.7 Selenium EPA 200.7 Selenium EPA 200.8 Silver EPA 200.7 Sodium EPA 200.7 Specific Conductivity SM 2510-B Strontium EPA 200.7 Sulfate EPA 300.0 SVOC-Acid Extractables EPA 625 SVOC-Base/Neutral Extractables EPA 625 Thallium EPA 200.7 Thallium EPA 200.8 Titanium EPA 200.7 Total Dissolved Solids SM 2540-C Total Organic Carbon SM 5310-13 Toxaphene EPA 608 Vanadium EPA 200.7 Vanadium EPA 200.8 Volatile Aromatics EPA 602 Volatile Aromatics EPA 624 Volatile Halocarbons EPA 624 Zinc EPA 200.7 Zinc EPA 200.8 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 12 of 12 GROUNDWATER Groundwater Analytical,Inc. P.O.Box 1200 228 Main Street ANALYTICAL Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 www.groundwateranalytical.com March 22, 2010 Mr. David Bennett Bennett Environmental Associates, Inc. P.O. Box 1743 Brewster, MA 02631 LABORATORY REPORT Project: Compass Realty Development/BEA10-10195 Lab ID: 131925 Received: 03-17-10 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-conformances, a quality control report, and a statement of our state certifications. The analytical results contained in this report meet all applicable NELAC or NVLAP standards, except as may be specifically noted, or described in the project narrative. The analytical results relate only to the samples received. 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 belief, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sincerely, Eric H.Je sen Operatio s Ma ager EHJ/elm Enclosures Page 1 of 14 GROUNDWATER ANALYTICAL Sample Receipt Report Project: Compass Realty Development/BEA10-10195 Delivery: Hand Temperature: 2.9°C Client: Bennett Environmental Associates,Inc. Airbill: n/a Chain of Custody: Present Lab ID: 131925 Lab Receipt: 03-17-10 Custody Seal(s): n/a Lab ID Field ID Matrix I Sampled I Method Notes; #, 131925-1 HB-2:8-12- Soil 3/16/10 10:30 ITPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C415328 250 mL Amber Glass Proline BX34114 None n/a n/a n/a Lab ID Field ID Matrix Sampled Method Notes 131925-2 HB-2:14-16- Soil 3/16/10 10:45 TPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C415326 250 mL Amber Glass Praline BX34114 None n/a n/a n/a Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 Page 2 of 14 GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: HB-2:8-12' Matrix: Soil Project: Compass Realty Development/BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 131925-1 QC Batch ID: HF-3074-M Sampled: 03-16-10 10:30 Instrument ID: GC4 HP 5890 Received: 03-17-10 15:10 Sample Weight: 16 g Extracted: 03-18-10 23:30 Final Volume: 1 mL Analyzed: 03-22-10 12:01 Dilution Factor: 2 Analyst: MB %Solids: 95 Qualitative Identification This sample has GUFID characteristics that are similar to: 1. Petroleum products in the Fuel Oil range. Analyte Concentration _ Notes Units Reporting Limit Total Petroleum Hydrocarbons 730 mg/Kg 120 QC Surrogate Compound I Spiked IMeasuredl Recovery QC Limits ortho-Terphenyl 1 2.7 1 2.2 1 82 % 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 Page 3 of 14 I GROUNDWATER ANALYTICAL ASTM METHOD D3328-00 (Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 131925-01 Hydrocarbons Laboratory 1.0 0.s 0.s 0.4 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 4 of 14 GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: HB-2:14-16' Matrix: Soil Project: Compass Realty Development/BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 131925-2 QC Batch ID: HF-3074-M Sampled: 03-16-10 10:45 Instrument ID: GC4 HP 5890 Received: 03-17-10 15:10 Sample Weight: 15 g Extracted: 03-18-10 23:30 Final Volume: 1 mL Analyzed: 03-22-10 11:10 Dilution Factor: 1 Analyst: MB %Solids: 96 Qualitative Identification No petroleum product was identified for this sample. Analyte r Concentration ,Notes Units, Reporting Lima Total Petroleum Hydrocarbons BRL mg/Kg 61 QC Surrogate Compound Spiked Imeasuredl Recovery QC Limits ortho-Terphenyl 2.7 1 1.9 1 69 % 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alpha-androstane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 Page 5 of 14 GROUNDWATER ANALYTICAL ASTM METHOD D3328-00 (Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 131925-02 Hydrocarbons Laboratory 1.0 0.a 0.6 0.4 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 6 of 14 GROUNDWATER ANALYTICAL Project Narrative Project: Compass Realty Development/BEA10-10195 Lab ID: 131925 Client: Bennett Environmental Associates,Inc. Received: 03617-10 15:10 A.Documentation and Client Communication The following documentation discrepancies,and client changes or amendments were noted for this project: 1 . No documentation discrepancies,changes,or amendments were noted. B.Method Modifications,Non-Conformances and.Observations The sample(s) in this project were analyzed by the references analytical method(s),and no method modifications, non-conformances or analytical issues were noted,except as indicated below: 1 . TPH by GC/FID Note: Sample 131925-1. Sample was diluted prior to analysis. Dilution was required to keep all target analytes within calibration. Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532Page 7 of 14 f GROUNDWATER - 226 Mel-"'ham P.O.Boa 12W Buzzards Bay,MA02532 ,CHAIN-'OF=CUSTODY:RECORD'- . r A'IVALYTICAL ' '• Isoe>iss:.r5 AND WORK ORDER�Prqjod Morris. 'TURNAROUND 'ANALYSIS REQUEST . _ O tOBuafnegi Days _ .-yrdit `yam Project Number. - - ;:Address: _ 13,5 Business. 9 Ed* ea w.e.. timr oumy. oo.r Ago .Io laS :tsr3 J �k S: .17�c3 -g Fn;Sh ou'a r me"Ruri:- Ahilhor aG1..Nunoan 0 i'R Sem-p-le(r.Nl afire. - _Gtyy,/St_a-te`/.Zlp: . - '�P asse Emall to:_ ' -4) - °❑° tt .° ° 3-iLk.T-.VJ -:IMA!`!s'}L�, M: :0263,r •O Please.FAX to:. ': ProleaMenager Telephone BILLING.- 1313 . INSTFiUC110N3:Use aeparrrte Orte:tor each contain ex ❑Thud Patty B®rrj; p { 9� �a � - (.Dept replicates)- 'O:.GWA Clime: �1 fi 'o iSom ,y O 13 e pgg ply' yatrli Type Contalnens) Praaeriranrm ! o`.' `o 0 o a o a " o. ° Doa LA1 SAI�LE" 3OFMMRr NUM .IDEMIFTCATION g. i $ a e .s s {{ BER .. •� .88• �.. } �i ° yg ° B°E g❑ ❑ ❑ JL i •.B g. .a $° (Lob U.0,, ) � P•d�� B . X - ... t k 1 - 1 •l 41 Q. l T ti'� •..: - . . REMARKS/SP f _ ECIAL INSTRUCTIONS DATA QUALITY OBJECTIVES 0iyrs ONO MCP Data CerBfkaljvs regtrlred. CHAIN-OF-CUSTODY RECORD. Reguratory Program Project a dCEFA Specific NOTE:An lea submnted Subject to Standard Terms and Conddnorts on reverse hereof. O YES.j�NO MCP DMlmtg Water Sample srdtded State Standard Deliverables Many regulatory programs and EPA methotlsrequlro protect (Vblame anal require duplicate collection and Trip Blanks). spedfic QC. Protect specilk;OC IrlWudea Sample DupOratae, Date Time Retelvod by. RooelPt Temperature: n O CT LQMCP GW-t/s-t ❑PWS Form Metric Spikes.and/or Matrix Spike Duplicates.Laboratory OC is ID Li 3p g ❑_°wea.me- 7 ❑Analyse andT Blind°only d Paslthe restate, ❑ME ❑MCP GW-2/S-2 O MWRA not Project specific unless Prearranged.Project apeeifk OC - (S,MA ❑NY STARS p semPbe are charged an a per sample beets Eech'NS.MSD -Dam 'Time Floadvod by: 3�7-1 D Container Cwau: and Sample Duplicate requires an additional sample ollquoL. OYES O rid Ibn required. O NN ❑prinking Water ❑NY ❑Wastexalor Project Syedno OC Required Sels°don of QC by Dab Time �pnetli ❑RI ❑Waste Disposal by Stuppkt. rdll (p ❑Matrix Duplicate ❑Pteaeo use : /D �.�L1\ !t Or: � O VT O.Dredge Materiel ❑Matrix Sp o !� of Shipment;A GW �evre3 Mae s 1J1 Custody Sosl ❑— O ❑Matrix spike Dlrptksb ❑UPS O Ha d❑ Num oor. GROUNDWATER ANALYTICAL Quality Assurance/ ualit Control Q Y Q Y 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 Evaluating 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. 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. 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. Percent 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 Page 9 of 14 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: ASTM D3328-00 Mod Hydrocarbon Fingerprint Instrument ID: GC4 HP 5890 QC Batch ID: HF-3074-M Extracted: 03-18-10 23:30 Matrix: Soil Analyzed: 03-19-10 17:17 Units: mg/Kg Analyst: MB Analyte Spiked Measured Recovery ,. QC Limits Fuel Oil No.2 130 100 78 % 60-140% QC Surrogate Compound Spiked_ Measured, Recovery QC Limits ortho-Terphenyl 2.7 2.2 81 % 30-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book ofASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5-alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. 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 02532Page 10 of 14 i GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: ASTM D3328-00 Mod Hydrocarbon Fingerprint Instrument ID: GC4 HP 5890 QC Batch ID: HF-3074-M Extracted: 03-18-10 23:30 Matrix: Soil Analyzed: 03-19-10 16:23 Analyst: MB Analyte Concentration , Notes Units I Reporting Limit Total Petroleum Hydrocarbons BRL mg/Kg 1 60 QC Surrogate Compound spiked Measured- Recovery. QC Limits ortho-Terphenyl 2.7 1 2.0 1 76% 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532Page 11 of 14 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.groundwateranalZical.com/gualifications.htm CONNECTICUT Department of Health Services,PH-0586 Potable Water,Wastewater,Solid Waste and Soil http://www.ct.gov/dph/l ib/dph/envi ronmental_health/environmental_laboratories/pdf/Out_State.pdf MASSACH USETTS Department of Environmental Protection, M-MA-103 Potable Water and Non-Potable Water http://public.dep.state.ma.us/labcert4abcert.aspx Department of Labor, Asbestos Analytical Services,Class A Division of Occupational Safety, AA000195 http://www.mass.gov/dos/forms/la-rpt_list—aa.pdf NEW HAMPSHIRE Department of Environmental Services, 202708 Potable Water,Non-Potable Water,Solid and Chemical Materials http://www4.egov.nh.gov/DES/NH E LAP NEW YORK Department of Health, 11754 Potable Water,Non-Potable Water,Solid and Hazardous Waste http://www.wadsworth.org/labcertlelap/comm.html RHODE ISLAND Department of Health, Potable and Non-Potable Water Microbiology,Organic and Inorganic Chemistry Division of Laboratories, 1A000054 http://www.health.ri.gov/labs/outofstatelabs.pdf U.S. DEPARTMENT OF AGRICULTURE USDA,Soil Permit, S-53921 Foreign soil import permit VERMONT Department of Health, VT-87643 Potable Water http://healthvermont.gov/enviro/ph_lab/water—test.aspx#cert Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 Page 12 of 14 GROUNDWATER ANALYTICAL Certifications and Approvals MASSACHUSETTS `Department of.Environmental Protection;.M'-MA-103 Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Potable Water(Drinking Water) Non-Potable Water(Wastewater) Analyte Method Analyte Method 1,2-Dibromo-3-Chloropropane EPA 504.1 Antimony EPA 200.7 1,2-Dibromoethane EPA 504.1 Antimony EPA 200.8 Alkalinity,Total SM 2320-B Arsenic EPA 200.7 Antimony EPA 200.8 Arsenic EPA 200.8 Arsenic EPA 200.8 Beryllium EPA 200.7 Barium EPA 200.7 Beryllium EPA 200.8 Barium EPA 200.8 Beta-BHC EPA 608 Beryllium EPA 200.7 Biochemical Oxygen Demand SM 5210-B Beryllium EPA 200.8 Cadmium EPA 200.7 Cadmium EPA 200.7 Cadmium EPA 200.8 Cadmium EPA 200.8 Calcium EPA 200.7 Calcium EPA 200.7 Chemical Oxygen Demand SM 5220-D Chlorine,Residual Free SM 4500-CL-G Chlordane EPA 608 Chromium EPA 200.7 Chloride EPA 300.0 Copper EPA 200.7 Chlorine,Total Residual SM 4500-CL-G Copper EPA 200.8 Chromium EPA 200.7 Cyanide,Total Lachat 10-204-00-1-A Chromium EPA 200.8 E.Coli(Treatment and Distribution) Enz.Sub.SM 9223 Cobalt EPA 200.7 E.Coli(Treatment and Distribution) NA-MUG SM 9222-G Cobalt EPA 200.8 Fecal Coliform(Source Water) MF SM 9222-D Copper EPA 200.7 Fluoride EPA 300.0 Copper EPA 200.8 Fluoride SM 4500-FL Cyanide,Total Lachat 10-204-00-1-A Heterotrophic Plate Count SM 9215-B DDD EPA 608 Lead EPA 200.8 DDE EPA 608 Mercury EPA 245.1 DDT EPA 608 Nickel EPA 200.7 Delta-BHC EPA 608 Nickel EPA 200.8 Dieldrin EPA 608 Nitrate-N EPA 300.0 Endosulfan I EPA 608 Nitrate-N Lachat 10-107-04-1-C Endosulfan II EPA 608 Nitrite-N EPA 300.0 Endosulfan Sulfate EPA 608 Nitrite-N Lachat 10-107-04-1-C Endrin EPA 608 pH SM 4500-H-B Endrin Aldehyde EPA 608 Selenium EPA 200.8 Fluoride EPA 300.0 Silver EPA 200.7 Gamma-BHC EPA 608 Silver EPA 200.8 Hardness(CaCO3),Total EPA 200.7 Sodium EPA 200.7 Hardness(CaCO3),Total SM 2340-B Sulfate EPA 300.0 Heptachlor EPA 608 Thallium EPA 200.8 Heptachlor Epoxide EPA 608 Total Coliform(Treatment and Distribution) Enz.Sub.SM 9223 Iron EPA 200.7 Total Coliform(Treatment and Distribution) MF SM 9222-B Kjeldahl-N Lachat 10-107-06-02-D Total Dissolved Solids SM 2540-C Lead EPA 200.7 Trihalomethanes EPA 524.2 Magnesium EPA 200.7 Turbidity SM 2130-B Manganese EPA 200.7 Volatile Organic Compounds EPA 524.2 Manganese EPA 200.8 Mercury EPA 245.1 Non-Potable Water(Wastewater) Molybdenum EPA 200.7 Analyte Method Molybdenum EPA 200.8 Nickel EPA 200.7 Aldrin EPA 608 Nickel EPA 200.8 Alkalinity,Total SM 2320-B Nitrate-N EPA 300.0 Alpha-BHC EPA 608 Nitrate-N Lachat 10-107-04-1-C Aluminum EPA 200.7 Non-Filterable Residue SM 2540-D Ammonia-N Lachat 10-107-06-1-B Oil and Grease EPA 1664 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 13 of 14 i GROUNDWATER ANALYTICAL Certifications and Approvals MASSACHUSETTS Department of Environmental Protection, M-MA-103' Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Non-Potable Water(Wastewater) Analyte Method Orthophosphate Lachat 10-115-01-1-A pH SM 4500-H-B Phenolics,Total EPA 420.4 Phenolics,Total Lachat 10-210-00-1-13 Phosphorus,Total Lachat 10-115-01-1-C Phosphorus,Total SM 4500-P-B,E Polychlorinated Biphenyls(Oil) EPA 600/4-81-045 Polychlorinated Biphenyls(Water) EPA 608 Potassium EPA 200.7 Selenium EPA 200.7 Selenium EPA 200.8 Silver EPA 200.7 Sodium EPA 200.7 Specific Conductivity SM 2510-13 Strontium EPA 200.7 Sulfate EPA 300.0 SVOC-Acid Extractables EPA 625 SVOC-Base/Neutral Extractables EPA 625 Thallium EPA 200.7 Thallium EPA 200.8 Titanium EPA 200.7 Total Dissolved Solids SM 2540-C Total Organic Carbon SM 5310-13 Toxaphene EPA 608 Vanadium EPA 200.7 Vanadium EPA 200.8 Volatile Aromatics EPA 602 Volatile Aromatics EPA 624 Volatile Halocarbons EPA 624 Zinc EPA 200.7 Zinc EPA 200.8 Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 Page 14 of 14 i GROUNDWATER Groundwater Analytical,Inc. P.O.Box 1200 228 Main Street ANALYTICAL. Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 www.groundwateranalytical.com March 31, 2010 Mr. David Bennett Bennett Environmental Associates, Inc. P.O. Box 1743 Brewster, MA 02631 LABORATORY REPORT Project: DeDecko/Compass Realty/BEA10-10195 Lab ID: 132072 Received: 03-24-10 Dear Dave: Enclosed are the analytical results for the above referenced project. The project was processed for Priority 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 or NVLAP standards, except as may be specifically noted, or described in the project narrative. The analytical results relate only to the samples received. This report may only be used or reproduced in its entirety. 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 belief, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. SincerelyVMaager Eric H.Je Operatio EHJ/elm Enclosures Page 1 of 24 i GROUNDWATER ANALYTICAL Sample Receipt Report Project: DeDecko/Compass Realty/BEA10-10195 Delivery: GWA Courier "Temperature: 2.7°C Client: Bennett Environmental Associates,Inc. Airbill: n/a Chain of Custody: Present Lab ID: 132072 Lab Receipt: 03-24-10 Custody Seal(s): n/a Lab ID Field ID Matrix Sampled Method Notes 132072-1 OB Stockpile Soil 3/24/10 10:00 TPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C1226551 250 mL Amber Glass Proline BX34645 None n/a n/a n/a Lab ID Field ID Matrix Sampled Method Notes 132072-2 SW-5:6-12' Soil 3/24/10 10:30 TPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot T Presery QC Lot Prep Ship C1226549 250mLAmberGlassJ Proline BX34645 None n/a I n/a n/a Lab ID Field ID Matrix Sampled Method Notes 132072-3 SW-N:6-12' Soil 3/24/10 10:35 TPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C1226550 250 mL Amber Glass Proline BX34645 None n/a n/a n/a Lab ID Field ID Matrix Sampled Method Notes 1320724 SW-E:6-12' Soil 3/24/10 10:40 TPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot—T Presery QC Lot I Prep I Ship C1226548 250 mL Amber Glassl Proline BX34645 None n/a I n/a I n/a Lab ID Field ID Matrix Sampled Method Notes 132072-5 SW-W:6-12' Soil 3/24/10 10:45 TPH by GC ASTM D3328-00 Mod Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C1226547 250 mL Amber Glass Proline BX34645 None n/a n/a n/a Lab ID Field ID Matrix Sampled Method Notes 132072-6 BOH:12-13' Soil 3/24/10 11:00 MA DEP EPH with PAHs Con ID Container Vendor QC Lot Presery QC Lot I Prep Ship C1226546 250 mL Amber Glass Proline BX34645 None n/a I n/a n/a Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 2 of 24 i GROUNDWATER ANALYTICAL Data Certification Project: DeDecko/Compass Realty/BEA10-10195 Lab ID: 132072 Client: Bennett Environmental Associates,Inc. Received: 03-24-10 15:30 MA DEP Compendium of Analytical Methods Project Location: n/a MA DEP RTN: n/a This Form provides certifications for the following data set: MA DEP EPH: 132072-6 Sample Matrices: Groundwater ( ) Soil/Sediment (X) Drinking Water ( ) Other ( ) MCPSW-846 8260E ( ) 8151A ( ) 8330 ( ) 6010E ( ) 7470A/1A ( ) Methods Used 8270C ( ) 8081A ( ) VPH ( ) 6020A ( ) 9012AZ ( ) As specified in MA DEP 8082 ( ) 8021 B ( ) EPH (X) 7000 S3 ( ) Other ( ) Compendium of Analytical 1. List Release Tracking Number(RTN),if known. Methods. 2. SW-846 Method 9012A(Equivalent to 9014)or MA DEP Physiologically Available Cyanide(PAC)Method (check all that apply) 3. 5-SW-846 Methods 7000 Series. List individual method and analyte. An affirmative response to questions A,B,C and D is required for"Presumptive Certainty"status. A. Were all samples received by the laboratory in a condition consistent with that described on the Chain-of-Custody documentation for the data set? Yes B. Were all QA/QC procedures required for the specified analytical method(s) included in this report followed,including the requirement to note and / discuss in a narrative QC data that did not meet appropriate performance / standards or guidelines? Yes C. Does the analytical data included in this report meet all the requirements for"Presumptive Certainty,"as described in Section 2.0 of the MA DEP / document CAM VI A,Quality Assurance and Quality Control Guidelines for the Acquisition and Reporting of Analytical Data? Yes D. VPH and EPH methods only: Was the VPH or EPH method run without significant modifications,as specified in Section 11.3? Yes A response to questions E and F below is required for"Presumptive Certainty"status. E. Were all QC performance standards and recommendations for the specified methods achieved? Yes F. Were results for all analyte-list compounds/elements for the specified method(s)reported? Yes All No answers are addressed in the attached Project Narrative. I,the undersigned,attest under the pains and penalties of perjury that,based upon my personal inquiry of those responsible for obtaining the information,the material contained in this analytical report is,to the best of my h nowledge and belief,accurate and complete. Signature: �j` Position: Operations Manager Printed Name: Eric H. ensen Date: 03-31-10 Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532Page 3 of 24 it GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: OB Stockpile Matrix: Soil Project: DeDecko/Compass Realty/BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 132072-1 QC Batch ID: HF-3077-M Sampled: 03-24-10 10:00 Instrument ID: GC4 HP 5890 Received: 03-24-10 15:30 Sample Weight: 15 g Extracted: 03-29-10 17:30 Final Volume: 1 mL Analyzed: 03-30-10 15:11 Dilution Factor: 1 Analyst: MB %Solids: 95 Qualitative Identification No petroleum product was identified for this sample. Analyte Concentration Notes Units Reporting Limit Total Petroleum Hydrocarbons I BRL mg/Kg 62 QC Surrogate Compound I Spiked Measured Recovery QC Limits ortho-Terphenyl 1 2.7 1 2.4 1 88 % 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alpha-androstane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 Page 4 of 24 GROUNDWATER ANALYTICAL ASTM METHOD D3328-00 (Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 132072-01 Hydrocarbons Laboratory 1.0 0.8 0.6 0.4 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 5 of 24 GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: SW-S:6-12' Matrix: Soil Project: DeDecko/Compass Realty/BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 132072-2 QC Batch ID: HF-3077-M Sampled: 03-24-10 10:30 Instrument ID: GC4 HP 5890 Received: 03-24-10 15:30 Sample Weight: 16 g Extracted: 03-29-10 17:30 Final Volume: 1 mL Analyzed: 03-30-10 16:06 Dilution Factor: 1 Analyst: MB %Solids: 93 Qualitative Identification No petroleum product was identified for this sample. Analyte Concentration Notes units Reporting Limit Total Petroleum Hydrocarbons BRL mg/Kg 61 QC Surrogate Compound I Spiked Measured Recovery QC Limits ortho-Terphenyl 2.7 1 2.4 88 % 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alpha-androstane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 page 6 of 24 GROUNDWATER ANALYTICAL ASTM METHOD D3328-00 (Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 132072-02 Hydrocarbons Laboratory 1.0 0.a 0.s 0.4 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 7 of 24 GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: SW-N:6-12' Matrix: Soil Project: DeDecko/Compass Realty/BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 132072-3 QC Batch ID: HF-3077-M Sampled: 03-24-10 10:35 Instrument ID: GC4 HP 5890 Received: 03-24-10 15:30 Sample Weight: 16 g Extracted: 03-29-10 17:30 Final Volume: 1 mL Analyzed: 03-30-10 17:01 Dilution Factor: 1 Analyst: MB %Solids: 91 Qualitative Identification No petroleum product was identified for this sample. Analyte Concentration Notes Units Reporting Limit Total Petroleum Hydrocarbons BRL mg/Kg 63 QC Surrogate Compound Spiked Imeasuredl Recovery QC Limits ortho-Terphenyl 2.8 1 2.4 1 85 % 60-140°% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 62532 Page 8 of 24 GROUNDWATER ANALYTICAL ASTM METHOD D3328-00(Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 132072-03 Hydrocarbons Laboratory 1.0 0.8 0.6 0.4 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 9 of 24 I GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: SW-E:6-12' Matrix: Soil Project: DeDecko/Compass Realty/BEA10-10195 Container: 250 mt.Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 132072-4 QC Batch ID: HF-3077-M Sampled: 03-24-10 10:40 Instrument ID: GC4 HP 5890 Received: 03-24-10 15:30 Sample Weight: 15 g Extracted: 03-29-10 17:30 Final Volume: 1 mL Analyzed: 03-30-10 17:55 Dilution Factor: 1 Analyst: MB %Solids: 94 Qualitative Identification No petroleum product was identified for this sample. Analyte Concentration Notes Units Reporting Limit Total Petroleum Hydrocarbons I BRL mg/Kg 63 QC Surrogate Compound Spiked Measured Recovery QC Limits ortho-Terphenyl 1 2.8 1 2.4 1 87 % 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 54phaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 025321age 10 of 24 GROUNDWATER ANALYTICAL ASTM METHOD D3328-00 (Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 1 32072-04 Hydrocarbons Laboratory 1.0 0.a 0.s 0.a 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 11 of 24 i GROUNDWATER ANALYTICAL ASTM Method D3328-00(Modified) Hydrocarbon Fingerprint by GC/FID Field ID: SW-W:6-12' Matrix: Soil Project: DeDecko/Compass Realty/BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 132072-5 QC Batch ID: HF-3077-M Sampled: 03-24-10 10:45 Instrument ID: GC4 HP 5890 Received: 03-24-10 15:30 Sample Weight: 15 g Extracted: 03-29-10 17:30 Final Volume: 1 mL Analyzed: 03-30-10 18:50 Dilution Factor: 1 Analyst: MB %Solids: 95 Qualitative Identification No petroleum product was identified for this sample. Analyte Concentration Notes Units Reporting Limit Total Petroleum Hydrocarbons BRL mg/Kg 62 QC Surrogate Compound Spiked IMeasuredl Recovery QC Limits ortho-Terphenyl 2.8 1 2.4 1 88 % 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 54phaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. Results are reported on a dry weight basis. 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532Page 12 of 24 GROUNDWATER ANALYTICAL ASTM METHOD D3328-00 (Modified) Hydrocarbon Fingerprinting by GC/FID Lab ID: 132072-05 Hydrocarbons Laboratory 1.0 0.8 0.6 0.4 0.2 0.0 0 5 10 15 20 25 30 35 40 45 Retention Time (Minutes) Page 13 of 24 GROUNDWATER ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GC/FID Field ID: BOH:12-13' Matrix: Soil Project: DeDecko/Compass Realty/BEA10-10195 Container: 250 mL Amber Glass Client: Bennett Environmental Associates,Inc. Preservation: Cool Laboratory ID: 132072-6 QC Batch ID: EP-3087-M Sampled: 03-24-10 11:00 Instrument ID: GC-12 Agilent 6890 Received: 03-24-10 15:30 Sample Weight: 15 g Extracted: 03-26-10 13:30 Final Volume: 1 mL Analyzed(AL): 03-27-10 06:14 %Solids: 97 Analyzed(AR): 03-27-10 07:00 Aliphatic Dilution Factor: 1 Analyst: KM Aromatic Dilution Factor: 1 EPH Ranges Concentration Notes Units Reporting Limit n-C9 to n-C18 Aliphatic Hydrocarbons t BRL mg/Kg 30 n-C19 to n-C36 Aliphatic Hydrocarbons t BRL mg/Kg 30 n-C11 to n-C22 Aromatic Hydrocarbons to BRL mg/Kg 30 Unad'usted n-C11 to n-C22 Aromatic Hydrocarbons t BRL mg/Kg 30 CAS Number Analyte Concentration Notes 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 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 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 mg1Kg 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 Compound Spiked Measured Recovery QC Limits Fractionation: 2-Fluorobiphenyl 2.7 2.0 75 % 40-140% 2-Bromonaphthalene 2.7 1.4 52 % 40-140% Extraction: Chloro-octadecane 2.7 2.0 76 % 40-140% ortho-Terphenyl 2.7 2.3 86% 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? No 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(Revision 1.1,2004). Sample extraction performed by microwave accelerated solvent extraction technique. Results are reported on a dry weight basis. 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 size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-C71 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 025320age 14 of 24 GROUNDWATER ANALYTICAL Project Narrative Project: DeDecko/Compass Realty/BEA10-10195 Lab ID: 132072 Client: Bennett Environmental Associates,Inc. Received: 03-24-10 15:30 A.Documentation and Client Communication The following documentation discrepancies,and client changes or amendments were noted for this project: 1 . No documentation discrepancies,changes,or amendments were noted. B.Method Modifications,Non-Conformances and Observations The sample(s)in this project were analyzed by the references analytical method(s),and no method modifications, non-conformances or analytical issues were noted,except as indicated below: ; 1 . No method modifications,non-conformances or analytical issues were noted. Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 0253Nge 15 of 24 _ 1•GROUNGWAT£R Brardn Sbeet,P.O.Baoc,200 n_ r. Bi�ardsBay,MAozs92 � CHAIN-OF-CUSTODY;RECORD " i4lYALYTICAL Teiea"ono(soy, sit o w,•FAX(SM)759-4475 j AND WORK ORDER w _ f ?www.groundWelen—lyticai,00m . r s Project Name: Firm: r „ 'TURNAROUNDS ANALYSISREQUEST 1 °� Q°" ! ' ►des, ,� ,- t� .r '��❑//, Busleese Days _ - - one" wn -:Project Number.' -Address: - !,/5 Business Days { � , erm. t� Y L76rJsIO .:W.1� 13 ❑RUSH RAN x p R - *•�• V .4 (RYetl'IOQutres RUN AI@I011ietlon Numeer) 'di1 '' � i ❑❑O •~ ; o E , 'Sampler Name:, �y/State/Zip:;.. _ -- lease Email to:. - -i - D ► t'�' .? PleaseFAXto •... { ` Q � Project Manager, wTelephone: BILLING + m r �° 5 �. ❑ if ❑: ❑ ❑ o❑ li ^ § O rchase.ORlerNo.:•".� -. pt ° .• Third Party Billkv. .; INSTRUCTIONS:Use separate Ilne tw-each container(except replicates). _ o ° �. P ❑ GWAOudte: 11 Syam tn9 Me - - ' oM o a o o a° aa a lx ContalnerTYPa (8)t Presereton ° K ❑ ❑ iit _ a 51 LAB SAMPLE , s' ORATORY•i' IK&&& e t F y� ° g ° ❑ �. i m NUMBER IDENTIFICATION' . �. '� e a a Y s t3 ' (Lab Use Only) mr. a w. :. 3 r e ❑ ❑ 3 6 0 ❑ _ : IA ID:35 `5v1-a::b-Q' Ig I 1 r ■� {{ i ho • s r< r ,. h a REMARKS L SPECIALjINSTRUCTIONS, r DATA QUALITY OBJECTIVES±y { r CHAIN-OF-CUSTODYRECORD: _YES O NO MCP Data Certftatlon nwired.- . .Regulatory Program - '*. - _ Project S Clfic OC .._ jS .. � Pe NOTE•All.samples suhmuaedsubject to Standard Terms and Conditions an reverse hereof.;: r OYES MCP OrirWng Wetsr;Sample Included.,. State Standard 'Deliverables;- Many regulatory programs end EPA Main s require project;• R' utshed plor Dalo 1 'Tine Aec tiy: ?� 1Y Rewipt 7amperaturdr (Volorl 'requlm dupltcate collection dW Tdp Blanks). -- - - - apecific OC.Project specific OC Includes Sample Duplicates,. ^� - #,, (, - - O:PWS Form 'watrix spikes,and/or Matrix Spike Duplicates.Laboratory OC,Is, _ "" 1 �; 13? •°/,•, " * ❑Arialyza Duplicates and Trips Blanks oNy r7.poslUve results, O,ME CP GW-21S-2"O MWRA. 'not project specific unless prearranged.Project specific QC _ - X. '-- •. ._. -. . - samples are charged don a r sample is.Each M MSD - - Time Bete Container Count -r a .sem .tiro e 1 basis.Ea S - ,y". - „- - � .. - nd _mple DupUcate requ_irettsn etlditlanel eampli Niquo4 `s t, -' " OYES�O NO P ❑NH':pDrihking Walet'.. ' `a ° '• a - 7 .. required., _ Sa —• ." .h _ 1 S _ + ❑NY, O Wastewater Project Specific QC Required Seleceon ofpC Sample- ., fished by:- _,tr. Date�' /Time• Received try Lebomta,.• Shipping/AlrbaG -y:,•' .i,� s ignature �R ' ❑-RI -O Waste.0lsposel' ,O Samptsoupacate. 'O.Ptease use&ample•r + n f. - _. - ,{ Number: N. O VT -O Dredge:Material= O Metric SPixe; SMpmenf WA Courier O Express Mail O Federal Express: +�'Custody Seal.. „•,. y "MeunOdM ,, , ❑._•'lT `�_ v❑MaMx Spike;Dupprate. _ ' ',� 'O-UPS O_F1end❑ Number. . N GROUNDWATER ANALYTICAL Quality Assurance/Quality Control A. Program Overview Groundwa,ter 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 Evaluating 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. 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. Percent 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 Page 17 of 24 it -- r GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Samples LCS LCSD Category: MA DEP EPH Method Instrument ID: GC-12 Agilent 6890 Instrument ID: GC-12 Agilent 6890 QC Batch ID: EP-3087-M Extracted: 03-26-10 13:30 Extracted: 03-26-10 13:30 Matrix: Soil Analyzed(AL): 03-27-10 01:41 Analyzed(AL): 03-27-10 03:12 Units: mg/Kg Analyzed(AR): 03-27-10 02:26 Analyzed(AR): 03-27-10 03:57 Analyst: KM Analyst: KM CAS Number Analyte LCS LCS Duplicate QC Limits Spiked measured Recovery Spiked Measured Recovery RPD Spike RPD 111-84-2 n-Nonane(C9) 3.3 1.8 54 % 3.3 1.8 55 % 2 % 30-140% 25% 124-18-5 n-Decane(C10) 3.3 2.1 62 % 3.3 2.1 63 % 2 % 40-140% 25% 1 12-40-3 n-Dodecane(C12) 3.3 2.3 68 % 3.3 2.3 71 % 3 % 40-140% 25% 629-59-4 n-Tetradecane(C14) 3.3 2.2 66 % 3.3 2.3 69 % 5 % 40-140% 25% 544-76-3 n-Hexadecane(C16) 3.3 2.5 75 % 3.3 2.5 76 % 2 % 40-140% 25% 593-45-3 n-Octadecane(C18) 3.3 2.7 81 % 3.3 2.8 83 % 3 % 40-140% 25% n/a n-C9 to n-C18 Group 20 13 68 % 20 14 70 % 3 % 40-140% 25% 629-92-5 n-Nonadecane(C19) 3.3 2.7 83 % 3.3 2.8 85 % 3 % 40-140% 25% 112-95-8 n-Eicosane(C20) 3.3 2.6 80 % 3.3 2.7 83 % 4 % 40-140% 25% 629-97-0 n-Docosane(C22) 3.3 2.7 80 % 3.3 2.8 84 % 4 % 40-140% 25% 646-31-1 n-Tetracosane(C24) 3.3 2.8 84 % 3.3 2.9 87 % 4 % 40-140% 25% 630-01-3 n-Hexacosane(C26) 3.3 2.6 80 % 3.3 2.8 85 % 6 % 40-140% 25% 630-02-4 n-Octacosane(C28) 3.3 2.7 81 % 3.3 2.8 84 % 4 % 40-140% 25% 638-68-6 n-Triacontane(C30) 3.3 2.7 82 % 3.3 2.9 87 % 5 % 40-140% 25% 630-06-8 n-Hexatriacontane(C36) 3.3 2.5 74 % 3.3 2.6 79 % 6 % 40-140% 25% n/a n-C19 to n-C36 Group 26 21 80 % 26 22 84 % 5 % 40-140% 25% 91-20-3 Naphthalene 3.3 2.0 60 % 3.3 1.9 58 % 3 % 40-140% 25% 91-57-6 2-Methyl naphthalene 3.3 2.2 66 % 3.3 2.1 65 % 1 % 40-140% 25% 208-96-8 Acenaphthylene 3.3 2.4 72 % 3.3 2.4 72 % 1 % 40-140% 25% 83-32-9 Acenaphthene 3.3 2.4 72 % 3.3 2.4 72 % 0 % 40-140% 25% 86-73-7 Fluorene 3.3 2.7 80 % 3.3 2.6 80 % 1 % 40-140% 25% 85-01-8 Phenanthrene 3.3 2.9 88 % 3.3 2.8 86 % 2 % 40-140% 25% 120-12-7 Anthracene 3.3 3.1 93 % 3.3 3.0 92 % 1 % 40-140% 25% 206-44-0 Fluoranthene 3.3 2.8 85 % 3.3 2.8 84 % 1 % 40-140% 25% 129-00-0 Pyrene 3.3 2.8 83 % 3.3 2.7 83 % 1 % 40-140% 25% 56-55-3 Benzo[a]anthracene 3.3 2.8 85 % 3.3 2.8 85 % 0 % 40-140% 25% 218-01-9 Chrysene 3.3 2.8 85 % 3.3 2.8 85 % 0 % 40-140% 25% 205-99-2 Benzo[b]fluoranthene 3.3 2.8 84 % 3.3 2.8 84 % 0 % 40-140% 25% 207-08-9 Benzo[k]fluoranthene 3.3 2.8 86 % 3.3 2.8 86 % 0 % 40-140% 25% 50-32-8 Benzo[a]pyrene 3.3 3.1 93 % 3.3 3.1 93 % 0 % 40-140% 25% 193-39-5 Indeno[1,2,3-c,d]pyrene 3.3 2.9 87 % 3.3 2.9 86 % 1 % 40-140% 25% 53-70-3 Dibenzo[a,h]anthracene 3.3 3.2 98 % 3.3 3.2 98 % 1 % 40-140% 25% 191-24-2 Benzo[g,h,i]perylene 3.3 2.9 89 % 3.3 2.9 87 % 1 % 40-140% 25% n/a PAH Group 56 46 83 % 56 46 82 % 1 .1 40-140% 251 QC Surrogate Compound Spiked Measured Recovery Spiked Measured Recovery QC Limits Fractionation: 2-Fluorobiphenyl 2.7 2.2 81 % 2.7 2.1 78 % 40-140% 2-Bromonaphthalene 2.7 2.0 74 % 2.7 2.2 81 % 40-140% Extraction: Chloro-octadecane 2.7 2.1 78 % 2.7 2.0 74 % 40-140% ortho-Terphenyl 2.7 2.5 93 % 2.7 2.4 89 % 40-140% Fractionation Breakthrough Evaluation QC Limits 91-20-3 Naphthalene I LCS 0 % LCSD 0 % 5% 91-57-6 2-Methylnaphthalene I LCS 0 % I LCSD 0 % 5% Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Method modified by use of microwave accelerated solvent extraction technique. 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. The LCS and LCSD are prepared from separate source standards than those used for calibration. Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay,MA 02532Page 18 of 24 i GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: MA DEP EPH Instrument ID: GC-12 Agilent 6890 QC Batch ID: EP-3087-M Extracted: 03-26-10 13:30 Matrix: Soil Analyzed(AL): 03-27-10 04:43 Analyzed(AR): 03-27-10 05:28 Analyst: KM EPH Ranges Concentration Notes Units Reporting Limit n-C9 to n-C18 Aliphatic Hydrocarbons t BRL mg/Kg 30 n-C19 to n-C36 Aliphatic Hydrocarbons t BRL mg/Kg 30 n-Cl1 to n-C22 Aromatic Hydrocarbons t0 BRL mg/Kg 30 !load-Lusted n-C11 to n-C22 Aromatic Hydrocarbons t BRL mg/Kg 30 CAS Number Analyte Concentration Notes 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 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 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 Compound Spiked Measured Recovery QC Limits Fractionation: 2-Fluorobiphenyl 2.7 2.3 85 % 40-140% 2-Bromonaphthalene 2.7 1.3 50% 40-140% Extraction: Chloro-octadecane 2.7 2.3 85 % 40-140% ortho-Terphenyl 2.7 2.5 94% 40-140% Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Sample extraction performed by 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 size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in 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 02534)age 19 of 24 I GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: ASTM D3328-00 Mod Hydrocarbon Fingerprint Instrument ID: GC4 HP 5890 QC Batch ID: HF-3077-M Extracted: 03-29-10 17:30 Matrix: Soil Analyzed: 03-30-10 12:52 Units: mg/Kg Analyst: MB Analyte Spiked Measured Recovery QC Limits Fuel Oil No.2 130 110 82 % 60-140% QC Surrogate Compound Spiked Measured Recovery QC Limits ortho-Terphenyl 2.7 2.3 88 % 30-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5-alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent technique. 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 02532Page 20 of 24 GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: ASTM D3328-00 Mod Hydrocarbon Fingerprint Instrument ID: GC4 HP 5890 QC Batch ID: HF-3077-M Extracted: 03-29-10 17:30 Matrix: Soil Analyzed: 03-30-10 11:02 Analyst: MB Analyte Concentration Not Units Reporting Limit Total Petroleum Hydrocarbons BRL mg/Kg 60 QC Surrogate Compound Spiked Imeasuredl Recovery QC Limits ortho-Terphenyl 2.7 1 2.4 1 90% 60-140% Method Reference: Comparison of Waterborne Petroleum Oils by Gas Chromatography,Annual Book of ASTM Standards,Volume 11.02, American Society for Testing and Materials(2000). Method modified to quantify total petroleum hydrocarbons in the range n-C 9 through n-C 36. Results are quantified on the basis of a series of aromatic and aliphatic hydrocarbons,using 5alphaandrostane as an internal standard. Sample extraction performed by microwave accelerated solvent 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 size and dilution. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532)age 21 of 24 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.groundwateranalZical.com/-qualifications.htm CON N ECTI CUT Department of Health Services,PH-0586 Potable Water,Wastewater,Solid Waste and Soil http://www.ct.gov/dph/l ib/dph/envi ron mental_health/environmental_laboratories/pdf/Out_State.pdf MASSACH USETTS Department of Environmental Protection, M-MA-103 Potable Water and Non-Potable Water http://public.dep.state.ma.us/labcert/labcert.aspx Department of Labor, Asbestos Analytical Services,Class A Division of Occupational Safety, AA000195 http://www.mass.gov/dos/forms/la-rpt—list—aa.pdf NEW HAMPSHIRE Department of Environmental Services, 202708 Potable Water,Non-Potable Water,Solid and Chemical Materials http://www4.egov.nh.gov/DES/N HE LAP NEW YORK Department of Health, 11754 Potable Water,Non-Potable Water,Solid and Hazardous Waste http://www.wadsworth.org/labcert/elap/comm.html RHODE ISLAND Department of Health, Potable and Non-Potable Water Microbiology,Organic and Inorganic Chemistry Division of Laboratories, LA000054 http://www.health.ri.gov/labs/outofstatelabs.pdf U.S.DEPARTMENT OF AGRICULTURE USDA,Soil Permit, 5-53921 Foreign soil import permit VERMONT Department of Health, VT-87643 Potable Water http://healthvermont.gov/enviro/ph_lab/water test.aspx#cert Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 Page 22 of 24 I GROUNDWATER ANALYTICAL Certifications and Approvals MASSACHUSETTS Department of Environmental Protection, M-MA-103 Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Potable Water(Drinking Water) Non-Potable Water(Wastewater) Analyte Method Analyte Method 1,2-Dibromo-3-Chloropropane EPA 504.1 Antimony EPA 200.7 1,2-Dibromoethane EPA 504.1 Antimony EPA 200.8 Alkalinity,Total SM 2320-B Arsenic EPA 200.7 Antimony EPA 200.8 Arsenic EPA 200.8 Arsenic EPA 200.8 Beryllium EPA 200.7 Barium EPA 200.7 Beryllium EPA 200.8 Barium EPA 200.8 Beta-BHC EPA 608 Beryllium EPA 200.7 Biochemical Oxygen Demand SM 5210-B Beryllium EPA 200.8 Cadmium EPA 200.7 Cadmium EPA 200.7 Cadmium EPA 200.8 Cadmium EPA 200.8 Calcium EPA 200.7 Calcium EPA 200.7 Chemical Oxygen Demand SM 5220-D Chlorine,Residual Free SM 4500-CL-G Chlordane EPA 608 Chromium EPA 200.7 Chloride EPA 300.0 Copper EPA 200.7 Chlorine,Total Residual SM 4500-CL-G Copper EPA 200.8 Chromium EPA 200.7 Cyanide,Total Lachat 10-204-00-1-A Chromium EPA 200.8 E.Coli(Treatment and Distribution) Enz.Sub.SM 9223 Cobalt EPA 200.7 E.Coli(Treatment and Distribution) NA-MUG SM 9222-G Cobalt EPA 200.8 Fecal Coliform(Source Water) MF SM 9222-D Copper EPA 200.7 Fluoride EPA 300.0 Copper EPA 200.8 Fluoride SM 4500-F-C Cyanide,Total Lachat 10-204-00-1-A Heterotrophic Plate Count SM 9215-B DDD EPA 608 Lead EPA 200.8 DDE EPA 608 Mercury EPA 245.1 DDT EPA 608 Nickel EPA 200.7 Delta-BHC EPA 608 Nickel EPA 200.8 Dieldrin EPA 608 Nitrate-N EPA 300.0 Endosulfan I EPA 608 Nitrate-N Lachat 10-107-04-1-C Endosulfan II EPA 608 Nitrite-N EPA 300.0 Endosulfan Sulfate EPA 608 Nitrite-N Lachat 10-107-04-1-C Endrin EPA 608 pH SM 4500-H-B Endrin Aldehyde EPA 608 Selenium EPA 200.8 Fluoride EPA 300.0 Silver EPA 200.7 Gamma-BHC EPA 608 Silver EPA 200.8 Hardness(CaCO3),Total EPA 200.7 Sodium EPA 200.7 Hardness(CaCO3),Total SM 2340-B Sulfate EPA 300.0 Heptachlor EPA 608 Thallium EPA 200.8 Heptachlor Epoxide EPA 608 Total Coliform(Treatment and Distribution) Enz.Sub.SM 9223 Iron EPA 200.7 Total Coliform(Treatment and Distribution) MF SM 9222-B Kjeldahl-N Lachat 10-107-06-02-D Total Dissolved Solids SM 2540-C Lead EPA 200.7 Trihalomethanes EPA 524.2 Magnesium EPA 200.7 Turbidity SM 2130-B Manganese EPA 200.7 Volatile Organic Compounds EPA 524.2 Manganese EPA 200.8 Mercury EPA 245.1 Non-Potable Water(Wastewater) Molybdenum EPA 200.7 Analyte Method Molybdenum EPA 200.8 Nickel EPA 200.7 Aldrin EPA 608 Nickel EPA 200.8 Alkalinity,Total SM 2320-B Nitrate-N EPA 300.0 Alpha-BHC EPA 608 Nitrate-N Lachat 10-107-04-1-C Aluminum EPA 200.7 Non-Filterable Residue SM 2540-D Ammonia-N Lachat 10-107-06-1-B Oil and Grease EPA 1664 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 23 of 24 GROUNDWATER ANALYTICAL Certifications and Approvals MASSACHUSETTS Department of Environmental Protection, M-MA-103 Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Non-Potable Water(Wastewater) Analyte Method Orthophosphate Lachat 10-115-01-1-A pH SM 4500-H-8 Phenolics,Total EPA 420.4 Phenolics,Total Lachat 10-210-00-1-13 Phosphorus,Total Lachat 10-115-01-1-C Phosphorus,Total SM 4500-P-B,E Polychlorinated Biphenyls(Oil) EPA 600/4-81-045 Polychlorinated Biphenyls(Water) EPA 608 Potassium EPA 200.7 Selenium EPA 200.7 Selenium EPA 200.8 Silver EPA 200.7 Sodium EPA 200.7 Specific Conductivity SM 2510-B Strontium EPA 200.7 Sulfate EPA 300.0 SVOC-Acid Extractables EPA 625 SVOC-Base/Neutral Extractables EPA 625 Thallium EPA 200.7 Thallium EPA 200.8 Titanium EPA 200.7 Total Dissolved Solids SM 2540-C Total Organic Carbon SM 5310-13 Toxaphene EPA 608 Vanadium EPA 200.7 Vanadium EPA 200.8 Volatile Aromatics EPA 602 Volatile Aromatics EPA 624 Volatile Halocarbons EPA 624 Zinc EPA 200.7 Zinc EPA 200.8 Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532 Page 24 of 24 eT eeKRAOE NeTes LEGEND 4 A.a n en4Nnplu An DnuTrras eaulro IdZ "ewTla uAxzaE Ar Q ECUs ' WARII9WWDE e W/DMLLMOLE WA/01 VALIB�— i C9/OR ML D FOUND FWN Nt9RAKT TF -1 MTER LINE "/�'swf� MAPLE AVENUE CB/DNhLH01E a'9• s iPEE FOUND- Ek1611N0 SPOT ORAOE - -_ (PUUC-40'WTDE) [NSTVIO GRADE AP \.� wD/NCEpITEA '"DD co No -�.----"'� LOCUS mscu ss.n' I i � i k �. N e•e1'so"tet.os ,�p'0 __ M>• _ oB/ORI FOUND LAIN I CERTIFY THAT THE 51RUCTURES ARE a1 / \�F LOCATED ON THE LOT AS SHOWN.AND \ THAT THEIR LOCATIONS CONFORM TO THE aK W.m N.Fri.Ewoort YINBWM SETBACK REOUDTDIEN75 OF THE a I°p N anp ay.\ +\ \ \ e urmA a u..aumrr BAANSTABLE ZONING BY-LAW. T 2 \\ \\ �� HOLMES AND MOGRATH.INC s !!! / 6m.� \\\\ Re9=04 Proresm"d O� R ua mroD ee� a 'b q C \. Lana sDn.Ta I Y � o P 1 CERTIFY THAT THE s ZO % / 19 LOCATED IN FLOOD PLAIN ZONE NE X AS LOT a '° SHOWN ON FLOOD INSURANCE RATE MAP 6 °svmrc°Y0 �� 1 COMMUNITY PANEL IM 25001C066W AND 0 m ® ermn / `� ,Y3 F4A.-•�' + / THAT FLOOD PLAIN ZONE z Is NOT A SPECIAL FLOOD HAZARD AREA. /WPemYAR 5 O;D rrrHHH"' eae7e:S.F. _� HOLlAES AND M TN.INa bMqMLOT 1 N/Oq/M� ' _ ce/DMu>aac R Prohselmal Lana su Dale . r _�: —.• \ rauuD rve„Tr u:wuTMi1N°�ar J� 'yee• -'1.=--.°__--•• ce/oa1 oiE yQffiE i\ WND ana wa Wnn 4T.s a�nimay Ysip w Nv EV.�H.Se W/DRp1r= .ege,pN PMaMd r�pu�.e.v°nicrwb i 9ma,v FWND (°ne peon pavA WwmnO _ Dg/NPILLHOLE /OUND p�NGtlpiw°�rmwe�Aw.ww was i rr u� ND �rW LLHgF `� VM/:° ;oom tone u.wR a vapJNftn moos •pw -�L°♦- NO , _ DATE DESCRIPTION ra ack R E V I S I O N S PLAN OF EIDSTING CONDITIONS NOTES a Ur r+ro ANTMOR .gY FA VA &PREPARED F RYAN HUNT 1.HOUSE NUMBER:148 PAIR(AVENUE FOR L 1.2& INfl48 PARK AVENUE 2.ASSIDSOR'S NUMBER:207-M 207-146 m 207-147 CENTERVILLE BARNSTABLE, MA 5.ZONING DISTRI"..RD-1&RESOURCE PROTECTION OVERLAY 4.PLOW HAZARD ZONE z 8.BENCHMARK: AS ONES' SCALE:I'.20' DATE:AUG.25..2015 e.TOPOGRAPHIC INFORMATION BASED ON AN holmes and mcprath, Inc. ON THE GROUND INSTRUMENT SURVEY. aRAP�c acA18 a w.noMee s aaa Im eu wDa e 7.ELEVATIONS SHOWN ARE BASED ON THE NORTH 0 10 20 90 - 205 37W ceilrf.mtlM n A4 548-55B49w0� AMFRICAN VERTICAL DATUM OF 1888.(WAVED@) ma 505 o6 u' a REFERENCE LAND COURT PLAN 19981-A&B.19257-A m rm DRAWN: PJR CHECKER: 9.WIND EWOSURE CATEOORM 8 , .eO n. rave Islas Dxc\na:e°+r c3o.Dxro JOB N0: 215/89 DWG.N0.: No.4/----- Fee------ - ------`J ---- BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationArVell Co0truction ermit Application is hereby made for a permit to Construct (v"), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel ^tat 4 —Ded� _---— — -- /�f 8—_ Owne Address d w Installer Driller — Driller �— Address Type of Building Dwelling —--- ----------------- Other - Type of Building--------------- No. of Persons--------------------------- -------- Type of Well—k r---; Purpose-of'Wel1--�f-�s;_•-- ---------_ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .ofCnompliance has been issued by the Board of Health.. — Gr.✓� - - ---- - -G�`�6` 3-- - Signed -- 9 � 6. )at 91, Application Approved By -- date , Application Disapproved for the following rea s:---------- - -- -- --------- --------- -------- --------------------------- ---------- date Permit No. �_—___-- Issued �- -------a — --- - —— - --__ BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( '1, Altered ( ), or Repaired ( ) ----------------------Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------Dated------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------- -- - —-- Inspector-- - —-------------------------------- 7 0 _----- --- -------- No. --------- Fee BOARD OF HEALTH TOWN OF BARNSTABLE Cication rVell Conaruction Permit { Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: I lG Location - Address Assessors Map and Parcel , / Mot 'w Owner Address — Installer - Driller — -- — Address Type of Building {¢fD"welling -------- — --- — Other - Type of Building-------------------- No. of Persons--------------- Type of Well 4 r --- ---------- — Capacit Purpose of Well---11l� --- --- — } Agreement: , The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Cewrtificatte .of�Cnompliann'ce has been issued by the Board of Health. Signed ^ ' C✓/ri.✓ — 1-'^—^----=— -Gl`���3—date/ Application Approved By _ � `r PU/ (/ ✓ /�\` date / 0 Application Disapproved for the following rea s:--' -------------------------------------------------- date �Permit No. � ���! -�----�� — Issued�7-!��r ------da�' r .0 BOARD OF-HEALTH TOWN OF BARNSTABLE t. . (Certificate ®f Compliance 2 THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) by Installer at- ---/ 1 j�G` 4•�e — --------------------------------------------- — - L-- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. —----- Dated----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. ' DATE--------- ----- — - -- Inspector-- ------ --- -- —------- , BOARD OF HEALTH �i TOWN OF BARNSTABLE �- Vell Con9truct ion Permit tv ' 7 No. -------- fino � 0 Fee-----___--_ Permission is hereby granted — to Construct (✓), Alter (/ ), or Repair.( an In avid?u-ItWell at- No. Street as shown n the plication for a Well o struction Permit Dated ------------------------- -n Board o. Health DATE -- �s / 3,� 05/APR/2010/MON 11:57 C-0—MM PIEE DEPT FAX No. 5087902385 P. 002 Make application to local Fire Department Fire Department retains original application and issues duplicate as Permit. APPLICATION ION and PERMIT Fee: �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 CMFf 9.00,application is hereby made by: Tank Owner Name(please print) Anthony DeDee�3 edx a X news ePaYtno pamdv Address 148 Park Avenue, Centerville MA, 02632 arrest A'y Wo Zo Company Name Michael Walker Co.or Individual Pont Pont Address Cahoon Lane a Harwich, MA Address Pnnt PrW if i permit) Signatur f appl ing for permit) p IFCI'Certified Odl®r (3IF0I`Cerdfied ❑ P Other Tank Location 148 Park Avenue, Centerville Sleet Address Cry Tank Capacity(gallons) 1,000 underground tank Substance Last Stored #2 Fuel Tank Dimensions(diameter x length) Remarks: g&,&'rA Firm transporting waste State L!P-# Hazardous waste manifest# E.P.A.# Approved tank disposal yard Tank yardP L���� �✓i-e �C �V��"'Vn+�1y ,� /[� �+ l , n. uV�i/L� v V tom► Type of inert gas �'•'" Tank yard address � y �'�'�-�\�'�`► A •• s City or Town Centerville rDID# 01920 Permit# 6Q Date of Issue March 15, 2010 Date of expiration March 29, 2010 Dig safe approval number. 20100110823 Dlg ja ToppiePY&HIslumber-800-322-4844 Signature/Title of Officer granting permit e After removal(s)(°Consumptive Use"fuel oil tanks exempted)send Form FP-29OR signed by Local Rre Dept.to UST Regulatory Compliance Unk,Department of Fire Services,P.O.Box 1025,State Road,Stow,MA 01776. i "International Fire Code Institute FP-292(Wised 4197) THE COMMONWEALTH OF MASSACHUSETTS ���, ,j ,,BOARD F HEALTH ..OF..... .. ..... .. . ApV trattun -fur Dtspniitt1 Works ( onstrnrtintt VrruW Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, Lo tion-t dress Lot No -----•. �- Q ------------------------------------- ,/ Own � �` Address R .wA /n J,} y� A�4 a •. -........ �_ �. e ....----•..................................•---••-•---------•---... InStaller� Address U Type of Building Size Lot... b_D _Sq. feet Dwelling—No. of Bedrooms.. ........................Expansion Attic ( ) Garbage Grinder Other—Type of Building - .. -.. r a g .4`M.�-No. of persons-...___. ______________ Showers (�O — Cafeteria ( ) d. Other fixtures -------------- -------•------------------•---- ------------•--•-----------------------------. .... W Design Flow....--__-_ Q........................ghons per e�rsoner�lay. Total daily flow_--_...___-_ ---- gallons.capacity- Width................ Depth.--__-------_. x Disposal Trench—No. .................... Width-----_ ___.-_ -- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------ Diameter__�_,_x__ ------ Depth below inlet.................... Total leaching are a. -----------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by--------------------------------------------------------------------------- Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...----_-.--.--._---_-. f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......------.----------- tyi ---- ----------------------------------------------------------------------------------------------------- O. Description of Soil -------- 5-•-�.-----t 1���...---. .-r - ��.._....-._v Z D e ---------------------------------------- U W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- •-•-------------------------------•-----------------••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha een is ued b the board of healt Signed --- ----- -------------------------------�J - - ------------------------ -------------------------------- Date ApplicationApproved By........................................................................................---------- Date Application Disapproved for the following reasons:----•---------------•---••-•----••------•--••---••----------------•=-••---•-•---•-•---------•.........---- •-••------------------•••-•••---•--•---•-••--•---•---•---------•••--•-••------------•--•------------••....•••--•--•••-----•----------•-----------------------...-----•-•--•-------------••--------•-•---- Date PermitNo......xj-�......................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS �r BOARD OF HEALTH ..........�/JGa.I.................0F..........e"1 ./.:rf...h'.,`C............:'. Trr#ifiratr of Toutjiftattre' 1,7/7 THIS IS TO CERTIFY That the Indivi e _.. ._, ' 1 Sewage D' sal st em constructed ( �) or Repaired ( ) _ �? I �J y Instal— at....... ' has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--------/,I-.(........................ dated......... ................ THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED PA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ 1 -----------/ ... Inspector................ ---- ------- .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /V,, �GGc /� .....7�4- / No......��1 ------• FEE....ZG-=-U�� Bispatial lVarkii Tongtrurtion Prrmit Permission is hereby granted ...:- _ -1 ?----------- to Construct (JO or Repair ( ) an Individual Sewage Disposal System at No............ -------- ----------------/i'�_/`l!r i_//'-, /-/" ---- ---------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Pe t N . ...> . --__... Dated........`'f."..':...--" _........... �� -- --------•-•-•-•-------•----------------- DATE. 7�> —24- Board of FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I1Ic., .......... FEa......! ...:...`........... f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF...............................................................................:......... Apphratiun -fur Bi,spuutt1 Workfi Ton,itrurtiun PPrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• _ 44 LC tion.Address or Lot No. a Ownej Address ---k Installer f Address 7 d Type of Building Size Lot.....Z-V'. -t'. Sq. feet Dwelling—No. of Bedrooms--(----------- ---------__-__---_.---.Expansion Attic ( ) Garbage Grinder O�• per, Other—Type of Building --_t t_"`. No. of per-soiis.........,F'.............. Showers ( 'Y,) — Cafeteria ( ) WDesign Flow•Other fixtures res .---- __ {lions per person per day. Total daily flow_.__._._..� E . ................gallons. WSeptic Tank—Liquid capacity-_�I%'::_gallons Length________________ Width................ Diameter__----.--------- Depth................ x Disposal Trench—No. .................... Width._._.._ _____--.-_.- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ Diameter... _ __ ----- Depth below inlet.................... Total leaching area------_----____-.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-, Percolation Test Results Performed by_-----' ---•-•----- ..................................................... Date-----•-•----------------------------.--- Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water-_---------------_--- (14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ W ...................... ---- -- ---- --•--------------------------•--------•------------------------•---- ----•-----------•----------- Descriptionof Soil----------------------------------...------•---•-------•----•---•---•--•=---=-------•---�'--�---=--r -=r`�--•-••---------------'----� ----------------- x W V Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ------------------------------------- ---------------------------------------------------------------•--•--•-------••-----------------------•---•••-----------••----•------------•--------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of healt Date Application Approved By.......................... Date Application Disapproved for the following reasons:................................................................................................................ ---•-••-------------•-•...-------•--------•---•-....--------•••-------....--••------••--•.-•------•--•--•I------------•--•------------------•-------.------•-----•---------------.----------------------- Date PermitNo.......AL-4...............................•---•--• Issued...................... ................................. Date J I RVILL 5 REFERENCE m Town of Barnstable Assessor's Map 207 w Q a LOCUS o BOTTOM OF HOLE @G' KEY SAMPLES 3/ 1 5/1 0 PLAN VIEW LEGEND SOIL SAMPLE 0 40 80 120 HAND BORING 3/1 G/10 Ao- hB HAND BORING SCALE 1 "=40' FORMER UST TANK GRAVE H 2 SEE DETAIL Q PROJECT: ANTMONY W. DEDECKO I�! 148 PARK AVENUE, CENTERVILLE, MA 02632 TITLE: LIMITED REMOVAL ACTION AREA OF EXCAVATION COMPLETION 12'(L) X 8' (W) X G- 12'(D) 148 PARK AVENUE, CENTERVILLE, MA 02G32 DETAIL 3/24/10 BENNETT ENVIRONMENTAL �3,9c ASSOCIATES, INC. 0 10 20 30 0 ' LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS, GEOLOGIST,SANITARIANS SCALE I "= 1 0' � 1573 MAIN STREET,P.O.BOX 1743,BREWSTER,MA 02361 PHONE:(508)896-1706 ww ,bennetttn.m. FAX:(508)896.5109 j SCALE: BY: Ct1EC7 JOB NUMBER: 3/24/10 As Noted DCB/s DCB IDEA 10-1 01 95 I I J }�c �.c rth � :yas �\ ! ster Ba Broom 4 :I�,� ' �I Y Master Bedroom - P tic ; l 2-8 aa• -uMu ty hall' bD zxa hv�dn IE ®�T T General Notes: I i P. z c 1, a v $ OAS d4lED Mwhotommp/yaWha app �. „aporulble trade pactlrr:a. ad to WI heW �Dand tcbd M=.OrAan ® U 13 ba�]b,oa(rdgaae ar Dods.olWavlloea � �' padau,daW ,fidr,wkna .b—x th A0. kIeW' to Cl 9e / me.aet bedddm. a mba: adetle W DATEba sd,,Aet oas�s ham andc oeadoedaedd, o DEPT. �KVAC, lmb � k0M�"@�a a Wk .VW, nt• AMrmzOo dMey""','.' 626 SF ad : r Bedroom 3 0 Bedroom 2 H.�. �No< FIRE DEPARTMENT p •athro N BOTH SIGN REQUIRED FOR PERM! g sP _ C, �y _ Second Floor Plan with new roof amen shown SP, d 6� � co M a.t Framing cc uj W ba m Wla4d m aunMara.inn ao app:d,le code. Q O m Scale: 1/4"= 1'-0" adma,ar.,e�n nae aid reeFmmle r ee Fn - Fmmng hmbm a to W-dned"-F a egmalla,t-th the f-4o 9 enmmun _ 26 1200 p91 1,400,000 P91 2110 1 100 P91 1,400,000 F9( 2a12 1000 p91 1,400.000 M O.W pot and beam hanger a mgllrod. ' J.W 2.G-brgm bedae typ,.A en I—M ftd athamae. batall all nmadaabe s p a&wt,m W"LVLaM ah, t mm t a,m ab,t amoMor< th nmida 9reri mqurrn • pranmq mnhato a to has fWl h,oadrdge d,a&—b.,and mvnbm - •••• '• . vpemate fthe AFFA Waed r--Carole-e—M.,W IIO Affn and Deck � N a a0—bcbv-tt w-mtr,mwe. `q X $ om u fz)13/a'x 9 12•LVl heats IIr'�1' ..I' � LIFT'� it �iIII a Imo` li :jl II if II it jl II ii II it I�j�i j I i' — I g' ! II , i 1 I� ,1 �I. 0 !I I !' Il Il II !1 1-II 1 i n<w k,rehen eaam:m ands -5 {@� ' ( I m•F Z a I ts Ud!Ill, ;; j _ I �II I i' I II I: i i I II I II II ' ;: II II II Cx3'-4•Ward muKeap LLJ -v a im de haegrr.as I I 4 C7] 'I II I� I! i ��I Il� IIj 1-Di I m at Llving Roomi oMl 11KitchenCre i I r ill3 ARCHITECT 15 TO REVIEW FRAMING ON E ALL IS DPOSEDARLHITE�T il�'k RE l& OkAS 1 II I I ! BEFORE ANY COLUMNS OR BEAMS INSTALLEDdry a Q 2 II,I —en(4)z,LL 2�.raochem Q� -- O t I it i�II41 II 1. III I! IIl llj II I II! I it I II uI o I Batr IGarage _ Ir-lo�rr• q lie ey I it II ,i i 4 II it 11 n it (I 11 ii Ill ll II �I . I tz�il s!a Y LVLIed> I' I I I i h it II II jI I 111 I� ! I' I! 1 II y9�l it II I 1 .I 1 li 1! ' 11 p II n II I jl II II I !i !j .p' jfll lIiI IiI!_(I�2I I`1Ij_�It'_II__-Lli Pot +IGi lI 'il i II I foyer Study 3ax I I]/H lVm ()213W.11]/&Lw Dlning > L — L � 0 60 1Yir5t`F16or Plan with second floor framin shown A' 11919,5113 )-7 e- 77 7" 3 Alcl 196 , 74 2 /z. h 0 7- �� rc /L F t,� / .. � �p�� �� ��� �/ l'�� �� PT/G +SY� TAM► 10 Leo - GG ea ! ✓[ac � ia77 41+77 5f it r--� o\ 41 to . CLAN OF LAN R Vi t � C-- MASS, nV Q1AflV m SY OF.ue� `/-_"�`'rdcy'` � Ac D E cA, O 1,3 •� '��� �� a f HA^Ik t. FRANK CUNEi Y 5 TRENTO N *T, v CONFcFt? c� u h I s2 > ' MASS. U260i No 651, `) p� y`r' ! :Pt t'iTER$b ENGIN[tR $ l:�r[!� Stt77ftELh, '`.��..�� �,\ • ..41yp Ku�.�S. ,L' r 1/ IN �ZD!' •. �ci r'7 I9 / !� jJ/7C /7 „ - J I s� LOT COVERAGE NOTES (FOR ZONING PURPOSES) CB DRILLHOLE CV)FOUND�,Q09 EXISTING PROPOSED MAXIMUM ALLOWABLE co Fn ' d a �,20,76 �9 80, BY STRUCTURES 6.4% 6.0% 20% x LOCUS AIL NOT T� LEA ?s4� x BAC ST. CB/DRILLHOLE BENCHMARK: CB/DRILLHOLE FOUND CONCRETE BOUND FOUND WTHE-43 48(NILL HOLE D W) P 27/4' SIG MAPLE AVENUE J GUY WIRE (PUBLIC-40' WIDE) 3. r Y r 43.1 CB DISC Y YYm rEocEs Y YYVw�B�FOUND G FOUND LOCUS MAP 42 Y CB/CENTER 3 -105.0 NOT TO SCALE NOT FOUND . .. 42 _ _ R \ EASEMENT TANGENT S77 58 0`_ 40 38.3 _ re . L.C. DOC. 28976 tiN _ 111.45 x o \ �� X 38.5 X 37.1 I 38 I X 37.3 CB DRILLHOLE 39.2 X s. GRq�t DR/1,EWA / I . 36 w / FOUND / �9�2 , \ AY 83.22' N78. 31 01"w LEGEND I J X 7.6 OI I� 34.7 X cc / 8.X 6'� `1 67.03' j EXISTING LEACHIN PIT 0 BE- o 34X 33.7 1 / x �~ �.,.` N UTILITY POLE PUMPED DRY REMOVED AND 40 1� x/>? I 35.4 ��� w BOUND �. `° / N DISPOSED OF OFF SITE AS 32 00 / CB/DRILLHOLE RHODODENDRONS �qss Sr v' h• / �'-? REQUIRED FO CONSTRUCTION. I -,J-�,� x 31.2 �, / SIGNS X 301.4,'••, i "� PAVED MN /, FOU N D v / 1 METAL COVER DR WAY, IVE 1 - GUY WIRE z' ?• /�, P OPOSED SO/L ABSORPTIO SYSTEM / ' ill ♦,''',•r ,,,� ti s `ti SEPTIC MANHOLE / XlS NG SEPTIC �o i;•: `v �'t; / (SEE SEPTIC SYSTEM DETAIL) / \ 37.78 ?AN TO REMAIN 55. IJ. '" : • Ro WATER SERVICEwV 7. �27.5' ►" '+` .` .� �,,,\ WATER VALVE D4 �1 w'' `•:.� LAWN -W F AG POLE >- -� •� w -1 /+� a CONC. SLAB c�Rkn EL=2s_3� , �•.'' r :• •w ,.'•/ e WATER LINE Q19J '`�/ '� 3 �_ ro ELE ==3 ----`--- '/• :,� `��, N F ►�� V 8 3 - APPROXIMATE / HYDRANT METAL COVER Y '; KEVIN M. MCELLIGOTT -X-X- �` LOCATION OF EXISTING • *:-'". i.r. FENCE c, G iTT►i Rh E1.=29.47 / �3• 8 x & LINDA G. McELLiGOTT (III, / T <� °��\ SEPTIC SYSTEi // `''.ti \�, � 31.5 A . EXISTING DECIDUOUS TREE ° a 36,7 8.3 � '� TIMBER �_ I / /ry EXISTING CONIFEROUS TREE 'N STEPS X28.4-F- Fa / 3x ` 24" ow + -- --- EXISTING SPOT GRADE 2s.3 x / m i R�a' I 29.5-142$- T01 BE REMOVED PATIO- - ----- --- -- 71 - o 'v PROP SED ROOF D•AIN / o N N -"*�- _ I _- -f w \\ rp 1 1 A & 1 B RESERVE AREA / m (DESIGN BY OTHERS) � P 5 - / I o I '' EXISTING -3s ENCLOSURE I / I ; � #2A & 2B�o I PROPOSED SPOT GRADE 32 sx ' _ o x w PROPOSED GRADE �g CATCH BAgN UNDER DECK 0 „ 1 - ----- ( , Rtm Ei-36.83 v z � ) TEST PIT NOT TANGENT \ \ RD ­39L 2 31/ z �2 x29•4 128 I \� 125 X 28.3 cv CATCH BASIN EXIS NG SEEP C \ LAWN c� c o I x PROPOSED \ 24" wlLLow �' m I PROPOSED FRENCH DRAIN ZDRAIN ® TANK AND LEACHING \ m�f m n I cn POOL PA n0 ROOF DRANN MANHOLE - I \ DESIGN BY OTHERS) (TYP.) -RD- - SIGN PIT T REMAI �'o N a I Z x28. 29.Ox -- _ f., \ \ iw a o m I I PROPOSED y - --- - \ CK�NIALK o-o -D I POOL o \\xZ8.1 ---- - - FRENCH DRAIN -FD- ,• BRI -+ !`�. :+6 .N r� a I O I� X 32.5 tv Q� \ BRICK 2c�s\�, C;'r--�-- g o 128. - OOL FENCE 8 j x 8 x 26.8 x 7 ao 31 JQ Rim B. 37.73 CBASN PILLAR < �s �' APPROXIMATE \ W 32.5+i x29.4 1/ _ o P I " -RD _ x 26.5 'P % Oa LOCATION OF - -- 34.6 ® \\��yz� <y\\EXIS ING SEPTIC 36.6 � �� / /_ --X28.5- -X2� 4 RD X 8 x \ // z X29.0'�" RD �' \ PROPOSED POOL FENCE, • 29.6 'DESIGN BY OTHtRS REFER C801I Sj=9- BRICK \\ �o� i 0.4 / 29.9 X 1.0 TO ARCHITECTURA PLANS Rim E1637.45 �O ��� -o / /L4 PROPOSED RETAINING WALL /APPROXIMATE (DESIGN\ X 36.7 o / BY OTHERS) ��O� � �9• 2g CBASIN LOCATIG,N OF ca' tQ Rfm a=37.55 EXISTING\WATER 36.5X /^ LOT 5 ® �$ SERVICE \ // TOTAL AREA °�EPR\�G 30 X 3s�s / 64,542t S.F. � 33.2 X ;ACBXDRILLHOLE- 35.1 3/ 32, + \ FOUND ^� / 102,63 34 34 •` - N82. 30 07"W FOUND ILLHOLE j CB/DISC 36 -FOUND 14.e4 38. 38 NOT A2i�i J TANGENT 39.6x 40 N/F DAVID W. NTHONY & ELA NE MA ANTHONY 42 3 n to N Fp NS 126 x 42.8 tv o BENCHMARK: � q MF 0. ? 44_ o CB/DRILLHOLE NT I"Jv N FOUND X 46.4 ELEV.=48.38 SB/DRILLHOLE (NAVD88) CB/DISC FOUND NOTICE Unless and until such time as the original (red) stamp of the FOUND responsible Professional Engineer, or Professional Land Surveyor CB/DRILLHOLE appears on this plan: R�3389' FOUND (A) no person or persons, including any municipal or other CB DRILLHOLE �6 15230. public officials, may rely upon the information contained herein; and /FOUND (B) this plan remains the property of Holmes & McGrath, Inc. DATE DESCRIPTION 716rawn hecked R E V I S I O N S PLAN NOTES � UP 211/5 OF PROPOSED PR DISPOSAL SYSTEM ANTHONY FAVA & RYAN HUNT 1. HOUSE NUMBER: 148 PARK AVENUE FOR LOT 5, #148 PARK AVENUE 2. ASSESSOR'S NUMBER: 207-038, 207-146 & 207-147 IN 3. ZONING DISTRICT: RD-1 & RESOURCE PROTECTION OVERLAY CENTERVILLE BARNSTABLE, MA 4. s. 0 FLOOD HAZARD ZONES: X ,✓, - _ =..�,, 5. BENCHMARK, AS SHOWN SCALE: 1" = 20' DATE: DEC. 29, 2015 �6. TOPOGRAPHIC INFORMATION BASED ON AN ON THE GROUND INSTRUMENT SURVEY. GRAPHIC SCALE ( ' '<< r holmes and me rath, Inc. 7. ELEVATIONS SHOWN ARE BASED ON THE NORTH AMERICAN VERTICAL DATUM OF 1988. NAVD88 r 'L civil engineers and Ian surveyors 20 o 0 20 60a ,� 205 Worcester court suite A4 508 548-3564 PHONE 8. REFERENCE: LAND COURT PLAN 19981-C PENDING n (PHONE) �(PENDING) >t '' falmouth, ma. 02540 508 548-9672 FAX 9. WIND EXPOSURE CATEGORY: B ( >N FEa;r ) zp,p ' ",^ DRAWN: PJR, LAC CHECKED: 10. PROPERTY IS NOT LOCATED WITHIN A WIND BORNE DEBRIS REGION. i ;inch = zo ft. ` FAVA 2T�5189 DWG 215189WS_C3D.DWG JOB N0: 215189 DWG, NO.: 88-5-24AI SHE T 1 OF 2 DEEP OBSERVATION HOLE LOG NO. 1 A SOIL SOIL TEXTURE SOIL COLOR SOIL (Oss, DEPTH ELEV. HORIZON (USDA) (Munsell) MOTTLING sMNR es. o19Sma X WVEL First Floor 0" 28.7 Elev.=38.3 0=62" 23.5 F/LL F/n/sh grade above and adjacent to system shall slope away at a min. of 2% = " Ab 4" dlom. cast Iron or Schedule 40 PVC pipe (tight joints). 62 20' min, distance (bulld/ng to edge of leaching system) Proposed access cover " 21.6B 95 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . within 3" of finished grade. =IJ5 175 c AEDAIM SANDN ' cvaj�w EXISTING GROUND SURFACE 4" PERFORATED PVC VENT PIPE Proposed D-box with ** NO GROUND WATER ENCOUNTERED Covers shall be set access manhole within Conc. Slab to finish grade. 3" of finished grade DEEP OBSERVATION HOLE LOG N0. 1 B (Typical) 30 Elev.=30.1 0.Of 29.33 29.�1 EXISTING GROUND, SURFACE 30.0f OTHER SOIL SOIL TEXTURE SOIL COLOR SOIL (smumm DEPTH ELEV. HORIZON USDA Munsell MOTTLING 1' MIN, 2" layer of �" to ( ) ( ) CMMMO X GM (H-20) CLEAN BACKFIL.L 3' MAX " washed stone 0" 287 41 LF. 4" PVC s=0.015 2' Elev.=27.0t or filter fabric D=62" 28.5 F/[L level I 21 L.F. s=0.02ITITIMIrmMmEXISTING p 0 p 2S Existing 1,500 GALLON 4" PVG. Pipe. o C3 O = " Ab Foundation SEPTIC TANK `� . . . . . . . o SANDY LOAM 10 YR NONE TANK TO REMAIN o, .a' s" layer of . . . . . . . . . .o Elev.=24.00" " = B crushed � =1 17 C M AN uxs GRcAxVEE? : : : : : : : compacted f "�to: : : " CC o stone t� r., C l; II double washed �'. . . . . . . . .. . . . . . . . . . . . . . . i V♦� a :� stone all around'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.�:.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.' ** NO GROUND WA R NC UN R Contractor shall install 4 r., " " ' " chamber 7£ E o TE" ED Schd. 40 PVC Tee and CZ ` , , . :H Gas Baffle if needed. ,o �,�� o l '� rz DEEP OBSERVATION HOLE LOG NO. 2A STRIPOUT NOTE: ( OTHER SOIL SOIL TEXTURE SOIL COLOR SOIL (SNKN s. THE CONTRACTOR SHALL EXCAVATE 5 FT. ALL AROUND THE LEACHING Bottom of Test Hole DEPTH ELEV. HORIZON (USDA) (Munsell) MOTTLING FACILITY AND DOWN TO THE MEDIUM SAND LAYER ELEV. 20.9f (8 f), El. 16.9t REMOVE AND DISPOSE ALL UNSUITABLE MATERIAL AND REPLACE WITH ON 28.6 15 . . . . . . . . CLEAN. GRANULAR SAND. CONFORMING .WITH. THE, SPECIFICATIONS. SET. 0" 72" FORTH IN 310 CMR 15.255 (3). — 22.6 FILL " 220 Ab Ex/stIng Existing 41 VARIES 79't-93o 20.9B Foundation Septic Tonk D-Box 500 Gallon Chomber " C M AN 4 V SEPTIC PROFILE ** NO GROUND WATER ENCOUNTERED SCALE: 1/4" = 1' DEEP OBSERVATION HOLE LOG NO. 213 SOIL SOIL TEXTURE SOIL COLOR SOIL (Osier, DEPTH ELEV. HORIZON (USDA) (Munsell) MOTTLING SMNM B M oo MAVW 12 SCREEN SCREEN 0" 28.6 83' 0=70" 22.8 FILL INSTALL POLYLOK FLOW EQUALIZERS 4, 4.83' 4, �-4" PVC VENT PIPE " Ab ON ALL OUTLET PIPES " B CONCRETE COVER - 10 s au� ALL OUTLET PIPES FROM THE ���� DISTRIBUTION BOX SHALL BE 2 layer of to i� = 16.9 C MEDIUM SAND4 w SET LEVEL FOR AT LEAST 2 FT. 5 - 5" OUTLET N-�f''•; 4" — " double washed FINISHED GRADE T. a KNOCKOUTS o Q stone ** NO GROUND WATER ENCOUNTERED n 7» C3 o C3 ----� INLET PITCH OUTLET a 7—f22" 4 ft. of i" to 1 4"double 4" PVC VENT PIPE MANIFOLD DESIGN CRITERIA 209* 500 GALLON CHAMBER washed chamber VENT all around 1/ENT PIPE DETAIL , 8 " 11" NOT TO SCALE Number of bedrooms 6 Equivalent to 110 gal. s/day 9» - 3" SCALE: 1/4" - 1' Garbage disposal unit: NO •' ' ; Leaching area - capacity required: 660 gal.'s/day •. Side area proposed: 253 sq. ft. 24" 4" Bottom area proposed: 648 sq. ft. Total area proposed: 901 sq. ft. * Proposed leaching capacity: 687 gal.'s/day PLAN SECTION CROSS—SECTION ��\ THE LEACHING FACILITY AND DOWN TO THE MEDIUM Water supply: TOWN 5 HOLE DISTRIBUTION BOX (H-201 THE CONTRACTOR SHALL EXCAVATE 5 FT. ALL AROUND Precast concrete units: H-20 loading design � PROPOSED SURFACE VENT LOCATION �� V SAND LAYER (ELEV 16.9) (8'f), REMOVE AND DISPOSE * LTAR shall be confirmed at time of installation NOT TO SCALE TO BE DETERMINED IN FIELD. �v� `' OF ALL UNSUITABLE MATERIAL AND REPLACE WITH contractor shall contact engineer. ' CLEAN GRANULAR SAND CONFORMING WITH THE � SPECIFICATIONS SET FORTH IN 310 CMR 15.255 (3). EXISTING 1,500 GALLON SOILTEST 1'j � ' • , SEPTIC TANK TO REMAIN Date of soil test: 10/2/15 A t• 55' : • .�'' \�`` • (5)-500 GALLON CHAMBERS WITH Test taken by. L. CARREIRO _ O111.>�'` ' = 4 FT. OF 3�4 TO 19 DOUBLE Results witnessed by: D. STATON • • ' ' • ' 10 MIN �`� J WASHED S ONE ALL AROUND *Percolation rate: 2 MIN./IN. 4" KNOCKOUT ` .��' ; . , CHAMBERS. Ground water NONE ENCOUNTERED .• ram, 41 - - - - - - - - - - - I 0 20" DIAMETER o �� — — — A� s- r. GENERAL NOTES 4 KNOCKOUT 4 KNOCKOUT 14 INSPECTION lNV_273� .' ?�,':' 1) No change to this system shall be made unless NOTICE COVER \ �O '�� ,` Unless and until such time as the original (red) stamp of the To be verified prior 1 approved in writing by holmes and mcgrath, inc. responsible Professional Engineer, or Professional Land Surveyor to construction 2 Subject to inspection during construction b the C`) ••.' ... . � appears on this plan: ? r ��!' ) ) p 9 y (A) no person or persons, including any municipal or other • ��r. 4" KNOCKOUT : i Board of Health and holmes and mcgrath, Inc, public officials, may rely upon the information contained herein; and • ,. 3) Heavy construction equipment shall not travel (B) this plan remains the property of Holmes & McGrath, Inc. l 5-HOLE 0/S7R/BU770N over disposal system during or after construction. 8' - s" c� Box (H-20) .: ' DATE DESCRIPTION FDrawn hecked z ' . _' 4) Disposal system to be constructed in accordance R with Title 5 of the State Environmental Code. R E V I S 1 0 N S ALL WALLS ARE 3" THICK cn ,. w 20"' DIAMETER 5) A copy of these plans must be kept on the site 8' _ 4" INSPECTION COVER (H-20) CONSTRUCTION DETAILS (TYP. OF 2) during the time of construction. 6) A copy of these plans must be furnished to the OF PROPOSED SEWAGE DISPOSAL SYSTEM ® ® 0 ® ® ® ® ® SEPTIC SYSTEM DETAIL contractor constructing the disposal system. PREPARED FOR ® ® ® ® ® ® ® SCALE: 1" = 10' 7) Before backfilling, the contractor shall notify ANTHONY FAVA & RYAN HUNT I FOR LOT 5 148 PARK AVENUE ® ® ® ® ® ® '' T N ® ® ® N Agent to inspect the system as constructed. # IN ® ® ® ® ® ® ® y ® ® ® 8) If the contractor encounters any variation between CENTERVILLE BARNSTABLE MA ® ® ® ® ® ® the existing conditions shown on the plan and the , 8' - s" 4' - 10" conditions encountered on the site, or any soil SCALE: AS SHOWN DATE• DEC. 29, 2015 ` condition different than shown on the soil to or ,�- TYPICAL 500 GALLON LEACHING CHAMBER® the contractor shall immediate) ;��a_T W any adverse sail, Y holmes and mcgrath,rath inc contact holmes and mcgrath, inc. Holmes and civil engineers and land surveyors �'';`"{ SCALE: 1/2 = 1' 9 9 (H-20 LOADING) mcgrath, inc. will examine the soil condition 205 Worcester court, suite A4 508 548-3564 (PHONE) and report to the owner an suggested revisions. falmouth, ma. 02540 508 548-9672 FAX) , r� "`'` ,,` DRAWN: LAC CHECKED: / �� FAVA 215189 DWG 215189WS C3D.DWG JOB N0: 215189 DWG. NO.: 88-5-24A SHE T 2 of 2