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TO OF ARNSTABLE
LOCATION SEWAGE #
VILLAGE ASSESSOR'S MAP LOT-?Yx
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /'&'D (2 f"T
LEACHING FACILITY:,(type) L '-'Q ' � (size),/; 3
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: f� -�� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 oachi facilij �F�"�-� Feet
Furnished by
2L Cl�
(14
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C o G -F> 0�
No. °" • 'f Fee---?
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS t
ZIppYication for Miquar *pg;tem Congaruction i3ermit
Application for a Permit to Construct( _)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location AdAress or Lot No.' Owner's Name,Address and Tel.No.
Assessor' a /Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms_ 3 Lot Size sq. ft. Garbage Grinder( ;
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Na a of R airs or Alterations(Answer when applicable) / 2
f
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 provisionsrOTINe 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issueNkby t is Ppard of WE
Signed �'— Date (G
Application Approved by Date
Application Disapproved for-the following reasons
Permit No. "'' Date Issued " -
9f"S�' �o�•ti .r._•.i�/YGw..i «..�.� tr.. �..n s..:,r. �M..7$S+'N"•r.Y �r7•X.N^,.. �ii"{�vv,iti�7"`•il...'f'.�:f'ewr`-'YC!n�j'>Yi.-.•:ti+..�.�.:..:r,•i�'--"r�'J�rsy�ry•�
No. �►' Fee
' THE COMMONWEALTH OF MASSACHUSETTS THE in computer: _ •-
` Yes
PUBLIC'HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migpogal *pgtem Congtruction Permit
A lication for a Permit to Construct )Repair( )Upgrade( Abandon ❑Complete System El Individual Components
PP ( ) P ( ) Pg ( )Abandon( ) P Y P
' = Location Ad ress or Lot No. Owner's Name,Address and Tel.No.
Assessor's a /Pazcel
Installer's Name;Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms--c Lot Size sq. ft. Garbage Grinder
Other Type of Building No. of,Pe Showers( ) Cafeteria( )
Other Fixtures �
r 71-
Design Flow all ns pt4r daily flow gallons.
Plan Date Nugiber 'f sheets Revision Date
Title
Size of Septic Tank ° Typet S-I.S. `
Description of Soil C^ /
Nature of R airs or Alterations(Answer when applicable)
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 proviisionsff*Tigle 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue by t is and of He h.r
Signed �•� Date /Z-- 2
Application Approved by , +3 Date
Application Disapproved for the following reasons
y Ong'+r I
Permit No. Date Issued
----------- ---�.. °—.-- -.—•--- --- ---
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE, IFY�that the-On-site Sewage Disposal System Constructed (' )Repaired'( )Upgraded ( )
Abandoned( )by
at has been.constructed in accordance
with the provisions of 'de 5 and the for Disposal System Construction Permit No Z dated Z
.�..�
Installer < //yOiA l? Designer
The issuance of this perInit shall no onst ued as a guarantee that the ys�functionde ' d.
Date Al 2 d"' �i �'C Inspect
.r
— �.—���--------------.—
No. --------.----Fee 5�U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migpogal pgtem Congtruction Permit
Permission is hereby granted Construct( Repair )U grade( )Abandon
System located at 5—
and
as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed w •
within three years of the date of this t.
p
Date: �� ^ ^ 7 Approved b I'
NOTICE: This Form is to be used for the Repair.of Failed
Septic Systems Only
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, ,hereby certify that the application for disposal works
construction permit signed-by me dated 1 l , concerning the
property located at ��.- -� WXL meets all of the
following criteria:
• There are no wetlands within 300 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility .
• There is no increase in flow and/or change in use proposed i
• There are no variances requested or needed.
SIGNED : /G' �'"� DATE:.
LICENSED SEP C SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
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SEWAGE # 94
LOCATION
VILLAGE e4Nn l ASSESSOR'S MAP&LOTS z-�1
:INSTALLER'S NAME&PHONE NO.
;SEPTIC TANK CAPACITY z.,o d 1
.LEACHING FACILI' .(type) L-�.� (size)
:NO;OF BEDROOMS
`BTII,DER OR OWNER '
2 - G COMPLIANCE DATE: `..:..
'ft I T DATA: �� � 5
;Separation Distance Between the:
::Maziinum Adjusted Groundwater Table and Bottom of Leaching Facility .�
Feet_
Pii.vate Water Supply Well and Leaching Facility (If any wells exist eet
on;site or within 200 feet of leaching facility)
:Edge.of Wetland and Leaching Facility(If any wetlands exist Feet ,
within 300 feet achii faciliY
Furnished by
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ENVIRONMENTAL SERVICES, INC.
325 WOOD ROAD-BRAINTREE,MA 02184
(61 7)849-1800
February 19, 1993
Mr. Brian Harrison
Barnstable Housing Authority
146 South Street
Hyannis, MA 02601
Re: Limited Subsurface Investigation
35 General Patton Drive
Hyannis, Massachusetts
CHES File No. E-3546: (RI-6760)
Dear Mr. Harrison:
Enclosed is an estimate for assessment services to evaluate subsurface conditions in response to a
30-gallon #2 fuel oil release from an aboveground oil tank. Estimated costs fora limited
assessment of subsurface soils (Option A) and a more extensive subsurface investigation (Option
B) are included to evaluate soils and groundwater. Selection of either of the two options provided
for the assessment should be based upon Department of Environmental Protection (DEP)
requirements and the potential for long-term liability to the Barnstable Housing Authority.
Option A: Limited Assessment of Subsurface Soils (Placement of Probe Holes)
Due to the limited release of oil, #2 fuel oil may have migrated only a few feet below surface
grades. As such, a limited assessment of the subsurface soils in the immediate area of the release
may provide sufficient data to demonstrate that only the shallow soils were impacted and that the
petroleum has not migrated to the lower soils or underlying groundwater.
To evaluate the horizontal and vertical extent of petroleum in the soil, one day of probe hole
sampling will be performed. Three or more probe holes will be place within or in the immediate
area of the release using a hand auger and/or a split-spoon sampler. The number and depth of the
probe holes will depend on evidence of contamination detected in the field and the density of the
soils.
Soil samples collected during the probe hole sampling program will be screened with a
photoionization detector (HNU meter) for volatile organic compounds (VOCs) using headspace
screening methodologies. Based upon the results of the headspace screening, representative
samples will be analyzed in the laboratory for total petroleum hydrocarbons by infrared
spectroscopy (IR). For the purpose of this Scope of Work, three soil samples have been allocated
for laboratory analysis.
"People and Technology Creating a Better Environment"
4j
Barnstable Housing Authority
35 General Patton Drive, Hyannis,MA
February 19, 1993
Page 2 of 4
Results of the probe hole sampling, including screening and laboratory analyses, will be included
in a letter report. The report will also include a sample location plan and support documentation
necessary to base recommendations for future work,if required.
Option B: Subsurface Investigation - (Placement of Monitoring Well(s)
Option B is a more extensive assessment which is designed to evaluate the lower soils and
groundwater. Because the soils may be relatively sandy, #2 fuel oil in the soils may extend
beyond the reach of the probe holes (as proposed under Option A). To evaluate the lower soils and
groundwater, a drill rig, equipped with hollow stem augers will be used to install soil borings and
monitoring wells on the site.
Specifically, the subsurface investigation proposed under Option B will include one day of drilling
(2 to 3 borings) to collect subsurface soil samples and to install monitoring wells, groundwater
sampling and analyses, and data analyses and report preparation. The data obtained from this
investigation will be used to assess the vertical extent of petroleum product in soils and evaluate
and monitor groundwater quality. The borings/monitoring wells will be located as close as
possible to the release area.
During the drilling, soil samples will be collected with a split-spoon sampler for headspace
screening and laboratory analyses for total petroleum hydrocarbons by IR. In general, soil
samples will be collected at two-foot intervals from the ground surface to the vertical extent of
contamination and screened for VOCs using headspace screening methodologies. Selected soil
samples will be submitted to CHES for laboratory analyses to determine the vertical and horizontal
extent of petroleum impacted soils.
Upon completion of the drilling, the monitoring wells will be developed and allowed to equilibrate
for approximately 3 days. Groundwater samples will then be collected from the monitoring wells,
and screened and analyzed for VOCs using headspace methodologies and laboratory analyses
(EPA Method 602). Groundwater samples will also be analyzed for total petroleum hydrocarbons
by IR. Results of the subsurface investigation will be tabulated and summarized in a Letter Report.
Based upon the findings of the subsurface investigation, recommendations will be made for
additional remedial action,if necessary.
The following is a breakdown of estimated costs associated with the assessment services for the
two alternatives:
OPTION A: Limited Assessment of Subsurface Soils
Ts Estimated Cost
Health& Safety Plan $350
Probe Hole Sampling (one day) $1,600
(including travel, expenses and field
sampling and screening equipment)
Laboratory Analyses of Soil Samples $350
(3 TPH samples by IR)
Clean Harbors Environmental Services,Inc.
Barnstable Housing Authority
35 General Patton Drive, Hyannis,MA
February 19, 1993
Page 3 of 4
OPTION A: Limited Assessment of Subsurface Soils (Continued)
Letter Report $1,500
Total Estimated Cost of Option A $3,800
OPTION B: Subsurface Investigation
Tom, Estimated Cost
Health& Safety Plan $350
i
Drilling and Installation of Monitoring Well(s) (one day) $3,350
(includes drill rig, well materials for 2 to 3, labor,engineer
/geologist mob/demob of equipment, expenses and field
sampling and screening equipment)
Laboratory Analyses of Soil Samples $350
(3 TPH samples by IR)
Groundwater Sampling $750
(Includes labor, expenses and equipment to sample
groundwater and screen samples for total VOCs using
an HNU meter.)
Laboratory Analyses of Groundwater Samples $650
(3 samples for TPH by IR and for VOCs by EPA
Method 602.)
Data Analyses and Letter Report Preparation $3,000
Total Estimated Cost of Option B $8,450
CHES estimates that one day will be required to install the test boring(s)/monitoring well(s) using
the drill rig. This estimate may need to be revised if site conditions require more extensive drilling
to reach the groundwater table. Should actual work requirements exceed the anticipated scope of
work,CHES will contact the client prior to incurring any additional costs. Please sign the attached j
Field Services Agreement and indicate which assessment the Barnstable Housing Authority is
requesting to initiate the contract.
Clean Harbors Environmental Services,Inc.
Barnstable Housing Authority
35 General Patton Drive, Hyannis.MA
February 19, 1993
Page 4 of 4
Thank you for allowing Clean Harbors Environmental Services, Inc. the opportunity to submit this
proposal. If you have any questions, please contact the undersigned at (617) 849-1200, extension
1390.
Sincerely,
1-7
Steven . Flemt
Environmental Eggineer
Janet Stroup
Senior Geologic
STF/stf
Attachment
cc: CHES Job File No. E-3546
Pio Lombardo,CHES -Braintree,MA
Dana Simpson,CHES -Braintree,MA
Timothy Burbank,Supervisor,CHES. -RI Field Services
Providence,RI
Donna Marandy,Barnstable Board of Health
STFI/3004 35 General Patton Drive,Barnstable
BHA-Proposal
r
Clean Harbors Environmental Services,Inc.
Cleadarbors
Environmental Services, Inc.
FIELD SERVICES AGREEMENT
Barnstable Housing Authority Customer Name: g Y Customer Contact Person:
Address: 146 South Street Mr. Brian Harrison
Hyannis, MA 02601 Telephone:508/771-7222 _
Job Location (if different): JoblWork Order #: E-3546 or RI=6760
35 General Patton Dr. , Hyannis, MA Customer Insurance Carrier:
SCOPE OF WORK: Site evaluation for 30-gallon oil spill.
(See Attached)
WORK SCHEDULE: Upon approval of the Scope of Work:
OPTION A 45 days to complete SOW
OPTION B 60 days to complete SOW
ESTIMATED COST: (See Attached)
The Customer acknowledges that the estimated cost is based on a preliminary on-site appraisal by the Clean Harbors field representative and that the
amount invoiced by Clean Harbors will be based on labor and materials actually expended in performing the Scope of Work.Any changes in the Scope of
Work will be billed at time and materials rates.
Customer hereby assigns to Clean Harbors all rights to any insurance payments that Customer may be entitled to receive to pay for the services provided.
under this Field Services Agreement and hereby authorizes its insurance company or agent to pay Clean Harbors directly.
CUSTOMER'S AUTHORIZED REPRESENTATIVE OR AGENT CLEAN HARBORS ENVIRONMENTAL SERVICES, INC.
PRINT NAME PRINT NAME
DATE DATE
IMPORTANT
STANDARD TERMS AND CONDITIONS ON BACK
CHI 106
WHITE—Clean Harbors 01lice 'CANARY—Customer Copy PINK—Clean Harbors Job File
LOFCATION S E W A G E PERMIT"QN-O
311
VI'LLAGE
INSETA L R'S /N/. ME & ADDRESS
B U.I'L D E R OR OWNER
.�=11✓lit
DAf ty PERMIT ISSUED
DATE COMPLIANCE ISSUED
. - JL.
v .s
No..............5 � - Fivs............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
.................O F............. ..'..... .. .... .............----...... .............
Xpli iratinn for I!iposal Workii Tonfitrnrtinn Dj niit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
_System at: -
---�5 �
---------•--=--------------•-••-••••--•••.�' . n:............. ............ ....-..---------------------------•••---
Location-Address or Lot No.
�-....0 .7----------------------------------------- ----------- 4.. Ss--•......... ......17
---------------------------•----- --- :.:.... .......---- ----- . ...........
Installer Address
d Typ of Building Size Lot----------------------------Sq. feet
Dwelling—'No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons................---......... Showers ( ) — Cafeteria ( )
Q' Other fixtures
d ---------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank Liquid capacity/.OP4allons Length---------------- Width................ Diameter................ Depth................
x Disposal Trench—//NJJ o. .................... Widtli.-..-. ------------- Total Length-.-.------..-..---_ Total leaching area....................sq. ft.
Seepage Pit No.....�......... Diameter.......... ..... Depth below inlet-----1�-.......... Total leaching area......--.._..-----sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date--------------------------------------..
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.....---............ Depth to ground water........................
fi Test Pit No. 2................minutes per me Depth of Test Pit.-..-------.-------. Depth to ground water........................
--------- --- ---------------------------------------------------------------------------------------------------------------------------
O Description of Soil----------------
x ...
W -----•-••----------------- -----------------------------•••...------•-----------------------------------. .-" "-- --------------- -%--......�_.........`J 3 ---------------
----- ----------
VNature of epairs or Alterations—Answe3 when applicyhle.... 'f/i-- --------1 l>--�--- --.. ..............
. '� ........------ l/�C>-----�.. = '------- ����-�------------------�
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i s ed by he boa 'of e th.
l
S.
Re
Date
Application Approved By. -:�. --• ..... -----
Date
Application Disapproved for the following reasons:................................................................................................................
-----•----------------------•-----------------------------------------------------------------------------------•...----------------------------•--•-•--•----------------------•-------------------•----
Date
PermitNo......................................................... Issued........................................................
Date
1
No.--••--••. Faa............................
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD .. HEA H
...........OF......... - ................
Appliration -for INciponal Works Tonntrttrtion ; rrniit
Application is hereby'maddee for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System-.6-: /,, dA
Location-Address or Lot No.
--•....................
..... ... ------•-•--------•--•-••--•-•------------- ..... ---.....
Installer Address
d Type of Building Size Lot----------------------------Sq. feet
DwellingL-;-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ------------------------------------------------------
W Design Flow__ _________________________________________gallons per person per day. Total daily flow............................................gallons.
WSeptic Tunk Liquid capacit} }U�gallons Length................ �1�idt11................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No..__ __________ Diameter......... Depth below inlet....l........... Total leaching'trea__________________sq. it.
Z Other Distribution box 06 Dosing tank ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. 1________________minutes per inch Depth of Pest Pit.................... Depth to ground water........................
G4 Test Pit No. 2................minutes perWinDepth of Test Pit.-_______-__________ Depth to ground water...........__...__......
R; ------------- - _...........•••---••------•••-•---------------•-•-•--•-----••---••---............-•-•--••-•--•-•-•-------•-•-••-----•----
O Description of Soil_________________ .x
----•-•------------------•-----•---------•-•--...--•..........••-••-••-•••-•-•-••--••-----•---•----•--••... ----------------- ----------
U Nature of Repairs or Aiterati ns—Answel when appli ble.... .... ........... zo� 5,......I..............
�..... .1dv......... .......... .......................... �---------------------j•�------------------------`------------------------------------------
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 i s ed b the boa d of lth.
Ied:------- •-• • ... --•- ...................... -------------------------
Application Approved By... .... �---- --- ------ -- -----4
Date
Application Disapproved for the following reasons:................... ......----------....._..............-•--•-•------------•-••-....-•-•-•-----
........................•-•---------...._....._.........--•-----•---•--••--•-•--•••-•••••----•-•-••--••......_...----••--......-•--••-------------•------_._...................--------...---........--•-
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
s
� ................OF........ . .a4�..'..-.......................................
f1l ofirate of Complittnrr
THIS ER FY at h Individual Sewage Disposal System constructed ( ) or Repaired--------------
( )
I*a�iIlas been installed in accordance with the provisions of I of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No .___..__.._ ....._.._.. dated.... d.'..7�.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
...-----.. ..............�� I " �' ----•--------•-- Inspector----
DATEY 1s j �=y
THE COMMONWEALTH OF MASSACHUSETTS
7 BOARD HEALTH
/ r/h.....OF.... . ... ............................................
No.-----fir'............. FEE........................
r QT111 Vrrntit
Permission is hereby grant d -- ----- ---------- ----- •• . --------- ----`-..._....-•-•--••-•••...••••......---------••••••••-------•-••-------•••..•---
to Construct or geir ( an ivi a Sewage D' p sal Sys
Street
as shown on the application for Disposal Works Construction Per No.... . ....... . Dated___..--7___"-_�._ ......
DATE---- .......................................... Board of Health '
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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