HomeMy WebLinkAbout0312 PINE RIDGE ROAD - Health 72 Piny Ridge Road,
006-063 Cotuit7,if
k
Y Commonw6alth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
:-k
312 Pine Ridge Road
Property Address
Jennifer,Livingston
Owner Owners Name
information is COtUIt
required for MA 02635 October 30, 2007
every page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important:When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell Q(� p (�
cursor-do not Ck
use the return Name of Inspector
key. Septic Inspection Services Co.
Company Name
189 Cammett Road
Company Address I h_
Marstons Mills MA E02648 `---
ICI Cityrrown State -f-Zip Code 1'�
508-428-1779y.
Telephone Number License Number ' a
_ fj
B. Certification t
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
� I
10/30/07
Ins ector'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.
07-241 Uvingston.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owner's Name
information is required for Cotuit MA 02635 October 30, 2007
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:
Leaching chambers have 6-8"of standing water with no high stains. Recommend pumping tank
within next 18-24 months.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined,"please explain.
❑ 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.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
07-241 Livingston.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
312 Pine Ridge Road
Property Address _
Jennifer Livingston
Owner Owner's Name
information is required for Cotuit MA 02635 October 30, 2007
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
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
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.
07-241 Livingslon.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owner's Name
information is required for Cotuit MA 02635 October 30, 2007
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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
❑ ® 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.
07-241 Livingston.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owners Name
information is COtUIt
required for MA 02635 October 30, 2007
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.): r
Yes No
® Any portion of a cesspool or privy is within a Zone 1 of a public well.
El ® 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 CM 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 owner system
y o er should contact the appropriate
regional office of the Department.
07-241 Livingston.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owners Name
information is Cotuit
required for MA 02635 October 30, 2007
eve ry page. Clt /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 b the owner, occupant, or Board p Y p 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)]
07-241 Uvingston.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
x Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owners Name
information is Cotuit
required for MA 02635 October 30, 2007
every page. City/Town State Zip Code Date of Inspection
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): 440
Number of current residents: 4
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)): 196,000 gal.
(268 gpd)
Sump pump? ❑ Yes ® No
Last date of occupancy: Currently
Occupied
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:
Last date of occupancy/use: Date
Other(describe):
07-241 Livingston.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
4 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owners Name
information is COtUIt
required for MA 02635 October 30, 2007
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Tank pumped in 2004 when new leaching system
was installed
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)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Compliance date for leaching system: 9/30/04
Were sewage odors detected when arriving at the site? ❑ Yes ® No
07-241 Livingston.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
Commonwealth of Massachusetts
ARK, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Je
nnifer Livingston
Owner Owners Name
information is COtUIt
required for MA 02635 October 30, 2007
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
1'
Depth below grade: 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.):
Septic Tank(locate on site plan):
1'
Depth below grade: feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
•-------------------------------------------------------------------------------------------------------------------------
Dimensions: 8.5' long x 5.2'wide- 1000 gal.
Sludge depth:
4"
Distance from top of sludge to bottom of outlet tee or baffle
26"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
6°
Distance from bottom of scum to bottom of outlet tee or baffle
10"
-
How were dimensions determined? Measured
07-241 Livingston.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
t
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owner's Name
information is Cotuit MA 02635 October 30 required for , 2007
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.):
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
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):
i
07-241 Livingston.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts '
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owners Name
information is Cotuit
required for MA 02635 October 30, 2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
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
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
No solids or high stains, liquid level at bottom of outlet pipes
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
07-241 Livingston.doe-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owners Name
information is COtUIt
required for MA 02635 October 30, 2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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:
Type:
❑ leaching pits number:
® leaching chambers number: Three 500 galdrywells
❑ 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.):
Observed 6-8"of standing water with no high stains. Soils and vegetation are normal.
I
07-241 Livingston.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r 312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owners Name
information is Cotuit
required for MA 02635 October 30, 2007
every page. Cltylrown State Zip Code Date of Inspection
D. System Information (cont.)
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
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.).
i
07-241 Livingston.doe-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owner's Name
information is Cotuit
required for MA 02635 October 30, 2007
every page. City1rown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
SN
% N
. . . . . . . . . . . . . . . . . . .
/ / / / / / / / / / / / / / / / r / / r , /
::Rhl�tW �f . . . . . . . . . .
29
65
4.
55 28
.R.
Water
Service
Pine Ridge Road
07.241 Livingston.doc•01106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r 312 Pine Ridge Road
Property Address
Jennifer Livingston
Owner Owner's Name
information is COtUIt
required for MA 02635 October 30, 2007
every page. Cltylrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to 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:
❑ Checked with local excavators, installers- (attach documentation)
® Accessed USG8 database-explain:
USGS topo map and town GIS.
You must describe how you established the high ground water elevation:
Town Groundwater contour map shows water below el. 5 and topo map shows property at or above
el. 30
07-241 Livingston.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15
L
THE Town of Barnstable
�F Tp�
ti�P� ti� Regulatory Services
MRNS,,BLE ; Thomas F. Geiler,Director
y M. g
1639. Public Health.Division
�TE'D MA'S A
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts,Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the "Disposal
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
TOWN OF BA TABLE
LQCATION SEWAGE#
Mutcr
t L A G E Ui�f ASS OR'S MAP&PARCEL
YP��NAME&PHONE NO. / �� r
SEPTIC TANK CAPACITY 110O
Q61-
LEACHING FACILITY:(type) size) U
NO.OF BEDROOMS
OWNER
PERMIT D DATE:
Separation Distance Between the: .
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY 1��
t
r
• . I
I
i
29 65
�5
Water
Service
P
ba ..
Pine Ridge Road
TOWN OF
fBA.RNSTABLE n
LOCATION QL �t h ea��c c �ccl, SEWAGE #oc `"4� p�
VECLAGE SJOTu• k' 44SS(ESSOR'S MAP & LOT 06 3
INSTALLER'S NAME&PHONE NO. .
I` SEPTIC TANK CAPACITY DOO G'H - s
LEACHING FACILITY: (type]- OO661_C m (sizej 33 �lx �3t
NOD.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: 'aq COMPLIANCE DATE: 6 -ot
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 of leaching facility) Feet
Furnished by -
pep
Q x
r
`'
No.
�pl. Fee oU'
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 14
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABL'ES MASSACHUSETTS
01pplication for 30i!�pogal *p5tem Conotruction Permit
Application for a Permit to Construct( . )Repair(Upgrade( )Abandon( ) ❑Complete System ❑.Individual Components
Location Address or Lot No. j a "Pt n C _� e Owner'LNIqrne,Address and Tel.No.
Assessor's Map/Parcel C-��v-�� 3 Q'?���L n_(����ry- L�„o�,ttY
Q Q �t�l t
Installer's Name,Apdress,and Tel.No. Designer's Name,Address and Tel.No.
3gc,-c.,--M_CcLk T� S i Aso,. l� I sc®_
C�a iC�l� 0 655- 8��� 018�YZA �erV qaa- 6�
Type of Building:
Dwelling No.of Bedrooms_ ` Lot Size sq.ft. Garbage Grinder(AO
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow '4--0- ( Ll L{O gallons per day. Calculated daily flow gallons.
Plan Date KEPT- Z'- d Lf Number of sheets Revision Date
Title _
Size of Septic Tank (1000 6 a EJCI�t rtS Type of S.A.S.3- 0664. / dv '
Description of Soil I
r
Nature of Repairs or Alterations(Answer when applicable) 1 h b t c�A D=3`(X
33_J )C t: JE `t4
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 Certifi-
cate of Compliance has been iss d by this B and of th
Signed Date sF .-/
Application Approved by Date C
Application Disapproved for the following reasons
i
Permit No. 009- qg.- Date Issued
No. V /0 .� Fee 10 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE.MASSACHUSETTS
4
rication forigoaf *pMent Congtructiorierntit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ). ❑Complete System ❑Individual Components
Location Address or Lot No. i,�C, �.a�e 4� Owner' aym�e,A'd�d-I'C and Tel.
�iJL:r`` v. �
Assessor's Map/Parcel C OY�'`l 1 1 ^
Installers Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
1CLCC .�tr
s ter. .lt� aa6S'S _ QL� s
Type of Building:
Dwelling No.of Bedrooms /` Lot Size y�,/°� sq.ft. Garbage Grinder
j
Other Type of Building No.of Persons Shower's( ) Cafeteria( )
Other Fixtures
Design Flow - _ gallons per day. Calculated daily flow gallons.
Plan Date ��' t 0 Number of sheets. Revision Date
{ Title _
Size of Septic Tank 1 CG y "�t' , C i ' S Type of S.A.S. -5 A f/��[vC J
Description of Soil f ��
Ii1.51C.�( .� itX �.
Nature of Repairs or Alterations(Answer hen apylicable) ��S' 1
.33.7 A <«y
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-s.ite 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 Certifi-
cate of Compliance has been iss&d by this : and of T
Signed Date
l Application Approved by Date )`I .0 q
Application Disapproved for the following reasons
u
Permit No. aU0 _ K Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO C1RTIF , that the On-site Sewage Disposal System Constructed ( )Repaired (Upgraded( )
Aballdo ed( )by
at has-been construe' kaccord
ance
with the p rovisions f Title<and the for Disposal System Construction Permit No. Ud y tS dated fy
Installer KcZlt X- Designer
The issuance ofithis permit shall not be construed as a guarantee that the sys m il)function as d signe•.
Date IUf U I Inspector
No. �.VU�,J..• r6�---------------------------Fee: lUV-�'
1 THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
M.5po.5al *pgtel� Con$truction Permit
Permission is hereby g nted to, onstruct( )R it(r )(J.pgrade ( )Abandon( )
System located at � 11`
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:Co truct n must be completed within three years of the date of t is errrhtE
`
9 1 / J=2� �Date: A r ved
o b ,
PP Y
�¢ TOWN OF BARNSTABLE
Y' ` LOCATION 3 e�w c \cn� SEWAGE #�c �'
VILLAGE y '� ASSESSOR'S MAP & LOT OM b�G
q Old
INSTALLER'S NAME&PHONE NO. Q
SEPTIC TANK CAPACITY DOO G' s
w LEACHING FACII.ITY:'(type) aD m (size)
NO.OF BEDROOMS 'T
' T O C f�\ L.�l l} rn Q SN'a V\
BEDROOMS—
BUILDER OR O�VVNER c�s
r PERMTTDATE: 5E T kL(Za�( 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
Edged Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
61
,
nN� G
�i
i. t
lf'W
Thomas&.Betts Corporation
452 John Dietsch Blvd.
P.O. Box 2510
Attleboro Falls, MA 02763
(508) 699-9800
Facsimile (508) 695-8111
rhOmasR efts
April 2, 1998
Robert C. Livingston
Jennifer J. Lempke
P.O. Box 424 �6 /b&3
Cotuit, Massachusetts 02635
Dear Mr. Livingston and Ms. Lempke: ��2 t Uc
Enclosed please find the laboratory results of the analysis of your well water,which we recently sampled. That
sampling was performed from a well which is no longer in service. The water samples were collected by GZA
GeoEnvironmental, Inc. and analyzed by the Mitkem Corporation laboratory. BTEX (benzene, toluene,
ethylbenzene, and xylene) and 1,2-dichloroethane [also known as ethylenedichloride (EDC)] were detected in
the samples taken from your well. I have been assured by the project's Licensed Site Professional that, given
the nature and concentrations of these contaminants, the distribution of the contaminants, and the
hydrogeologic conditions, these contaminants are not associated with the 106 Falmouth Road Site. This
information has been sent to the Massachusetts Department of Environmental Protection ("DEP"). If you have
any questions regarding these contaminants, you should consult with the DEP.
The contaminants of concern at the 106 Falmouth Road Site were industrial solvents and cleaners potentially
related to historic operations at that facility in Mashpee. To test for such materials, the laboratory analyzes for
the range of VOCs specified by the EPA's testing method.
GZA took two samples of your well water,vthe second as a "blind duplicate" for quality conttrol purposes. The
concentrationsofiEDC were 18.and 23-ppb.+The drinking water standard for EDC is 5 ppb. None of the BTEX
compounds detected exceeded applicable drinking water standards, which are: benzene, 5 ppb; toluene, 1-000
ppb; ethylbenzene, 700 ppb; and xylene, 10,000 ppb. These compounds are constituents of gasoline and fuel
oil. In addition, EDC may be affiliated with gasoline and has independent uses, although it can be a derivative
compound of industrial solvents.
We appreciate your allowing us to come and test the groundwater at your property. If you have any questions,
please do not hesitate to call Tom McShane at Thomas & Betts (508-699-9820).
I
Sincerely,
William 0. Frigon
Attachment: Laboratory Analysis Reports
cc: Town of Barnstable Board of Health
Mark Wood, DEP
�l
CORPORATION
'; 1,
APR 0 2 1998
March 31, 1998
GZA GeoEnvironmental, Inc. u U
140 Broadway •------�"'�"'+`
Providence, RI 02903
Attn: Ms. Hilary Fortune
RE: Client Project#: 31751.13, Cotuit Well Sampling (IRA)
Lab Project#: E0410
Dear Ms. Fortune:
Enclosed please find the data report of the required analyses for the samples associated
with the above referenced project. If you have any questions regarding this report, please
call me.
We appreciate your business.
Sincerel
Edward A. Lawler
Laboratory Operations Manager
175 Metro Center Boulevard • Warwick, Rhode Island 02886-1755 • (401) 732-3400 • Fax (401) 732-3499
1232 East Broadway, Suite 210 • T'empe, Arizona 85282 • (602) 303-9535 • Fax (602) 921-2883
email: mitkem@worldnet.att.net
i
CORPORATION
Client: GZA GeoEnvironmental,Inc.
Client Project: 31751.13, Cotuit Well Sampling(IRA)
Lab Project: E0410
Date samples received: 3/27,3/30/98
Project Narrative
This data report includes the analysis results for ten(10) aqueous samples that were received
from GZA GeoEnvironmental, Inc. on March 27,30 1998. Analyses were performed per
specification in the Chain of Custody form. For reference, a copy of the Mitkem Sample Log-
In form is included for cross-referencing the client sample ID and laboratory sample ID.
All of the analyses were performed according to method specifications. The method blank
associated with these volatile organic sample analyses contained low levels of common
laboratory contaminants methylene chloride and 1,12-trichloro-1,2,2-trifluoroehtane. These
compounds were also detected in several samples. Where they are detected in samples, their
concentrations are flagged with a"B". No other unusual occurrences were noted during sample
analysis.
This data report has been reviewed and is authorized for release as evidenced by the signature
below.
Edward A. Lawler
Laboratory Operations Manager
` � 1
Data Qualifiers:
J This flag indicates an estimated value due to either
• the compoundwas detected at below the Reporting Limit, or
• estimated concentration for Tentatively Identified Compound
B This flag indicates the analyte was also detected in the associated
Method Blank
D This flag indicates the analyte concentration was obtained from a
diluted analysis
E This flag indicates the analyte concentration exceeded the
Calibration Range
P This flag is used for Pesticides/PCB/Herbicide analyte when there
is a greater than 50% difference for detected concentration between
the two GC columns used for Primary and Confirmation analyses.
The lower of the two values is reported in the Analysis Report.
0O '
CORPORATION
Analysis Report: Purgeable Volatile Organics
Client: GZA GeoEnvironmental, Inc. Analysis Date: 3/31/98
Client ID: RW-18 Concentration in: ug/L
Lab ID: E0410-06 Dilution: 1
Analysis: Method 524.2
Reporting
Analyte Result UO3A
Dichlorodifluoromethane ND 0.5
Chloromethane ND 0.5
Vinyl chloride ND 0.5
Bromomethane ND 0.5
Chloroethane ND 0.5
Trichlorofluoromethane ND 0.5
1,1-Dichloroethene- ND 0.5
Methylene chloride ND 0.5
trans-1,2-Dichloroethene ND 0.5
1,1-Dichloroethane ND 0.5
2,2-Dichloropropane ND 0.5
cis-1,2-Dichloroethene ND 0.5
Bromochloromethane ND 0.5
Chloroform ND 0.5
•.1,1,1-Trichloroethane ND 0.5
Carbon tetrachloride ND 0.5
1,1-Dichloropropene ND 0.5
Benzene 2 0.5
1,2-Dichloroethane 18 0.5
Trichloroethene ND 0.5
1,2-Dichloropropane ND 0.5
Dibromomethane ND 0.5
Bromodichloromethane ND 0.5
cis-1,3-Dichloropropene ND 0.5
Toluene 2 0.5
trans-1,3-Dichloropropene ND 0.5
1,1,2-Trichloroethane ND 0.5
Tetrachloroethene ND 0.5
1,3-Dichloropropane ND 0.5
Dibromochloromethane ND 0.5
1,2-Dibromoethane ND 0.5
Chlorobenzene ND 0.5
1,1,1,2-Tetrachloroethane ND 0.5
013
Page 1 of 2 E0410-06
.CORPORATIONMITKEM
Client ID: RW-18 Lab ID: E0410-06
Reporting
Analvte Result LimL
Ethylbenzene 0.8 0.5
Xylenes (total) 1 0.5
Styrene ND 0.5
Bromoform ND 0.5
Isopropylbenzene ND 0.5
Bromobenzene ND 0.5 .
1,1,2,2-Tetrach loroethane- ND 0.5
1,2,3-Trichloropropane ND 0.5
n-Propylbenzene ND 0.5
2-Chlorotoluene ND 0.5
4-Chlorotoluene ND 0.5
1,3,5-Trimethylbenzene ND . 0.5
tert-Butylbenzene ND 0.5
1,2,4-Trimethylbenzene ND 0.5
sec-Butylbenzene ND 0.5
1,3-Dichlorobenzene ND 0.5
4-Isopropyltoluene ND 0.5
1,4-Dichlorobenzene ND 0.5
1,2-Dichlorobenzene ND 0.5
.;,n-Butylbenzene ND 0.5
1,2-Dibromo-3-chloropropane ND 0.5
1,2,4-Trichlorobenzene ND 0.5
Hexachlorobutadiene ND 0.5
1,2,3-Trichlorobenzene ND 0.5
Naphthalene ND 0.5
1,1,2-Trichloro-1,2,2-trifluoroethane ND 0.5
I
QC Batch: V5B0330A
Surrogate Recovery:
Bromofluorobenzene 92%
1,2-Dichlorobenzene-d4 100%
ND= Not Detected
* Single point calibration
U14
Page 2 of 2 E0410-06
CORPORATION
Analysis Report: Purgeable Volatile Organics
Client: GZA GeoEnviron mental, Inc. Analysis Date: 3/31/98
Client ID: RW-24 Concentration in: ug/L
Lab ID: E0410-03 Dilution: 1
Analysis: Method 524.2
Reporting
Analyte Results Limit -
Dichlorodifluoromethane ND 0.5
Chloromethane ND 0.5
Vinyl chloride 'ND 0.5
Bromomethane ND 0.5
Chloroethane ND 0.5
Trichlorofluoromethane ND 0.5
1,1-Dichloroethene ND 0.5
Methylene chloride ND 0.5
_trans-1,2-Dichloroethene ND 0.5
111-Dichloroethane ND 0.5
2,2-Dichloropropane ND 0.5
cis-1,2-Dichloroethene ND 0.5
Bromochloromethane ND 0.5
Chloroform ND 0.5
1,1,1-Trichloroethane ND 0.5
Carbon tetrachloride ND 0.5
1,1-Dichloropropene ND 0.5
Benzene 3 0.5
1,2-Dichloroethane 23 0.5
Trichloroethene ND 0.5
1,2-Dichloropropane ND 0.5
Dibromomethane ND 0.5
Bromodichloromethane ND 0.5
cis-1,3-Dichloropropene ND 0.5
Toluene 3 0.5
trans-1,3-Dichloropropene ND 0.5
1,12-Trichloroethane ND 0.5
Tetrachloroethene ND 0.5
1,3-Dichloropropane ND 0.5
Dibromochloromethane ND 0.5
1,2-Dibromoethane ND 0.5
Chlorobenzene ND 0.5
1,1,1,2-Tetrachloroethane ND 0.5
Pagel of 2 E0410-03
MITKEIVI
CORPORATION
Client ID: RW-24 Lab ID: E0410-03
Reporting
Analyte Result Load
Ethylbenzene 1 0.5
Xylenes (total) 1 0.5
Styrene ND 0.5
Bromoform ND 0.5
Isopropylbenzene ND 0.5
Bromobenzene ND 0.5
1,1,2,2-Tetrachloroethane N D 0.5
1,2,3-Trichloropropane ND 0.5
n-Propylbenzene ND 0.5
2-Chlorotoluene ND 0.5
4-Chlorotoluene ND 0.5
1,3,5-Trimethylbenzene ND 0.5
tert-Butylbenzene N D 0.5
1,2,4-Trimethylbenzene ND 0.5
sec-Butylbenzene ND 0.5
1,3-Dichlorobenzene ND 0.5
4-Isopropyltoluene ND 0.5
1,4-Dichlorobenzene ND 0.5
1,2-Dichlorobenzene ND 0.5
:,n-Butylbenzene ND 0.5
1,2-Dibromo-3-chloropropane ND 0.5
1,2,4-Trichlorobenzene ND 0.5
Hexachlorobutadiene ND 0.5
1,2,3-Trichlorobenzene ND 0.5
Naphthalene ND 0.5
1,1,2-Trichloro-1,2,2-trifluoroethane ND 0.5
QC Batch: V5B0330A
Surrogate Recovery:
Bromofluorobenzene 94%
1,2-Dichlorobenzene-d4 101%
ND= Not Detected
Single point calibration
1rf f -� li
v
l{
Page 2 of 2 E0410-03
r
MITKENI
CORPORATION
Analysis Report: Purgeable Volatile Organics
Client: GZA GeoEnviron mental, Inc. Analysis Date: 3/31/98
Client ID: TB (3/27) Concentration in: ug/L
Lab ID: E0410-08 Dilution: 1
Analysis: Method 524.2
Reporting
Analyte Results �IDlt
Dichlorodifluoromethane ND 0.5
Chloromethane ND 0.5
Vinyl chloride ND 0.5
Bromomethane ND 0.5
Chloroethane ND 0.5
Trich lorofl u oro methane ND 0.5
1,1-Dichloroethene ND 0.5
Methylene chloride 0.6 B. 0.5
trans-1,2-Dichloroethene ND 0.5
1 1-Dichloroethane
ND 0.5
2,2-Dichloropropane ND 0.5
cis-1,2-Dichloroethene ND 0.5
Bromochloromethane ND 0.5
Chloroform ND 0.5
1.,1,1-Trichloroethane ND 0.5
Carbon tetrachloride ND 0.5
1,1-Dichloropropene ND 0.5
Benzene ND 0.5
1,2-Dichloroethane ND 0.5
Trichloroethene ND 0.5
1,2-Dichloropropane ND 0.5
Dibromomethane ND 0.5
Bromodichloromethane ND 0.5
cis-1,3-Dichloropropene ND 0.5
Toluene ND 0.5
trans-1,3-Dichloropropene ND 0.5
1,12-Trichloroethane ND 0.5
Tetrachloroethene ND 0.5
1,3-Dichloropropane ND 0.5
Dibromochloromethane ND 0.5
1,2-Dibromoethane ND 0.5
Chlorobenzene ND 0.5
1,1,1,2-Tetrachloroethane ND 0.5
Page 1 of 2 E0410-08
MITKENI
CORPORATION
Client ID: TB (3/27) Lab ID: E0410-08
Reporting
Analyte Result LMA
Ethylbenzene ND 0.5
Xylenes (total) ND 0.5
Styrene ND 0.5
Bromoform ND 0.5
Isopropylbenzene ND 0.5
Bromobenzene ND 0.5
1,1,2,2-Tetrachloroethane ND 0.5
1,2,3-Trichloropropare ND 0.5
n-Propylbenzene ND 0.5
2-Chlorotoluene ND 0.5
4-Chlorotoluene ND 0.5
1,3,5-Trimethylbenzene ND 0.5
tert-Butylbenzene ND 0.5
1,2,4-Trimethylbenzene ND 0.5
sec-Butylbenzene ND 0.5
1,3-Dichlorobenzene ND 0.5
4-Isopropyltoluene ND 0.5
1,4-Dichlorobenzene ND 0.5
1,2-Dichlorobenzene ND 0.5
n-Butylbenzene ND 0.5
1,2-Dibromo-3-chloropropane ND 0.5
1,2,4-Trichlorobenzene ND 0.5
Hexachldrobutadiene ND 0.5
1,2,3-Trichlorobenzene ND 0.5
Naphthalene ND 0.5
1,1,2-Trichloro-1,2,2-trifluoroethane 0.7 B 0.5
I
QC Batch: V5B0330A
Surrogate Recovery:
Bromofluorobenzene 94%
1,2-Dichlorobenzene-d4 102%
ND= Not Detected
" Single point calibration
Page 2 of 2 E0410-08
MITKEINI
CORPORATION
Analysis Report: Pur eable Volatile Organics
Y P 9
Client: GZA GeoEnvironmental, Inc. Analysis Date: 3/30/98
Client ID: Concentration in: ug/L
Lab ID: Method Blank,V560330A Dilution: 1
Analysis: Method 524.2
Reporting
Analyte Results Lima
Dichlorodifluoromethane ND 0.5
Chloromethane ND 0.5
Vinyl chloride ND 0.5
Bromomethane ND 0.5
Chloroethane ND 0.5
Trichlorofluoromethane ND 0.5
1,1-Dichloroethene ND 0.5
Methylene chloride 0.4 J 0.5
trans-1,2-Dichloroethene ND 0.5
111-Dichloroethane ND 0.5
2,2-Dichloropropane ND 0.5
cis-1,2-Dichloroethene ND 0.5
Bromochloromethane ND 0.5
Chloroform ND 0.5
.1,1,1-Trichloroethane ND 0.5
Carbon tetrachloride ND 0.5
1,1-Dichloropropene ND 0.5
Benzene ND 0.5
1,2-Dichloroethane ND 0.5
Trichloroethene ND 0.5
1,2-Dichloropropane ND 0.5
Dibromomethane ND 0.5
Bromodichloromethane ND 0.5
cis-1,3-Dichloropropene ND 0.5
Toluene ND 0.5
trans-1,3-Dichloropropene ND 0.5
1,1,2-Trichloroethane ND 0.5
Tetrachloroethene ND 0.5
1,3-Dichloropropane ND 0.5 .
Dibromochloromethane ND 0.5
1,2-Dibromoethane ND 0.5
Chlorobenzene ND 0.5
1,1,1,2-Tetrachloroethane N D 0.5 0 2 3
Pagel of 2 E0410-MB
MITKEINI
CORPORATION
Client ID: Lab ID: Method Blank, V5B0330A
Reporting
Analyte Result Lima
Ethylbenzene ND 0.5
Xylenes (total) ND 0.5
Styrene ND 0.5
Bromoform ND 0.5
Isopropylbenzene ND 0.5
Bromobenzene ND 0.5
1,1,2,2-Tetrachloroeth ane ND 0.5
1,2,3-Trichloropropane ND 0.5
n-Propylbenzene ND 0.5
2-Chlorotoluene ND 0.5
4-Chlorotoluene ND 0.5
1,3,5-Trimethylbenzene ND 0.5
tert-Butylbenzene ND 0.5
1,2,4-Trimethylbenzene N D 0.5
sec-Butylbenzene ND 0..5
1,3-Dichlorobenzene ND 0.5
4-Isopropyltoluene ND 0.5
1,4-Dichlorobenzene ND 0.5
1,2-Dichlorobenzene ND 0.5
-.n-Butylbenzene ND 0.5
1,2-Dibromo-3-chlorop.ropane ND 0.5
1,2,4-Trichlorobenzene ND 0.5
Hexachlorobutadiene ND 0.5
1,2,3-Trichlorobenzene ND 0.5
Naphthalene ND 0.5
1,1,2-Trichloro-1,2,2-trifluoroethane 0.6 0.5
QC Batch: V5B0330A
Surrogate Recovery:
Bromofluorobenzene 93%
1,2-Dichlorobenzene-d4 99%
ND= Not Detected
Single point calibration
U ? 4
Page 2 of 2 E0410-MB
MITKEM CORPORATION
Lab Project 41�
9
Client Name: GZA GeoEnvironmental, Inc.
Client Proj #: 31751.13 Logged In By
Client PO #: 3-01096
Project Name: Cotuit Well Sampling (IRA) Reviewed By: M-5
Date Due: 3/31/98
Total Price: $ - Date: Time: 0 70
Project Mgr: PAS
Salesman: PAS
Del Req'd: NA
Completed?: YES
Lab ID Client ID Matrix n I i Price Sampled Received M M B.NA Herb 11P Wd Mrd V-GC V-MS
-01 RW-1 AQ 524.2 3/27/98 3/27/98 1
-02 RW-7 AQ 524.2 3/27/98 3/27/98 1
-03 RW-24 AQ 524.2 3/27/98 3/27/98 1
-04 RW-17 AQ 524.2 3/27/98 3/27/98 1
-05 RW-23 AQ 524.2 3/27/98 3/27/98 1
-06 RW-18 AQ 524.2 3/27/98 3/27/98 1
-07 RW-8 AQ 524.2 3/27/98 3/27/98 1
-08 TB (3/27) AQ 524.2 3/27/98 3/27/98 1
-09 RW-15 AQ 524.2 3/28/98 3/30/98 1
-10 TB (3/28) AQ 524.2 3/28/98 3/30/98 1
TPH IL BNA Herb Plp Wd Ntt V-G V-MS Su4
CD
CD 0 0 0 0 0 0 0 0 10 0
13/31/98 9:52 AM Page 1 of 2 Lab Project #: E0410
MITKEM CORPORATION
Lab ID Client ID Matrix Analysis Price Sampled -Received TPH 1R B A Herb EL W&t MS.t
NOTES: Add FreoBl`l �toltoa� oln�a��tb�atiar ,,, a ,
ORIGINAL REPORT GOES TO' INVOICE GOES TO: ADDITIONAL REPORT GOES TO:
GZA GeoEnvironmental, Inc Attn: Hilary Fortune Same None
140 Broadway Phone: 401 421-4140
Providence,RI02903 Fax: 401 751-8613
C'
Gy/31/98 9:52 AM Page 2 of 2 Lab Project#: E0410
WHITE COPY-Original YELLOW COPY-Lab Files PINK COPY Project Manager W.O. #
CHAIN-OF-CUSTODY RECORD (for lab use only) .
ANALYSES REQUIRED
Sample Daterrime Matrix Y m S s
cc
I.D. m s
s=soa 8 m g Total
Gw=G,ou,d W. m o a
(Very Important) , a N '— °
sw=sunao.w. �' p of Note
ww=Waste W. 1 N 9 '1 N (7 Cont. Y
OW=Drinking W. G 2 � m 3, 2 U
Oine,('Pndy) '= 3
2-4-cf13 . DVJ y yl
RW - } " / I`I : gV DvJ
PAW — 24 ti. I5•.00 Gw
ttl— I 1i : 3 Did
�WV 23 12•.o2 D01
RvU- I S I`I :2s Gw'
RvV_ g io:�t� DVV
PRESERVATIVE (CI-HCI,N-HNO3,S-H2SO4,Na-NaOH,O-Other)'
CONTAINER TYPE (P-Plastic,G-Glass,V-Vial,T-Tellon,O-Other)'
)tELINQUISHED BY:(Affiliation) DATErrIME RECEIVED BY:(Affiliation) NOTES:Preservatives,special reporting limits,known contamination,etc.:
(Unless otherwise noted,all VOA vials have been preserved w/1:1 HCL.)
r ueJ�
EI BY: Affiliation eft cQ T
RELINQUISHED BY:(Affiliation) DATEIfIME ( ) �Q ci r. etiJ 6 s1 �cI /� /
'D`i ' 21 9�- �' `� rnu �, ex u 1zr o r�J ���� safu�.�[�,
RELINQUISHED BY:(Affiliation) DAT !TIME RECEIV D BY:(Affiliation) /� /
f4-J
PROJECT MANAGER: �>✓rU rJ� EXT:
TURNAROUND TIME:❑Standard Lvl Rush --al—Days,Approved by:
GZA FILE NO. 3 1 151•( S P.O. N.O.
GZA GEOENVIRONMENTAL, INC.
ENGINEERS AND SCIENTISTS PROJECT 0-OT-0I'I- W&L.L- !S n PL-IM �L �
140 Broadway
PROVIDENCE,RI 02903 LOCATION COTo IT-, 1,&A,
—
(401)421-4140 ,
FAX(401)751-8613 COLLECTOR(S) Ct/k`�/n I,�/�t/TI� SHEET OF�_
WHITE COPY-Original YELLOW COPY-Lab Files PINK COPY- Project Manager W.O. #
CHAIN-OF-CUSTODY RECORD (for lab use only)
ANALYSES REQUIRED
Sample Datefrime Matrix d m a Q
I.D. � a
s_sod s ' 8 m g Total
(Very Important) cw=m—aw. m e a < d 3 a = J tr of Note
Sw=S.Aacs W.
wW=Waste W. , ti n -., � LL n g _ _ Cont. #
DW=04nk,ng W. n 2 U ,� m m m g $ U = I
Olhe,(spncdy) _l S (5 7 'l
Ili; zo GVl
PRESERVATIVE (CI•HCI,N-HNO3.S-H2SO4,Na-NaOH,O-Other)'
CONTAINER TYPE (P-Plastic,G-Glass,V-Vial,T-Tellon,O-Other)'
R I UISHED BY: (Affiliation) DATE/TIME RECEIVED BY:(Affiliation) NOTES: Preservatives,special reporting limits,known contamination,etc.:
u� 3 0�l /,�S 1 (Unless otherwise noted,all VOA vials have been preserved w/1:1 HCL.) r I
RE IN 1 HE BY: (Affiliation DATE/TIME , RECEIV D BY:(Affiliation) to h W,�t Sct�i�p leS Gv(J �.&C C'e"J 'Je-r rvV�t-e-A+Z) I� ov►
3 IlLD
RELINQUISHED BY: (Affiliation) DATE/TIME IVED BY:(Affiliation)
PROJECT MANAGER: IL-4kg:zX �'' 2Tyt-3C' EXT: 3 t 2-6
TURNAROUND TIME:❑Standard O Rush —Days,Approved by:
GZA FILE NO. :5 I-4SI 13 P.O. N.O.
GZA GEOENVIRONMENTAL, INC. �
ENGINEERS AND SCIENTISTS PROJECT Co-rutTUJ0LL-5A\AAP I,-V, CZ ,I
140 Broadway
PROVIDENCE,RI 02903 LOCATION rurr- AAA
(401)421-4140 J +'
�i FAX(401)751-8613 COLLECTOR(S) W. SHEET_ OF�_
f
MITKEM CORPORATION
Sample Condition Form Page L14
-T-
Received By: Reviewed By: Date: YJ Y o IMITKEM Project:
Client Project: �� t(t. Client: 6p
Sample ID Preservation (pH) Comments/Remarks/
Condition: Lab Client HNO3 H2SO4 HC1 NaOH Corrective Action`
1) Custody Seal(s) Presen Absent
Cooler /Bottles
,
Intact/Broken
3
2) Custody Seal Number(s) X)
— —0
3) Chain-of-Custody Presen bsent
4) Cooler Temperature
Coolant Condition
5)Airbilf(s) Presen bsen
Airbill Number(s)
6) Sample Bottles I tta
Broken
Leaking
7) Date Received
8) Time Received
9) Project Due Date
* See Sample Condition Notification/Corrective Action Form yes no
C
MITKEM CORPORATION
Sample Condition Form Pagd.::bf-2
Received By: Reviewed By: Date: 3 3 a C MITKEM Project: b
Client Project: Client:
Sample ID Preservation (pH) Comments/Remarks/
Condition: Lab Client HNO3 H2SO4 HCI NaOH Corrective Action`
w
1) Custody Seal(s) (Presen Absent ID
ooler�/Bottles
1
c Broken
2) Custody Seal Number(s)
3) Chain-of-Custody !roAbsent
4) Cooler Temperature
Coolant Condition c <<
5)Airbill(s) Prese Absent
Airbill Number(s) -
6) Sample Bottles Intact
Broken
Leaking
7) Date Received 3
8)Time Received
9) Project Due Date
/
See Sample Condition Notification/Corrective A,�tion Form yes no
VJU
Last Page of Data Report
MAILING LIST FOR 106 FALMOUTH ROAD SITE-MASHPEE,MASSACHUSETTS
DATE: / FILE NO.
DOCUMENT:4L'/Z/ z,z Clk44�"L JA�4ZI&171�
ADDRESSEE "reg:&: "blind cr." VIA SENT
Massachusetts Dept.of Environmental Protection
Southeast Regional Office 111
20 Riverside Drive
Lakeville.Massachusetts 02347
n: Mr.Gerard Martin,Acting Chief
Attn: Mr.Mark Wood,Project Manager
Massachusetts Department of Public Health
Environmental Health Assessment
250 Washington Street,r Floor
Boston,Massachusetts 02108
Attn: Ms.Elaine Kroueger,Chief,Environmental
Toxicology
Mashpee Board of Health
16 Great Neck Road
Mashpee,Massachusetts 02649
Attn: Mr.Elias McQuaid,Chairperson
Mashpee Board of Selectmen
P.O.Box 1108
16 Great Neck Road
Mashpee,Massachusetts 02649
Attn: Ms.Judith Mills,Chairperson
Mashpee Water District
P.O.Box 1543
Mashpee,Massachusetts 02649
Attn: Mr.Dave Rich
Mashpee Public Library
P.O.Box 657
Mashpee,Massachusetts 02649
Barnstable County Dept.of Health and the Environment
Superior Court House
P.O.Box 427
Barnstable,Massachusetts 02630
Attn: Mr. Stetson Hall
Barnstable Board of Health
Attn:
Thomas&Betts Corporation
452 John Dietsch Blvd.
Attleboro Falls,Massachusetts 02763 Jy
Attn:Mr.William Frigon
Thomas&Betts Corporation /
1555 L}}��nnfield Road
Men}¢hisI Tennessee 38119 ✓ Ki(�
t� Attn:Mr.Om Chopra /y
Hale&Dorr
1455 Pennsylvania Avenue
Washington,DC 20004
Attn: Mr.Jeffrey J.Davidson,Esq.
Willowbend Development Corporation
130 Willowbend Drive
Mashpee,Massachusetts 02649
Attn: Mr.Bruce A.Besse,Jr.,V.P.
IN-HOUSE COPIES
Michael A.Powers,P.E.,LSP
Hilary Downes Fortune,P.G.
File Copy
Toni XC &R e
j:jobslenvl31751-1.mapladres-3.doc
t
COTUIT WELL SAMPLING PROGRAM
This well sampling work plan was prepared by GZA GeoEnvironmental, Inc. for the
Thomas & Betts Corporation (T&B). The plan was prepared to describe how certain
residential wells in Cotuit, Massachusetts will be tested for Volatile Organic Compounds
(VOCs). The program is part of an ongoing study being conducted pursuant to the
Massachusetts Contingency Plan ("MCP") and in coordination with the Massachusetts
Department of Environmental Protection ("DEP"), and is designed to meet all applicable
state standards.
PURPOSE
The purpose of this sampling program is to provide additional information related to
groundwater contamination associated with the former Augat manufacturing facility in
Mashpee. The specific purpose of this work plan is to describe: (1) how wells were
selected for sampling; (2) how samples will be collected and transported; (3) how samples
will be analyzed; and (4) how the results of the testing will be documented and reported.
The testing program is intended to provide information which will identify an
unanticipated condition. Beyond this sampling program, ongoing and additional studies
will be aimed at better defining the discharge location of the contaminated groundwater
which is found beneath portions of the .106 Falmouth Road Site in Mashpee, and will help
establish the long-term monitoring program required to confirm the identified discharge
location(s).
BACKGROUND
Groundwater contaminated with volatile organic compounds (VOCs), primarily
trichloroethene (TCE), tetrachloroethene (PCE), 1,1,1-trichloroethane (TCA), and
associated degradation products, was found at the 106 Falmouth Road Site in Mashpee,
Massachusetts in 1997. T&B has assumed responsibility for compliance with MCP
procedures with respect to that contamination. The vertical and horizontal extent of that
groundwater contamination has been well delineated from just south of Falmouth Road
(Route 28) to the edge of Shoestring Bay.
Based on the geometry of the aquifer and the Bay, and well-established geohydrological
principles, it was initially estimated that the contaminated groundwater discharged to
Shoestring Bay in the immediate vicinity of Bryant's Point. Subsequent detailed
piezometric studies found that the groundwater discharge mechanism is more complex.
Based on measured hydraulic heads and inferred hydraulic parameters, we now believe that
the VOCs are discharging, or will discharge, to Shoestring Bay at locations more distant
from shore than originally estimated. Although very unlikely,.there is a possibility that at
least a portion of the groundwater flow beneath Shoestring Bay also flows beneath Cotuit.
I
Page 1 of 3
Because the discharge location has not yet been fully defined, and based on technical
' discussions with the DEP, T&B has elected to undertake a one-time testing of certain
residential water supply wells in Cotuit for VOCs. This work plan describes that sampling
and analysis program.
It is noted that, because of the observed geohydrological conditions, the distances of the
subject wells from the Site, and the earliest possible date of a release of VOCs, it is highly
unlikely that Site-related VOCs will be found in groundwater beneath Cotuit. We also
emphasize that the sampling and analysis program detailed in this work plan is only a part
of T&B's ongoing effort to be sure historical releases of VOCs pose no unacceptable risk
to human health or the environment. Additional tasks to better delineate.the discharge
location of Site-related VOCs continue to be performed as part of an evaluation of the
Site's Class C Response Action Outcome (RAO).
SELECTION OF RESIDENTIAL WELLS
Based on published geologic information, the identified groundwater flow path at the 106
Falmouth Road Site, and topographic features in Cotuit, it is evident that if groundwater
from the Site passes beneath Shoestring Bay to beneath Cotuit, it does so in the vicinity of
Fullers Marsh. We selected 20 residences which utilize private drinking water wells in the
area of Fullers Marsh from a map depicting properties serviced by the Cotuit Water
Company2. It is our intent to sample and test all 20 of these wells.
SAMPLE COLLECTION
We will make good faith efforts to contact owners at each of the identified 20 properties.
With the permission of the owner, we will draw a sample of water from a cold water tap
within the home. To the extent practical, we will observe the plumbing system so that
samples are collected before any water treatment systems, and we will obtain whatever
information the owner has on the construction of the well. The water will be run
vigorously for a minimum of 15 minutes or until, two volumes of any holding tank are
withdrawn. This is to help ensure that the sampled water has not been in residence in the
house's plumbing system for an.extended duration.
The sample will be collected by running the water gently (without an aerator) into new 40
ml glass vials, preserved with hydrochloric acid to a pH <2, and sealed with caps equipped
with a teflon septum. The vials will be uniquely labeled, in the field, using a project code,
placed on ice, and transported to the selected laboratory under chain-of-custody within 48
hours of collection. A trip blank will be transported in each cooler, and provided to'the
' Use of Particle tracking to Improve Numerical Model Calibration and to Analyze Groundwater Flow and
Contaminant Migration,Massachusetts Military Reservation.Western Cape Cod,Massachusetts. USGS
Open-File Report 96-214, 1996.
'Map of Parcels with Connections to the Cotuit Water Company in the Poponessett Bay Area. Barnstable
G.I.S. Unit G.M.C. 1/21/98.
Page 2 of 3
laboratory for testing. Additional QA/QC procedures will include the collection of two or
more samples for analysis as blind duplicates.
SAMPLE ANALYSES
Samples will be analyzed by EPA Method 524.2 by an independent laboratory certified in
Massachusetts using contract laboratory procedures.
REPORTING
GZA will compile the analytical results in a table, identifying each constituent found above
its laboratory method detection limit. We will also compare these data to those compounds
which have been found at the 106 Falmouth Road Site. The table will be supplemented
with a brief report which will describe the sampling procedures and provide complete
copies of the actual laboratory Certificates of Analysis.
Each homeowner will be provided a copy, of the. Certificate of Analysis and a letter
providing an appropriate description of the laboratory's analysis of the sample collected
from their well.
SCHEDULE
Contingent upon homeowners' availability, the sampling will be conducted over a period
of three days, from March 27 to March 30, 1998. The distribution of results to
homeowners will occur within a week of sampling. The final report will be provided to the
DEP,local officials and homeowners on or before April 10, 1998.
gAjobs\env\31751-l..map\coruiftorkplan.doc
1
Page 3 of 3
Nit C14Ate V__'V....d _ZW
WC Thomas&Betts Corporation
40 t - :ZI—-414 ,0 452 John Dietsch Blvd.
P.O. Box 2510
i Attleboro Falls, MA 02763
(508) 699-9800
Facsimile(508) 695-8111
March 20, 1998 MAR' 2;3 1998 ' �
TOWN OF BARNS TABLE
HEALTH DEPT.„;
Dear (Homeowner):
Just over a year ago,Thomas'&?Betts acquired>Augatjnc.',which operated a manufacturing
facility in your neighboring town of Mashpee` Augat conducted manufacturing operations at its
facility,.located at 106,Falmouth'Road,from the late,1960's until the plant was retired in
December 1996. Upon closing the plant, Augat began a standard assessment of their property to
determine if there was any historical industrial contamination at the site. Groundwater at the
facility was found to.be contam nated'witfi volatile organic compounds associated with the use of
industrial cleaning solvents. Since then, Augat,'arid subsequently Thomas & Betts, have been
conducting a full technical investigationto resolve any potential environmental issues.
As an extension of this investigation, Thomas & Betts is now requesting your permission to take
R
a sample of water from your well at (address). That sample will be analyzed for volatile organic
compounds. If you agree to participate, you will be provided with a copy of the laboratory results
within roughly a week of the sampling. Obviously, this testing will be done at no charge to you.
The purpose of this testing is to provide additional information for the on-going study related to
the groundwater contamination that was found at the former Augat facility in Mashpee.
Based upon the current facts and the professional opinion of our Licensed Site Professional and
our engineering consultants, Thomas &Betts believes that the contamination originating at the
former Augat facility has or will discharge into Shoestring Bay. The quantities of contaminants
released to the Bay are expected to be so small that they will present no significant risk to the
Bay or the environment. However, although very unlikely, there is also a possibility that at least
a portion of the groundwater flowing beneath Shoestring Bay may also flow beneath Cotuit.
Therefore, as a precautionary measure and as part of our coinplete hydrogeological assessment,
Thomas & Betts; in coordination with the state Department of Environmental Protection, would
like to sample certain residential wells including your own. Of course, if this data suggests any
need for concern or follow-up action, we will imrnediatel.y contact you directly. A more detailed
description of the sampling program which we have outlined to the state DEP is attached.
t
Page Two
A representative of Thomas &Betts.will be calling you in the next few days to further answer
any questions and hopefully to schedule a convenient time to take the water sample. In the
meantime, should you wish to contact us,please call Tom McShane at(508) 699-9820.
Thank you in advance for your cooperation.
Sincerely,
William O. Frigon
Manager Corporate Environmental, Health & Safety
Attachments: Well Sampling Work Plan - Area Map
cc: Massachusetts Department of Environmental Protection
GZA Engineers and Principals:
GeoEnvironmental,Inc. Scientists John P.Hartley,
District Office Manager
Michael A.Powers,PE.,L.S.P.
David R.Carchedi,Ph.D.,P.E.
John J.Spirito,P.E.,L.S.P.
Philip P.Virgadamo,P.E.,L.S.P.
March 20, 1998 Russell J.Morgan,P.E.
File-No. 31751.1
Mr. Mark Wood 2
Department of Environmental Protection 1 .2
20 Riverside Drive 1�► Q
Lakeville, Massachusetts 02347 RECEIVED
Re: Immediate Response Action Work Plan MAR 2 6 1998
106 Falmouth Road Site TOWNOF.BARNSTA9LE
® HEALTH DEPT. !
.Mashpee, Massachusetts (RTN 4-11904) d®
140 Broadway
Providence Dear Mr. Wood:
- Rhode Island 02903 M
401-421-4140
FAX 401a51-8613 GZA GeoEnvironmental, Inc. prepared the attached Immediate Response Action (IRA) work
plan for the 106 Falmouth Road.Site in Mashpee, Massachusetts. We are submitting this
document on behalf of our client, the Thomas & Betts Corporation (T&B), in accordance
with 310 CMR 40.0420.
We believe this document provides the information you require. If you have any questions,
please do not hesitate to call us at(401)421-4140.
Very truly yours,
GZA GEOENVIRONMENTAL,INC.
Hilary Do nes Fortune, P.G. Mi ael A. Powers, P.E.,LSP
A Subsidiary of GZA Seri' oject Manager Se for Principal
GeoEnvironmental
Technologies,Inc. Attachments: BWSC-105: IRA Transmittal Form
IRA Work Plan
cc: Town of Mashpee Board of Health
Town of Mashpee Board of Selectmen
Mashpee Public Library
Barnstable County Department of Health
;/Town of Barnstable Board of Health
Cotuit Water Company
William Frigon,T&B
J:\JOBS\ENV\31751-I.MARCOTUrRIRA-LET.DOC
An Equal Opportunity Employer WFN/H
IMMEDIATE RESPONSE ACTION (IRA) WORK PLAN
This document is an Immediate Response Action (IRA) Work Plan. It was prepared by
GZA GeoEnvironmental, Inc. for the Thomas &Betts Corporation (T&B).
PURPOSE
The purpose of this IRA is to provide additional information related to groundwater
contamination associated with the 106 Falmouth Road Site (the Site) in Mashpee,
Massachusetts. The specific purpose of this work plan is to describe: (1) how wells were
selected for sampling; (2) how samples will be collected and transported; (3) how samples
will be analyzed; and (4) how the results of the testing will be documented and reported.
The testing program is intended to provide information which will identify an
unanticipated condition. Additional studies will be aimed at'better defining the discharge
location of the contaminated groundwater which is found beneath portions of the 106
Falmouth Road Site, and will help establish the long-term monitoring program required to
confirm the identified discharge location(s).
BACKGROUND
Groundwater contaminated with volatile organic compounds (VOCs), primarily
trichloroethene (TCE), tetrachloroethene (PCE), 1,1,1-trichloroethane (TCA), and
associated degradation products, was found at the 106 Falmouth Road Site in Mashpee,
Massachusetts. T&B has assumed responsibility for compliance with MCP procedures
with respect to that contamination. The vertical and horizontal extent of that groundwater
contamination has been well delineated from just south of Falmouth Road (Route 28) to
the edge of Shoestring Bay.
Based on the geometry of the aquifer and the Bay, and well-established geohydrological
principles, it was initially estimated that the contaminated groundwater discharged to
Shoestring Bay in the immediate vicinity of Bryant's Point. Subsequent detailed
piezometric studies found that the groundwater discharge mechanism is more complex.
Based on measured hydraulic heads and inferred hydraulic parameters, we now believe that
the Site VOCs are discharging, or will discharge, to Shoestring Bay at locations more
distant from shore than originally estimated. Although very unlikely, there is a possibility
that at least a portion of the groundwater flow beneath Shoestring Bay also flows beneath
Cotuit.
Because the discharge location has not yet been fully defined, and based on technical
discussions with the DEP, T&B has elected to undertake a one-time testing of certain
residential water supply wells in Cotuit for VOCs. This IRA work plan describes that
sampling and analysis program.
Page 1 of 3
It is noted that, because of the observed geohydrological conditions, the distances of the
subject wells from the Site, and the earliest possible date of a release of VOCs, it is highly
unlikely that Site-related VOCs will be found in groundwater beneath Cotuit. We also
emphasize that the sampling and analysis program detailed in this work plan is only a part
historical releases of VOCs pose no unacceptable risk
of T&B s ongoing effort to be sure his p p
g g
to human health or the environment. Additional tasks to better delineate the discharge
location of Site-related VOCs will be performed as part of an evaluation of the Site's Class
C RAO.
SELECTION OF RESIDENTIAL WELLS
Based on published geologic information) the identified groundwater flow path at the 106
Falmouth Road Site, and topographic features in Cotuit, it is evident that if groundwater
from the Site passes beneath Shoestring Bay to beneath Cotuit, it does so in the vicinity of
Fullers Marsh. We selected 20 residences which utilize private drinking water wells in the
area of Fullers Marsh from a map depicting properties serviced by the Cotuit Water
Company2. It is our intent to sample and test these 20 wells.
SAMPLE COLLECTION
We will make good faith efforts to contact owners at each of the identified 20 properties.
With the permission of the owner, we will draw a sample of water from a cold water tap
within the home. To the extent practical, we will observe the plumbing system so that
samples are collected before any water treatment systems, and we will obtain whatever
information the owner has on the construction of the well. The water will be run
vigorously for a minimum of 15 minutes or until two volumes of any holding tank are
withdrawn. This is to help ensure that the sampled water has not been in residence in the
house's plumbing system for an extended duration.
The sample will be collected by running the.water gently (without an aerator) into new 40
nil glass vials, preserved with hydrochloric acid to a pH <2, and sealed with caps equipped
with a teflon septum. The vials will be uniquely labeled, in the field, using a project code,
placed on ice, and transported to the selected laboratory under chain-of-custody-within-48
hours of collection. A trip blank will be transported in each cooler, and provided to the
laboratory for testing. Additional QA/QC procedures will include the collection of two or
more samples for analysis as blind duplicates.
SAMPLE ANALYSES
Samples will be analyzed by EPA Method 524.2 by a laboratory certified in Massachusetts
using contract laboratory procedures.
Use of Particle trackingto o Improve Numerical Model Calibration and to Analyze Groundwater Flow and
Contaminant Mi;ration Massachusetts Military Reservation Western Cape Cod,Massachusetts. USGS
Open-File Report 96-214, 1996.
Z Map of Parcels with Connections to the Cotuit Water Company in the Poponessett Bay Area. Barnstable
G.I.S. Unit G.M.C. 1/21/98.
Page 2 of 3
REPORTING
GZA will compile the analytical results in a table, identifying each constituent found above
laboratory method detection. Samples will be identified so that, with the aid of a separate
key, the DEP will be able to identify which sample came from each residential well. We
will also identify, on that table, which compounds, if any, have also been found at the 106
Falmouth Road Site. The table will be supplemented with a brief report which will
describe the sampling procedures and provide copies of the laboratory Certificates of
Analysis.
Each homeowner will be provided a copy of the Certificate of Analysis and a letter
providing an appropriate description of the laboratory's analysis of the sample collected
from their well.
SCHEDULE
Contingent upon homeowners' availability, the sampling will be conducted over a period
of three days, from March 27 to March 30, 1998. The distribution of results to
homeowners will occur within a week of sampling. The final report will be provided to the
DEP, local officials and homeowners on or before April 10, 1998.
g:\jobs\env\31751-1..map\cotuit\ira-3.doc
Page 3 of 3
TABLE
COTUIT PROPERTIES SELECTED FOR RESIDENTIAL WELL SAMPLING
IMMEDIATE RESPONSE ACTION PLAN
106 Falmouth Road Site -Mashpee, Massachusetts
WELL LD. PLATIVIAP LOT ADDRESS
...,
1 6 48 750 Santuit Road
2 5 68 122 Pin uickset Cove Road
3 5 69 144 Pin uickset Cove Road
4 5 70 160 Pin uickset Cove Road
5 5 71 180 Pin uickset Cove Road
6 5 72 190 Pin uickset Cove Road
7 5 73 189 Pin uickset Cove Road
g 4 6 167 Pin uickset Cove Road
9 4 7 1617 Main Street
Pin uickset Cove Road
10 4 8 1619 Main Street
(Peppercorn Lane
11 4 9-1 114 Peppercorn Lane
4 9-2 120 Peppercorn Lane
4 10 144 Peppercorn Lane
4 11 160 Peppercorn Lane
4 12 N/A
12 6 10 12 Clarnshell Cove Road
13 6 26 605 Po onesset Road
14 5 18 off Santuit Road conservation land
15 16 32 85 Peppercorn Lane
16 15 7 315 Vineyard Road
17 3 4 42 Bailey Road
18 6 63 312 Pine Ridge Road
19 5 35 72 Cotuit Cove Road
20 5 3 262 Clamshell Cove Road
G:\IOBS\ENV\31751-INAMOTUMCotuit-i.xls Page I of 1 3/20/98
Massacnuseas ueparurrenc of Cnviruiiisiwiit"i f-hu.a%u..od avva�.-iva
Bureau of Waste Site Cleanup
Release Tracking Number.
IMMEDIATE RESPONSE ACTION (IRA) ❑
TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) 4 - 11904
A. RELEASE OR THREAT OF RELEASE LOCATION:
Release Name:(opts
street 106 Falmouth Road Location Aid: West of Boffin Road
Cityrrown: Mashpee --. ZIP Cade: 02649
❑ Check here if a Tier classification Submittal has been provided to DEP for this Release Trac king Number.
❑ Check here it this location is Adequately Regulated,pursuant to 310 CMR 40.0110-0114.
Specify Program:❑ CERCLA ❑ HSWA Corrective Action ❑ Solid Waste Management ❑ RCRA State Program(21 C Facilities)
Related Release Tracking Numbers That This IRA Addresses:
B.THIS FORM IS BEING USED TO: (check all that apply)
Submit an IRA Plan(complete Sections A,B,C,D,E,H,I,J and Iq.
❑ Check here if this IRA Plan is an update or modification of a previously approved written IRA Plan. Date Submitted:
❑ Submit an bmdnent Hazard Evaluation(complete Sections A,B,C,F,H,1,J and Iq.
❑ Submit an IRA Status Report(complete Sections A,B,C.E,H,I,J and Iq. .
❑ Submit a Request to Terminate an Active Remedial System and/or Terminate a Continuing Response Action(s)Taken to Address an
Imminent Hazard(complete Sections A,B,C,D,E,H,1,J and Iq.
❑ Submit an IRA Completion Statement(complete Sections A,B,C,D,E,G,H,I,J and Iq.
You must attach all supporting docrunentation required for each use of form indicated,including copies of
any Legal Notices and Notices to Public Officials required by 310 CMR 40.1400.
C. RELEASE OR THREAT OF RELEASE CONDITIONS THAT WARRANT IRA:
Identify Media and Receptors Affected: (c heck all that apply) + ❑ Air j] Groundwater ❑ Surface Water ❑ Sediments ❑ Soil
❑ wetland ❑ Storm Drain ❑ Paved Surface ❑ Private wen ❑ Public water supply ❑ Zone 2 ❑ Residence
❑ School ❑ unknown ❑ other Specify.._
Identify Conditions That Require IRA,Pursuantto 310 CMR 40.0412 (check an that apply) ❑ 2 Hour Reporting Condition(s)
❑ 72 Hour Reporting Co dil oh(s) ❑ Substantial Release Migration ® Other Condition(s)
Describe: While very unl i kel ypthere is a aotenti al or QronndvatPr
to mi aratf, beneath a p nrt i nn of COtuit
Identify Ons and Hazardous Materials;Relased: (check an that apply) ❑ Ons ® Chlorinated Solvents ❑ Heavy Metals
❑ Othos specify..
D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply)
Assessment and/or Monitoring Only ❑ Deployment of Absorbent or Containment Materials
❑ Excavation of Contaminated Soils ❑ Temporary Covers or Caps
J0 , ❑ Re-use,Recycling or Tmat mart ❑ Bioremediation
O On Site O Off Site Est.Vol.: cubic yards ❑ Sal Vapor Extraction
Describe: ❑ Structure Venting System
❑ Store O On Site O Off Site Est.Vol.: cubic yards ❑ Product or NAPL Recovery
❑ Landfill O Cover O Disposal Est.Vol.: cubic yards ❑ Groundwater Treatment Systems
❑ Removal of Drums,Tanks or Containers ❑ Air Sparging
Dube: ❑ Temporary Water Supplies
SECTION D IS CONTINUED ON THE NEXT PAGE.
Revised 2124195 Supersedes Forms BWSCr0051 006, 010(n part)and 011 Page 1 of 3
Do Not Alter This Form
Massachusetts Department of Environmental Protection ,BWSC-105 ,
Bureau of Waste Site Cleanup
Release Tracking Number
IMMEDIATE RESPONSE ACTION (IRA)
TRANSMITTAL FORM Pursuantto 310 CMR 40.0424-40:0427(Subpart D) — 11904
D. DESCRIPTION-OF RESPONSE ACTIONS(continued):
Removal of Other Contaminated Media Temporary Evacuation or Relocation of Residents
Specify Type and Volume: Fencing and Sign Posting
Other Response Actions Describe:
Check here if this IRA involves the use of Innovative Technologies(DEP is interested in using this information to.aid in creating an Innovative
Technologies Clearinghouse).
Describe Technologies:
E. TRANSPORT OF REMEDIATION WASTE: (if Remediation Waste has been sent to an off-site facility,answer the following questions)
Name ofFadlity; Not Applicable
Town and State:
Quantity of Remediation Waste Transported to Date:
F. IMMINENT HAZARD EVALUATION SUMMARY: (check one of the following) _ ...
Based upon an evaluation,an Imminent Hazard exists in connection with this Release or Threat of Release.
Based upon an evaluation,an Imminent Hazard does not exist in connection with this Release or Threat of Release.
Based upon an evaluation,it is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release,and further
assessment activities will be undertaken.
Based upon an evaluation,it is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release. However,
response actions will address those conditions that could pose an Imminent Hazard.
G. IRA COMPLETION STATEMENT:
Check here if future response actions addressing this Release or Threat of Release will be conducted as part of the Response Actions planned
for a Site that has already been Tier Classified under a different Release Tracing Number,or a Site that is identified on the Transition List as
described in 310 CMR 40.0600 0.a.,a Transition Ste,which includes Sites with approved Waivers). These additional response actions must
occur according to the deadlines applicable to the earlier Release Trading Number 0.e.,Site ID Number).
State Release Trading Number p.e.,Site ID Number)of Tier Classified Site or Transition Site.
If any Rernedlation Waste will be stored,treated,managed,recycled or reused at the site following submission of the IRA Completion
Statanent,you must submit either a Release Abatement Measure(RAM)Plan or a Phase IV Remedy Implementation Plan,along with the
appropriate transmittal form,as an attachment to the IRA Completion Statement.
H. LSP OPINION:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form,including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of lore in 309 CMR
4.02(1),(in the applicable provisions of 309 CMR 4.02(2)and(3),and ui the provisions of 309 CMR 4.03(5),to the best of my knowledge,
information and belief,
if Section B of this tbmt indicates that an Immediate Response Action Plan is being submitted,the response action(s)that is(are)the subject of
this submittal(t)has(have)been developed in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(0)is(are)
appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310
CMR 40.0000 and lu compfies(y)with the identified provisions of all orders,permits,and approvals identified in this submittal;
if Section B of this fait indicates that an Imminent Hazard Evaluation is being submitted,this Imminent Hazard Evaluation was developed in
acccrdance with the applicable provisions of M.G.L c.21 E and 310 CMR 40.0000,and all assessment activities(y)undertaken to support this
Imminent Hazard Evaluation complies(y)with the applicable provisions of M.G.L c.21 E and 310 CMR 40.0000;
if Section 8 of this form indicates that an Immediate Response Status Report is being submitted,the response action(s)that is(are)the subject
of this submittal(i)is(are)being implemented in accordance with the applicable provisions of M.G.L c.21 E and 310 CMR 40.0000,(t)is(are)
appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L c.21 E and 310
CMR 40.0000 and(III)complies(y)with the identified provisions of all orders,permits,and approvals identified in this submittal;
if Section B of this form indicates that an Immediate Response Actfon Completion Statement or a Request to Terminate an Active Remedial
System and/or Terminate a Continuing Response Action(s)Taken to Address an imminent Hazard is being submitted,the response action(s)
that is(are)the subject of this submittal()has(have)been developed and implemented in accordance with the applicable provisions of M.G.L c.21 E
and 310 CMR 40.0000,(i)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable
provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(ii)complies(y)with the identified provisions of all orders,permits,and approvals identified in
this submittal.
SECTION H IS CONTINUED ON THE NEXT PAGE.
Revised 224195 Supersedes Forms BWSC-005, 006, 010(in part)and 011 Page 2 of 3
Do Not Alter This Form
Massachusetts Department of Environmental Protection BWSC-105
Bureau of Waste Site Cleanup
IMMEDIATE RESPONSE ACTION (IRA) Release Tracking Number_
TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) a 11904
H. LSP Opinion(continued):
I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false,
inaccurate or materially incomplete.
Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s)and/or approval(s)issued by
DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions the reo Ad44
LSP Name: Michael A. Powers LSP#: 3436 Stamp: .v,��N OF�4S
Telephone: (401) 421- 4140 Ext.: 3404 MIC G
FAX(optional) (401) 751-8613 P 8 y
. 3 36Q v
Signature: ,�QfS
Date: Mar 20, 1998 F�S1TE PEIOE`c"S�
I. PERSON UNDERTAKING IRA:
Name of Organization: '1hC6W & BettS COrPOrati0n
Name of Contact: William 0. Frigon Tine: Corp. Manager, E Vlrcmirwntal
Street: 452 John Dietsch Boulevard health & Safety
CityfTown: Attlpltnrn Fal7c State: MA ZIPCode: 02763
Telephone: (508) 699-7646 Ext.: FAX(optional) (508) 695-7010
Check here if there has been a change in the person undertaking the IRA.
J. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA: (check one)
® RP or PRP Specify: J) Owner O Operator O Generator O Transporter Other RP or PRP:
Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2)
Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50))
Any Other Person Undertaking IRA Specify Relationship:
K. CERTIFICATION OF PERSON UNDERTAKING IRA:
1 William 0. F rigor ,attest under the pains and penalties of perjury(I)that I have personally examined and am
familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form,(ii)that,based on my inquiry
of those individuals immediately responsible for obtaining the information,the material information contained in this submittal is,to the best of my
knowledge and belief,true,accurate and complete,and(III)that I am fully authorized to make this attestation on behalf of the entity legally responsible for
this submittal. I/the person r entity on whose behalf this submittal is made amfis aware that there are significant penalties,including,but not limited to,
possible fines and i ` nment,f 'llfully submitting false,inaccurate,or incomplete information.
gy Tine: Corp. Manager, Effldxonmental
(signature) Health & Safety
For. Tbcmas & Betts Qpgp ration Date: March:20 1998
(print name of person or entity recorded in Section 1)
Enter address of the person providing certification,if different from address recorded in Section I:
Street:
City/Town: State: ZIP Code:
Telephone: Ext.: FAX:(optional)
YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS
INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING
A REQUIRED DEADLINE.
I
Revised.224195 Supersedes Forms BWSC-005, 006, 010(in part)and 011 Page 3 of 3
Do Not Alter This Form
�\ COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS.
DEPARTMENT .OF ENVIRONMENTAL PROTECTION
SOUTHEAST REGIONAL OFFICE
ARGEO PAUL CELLUCCI TRUDY COXE.
Governor 1 i1 Secretary
v DAVID B. STRUHS
Commissioner
March _26 , -1998
Mr. William Frigon RE MASHPEE--W.SC/SMP 4-11904 '
Thomas and Betts Corporation. 106 Falmouth Road
452 John Dietsch Boulevard IMMEDIATE RESPONSE ACTION
Post Office Box. 2510 PLAN APPROVAL
Attleboro Falls, Massachusetts 02763 MGL c . 21E & 310 CMR
40 . 0000
Dear Mr. Frigon:
The Department . of 'Environmental Protection, Bureau of Waste
Site Cleanup (the Department) , received and verbally approved an
Immediate Response Action (IRA) Plan on March 23 , 1998 , for the
above-referenced disposal .site.. The IRA ,P,lan ,:was submitted by .GZA
GeoEnvironmental; -. 'Inc -.(GZA) ion ,behalf. - of Thomas and Betts
Corporation- .(T&B)
Recent information presented to .the Department indicates that
fresh grouhdwater .exists below the .portion of Shoestring Bay near
where the contaminated groundwater is located. This fresh
groundwater may provide a pathway for the contaminated groundwater
in the plume migrating from south of the Augat 'Facility to beneath,
Cotuit . As a result, an IRA Plan was discussed and proposed during .
meetings at the Department' s Southeast Regional Office in Lakeville
on February 6 , 1998 and February 27, 1998. A written submittal was
requested by the Department at the February 27, .1998 meeting.
. -
The IRA Plan proposes the sampling of 20 residential welTMls in
�Cotuit-t The poteritia"1exists for these wells to be impacted with ,
contaminated groundwater from the Site if it passes beneath
Shoestring . Bay. Sample locations are based on identified
groundwater flow ' paths and topographic features in Cotuit .
Sampling is contingent. upon homeowners' availability and approval .
Each homeowner will be provided a � copy of . the Certificate of
Analysi,s ,and a letter providing .a description of the laboratory' s
analysis _of the sample collected from their well.. As stated in-the t
Thomas. and Betts Corporation letter to,-individual homeowners, dated
March -20 ,- -1998 if. data suggests any need for concern or followup,
the 1.homeowner will be -immediately contacted.-- A final report will
be provided to- the-DEP, local officials and homeowners on.or before
April ,.10, 1998 . =
20 Riverside Drive 0 Lakeville, Massachusetts 02347 • FAX(508) 947-6557 0 Telephone (508) 946-2700
-2-
In addition, Thomas and Betts has proposed to conduct
additional tasks to better delineate the discharge location of
site-related volatile organic compounds as part of the work
conducted to support the review of the Class C (temporary) Response
I Action Outcome .
The Department hereby approves the IRA;plan with the following
conditions/modifications :
1 . A detailed plan for any proposed additional studies to
better delineate the discharge location of site-related
volatile organic compounds must be submitted to the
Department within 30 days of the final report due date
(April 10, 1998)
If you have any questions, please contact Mark Wood at the
letterhead address or at (508) 946-2874 . All future communications
regarding this site must reference the site number: 4-119.04 .
Sinc ely,
er M.R. Martin, Chief
Site Management & Permits Section
M/MW/cb
CERTIFIED MAIL NO. Z 333 584 123
RETURN RECEIPT REQUESTED
cc : Barnstable Board of Health
Post Office Box 534
Hyannis, MA 02601
ATTN: Thomas A. McKean, Chairman
Barnstable Board of Selectmen
-367 Main Street
Barnstable, MA 02601
ATTN: William Rutherford, Chairman i
Mashpee Board of Health
16 Great Neck Road North
Mashpee, MA 02649
ATTN: Mr. Elias McQuaid, Chairperson,
Mashpee Board of Selectmen
Post Office Box 1108
16 Great Neck Road ?
Mashpee, MA 02649
ATTN: Ms . Judith Mills, Chairperson
-3-
cc : Mas.hpee Water District
108 Cape Drive
Mashpee, MA 02649-3077
j ATTN: Mr. Dave Rich
GZA GeoEnvironmental,. Inc .
140 Broadway .
Providence, RI 02903
ATTN: Mr. Michael Powers
John C. and .Ramuta H. Bacon, .
750 Santuit Road
Cotuit, MA 02635
John T. and .Gladys E.. McCubbin
206 Thornton Court
Palm Beach Garden, FL 33418
John Sedlack, Tr.
243 Westbourne Street
La Jolla, CA 92037 -
Enid- 13 . Zimbler
Post -office Box 2007
Cotuit, MA 02635
Robert E. and Regina G. Flynn
30 Lincoln Road
Wellesley, MA 02181
Beth F. McParland
220 Boylston Street, #9018
Boston, MA 02116
Kathleen C. France
20 Bogart Court
Princeton, NJ 08540
Gregg- and Roberta M. Ribatt
. . 84 Eldredge Street
Newton, MA 02158
Margaret H Lloyd
524 E . 72nd Street, Apt . 28B
New York., NY 10021
David G. Mugar
222 Berkley Street
Boston, MA 02116
I
-4-
cc : Benjamin H. Heckscher, Trs
Maurice Heckscher, II, Trs .
John H. Heckscher, Trs
5 Guernsey Road
Swarthmore, PA 19081
Richard A. Kraus and Patricia G. Fiero
12 Clamshell Cove Road
Cotuit, MA 02635
Carl and Bettina S . Sonderegger
605 Popponesset Road
Cotuit, MA 02635
Town of Barnstable
Conservation Commission`
Town Offices
367 Main Street
Hyannis, MA 02601
ATTN: Rob Gatewood
Paul A. and Maureen K: Tempesta
Post Office Box 452
Cotuit, MA 02635
Amnon and Prudence Rosenthal
2105 Devonshire Road
Ann Arbor, MI 48104
Wingate and Janet W. Lloyd
4500 Cathedral Avenue, NW
Washington, DC 20016
Jennifer J. Lempke and Robert C. Livingston
Post Office Box, 424
Cotuit, MA 02635
E.T. and R.A.r Martin et . al . , Trs . , r
2750 Gulf Shore Boulevard, N. , Ste . 602
Naples,. FL 33940
Frances M. Tallman
262 Clamshell Cove Road
Cotuit, MA 02635
Cotuit-Santuit Civic Association
Post Office Box 121
Cotuit, MA 02635
ATTN Richard G. Barry, President
SCC Coalition
C/o Mr: Christopher Tufts
76 Sampson' s Mill Road
Mashpee, MA 02649
-5-
cc : Mashpee Environmental Coalition
Post Office Box 274
Mashpee, MA 02649
ATTN: Mr. Charles Costello.
Mastipee Public Library.
Post Office Box 657
Mashpee, MA 02649
ATTN: Augat Information Repository .
DEP-SERO-Operations
ATTN: Kevin Kiernan, Assistant Regional Counsel
DEP-SERO
ATTN: Liz Kouloheras, Chief, Cape Cod Watershed
DEP-SERO-Data Entry
CO TUIT WELL SAMPLING AREA
m Y ct °
OUPSN7 RDi` c` �y cOONIBS RD ?4aC2 JS'�' •f`� 9�, Ty9'' GO ,g 1- O h'AT
PORO
O 'O'N 110,
AM,"A WAY 1- 9 ° .bnos Pond 2 !y _/ NIXON chi
COO.MRS LN o (p Tyy�f'pros0 ,I.tt\NE\
z V
F.a Qls Paid ORO,NP{.
GINGHAM $ Former Augat Plant e9 �x any
7r, 00p M1'D
ia�y cYi - 2 w 9 ¢ 9 7y
a
8881 O r'
4 Qo v RD 05rg4 Pay A
O o' � 2� m 0L0 Q1 'OF<
VISTA t A SA�SONS MILL RD p a 2 '�' O 't RO
HERS PATH OP CRAWERRY RIDGE RD U °O � ® x 0L.Dp05
i �9Pp c
Po FN ME DOT RD 7 A °XFORD .1011 Lowell Pad
00'
O p�+ 9WEEl x
dandy Point V?.un
T Y
Tlms Point
WN 1 ICE COVE
TRIAY
H 2
n _ � 003 _ ru IEWISP RD i �ptNm
Area of Contaminated Cuoundwater Qa cyst o Noisy Point
=Pine Tree Corner A SHPS AIFEE f '-- vN a
PORTHOLE
' SHIPS ANCHOR ` C.otuit`,p
Y x RECK O a Coluit Bay w
� swPw
I a ¢ 2 r9949
RO �~a
28 BOB WHTE CRES
W EIF. 0J h
�SPtNy�e h. F F"1ttn.
R Residential Well Targeted for Sampling by T&B(typ.) Bluff Point
TIMBER LA"DIN4 RD `sy, 5`�E ,
`W � � TREE qp.
RD Y Sam :ros Wand�anctt.
AMgS 01
WDOO RD �Okv, OAK wL,ACoNit Highlands !^r
SUGAR PNE m �t'tG Hp o"I�pU• NO f ___ U I—
oSampsons Island
y eq �m Northeast Boundary of Voluntary Testing Program
JAr• A
VV
24 i.-11's;t larsh 3
�i
Q W
FROG POND CLOSE o0pt
CFucoRY orocker Neck
GREATPIWS''RA,13,. kl �¢ vMM�ashpee Neck 0 $ 1•:,�;r:�ickvrt C' a Hndir.Llarsh Pond
v �2yef eld Point y
. o 0
� 0 Z
��AO,yrr � y`oe � < ColuitrLtchnraga
EE RORom¢- 7 c
Gooseberry Island
h P pUWIIDRN pcwT RD
Dunkhom Point . Q• o
•ills Hill 40 l'OrPW'2.ss�t BqI m
O oa Daniels Island
e G.Ll a vMeadow Point popponesset Beach
7fi ,;A,rgt Bul 0� -
Ann.sCo,,; AP Thatch
Neck Thatch Island. -
o Q 9Poppenesset Bird Sanctuary
9L ��4 ? �
O �!?o1lv9Ln-� C
-�;h" WATERWAYl Popponesset Island
RED BROOK RD
South Mashpee hrgEY i�p °� oLlttle Thatch Island
O
GO
Or =OPT y9Q 9!.
ItO
{
1996 Del-orme Street Atlas USA
i
�.01
_ 2 1998
®It TOWN
THOEpTTAQ(f
l� Z
MAR 2 _. .,
3 1998
®� TOINNOF
�� NfA(y p�T4B(f
�j.
2ff 1,!4l 4
Bill Frigon (508)699-9946
Manager,Corporate Fax:(508)643-3761
Environmental Health&Safety billfrigon/chq/augat@augat
Thomas&Betts Corporation !
8155 T&B Boulevard
_. . Memphis,TN 38125
1 (901)252-5000
www.TNB.com
Thomas efts
i p
I
LOCATION SEWAGE PERgIT p0•
VILLAGE
INSTA LLER'S NAME A ADDRESS i
�,P���•� G% lie��� l
f) UILDE R OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
I
r
s.
moo/ '
No........
.._. d ....
.,
3 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
..............................O F.............................---.........----.--------------------------••--..---------••-
,� �ir�t mart for Bhiv iial Workfi Tongtrurtion ramit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
312 Pine Ridge Rd. Cotuit , Ma. Lot $5
----------------__•..............-•---......----•-•--........------..........-•----••._._....-- ........ -•-• ........._...._.
fit} ---
k lrai� or Lot No.
StePhe--_ B. °° on• ddr 5. Williams -_Coolidge St_...,RFD,••,Cotu t.,...Ma.
_•-•-••--•-•-•--••---••••..----- ...........
Address
----.- ---•------•- ------------- - ----- --•----- ----------- ----- -------.-----------.-- --- -
�"� Installe Address
Q Type of Building Size Lot......
4a.___Q___.....Sq. feet
Dwelling—No. of Bedrooms................3
............................ Attic ( ) Garbage Grinder04 ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixt r s .........--•----•••••--••--
W
Design Flow-•.--.•----- ------— -------------------gallons per person per day. Total daily flow_______._330..._._....................gallons.
WSeptic Tank—Liquid capacit4QQQ_.gallons Length.8.t_-6 ii.. Width---14 .'_ l00iameter................ Depth...h.!_-.0-��
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------l.__.-___-- Diameter.lQ t _Q" Depth below inlet r_-.Q_........ Total leaching area-2b7.........sq. ft.
z Other Distribution box ( X) Dosing tank ( )
'—' Percolation Test Results Performed by__Ga.Ps...C_o.d..Suryey..T Cnri3ultantDate_...0.43/78--__----_--•__--
Test Pit No. 1_I�I�Siez'_m2nutes per inch Depth of Test Pit_12............. Depth to ground water..riIIn—
Test Pit No. 2................minutes per inch Depth of jest Pit.................... Depth to ground water........................
p4 •••-•••••••-------•-•-...-------•-••••••-•-------•••••-•-•-•-•-•--•-•-••----------------•---•------•--•-•-•-------•-------------•--••--------------•---------
O Desciption of Soil�Q.,.Q-O.._5...MQQd...J,.O.r�M.....Q�.5=3_.Q...S.Ub_s0i4._-5..Q-l2..Q-._madium..sand---_
X ............................i•••••-•-••------ ---------•------------------•----------------.....---..............................•--
W ...........................................................................................-•---•-- -----------•----------••-----••••-•••••••••--•••••------•--•••-•----•......••-•-•-•••--------••--
UNature 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 iIT .;
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in •
operation until a Certificate of Compliance has been issued by the board of health.
gn*eo..O. ..1%�?
Date
Application Approved By--• �tZ�"Q ••f:�' ! ....................................... ---- - .......
Date
Application Disapproved for the following reasons----------------•------------•-------------------------------------------------------......-•••-•--••-.........._
-........................
Date-------------
PermitNo......................................................... Issued -----••--/ 1--_ �......
Date
No................ ....... Fxs..........................
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
...........................................0 F..........................._...._.........-----------•--•---------------..................
rpliration for Disposal Works Tonstrurtinn rrntit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at:
312 Pina`.Ridge Rd. Cotuit Ma. ....................................... Lot $
...... •-----------•------•---.J_.. - ! ....................
ocon; dd s or Lot No.
_Y� Williams. •.. ...........33.._COp� .dg .. t.....�FD,.._Cnuit
Address
W
a ......... ..................
Installer Address
Type of Building Size Lot____-44.x000.....Sq. feet
Dwelling,—No. of Bedrooms............. .............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fix r>rs -------------------------------- .
W Design Flow............................................gallons per person per day. Total daily flow---------33.O.....__....._._ _.____._
....
WSeptic Tank—Liquid capacit}u.QQO•.gallons Length8.1.-6.tt.. Width...�j,.f_-10Diameter_______--------- Depth---I.V!_Q1I
x Disposal Trench—No. ...............:.... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......1------------- Diameterl O...... ._ Depth below inlet6.'..-Q.. Total leaching area2.67.........sq. ft.
Z Other Distribution box (X) Dosing tank ( )
a Percolation Test Results Performed by.-Gape...C o.d..B ury ey. ...GonsultantDate 6 -.3/78�-------•--•-__--
,.a Test Pit No. I MAde!Ln2nutes per inch Depth of Test Pit-12.............. Depth to ground water..Ilo-rw...........
f� Test Pit No. 2..:.............minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -.............................................................................................................................................................
0 Desci tinof S o ilog._0.-O..5..W9Q ... •-sub.s_oil.,...5-00-12..Q..medium---sand-----
Vx � tuit ........ -• •----••--•-•........................................•-••-•---•--•--•-•---•----•--•-••-•--••••----......----- ............................................
..•--•.-•---
W --•-•--•---•-----------------•.......................----------••---••-••••••--.....-•--•-••--.....-------••--•------.._....-•-•-----------•--•---••••--...............................................
U 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 TIT?.;. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the
board of health.
Date
Application Approved By.._O� ---• --••- . . N. 7� 'A
Date
Application Disapproved for the following reasons:.................................................................................................................
....----••---------------------•-------•......_.....`.........-----•---•-----•----------------•-••........--•••-......-•-••----•-----••••-----------••••--••--•----------•••----•-•-•-----••---------•--
u,:: Date
PermitNo........................................................ Issued.......................................................
— Date
i
THE'COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
4
� 14
�. .... ...O F..::.... �'L .'1 .� ...............•
Trr#if i.rFaU of Toutplianrr
T4,R at the Individual Sewa e Dis osal S-stem constructedr Repaired
g P �' ( ) P'• ( )
b ............................................. ...•---• _....
�I•f�,,� • Installer
has been'install in accordance with the provisions of T i �' ,r1 of T e Sta e Sanitary Code as described in the
ia
application for Disposal Works Construction Permit No__.. ..__..(.__ '..._....... dated-... d._----___'._. '_________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
-
DATE............ .......... • ---....-----. ............-----....:... Inspector.:----- ........... ................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ® , HEALTH
No......................... ♦ e FEE....��'"".......... ,
n
t nr �� r Uan anti
Permission,is„hereby granted....................... .................................................... --
to Cons ct ( or ,_pai ( divldual Sew .e s osal Sys
at NV 6P014
Stregt
as sh on the application for Disposal Worls Construction P it N .:_ ._____.. Dated._/ _:^_ �....
................
,�- _,[�,� ..........................
7 / CPO-- Board of.Health
DATE. ---•--------------•.........---..... ........_-- --•--
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
� �� M �
. `t'"'4'.,. _...� ,{ �.1:k:,„.. �...s,_ -.Jh,_ >`�",,... e:'I�;i1,� ra"'�f.7iP �d.�'�,Gihr�,� .z�- .,.. ...,;R•'17..,7..pi-'-:, '•.u.a.+w_.,. - .. ..et. .+ ` -
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS:2 -2 /�i-/✓ ly/lJ C/" 41). r a U /1� MAP NO. PARCEL NO. 3
OWNER NAME: ?A1/1- !_/ l > VILLAGE: co-0 1/!
INSTALLATION DATE: 192 9 BY:
ADDRESS: f CERT. NO.
TANK INFORMATION
LOCATION OF TANK: 4j �`� )
s CAPACITY 5�41/} TYRE L AGE FUEL/CHEMICAL'fr7C ! V ,L,
TESTING CERTIFICATION C I PASS C ] FAIL DATE
LEAK DETECTION F<3 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES C ] NO DATE TO BE REMOVED
FIRE DE PT. PERMIT ISSUED C ] YES C 7 NO DA
TE
K
CUNSERVATION C RKIF N/A DATEBOARD OF HEALTH TAG NO3E
]C ]C ]C ] DATE 4
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
3/now, Rla
SMEA
KEEPING You ORGANIZED
No. 10334
2453L
MAOE W USA
GET ORGANIZED AT SMEAD.COM
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2".PEASTONE LOAM I1 FILL- 124 MAX.
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411C.1. DIST . • D
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BOX I.. °° ° o 01
c r ' ° 0
, +I 1 24"MIN. +IG•S°�r -
/O,MIN. 1000 ° D r C.♦ 1000— GAL. o 01
GAL. r °°: PRECAST OR ° ° .1 S
SEPTIC 6' n o ° BLOCK ° °°
°
TANK ��°,�° o ° SEEPAGE" PIT o° r°
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r r �o�0/rl i 7gS. ° D
' 20, MINIMUM °°°•'�IW'
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FOUNDATION I e
WASHED STONE
° J No tvgTE%C.-
ELEVATION SKETCH 10 Dana. 92AT13 s�✓o " Z `�"''
SCALE: I°= 4' TEST BY cC.vc,;�r�,r'.c� MSVL7. ivlf
TOWN INSPECTOR f'.v>�- .r•♦`.r✓.e,/
BACKHOE OPERATOR
`--- TEST MADE ON
/,)Esfi/»ofed p0�/y 7o,w o/ 7-h of STAB
s stern B,PE = 2209f'd• Bum, Tot l�Ss• 1 F v
�o Gorb49G e�•r/n�dr) �, I � /�' �/ ''�o � o �I►Q -
X A / .Doi% /'ow /78.ZC- 1
r 2�Mo /o�vabJ� y A-low �+ _ l � _
5, /88 X 2.51:=470 d.
Booms s �9 x J,o �: I i
• Ole ' / 40
` afpo E� i
107
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r - /oz WILLIAM yG\` �
H i. BoX` >oao 501 ;.
BRYANT in �9�actirt . ;*sic
NAL
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ELEVATION SCHEDULE PROPOSED SITE PLAN
1. INV. AT FOUNDATION
2. INV. INTO SEPTIC TANK = /Gr6D IN
3. 1 NV. OUT OF SEPTIC TANK = �����-r `A'T >��NE �•QCa �
4. INV. INTO DISTRIBUTION BOX o SCALE .111=;��' 10P7.40 19 764
5. 1 NV. OUT OF DISTRIBUTION BOX = '! C-45,
6. INV INTO SEEPAGE PIT , Io •SO • CAPE COD; SURVEY CONSULTANTS
ROUTE 132
71BOTTOM OF PIT HYANNIS,MASS.
I A DIVISION BOSTON SURVEY CONSULTANTS. INC.
8. 1BOTTOM OF STONE LAYER
.^ITE PLAN 6--Q �12 �INEFF� IEE RC• COTUIT, MAy �
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ci/ TOP OF FOUNDATION
.�,��5. \ 1 CONCRc i c COVERS err
� ILI r. •/ 4 . .. , � 'T,'�1sTJT.� . . �/��t.ry C.7`.�<lilr/
. --
1J' LEACHING TRENCH (/)REQ
y fQ - _ — ; OR SCHEDULE 40
4•SCHEDULE 40 P.V.C. (Ot Y) 9'NI1N . 36" MAX.
( \� / P.V.C. PIPE MIN. PIPE- MIN. 1/2" WASHED ST E
7 l
-1 - � ��,,� '1 t �. ___I- •'� PITCH I/4•PER.FT. PITCH I/4"P`R.FT. 21
8. a NVERT
EL C TANK _ „
'• I J'� � ,�. � INVERT � Di ( INVERT .q� b' [O�Ci;'C7t"CI Cl Cl 'L'7, � 24
' s-- — �. fox I� \ SEPTIC EL/�.�i B X EL`�..:F. o,'CJ,Cj �','d� ct) o,j p
D Y �y \ \ INVERT - O INVERT . . _ I J Esc
. ., ELlQ.9.f lD GAL.. EL/. 1. z Precast 500 Gal.Leach 3/a -I/2"
�X/STN� /Q�69C -�- EL/:G:'r.�. (3) REQ. .,
`c„ A�' �!r"in:� i- ✓,( I . ; 6"CRUSHED STONE I H_ Chamber WASHED STONE
7,
PROFI LE Or
7%- GROUND WATER TABLE
SENVAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION
SOIL LID G
No SCALE LEACHING RENCH .
9
-- -
/� � C T
DAT2��r.''•��,��TI IAc . . . NO �...A.L
4),00 / / TEST HOLE 'I TEST HOLE 2
r i ' �Q ;�" DESIGN DATA " F 1
-- ELEV. /4-4 ,A .. . . ELEV. i%8 --112• f a
�p �� 9. 'I{N. _WCSHED 36"MAX
�j C 'Q r NUMBER OF BEDROOMS !� SANE
r , ✓� TOTAL ESTIMATED FLOW . . . .9. �?. GALLONS/DAY
V/ L I �� - -- <j s y; J l �,n1/�cs►No �' j O �.r 4.
`ZJ n� r 3i Q BOTTOM L,- CHING AREA y��. / '' p
G�� f lr,�rIJ./13 ?� A SQ.FT inENCH Q 24
i o ti o .� -
L� � T F SIDE LEACHING AREA SQ.FT./TRENCH
y ae
11" j dr JC. � GARBAGE DISPOSAL . ..(50% AREA INCREASE)
76" TOTAL LEACHING AREA SO.Fi.
f
G 1,yI�, PERCOLATION RATE'. t�PER.INCH
LEACHING AREA PER PERCOLATION RATE-7 l�• ,,�WSQ.FT.( _ T G `)'i,�✓ YI
GROUND WATER TABLE
APPROVED . . . . . . . . . . . . .. BOARD OF HEALTH
/)/C%.WATER ENCOUNTERED DATE .. . . . . . . . . . . SHOFA�gss
26 <s �_/''�� ? �'�''j� WITNESSED BY : AGENT OR INSPECTOR �
E�VIM1Pfb / ✓� .�? G!'�. . . 80ARD OF HEALTH
ENG1NEER
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"'� C.��-�✓�LG-�� �jq ��lO'-'~S PETITIONER ----��