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0280 PUTNAM AVENUE - Health
280 PUTNAM AVE. A=©3'1 on9 MOSSWOOD CEMETERY. �i i 03f�-C67 °F� rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 "MA.q 200 Main Street• Hyannis, MA 02601 ,659 e,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT tF0 MAC � ` Business Name: (�'f� V �®� 1 Date: ©_ Location/Mailing Address: U115 MQ ' Contact Name/Phone: Inventory Total Amount:_ MSDS:—�= License#: Tier II fib Labeling: e' Spill Plan: C Oil/WaterSeparator: Floor Drain 06 Emergency Numbers: Storage Areas/Tanks: (�IP-� Emergency/Containment E u' ment: J Waste Generator ID: /AV,60-6 N06320 Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: I Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1194 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-Mosswood Cemetary 280 Putnam Avenue, Cotuit, MA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: ---------------------------------------------------------------------- ------------------- ------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Number Fee 505 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-S&G 800 Pitcher's Way, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: ..-----------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Number Fee 1320 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable DPW-HYMIce Rink .-------------------------------------------------------------------------------------------------------------------------------- 141 Bassett Lane, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f Town .of Barnstable Inspectional Services oFA K�E ro BARNSTABLE Public Health Division --&,' , 4t UARNSTA9LE, I Thomas.McKean,Director' 4 MASS. e 639. 200 N.1ain.Street,FIvarmis, NIA 0260.1 Officc: 508-562-464 4 tlax: 08-790-630.1 APPLICATION FOR PERMIT TO STORE ANn/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH TIME TOWN.O BARNS TABLE GENERAL ORDINANCE,CI-IAPTER IOS, HAZARDOUS MATERIALS,ALL BUSINESSES 71-im-HANDLE:OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIE E.I EIQS ARE TO OBTAIN AN ANNUAL PERMIT(RUNS JULY Ist—JUNE 30th). APPLICATION FIDES CATEGORY I PERMIT 26— 110 Gallons: 50.00 El _/. CATEGORY 2 PERMIT 111 —499 Gallons: $12500 CATEGORY 3_;PERMIT 500 orn ore Gallons: $150.60 ❑ Pdrva�e *A late eharae ol'SIO 00 will be assessed ifpavment.is not received by .I_uh' 1st. ` U 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL". 7\4_YES_NO. IF YES.,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATION'S, INDICATE WHETHER BUSINESS HAS ZONINGIBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE[USE OF GREATER THAN HOUSIJIOLD QUANTITIES (25.GALLONS)?�YES NO. 4. FULL NAME OF APPLICANT `o�! 0�__ D,a Vl 7 5. NAME OF ESTABLISHMENT �( 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �6 �f`�-Er txf IS wCl��l r yGnn�sr rn�9 8. TELIE,PHONE NUMBER OF ESTABLISHMENT: Lt;�,q-5C 4 3 9. EMAIL ADDRESS: b6__2 n jp_�Ct VI5 ��W)�l d-'C.t f1') G i 10. SOLEOWNER: YES NO.IF NO,NAME Or PARTNER: 11. FULL NAME,HOME ADDRESS,AND TEL , 'HOt � # OF CORPORATIONNAy1E �n Q '' d6Ck S13::a� PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME.- TELEPHONE # COMPANY ADDRESS EMAIL: *S.IG.\'ATIJRE OF APPLICANT DATE (:':1UsCr;ltrippvincsktot�llZcieeal Applications fl,12 _v Z.VS'r 4uick l.cinkupll lai Mat App 12cvisedtl9.10;t3.dUcs o • Town of Barnstable; ; Inspectional.Services B�IRNSTABLE FtK�%Er ti Public Health Division nnluvsrAete Thomas McKcan,Director �A R1ASS. n �b tbzq •�`° 200''Main Strcet, I-lN s►t1nis, I:\ 0200'1 •Orea R'IAy s Fax, 508-7190•630} Office: i08-862-4644 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZI HAZARDOUS MATERIALS. IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GL'NERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE!-HAZARDOUS MATERIALS GREATER,rl-IAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY Ist—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 36— 110 Gallons: $ 50:06 ❑ CATEGOR Y 2 PE 11 l —499 Gallons: $125.00 ® d CATEGORY 3 PERMIT 500 or mote Gallons: $1�0.00 *A Hat d 4f xivment is not received bv.Ju1v 1st. I. ASSESSOR'S MAP AND PARCEL N0: 2. IS THIS A PERMIT RENEWAL?)�_YES NO. IF YES,SKIP QUESTION,3. 3. FOR ALL NEW PER1bIIT APPLICATIO.NS,INDICATE WHETHER BUSINESS 13AS ZONING/BUILDING.APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YE S NO. 4. FULL NAME OF APPLICANT: r �, �0vn S 5. NAME OF ESTABLISHMENT: , 6. ADDRESS OF ESTABLISHMENT: 6 O , 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: TELEPHONE NUMBER OF ESTABLISHMENT: � Q�—� 3 6— $. TC. 9. EMAIL ADDRESS: 10. SOLEOWNER: "'-A YES_NO>IF NO,.NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND`I'EL� 'Ili OM OF: �/.�,C, CORPORATION NAMEcKr�s � PRESIDENT TREASURER CLERK 1.2. IF PREPARED ICY OUTSIDE PARTY: TELEPHONE## • NAiVIE: EMAIL: COMPANY ADDRESS *'SIGNATURE OF APPLICANT a DATE C:\tJscrs\lrpp'1RcsktopFRcncal Applications l tr 2030." %fnr VS4 Quiet,hookup\l l i �4a1 t\pp Revised 09-10•fS.dncs Towel of Barnstable Inspectional Services BrRNSTABI;E 4 row Public Health Division ". .u't=°` ' flna+.srAIIt.E..` Thomas McKean,Directar � MnSS. o . 200,Nfatin Street, Hyannis, NNIA 02601 Office: 308-862-4644 1 m 508-790-6304. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE. HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN Or BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR SPORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN.AN ANNUAL PERMIT(RUNS. DULY I st—1UNE 3001). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 0 CATEGORY 2 PERMIT 11 499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 U *A late charge of$10-(Q0 will be assessed if payment is not received by Ju v 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?L YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE(USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)?4 YES NO. 4. FULL NAME OF APPLICANT: Tdwn 0E 63c,(nn5 ln 5. NAME OF.ESTABLISHMENT: C(y)Y115 JCOMmyo i � G. ADDRESS OF ESTABLISHMENT: I Lf( B Ct S tY l T'� �tl'i t�IJS! f'� 0 $0 I 7. MAILING ADDRESS (IF'"DIFFERENT FROM ABOVE:q66 Pi+JUrs Wck� t4yC kini-TiI'll od:60.1 8. TELEPHONE NUMBER OF.ESTABLISHMENT: 9. EMAIL ADDRESS: n pt Q\/U ,bCA(n6;6b le_�-rt c-1 10. SOLEOWNER:-X-YE'S,NO'IF NO,NAME OF PARTNER; I.I. FULL NAME, HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME :a-0 W Y1 O �-j G PRESLDENT TREASURER CLERK 12..IF PREPARED BY.OUTSIDE PARTY: NAME:. TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT �� �� DATEs n Catiscr ltrinpelDcsktoplRcncad,Alaplications for_ �, ,c u Wl'Quick LookulAl Ia z N4at App Revised 09-10-1,8.docx TOWN OF BARNSTABLE PAGE: 1 OF 1 I CHECK NUMBER:01021522 is 06/30/2020 MOSSWOODHAZMAT GENERALIBUILDINGS&GROUNDS r f t $125.00 PO#:20001654 E GL#'017402 .641270 f'" � $125 00," 06/3012020 S&GHAZMAT GENERAL BUILDINGS&"GROUNDS 1125.00 1 PO#:20001654 d GL#'017402=641270 $125 00 E 06/3012020 HYCCHAZMAT ' GENERAL'BUILDINGS&GROUNDS' $125 00'` PO#:20001678' ' - GL#687406 641270 $1.25 001 E 1 E 1� I � J 4595 TOWN OF BARNSTABLE 10215 07/30/2020 $375.00 Number Fee 1194 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-Mosswood Cemetary 280 Putnam Avenue, Cotuit, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ----------------- = --- -- -------------------------- ----------------------- ------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ------------------------------------ PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Number Fee 505 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-S&G 800 Pitcher's Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. - ------------------------------ PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Number Fee 1320 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable DPW-HYCC/Ice Rink 141 Bassett Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health 11� �PP� rec� � I�IOICE, INVOICE10, INVOICE dESCRIPTION N�T IN�/OIC CHA YE- At6 I NUMBER` a ;: a W41NAss I T DER# \ 5/21/2019 474519 HOLD BLDG DIVISION HAZMATERIA $125.00 _ 19010863 017402-641270 5/21/2019 474520 HOLD BLDG DIVISION HAZMATERIA $125.00 19010863 017402-641270 5/21/2019 474521 HOLD BDLG DIVISION HAZMATE RIAL $125.00 19010864 687406-641270 Tim ra �:VEND®R �/EN®®R NAME CHECK AMOUNTf CHCICDATE "ChF£CK NMBRs' e � ' �_ 4595 TOWN OF BARNSTABLE $375.00' 06/06/2019 998651 REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT OF ITEMS SHOWN HEREON. ' IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION. Town of Barnstable Finance Department 230 South Street Hyannis, MA 02601 Tel: 508-862-4654 ! ) ) Fax: 508-862-4717 i J y � 1 . .� - .._..........�.,,..�..�.,�-��s,�- ,�..._. ..�,. �...�'.� Print Cert i „ Frr �, License 1320 .- Activei Name.' Town of Barnstable DPW HYCC/Ice Rink -77" �. Quantity:1111 -499 gallons Street no:- 141 :Street: „Bassett Lane Town-,Hyannis Mailingif.different - _��= � Year Pay Date Fee^ s g f Address: Attn: Steve Sundelm or Megan Savage Town:- Hyannis } 018-201 6/29/2018 125.00 mow.-� '�.�- .,, -.,.. ,«,�. ...,,,.,.�...,.�...:. _=._.. State Zip02601 -_ � -� 2017 M1 r, Phone .s i i Name „ Street no Street:, �t Town State. Zip.-. Phone v' L .M 6 �y k . d} • .,.�,,.���,� ;��...,� ,.�, .. Print Cert .. r License:, 1194 Active. ry i a Name Town of Barnstable-Mosswood Cemetary Quantity,1111 -499 gallons k ' `Street nu." 280 z^o. Street: Putnam Avenue 'Town Cotuit +t ; Mailing(if d iff t) - ,mm ay Year Pay Date• ;Fee ' Address: 800 Pitcher s Way Town Hyannis ' 2018 201 6/4/2018 � $125 00 17 $125 00 , State:f MA Zip: 02635 1 6/22/20 2 201 016 = 7/19/2016 $125.00 Phone: 508-428 8643 r — 2015 8/18/2015 $100.00 Name Street no I Street Town yk iud r. - '..w'`..,.... �.r..e+ .—k„ '^ """'°4^" ^,�""�-°..,^.,�.. -- ,,+a..a,.= -.mow. ..- mw^•«,•r., i.d P A `wimi �� l�mfir fi n ,�uil� not .. u�" iuo n 47 uu a 4 v, Z. ON NW ru�,a.,.•new,...w...«r....._.�.°��.0.....,,.,�.,...��.,... d Phone, 1t ,mm Print Cert License 50,. Active: C Name Town of Barnstable-S&G � Quantity:�111 499 gallons ;Street no 800 - Street Pitcher's Way Town, Hyannis ,r� ��a g Mailing if different) - �-., - . , r= �— ,, ,¢ :»-. t ay Year Pay Date Fee Address Town:„ 2018 /4/201 62018. _. .$125 00 n �i - MA. I 7 10260 a 2017-201 6/22/201 $125.00 State t Zip. 02601 `t - ,' 2016 7/5/2016 $125 00 .. a Phone 15508-790 6320 - - - - ei, —W - - w — 2015 6/30/2015 $100.00 j d. - - - r 2014 -7/15/2014 $10000 ' Name 7/16/2012 . .� e . , .. . 012 $100 00 Street no. Street A W - 'Y .t:. "wmw•.� �«mho.-..'xw'ww.+ww'K:+tiw'-�".r,..— •wWawr.wnww,..wwu�nKwn:.. State:. -- zip'. 4 Phone: Mz • s s Number Fee 1194 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-Mosswood Cemetary 280 Putnam Avenue, Cotuit, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health i "E r Town of Barnstable office: 508-862-4644 ., Fax: 508-790-6304 Regulatory Services Department • l- svxa Public Health Division Thomas A.McKean,CHO saq. � 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/4/2018 Permit number: 1194 Check number: 976985 Check amount: $125.00 Name on check: Town of Barnstable `Business: Town of Barnstable- Mosswood Cemetery Owner: TOWN OF (CEM) ? .Address: 280 PUTNAM AVENUE, Cotuit .Note: 2018-2019 Category II Permit Number Fee 1194 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-Mosswood Cemetary 280 Putnam Avenue, Cotuit, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ----------------------------- ---------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health T Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 �' Regulatory Services Department . ; . • t trr�rA ILE . Public Health Division Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Y Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/22/2017 Permit number: 1194 :Check number: 956632 Check amount: $125.00 Name on check: Town of Barnstable ';Business: Town of Barnstable- Mosswood Cemetary Owner: TOWN OF(CEM) ;Address: 280 PUTNAM AVENUE, Cotuit Note: 2017-2018 Category II Permit i ..... .. TOr'V ',OF BARNSTABLE ma 44 M "� � INVOICE INVOICE 6 -�NET INVOICE PURCHASE ONE AMOUNTS DATE NUMBER R SCRIPTI � � e r ;ORDER# INVOICE DE 6/1/2017 390568 HAZMAT MOSSWOOD JUNE2017 HOLD $125.00 17000414 017402-641270 1 t I � 1 VENDOR# VENDOR NAME ` `� CHECK AMOUNT CHECK DATE GHECKNUMBER 2 _ 4595 TOWN OF BARNSTABLE ( $125.00 06/22/2017 956632 REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT OF ITEMS SHOWN HEREON. IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION. Town of Barnstable Finance Department 230 South Street Hyannis, MA 02601 , Tel:508-862-4654 Fax:508-862-4717 r , � l l J • 1 J� Number Fee 1194 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-Mosswood Cemetary 280 Putnam Avenue, Cotuit, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------- ---------- -------------------------------------------- -------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 o Regulatory Services Department • Public Health Division eatt�vsrnst MAC• Thomas A.McKean,CHO � s 200 Main Street, Hyannis, MA 02601 Payment Receipt ,Hazardous Materials Payment received: 125.00 (Check) on 7/19/2016 Permit number: 1194 ;Check number: 936671 Check amount: $125.00 Name on check: Town of Barnstable 'Business: Town of Barnstable- Mosswood Cemetary Owner: TOWN OF(CEM) ;Address: 280 PUTNAM AVENUE, Cotuit- i Note: TOB-Mosswood Cemetary I .._ .......- ............. .. .--- .....-.. • I TOM OF BARNSTABLE' INVOICE INVOICE s NET INVOICE PURCHASE D INVOICE DESCRIPTION ` ATE . , NUMBER " AMOUNT ORDER#, 6/8/2011 353127 HAZMAT MOSSWOOD JUNE 2016 $125.00 16011917 017404-673010 1 J VENDOR# VENDOR NAME CHECK AMOUNT CHECK DATE CHECK NUMBER <.. 4595 TOWN OF BARNSTABLE $125.00 07/14/2016 936671 REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT OF ITEMS SHOWN HEREON. IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION. Town of Barnstable r Finance Department 230 South Street Hyannis, MA,'02601 Tel:508-862-4654 I Fax:508-862-4717 ' J / I � � I Number Fee C- 1194 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Town of Barnstable-Mosswood Cemetary 280 Putnam Avenue, Cotuit, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable r Regulatory Sen4ces g rY Richard V. Scali,Director RARN9= Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee:$100.0.0 ASSESSORS MAP AND PARCEL NO. ::5F3 7 OD..7 DATE t9sl.�'911-r APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME I OF APPLICANT d Y19 S �� D��'u.�-t / /1 NAME OF ESTABLISHMENT /'' S.J wo�I�'t .zc 7�eL ADDRESS OF ESTA.BLISHMEI`TT TELEPHONE NUMBERlf�� SOLE OwNER:- YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL CiVFa PARTNERS: DEBT. OF puE�L1C V"Vr}R<<S JUL 21 201 TOWN Of-6F,R"dSTI.B1-E "!R�!CTUIIES GROUN"DS01V'S104d IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. yy OCR I D7R STATE OF INCORPORATION ��^�t^�^^^" •' ^�►-� FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# CAcache\Temporary Lntemet Fi1es\0LKD3\1AZAPP Rev2015.DOC s � Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department Public Health Division BA LK MASS. Thomas A.McKean, CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt (Hazardous Materials Payment received: $100.00 (Check) on 8/18/2015 Permit number: 1194 'Check number: 917274 Check amount: $100.00 Name on check: Town of Barnstable 'Business: Town of Barnstable- Mosswood Cemetary Owner: TOWN OF (CEM) i Address: 280 PUTNAM AVENUE, Cotult 4 to d `°FtHE rogti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"M SM�E.� 200 Main Street• Hyannis, MA 02601 i639 M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 A'S Business Name: .0\'J p CAT ' Date: 7 Location/Mailing Address: "�. Contact Name/Phone: Inventory Total Amount: '—s c® SDS: S Libense#: Tier II : o Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: N Emergency Numbers: Storage Areas/Tanks: �� U TO `G Emer enc /Containment E ui ment: NPAI K i Waste Generator ID: v�0 Waste Product: Q` Date&Amount of Last Shipment/Frequency. 19 Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage a disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze l o ry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes ug and tar removers Hydraulic fluid (including brake fluid) !�/Windshield wash-` 6 Motor oils V Miscellaneous Corrosives asoline,jet fuel, aviation gas 4 d Cesspool cleaners iesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages V Pesticides:V Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine 'Asphalt varnishes, stains, dyes L Lye or caustic soda Lacquer thinners V Miscellaneous Combustible � Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables — Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: �t INFORMATION/RECOMM NDATIONS: i � L` IV4 n0 Oe U (u. Inspector:. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS i °p�ME►°� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 RARMASS . . $ 200 Main Street• Hyannis, MA 02601 �prfDMP+I, TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: I o P w & -Z at, Date: Location/Mailing Addr ss: m D v Contact Nam Phone: - 7 Inventory Total Amount: A- 56 0 41 SDS: re-g License* Tier II : J 0 Labeling: X &Le- Spill Plan:-- Z Oil/WaterSeparator: ti Floor Drains: o Em encv Numbers: Storage Areas/Tanks: C-10 2-76qdAtrf�, I 9c n ,e u�coK-�'4,►� �Qo� Emergency/Containment Equipment: d , -w oo So�aA� l ��j v sic qS-r �,�cs µea,.�ot Waste Generator ID: Waste Product: D rgn I 4 Date&Amount of Last Shi ment/Fre uenc : 18 I 1 -(� �vk. t,� 14 Licensed Waste Hauler&Destination: e. l C�aang o �,oust i. � Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS �O w�r110! cl,�a�� ,v� �v�vlv� os �j tAcx N0,6-- NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardou✓material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids ✓ Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum pro3ucfs: Road salts grease, lubricants, gear oil a� Refrigerants y' Degreasers for engines&garages�o°(� �� Pesticides: Caulk/Grout e4 �G.► insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine �— Paints, varnishes, stains, dyes Lye or caustic soda �- Lacquer thinners �- Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: v -L- OL le.�cR-w����. CI-��^`� Rvl 5 i�l� �a �,��� ovk- .+(fit— Inspector: �.c,V-L��� Facility Representative: WHITE COPY- - O HEALTH DEPARTMENT CANARY COPY BUSINESS °*IKE►, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B`RM SS. ' 200 Main Street• Hyannis, MA 02601 039. �"rFOMP� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name:— �P S C7� (�v��a�C�e-S Date: 6 30 /6 Location/Mailing Address: SO S+y\ -je Contact Name/Phone: P e o - qZ -8 6 q 3 t>Q+ti ,,,- r�tLc Inventory Total Amount. ti 0 40 MSDS:4 License#: 11I L4 Tier II : 00 I'Labe in Sill Plan: Oil/Water Separator: Floor Drains: N o Emergency Numbers: Ve s Storage Areas/Tanks: �= �� �� o�1 `} kv,� w act -,-1 al AK „t ,-e6%"np �k vv cox VL, -S Qldts vt� !ov 41A5� "4' Emer enc /Containment E ui ment: S k�JWi or 2 S Waste Generator ID: MV 175� 0 S20 Waste Product: Date&Amount of Last Shipment/Frequency: •' 5- 11. NEW 20 o, I Licensed Waste Hauler&Destination: Pa c`I 5 e-je-4`",,v- ek7 .ecm.-j D - C y►ti � 1 Other Waste Disposal Methods: �5X►"��� Qa1v��g� �c(v��w�.„�� LIST OF TOXIC AMD HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) V Windshield wash Motor oils I DX t 10-+ %oo v>4.�kG Miscellaneous Corrosives Gasoline,jet fuel, aviation gas �� Cesspool cleaners 2 Diesel fuel kerosene, #2 heating oil Disinfectants Miscellaneous petrolet products: Road salts to grease, lubricants, gear oil Refrigerants Degreasers for engines&garages 1 1 o Pesticides: %o �— Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) 1 Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners I o Miscellaneous Combustible ko Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATI N/RECOMMENDATIONS: GtZVOok V?,",Al)2 t70A-. c. b— Inspector: 1 J'«�SSse l�CL ► �, �. / Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i � aIMEr Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BnRMA�BLE.9• 200 Main Street• Hyannis, MA 02601 prFDMP+a`e TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: I 0 �Y l.J J `C7 Date: Location/Mailing Addr ss: CO' O Aar R10 Contact Name/Phone: -5-ba qZ 8 vl Inventory Total mount: '�zSO �� bp0o b MSDS: -le- 5 License it. Tier II : NJ 0 Labeling: Rol Spill Plan: C-5 Oil/WaterSeparator: Floor Drains: N 0 Emergency Numbers: �5 Storage Areas/Tanks: ors Emergency/Containment Equipment: ►o0 9� A �� e.°' S c 5 �) k S Waste Generator ID: A509 12r30 bq3 Waste Product: DI af�5 ►tie✓ Date&Amount of Last Shipment/Frequency: K. 0, 1 too j41 alig-114 IX Licensed Waste Hauler&Destination: "� vti�)�o►1� Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash X-W Motor oils it w +°0 'V&S ti- Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: (,Ooolb Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages +5 to Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine �— Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: - a '' n' a ,►1 4: —!2.4�a 41 1e% 0 Cl'v�01144:AA M 10 4 AA L2 kaK VS`2 Inspector: ,-� L Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS 5s 0 B8� Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS .Generator ID Number 2.Page 1 of 3.Emergency Response(Phone 4.Manifest t T k' Number RDOUIS es rac ln�q SKS WASTE MAN IFEST 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) T-,I vkm 01f 8-a'r--i s.f,i!t bi I.�i i1 I-icy s Pt t trait Av Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address N E3'YS T Et NC U.S.EPA ID Number 1wJ 1 -ML_t-.t. G 7.F4 EP T C PAI V�.j T 30 N! 27 tS I q)8 el rn Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WtNol. 13.Waste Codes M 4"WHA' f-'GT11 W-1--133P 1,i 6,06, 3. 4. 14.Special Handling Instructions and Additional Information -TI F24 HR EKER(34 NGY A, A.t 1,5 F'ry 'r n ',,c,-r.,N I T FT-10 011:' �'JOAf--i-FT)."IVNT 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. toes/Offeroes Prin,t.ed[Typed Name Signature Month Day Year -j 16.International Shipments 1.- 1:1 Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: LW rt6 17.TransRoAcknowledgment of Receipt of Materials U Ej Transporter 1 Printed/Typed Name Signature Month Day Year. U) Of, Z!Transporter 2 PrintedlTyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space El Quantity El Type ❑Residue El Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number Facility's Phone: U L— 18c.Signature of Alternate Facility(or Generator) -7 nth Year 1 Day 1 .19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. --T 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY } _ BRANCH RIS CSG 41 Jonathan Holt 01/16/15 13:16 PAGE 1 Safety-Kleen Systems, Inc. 2600 N Central Expy, Suite 400 Richardson, TX 71080 CORPORATE: 800-669-5740 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) 4017810809 REFERENCE NOR. CUSTOMER# ST27210 Town Of Barnstable Structures & Grounds Dept 65198712 280 Putnam Ave SRVC WEEK: 2015-3 Cotuit MA 02635-2815 SRVC DATE: 01/16/15 13:16 PHONE 508-428-8643 BILL TO CUSTOMER# BILL TO ADDRESS: ST27210 Town Of Barnstable Structures &Grounds Dept 280 Putnam Ave Cotuit MA 02635-2815 PHONE 508-428-8643 PURCHASE ORDER# TAX EXEMPT# PRODUCT/SERVICES SERVICE/ TOTAL PRODUCT QTY UNIT PRICE TAX CHARGE 16150 MDL 16 WITH PREMIUM SOL 1.000 464.4000 0.00 464.40 S/N 11056093 TAG TOUOOOUOXX90003428 CLEAN 8.00 SPENT 8.000 SERVICE TERM 24 WEEK SCANNED YES # CONTS: I TSOF: CRR MANIFEST#: 004$85835SKS FORM CU: US SK SHIP# 214795670 CNT#: 141126356558 QTY: 8 WT/VOL G PROF# 150055 SKDOT 717 100001 FEE, FUEL SURCHARGE 2.000 14.6400 0.00 14.64 - 10044 EXTENDED SERVICE AREA FEE 1.000 0.0000 0.00 0.00 ----------------------------------------- TOTAL SERVICE/PRODUCTS 479.0400 0.00 479.04 TOTAL CHARGE 479.04 CREDITS 0.00 TOTAL DUE 479.04 UNPAID BALANCE THIS RECEIPT 479.04 Machine clean and good condition? Yes Lamp Assembly Condition Yes Decals in place and legible? Yes Fusible link installed? Yes Emergency closing of lid unobstructed? Yes Machine properly grounded? Yes Local Phone No. Sticker Affixed to Machine Yes Spent solvent meets acceptance criteria? Yes GENERATOR STATUS „ 0-220 lbs/month Customer certifies that (i) the above-named materials are properly classified, packaged, marked and labeled, and are in proper condition for transportation according to the applicable regulations of the _ Department of Transportation and (ii) no material change has occurred either in the characteristics of the waste/material or in the process generating the waste/material. Customer agrees to pay the above charges and to be bound by the terms and conditions (1) set forth in (a) the General Terms aid Conditions provided separately to Customer or (b) any SK agreement signed by Customer and SK, and (2) incorporated herein by reference. Unless otherwise indicated in the payment received section, SK is authorized to charge Customer's account for this transaction. Customer certifies that the individual signing this Service Acknowledgement is duly authorized to sign and bind Customer. The following provision is applicable to Safety-Kleen's parts cleaner and paint gun cleaner services: Customer agrees that it will nut latruuuce airy subsLante into Lim sulveut ur ayutuus cleaning solution, including without limitation any hazardous waste or hazardous waste constituent, except to the extent such introduction is incidental to the normal use of the machine. Customer further- agrees that it will not clean parts/paint guns that have been contaminated with or otherwise introduce polychlorinated biphenyls (PCB's), herbicides, pesticides, dioxins or listed hazardous waste into the solvent or aqueous cleaning solution. Safety-Kleen has the capacity and is permitted to accept, store, and/or reclaim the spent parts washer solvent; paint thinners, solvents and paints generated by customer; or dry cleaning filter cartridges, powder, and still -residues containing perchloroethylene, petroleum naphtha, or triflurotrichloroethane dry cleaning solvents. Customer agrees that it is responsible for properly classifying its waste streams as Used Oil or Nonhazardous Waste in accordance with the provision of 40 CFR 262.11 and applicable state laws. Customer agrees that it will not introduce any non-conforming substance into the SK Property, including, without limitation, any hazardous waste or hazardous waste constituent,(i.e., polychlorinated biphenyls ("PCBs"), herbicides, pesticides, dioxins, or listed hazardous wastes) except to the extent' such introduction is incidental to the normal use of the SK Property. In the event of the introduction of such non-conforming hazardous waste, Customer agrees that it will be responsible for all costs and remediation expenses related to or arising from the proper management and disposal of tire non-conforming waste, including the cost of equipment decontamination and subsequent disposal. Final invoicing will be based on the actual services provided, which may include additional charges for off specification waste and surcharges. Final invoice amount may be more than the amount listed on the printed receipt. If any legal action is commenced because of an alleged dispute, breach, default or misrepresentation, the Customer also agrees that the prevailing party will be entitled to recover, reasonable attorney's fees and costs associated with the non-conforming cuntaanination event. Safety-Kleen's failure to screen Customer's material or take a retain sample, in no way constitutes a waiver of Customer's obligation to properly classify its materials. Safety-Kleen relies on Customer's representations and Customer is GENERATOR NAME: Town Of Barnstable Structures & Grounds Dept MAkNIF -6T OR SALES SERVICE NO U> SK Pursuan^ to 40 urn coo. ' `a/ , I hereby notify that this shipment contains waste restricted under 40 CFR par 268 land dispoial restrictions (LDR) . ---------------------------------- A. GENERAL WASTE NOTIFICATION EPA WASTE CODES & LDR SUBCATEGORIES (IF ANY) ,. Treatability groupi NNW Non-Waste Water Waste Constitaent Notification - Legend Number Constituent 184 METHYL ETHYL KETONE 250 CADMIUM 231 CHROMIUM (TOTAL) 255 LEAD 257 MERCURY ALL OTHERS EXP NOTICE: THIS LDR EXPIRES ON 12/31/2014 SIGNATURE (PRINTED OR TYPED) TOP COPY: GENERATOR MIDDLE COPYv FACILITY D�� -�--- ' BOTTOM COPY: TRANSFEf z, 5 M E A KEEPING YOU ORGANIZED No.10334 3-153L MADE M USA GET ORGAMZEDATSMEAD.COM Date: TOWN OF BARNSTABLE a-//�-/�� TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: Woos & c BUSINESS LOCATION: ZP 6 7V INVENTORY MAILING ADDRESS: As MeV1,E TOTAL AMOUNT- TELEPHONE NUMBER: J-m - yzr- r� /r�6 CONTACT PERSON: A-N ST. 2a2a£ EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: E C renu.vs /�A��T�'�c1 GS INFORMATION/RECOMMEN ATIONS: St-� ltis/����o,cJ L��� Fire District: b,�,0 6E6 • a g Agate Aei�-C�e-iv/T Waste Transportation: Last shipment of hazardous,waste: 1°-°-7 Name of Hauler- Destination: Waste Product: s y vku s Licensed?,� No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) + � Diesel Fuel, kerosene, #2 heating oil NEW USED JO Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers 16kLW_,0AJ 4WOA)1 4 (including bleach) �z, LONSISc�UL/F,c1EflUS Spot removers &cleaning fluids (dry cleaners) �, �oU�vi�.f�3a.� jfQ PoUNi� F>ArS� Other cleaning solvents pF OD�SS/Uf( %fZ0 i�� AJ A Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS:BUSINESS LOCATION: INVENTORY MAILING ADDRESS: /5 TOTAL AMOUNT: TELEPHONE NUMBER: G3 ljZ� I`fj P CONTACT PERSON: T1-/Iy J%. EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: eENE 721< ,eourji)s 11V g1,�-17Tti,y,jc_ y°.S INFORMATION/RECOMMENDATIONS: ��� /�si'e`n J ��'� i2 Fire District: `EL3,yuflf2 611�� Waste Transportation, Last shipment of hazardous.waste: �D °7 Name of Hauler•.-:-7111 , Jf cli- Destination: Waste Product: _Se-��,vrs / /�isrEUi� Licensed?�Y(e�% No NOTE: Under the provisions of Ch. 111,-Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division, LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze(for gasoline or coolant systems) Misc.Corrosive NEW USED Cesspool cleaners Automatic transmission fluid 3 Disinfectants Engine and radiator flushes Road Salts(Halite) Hydraulic fluid(including brake fluid) Refrigerants /G Motor Oils Pesticides NEW / USED (insecticides, herbicides, rodenticides) Gasoline,Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene,#2 heating oil NEW USED Misc. petroleum products:grease, Photochemicals(Developer) lubricants,gear oil NEW USED 4 Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc.Combustible Car wash detergents Leather dyes Car waxes and polishes 3 Fertilizers Asphalt&roofing tar PCB's Paints,varnishes,stains,dyes Other chlorinated hydrocarbons, Lacquer thinners (inc.carbon tetrachloride) NEW USED Any other products with"poison"labels Paint&varnish removers,deglossers, (including chloroform,formaldehyde, Misc. Flammables_ hydrochloric acid,other acids) Floor&furniture strippers Other products not listed which you feel `Metal polishes may be toxic or hazardous(please list): Laundry soil&stain removers j ,,fL.Lo cJ...//f10titH (including bleach) lFLI GA!S /-(JSrE.LLit,t1E:OL'S Spot removers&cleaning fluids �.� �/C-Ak pS (dry cleaners) %. Sc /wvi,i> Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable oFI E T Regulatory Services . y�P� °wtio� Thomas F. Geiler,Director Public Health Division BAMSTABLE, Thomas McKean,Director 9 MASS. �A tb 0.39. 200 Main Street, Hyannis,MA 02601 prFD MA'1�` Phone: 508-862-4644 Email: health(o-)town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 February 14,2008 Mr.Daniel St.Pierre, RE: Toxic and Hazardous Materials Forman of Cemeteries On-Site Inventory and Inspection, Town of Barnstable Mosswood Cemetery, 280 Putnam Avenue 280 Putnam Avenue, Cotuit,MA426-48 p2'-S5 Cotuit Dear Mr. St. Pierre: On January 24,2008,a Toxic and Hazardous Materials On-Site Inventory and Inspection of the above referenced site was conducted by the Public Health Division(PHD).A follow-up Inspection was performed on February 12,2008.An On-Site Inventory and Inspection is a review of the sites storage,transport, utilization and/or disposal of toxic and hazardous materials as it relates to the Town of Barnstable Ordinance,Chapter 108:Hazardous Materials. This Ordinance was adopted to protect the public health and welfare,especially as it pertains to the public drinking water supply. The following is a description of the.results of the Inventory(enclosed)and Inspection. MATERIALS INVENTORY AMOUNT AND PURPOSE:- The Inventory of this site indicates the use or storage of approximately seven-hundred and eighteen(718) gallons of toxic and hazardous material.This material is used in the grooming and maintenance of the facility,cemetery grounds,motorized equipment and irrigation well. Please be aware that the Town of Barnstable has determined that a minimum of one-hundred and eleven(111)gallons of toxic and hazardous materials requires an annual license. GENERAL STORAGE AREAS AND CONDITIONS: • The lunch room of the Cemetery Grounds Facility which houses a variety of household cleaners. • The Equipment.Barn which houses two Pesticide Lockers,a Flammables Cabinet and pallets holding thirty-two(32)forty(40)pound bags of potassium chloride(de-icer). • The Work Shop,located adjacent to the Equipment Barn,which houses a small Flammables Cabinet,a Safety Kleen station,a latex water based Paint Cabinet,an oily rag container,and an and oxygen tank.Although not required to be included in the inventory,a two-hundred and seventy-five(275)gallon,#2 fuel oil tank(used for heating)was observed in the Work Shop. • A propane tank adjacent to the Greenhouse. • Equipment Barn exterior storage area of a two-hundred and seventy-five(275)gallon aboveground diesel storage tank(used for the power equipment),and two waste oil drums. -2- • A two-hundred and seventy-five(275)gallon aboveground diesel tank adjacent to the irrigation well Pump House. All exterior storage areas were sheltered and provided with containment.There were no floor drains observed at the facility.All materials were labeled appropriately with the exception of the Pump House diesel tank,waste oil drums and propane tank. SAFETY AND DOCUMENTATION: The required Material Safety Data Sheets and Contingency Plan were up to date and posted in the lunchroom. Manifest sheets for the transport of hazardous materials were also available for review. Fire extinguishers were present and their inspection up to date.The site was not in receipt of a Town of Barnstable annual license. SITE FACILITIES: The site building is served by a septic system;the domestic water is supplied by Cotuit. Any deficiencies which were discovered in-the course of this inspection with regards to the Hazardous Materials Ordinance are described below. VIOLATION,ORDINANCE REQUIREMENTS AND CORRECTIVE ACTION TO BE TAKEN: Mosswood Cemetery was not in receipt of an annual license to store I I I gallons-or more of hazardous materials. Hazardous Materials Chapter 108-6B states in relevant part that,"The Health Department shall require,after reviewing the submitted registration information set forth in 108-4,an owner to obtain an annual license." Therefore,Mosswood Cemetery shall complete and submit to the PHD the enclosed "Application for permit to store and/or utilize more than 111 gallons of hazardous materials". Until further notification the Application Fee is waived. OTHER: The two waste oil drums and the diesel tank adjacent to the Pump House shall be labeled as such. The propane tank should be labeled as Flammable. The PHD appreciates your cooperation and acknowledges your recent initiative demonstrating.your intent to maintain compliance with the Hazardous Materials Ordinance. Please contact me at the above telephone number should you have any questions or comments regarding the Inspection of your site. Very ly yours, C is A.Martin Ha ardous Materials Specialist All orders to correct violations of Chapter 108 of the Town of Barnstable Ordinance:Hazardous Materials shall be co-m leted pon receipt of this letter. �ms A.McKean;RS,CHO Director of Public Health -3 - Enclosures: Toxic and Hazardous Materials On-Site Inventory Application for permit to store and/or utilize more than 111 gallons of hazardous materials I ' I Town of Barnstable Regulatory Services r _ a ; Thomas F. Geiler,Director W Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Appl cationfee:$100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT.TO.STORE.AND/OR UTILIZE.MORE.THAN. 111.GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER t, SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Hazdoc/wp/q r TOWN OF BARNSTABLE LOCATION .2eo SEWAGE#a(t0710 .VfLLAGE ASSESSOR'S MAP&PARCEL 3 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY AJyo g�-/� LEACHING FACILITY:(type) �� ,C,�i� (size) XA P 4,.r� NO.OF BEDROOMS OWNER r PERMIT DATE: ® 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet n FURNISHED BY -C D 2) ,� it 3, 3 re .7 w 14 -a TOWN OF BARNSTABLE & 007- a0? LOCATION %rOffU2 Lj SEWAGE # :VILLAGE �� i7 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO., )W,12 p fl�Af 2ST hl�_ SEPTIC TANK CAPACITY MO LEACHING FACILITY:(type) 1&tt f4rdt3 (size) 3"Y/5 A, NO. OF BEDROOMS a PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Zl DATE PERMIT ISSUED: 9_? DATE COMPLIANCE ISSUED: 42- .-1.7 % :3 VARIANCE GRANTED: Yes = No l� � �� I� ,��, �_ �i^ t0 t ..-..•'�.�...4'..9... �-�iCarr/T'�,.�,""".'.+..'.�„w-_ry.,Y�„n/�'./��r{�-`t� ... . s�.'w'J'w- �'.'tiY-�I... ,.ten- r . _•-i. No. E/—— � � � i j Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppricatton for 30igpogat 6potem Cortgtruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade)4 Abandon( ) Complete System ❑Individual Components Location Address or Lot No.28v T ,1�E, Owner's Name,Address,and Tel.No. c` !for V UJ `10-0N Ge �l rt LL (9,ye))-190-b32-q Assessor's Map/Parcel dyl t KY onvms M V+ o Installer's Name,Ad�re js,�and Tel o. 1 Designer's Name,Address and Tel.No. c� QJK A C>'LSSo Type of Building: ' .i f-- Dwelling No:of Bedrooms LotSize^[O tS st)-ft- Garbage Grinder ( ) Other y1. Type of Building F-��AUiC�1P�L, No.of Persons IQ Showers( ) Cafeteria( ) Other Fixtures' Design Flow(min.required) C gpd Design flow provided ?3Z gpd Plan Date _ �N,3 Number of sheets I Revision Date tk� -b� Title StPnC_ Q. C�( -MC�SCt�iL�� C.1�(••t# Q, Size of Septic Tank 2-CC)fAD&QJ]MM 'ype of S.A.S. mu `1 rl!KbKK Description of Soil '�.�vl (�' �,2` R lL -7 (, - Sid-QY LC AAA IZ-3.cp &00,0 3' ,0- ( If C "(nww1uto � apt Nature of Repairs or Alterations(Answer when applicable) ( -C CtUT S^E CJTI(r "tA i�C . C t�-� i�Y�-7C �-CUT Date last inspected: Agreement: The undersigned agrees to ensure the,construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of c i Compliance has been issued by this Boa f H 1t . Signed Date Application Approved �L__lT— Date Application Disapproved by: Date for the following reasons Permit No. '''�(O - Date Issued - r •k.� ,.,,.:4 ,. ..m.,:. ._-.-.:._,...� .� t._.:=.. e.. -.- ,.-.-i:..ees.•rti..=y"-. +...�' .. .;`4.�a.`:.n-. y- F- ,h +. 'y,." - ;; .. -:r-- - No. `� a o :.,. Fee. Clio w THE COMMONWEA LTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes =- r 2ppricatiou. for nigogal *pgtem Cow5truction permit Application for a Permit to Construct O Repair O Upgrade ) . Abandon{ ) Complete System ❑Individual Components Location Address or Lot No.-B(,1'C o� l Owner's Name,Address,and Tel.No. i -7 �O'fU� Ic�c�tJ.csr. C�p�2NSt1�$l_i` Assessor's-Map/Parcel d3 (cc:)—, �j -0 l Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No. ! `l&VI l t t t +tces Lu Y w('C VttV C ecuP c'� \-�►'� C atti�Ot v�cr t M d� c�Z S b Type of Building: - f f Ac... Dwelling No.of Bedrooms �i Lot Size" P. S 1s'q-ft. Garbage Grinder ( ) "- Other Type of Building No.of Persons 1C) Showers( ) Cafeteria( ) Other Fixtures r > Design Flow(min.required) ZCX gpd Design flow provided gpd Plan Date -� ZC >� Number of sheets Revision"Date '�L� ' Title S{..Pr_1 L L- Pc\Q Ao(-: M�SSt�c C L M t'�SZ (4 � � � ® 7 m Size of Septic Tank C}lVty/t'j;mE,,/►t'Type of S A.S. �r Description of Soil S 0_ �•2.' FI l L (, ff ,() f� 1 ( V\ 14 C �4 Cj uµ WA a MQi Nature of Repairs or Alterations(Answer when applicable) lL "2-C c mPky i oic U\ C �Scx-) (1 A Date last inspected: Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until'a Certificate of "Compliance has been issued by this BBo�ard of H alth. / .j --- �J Signed , e;17'"" Date Application Approve Date Application Disapproved by: Date for the following reasons 't Permit No. r ""/!O 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS y BARNSTABLE, MASSACHUSETTS Certificate of Compliance r THIS IS TO CERTIFY,that the On- ite�Seewage Di/p�ossal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by © /7 at cP-'�?Q PL) r1a YA NV Q �d y� has been constructed in accordance l/�7 with the provisions of Title 5 and the for Disposal System Construction Permit No. Cb 7" _3 dated Installer t j f° Designer H tj #bedrooms Approved design flow r o i gpd The issuance of this, it sl�all no 7be construed as a guarantee that the system ill functiorLaa?s designed) B Datel p f/( �J :_ A/; Ins ector J -------- / r r --------------------- ------------- No. cCO 7 10 J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Digpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair. ( DO Upgrade ( ) Abandon ( ) System located at @?4 fy r a'In �v Q , cc'u�d' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constructiop must be completed within three years of the date of this permit. ,t Date / Q 1 a 7 Approved by . Town of Barnstable Regulatory Services do Thomas F. Geiler,Director w r * BARNSTABLE, " MASS. Public Health Division t639• �0 AIF039 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 8/29/07 Sewage Permit# 2007-163 Assessor's Map\Parcel 37\9 Designer: Horsley Witten Group, Inc. Installer: Bortolotti Construction, Inc. Address: 90 Route 6A Address: P.O. Box 704 Sandwich, MA 02563 Marstons Mills, MA 02648 On April 25, 2007 Bortolotti Construction was issued a permit to install a (date) (installer) 280 Putnam Ave Cotuit (Mosswood Cemetery) ; septic system at based on a design drawn by (address) c-� Horsley Witten Group, Inc. dated January 2007 (Rev. 4/16/07) (designer) x I certify that the septic system referenced above was installed substantially according to:;- the design, which may include minor approved changes such as lateral relo ation oaf the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ���SH OF MAs�c V �g FAT PIU N� lEE H (Insta is Signature) crva NO.42824 ���sSlONALENG (D signer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc 9-2007 07:56 From:BORTOLOTTI CONST 5084289399 :To:5088333150 P.2 TOWN OF BA1tNSTABLE LOCATION a_ra.._P(s .r.� fh/t• SEWAGE# VILLAGE - �1T .,ASSESSOR'S MAP&PARCEL, INSTALLM NAME&PHONE NO. ` S1~PT[C TANK GAVACTI'Y LFACH NG FACILPPY;(type) NO.OF BI"sDROOMS C 1 OWNFA "7-7 , PBRMCT DATE: COMPLIANCE DATE: Separation Distance Between the; Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility P"a Private Water Supply WoH and Leaching Paoility(If any wells exist on site or within 200 feet of leaching fucility) Feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 Poet of leaching facility) Fad FURNISIM BY l .71 •� ! 1432. d:\6138 Bam DPW-Sept1c\Drawings-6138\6J38 Mosswood\dwg\6138 MOSSWOOD AB.dwg .\ PAVED PARKING AREA GARAGE �9 WASTEWATER SYSTEM SCHEDULE j OF ELEVATIONS \ _ RETAINING IN VERTATFOUNDA77ON 93.75 _92` WALL p/ SEPTIC TANK-INLET 93.25i t _ SEPTIC TANK-OUTLET 93.00 — / I D-BOX-INLET 9295'i D-BOX-OUTLET 92 78 TRENCH INVERT IN r 92 73 TRENCH INVERT END 1 92.611 BREAKOUT! 93.3 ! EXISTING BOTTOM OF SYSTEM 90.731 m BUILDING 1 ESHGW(TECH. SULLETIN92-001) cc (#280) cZ)i TOP OF FDIC . w FENC EL 96.75 zPREVIOUSLY SHRUBS) ( Y SHRUBS FENCE 0 EXISTIN UGE ELF TEIE SEPTI � 'TE SYSTEM s0`t UGE�� (ABANDONED IN PLACE) \ 1500� GALLON \ CLEANOUT w TP-1 2—COMPARTMENT v `6� SEPTIC TANK 0 1 1 't 3—OUP LET � D—B0� 12't CONCRETE CURB ,\ LEACHING TRENCHES \ 2 ® 2' VIDE X _-- -- 2'DEEP X 25'\\ONG DRIVEWAY THE SEPTIC SYSTEM WAS INSTALLED BY BORTOLOTTI CONSTRUCTION INC. ON AUGUST 6-7, 2007. 0 20 DIMENSIONS TO SEPTIC COMPONENTS PROVIDED. BY •—•�I BORTOLOTTI CONSTRUCTION.; INC. SCALE IN FEET Prepared For. ;Plan Title: Horsley Witten Group,Inc. TOWN OFBARNSTABLE wASTEw RECORD PLAN Sustainable Environmental Solutions A�ER c � � www.harsleywitten.com DEPARTMENT Of PUBLIC WORKS MOS9WtOOD CE1I�TERY �? FIX/P1' �� � STRUCTURES&GROUNDS DIVISION 28UPUT1VIIM AVENUE � a 90 Route 6A GO JOHN JUROS,ALA COTUIT,TNU A VE41JE S. CNilti Sandwich,MA 02563 800 PITCHER'S WAY 508-833-6600 voice HYANNIS,MA 508-833-3150 fax Project Number. Date: Scale: 6138 0 9-2007 1"=40 Feet Sheet Number. File Location: p G Design By: Drawn By- Checked By. 1 of 1 r/ O ERK ERK. .. . _.. FPL.. .. r J:\6138 Barn DPW-Septic\Drawings-6138\6138 Mosswood\dwg\6138_MOSSWOOD AB.dwg PAVED —� PARKING AREA \ GARAGE \ 90 , WASTEWATER SYSTEM SCHEDULE OF ELEVATIONS __T RETAINING INVERT AT FOUNDATION 93.75 --92- WALL �/ SEPTIC TANK-INLET 1 9-3.25 SEPTIC TANK-OUTLET r 93.00 INLET 92.95 / D-_BOX-OUTLET 92.78 /# TRENCH INVERT IN 92.73 _ TRENCH INVERT END 92.61 _ BREAKOUT 93.31 EXISTING BOTTOM OF SYSTEM 90.73 00 BUILDING _ESHGW(TECH. BULLETIN 92-001) ^^ 83.65 #280 v q�k�gY TOPOF FDN. / FENCE EL 96.75 c ZPREVIOUSLY SHRUBS I I� Y SHRUBS FENCE U EXISTING \ �Q' -' \S ? GE-----,-`\EL SEPTIC T ------ SYSTEM 20 UG UGEt-� (ABANDONED IN PLACE) 15001 GALLON \ CLEANOUT w TP-1 O �- 2-COMPARTMENT SEPTIC TANK � U \ OUTLET \ U \ D-BOX\ 12'± `, 1 CONCRETE CURB \ 1 LEACHING TRENCHES 2 @ 2' 'WIDE X r - - 2'DEEP X 25'\ LONG DR/VEwAY THE SEPTIC SYSTEM WAS INSTALLED BY BORTOLOTTI CONSTRUCTION INC. ON AUGUST 6-7, 2007. 0 20 DIMENSIONS TO SEPTIC COMPONENTS PROVIDED BY BORTOLOTTI CONSTRUCTION, INC. SCALE IN FEET Prepared For: '.Plan Title: a Horsley Witten Group,Inc. TOWN OF BARNSTABLE WASTEWA TER RECORD PLAN :�� Sustainable Environmental Solutions � y� ., DEPARTMENT OF PUBLIC WORKS N www.horsleywitten.com STRUCTURES&GROUNDS DIVISION MOSSWOOD CEMETERY �� fAT P1t1 '��® 90 Route 6A CO JOHN JUROS,ALA 280 PUTNUM AVENUE '" , COTUIT,MASSACHUSETTS CMl ® Sandwich,MA 02563 800 PITCHER'S WAY 508-833-6600 voice HYANNIS,MA 508-833-3150 fax Project Number: Date: Scale: 0 6138 08-09-2007 1"=40 Feet Sheet Number: File Location: R Design By: Drawn By: Checked By: 1 of 1 v l� O ERK ERK FPL tta� st4utill�ilEi' a r 4 r' y Department of Regulatory Services ? . F Public Health Division Date 1?/�Lxo leip. 200 Main Street,Hyannis MA 02601 U Date Scheduled (7 Tune Fee Pd. O SDA Suitability Assessment for erf bps ewe a Dis al g Performed By - �1 � l `�r � Witnessed By: 1 J LOCATION& GENERAL INFORMATION Location Address Z � PUT�NA(A Ao Owner's Name fiQuvloF 6 ,tr+►51���e - (►MUSst�t%IvC� C�m,�-K�J�C�E��;l-dress AssesiWs MapfflW=h O 3� / Engineer's Name {iI EP CAS,!f l7�e('1��� NEW CONSTRUC nON REPAIR _J _ Telephone# N-b> 0S S--(.)�oo ^' p � Land use Ctw��tt ti Slopes(96) 2-7o Surface Stones ------------ Distances from: Open Water Body it Possible Wet.Arez W}t Drinking Water Well lft Drainage Way ft Property Line _ft Other ulrft SKETCH:(Shedt name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands to proximity to holes) P&I material(geologic) CJLAA Depth to Bedrock i Dfipd�16 0roundwater Standing Water in Hole Weeping Thom Pit Pace i IJ Biiid)a9beas?onal High Groundwater �' ETERMINATION FOR SEASONAL HIGH WATER TABLE Method U �) bsetved standing in obs.hole: In. Depth to$oli mottles: in. d {I weeping from side of obs.hole: In. Groundwater Adjustment k Index Well�)� . ;,r Reading Date. Index Well level AO.11sclor Adj.droundwatel Level,,,,, PERCOLATION TEST Date Thee Observatill _ �( Hole# I Time at 9" Depth off'il�e / Time at 6" Start Prilsl�fik Timd 0 V/�U 1 11me(9"-6")1,00 _.�. End Pre-add r Rate MinAnch G�I Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back------- It percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG ;; Hole# Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones;Boulders. consistency. e r Lo H-11WO Z DEEP OBSERVATION HOLE LOG Hole# De)9th frorr0 Soil Horizon . Soil Texture Soil Color Soil Sditace(in.) (USDA) (Munsell) Mottling (Structure,j� Of B41 lU — H 0#11Ah c1� 7 FP-- �F^�r jIr7ri DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Muosell) Mottling (Structure,Stones,Boulders. •—� r I • r� DEEP OBSERVATION HOLE LOG # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottlin8 (Stlucture,Stones;Boulders. �nsisr.nev,%Qmvell—•- i • I �d Flo 1 I@Is�J�t'�tce Rate Map: y C``o I c 1 I A�O4 560 year flood boundary No_ Yes �� X- l WhA 500 year boundary No_ Yes Wes)boo year flood boundary No Yes D Jjh of l�s rally Occurring Pervious Material Doh at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? F If not,what is the depth of naturally occurring pervious raterial? Cectiflcation jqbI certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 3 10 CMR 15.017. Signature � L1Q l �" �, Date Q:WFnC RRCFORM.DOC Town of Barnstable Regulatory Services y .', Thomas F. Geiler,Director } Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee;$100.00 ASSESSORS MAP AND PARCEL NO. DATE a ra _ APPLICATION.FOR PERMIT.TO. STORE.AND/OR UTILIZE.MORE.THAN. r2W 111.GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT 51 ' ��- NAME OF ESTABLISHMENT a T � 6,Sod ��,��, e // CL ADDRESS OF ESTABLISHMENT oV 96 TELEPHONE NUMBER -7� SOLE OWNER: YESXNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# ` Hmdodwp/q I MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan(to handle hazardous waste spills, etc). In addition,please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven(7)working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call(508) 862-4644 1L,.< a Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY 5 es NAME OF BUSINESS: 'TCM,,M sq AaA-ins ct,J 04e_/.D Pw 14 ids BUSINESS LOCATION: 42W Etx- 119.rn AlteLZ 103sutr"A INVENTORY MAILING ADDRESS: i1 C __ TOTAL AMOUNT: TELEPHONE NUMBER: SD g 19(0 LA O GaGGarns CONTACT PERSON: ze-ke:�bQw► EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? ((P,:2.• TYPE OF BUSINESS: Ce4/hg2t'ar.::�, 24C4. 7 0-6s�G� �l \ 51 INFORMATION/RECOMMENDATIONS: >�y=•� e- ��� Fire Dlstrlct: J o-214A a,4aa &ie d. �p at u�i e ag au w a v— &&A Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: J Destination: Waste Product: O Licensed `e J Noon `NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. * f� rrte sl w i l P �+� ccgre �l LIST OF TOXIC AND HAZARDOUS MATERIALS S Cr �acv4`fit� �r�s��eeo(• The Board of Health and the Public Health Division have determrned that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum _ Antifreeze (for gasoline or coolant systems) Misc. Corrosive 64ANEW USED Cesspool cleaners Automatic transmission fluid Ll 040 Disinfectants Engine and radiator flushes �-f3 A6Z1 Road Salts (Halite)/_Cc_e_ f'► eA.*- Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides R®' VEW USED (insecticides, herbicides, rodenticides) asoline, Jet fuel, Aviation gas Photochemicals (Fixers) A�Diesel F kerosene, #2 heating oil NEW USED a Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Ll Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes 0(o QWFertilizers Asphalt & roofing tar PCB's Z 40APaints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers S (including bleach 3 Spot removers &cleaning fluids (dry cleaners) Ito Other cleaning solvents Bug and tar removers Vie,°' 07 Windshield wash Pk) WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS n f i A Town of Barnstable t Regulatory Services Thomas F. Geiler,Director Public Health Division * " $ Thomas McKean,Director 9 �, 200 Main Street, Hyannis,MA 02601 Phone: 508-862-4644 Email: health aAtown.bamstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—5:00 September 6,2004 Town of Barnstable Structures&Grounds Attention: Stephen J. Sundelin,Supervisor 280 Putnam Ave. Cotuit,MA 02635 RE: Hazardous Materials On Site Inventory and Inspection Status-Incomplete Dear Mr. Sundelin: Thank you for your time and cooperation during your annual hazardous materials inventory and site visit on September 3, 2004. This letter contains information from that visit that will help the Town of Barnstable Structures and Grounds Division(at Mosswood Cemetery)gain compliance with Article 39 of the Town of Barnstable Ordinance: Control of Toxic and Hazardous Materials: Enclosed is a copy of the Toxic and Hazardous Materials On-Site Inventory form from your site visit. Please note the problem areas that need improvement and their corresponding orders/recommendations listed below: Problem: One large vehicle battery is stored outdoors with no secondary containment and no cover to _ protect it from the elements. Order: • Please comply with the Town of Barnstable Ordinance:Article 39, Section 5-1 (copy enclosed)which states that all hazardous materials stored outside must have 110% containment and a roof to conceal them from the elements, leakage, accidental damage and vandalism. • Please keep all waste batteries indoors until they are properly disposed of by a licensed hazardous waste hauler or taken to a place of business that accepts waste batteries and has them disposed of by a licensed hauler. Problem: Waste oil generated at this site (in small amounts)is taken to another location for use as heating oil. These self-hauls of hazardous waste are not documented. Order: • Disposal of hazardous waste must be documented(i.e. manifests retained for no less than five years). Self hauling of hazardous wastes must be documented as well to account for the proper handling and compliant disposal of chemical wastes (i.e. "Cradle to grave" responsibility). • From this point forward,please keep records of when any hazardous waste is hauled to a secondary location for disposal or use as heating oil. Please log what material was taken, the amount of the material(must be under 55 gallons per trip)to whom the material was taken,the location, and date of delivery. • Federal law allows hazardous waste to be self-hauled without a federal i.d.number or permit if the amount is 55 gallons or less per trip. Problem: The diesel and propane storage tanks at this location do not specifically indicate the level of health hazard they can have. Order: • Please label ALL hazardous material/waste containers and tanks with their health hazard (i.e. "TOXIC", "FLAMMABLE","HAZARDOUS WASTE"). • In addition to this,the type of hazardous material/waste must be labeled on the appropriate storage containers or tanks. Problem: There is incomplete access to the Structures&Grounds Division Material Safety Data Sheets containing physical characteristics, flammability,reactivity,toxicity,emergency response procedures and the health and safety hazards of all chemical-based products used/stored/handled in this maintenance shop area. Order: • Section 4-2 of Article 39 requires all businesses and facilities in the Town of Barnstable to make these available upon request of the Health Department,Fire Department,or Department of Environmental Protection. • Please obtain a thorough hard copy list of MSDS for all chemical-based products used/stored/handled at the Structures&Grounds shop at Mosswood Cemetery. Problem: Hazardous waste disposal manifests or receipts were not accessible to the Health Department during this site visit/inspection. Order: • The Town of Barnstable General Ordinance,Article 39: Control of Toxic and Hazardous Materials, Section 12-3 requires all records pertaining to storage,removal or disposal of toxic or hazardous wastes shall be retained for no less than five years and shall be made available for review by the Health Department upon request. • Please keep either the originals or copies of hazardous waste disposal manifests at the Structures&Grounds office at Mosswood Cemetery. • This disposal documentation must be readily accessible for any local, state or federal inspector to view at any time. The Toxic and Hazardous Materials On-Site Inventory from September 3rd shows that you have approximately 1,030 gallons of toxic and hazardous materials being used,stored, generated and disposed of at the Town of Barnstable Structures&Grounds shop at Mosswood Cemetery. The Board of Health has determined that the using,storing, generating and disposing of over 111 gallons of hazardous materials per month requires businesses and municipal facilities in the Town of Barnstable to obtain an annual license/permit. The Structures&Grounds Division permit for fiscal year 2004-2005 should be purchased by the division supervisor,Joe Slominski. One permit should be purchased for all facilities that fall under the Structures&Grounds Division. A permit x�y application will be mailed to Mr. Slominski when all hazardous materials inventories and inspections for Structures&Grounds facilities have been completed. Why are these recommendations being made for the Structures& Grounds Division? • This information is intended to educate you,a facility operator in the Town of Barnstable,in order to keep your division in compliance with local,state and federal toxic and hazardous materials laws so that you can avoid future regulatory,legal and possibly,financial problems. • Complying with the Control of Toxic and Hazardous Materials ordinance(Article 39)can prevent contamination of Barnstable's existing and future drinking water supply and prevent environmental contamination which can bankrupt site owners, lower or destroy land values,drive out residents and industry,depress local economies and endanger public health. This letter is the follow up to the site visit and inventory completed on September 9, 2004. The changes you are being asked to implement at your facility to make these orders/instructions part of your standard operating procedures will bring your facility into full compliance with Article 39. If you have any questions about these problems and/or their orders, or you need further information,please do not hesitate to contact me at the Public Health Division. Sincerely, Tho A.McKean,RS, CHO Director of Public Health enc. On-Site Inventory (copy) Article 39: Control of Toxic and Hazardous Materials cc: Marks Ells,Director of Public Works,Town of Barnstable Bud Breault,Assistant Director of Public Works,Town of Barnstable D e_ 5`o/zc�.r wccs- R-11le �itswsr�s lime Town of Barnstable P# ZZ . K ' Department of Regulatory Services � Public Health Division Date b 200 Main Street,Hyannis MA 02601 Date Scheduled / �(D / l Time r Fee Pd. l Soil Suitability Assessment for Sewage Disp , al Performed ByZiy\���1 '1( .� Witnessed By: LOCATION& GENERAL INFORMATION Location Address YU r� Ow-nees Name •Address J� Assessor's Mapftrcel: 0 31 /a� Engineer's Name t t( �C{ (✓J� (�C1 NEWCONSTRUC7ioN 'D REPAIR Telephone# Land Use C `i Slopes M 'C—z 70 Surface Stones Distances from: Open Water Body Possible Wet Ami .°_ft Drinking Water Well 11_uj�jft Drainage Way '— ft Property Line l W ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) - Z Parent material(geologic) Depth to Bedrock �. Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face ' Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _in, Depth to soil mottles: Depth to weeping from side of obs.hole: — _— in, Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.&ctor— Adj.Groundwater' Level,,9 PERCOLATION TEST Date Thne Observation Hole# I Time at 4" C3, n ' Depth of Per Time at 6" Start Pre-soak Time @ v r` �"-- " 'lime(V-61 /1 � - S -t End Pre-soak It UV�/ s3 W Rate MinJlnch N: Site Suitability Assessment: Site Passed_ SiteFailed: Additional,Testing Needed(Y/N) . Original: Public Health Division Observation Hole Data To Be Completed on Back----------- aa*If percolation test is to be conducted within 100' of wetland,you must;first notify the. Barnstable Conseilwation Division at least one(1) week prior to beginning. Q:SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in:) (USDA) . (Munsell) Mottling (Structure,Stones,B_oulders._ i t ve V �I t/ —ELL— A-I SA� U I ` O ------------ DEEP OBSERVATION HOLE LOG Hole# 2— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ns' ^` DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i Gravel) DEEP OBSERVATION HOLE LOG i; Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. o e 5 Flood Insurance Rate Man: �( Above 500 year flood boundary No— ;Yes .! Within 500 year boundary No�( Yes Within 100 year flood boundary No Yes. Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the bso s `{ area proposed for the soil absorption tion y stem? , of what is the depth of naturally occurring pervious material?,r..�-- If n P Certification I certify that on l (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise�and experience described in 3 10 CMR 15.017. �;y" � Signature Date�- , Q.WEPTIOPERCFORM.DOC z o ' ENVIRONMENTAL TECHNOLOGIES, INC. 1 1 1 t 1 t 1 � Engineers & Environmental Scientists 1 1 1 � 1 1 I � 4)Aflanfic® - BWIRONMENTAL TECHNOLOGIES,NC. 84GINEERS&RW RONNIMM SCIENTISTS December 29, 1999 Mr. Richard Packard, Section Chief MADEP Emergency Response FRJ 20 Riverside Drive Lakeville, MA 02347 ^COG i -- D.E.P. RE: IRA Completion Report & RAO Statement SOUTHEAST REGION Moss Wood Cemetery 280 Putnam Avenue Cotuit, MA RTN 4-15134 Dear Mr. Packard, On behalf of the Town of Barnstable Structures and Ground Department, Atlantic Environmental Technologies, Inc. is pleased to submit the enclosed Immediate Response action Report(IRA) and Class A-2 Response Action Outcome Statement (RAO). Should you have any question or require additional information regarding this project, please contact the undersigned at your convenience. f Very truly yours, Atlantic Environmental Technologies, Inc. � 7 Toivo A. Lammine , Jr. William H. Hoyermk, P.G. LSP/Principal Division Manager enc: IRA Report and RAO Statement cc: Mr. Paul Coleman, Town of Barnstable Structures& Grounds Dept. Mr. John Klimm, Town Manager, Town of Barnstable Mr. Edward Barry, Town of Barnstable Board of Health Mr. Edward Price, Contracts Manager, CleanVenture/CycleChem Faunce Comer Office Park PO.Bax 1051 86 Faunce Comer Rd • Suite 410 Sandwich,MA 02563 N.Dartmouth,MA 02747 (508)888-9282 0 FAX 888-5859 (508)997-5422•FAX 999-4060 email:adeinc@cape.com email:atlantic@ultranetcom 4)zitiantK DWIRONMENTAL TECHNOLOGIES,NC. ENGNEERS&DMRONMDVTAL SCIENTISTS JAN 6 20M - 1 so HEAsj REG I=_----- -- IMMEDIATE RESPONSE ACTION (IRA) COMPLETION REPORT AND RESPONSE ACTION OUTCOME (RAO) STATEMENT ' Town of Barnstable Structures& Grounds Dept. Mosswood Cemetery ' 280 Putnam Avenue, Cotuit, MA 02636 DEP RTN#4-15134 Prepared for: Massachusetts Department of Environmental Protection Southeast Regional Office ' 20 Riverside Drive Lakeville, MA 02347 Prepared By: Atlantic Environmental Technologies, Inc. 86 Faunce Corner Road, Suite 410 North Dartmouth, Massachusetts 02747 ' December 29, 1999 AET Job No. 5690.01 1 Faunce Comer Office Park PQ Bca 1051 86 Faunce Comer Rd - Suite 410 Sandwich,MA 02563 N.Dartmouth,MA 02747 (508)888-9282 - FAX 888-5859 (508)997-5422-FAX 999-4060 ' email:adeinc@cape.com email:atlantic@ultranetcom Mosswood Cemetery:RTN 4-15134 ' �tltlantic® 280 Putnam Avenue,Cotuit,MA December 29,1999—Page i IMMEDIATE RESPONSE ACTION(IRA) COMPLETION REPORT AND RESPONSE ACTION OUTCOME (RAO) STATEMENT Town of Barnstable Structures & Grounds Department Mosswood Cemetery 280 Putnam Avenue, Cotuit, MA 02636 ' DEP RTN# 4-15134 Eric G. Cardinal — ' Environmental Scientist William R. HoY erm n P.G. Division Manager ' Toivo A. Lamminen, Jr. Licensed Site Professional (LSP # 6846) Mosswood Cemetery:RTN 4-15134 ' MAtianti ® 280 Putnam Avenue,Cotuit,MA c December 29,1999—Page ii IMMEDIATE RESPONSE ACTION (IRA) COMPLETION REPORT AND RESPONSE ACTION OUTCOME (RAO) STATEMENT ' Town of Barnstable Structures & Grounds Department Mosswood Cemetery 280 Putnam Avenue, Cotuit, MA 02636 DEP RTN# 4-15134 1.0 INTRODUCTION............................................................................................. 1 1.1 Statement of Compliance....................................................................... 1 2.0 SITE DESCRIPTION........................................................................................ 1 2.1 Site Description Summary..................................................................... 1 2.2 Description of Release............................................................................ 2 3.0 RESPONSE ACTIONS..................................................................................... 2 ' 4.0 ANALYTICAL DATA......................................................................................3 4.1 Sample Collection Method ....................................................................3 4.2 Groundwater Sampling.........................................................................3 4.3 Analytical Results .................................................................................. 3 5.0 REMEDIATION WASTE MANAGEMENT.................................................. 4 6.0 IRA COMPLETION STATEMENT & RAO STATEMENT CONCLUSIONS................................................................................................ 4 6.1 Immediate Response Action Statement................................................. 4 6.2 Response Action Outcome Statement................................................... 5 Fi res Figure 1 Regional Location Map Figure 2 Site Map (RAO Specific Area) Table Table 1 Soil Quality Summary Table ' Appendices Appendix A Site Photographs ' Appendix B Laboratory Analytical (Soil &MA Disposal Parameter Sampling) Appendix C Bardon Trimount Inc. Soil Disposal Paperwork& MADEP BOL Appendix D RAO Statement; BWSC-104, IRA Completion Report; BWSC-105 & Release Notification Form; BWSC 103 f Mosswood Cemetery,RTN 4-15134 Atlantic® 280 Putnam Avenue,Cotuit,MA December 10,1999-Page 1 1.0 INTRODUCTION ' This document is submitted in support of an Immediate Response Action (IRA) Completion ' Report and a Response Action Outcome (RAO) Statement on behalf of the Town of Barnstable Structures & Grounds Department (Town of Barnstable), located at 800 Pitchers Way, Hyannis, Massachusetts. Mr. Paul Coleman (Division Supervisor) is the acting administrator in regard to environmental matters. Atlantic Environmental Technologies, Inc. (AET) has been retained by CleanVenture/CycleChem (CV/CC) to provide Licensed Site Professional (LSP) services for the release of approximately 25 gallons of diesel fuel released to the soil at the Mosswood Cemetery located at 280 Putnam Avenue, Cotuit, Massachusetts. To determine whether a condition of No Significant Risk exists at the subject site, concentrations of Extractable Petroleum Hydrocarbons (EPH) and Target Poly Aromatic Hydrocarbons (PAH's) in the soil were compared to Massachusetts Department of Environmental Protection (MADEP) Method 1 S-1/GW-2 & GW-3 Cleanup Standards upon soil removal activities. Response actions have effectively reduced concentrations of petroleum hydrocarbons from the diesel fuel release in the soil to below MADEP Cleanup Standards (Table 1). The IRA is therefore considered complete as a condition of No Significant Risk has been achieved. 1.1 Statement of Compliance This IRA Completion Report was prepared in accordance with 310 CMR 40.0427 (2). The RAO Statement was prepared in conformance with 310 CMR 40.1000. This RAO is considered a Class A-2 RAO per 310 CMR 40.1036 (2). All analytical data were collected in conformance with 310 CMR 40.0000 inclusive and any appropriate MADEP guidance documents. 2.0 SITE DESCRIPTION 2.1 Site Description Summary ' The 280 Putnam Avenue site is the location of the Mosswood Cemetery, owned and operated by the Town of Barnstable Structures and Grounds Department. It is located in a residential/commercial area of Cotuit, Massachusetts (Figure 1). The release occurred within the maintenance department's 50'x 50' equipment storage area (Figure 2). This IRA Completion Report/RAO Statement is limited to the maintenance area impacted by the diesel fuel release as delineated in Figure 2. i 1 Mosswood Cemetery:RTN 4-15134 ��rlanrlC® 280 Putnam Avenue,Cotuit,MA December 29,1999—Page 2 2.2 Description of Release The release occurred on Tuesday, November 23, 1999 when a cemetery department employee was filling fuel containers from the 275-gallon above ground storage tank(AST) according to the I cemetery foreman. The fuel stored in the AST is used to fuel cemetery maintenance equipment. The cemetery employee went to answer the telephone and the container overflowed. Approximately 25-gallons of diesel fuel was released before it was detected and stopped. Mr. Edward Barry, the Town of Barnstable's Health Agent, informed AET that MADEP had been notified of the release in the required MADEP 2-Hour Reporting time frame. The former AST was located in the northeast corner of the fenced in equipment storage yard (Appendix A Photo 1). The yard slopes gently to the northwest. The surface is medium grained sand and gravel (Appendix A Photo 2). The slope and soil characteristics at the site allowed the diesel fuel to remain in the top one-two feet of soil, cross the yard and collect in the low southwest corner (Appendix A Photo 3). 3.0 RESPONSE ACTIONS ' Initial Response Action Summary On Tuesday, November 23, 1999, MADEP was notified of the release at 0855 in the 2-Hour Reporting time frame according to Mr. Barry. The Town of Barnstable contracted the emergency spill response services of CV/CC of Stoughton, Massachusetts. Upon CV/CC's arrival and inspection of the release,' Mr. Edward Price contracted AET to provide LSP services.AET personnel arrived on-site on November. 23, 1999 to supervise the removal of diesel fuel contaminated soil by a cemetery backhoe operator. Throughout the excavation process, AET personnel conducted field screening and head space tests using a HNU Photoionization Detector ' (PID). All head space test were below 100 parts per million(ppm). Three closure soil samples (EX-1 to EX-3) were collected from areas of the excavation most likely to be impacted by the release and submitted to Groundwater Analytical (Groundwater) of Buzzards Bay Massachusetts, for EPH and target PAH analysis. A composite sample was collected from the stockpiled soil and submitted to Groundwater for Massachusetts Basic Soil ' Disposal Criteria analysis. Excavated soil was stockpiled and covered with poly sheeting within the fenced in yard. Due to darkness, excavation activities were concluded and the site was secured. Excavation activities resumed on November 24, 1999. Upon AET s arrival, cemetery employees had removed the remaining diesel fuel from the AST and stored it in 5-gallon containers. The cemetery employees used a backhoe to remove the AST, its 4'x 8' concrete slab and the impacted soil beneath it. Soil field screening, head space testing and soil removal was conducted until readings were not detected. r Mosswood Cemetery:RTN 4-15134 LDLitIan tIc® 280 Putnam Avenue,Cotuit,MA December 29, 1999—Page 3 Approximately 25 cubic yards of soil was excavated and stockpiled on-site from the excavation activities (Appendix A Photo 4). Three closure soil samples (EX-3 to EX-6) were collected and submitted to Groundwater for EPH and target PAH analysis from the further excavated area on November 24, 1999. Since the public does not have access to the fenced in storage yard, the excavated area was left open awaiting the laboratory closure results. Final Response Action Summary On December 17, 1999, the excavation was backfilled with approximately 25 cubic yards of clean fill by cemetery department workers. On December 17, 1999, upon soil disposal acceptance from Bardon Trimount, Inc. (Bardon), the stockpiled soil was transported to their South Dennis, Massachusetts facility for disposal/recycling. 36.4 tons (24.3 yards) of diesel fuel impacted soil was accepted. The Bardon soil acceptance paperwork and MADEP Bill of Lading (BOL) is located in Appendix C. 4.0 ANALYTICAL DATA 4.1 Sample Collection Method Soil samples were collected and submitted in accordance with applicable MADEP protocols. ' Soil samples were analyzed for EPH and Target PAH compounds. 4.2 Groundwater Sampling ' Based on the shallow nature of the release, immediate excavation of petroleum contaminated soils, non-detect head space tests and the laboratory results from the closure soil samples, it is ' not likely that the ground water was affected by the diesel fuel release. Therefore no groundwater sampling was conducted. 4.3 Analytical Results ' On November 23, 1999, AET personnel collected and submitted three soil samples (EX-1 to EX- 3)to Groundwater from areas of the excavation most likely to be impacted by the release (Figure 1). The samples were analyzed for EPH and target PAH's. All laboratory analytical results are located in Appendix B. No EPH carbon fractions or target PAH's were detected in closure samples EX-1, 2 and 3 (Table 1). A composite sample was collected from the stockpiled soil and submitted to Groundwater for Massachusetts Basic Soil Disposal Criteria analysis. This analysis is required in order to obtain soil disposal acceptance. Mosswood Cemetery:RTN 4-15134 Atlantic280 Putnam Avenue,Cotuit,MA December 29,1999—Page 4 At the completion of excavation activities on November 24, 1999, AET collected three soil samples (EX-4 to EX-6) from the further excavated area (Figure 1). No EPH carbon fractions or PAH compounds were detected in the closure soil samples above MADEP Method-1 S-1/GW-2 standards (Table 1). In AET's opinion, the groundwater underlying the site would fall under the GW-2 and GW-3 classifications. Groundwater category GWA covers potentially productive aquifers. According ' to the GIS Map for Cotuit, this area is classified as non-potentially productive. Groundwater category GW-2 includes areas that could be potential sources of harmful vapors of OHMs to indoor air. It also includes areas within thirty (30) feet of an occupied building and where the i average depth to groundwater is less than fifteen (15) feet. .Groundwater category GW-3 applies to those groundwaters that could potentially discharge to surface waters. From the documentation in .this report, Groundwater Categories GW-2 and GW-3 are applicable to the subject site. Furthermore, the laboratory data was compared to the most stringent S-1 Soil classification due to the shallow nature of the release and possible exposure to humans. In AET's professional opinion, contamination pto nation from the diesel fuel release has been remediated and meets MADEP Method-1 Cleanup Standards for S-I/GW-2 & GW-3 soils. 5.0 REMEDIATION WASTE MANAGEMENT On December 17, 1999, the stockpiled soil was transported under MADEP BOL to the Bardon Trimount, Inc. disposal facility in South Dennis, Massachusetts for asphalt batching (Appendix D). Bardon accepted 36.4 tons of soil for disposal/recycling. . The Bardon soil acceptance paperwork and.MADEP BOL is located in Appendix C. 6.0 IRA COMPLETION STATEMENT & RAO STATEMENT CONCLUSIONS 6.1 Immediate Response Action Statement It is AET's professional opinion that the conditions that gave rise to the Immediate Response Action under RTN 4-15134 have been stabilized at the site. Imminent hazards to health, safety, public welfare and the environment have been eliminated without the continued operation and maintenance of an active remedial system. The IRA is considered complete because: • A condition of NO SIGNIFICANT RISK exists at the site from the diesel fuel release on r November 23, 1999, in regard to human health, welfare, and the environment due to Immediate Response Actions that contained and removed soil impacted above MADEP S- I/GW-2 and S-I/GW-3 Soil Cleanup Standards. Mosswood Cemetery:RTN 4-15134 MAMantic® 280 Putnam Avenue,Cotuit,MA December 29, 1999—Page 5 • An Activity and Use Limitation (AUL) is not required to maintain a condition of NO SIGNIFICANT RISK in regard to the diesel fuel saddle tank release. • There are no dangerous structures or open holes remaining at the site. • There are no uncontainerized materials exhibitingthe characteristics of corrosivit , Y reactivity, toxicity, or flammability remaining on the site. 6.2 Response Action Outcome Statement It is AET's professional opinion that the conditions for an A-2 Response Action Outcome of NO SIGNIFICANT RISK regarding RTN 4-15134 have been met pursuant to 310 CMR 40.1036 (2) Iand that No Further Action is required at this time within the limits of the RAO area depicted in Figure 2 (RTN 4-15134). The RAO Statement. (BWSC-104), IRA Completion Statement (BWSC-105) and Release Notification Form (BWSC 103) are included in Appendix D ' respectively. The additional cost to remediate beyond No Significant Risk to levels that approach background is estimated to exceed 20% of the cost to remediate to No Significant Risk. Remediation to approach background is therefore considered infeasible per draft "DEP Guidelines on Evaluating the Feasibility of Achieving or Approaching Background" (July 23, 1998, p.10). 1 i I 1 1 i 1 Kjl. ..,/ __ e a '�.e '�� a•eti'.• '0 e I I F � o'' 0. rry ova+p — l�rvei )Y • ��jd "C) • o- I OEt J 71 S• ultC�rs°' °°O� °a o::F L� Iu p0 O e / 1• %�- a .' a' `,Co 19 vaUiC O aea` 39 Cranbefry \ prslabon Bogs. ' Ito It It 11, It it n I rx 62 ��— SITE �I 1 aZ n It ; Low/' �• ' .s�l��\ ,•8; 1, ,6 11 1 - — a 'f n - P _ C a bey a z u - 1 A 0 B t - ce b it - n 1� 10 110 1 � lID 11 1 ,O - � 11 • °. n II p _: ,, JIfo 11 t to •_ __ n, •� _ • Tlms �'�Ttms . .. 1 / Cove • -Handy 'OL Pt c d II n �� 1 0 „ Pt j D .•• (Hoopers. ° . 2�r.LBtvte •o• Bed / Qolf Club Oyster' ••�• Noisy/5 arbors h 10 /°yrq(1 y/ (y/hNS ••'° •' •I 1t Pt Jz 0 andin ^/ RVI a S LE -LAND tp ant PSO '/' �_. n n ✓/' �. Isla Oead n u / r • • �,,` a� 1 0 Ha boys •e 11 J I ter z z Va7`ro i 4 -aqJ. �o`olo^I"�•�PIN,^ J Iz n � � �- c „I o Z n to•� 970� g•(r �� 'Marsh; � It 4 -r n oseberry a I It L\I cJhl C I) Environmental Technologies,Inc.InRegional Location Map OJECT# 57280.00 DATE: 12/�0(gg 86 Faunce Corner Road, Suite 410 Mosswood Cemetery SCAM N10 Figure 1 North Dartmouth, Maerachureits 02747 (508) 997-5422 288 Putnam Avenue, Cotuit, MA DRAWNBY: EGC NORTH rf f• :, EX-6; ;. EXTENT OF (1 ) EXCAVATION EX— EX 1 1.5 'rff /f�1Jf�lr/rll��J�lf r•� EX-4 GATE ( ):= -�,:'_ �'— ��f`` - FORMER NEW AST AST CONTAINMENT LOCATION LEGEND • SAMPLE LOCATION EX-5 MAINTENANCE CHAIN—LINK FENCING BUILDING RESPONSE ACTION AREA FIGURE 2 momcr#: Site Map_ ry DATE: 12gg NF Com�� �d,s41t0 en 1 PUb'{81ug f SCALE. Nom� W�drram OZ747 DRAWN BY: AAR � �� i� � � i � � �► � � � � � � � r lam: � Atlantic° Table 1. Soil Quality Summary Table, Moss Wood Cemetery Site, 280 Putman Avenue, Cotuit, Massachusetts. Sample ID: EX-1 EX-2 EX-3 EX-4 EX-5 EX-6 MADEP MADEP Matrix: Soil Soil Soil Soil Soil Soil Method 1 Method I Date Collected: 11/23/99 11/23/99 11/23/99 11/23/99 11/23/99 11/23/99 Cleanup Cleanup Sample Purpose: Lab Lab Lab Lab Lab Lab Standard Standard Depth: 1' 8" 2' 6" T 2' (S I/GW--2) (S-1/GW--3) Analyte Concentration: mg/kg mg/kg mg/kg mg/kg mg/kg mg/kg mg/kg mg/kg EPH Carbon Fractions nC9-nC18 aliphatic U(30) U(31) U(31) U(31) U(30) U(33) 1,000 1,000 nC19-nC36 aliphatic U(30) U(31) U(31) U(31) U(30) 36 2,500 Z500 nCl1-nC22 aromatic U(30) U(31) U(31) U(31) U(30) U(33) 800 800 PAH Compounds Acenaphthene U(0.50) U(0.51) U(0.51) U(0.51) U(0.50) U(0.55) 1,000 1,000 2-Methylnaphthalene U(0.50) U(0.51) U(0.51) U(0.51) U(0.50) U(0.55) 500 500 Naphthalene U(0.50) U(0.51) U(0.51) U(0.51) U(0.50) U(0.55) 100 100 Phenanthrene U(0.50) U(0.51) U(0.51) U(0.51) U(0.50) U(0.55) 1,000 100 Analyte concentrations that exceed the MADEP S-1/GW-2 Groundwater Cleanup Standards are shown BOLD and UNDERLINED. EPH Extractable Petroleum Hydrocarbons MADEP Massachusetts Department of Environmental Protection mg/! Milligrams per liter(equivalent to parts per million(ppm)) PAH Polyaromatic Hydrocarbons U Not detected at the indicated method detection limit concentration. � � 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 f 1 . x ' WQ IL a Q � MAtiantic' 1 1 1 1 1 1 1 ' Paonaix n: Site rnomeapn: Photo 1: Location of the former 275-gallon AST. Photo 2: Soil excavation and migration path of the diesel fuel. r Q UW. 5728.00 L\�I C1h c Environmental i echnologles,Inc DATE: 12/99 86 Faunce Corner Road, Suite 410 Site Photographs SCALE: N/A North Dartmouth, Massachusetts 02747 (508) 997-5422 DRAWN NY: EGC Photo 3: Excavated "low" area in the southwest corner of the storage yard. Photo 4 : Diesel fuel impacted soil stockpile. pR(MFCT 5728.00 &Idhhc"' F:mironmentalIechnologies,Inc DATE- . 1 2/99 86 Faunce Corner Road, Suite 410 Site Photographs SCALE:E: N/A North Dartmouth, Massachusetts U2747 (508) 997-5422 DPAWNBV: EGC I � 1 1 i III ' 1 1 1 1 1 1 1 1 1 1 � 1 1 1 1 f i i p Z `. a m ' a a f j 1 MAtIantic 1 i 1 J 1 1 i 1 1 Appendix B: Laboratory Analytical (Soil & MA Disposal Parameter Sampling) i 1 1 1 1 � 1 ' GROUNDW Groundwater Analytical,Inc. WATER P.G.Box 1200 ANALYTICAL 228 Main Street Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 December 1, 1999 Mr. Eric Cardinal Atlantic Environmental ' 86 Faunce Corner Rd. North Dartmouth, MA 02747 Project: Mosswood Cemetery/5728.00 Lab ID: 30242 Sampled: 11-23-99 and 11-24-99 Dear Eric: Enclosed are the Volatile Organics, Extractable Petroleum Hydrocarbons, PCBs, Hydrocarbon Fingerprint, Metals, Corrosivity, Ignitability and Reactivity Analyses performed for the above referenced project. This project was processed for Rush turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a project narrative indicating project changes and non-conformances, a brief description of the Quality Assurance/Quality Control procedures employed by our laboratory, and a statement of our state certifications. ' I attest under the pains and penalties of perjury that, based upon my inquiry of those.individuals immediately responsible for obtaining the information, the material contained in this report is, to the best of my knowledge and belief, accurate and complete. ' Should you have an questions y y q tons concerning this report, please do not hesitate to contact me. Sincerely, Jonathan R. Sanford President J RS/awc ' Enclosures F GROUNDWATER ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GORD Field ID: EX-1 Laboratory ID: 30242-01 ' Project: Mosswood Cemetery/5728.00 QC Batch ID: EP-0805-M Client: Atlantic Environmental Sampled: 11-23-99 Container: 250mL Glass Received: 11-24-99 Preservation: Cool Extracted: 11-29-99 ' Matrix: Soil Analyzed: 11-30-99 % Moisture: 3 Dilution Factor: Aliphatic:1 Aromatic: 1 EPH Ranges Concentration Units Reporting Limit' n-C9 to n-Cl8 Aliphatic Hydrocarbons 1 BRL mg/Kg 30 - - - n-C19 to n-C36 Aliphatic Hydrocarbons' BRL mg/Kg 30 n-C1 1 to n-C22 Aromatic Hydrocarbons f BRL mg/Kg 30 ' Unadjusted n-CI1 to n_C22 Aromatic Hydrocarbons —_BRL mg/Kg -- 30 I CAS Number Target Analytes Concentration Units Reporting Limit 91-20-3 Naphthalene BRL mg/Kg 0.50 ' �91-57-6 1 2 Methylnaphthalene BRL mg/Kg ! 0.50 85-01-8 Phenanthrene BRL mg/Kg i 0.50 83-32-9 Acenaphthene i BRL mg/Kg i 0.50 QC Surrogate Compounds Recovery QC Limits Fractionation: 2-Fluorobiphenyl j 81 % j 40- 140% 2-Bromonaphthalene 74 % I 40- 140% Extraction: Chloro-octadecane 65 % 40- 140% ortho-Terphenyl 79 % 40-140% QA/QG Certification -77771 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performancelacceptance standards for the required QA/QC procedures achieved? Yes i 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it ' that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. I Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP EPH Method ' Extractable Petroleum Hydrocarbons by GCFI D Field ID: EX-2 Laboratory ID: 30242-02 Project: Mosswood Cemetery/5728.00 QC Batch ID: EP-0805-M Client: Atlantic Environmental Sampled: 11-23-99 Container: 250mL Glass Received: 11-24-99 Preservation: Cool Extracted: 11-29-99 Matrix: Soil Analyzed: 11-30-99 %Moisture: 7 Dilution Factor: Aliphatic: 1 Aromatic: 1 EPH Ranges __ Concentration 1 Units Reporting limit n-C9 to n-C18 Aliphatic Hydrocarbons t BRL mg/Kg 31 n-C19 to n-C36 Aliphatic Hydrocarbons ' BRL mg/Kg 31 s - -- -- -- n-Cl1 to n-C22 Aromatic Hydrocarbons BRL mg/Kg 31. Unadjusted n-C11 to rnC22 Aromatic Hydrocarbons' BRL ---mg/Kg 31 CAS Number Target Analytes Concentration Units Reporting Limit ' _91-20-3 _ ethlna Naphthalene_ __ _ _BRL mg/Kg 0.51 91-57-6 2-Myphthalene _BRL mg/Kg 0.51 85-01-8 Phenanthrene BRL mg/Kg 0.51 j 83-32-9 Acenaphthene BRL mg/Kg ; 0.51 QC Surrogate Compounds Recovery QC Limits Fractionation: 12-Fluorobiphenyl I 77 % 40- 140% 2-Bromonaphthalene 77 % 40- 140% Extraction: � C�hloro-ostadneeca 65 % 40- 140% ortho-Terphenyl 78 % 40-140% x QA/QC Certification.` 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performancelacceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration, if any,is below reporting limit for analyte. Reporting limit is the lowest i concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-C11.to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. M Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GOND Field ID: EX-3 Laboratory ID: 30242-03 Project: Mosswood Cemetery/5728.00 QC Batch ID: EP-0805-M Client: Atlantic Environmental Sampled: 11-23-9 P 9 Container: 250mL Glass Received: 11-24-99 Preservation: Cool Extracted: 11-29-99 Matrix: Soil Analyzed: 11-30-99 % Moisture: 7 Dilution Factor: Aliphatic:1 Aromatic: 1 EPH Ranges _ Concentration Units I Reporting limit; n-C9 to n-C18 Aliphatic Hydrocarbons ' BRL mg/Kg 31 n-C19 to n-C36 Aliphatic Hydrocarbons 1 BRL mg/Kg 31 n-C1 1 to n-C22 Aromatic Hydrocarbons 1 BRL mg/Kg 31 _ nadj cu_ted n-CI1 to n_C22 Aromatic Hydrocarbons' _ _ —BRL mg/Kg 31 CAS Number Target Analytes Concentration Units Reporting Limit 91-20-3 _Naphthalene _ _ _BRL mg/Kg 0.51 1-5 97-6 2-Methyl naphthalene BRL mg/Kg 0.51 85-01-8 Phenanthrene. BRL mg/Kg 0.51 83-32-9 Acenaphthene BRL mg/Kg 0.51 QC Surrogate Compounds Recovery_____7 QC Limits i Fractionation: 12-Fluorobiphenyl 1 79 % 40-140 % j 2-Bromonaphthalene 80 % _ 40-140 Extraction: Chloro-octadecane 60 % j _ 40-140% ortho-T erphenyl 65 % I 40-140% ,�� ,......;:•' _�.. : ':'QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yesy 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting.limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it ' that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GORD Field ID: EX4 Laboratory ID: 30242-04 Project: Mosswood Cemetery/S728.00 QC Batch ID: EP-080S-M Client: Atlantic Environmental Sampled: 11-24-99 Container: 250mL Glass Received: 11-24-99 Preservation: Cool Extracted: 11-29-99 Matrix: Soil Analyzed: 11-30-99 Moisture: 9 Dilution Factor: Aliphatic: 1 Aromatic: 1 EPH Ranges Concentration Units Reporting limit; n-C9 to n-C18 Aliphatic Hydrocarbons ' BRL mg/Kg 31 n-C19 to n-C36 Aliphatic Hydrocarbons r _ BRL mg/Kg 31 n-Cl1 to n-C22 Aromatic Hydrocarbonst0 _ BRL _ _ _ _mg/Kg _ 31 Unadjusted n-C11 to n-C22 Aromatic Hydrocarbons BRL_ mg/Kg _31 _ ! CAS Number Target Analytes Concentration Units Reporting limit 91-20-3 Naphthalene BRL mg/Kg 0.51 ' -91-57-6 2-Methyl naphthalene BRL mg/Kg 0.51 ; 85-01-8 Phenanthrene BRL mg/Kg 0.51 83-32-9 I Acenaphthene _ I BRL -� mg/Kg 0.51 QC Surrogate Compounds Recovery QC Limits Fractionation: 2-Fluorobiphenyl 83_%_ 40- 140% 2-Bromonaphthalene 84 % _ __40-140%-- Extraction: Chloraoctadecane _ 71 % ! 40-140% 1 ortho-Terphenyl - i __-- 83 % 40- 140% —� Q V(X Ce rtification 1. Were all QA/QC procedures required by the method followed? Yes ' 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration,if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it ' that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. I Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GCJFI D Field ID: EX-5 Laboratory ID: 30242-05 ' Project: Mosswood Cemetery/5728.00 QC Batch ID: EP-0805-M Client: Atlantic Environmental Sampled: 11-24-99 Container: 250mL Glass Received: 11-24-99 Preservation: Cool Extracted: 11-29-99 Matrix: Soil Analyzed: 11-30-99 Moisture: 6 Dilution Factor: Aliphatic: 1 Aromatic: 1 EPH Ranges Concentration Units Reporting limit; n-C9 to n-C18 Aliphatic Hydrocarbons BRL mg/Kg 30 — 3 - - n-Cl9 to n-C36 Aliphatic Hydrocarbons r BRL mg/Kg 30 — - ._. _ n-C11 to n-C22 Aromatic Hydrocarbons f° BRL _ _ mg/Kg___ 30 _ Unadjusted n-CI1 to n_C22 Aromatic Hydrocarbons' _BRL _ _ mg/Kg 30 CAS Number Target Analytes Concentration units Reporting Limit 91-20-3 1 _Naphthalene _ _ _BRL _ mg/Kg 0.50 91-57-6 2-Methyl naphthalene BRL mg/Kg 0.50 85-01-8 Phenanthrene _ BRL mg/Kg 0.50 83-32-9 Acenaphthene i BRL mg/Kg 0.50 QC Surrogate Compounds Recover y QC Limits j Frachonation: 2-Fluorobiphenyl j _ 74 % 40-140°k _ _ L 2-Bromonaphthalene _ 75 % __ 40-140% Extraction: Chloro-octadecane_ _ 65 % _ _ _ 40- 140% —� ' ortho-TerphenYl — 74 % _ _40-140% ---' ;;QA/QC Certification , ';. a j 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative ' and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. 1 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Massachusetts DEP EPH Method Extractable Petroleum Hydrocarbons by GOOD Field ID: EX-6 Laboratory ID: 30242-06 Project: Mosswood Cemetery/5728.00 QC Batch ID: EP-0805-M Client: Atlantic Environmental Sampled: 11-24-99 Container: 250m1 Glass Received: 11-24-99 Preservation: Cool Extracted: 11-29-99 Matrix: Soil Analyzed: 11-30-99 % Moisture: 11 Dilution Factor: Aliphatic: 1 Aromatic: 1 EPH Ranges Concentration Units Reporting limit' n-C9 to n-C18 Aliphatic Hydrocarbons' BRL mg/Kg 33 . . - -- 8. n-C19 to n-C36 Aliphatic Hydrocarbons f 36 mg/Kg 33 n-C11 to n-C22 Aromatic Hydrocarbons BRL mg/Kg 33 _ --_- -- _- - _-_-_ _-- -_-_- - _-- - -------_—_ - -----_ _ nadjusted n-C11 to n-C22 Aromatic Hydrocarbons' - BRL mg/Kg 33 ' CAS Number Target Analytes Concentration Units Reporting limit 91-20-3 Naphthalene BRL mg/Kg 0.55 91-57-6 2-Methyl naphthalene BRL mg/Kg 0.55 85-01-8 Phenanthrene BRL mg/Kg 0:55 83-32-9 Acenaphthene BRL mg/Kg 0.55 QC Surrogate Compounds Recovery QC Limits �. Fractionation: j 2-Fluorobiphenyl 82 % I 40- 140% 2-Bromonaphthalene ; 83 % 40-140% j Extraction: Chloro-octadecane 64 % 40-140% ortho Terphenyl 75 40 140% - 1. Were all QA/QC procedures required by the method followed? Y� 2. Were all performancelacceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.1.1? Yes Method non-conformances indicated above are.detailed below on this data report,or in the accompanying project narrative and project - p led quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Results are calculated on a dry weight basis. Method modified by use of microwave accelerated solvent extraction technique. Report Notations: BRL Indicates concentration,if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-C11 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL ' EPA Method 8082 Polychlorinated Biphenyls (PCBs) by GGECD Field ID: Stockpile Laboratory ID: 30242-07 ' Project: Mosswood Cemetery/5728.00 QC Batch ID: PB-0948-M Client: Atlantic Environmental Sampled: 11-24-99 Container: 250m1 Glass Received: 11-24-99 ' Preservation: Cool Extracted: 11-29-99 Matrix: Soil Analyzed: 11-30-99 % Moisture: 7 Dilution Factor: 1 CAS Number Analyte Concentration Units i Reporting limit ' 12674-11-2 Aroclor 1016 BRL ug/Kg 86 1267 --11- --- - Aroclor - -- - - - - - -- - - - - - - - -- ---- 1 4- 8-2 Aroclor 1221 BRL ug/Kg 86 1 1 1 41-1 6-5 Aroclor 1232 BRL ug/Kg__ 86 ' S3469-21-9 Aroclor 1242 BRL ug/Kg 86 12672-29 6 Aroclor 1248 _ BRL ug/Kg 86 1 1 09 7-69-1 Aroclor 1254 BRL ug/Kg 86 11096-82-5 ; Aroclor 1260 BRL ug/Kg 86 ' QC Surrogate Compound Recovery QC Limits � Tetrachloro-m-xylene 76 % 25- 121 Decachlorobiphenyl 94 % 28- 138 % ' Method Reference: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition, Update III(1996). Analyte list as Aroclor analytes formerly specified by EPA Method 8080A. Results are reported on a d weight p basis. dry Report Notations: BRL Indicates concentration, if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. 1 I 1 1 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GRDUNDWATER ANALYTICAL EPA Method 8260B TCL Volatile Organics by GGMS Field ID: Stockpile Laboratory ID: 30242-08 Project: Mosswood Cemetery/5728.00 QC Batch ID: VMS-1084-S ' Client: Atlantic Environmental Sampled: - 11-24-99 Container: 60mL Glass Received: 11-24-99 Preservation: Methanol/Cool Analyzed: 11-30.99 Matrix: Soil Dilution Factor: 10 % Moisture: 7 CAS Number Analyte Concentration Units I Reporting limit 74-87-3 Chloromethane BRL ug/Kg 4,400 75-01-4 Vinyl Chloride BRL _ ug/Kg 4,400 74-83 9 Bromomethane BRL ug/Kg 4,400 75-00-3 Chloroethane BRL u� -- - --. -g---------- K 4,400 - - - ------ - -.. - - -- --- -4 1,1-Dichloroethene BRL ug/Kg 2,200--- 67-64-1__ __ Acetone � _ BRL ug/Kg 22,000 75-15-0 __ Carbon Disulfide _ BRL ug/Kg 22,000 _75-09-2 _Methylene Chloride BRL ug/Kg 4,400 ' 156_-60-5 --_- trans-1,2-Dichloroethene" _BRL ug/Kg 2,200 75-34-3 1,1-Dichloroethane BRL ug/Kg 2,200 _156-59-2 cis-1,2-Dichloroethene _ BRL ug/Kg 2,200 78-93-3 2-Butanone(MEK) BRL ug/Kg 22,000 ' i 67-66-3 Chloroform BRL ug/Kg 2,200 71-55-6 1,1,1-Trichlorcethane BRL ug/Kg y 2,200 56-23-5 I Carbon Tetrachloride j BRL j ug/Kg 2,200 71 43 2 _ Benzene ( BRL ! ug/Kg 2,200 107-06 2 1,2-Dichloroethane BRL ug/Kg 2,200 79-01-6 Trichlorcethene BRL _ ug/Kg 2,200_ 78-87-5 1,2-Dichloropropane __ BRL ug/Kg 2,200 75-27 4 Bromodichloromethane _ BRL ug/Kg _2,200 t 10061-01-5 cis-1,3-Dichloropropene __ - BRL ug/Kg � 2,200 108- 00-1 14-Methyl-2-Pentanone(MIRK) _ BRL ug/Kg I 22,000 108-88-3 Toluene __BRL_ ug/Kg 2,200 ' 10061-02-6 trans-1,3-Dichloropropene 1 BRL __ ug/Kg ; 2,200 79-00-5 1,1,2-Trichlorcethane BRL ug/Kg 2,200 -12 7-18 4 . _ Tetrachlorcethene _ _ BRL _ ug/Kg _-2,200 _ 591-78-6 2-Hexanone BRL ug/Kg j 22,000 12448-1 Dibromochloromethane BRL ug/Kg 2,200 108-90-7 Chlorobenzene BRL ug/Kg 2,200 100-41-4 Ethylbenzene BRL ug/Kg 2,200 108-38-3/106-42-3 meta-Xylene and para-Xylene 2,000 j ug/Kg 2,200 ' 95-47-6 ortho-Xylene 1,000 j ug/Kg 2,200 10042-5 Styrene BRL ug/Kg I 2,200 75-25-2 Bromoform BRL I ug/Kg 2,200 j 79-34-5 1,1,2,2-Tetrachlorcethane BRL ug/Kg 2,200 ' QC Surrogate Compounds Recovery ,QC Limits Dibromofluoromethane 104 % 80-120% 1,2-Dichloroethane-d4 100 % 80-120% ' Toluene-d8 103 % 81 -117% 4-Bromofluorobenzene 105 % 74 121 % i Method Reference: Test Methods for Evaluating Solid.Waste,US EPA,SW-846,Third Edition, Update III(1996). Analyte list as specified by the Target Compound List(TCL)of the US EPA Contract Laboratory Program. Results are ' reported on a dry weight basis. Analysis performed utilizing methanol extraction technique. Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. ' j Indicates an estimated value detected below the reporting limit for the analyte. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 GROUNDWATER 1 ANALYTICAL ASTM Method D3328-90 (Modified) Hydrocarbon Fingerprinting by GGFID ' Field ID: Stockpile Laboratory ID: 30242-07 Project: Mosswood Cemetery/5728.00 QC Batch ID: HF-1245-M Client: Atlantic Environmental Sampled: 11-24-99 Container: 250mL Glass Received: 11-24-99 Preservation: Cool Extracted: 11-29-99 Matrix: Soil Analyzed: 11-30-99 ' % Moisture: 7 Dilution Factor: 1 Qualitative Identification ' This sample has GC/FID characteristics that are similar to: 1. Fuel Oil No.2/Diesel Fuel. 2. Based on the distribution of the isoprenoid hydrocarbons to the n-C alkanes,the Fuel Oil ' No.2/Diesel Fuel appears to be mildly weathered. ' Analyte Concentration Units Reporting Limit Total Petroleum Hydrocarbons 480 mg/Kg I 65 ;QC Surrogate Compound Recovery QC Umits ortho-Terphenyl _ v 86 % I 60-140% Method Reference: Comparison of Waterbome Petroleum Oils by Gas Chromatography,Volume 11.02,Water,American ' Society for Testing and Materials(1990). Analytical protocol modified by use of an internal standard. Results are quantified on the basis of 5a—androstane. Sample preparation protocol modified by use of microwave accelerated solvent extraction. Results are reported on a dry weight basis. Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest 1 concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution and sample size. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 GROUNDWATER ANALYTICAL ASTM METHOD D3328-90(Modified) Hydrocarbon Fingerprinting (GC/FID) ' Lab ID: 30242-07 HYDROCARBONS LABORATORY 2 1 1GD- 1 1 t � ' 5 10 15 20 25 30 35 40 45 5D Retention time (minutes) GROUNDWATER 1 ANALYTICAL RCRA Hazardous Waste Characterization Field ID: Stockpile Laboratory ID: 30242-07 ' Project: Mosswood Cemetery/5728.00 Sampled: 11-24-99 Client: Atlantic Environmental Received: 11-24-99 Container: 250ml.Glass Preservation: Cool ' Matrix: Solid R g rtinUnts RCRA Limit Analyzed MethodAnalyte Result Limit Corrosivity(as pH) _6.6 pH 2.0_ >2.0and <12.s 11 30 99 EPA 9045C Ignitability(as Flashpoint) > 165 OF 70 t 11-30-99 EPA 1010-Mod i Reactive Cyanide BRL mg/Kg 5 250 °` 11-30-99 SW-846 Chp.7.3.1 Reactive Sulfide j BRL 1 mg/Kg 25 500 ° 11-30-99 I SW-846 Chp.7.3.4 Method References: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition, Update III(1996). ' Report Notations: BRL Indicates result, if any, is below reporting limit for analyte. Reporting limit is the lowest value that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution and sample size. ' t When ignited,burns so vigorously and persistently that it creates a hazard(40 C.F.R.261.22). 0 Current EPA guidance level(SW-846). Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL ' Trace Metals by ICP-AES and CVAA Field ID: Stockpile Laboratory ID: 30242-07 ' Project: Mosswood Cemetery/5728.00 Sampled: 11-24-99 Client: Atlantic Environmental Received: 11-24-99 Container: 250ml.Glass %Solids 93 Preservation: Cool Matrix: Soil Reporting CAS Number Analyte Concentration Units Limit Analyzed QC Batch Method 7440-38-2 Arsenic,Total 1.6 mg/Kg 1.1 12-01-99 MM-0871-S 60108 7440-43-9 Cadmium, Total— —__ —_ BRL mg/Kg 0.55 12-01-99 MM-0871-S 60106 744047-3 i Chromium,Total 9.1 ~mg/Kg 1.1 12-01-99 MM-0871-5 60106 ' ! 7439-92-1 Lead,Total BRL I mg/Kg 11 12-01-99 MM-0871-S 60106 7439-97-6 Mercury,Total BRL ! mg1Kg 0.05 ; 12-01-99 MP-0677-S 7471A ' Method Reference: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition,Update III (1996). Kesuits are reported on a dry weight basis. Report Notations: BRL Indicates concentration,if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can oe reiiauiy quantified under routine laboratory operating conditions. ' Keporting limits are adjusted tor sample diwtion and sample size. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Project Narrative Project: Mosswood Cemetery/5728.00 Lab ID: 30242 Client: Atlantic Environmental Received: 11-24-99 ' A. Physical Condition of Sample(s) This project was received by the laboratory in satisfactory condition. The sample(s) were received undamaged in appropriate containers with the correct preservation. ' B. Project Documentation This project was accompanied by satisfactory Chain of Custody documentation. The sample container label(s)agreed with the Chain of Custody. ' C. Analysis of Sample(s) No analytical anomalies or non-conformances were noted by the laboratory during the processing of these sample(s). All data contained within this report are released without qualification. ' Groundwater Anal ical, Inc., P.O. Box 1200 228 Main Street, Yt t eet, Buzzards Bay,MA 02532 R D Buzzards Bay.MAo 532 CHAIN-OF-CUSTODY RECORD ANALYTICAL Telephone(508)759-4441 AND WORK ORDER N? 389, FAX(508)759-4475 Project Name: Firm: M oSS W eb(7 TURNAROUND ANALYSIS REQUEST r .iTfi2r IxIW W s. rwu axesrr easrrty Project Number: Address: O STANDARD(10 Business Days) v;"A i 0 PCei ^""� raw ❑PRIORITY(5 Business Days) 1} S?2d'• d'G 1`p}cllJG� �� t�usH(RAN- a $ (Rush requires Rush Authorization Number) n !! $ i 8 Sampler Name: City State Zip: f A Please FAX ES ❑NO g o F 4 v- / ,44L^r),�jj'l FAX Number o F Q° Project Manager: Telephone: BILLING c �� $ - -' i f 1 �r1rC (��fe�J 4L Sup 7�s�—f�(ZZ Purchase Order No.: GWA Reference No.: o13 � m W € _ a 0 INSTRUCTIONS:Use separate line for each container(except replicates). i` z S : $ � � � s Sam Iln 3 $ $ s '� 3 `$ t ; o P 9 Matrix Type Container(s) Preservation niurw n r. n ri e n n u n ;, ;i .i ❑ // !!!� ❑ SAMPLE LABORATORY W E o _ e ° ° ° IDENTIFICATION a u .. n NUMBER /� ss A i p ❑ W 8 W S 5 5 a 5 a £ (Lab Use Only) c } "s e s p d �p f ❑ 6° 5 T A S 2 4 a $ $ $ $ 5 a $ $ o s e y ° E 3 3 ° ! a ct II % ►�z3 I L5� - �� at FT- ►► d ►dsb I S � 2 k - I 9Z =FM I REMARKS/SPECIAL INSTRUCTIONS DATA QUALITY OBJECTIVES CHAIN-OF-CUSTODY RECORD Regulatoryram Protect Specific DC NOTE:All samples submitted subject to Standard Terns a rp nd Conci0o on reverse hereof. ❑Safe Drinkingg water Water Act ❑MA DEP Form Many regulatory programs and EPA methods require project R by plev Sam ggqqaaa�te Time Received by: Receipt Temperatu specific OC.Project specific OC includes Sample Duplicates, j IZ ❑NPDES/Clean Water Act Matrix Spikes,and/or Matrix Spike Duplicates.Laboratory OC is p Specify State: not project specific unless prearranged.Project specific OC ❑RCRA/Haz.Waste Char. samples are charged on a per sample basis.For water samples, iYelinquished by: Date Time Received by: PPi^DrN ❑MA MCP(310 CMR 40) each MS.MSD and Sample Duplicate requires an additional Number: Reportable Concentrations sample aliquot. O RCGW-1 ❑RCS-1 Pro)ect Specific OC Required Selection of OC Sample Relinquished by: D to Time Received by Laboratory: Custody Seal) Cooler Ser4d ❑RCGW.2 O RCS-2 O Sample Duplicate ❑Selected by laboratory I Ly'g9 �� Number: ❑MA Dredge Disposal ❑Matrix Spike O Please use sample: ❑NH O RI❑CT p ME Meow of Shipment: L7 GWA Courier L7 Express Mail ❑Federal Expr Specify Category: 0 Matrix Spike Duplicate - ❑UPS 0 Hand 0 GROUNDWATER ANALYTICAL Quality Assurance/Quality Control ' A. Program Overview Groundwater Analytical conducts an active Quality Assurance program to ensure the production of high ' quality, valid data. This program closely follows the guidance provided by Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans, US EPA QAMS-005/80 (1980), and Test Methods for Evaluating Solid Waste, US EPA, SW-846, Update III 0 996). Quality Control protocols include written Standard Operating Procedures (SOPS) developed for each analytical method. SOPS are derived from US EPA methodologies and other established references. Standards are prepared from commercially obtained reference materials of certified purity, and documented for traceability. Quality Assessment protocols for most organic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. All samples, standards, blanks, laboratory control samples, matrix spikes and sample duplicates are spiked with internal standards and surrogate compounds. All instrument sequences begin with an initial calibration verification standard and a blank; and excepting GUMS sequences, all sequences close with a continuing ' calibration standard. GC/MS systems are tuned to-appropriate ion abundance criteria daily, or for each 12 hour operating period, whichever is more frequent. Quality Assessment protocols for most inorganic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. Standard curves are derived from one reagent blank and four concentration levels. Curve validity is verified by standard recoveries within plus or minus ten percent of the curve. F_ B. Definitions Batches are used as the basic unit for Quality Assessment. A Batch is defined as twentyor fewer samples of P the same matrix which are prepared together for the same analysis, using the same lots of reagents and the same techniques or manipulations, all within the same continuum of time, up to but not exceeding 24 hours. Laboratory Control Samples are used to assess the accuracy of the analytical method. A Laboratory Control Sample consists of reagent water or sodium sulfate spiked with a group of target analytes representative of the method analytes. Accuracy is defined as the degree of agreement of the measured value with the true or expected value. Percent Recoveries for the Laboratory Control Samples are calculated to assess accuracy. Method Blanks are used to assess the level of contamination present in the analytical system. Method Blanks ' consist of reagent water or an aliquot of sodium sulfate. Method Blanks are taken through all the appropriate steps of an analytical method. Sample data reported is not corrected for blank contamination. Surrogate Compounds are used to assess the effectiveness of an analytical method in dealing with each ' sample matrix. Surrogate Compounds are organic-compounds which are similar to the target analytes of interest in chemical behavior, but which are not normally found in environmental samples. Percent Recoveries are calculated for each Surrogate Compound. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: MA DEP EPH Method QC Batch I D: EP-0805-M Matrix: Soil Units: rng/Kg CAS Number Analyte Spik suLo 111-84-2 n-Nonane(Cq) — __L__�_Recovery I QC Limits 5.0 2.3 45 % 40- 140 % -�b-%-- 4d---- /o----- (C14) 50 n-Nonadecane(C,q) 5.0 3.6 72"%-- -- 14-0-%--- -112-95-8 n-Eicosane(C20) 5.0 3.9 630-02-4 n-Octacosane(C2.) 5.6 3.6 71 % 40- 140 % 91-20-3 Naphthalene 5.0 3.2 64% 40- 140 % i 83-32-9 1 Acenaphthene 5.0 3.6 72 % 40- 140 % QC Surrogate Compounds Recovery QC Limits Fractionation: 2-Fluorobiphenyl 76 % 40- 140 % 1 2-Bromonaphthalene 76 % 40- 140% Extraction: I Chloro-octadecane 74 % 40- 140% ortho-Terphenyl 82 % 40- 140% Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ,, ANALYTICAL j , Quality Control Report Method Blank Category: MA DEP EPH Method QC Batch ID: EP-0805-M Matrix: Soil EPH Ranges Concentration I Units JRep::or—tingL—*imt, n-C9 to n-C18 Aliphatic Hydrocarbons BRL mg/Kg. 30 n-C19 to n-C36 Aliphatic Hydrocarbons'— mg/Kg 30 ---------- n-C1 I to n ----- -C22 Aromatic Hydrocarbons' BRL mg/Kg 30 Un-adilu5le—dn-Cl I to n-C22 Aromatic Hydrocarbons mg/Kg 30 L_CAS Number Target Analytes; Concentration Units I Re-porting Limiti 91-20-3 Naphthalene BRL mg/Kg 0.50 91-57-6 2-methyl naphthalene BRL mg/Kg 0.50 85-01-8 Phenanthrene I BRL mg/Kg 0.50 83-32-9 Acenaphthene j BRL mg/Kg 0.50 QC Surrogate Compounds Recovery QC Limits Fractionation: 40-140% L?:�uorobiphenyl 77 % 2-Bromonaphthalene 78 % 40-140 % Extraction: Chloro-octadecane 75 % I 40-140 % ortho-Terp-henyl 77 % 40-140% Method Reference: Method for the Determination of Extractable Petroleum Hydrocarbons,MA DEP(1998). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting it that range. 0 n-C1 1 to n-C22 Aromatic Hydrocarbons range data excludes the method target analyte concentrations. 1 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: EPA Method 8082 QC Batch ID: PB-0948-M Matrix: Soil Units: ug/Kg CAS Number Analyte Spiked Measured Recovery QC Limits 1 1 09 7-69-1 Aroclor 1254 330 400 119% 60- 140 QC Surrogate Compound Recovery QC Limits Tetrachloro-m-xylene 9190 _25 121_% —Decachlorobiphenyl__-- -- _ _ 96% 28- 138 Metnoa Keterence: test Memoos ror tvaivanng Bona waste, u�o trh,Zw-d4b, i niro toiuon, upaate in t i yyb). Kesuits are caicuiatea on a ary weight oasis. Keport Notations: nu caicuiauons perrormea prior to rounaing. tluauty t-ontroi Limits are aerinea oytne metnoaoiogy, or aiternanveiy oasea upon the nistorncai average recovery plus or minus tnree stanaara aeviauon units. r r r r r r . r r r Groundwater Analytical, Inc., P.O.Box 1200, 228 Main Street, Buzzards Bay, MA 02532 r GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: EPA Method 8082 QC Batch ID: PB-0948-M Matrix: Soil CAS Number Analyte Concentration Units R—T—�r---- �tingun7j�jt 1 2 6 74-1 1-2 Aroclor 1016 BRL ug/Kg 80 11104-28-2 Aroclor 1221 --BRL ug/Kg 80 1 1 1 41-1 6-5 Aroclor 1232 BR--L ug/Kg 80 '-'-' BRL ug/Kg 80 12672-29-6 Aroclor 1248 BRL ug/Kg,*- 1 1 09 7-69-1 Aroclor 1254 BRL ug/Kg 80 11096-82-5 Aroclor 1260 BRL ug/Kg 80 QC Surrogate Compound Recovery QC Limits------] Tetrachloro-m-xylene 89 % 25- 121 % Decachlorobiphenyl 95 % 28- 138 % mein0a Keterence: lest metnoas tor tvaivating.-)oiia waste, u.-)tr^, VV-?J 4 b, inira taition,upciate iii k I'JJb). ^naiyte list as Aroclor anaiytes tormeny specinea oy ttA metnoa WWA. Kesuits are reportea on a ary weignt oasis. Keporl Notations: bKL inaicates concentration, it any, is Deiow reporting limit tor anaiyte. Keporiing limit is ine iowest concentration triat can De reliably quantinea uncier routine ianoratory operating conaitions. Keporting limits are aajustea tor sample atiution,percent moisture ana sample size. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Quality Control Report Laboratory Control Sample Category: ASTM Method D3328-90(Modified) QC Batch ID: HF-1245-M Matrix: Soil Units: mg/Kg Analyte Spiked Measured Recovery QC Limits Fuel Oil No. 2 130 110 86% 60- 140 QC Surrogate Compound Recovery QC Limits ortho-Terphenyl 83 % 60- 140 tMethod Reference: Comparison of Waterbome Petroleum Oils by Gas Chromatography,Volume 11.02,Water,American Society for Testing and Materials(1990). Analytical protocol modified by use of an internal standard. Results are quantified on the basis of 5a—androstane. Sample preparation protocol modified by use of microwave accelerated solvent extraction. Results are reported on a dry weight basis. Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. r . r i . Groundwater Analytical, Inc. P.O. Box 120 yt 0, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ' ANALYTICAL Quality Control Report Method Blank Category: ASTM Method D3328-90(Modified) QC Batch ID: HF-1245-M Matrix: Soil rtin Analyte Concentration Units Repo g 1 im'} Total Petroleum Hydrocarbons BRL mg/Kg 60 QC Surrogate Compound Recovery QC Limits ortho-Terphenyl 94 % 60- 140% Method Reference: Comparison of Waterbome Petroleum Oils by Gas Chromatography,Volume 11.02,Water,American Society for Testing and Materials(1990). Analytical protocol modified by use of an internal standard. Results are quantified on the basis of 5a—androstane. Sample preparation protocol modified by use of microwave accelerated solvent extraction. Results are reported on a dry weight basis. on a dry weight basis. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution and sample size. r Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: EPA Method 8260B QC Batch ID: VM5-1084-SL Matrix: Soil Units: u.g/Kg CAS Number Analyte Spiked Measured Limits 75-354 1,1-Dichloroethene 2,500 2,500 102 % 70- 130% 7143-2 Benzene 2,500 2,500 101 % 70--- 130% 79-01-6 Trichloroethene 2,500 2,600 104 % 70- 130 % 108-88-3 Toluene 2,500 2,300 91 % 70- 130 % 108-90-7 Chlorobenzene 2,500 2,500 102 % 70- 130 % QC Surrogate Compounds Recovery QC Limits Dibromofluoromethane 105 % 80- 120% 1,2-Dichloroethane-d4 96 % i 80-120% Toluene-cl, i 92 % 81 -117% Method Reference: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition, Update 111(1996). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay,MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Method Blank, Category: EPA Method 8260B QC Batch ID: VM5-1084-SB Matrix: Soil i CAS Number Analyte Concentration Units IReporting Limit 74-87-3 Chloromethane BRL ug/Kg 500 --- - -- ------ - - - ----------- -- ---- -... . - -. --------- --- 75-01-4 Vinyl Chloride BRL ug/Kg 500 ---- - - - ... - -- -- --- -._ .._ - -- -- - ----------- 74-83-9 Bromomethane BRL ug/Kg 500 75-00-3 Chloroethane BRL ug/Kg 500 75-35 4--- _1,1:Dichloroethene _- -_--- -- --- -- BRL - - u K 250 67_64-1 Acetone BRL ug/Kg 2,500 75-15-0 _ _Carbon_Disulfide _BRL ug/Kg 2_,500 -75-09-2 -Methylene Chloride BRL — _- ug/Kg 500 156-60-5 trans-1,2-Dichloroethene _ BRL __ ug/Kg 250 1634-04-4 Methyl tert-butyl Ether(MTBE)° BRL ug/Kg 250 75-34-3 1,1_Dichloroethane BRL ug/Kg 250 156-59-2 cis-1,2-Dichloroethene j BRL ug/Kg 250 78-93-3 2-Butanone(MEK) BRL ug/Kg a2,500 67-66 3 Chloroform BRL ug/Kg 250 j 71-55-6 1,1,1-Trichloroethane F BRL ug/Kg 250 56-23-5 Carbon Tetrachloride j BRL ug/Kg 250 j71-43-2 Benzene BRL ug/Kg j 250 107-06-2 j 1,2-Dichlorcethane BRL ug/Kg 250 t- 79-01-6 Trichloroethene .BRL ug/Kg 250 78-87-5 1,2-Dichloropropane BRL ug/Kg j 250 75-274 Bromodichloromethane BRL I ug(Kg 250 10061-01-5 cis-1,3-Dichloropropene BRL I ug/Kg 250 108-10-1 14-Methyl-2-Pentanone(MIBK) BRL ug/Kg 2,500 108-88-3 Toluene BRL j ug(Kg 250 10061-02 6 trans-1,3-Dichloropropene BRL ug(Kg i 250 79-00-5 1,1,2-Trichlorcethane BRL ug/Kg 250 127-18-4 Tetrachloroethene BRL ug/Kg I 250 591-78-6 2-Hexanone BRL ! ug/Kg j 2,500 ! 12448-1 Dibromochloromethane BRL j ug/Kg j 250 108-90-7 j Chlorobenzene BRL ug/Kg 250 100414 Ethylbenzene BRL I ug/Kg 250 108-38-3/10642-3 meta-Xylene and para-Xylene BRL ug/Kg 250 �. 9547-6 j ortho-Xylene BRL ug(Kg 250 100 42-5 Styrene BRL ug/Kg 250 75-25-2 I Bromoform BRL I ug/Kg 250 79-34-5 1,1,2,2-Tetrachloroethane BRL i ug/Kg 250 QC Surrogate Compounds Recovery QC Limits Dibromofluoromethane j 104 % 80-120 1,2-Dichloroethane-d4 97 % ; 80-120% Toluene-de 92 /o ° i 81 -117q° , 4-Bromofluorobenzene 105 % 74-121 Method Reference: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition,Update III(1996). Analyte list as specified by the Target Compound List(TCL)of the US EPA Contract Laboratory Program. Results are reported on a dry weight basis. Analysis performed utilizing methanol extraction technique. Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution,percent moisture and sample size. 0 . Indicates additional target analyte. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards BaY, MA 02532 GROUNDWATER i ANALYTICAL QUALITY ASSURANCE Laboratory Control Sample Recovery Category: Trace Metals Matrix: Soil Units: mg/Kg Laboratory Control Sample SPIKE SPIKED PERCENT QC ANALYTE BATCH ID ADDED RESULT RECOVERY LIMITS Arsenic MM-0871-SLI 100 92 92 % 75-125 Cadmium MM-0871-SLI 100 92 92 % 7.5-125 Chromium MM-0871-SLI 100 91 91 % 75-125 Lead MM-0871-SLI 100 91 91 % 75-125 Mercury MP-0677-SL 0.250 0.240 95 % 75-125 1' Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. GROUNDWATER 1 ANALYTICAL QUALITY ASSURANCE Method Blank Category: Trace Metals Matrix: Soil REPORTING EPA PARAMETER CONCENTRATION LIMIT BATCH ID METHOD (mg/Kg) (mg/Kg) Arsenic BRL 10 MM-0871-SB 6010 Cadmium BRL 0.50 MM-0871-SB 6010 Chromium BRL 1.0 MM-0871-SB 6010 1� Lead BRL 10 MM-0871-SB 6010 Mercury BRL 0.050 MP-0677-SB 7471 BRL = Below Reporting Limit. Method References: Test Methods for Evaluating Solid Waste, US EPA SW-846, Third Edition (1986). Graphite Furnace analyses performed with Zeeman background correction and Lvov platform technique. GROUNDWATER ' ANALYTICAL Certifications and Approvals CONNECTICUT, Department of Health Services, PH-0586 Potable Water,Wastewater/Trade Waste,Sewage/Effluent,and Soil pH,Conductivity,Acidity,Alkalinity,Hardness,Chloride,Fluoride,Ammonia,Kjeldahl Nitrogen,Nitrate,Nitrite,Orthophosphate,Total Dissolved Solids,Cyanide,Aluminum,Antimony,Arsenic,Barium,Beryllium,Cadmium,Total Chromium,Hexavalent Chromium,Cobalt,Copper,Iron,Lead, Magnesium,Manganese,Mercury,Molybdenum,Nickel,Potassium,Selenium,Silver,Sodium,Thallium,Tin,Titanium,Vanadium,Zinc,Purgeable Halocarbons,Purgeable Aromatics,Pesticides,PCBs,PCBs in Oil,Ethylene Dibromide,Phenols,Oil and Grease. MAINE, Department of Human Services, MA103 Drinking Water Reciprocal certification in accordance with Massachusetts certification for drinking water analytes. +� Waste Water Reciprocal i r oval certification in accordance with Massachusetts certification for waste water analytes. MASSACHUSETTS, Department of Environmental Protection, M-MA-103 Potable Water Antimony,Arsenic,Barium,Beryllium,Cadmium,Chromium,Copper,Lead,Mercury,Nickel,Selenium,Thallium,Nitrate-N,Nitrite-N,Fluoride, Sodium,Sulfate,Cyanide,Turbidity,Residual Free Chlorine,Calcium,Total Alkalinity,Total Dissolved Solids,pH,Trihalomethanes,Volatile Organic Compounds,1,2-Dibromoethane,1,2-Dibromo-3-chloropropane,Total Coliform,Fecal Coliform,Heterotrophic Plate Count,E-Coli Non-Potable Water Aluminum,Antimony,Arsenic,Beryllium,Cadmium,Chromium,Cobalt,Copper,Iron,Lead,Manganese,Mercury,Molybdenum,Nickel,Selenium, Silver,Strontium,Thallium,Titanium,Vanadium,Zinc,pH,Specific Conductance,Total Dissolved Solids,Total Hardness,Calcium,Magnesium, Sodium,Potassium,Total Alkalinity,Chloride,Fluoride,Sulfate,Ammonia-N,Nitrate•N,Kjeldahl-N,Orthophosphate,Total Phosphorus,Chemical Oxygen Demand,Biochemical Oxygen Demand,Total Cyanide,Non-Filterable Residue,Total Residual Chlorine,Oil and Grease,Total Phenolics, Volatile Halocarbons,Volatile Aromatics,Chlordane,Aldrin,Dieldrin,DDD,DDE,DDT,Heptachlor,Heptachlor Epoxide,Polychlorinated Biphenyls(water),Polychlorinated Biphenyls(oil). MICHIGAN, Department of Environmental Quality Drinking Water Trihalomethanes,Regulated and Unregulated Volatile Organic Compounds by EPA Method 524.2;1,2-Dibromoethane,1,2-Dibromo-3- chloropropane by EPA Method 504.1 NEW HAMPSHIRE Department of Environme ntal ental Services, 202798 Drinking Water Metals by Graphite Furnace,Metals by ICP,Mercury,Nitrite-N,Orthophosphate,Residual Free Chlorine,Turbidity,Total Filterable Residue,Calcium Hardness,pH,Alkalinity,Sodium,Sulfate,Total Cyanide,Insecticides,Herbicides,Base/Neutrals,Trihalomethanes;Volatile Organics,Vinyl Chloride,DBCP,EDB,Nitrate-N. Wastewater Metals by Graphite Furnace,Metals by ICP,Mercury,pH,Specific Conductivity,TDS,Total Hardness,Calcium,Magnesium,Sodium,Potassium, Total Alkalinity,Chloride,Fluoride,Sulfate,Ammonia-N,Nitrate-N,Orthophosphate,TKN,Total Phosphorus,COD,BOD,Non-Filterable Residue, Oil&Grease,Total Phenolics,Total Residual Chlorine,PCBs in Water,PCBs in Oil,Pesticides,Volatile Organics,Total Cyanide. RHODE ISLAND, Department of Health, 54 Surface Water,Air,Wastewater, Potable Water,Sewage Chemistry: Organic and Inorganic Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 1 1 1 1 1 1 1 f 1 1 1 1 1 1 1 1 1 A 1 1 1 1 1 1 ' 1 1 1 1 1 1 1 1 1 1 1 1 MAtIantic 1 1 1 1 i 1 1 1 Appendix C. Bardon Trimount Soil Disposal.Paperwork & NL DEP BOL 1 1 1 1 1 1 t 1 AM December 21, 1999 BABOON ' TRIMOUNT ED PRICE ' CLEAN VENTURE INC. 378 PAGE STREET UNIT 16 STOUGHTON, MA 02072 Re: Soil, Moss Wood Cemetery 280 Putnam Avenue ' Cotuit, MA Release Tracking #, : 4-15134 t Recyclable soil from the above address was received at our facility on December 17, 1999. Attached is the shipper's log of soil receipts totaling 36.4 tons along with the Bill of Lading and other receipt documentation. ' We will issue a "Certificate of Recycling" upon request after processing. ' Thank you for recycling soil at our So. Dennis facility. ' Yours truly, JF David M. Peter General Manager ' Environmental Services BARDON TRIMOUNT, INC. 1101 Turnpike Street Stoughton,Massachusetts 02072 Telephone 781 344 1100 Facsimile 781 341 5523 Environmental Services ' Telephone 781 341 5500 Facsimile 781 341 2440 An AGGREGATE INDUSTRIES Company E ' Page 1 ' Untitled South Dannis RARDON TRIMOUNT -------------------------------------------------------------------------------- ' t------------------------------ TICKET INQUIRY ------------------------------t LOCATION: 331 South Denni9 ;t---------------------------- CUSTQMR / ORDER ----------------------------r; t---- 12/17/99 -----r; ; CUSTOIER: 137244 CLEAN VENTURE I 1 Load ORDER: 20416 SOIL/COTUIT-PUTNAH AVE ; 36.40 TON--- t------------ --t,* t; TICKET TIM ORDER PRODUCT HAULER TRUCK QTY ------ ----- ------ ----------------- ---------- ----- --------- ; 209094 11:14 20416 RECY SOIL OIL FOB TRUCKS 00022 36.40 TON ; ; ; r----------------------------------------------------------------------------t ------------------------------------------------------------------------------ ESC to exit 1Halp 33aarch 7Clear it THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) � mP� LI DATA Denril s js, t .4 h�'_d(f+ . #1' .•:�;�' `'�',�..F•r � i +2I+ f, 8TOMER PURCH1ISE ORDER NO. `t :rCODE $ALE% ZONE- • , '� c •� <t ��f�, CUSTOMER NAME JOB NAME/DIRECTIONS DUCT QUANTITY UNIT PRICE AMOUNT MEGAGRAMS POUNDS TONS GROSS / 1 �! l!:•R� �' fill / ' TRUCKING RATE TARE :, .•��4, I TAX (ihi NET 3 TOTAL DUE e relieve the seller of any liability for personal injury or property ARRIVE JOB DEPART JOB WAITING TIME WEIGHTMASTER mage when delivery is made beyond the curb line. Di an e our business is greatly valued. Driver: Waiting time in excess of F C)F'• f RUi'Kr_ f 1/4 hour will be charged at ieceived by: current prices. ' BT-25 CUSTOMER COPY CONTROL NO. 0758499 '/99) ' BARDON TRIIKOUNT a 1101 Tt1BNpQCB �v������STREET.S'1�OtJ�3RTON.MA 02072 PRONE (781)341-SS00 FAX (781)341--2440 SOIL RECYCLD(G SUBMITTAL ' (Revised 3iIV99) Site Information: ' 'Fame: (155 (12 CLh -�z� Contact: STD yi-eN) SV'v 1k C,z-�J J Street. ,�d'C �T ,� f}VF. Phone,7: � � qa—e6g3 Le e/Town: CT,)zr State/Zip: _ _ M 0Z,63—r— ' Gene;�t��ILfo�•t�atio�t; Iv,une: IC:- B," ,ti Contact: L e5�1-.n.4,J S'rcet: w Ijf'l Phone#: 63EC City/Town- 9 KANrJil S StateiZip:_ 0,26 _-- Consultant Inforaw tom: Name: rcCr r u.. £cKS. rt L'Contact G,�s`" Street: 8( rAJw'cf alit aaV Oty/Town: State;Zip: y 27`l 7 Estimated Soil Quantity. Tons 60 Cubic Yards ' Soil Contaminarns(gasoline, diesel fuel, motor oil, etc.) Analyses Performed (check all that apply) TPH, VOCs, _ Flash, PH, ;—_ Reactivity (S. CN), PCBs As. Cd, CT, Hg, Fb, ' ____ MP (metals), if required based on tctal levels _U7_All the above tests were performed Other ' Laboratory Analytical Data Attached. V Screening Data Attached Instrument Used and Constituents Found 1 - Nscription/Somrce of� Othtr, USI, Da=ihe ASr- 6VY1 GAS DaW of Releasa _._�Z 3 ? Scil Description Physical Descriptiot(sa-.d, grave!, silt, etc.) Classifization Method ' Check if the fo,',vwing-nateries are present: clay, corstntction debris. _ vegetative matter, ash, c:)aL ---of-her delec:riou mau rats ;Iist..i -- Soil Characie-iDitiOn McLhc.:.;Iogy Sampling Method Grat• V/-�Com.posi to Biased samples (e.g .is e�adspace streeaed, visually containi:iated) Constitutes of Concern Si L C,(, _— Site History (check if extra sheets attached) Currem Use Past Use ' I. the generator, ha--Ing used due diligence, determined that there is nc reason to suspect cr believe that the petroleum contaminated soil has been i rrected by any rel.ases ef oil or ' hazardous materials otter than that of the known source or I have identified &.,! additional oii am! haaarde,3s materials that are suspected or known to be orese>rt in the soil, in add:cian to those associated with the Imown release, including ary anarorneni: contaminants. I, the generator, realize that cite diligence shall consist of a search of informat'.an and records rjasonably available to tic generator of the contaminated scil and suP icienr to make the derermination. Srch records and infon ation may include, but are not limited T, those of the g_ncratcr, location of generation(i.e. f3ciEty if rot the generator), the Deparanent's Bureau of Waste Site Ctea,tup and the muna.6pali (i.e. Board of Health, Fire Department) wi i.�t which the site it located. All samples for VOC analysis were collected according to DEP policy ' VOCA#99-•41.5. ' Si nature oTi3enerator Late rorQ I- co'�&'K Al'i Generztor- Printed Name I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM ^� C DATA I ' `:0'� �i101 • A site dignm b rcqWzed lDdV-A*AnY Ingdor structures or roads,excavation areas and stockpile locatiow. AR 3=Vlmg locatjow aust be noted. Cheek if dft=attached. SITE DIAGRAM ? -Y, V7 C70 1 j XL Os C- C- ACC' 7- Y-i 'S Name of Individual preparing diagram- BTES1900 3112199 OT aiiiilanusens mepartment of Environmental Protection BWSC-012A Bureau of Waste Site Cleanup BILL OF LADING (Pwsuant to 310 CUR so ooao) �" i5134 A. LOCATION OF SITE OR DISPOSAL SITE WHERE REMEDIATION WASTE WAS QENERATM Release Name(optwnal): MoaS Wood Cemetery Street 280 Putnam Avenue ,�,rr Location Aid: C cwn: Cotuit Zip Code: 02635 _ 0000 Daterr+od of Generation: l.1 /23 / 99 to 12/ 1 / 99 Additonaf Release Tracking Numbers Associated with this Bill of Lading: *Note: if this Bill of Lading Is the result of a Limited Removal Action(LRA)taken prior to Notification,a Release Tracking Number/s not needed. B. PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH BILL OF LADING: Narre of Organization:Town of Barnstable Cemetery Department Nar-e -.Contact: Paul Coleman Title: Division Manager Street 280 Putnam Avenue Cotuit State: MA Zip Code: 02615 - 0000 -ce.rc„e: 508 - 790 - 6320 Ext. C. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH BILL OF LADING: (check one/spect y) U R� Specify(circle one): Owner Operator Generator Transporter Other RP: DI Fct.D Specify(circle one): Owner Operator Generator Transporter Other PRP: ❑ Fctuciary/Secured Lender DI A,2ency/Public Utility on a Right of Way C-,vr Person: !f an cm-ier and/or operator is not conducting the response action associated with the Bill of Lading,provide on an attachment the name, con;ac7.person,address and telephone number,including any area code and extension,for each,if known. D. TFLANSPORTER/COMMON CARRIER INFORMATION: 7ra^scmter/Common Carrier Name: Town of Barnstable Department. of Public Works Coraac-Person Tn zPnb. Slominski Title: Streer 800 Pitchers Way City;,ter: Hyannis State: MA Zip Code: 02601 - 0000 Teiearone: 508 - 428 - 8643 Ext. E. RECEIVING FACILITY/TEMPORARY STORAGE LOCATION: -w=-or;'Facility Name: Bardon Trimount, Inc. Cccac:Person: David M. Peter Title: General Mgr. Env. Svcs. Stree: 230 Great Western Road ;,i South Dennis State: MA Zip Code: 02660 _ 0000 Telepr cne: 781 _ 341 _ 5500 Ext. Type zf Facility. [X Asphalt Batch/Cold Mix ❑ Landfill/Disposal ❑ Incinerator (chc-atone) Asphalt Batch/Hot Mix ❑ Landfill/Daily Cover ❑ Temporary Storage ❑ Thermal Processing ❑ Landfill/Structural Fill ❑ Other: 'D-m%cn of Hazardous Division of Solid Waste Was;e,Vass A Permit N: S-75-042 Management Permit#►: EPA Identification c MAD985286384 Ar:-zc'A,%cipa:ed Period of Temporary Storage(specify dates if applicable): /_ /— to Reasc*-for Temporary Storage(if applicable): '�• `d �:r1/93 This torn is printed on recycled paper. Page 1 of 2 Massachusetts Department of Environmental Protection BWS"12A Bureau of Waste Site Cleanup , hM�M T�NunO�r: DEP BILL OF LADI 4 15134 NO (purst�nt to�10 CMR 4o.00ao� L RECEIVING FACILITYREMPORARY STORAGE LOCATION(eontirAisMi Temporary Storage Address: Street: City/Town: State: Zip Code: F. DESCRIPTION OF REMEDIATION WASTE: (check all that apply) " ® Contaminated Media(circle all that apply): Soil Groundwater Surface Water Other: ❑ Contaminated Debris(circle all that apply): DemolitiorVConstruclion Waste Vegetation/Organic Materials ' Inorganic Absorbant Materials Other: ❑ Non-hazardous Uncontainerized Waste(circle all that apply): Non-aqueous Phase Liquid Other: ❑ Non-hazardous Containerized Waste(circle all that apply): Tank Bottoms/Sludges Containers Drums Engineered Impoundments Other: Type of Contamination(circle all that apply): Gasoline <EiFuio p2 Oil #4 Oil M6 Oil Waste Oil Kerosene Jet Fuel Other: Estimated Volume of Materials: Cubic Yards: 60 Tons: 90 Other: Contaminant Source(check one/specify): ❑ Transportation Accident ❑ Underground Storage Tank U Other: AST overf low Response Action Associated with Bill of Lading(circle one): Immediate Response Action Release Abatement Measure Utility-Related Abatement Measure Limited Removal Action(LRA) Comprehensive Response Action Other(specify): ' Remediation Waste Characterization Support Documentation attached: Ej Site History Information ❑ Sampling and Analytical Methods and Procedures ,}❑X Laboratory Data ❑ Field Screening Data If supporting documentation is not appended, provide an attachment stating the date and in connection with what document such ' information was previously submitted to DEP. G. LICENSED SITE PROFESSIONAL(LSP) OPINION: Name of Organization: Atlantic Environmental Technologies, Inc. LSP Name: Toivo A. Lamminen, Jr. Title: Principal/LSP Telephone: 508 — 997 — 5422 Ext. I have personally examined and am familiar with the information contained on and submitted with this form. Based on this information,it is my Opinion that the testing and assessment actions undertaken were adequate to characterize the Remediation Waste,in accordance with 310 CMR 40.0030,and that the facility or location can accept remediation wastes with the characteristics desgibert'frhis submittal. I am aware that significant pe Ities including,but not limited to,possible fines and imprisonment may result if I veil s�Ril1h oration which I know to :: V be false,inaccur or materia n plete. e�+ M,'t&10- Signature: 6y"� ry` TO)VO <'` Seal: A. �^ Date: :�► �� Z°. '.sIN R. ;') ' License Number: 6846 .' `f ,9 ice'684sGc 4� f� H. CERTIFICATION OF PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH THIS BILL OF LADING: I certify under penalties of law that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this certification,and that, based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained herein is,to the best of my knowledge and belief,true,accurate and complete. I am aware that there are significant penalties, including,but not limited to, possible fines and imprisonment,for wilfully submitting false,inaccurate,or incomplete infor a on. Signature: Date: z� g Name of Person(print): Paul Coleman Revised 1011/93 This form is printed on recycled paper. Page 2 of 2 Bureau of Waste Si1�P�rtneorst of Fnvlronrn(�nta,l e Cleanup �toctlon E1KSC-0128 •ILL OF LADIN LOQ � ocMltso.00soy aw.«tr•y�ty+Mc L0"tlip� T10lW a' 15134 AD t S"I a T � n4tive: f l��c�t-Y.s,•u � r Oste d srip et,e a S+ti �u I T R.c.tvtno , y �Pirnent: ary sage Re aentatim ' rkta Fie, ; (cirue 0I aWpm Date of pt. T Receipt q�TrE W;Wion (if any). O a �OA Muv � 09 (circ:a one)) r amrprn 9rvtwe of Transporer -------_ load Size(cu. d one Reprossrutive' d y,, i Receving FacJiry/Tempasry Stag a M�ert. Time Of SniPit: f g Re r P esentstive , ' (cirle on r ; Dale or Aecov Tune of Rec i 1 -�•��T-ac:a � elampm � _ ep:: `—'�'9 atradon: Trailer Registration(if rter (c rcle ane)Ar vo, LOAD �t SQ�etur0 of Transpo ReD resantative: i LOad Size(cu.)ds.,aons): .a!e cf 5ry i Receivng Faci!irylTernpaary Storage Representative: txTtiant: Time d S+tiprrWt f �-- (Circ'e one)smrpm i Oate of Receipt True of Receipt. "��'-acts�j+avaticr.: ! ` /,�. /_ Trailer Registration(if any). r ' r (ci�c,e one)amrprr LOAD k S,V11"Oture Of Trans Load Sizt(cu Ydt+.Aona) Porter Representative: date d 5niprrL , R•cettinq FacilirylTemporary Storage Represartstive: T1me of&iPrtwL f y_ (circle One)em/pm , Date of Receipt: Time of Aeceix: ti+csvTractor Registration: Trailer Regisuttion(!f any, (circle Ole)am/pm LOAD Ot S V%arure d Transporter R Load Size(cu.yds.Acns): eprosentative: ! Receiving Facllir#femporar R' :we cr SNPr-�r;t. Tune of Sh;Pment: j y S rtaa^e epreaenta:ive. /' /— ' — (clrcle One)anVpm bate Of Receipt: Tune of Rece:p:: Trailer Registration('f anI ' (circle tee)arNpm LOAD0: S19ruture of Tranapater Representative: t load S!ze(cu.vds AoI Receiving Facilltyr?emporary Storage Repreeen:ativo. �e �'L Time of Shi r (circle one)amopm Date of Receipt: Time of Aeeeipe / "rector F*9,atratior;: ' 1 /_ /_ Trailer P491stration(W any). r (C'v:!e one}ar,'pm 6VAM 71 S�*.ature d Trs^aW.er Load Size(cu.yda/lons)! ReWeeentative: ReCe vine Facility/Temporary Storage Representative i :•a:•d Snitx-a+nt: T!me of$►,l � . Prt'�ent: -- /-- /— f Oate of Aecoi Time of Receipt. (Cif Cie one)aayprn t �: •dC�rt►Cta F�egi:oat)on: TrNter Registrat:On(if any): r f (circle one)smiprr ' J. LOd iHFNT VOLUMt INFORMATIONr i Load Site(cu.yde.Aona): Total Voiurne TN;Page g (aU.ydaAona): Total Carried Forward(a+,yds Aons): ,•e rec t � Or t, Total Carried FOit"rard and Tnfs Page(cu.yds.Aona): /J ]� nu onn Is prated ort recyc. paper 7 �ifta i�Ca✓ / I4 k M17,3f I � c t This page intentionally left blank. Massachusetts Department of Environmental Protection BWSC-0 22C Bureau of Waste Site Cleanup RsMas�Trawra N-sbar. BILL OF LADING(pursuant to 310 CMR 40.0030) ' -SUMMARY SHEET OF K. SUMMARY OF SHIPMENTS: 1 DATE OF SHIPMENT: DATE OF RECEIPT: NUMBER OF LOADS SHIPPED: DAILY VOLUME SHIPPED(CU.YD fro Sy --------------- ! _17=9 9-- ------------ ------------- -------- - 40 1 --------------- --------------- -7---------- ------------ ---- ---------------- --------------- --------------- --------------------------- --------------------------- --------------- --------------- --------------------------- ---------------------------- ' --------------- --------------- -------------------------- ----------------------------- ---- --------------------------- ----------------------------- i _______________ _______________ ___________________________ _____________________________ ----------------------------- _______________ ___________________________ _____________________________ 1 ____ _______________ ___________________________ _____________________________ _____________ _______________ ___________________________ _____________________________ 1 --------------- --------------- --------------------------- ----------------------------- --------------- --------------- --------------------------- ----------------------------- ________________________ 1 _______________ ______ ______ __________________________- -___________----------------- 1 _______________ _______________ ___________________________ _____________________________ _______________ ___________________________ _____________________________ ---------- ------------------------------ 1 _______________ _______________ ___________________________ _____________________________ _______ _________ ___________________________ _____________________________� 1 SUMMARY SHEET TOTAL SHIPPED: ` �U BILL OF LADING TOTALSHIPPED(only It different): Revised 10/1/94 i r s pn n r yc paper. Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC-012C BILL OF LADING(pursuant to 310 CMR 40.0030) R�lesserrsektnglkmbey: ' SUMMARY SHEET L. ACKNOWLEDGEMENT RECEIPT OF REMEDIATION WASTE AT RECEIVING FACILITY,OR TEMPORARY STORAGE LOCATION: Receiving FacTtyrfempor Location Representative pri ty Dav �d eter Title: V.P.—Env. Services Signature: D M. ACKNOWLEDGEMENT OF SHIPMENT AND RECEIPT OF REMEDIATION WASTE BY PERSON CONDUCTING RESPONSE ACTION ASSOCIATED WITH THIS BILL OF LADING: I certity under penalties of law that 1 have personally examined and am familiar with the information contained in this submittal,including any and att documents accompanying this c5rtification, and that, based on my Inquiry of those Individuals immediately responsible for obtaining the information,the material Information contained herein Is,to the best of my knowledge and belief,true,accurate and complete. I am aware that there are significant penalties. Including, but not limited to, possible fines and Imprisonment, for wilfully submitting false, inaccurate, or Incomplete information. Signature: Date: Name of Person(print): Revised 10/M4 rs 73rm rs pane on sec c Y P�Pen Page2of2 ' Massachusetts Department of Environmental protection BWSC-012C Bureau of Waste Site Cleanup taww Traddnp p,�rpr; � ' BILL OF LADING bwVM t to 310 tt:QIR 40.OM) SUMMARY UEET a4 ' 15134 L ACKNOWLEDGEMENT OF RECEPT OF REMEDIATION WASTE AT RECEIVING FACILITY OR . TEMPORARY STORAGE LOCATIONS Receiving Fae ty/Temporary Location Representative(print): Toe, ' Signature: /— Date: M.ACKNOWLEDGEMENT OF SHIPMENT AND RECEIPT OF REMEDIATION WASTE BY PERSON ' CONDUCTING RESPONSE ACTION ASSOCIATED WITH THIS BILL OF LADING: I certify under penalties of law that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this certification,and that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained herein is,to the best of my knowledge and belief,true,accurate and complete. I am aware that there are significant penalties,including,but not limited to,possible Tines and imprisonment.for wilfully submitting false,inaccurate,or incomplete information. Signature: Date: Z .Z 1 / f f ' Name of Person(print): Paul Coleman t c: tat/sc3 nits b prf W on recyawP� . rPage 2 of 2 e i � x i i X G Zo w a a a 1 1 .4)Aitiantice i 1 i 1 1 1 1 1 Appendix D: Immediate Response Action Transmittal Form (BWSC-105) Response Action Outcome Statement (BWSC-104) Release Notification Form (BWSC-103) 1 1 1 1 i i 1 1 1 Massachusetts Department of Environmental Protection BWSC-106 tBureau of Waste Site Cleanup Release Tracking Number IMMEDIATE RESPONSE ACTION (IRA) - 15134 TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) A. RELEASE OR THREAT OF RELEASE LOCATION: Release Name:(optional) Mr,s,; Wood em ry ' Street: 280 Putnam Avenue Location Aid: Old Post Road City/Town: -Cotuit ZIPCode: 02635-0000 ' Check here if a Tier Classification Submittal has been provided to DEP for this Release Tracking Number. Check here d this location is Adequately Regulated,pursuant to 310 CMR 40.0110-0114. Specify Program: !_j CERCLA ❑ HSWA Corrective Action E. Solid Waste Management RCRA State Program(21C 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 K). ❑_ Check here if this IRA Plan is an update or modification of a previously approved written IRA Plan. Date Submitted: ' ❑i Submit an Imminent Hazard Evaluation(complete Sections A,B,C,F,H,I,J and K). ❑ Submit an IRA Status Report(complete Sections A,B,C,E,H,I,J and K). ' ❑ 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,I,J and K). Submit an IRA Completion Statement(complete Sections A,B,C,D,E,G,H,I,J and K). You must attach all supporting documentation 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: (check all that apply) ❑ Air ❑ Groundwater ❑ Surface Water ❑ Sediments ® Sal ❑ Wetland ❑ Storm Drain ❑ Paved Surface ❑ Private Well ❑ Public Water Supply ❑ Zone 2 ❑ Residence ❑ School ❑ Unknown ❑ Other Specify. ' Identify Conditions That Require IRA,Pursuant to 310 CMR 40.0412: (check all that apply) ® 2 Hour Reporting Condition(s) ❑ 72 Hour Reporting Condition(s) ❑ Substantial Release Migration ❑ Other Condition(s) ' Describe: Suddf-- Release of approximately 25 cral 1 ons of di PG 1 fuel from an AST ' Identify Oils and Hazardous Materials Released: (check all that apply) ® Oils ❑ Chlorinated Solvents ❑ Heavy Metals ❑ Others 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 ' Re-use,Recycling or Treatrrient ❑ Biorermediation 0 On Site 4 Off Site Est.Vol.: Z5 cubic yards ❑ Soil Vapor EAraction Describe: Diesel fuel rnntami nated Soil ❑ Structure Venting System ❑ Store 0 On Site 0 Off Site Est.Vol.: cubic yards ❑ Product or NAPL Recovery ' ❑ Landfill 0 Cover 0 Disposal Est.Vol.: cubic yards ❑ Groundwater Treatment Systems ❑ Removal of Drums,Tanks or Containers ❑ Air Sparging Describe. ❑ Temporary Water Supplies ' SECTION D IS CONTINUED ON THE NEXT PAGE.. Revised 2/24195 Rimp ArfaC Fnrmc nwgr-nns nna n1n fin nartl and n11 Paoe 1 of 3 I Massachusetts Department of Environmental Protection BWSC-105 ' Bureau of Waste Site Cleanup Release Tracking Number IMMEDIATE RESPONSE ACTION (IRA) - 15134 TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) 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 of Facility: -Bandon T r i met, T nc ' Town and State: Stou-hton, MA Quantity of Remediation Waste Transported to Date: 36.4 Tons ' 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. Gl 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 Tracking Number,or a Site that is identified on the Transition List as described in 310 CMR 40.0600(i.e.,a Transition Site,which includes Sites with approved Waivers). These additional response actions must occur according to the deadlines applicable to the earlier Release Tracking Number(i.e.,Site ID Number). ' State Release Tracking Number(i.e.,Site ID Number)of Tier Classified Site or Transition Site: If any Remediation Waste will be stored,treated,managed,recycled or reused at the site following submission of the IRA Completion Statement,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 personalty 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 care in 309 CMR ' 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge, information and belief, > if Section B of this form indicates that an Immediate Response Action Plan is being submitted,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)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 Imminent Hazard Evaluation is being submitted,this Imminent Hazard Evaluation was developed in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,and the assessment activity(ies)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 B 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,(ii)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; > d Section B of this form indicates that an Immediate Response Action Completion Statement or a Request to Terminate an Active Remedial System and/or Terminate a Continuing Response Actions)Taken to Address an Imminent Hazard is being submitted,the response action(s) that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)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. SECTION H IS CONTINUED ON THE NEXT PAGE. Revised 2/24/95 4unRrcarfas Fnrms R WSC:-nn.5 nnB nin(in nart)and n11 Paae 2 of 3 Massachusetts Department of Environmental Protection BWSC-105 ' Bureau of Waste Site Cleanup Release Tracking Number IMMEDIATE RESPONSE ACTION (IRA) _ 34 TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) 51 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. �j Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any lt(s)and/or approval(s)issued by `- DEP or EPA If the box is checked,you MUST attach a statement identifying the applicable provisi 1i0F LSP Name: Soivo A. Lamminen, Jr LSP#: 6846 Stamp: Tow 'G ' Telephone: _5 0.8-9 9.7_-5 4.2 2--.------------------------- Ext.: ------- fa n FAX(optional) _50 -99-9-4—— -_ ty'1 ,; NO 6846 0 Signalure: V S Date: ----, -� -.� -.._—. ------------ — ---- ; 1. PERSON UNDERTAKING IRA: ' Name of Organization: Town of Barnstable Department NameofContact: Paul Coleman Title: -Division Sul)ervi sor ' Street: 280 Pu -nam Ave City/Town: ro to i t State: MA ZIP Code: 0 6 3 5-0 0 0 0 Telephone: 5 0 2 42 8-8 6 4 3 Ext.: FAX(optional) 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: 0 Owner ® Operator 0 Generator 0 Transporter Other RP or PRP: Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) 0 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, Paul .o l -man ,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 or entity on whose behalf this submittal is made ads aware that there are significant penalties,including,but not limited to, possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. By. it 6�� Title: Division S Deryi sor (signature) For.Town of BarnG ahl e Cemetery Dent- Date: Z �o I A (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: End.: 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. Revised 2/24/95 .SnnPmPr1#.s Farms RWSt;-nn.5 nOR n1n!in narfl anrl n11 Paoe 3 of 3 Massachusetts Department of Environmental Protection BWSC-104 1 Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME (RAO) STATEMENT & Release Tracking Number ' DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM a _ 15134 Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) A. SITE OR DOWNGRADIENT PROPERTY LOCATION: SiteName:(optional) Moss Wood Cemetery Street: _2-8 Q__P.Ltt.nam_Atienue Location Aid: Old Post Road ' City/Town: C9tuit ZIP Code: 02.635-0-020 ] Check here d this Site location is Tier Classified. If a Tier I Permit has been issued,state the Permit Number:. Related Release Tracking Numbers that this Form Addresses: __..._._.__------------------.._.__._._.-------__---- —_--._- If submitting an RAO Statement,you must document the location of the Site or the location and boundaries of the Disposal Site subject to this Statement. If submitting an RAO Statement for a PORTION of a Disposal Site,you must document the location and boundaries for both the portion subject to this submittal and,to the extent defined,the entire Disposal Site. If submitting a Downgradient Property Status Submittal, ' you must provide a site plan of the property subject to the submittal and,to the extent defined,the Disposal Site. B. THIS FORM IS BEING USED TO: . (check all that apply) Submit a Response Action Outcome(RAO)Statement(complete Sections A,B,C,D,E,F,H,I,J and Q. u Check here if this is a revised RAO Statement. Date of Prior Submittal Check here K any Response Actions remain to betaken to address conditions associated with any of the Releases whose Release Tracking ' Numbers are listed above. This RAO Statement will record only an RAO-Partial Statement for those Release Tracking Numbers. Specify Affected Release Tracking Numbers: Submit an optional Phase I Completion Statement supporting an RAO Statement or Downgradient Property Status Submittal (complete Sections A,B,H,I,J,and Q. ' Submit a Downgradient Property Status Submittal(complete Sections A,B,G,H,I,J and K). Check here if this is a revised Downgradient Property Status Submittal. Date of Prior Submittal: ' Submit a Termination of a Downgradient Property Status Submittal(complete Sections A,B,1,J and Q. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution(complete Sections A,B,H,I,J and Q. ' Specify one: For a Class C RAO For a Waiver Completion Statement indicating a Temporary Solution Provide Submittal Date of RAO Statement or Waiver Completion Statement: You must attach all supporting documentation 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. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply) ' Assessment and/or Monitoring Only Deployment of Absorbant or Contaminent Materials ® Removal of Contaminated Soils Temporary Covers or Caps ® Re use,Recycling or Treatment Bioremediation 0 On Site 4) Off Site Est.Vol.: 2-51 cubic yards Sal Vapor Extraction Describe: D;eGel Fue1 Contaminated Soil Structure Venting System ' ❑ Landfill 0 Cover 0 Disposal Est.Vol.: cubic yards Product or NAPL Recovery Removal of Drums,Tanks or Containers Cl Groundwater Treatment Systems Describe: Air Sparging Removal of Other Contaminated Media Temporary Water Supplies Specify Type and Volume: n Temporary Evacuation or Relocation of Residents Other Response Actions 0 Fencing and Sign Posting ' Describe: SECTION C IS CONTINUED ON THE NEXT PAGE. Revised 417/95 Rimarcarlac Fnrmc RW.gr-1104 and nin tin nartl PaOe 1 of 4 Massachusetts Department of Environmental Protection BWSC-104 ' Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME(RAO) STATEMENT & Release Tracking Number ' DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM _ 15134 ia Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) C. DESCRIPTION OF RESPONSE ACTIONS: (continued) ❑ Check here if any Response Action(s)that serve as the basis for this RAO Statement involve the use of Innovative Technologies. (DEP is interested in using this information to create an Innovative Technologies Clearinghouse.) Describe Technologies: D. TRANSPORT OF REMEDIATION WASTE: (if Remediation Waste was sent to an off-site facility,answer the following questions) NameofFacility Bard-on Trimount, Tnc Town and State: -S.t-auq t.9n,_MA__ __ - Quantity of Remediation Waste Transported to Date:_ 36.4 Tons ' E. RESPONSE ACTION OUTCOME CLASS: Specify the Class of Response Action Outcome that applies to the Site or Disposal Site. Select ONLY one Class: Class A-1 RAO: Specify one of the following: Contamination has been reduced to background levels. 0 A Threat of Release has been eliminated. [Class A-2 RAO: You MUST provide justification that reducing contamination to background levels is infeasible. ❑ Class A-3 RAO: You MUST provide both an implemented Activity and Use Limitation(AUL)and justification that reducing contamination ' to background levels is infeasible. If applicable,provide the earlier of the AUL e)piration date or date the design life of the remedy will end: ' ❑ Class B-1 RAO: Specify one of the following: ❑ Contamination is consistent with background levels ❑ Contamination is NOT consistent with background levels. ' ❑ Class B-2 RAO: You MUST provide an implemented AUL. If applicable,provide the AUL expiration date: ' ❑ Class C RAO: ❑ Check here if you will conduct post-RAO Operation,Maintenance and Monitoring at the Site. Specify One: O Passive Operation and Maintenance O Monitoring Only O Active Operation and Maintenance(defined at 310 CMR 40.0006) F. RESPONSE ACTION OUTCOME INFORMATION: ❑ If an RAO Compliance Fee is required,check here to certify that the fee has been submitted. You MUST attach a photocopy of the payment. ❑ Check here if submitting one or more AULs. You must attach an AUL Transmittal Form(BWSC-113)and a copy of each implemented AUL related to this RAO Statement. Specify the type of AUL(s)below: (required for all Class A-3 RAOs and Class B-2 RAOs) O Notice of Activity and Use Limitation O Grant of Environmental Restriction Number of AULs attached: ' Specify the Risk Characterization Method(s)used to achieve the RAO described above and all Sal and Groundwater Categories applicable to the Site. More than one Soil Category and more than one Groundwater Category may apply at a Site. Be sure to check off all APPLICABLE categories,even if more stringent soil and groundwater standards were met. ' Risk Characterization Method(s)Used: ❑ Method 1 ❑ Method 2 ❑ Method 3 Sal Category(ies)Applicable: S-1 ❑ S-2 ❑ S-3 Groundwater Category(ies)Applicable: ❑ GW-1 ® GW-2 Wi GW-3 > When submitting any Class A-1 RAO or a Class B-1 RAO where contamination is consistent with background levels,do NOT specify a Risk Characterization Method. ' > When submitting any Class A-2 RAO or a Class B-1 RAO where contamination is NOT consistent with background levels,you cannot use an AUL to maintain a level of no significant risk. Therefore,you must meet S-1 Soil Standards,if using Risk Characterization Method 1. Revised 4l7195 Cnnorcn,fnc J:^ my RIArQr_Md and/14/1 fin norfl pans 9 tiA Massachusetts Department of Environmental Protection BWSC-104 ' Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME (RAO)STATEMENT & Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM _ 134 Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) 5 ki G. DOWNGRADIENT PROPERTY STATUS SUBMITTAL: ❑ If a Downgradient Property Status Submittal Compliance Fee is required,check two to certify that the fee has been submitted. You MUST attach a photocopy of the payment. ❑ Check here if a Release(s)of Oil or Hazardous Material(s),other than that which is the subject of this submittal,has occurred at this property. ' Release Tracking Number(s): Check here if the Releases identified above require further Response Actions pursuant to 310 CMR 40.0000. ' Required documentation for a Downgradient Property Status Submittal includes,but is not limited to,copies of notices provided to owners and operators of both upgradient and downgradient abutting properties and of any known or suspected source properties. 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 care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge,information and belief, > if Section B indicates that a Downgradient Property Status Submittal is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii) is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in 310 CMR 40.0183(2)(b),and(iii)complies(y) with the identified provisions of all orders,permits,and approvals identified in this submittal; ' > if Section B indicates that either an RAO Statement,Phase 1 Completion Statement and/or Periodic Review Opinion is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as sot 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 I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if 1 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,N any,are(were)subject to any ord ) permit(s)arKVor approval(s) issued by DEP or EPA If the box is checked,you MUST attach a statement identifying the appli LSPName: Toivo A_ Lammin -n, Jr_ LSP#: 6846 Stamp: TO Telephone: 5 0 8-9 97-5 4 2 2 Ext.: A. g. f<. l Axc l�4fe},,tR ;s ,J% FAX(optional) 5 0 8-9 9 9-4 0 6 0 �, ko 5846 Signature: Date: L PERSON MAKING SUBMITTAL: NamecfOrganization: Torn of Barnstable m ryDeD nartment NameofContact: Paul Coleman Title: Division S upprvi sor Street: 280 Putnam Avenue City/Town: Cotttit State: MA ZIPCode: 02635-0000 Telephone: 5 0 8-4 2 8-8 6 4 3 Ext.: FAX(optional) ' J. RELATIONSHIP TO SITE OF PERSON MAKING SUBMITTAL: (check one) ® RP or PRP Specify: O Owner 4 Operator ❑ Generator ❑ Transporter Other RP or PRP: ' ❑ Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) ❑ Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) ' ❑ Any Other Person Submitting This Form Specify Relationship: Revised 417195 Stinarcarlwz Fnrmc RW.gr-nn4 and of n fin na►t1 Paoe 3 of 4 Massachusetts Department of Environmental Protection BWSC-104 ' Bureau of Waste Site Cleanup RESPONSE ACTION OUTCOME(RAO) STATEMENT & ReleaseTraddng Number ' DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM ❑ Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)rl<40.1056(Subpart J) 4 15134 K. CERTIFICATION OF PERSON SUBMITTING DOWNGRADIENT PROPERTY STATUS SUBMITTAL: I, attest under the pains and penalties of perjury(i)that I have personally examined and an m>familiar with the infoation contained in this submittal,including any and all documents accompanying this transmittal form;(i)that,based an my inquiry of thelthose individual(s)immediately responsible for obtaining the information,the material information contained herein is,to the best of my knowledge, information and belief,true,accurate and complete;(ii)that,to the best of my knowledge,information and belief,11the person(s)or entity(ies)on whose 1 behalf this submittal is made satisfy(ies)the criteria in 310 CMR 40.0183(2);(N)that[the person(s)or entity(ies)on whose behalf this submittal is made have provided notice in accordance with 310 CMR 40.0183(5);and(v)that I am fully authorized to make this attestation on behalf of the person(s)or entity(iies)legally responsible for this submittal. Ifthe person(s)or entity(iies)on whose behalf this submittal is made is/are aware that there are significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. By. Title: ' (signature) ' For --------- — -- Date: ------- (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: EA.: FAX(optional) L. CERTIFICATION OF PERSON MAKING SUBMITTAL: If you are completing only a Downgradient Property Status Submittal,you do not need to complete this section of the form. I, Paul Co 1 eman ,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. [the person or entity on whose behalf this submittal is made amrs aware that there are significant penalties,including,but not limited to, possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. ' By Z'k Title: ni vi si on S lot-ryi sar (signature) c For. Town of Barns able m rVDpnar m .n Date: _r A 7 (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,AND YOU MAY INCUR ADDITIONAL COMPLIANCE FEES. Revised 417/95 SunamAdns Fnrmc RWSr-n04 and of n fin narfl Paoe 4 of 4 Massachusetts Department of En r iWa&r6 ;; BWSC-103 Bureau Of Waste Site Cleanup ' : !: Release Tracking Number RELEASE NOTIFICATION & NOTIF ION REtRACTI 4❑- 15134 D FORM Pursuant to 310 CMR 40.0335 and 310 M Fwa K assgrted by DEP A. RELEASE OR THREAT OF RELEASE LOCATION: SOUTHEAST R StleW 280 Putnam nvu - IAcationAid: Old Post- Road ' City/Town: Cotui_t ZIPCode: 02635-0000 B. THIS FORM IS BEING USED TO: (check one) jj Submit a Release Notification(complete all sections of this form). Submit a Retraction of a Previously Reported Notification of a Release or Threat of Release(complete Sections A,B,E,F and G of this ' form). You MUST attach the supporting documentation required by 310 CMR 40.0335. C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE(TOR): Date and time you obtained knowledge of the Release or TOR. Date: .11 L2:3234_ Time: 1:-QO_ Specify: AM ;I PM The date you obtained knowledge is always required. The time you obtained knowledge Is not required if reporting only 120 Day Conditions. IF KNOWN,record date and time release or TOR occurred. Date: 11 /2 3/99 Time: _8:00 Specify. AM PM J. Check here if you previously provided an Oral Notification to DEP(2 Hour and 72 Hour Reporting Conditions only). Provide date and time of Oral Notification. Date: 11/2 3/9 9 Time: 8:5 5 Specify AM PM Check all Notification Thresholds that apply to the Release or Threat of Release. (for more information see 310 CMR 40.0310-40.0315) 2 HOUR REPORTING CONDITIONS 72 HOUR REPORTING CONDITIONS 120 DAY REPORTING CONDITIONS ' Sudden Release ❑ Subsurface Nan-Aqueous Phase ❑ Release of Hazardous Material(s)to Sal or Liquid(NAPE)Equal to or Greater than Groundwater Exceeding Reportable ❑ Threat of Sudden Release 1/21nch Concentration(s) ❑ Oil Sheen on Surface Water ❑ Underground Storage Tank(UST) ❑ Release of Oil to Sal Exceeding Reportable Release Concentrations)and Affecting More than 2 Cubic ❑ Poses Imminent Hazard Yards ❑ Threat of UST Release ❑ Could Pose Imminent Hazard ❑ Released Oil to Groundwater Exceeding Reportable Release to Groundwater near Concentration(s) Cj Release Detected in Private Well ❑ Water Supply ❑ Subsurface Nan-Aqueous Phase Liquid(NAPL) ❑ Release to Storm Drain ❑ Release to Groundwater near Equal to or Greater than 1/8 Inch and Less than 1/2 ❑ Sanitary Sewer Release School or Residence Inch (Imminent Hazard Only) ' List below the Oils or Hazardous Materials that exceed their Reportable Concentration or Reportable Quantity by the greatest amount If necessary,attach a list of additional Oil and Hazardous Material substances subject to reporting. Name and Quantities of Oils(0)and Hazardous Materials(HM)Released: O or HM Released O HM CAS# Amount or Units Report ConcentrationspliApplicable (check one) (if known) Concentration Applicable (RCS-1,RCS-2,RCGW-1,RCGW-2) Diesel Fue1 W ❑ 25 Gal _ 1 ❑ ❑ Ell ' D. ADDITIONAL INVOLVED PARTIES: ❑ Check here if attaching names and addresses of owners of properties affected by the Release or Threat of Release,other than an owner who is ' submitting this Release Notification(required). ❑ Check here if attaching Licensed Site Professional(LSP)name and address(optional). ' You may write in names and addresses on the bottom of the second page of this form. Ra�icari�H/A5 giinargAr1AC Fnrm RW.Rr-nna Pena 1 ri 7 Massachusetts Department of Environmental Protection BWSC-103 Bureau of Waste Site Cleanup Release Traftv Nuraw RELEASE NOTIFICATION & NOTIFICATION RETRACTION 0- FORM Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C) If assigned by DEP E. PERSON REQUIRED TO NOTIFY: ki NarredOrgenizzbon: Tnwn of Rarnstahl e - Mosswond Cemetery ' NamedContack Paul Coleman Title: Ili vi si on S un - vi so Street: 280 Putnam Ave- City/Town: r atui-t— State: MA ZIP Code: 0 2 6 3 5-0 0 0 0 Telephone: �.0 8-4 2.8�.6 4.3.-- -- -- - ----- Ext.: - ---- — FAX(optional) -- ------- ----- ' F. RELATIONSHIP OF PERSON REQUIRED TO NOTIFY TO RELEASE OR THREAT OF RELEASE: (check one) J RP or PRP Specify. Owner V Operator Generator Transporter Other RP or PRP: Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) ii Any Person Otherwise Required to Notify Specify Relationship: G. CERTIFICATION OF PERSON REQUIRED TO NOTIFY: I }?au 1 Co 1 eman - ,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 knoNledge 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. Ifthe person or entity on whose behalf this submittal is made amrs aware that there are significant penalties,including,but not limited to, possible fiT and imprisonment,for willfully submitting false,inaccurate,or incomplete information. Lk ' By. Title: Division Stlpervi sor (signature) - - - - For. Town c)f Rarns ahl e m e �j Denar m n Data (print name of person or entity retarded in Section E) Enter address of the person providing certification,if different from address recorded in Section E: ' Street: Cityrrown: 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. LSP #6846 ' Toivo A. Lamminen, Jr. Atlantic Environmental Technologies, Inc. 86 Faunce Corner Road, Suite 410 North Dartmouth, MA 02747 ' (508) 997-5422 fax: (508) 999-4060 RMACM 4/1to5 'Zimarrerine Fnrm RIN.C(`-n(14 P�no of 7 1 1 1 1 1 1 1 1 1 i i 1 1 1 1 1 1 1 1 TOWN OF BARNSTABLE DEPARTMENT OF PUBLIC WOE STRUCTURES&GROUNDS DIVISION STMIM � m 9 i6j9. �0 �prED MPy' Stephen J.Sundelin supervisor,Cemetery operations (508)428-8643 2$0 Putnam Ave. , Fax(508)420-0189 Cotuit,MA 02635 Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS 014 �ElNyf NTORY NAME OF BUSINESS: _rCrL01''► OaAXi>4C -fie e Q k94V 1 CrZ 3 BUSINESS LOCATION: �QZ® - INVENTORY MAILING ADDRESS: O TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? e-A. TYPE OF BUSINESS: �h �'►$ �s =-S� '�•r.� ,e- wgx i : ire st ict'INFORMATION/RECOMMENDATIONS: � '' e: w a,o. o.;A 5 ¢..�.�.,•- • Cr r v,,oA Avr k c t_* K e W Gt.Irt� cs'FS cm�s`f-�- . L a. bet Pu"&..t &AA 041 , Waste Transportation- LAI Last shipment of hazardous.waste: Name of Hauler• eAA. "c-"A _Destination. Waste Product: . a4.A : 504A ' '- Licensed- S No VI NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month re uiresa lic a se fro the PublIi ealth D'v sI LIST OF TOXIC AND HAZARDOUS MATERIALS S G- �jac�.G'fr'ea �ns� • The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes 2't3 Road Salts (Halite)/.rC.Q Mq.� / Hydraulic fluid (including brake fluid) Refrigerants ✓ Motor Oils Pesticides �EW USED (insecticides, herbicides, rodenticides) as� oline,Jet fuel, Aviation gas Photochemicals (Fixers) �eig� kerosene, #2 heating oil NEW USED c to Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) '4 Caulk/Grout Swimming pool chlorine N Battery acid (electrolyte)/Batte_1j Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes S Car waxes and polishes ' 044Fertilizers Asphalt & roofing tar PCB's Z °Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): & Laundry soil& stain removers.,, o-� - - L (including LWaQW 2..� Spot removers &cleaning fluids (dry cleaners) !� Other cleaning solvents Bug and tar removers e-C Gv2ff C.//,s Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable-Health Department Page 1 f �� HAZARDOUS MATERIALS INVENTORY SITE VISITS � 4 DBA: Structures&Grounds Fax Corp Name: Mailing Address 1 Location: i800 Pitchers Way,Hyannis Street: 800 Pitchers W y _. C. .. ... ...:.... ...__..._ mappar: City: Hyannis Contact:` ®ems '�5-4 e— State: Ma Telephone: Zip: 02601 Emergency: Person Interviewed: Business Contact Letter Date: ...... ._.,.... ........ Category: Miscellaneous Inventory Site Visit Date 9l3/2004 _.._... .......... Type: Municipal Facilty Follow Up/Inspection Date: _ 91 public water indoor floor drains El outdoor surface drains license required CV ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed �To-e S� ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir -- ------- ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: .......................REMARKS: 1999-All vehicles @ Highway Dep.Have a small engin compliance: hL1 repair done on site.Have a laundry service.Use Speedy dry.ORDERS: 04— Remove 55 gal.Haz.Waste;55 gal.label.unknown. , - l � Sm� s>a� 7 �S 1 0 j '� j zr Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals /BZgty's 111 gals or more S Waste Transp er: ;Chemical Waste Management Fire District: Last HW Ship ent Date: Waste Hauler icensed: 40 ar,�,`'t cnt , ....... ..... C yV, sue, ��- ING me A " - 5 vim- 011� F gr PETER , I No' . 29733 OF RICHARD ` E .�Nm 24%8 , Lo7 3f3 .3 r , i Y 1_ y N 5' Z 3z DESIGN' ?A 30' \� 51 NCGLE P=Aml Ly 3. 13F��z�M z9 Jam, 1�201� lwp \33 �33 GArZFLAGE C,xi _pC'1Z. ��sn� —` FN D. laA I LY FL<WQ 1 i o k 3 33� G-t hD �r `� I •. i 3/ 5.1=pTI G -TANK= X ISo�o Lf95 C,;P� _ H„�. 9 . so' I I I 2 VSs G' Ci3 Z: A Z6A I I �`\ •�\ zg 1. _ T1�tvlL in N ,� $ �t 5PO541.. PIT: -U U5E: loon GZ,d,(,. _ ) �L Z7 , 51 rx wa A42F-A- s 51 R. � I�� i l\ 37S" G 1? tom, =`, I zs , z44 �5. Z5 3 \ o 31 So 51= h 1� O So 7Z)TN_ vasl6tj= 425- GP.D, TOTAL. t4&,I L Y , bW 33 o G R[D, u Zl/ O FZ. L-t=SS ' I fi f cL� Fes_�v. F3 S,430 W)TN E.�6 GD $Y Pq y C LA�J D C-RS C3:0• H. �wr�✓�1�.. I / EL 30,8 ' hG= Z 7'''' 1:G= ZG. ry PN 3 0 z zs.g /crw 1000 b16? �l QvZS �X Gt.AL Z g, N�/. . Lsk_1-1 z¢ 5 1'1 G c�r,T PIT Sgwo YNiT N1IQV, 1 Nv , `, 31y To lyz Z¢Z, z4.4. Y�GHCh f STZ�NE `• �'Lw. � 7.oN T_ 710 4 3 f FoPID g h1,d 1=L Lt-4 I hL40Q I Gt✓Tzl"I P( THA7 _TP. �v�(� �o�.i SfJlovV I'Q T N ot�l G01.�[�L`�S W I?►-� � S�G�L-1 ti E' RG2�rGT E12 I_AQ tD jtJ�z�Q(OFZ4! Ad 417� �a'�K. �zEQUt7-eI C-PTS coF- THt= o�-rEx�vlt.�k-„M�ss, TpyU1-� c�F- l n/st /a-ti b 1-5 /O � TF-0 WIT4 I N TH I= 1 U pi- I tJ I TI A 1 S IFU& N I s No7 p46er-> d K),d,N 11.J U melli-f' i5tUTz_VEFY A N,tom ©)=FS�.TS sW$1. 15H L.p-T L_INeS, I FINISH GRADE OVER TANK EL.= �t FINISH GRADE OVER I 9 MIN DISTRIBUTION BOX= �f •� \p � � 4, � -I. I'L .� Nv �. ,/ EL. 96.Of w o I RISERS TO WI THIN .7; X MAX 6» OF RN/SH GRADE 9" MIN FIRST 2' LEVEL ; ,� 2� m ,. SER TO WITHIN {• 9 MIN. 3 MAXC6' OF FINISH GRADE BACKFILL. BACKFILL BACKFILL' 36" MAX. Z =_ __�_ __--....�.-.. ti .� _ _ -_ -_- _____ i EL. 93.31 F _ ___ -_-__CLEAN BACKFILL _ -_ ___-_ LOAM ND SE --- i - -- - - - - _ - -- - - - - _=__ --= - ' - - - - -_ -_____= _ d Et 92.73 3„ PEASTONE (TYP.) a 8 - - . - -- -- - - I -CLEAN - -_ -- g --- I BACKFILL a ¢ 1=93.7 93.25 �_=_ 10" 10" M N � 14 =____�_- 1=92.95---- -- 0 /=92.78 2.0' a a 6» __ 1=93.Q I-•__= - _ ----_ 3/4» _ 1-1/2" DOUBLE WASHED STONE 2 - -- MlNtMUM 48" GAS _ CA m m m m 3" OROP AFFLE __ j 3 _ _ _p 100R OF o 0 o a 20OX OF DESIGN FLOW DESIGN FLOW •� MIN. 946 GAL MIN. 473 GAL •�' N `� `r g 6 OF 3 4 COMPACTEp C USEED STONE 6" OF 3/4" COMPACTED CRUSHED STONE , , a ' - 4» SCH. 40 PVC 4„ SCH. 40 PVC ' ._._.UNDISTURBED EARTH , l DISTRIBUTION DISTRIBUTION I TYPICAL DISTRIBUTION BOX DETAIL LATERAL 2' LATERAL �TYP.) 2 T 1500 GALLON SEPTIC NOT TO SCALE 25' owl-I , DUAL COMPARTMENT 5 MIN. 0 TANK PROFILE PROVIDE 3 OUTLET DISTRIBUTON BOX (1 PLUGGED) TYPICAL TRENCH PROFILE NOT TO SCALE INSTALLED ON LEVEL STABLE BASE. INSTALL FIRST TWO FEET t,Z,y PROPOSED 1500 GALLON CONCRETE SEP17C TANK GROUNDWATER NOT ENCOUNTERED ESTIMATED GROUNDWATER EL. = 83.65 e _ -e DEPTH: _ OF OUTLET PIPES LEVEL. UNDISTURBED EARTH OR ° Q m M DEL 1500 H-10 B�ACME PRECAST OR'EQUAL MODEL NO. D6J (H10) BY ACME PRECAST OR EQUAL COMPACTED BACKFILL O o 3 PAVED AREA LANDSCAPED AREA m E , . ; LeBARON SEWER �, F V M m 00 c CLEANOUT RING ._. _.,. .__ _..__.m.w ...,. . �.._ ..." _. _,.... _w _. _ ea r: a 910 W A o �. ., t. ......,, •� . fr.,' ,, : � •.LL. & COVER LAO .____.. ._".�.�_ __._.. _.�. ..__ ,_._ _._.r_,._. _._u_...._ m.,._.,:___"_ _"._��_ _,1_..�__ ,..,_,.�._. _._,. _.� _...,._,__ _._.�.__�� � s. ' #fi, CLEAN-OUT ADAPOTOR oR EQUAL DESIGN CRITERIA ZONING & RESOURCE PROTECTION NOTES , y "� g N + = AND PLUG .e m r> y: „ s ,,!- .-, .:.v,':4zj...r n ,,., �_,. •"t�-"� ,. .--..rc�` ''R' �s;' f`r. � sd'�, `' ...._ ._.,.,_.__..- .,_._,_..,...._._ _.._,...,__,. ..,_,_,_._.. ...._._._.._.,....__...... ,�... _ ,.,_S 10 ,� (� � ._"USE IPUBLIC PARK IN% y .'~ ,°C a M s O Cp DO Q e FINISH GRADE FLUSH TOL/ETS 1. ASSESSORS MAP#: 37 PARCEL: 9 y a ._. o� FINISH GRADE OWNER OF RECORD: TOWN OF BARNSTABLE CEMETERY �' d r u 6" DESIGN FLOW i 10,GPD/PERSON = �' `� o f0 ) AT PAVEMENT .,.,_..._ N Y "j ADDRESS: 367 MAIN STREET, BARNSTABLE MA 02604 NUMBS DF EMPLOYEES _20 P OPLE R E t . GARBAGE"DISPOSAL, NO .,.. I , ���* � 7 � � ,�'� x �••• 5 � g �€ 2. THE LOCUS IS LOCATED IN FLOOD ZONE C AREA OF MINIMAL FLOODING/1 rk , ?=.{ uq. z',-` ''M4 # y3'` _ tic - •'N# "e `.� '• 0 t GPD i :• _ _, ,: . ': ON 1 TOTAL DAILY FLOLW 20 00MM F LL/ __..• _ _ _.._ _ AS SHOW N F.I.R. AP 50001 01 . ..,,. 4K •.. .' _ 12" ORDINARY BORROW __..,__. _n. ._.. I N 0 M M SD x I i I I I i I SEPTIC TANK€ q w ,. .. . . _e.._ T_ ...n"., _ .. _.:, _ _,_s. ..__ ._ _..1ww._-_ �._._ �, .�,_. . 3. THERE ARE NO SURFACE WATER SUPPLY OR GRAVEL PACKED WELLS Y`,r• •`s .",� : ? 1 s- Li'iry'a�''2 i' , .n.. _ d F C " .. . f f,F _ . SEE PLANS FOR CONCRETE 45 PVC BEND , ..__ , _ ,�.. �. _..___ -� n WITHIN 400 NO TUBULAR PUBLIC WELLS WITHIN 250 . \C�. : �`• �„ , INVERT AND PIPE SIZE COLLAR OR WYE CONNECTION SEPTIC TANK(200% DESIGN FLOW) 400FGAL I DWATE PROTECTIO OVER Y D TRICT OR A i 4. SITE is Nor IN A GROUN R N LA IS e ., 'fi "'r„t,,-s"�`.r •P ..„,_ x, J•....'�, f" '":,;:� { ., ,a �. ...7>„k�,vr,5 1,.,( ..�"„ .. ,..,,. _ _ ..,c..... ...r.,., .,.� USE EXISTING 1,000 GALLON SEPTIC TANK R � ZONE ll RECHARGE AREA. FLOW ----- �.•-O C Uv�' P�-AN LEACHING SYSTEM DESIGN CRITERIA � . _._ GENERAL NOTES SCALE: I'�=2000' TYPICAL C LEANO UT DETAIL I SOIL ABSORPTION SYSTEM, I NOT TQ } _... __ ._ .._ _,... _,..__ . .. _... ___ .._ .M.r_.._._ __ .__. _. _.-_. _ .._.__ ,..; 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND , ---------,� _."__ __._._.. _._..A .. _ ,.mr�___ ___._�.. ,._ __.t CONSTRUCTION METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF LEACHING SYSTEM USED ;STONE TRENCHES _ THE STATE ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF ^ 0= DESIGN PERCOLATION RATE 2€MIN/lN THE BARNSTABLE BOARD OF HEALTH. LLI - SOIL CLASS:a.__,.._ I¢. ►�`.I 4 GRAPHIC SCALE LONG TERM ACCEPTANCE RATE(GTAR) 4 0 741GPD/S F. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ( TOTAL AREA REQUIRED TITLE 5 271'S F OF HEALTH AND THE DESIGN ENGINEER. _.._. 0 ;,_._ 3. USE 4 IN. SCH. 40 PVC PIPING WITH WATERTIGHT-JOINTS UNLESS in EN r4y 1�d Q I „ TOTAL AREA PROPCJ►SED I NT OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE PLACED ON A _ I COMPACTED FIRM BASE. 0 , '� ` IN FEET A sideml/ 25'+2'+ 25'+ 2 x 2'x 2 216 I S F ' 1 inch _ 20 ft A(botfom): 25'x 2'x 2. '. 100 S.F 4. T N- 1 F R �) __...,,. . r._..__.w,._.. _..__ S _. _. . HIS O 5 TE WASTEWATER TREATMENT SYSTEM 1S NOT DESIGNED O_ TOTAL AREA 316 S F € USE WITH A GARBAGE GRINDER. O c� ` FENCE TOTAL FLOW. . 233 GPD BENCHMARK: .... USE 2 25'L X 2'W x 2'D LEACHING,TRENCHES p 5. ELEVATIONS AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON ❑ _ . _..__ w_ _,._. _. ,. _.._ ._ . _ .. ."_ r . . .__.. . FIELD SURVEY AND PLAN BY HORSLEY WITTEN GROUP PERFORMED CY) PK SET 3 EL. 89.97 _ _ _ _ _ DECEMBER 15, 2006. WASTEWATER SYSTEM SCHEDULE OF ELEVATIONS 6. ELEVATIONS ARE BASED ON AN ASSUMED BENCHMARK. O .� EXISTING PROPOSED i �' © 7. PROPERTY LINES ARE PROVIDED BY THE TOWN OF BARNSTABLE GIS x _ .. a. . DEPARTMENT AND ARE ONLY APPROXIMATE. C NO INVERT AT FOUNDATION; 93 75' a a PAVED _" SEPTIC TANK INLET i 93 55 93 25? 8. CALL "DIGSAFE" AT LEAST 72 HOURS PRIOR TO COMMENCING PARKING ..R CONSTRUCTION AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE 00 AREA SEPTIC TANK OUTLET a 93 30 a 93 00 wD-BOX �UTLETI 92,78 AGENCIES NECESSARY TO FIELD VERIFY LOCATION OF EXISTING UTILITIES. INLET� 92 95 I \ ' 9. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL ❑ - GARAGE TRENCH INVERT IN s2 _ POINTS WHERE PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. o �- I TRENCH INVERT END` 92 61 +`- 3 A N _,..,m. BREAKOUT s m „ µ 93 31µ 10. REFER TO SITE PLAN FOR LOADING CAPACITIES OF INDIVIDUAL SEPTIC tip 0 u.._.,.w _80TTOMOFTMSYSTEM�'µ •90 73 SYSTEM COMPONENTS. ` ESHGW TECH BULLETIN 92-001 83 65 ,� RETAINING (__n.r. -_.. ) �-`-`2 �yVALL \ 11. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT, DUST AND m FINES. `" Tv 12. THE CONTRACTOR IS RESPONSIBLE TO REPORT ANY DISCREPANCIES ❑ _ - ; FOUND IN SITE CONDITIONS FROM THOSE SHOWN ON THE PLAN TO THE - DESIGN ENGINEER. Q• " �- ' INSPECTOR DON DESMARAIS +INSPECTOR DON DESMARAIS CONNECT TO SOIL EVALUATOR ELI7ABETH KITT1LAa ISOII EVALUATOR lELIZABETH KITTILA, fn EXIST. PIPE EXISTING x._ , _ _ _.- __..r. ,.._,.__.. _, ... 13. CHANGES TO EFFLUENT FLOW, GRADING OR LANDSCAPING, EITHER BUILDING ,DATE 1/26/2007 DATE 1/26/2007i m '1 - ON-SITE OR ADJACENT TO THE SITE, OR FAILING TO PROPERLY INSPECT (#280) _ P# s M 11593° mP# 11593a Gw" OR PUMP THE SEPTIC TANK MAY EFFECT THE PROPER FUNCTIONING OF c� q�k�gY TOP OF FDN. j" TP 1 ' TP 2 THE LEACHING SYSTEM. G� _.,.u.._. .,_.. ._ _ .. w EL 96.75 ODz' E967 I i 00 '` ° I965 / 6- FENCE 36 ,". . _,._._..... _. _ �_ - - _ 14. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 SHRUB ' _m..,. .. . __._ _,._,..m...T .n-. _--- . _.__ s _..._ _ I,., __...__... ,_ _ ,._"_, � YEARS. EXISTIN SHRUBS FENCE FILL FILL M t� ~y TEE 1 0 95.7 95 3 1 15. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION , SEPTI CLEAN 3 UGE �- TELE ' 1 2 }' cfl �' ' `� UGE--- _ -' "'---- A s J A NECESSARY TO LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE �y ❑ SYSTEM OU 20'M ` . UGE--___._ _._,. ._w._ _,._ w . _.." 5.._.._ .. . _._..__wrv. .....____._ _._. ... w,. .W .. . ._ ...w __a. .. ..__" w... . _,v.w... DISPOSAL SYSTEM REPRESENTED ON IT AND SHOULD NOT BE USED FOR f IN I g _ I ANY OTHER PURPOSES. -L r �, TO BE ) ,� ,, � SANDY LOAM E � ; SANDY LOAM ABANDONED PROPOSED 10YR 3/3 I a, 10 YR 3/3 Y PKBENCHMARK: SSE NOTE 16) ►�' TP-1 31 150b GALLON �-�. l 15 95 2 2 0 ; t 94 5 1 16. ( 0 A a� v �' Q w L_5• 1500 GA LOMENT - , EXISTING SEPTIC SYSTEM 1, 00 G LLON TANK, LEACHING AREA AND m , EXIST. cc + 8 & B # t M p DBOX SHALL BE ABANDONED IN PLACE IN ACCORDANCE WITH TITLE 5, o M p_.. ... .. _. _._,_. .w EL. 100.00 TANK o S=1% SEPTIIC TANK _... "i " Mw. F _ .."" __._... " 310 CMR 15.354(3). TANK SHALL BE PUMPED DRY RUPTURED, AND "�. � c� , PROPSED LOAMY SAND g LOAMY SAND FILLED WITH CLEAN SAND. t t .� S 11 3-OUTLET L 7 s I 10YR 5/6 ° 10 YR 5/6 a. c "' S=1% D-B0 f r.._.__y3.0 93 7..•.__f F3_� 93__5__, INSPECTION NOTES w A 1 o Q " �� E _.• _.. _._._.._ _ _.__ ._ Registration: V .a REMOVE SECTION CONCR�E 148 �'Q, ( 1. FINAL CONSTRUCTION INSPECTION OF ALL SYSTEM COMPONENTS INCLUDING c WALKWAY BETE CURB t „ V s INVERT ELEVATIONS ARE TO BE CONDUCTED BY THE DESIGN ENGINEER AND � tNOF • 4" S H.40 PVC - - = 42 - - -- - rvI -- THE BOARD OF HEALTH OR THEIR REPRESENTATIVE PRIOR TO BACKFILLING sz REPLACE/REPAIR CD AS NECESSARY L= S=l% p _F. MEDIUM � "► Ri SYSTEM. FAQ �EWgY SAND MADIUM 2. IT IS THE RESPONSIBILITY OF THE CONTRACTOR(S) TO MAINTAIN UP TO t2a�t '~ 1 SAND 54" 2.5 Y 7/3 w-, i DATE AS-BUILT MARK UP DRAWINGS AND NOTES (PREFERABLY IN A co PERC TEST 2.5 Y 713 SURVEY FIELD NOTEBOOK) INDICATING THE HORIZONTAL AND VERTICAL CONCRET b. E CURB - ! 2 MINANCH I LOCATION OF ALL SYSTEM COMPONENTS INSTALLED. THESE MARK UP DRAWINGS AND NOTES WILL BE UTILIZED BY THE ENGINEER FOR THE Project Number: PREPARATION OF AS-BUILT PLANS. 61 38 PROPOSED LEACHING _ I _ 11.0"'' 85.7 110 ; 85.5 E TRENCHES 2 ® - Sheet Number: 2' WIDE X 2'DEEP X y_� -`"'- NO GROUNDWATEWMOTTLES NO GROUNDWATER/MOTTLES 25' LONG `' -� Q � Of 0? c6