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Home My WebLink About0206 STARBOARD LANE - Health 206 Starboard Lane - Osterville A= 166-053 I r t� Massachusetts Department of Environmental Protection Bureau of Resource Protection k Well Completion Reports a Well Driller C r.a Please specify work performed: Address at well location: P�h C15 [ew Well v l Street Number: Street Name: 1-4 + 206 STARBOARD LANE r Please specify well type: Building Lot#: Assessor's Map#: OD Irrigation 166 r.� Assessor's Lot#: ZIP Code: Number Of Wells: 053 02655 City/Town: Well Location BARNSTABLE In public right-of-way: GPS North: West: 41.63844 70.36459 Subdivision/Property/Description: Mailing Address: �i click here if same as well location address Property Owner: Street Number: Street Name: JOSEPH KELLER 91 ICE VALLEY ROAD . City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02655 Board of health permit obtained: l!YYes r Not Required Permit Number: Date Issued: W2018 017 05/11/2018 Go US Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock (Auger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid 0 20 Fine To Coarse S YES NO � Loss Addition 40 Fine To Coarse S w Brown YES NO (Fast r Slow -- 20 N Loss Addition 40 50 Fine To Coarse S i* Brown + C Fast t Slow YES NO Loss Addition . LIGHT BROWN t f` L _ C {" 50 55 Medium Sand 1>i` Brown ('Fast r Slow YES NO Loss Addition � 111 55 60 Mediu � t^ Br m Sand own Fast f Slow_.IL Lss Addition YE _............ __. I-1 .._...._....._.......__.._............. WELL LOG BEDROCK LITHOLOGY _.---.--......_..........._...._. __..__...__......_........_............_.___.._.___._............. ....._.._.............._.__._.____ Loss or Extra From(ft) Tol.ft) Code Comment Drop in Extra fast or addition of Visible Rust Large drill stem slow drill rate fluid Staining Chips P Choose Code J YES NO Fast Slow Loss Addition if Yes r Yes ADDITIONAL WELL INFORMATION Developed Disinfected G Yes('No Total Well Depth 60 Depth to Bedrock Surface Seal Type None _ �racture Enhancement 'Yes No CASING rIs Casing above ground? From To Type Thickness Diameter Driveshoe (0 jPi= Polyvinyl ChlorideSchedule 40 �, 4es 0 � (_�_ SCREEN No Screen From To Type Slot Size Diameter 56 60 Stainless Steel Well Point 0.012 WATER-BEARING ZONES r DrVVELL(,To pm) 36 :._._.... 60,___...._.._ 12._ _ PERMANENT PUMP(IF AVAILABLE) ( w Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) 3 Wire Variable Speed 1 Pump Description ISubmersible � Horsepower 1/2 Pump Intake Depth(ft) 54 Nominal Pump Capacity(gpm) 25 ANNULAR SEAL/FILTER PACK Water Batches Method Of From To Material Weight Material Weight (gal) (count) Placement UC� Choose Material F-- Choose Material � I- Choose One WELL TEST DATA ' Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 6l7/201 B Constant Rate Pump 136 J WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured COMMENTS E WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. PATRICK Monitoring[M] Supervising Driller DESMOND, DrillerDESMOND Registration# 877 Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 024 Date Job Complete 6/18/2018 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. I Co(v -o 6,3 - ; CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory(1 - iA009) �i.ACriOsw�/ �, Recipient: Sally Desmond Order No.: G1:8106737 rd' Desmond Well Drilling Report Dated:. 0 6111/2 0 1 8 P O:Box 27.83. Submitter:; Well Driller Orleans, MA 02553 Description;, Contract#:r Month 1> Laboratory ID#: 1 810.6737-01 , Matrix: Water Irrigation Well e Sample.#: Sampled: 06/07(2018 13:00 By.;. DWD Collection Address: 206 Starboard ln,.Osterville Received:.: 06107/2018 14:00 By: Tfiiago. Sample Location: irrigation 60733' Turn Around.: 48.Hr.Rush Routine M ITEM - -RESULT, , UNITS RL., MCL+. METHOD# ANALYST TESTED TIME Nitrate as Nitrogen 4.9 mg1L ;0,10 10 EPA 300 0;' LAP 06/07/2018 11:55` Iron. 01,14 mg1L 010 0.3 SM 31116: LAP 06/11/2018 15:12 Manganese. 0,13 ri gLL 0.025 0.0.50' SM 311'16 LAP 0611//2018 15:12 pH 6:$ PH AT 25C NA: 6.5=8.5: SM 4506 H=B; DCB 66/07/2018 8:05 Sodium 40 mg/L 2.5 20 SM 3111R LAP 06/11/2018 15:.12 I Total Coliform Absent P/A 0 0 SM.9223 RG 06/07/2018 16:19 Conductance 360. umohs/cm 2.0 SM.2510.B DCB 06'/07/2018 Irrigation'60Y33` ................. Attached please find the laboratory certified parameter list. - 1. ,�- Approved By: (Lab Director). ND=None petected. RL, = Repo.rting.Limit MCL=Maximurn Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-3M6605 Page:.. 1 of 1 Commonwealth of Massachusetts _ "I"I le 5 Offidal Inspects®n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 206 rd Starboa -_ _ Lane C Property Address ------------------ ----- ------ C Tru:dy_o: Michael Sullivan Owner Owner's Name ---------- --------- P information is Cfi required for every OsiervillE _ _— Ma. 02655 10/27/2016 page. City.'To,vn State Zip Code Date of Inspection Inspection results must ba submitted on this form. Inspection forms may not be altered..n y way. Please see completeness checklist at the end of the form. Important:When fillingng outforms A. General Information out forms on the computer, use only the tab Inspector: key to move your cursor—do not Michael - use the return ___--_--T BlSlenere— - ---- ---- key. Name of Inspector — ------ —Ca e Septic—Inspections —_ r� Company Name • 624 Old Barnstable Road Company Address----"*------ — ret�, Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 — --—------- —-------- ------ _S1393_8 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported belov; ?s true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Z Passes ❑ Conditionally Passes ❑ Fails ID Needs Further Evaluation by the Local Approving Authority I inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3r13 Tile Z,Official:rscactior•Form:Subsurface Sewage Disposal System•Page 1 of 17 �OyltdVS •, Commonwealth of Massachusetts . Title 5 Offid'al Inspection Form ' 1si Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 206 Starboard Lane Property Address ------- --- +-- (" u:dv & Michael Sullivan Owner Owner's Name ------------ ---- ------- information is required for every Osterviile Ma. 02655 10/27/2016 page. City.!!o-.:vn State Zip Code Date of Inspection B. Certification (cant.) inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: IRI I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. ' om ents: B) System Conditionally Fusses: !! One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for`yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health- *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. . 71 Y ❑ N ❑ ND (Explain below): =.5ir:s•31'3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts =�"°��0�� .J��°��W N��m�� 0°07�0 ' � m��m� �� n��NQ0��D�uN Umn�� 0 �~ ��« ��u m Form Subsurface Sewage Disposal System Fmriw ' Not for Voluntary Assessments 2O� 8��rboardLans Propa Address ' -' - �-----'---------------'--------------�- Michael �u|cvan owoa, Ow-- -- -'--'---- -------------- -- ---- no/ewsma ---------'-----'----------- infvxnsUonio required t»revery Ostenvi8o _-__-___________________ -Ma. D2G55 10/27/2018 page. C�y�uwn n*we -- Zip Code -date -of --------�-------- ction B. Cerfificat'on (C0Ot] � LJ Pump Chamber pumps/alarms not operational. SysternwiUpaaavvithBoordofHaolthapprova| if � pumps/a!snnsuns repaired. � B) System Conditionally Passes (oon' ): Lj Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will peaSs inspect-ion if(wi�h approval of Board ofHeg|th): . ' - broken ios(s) ans replaced Y 'N F-1 NO (Explain below\: ^ �l oba�uotioniaremoved ' El Y E] N F-1 ND (Explainbelow): [� distribution box is leveled Orreplaced [-I Y [I N NO (Explain below): ' . . L1 TheSyStem required pumping nx}Rath8n4dnneS@ye8rdueb] b[OkeOO[ObStrUCbedpioeka . The system mjUpass inapaot�n ��v�h approval of the Board ofHee�h): ' ` ' i] broken pipe(S) are replaced ' El Y [l N F� ND (Explain be|ow): [1 obstruction iaremoved E] Y F-I N 0 ND (Explain be|ow): --- C) Further Evaluation is, Required by the Board of Health: |l Conditions axistxvh|ch require further evaluation by the Board ofHealth in order tD determine if the system is failing to protect public health, safety or the environment. 1. Systemm will pass unless Board mf Health determines in accordance with 310CMR � 15.303/l\(b)'that the system io not functioning imm manner which will protect public health, safety and the environment: L' Ceaspoo| or privy im within 5O feet Of83urf8Cel water (:.ess000l or privy is within 550 feet of a bordering vegetated wetland or a salt marsh ''ins'oy ' Title s Official msoection Form:Subsurface Sewage Disposal System'Page oofn Commonwealth of Massachusetts 2 0 0131 Title 5 Offidal Inspection For 1 m MEN? Subsurface Sewage Disposal System Form Not for Voluntary Assessments 206 Starboard Lane Properzy Address Trul! & AiGh3ei SLi!iNan Owner 6wve,r's Nar—ne inforrratic.;,is rEq Jired for every Osierville Ma. 02655 10/27/2016 page. City:T Own State Zip Code Date of Inspection Cen.mcation (cont.) 21. System will fail unless the Board of Health (and Public Water Supplier, if any) detrurrrines:that the system is functioning in a manner that protects the public health, safety and environment: E-1 -I-rhe system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. -y L . Q;,sc-e,,n Inas a septic tank a,id SAS arid? the SAS is within a Zone 1 of a,public water �Ltppty. j The sys-.1-Ern has a.septic tank and SAS and the SAS is within 50 feet of a private water SLIP�lly Well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or rn-are from a private water supply well**. iNlrethod used To determine distance: This sy stem ystem passes ;f the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to c:--lass than 5 opm, provided that no other failure criteria are triggered. A copy of the analysis must ae at'-adhed to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You, must indicate "'Yes" or"No" to each of the following for all inspections: Yes No Backup of sawag= into facility or system component due to overloaded or LJ R dogged SAS or cesspool C:'!scharge or ponding of Effluent to the sj,,fa--e of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool. ool is less than 6" below invert or available volume is less than 1/2day flow t j!ns-311 T 1t'a 5 Off!".l:aSpaction.Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachuseft � = _ TMe 5 Official Inspection Form Subsurface Sewage Disposal System Foram - Not for Voluntary Assessments 206 Starboard Lane Proper•.y Aoaress _i:-- 9'' �: �121C.i�ae Sul; Owner Owner's Naive i r'orrr. ,*:1 is required for every Jstervi!ie _ - _ Ma. 02655 - _ 10/27/2016 page. Ciry;Town —_ — stare Zip Code 'Date of inspection B, Certification (cunt.) Yes No �I Required pumping more than 4 timas in the last year NOT due to clogged or - obstructed pipe(s). Number of times pumped: Any portion of the SAS, cesspool or privy is below high ground water elevation. C +Ri Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary.to a surface water supply. Ll C' Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well Any portion of a cesspool or privy is 'less than 100 feet but greater than 50 feet from a private water sunrily we!]with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal collform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered:A copy of the analysis and chairs of custody mast be attached to this form.] The system is a cesspoo! serving a facili y with a design flowof 2000gpd- -. 10,000gpd. Tiia system fails. ! have aeterminE:d that cne or more of the abode failure criteria exist 2s acsc;r'!bed in 310'C MR 15.303, therefore the system fails. The Systerl owner shouia contact the Buard of'Health to determine what will be necessary to correct the failure. E) Large Systems: To bp considered a large -system the system must serve a facility with a dasigra flow of 10,000 gpd to 15,00 gpd. For large systems, you must indicate either"yes"or'no" to each of the following, in addition to the questions in Section D. C; [ the system is within 400 feet of a s-jrflace drinking water supply C the system is within 200 feet of a tributary to a surface drinking water supply El the system is located in a nitrogen sensitive area (interim Wellhead Protection — Area—IWPA) or a mapped Zone Il of a,public water supply well I If ou have answered -yes" to an question it i tile � i y y y que., � Section E r..n� System is considered a significant threat, or:answered "yes" in Section D above`ne !_.rge system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the sys!:err! in accordance with 310 Citr1P 15.304. The syste-m owner should contact the appropriate regional o-iYice of the Department. r ' i iiie 5 Gf z:a.nspe on=orm:suosurface sewage Disposal system•Page 5 of 17 f - _' Commonwealth of Massschusetis Title 5 Offidal Inspection For 1 -' Subsurface Sewage Disposal System Fo' rm - Not for Voluntary Assessments 206 Starl-_,card L�.na Propery Aa,.ress - —- -- — - ---. ---— ---- 6 U SIC naE `�i.ti V `l C,Eane; iniorrrj_.ioa is required`orevery Ostarville ---- — Ma._ 02655---- 10/27/2016 page. Citv/rcYrr- _ State Zip Code Date of Inspection C. ched is Cnec if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ice' i-1 Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? .J `II Has the system received normal flows in the previous two week period? Have large volumes of water been ir:-:roduced to the system recently or as part of u this inspection? J Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was.the facility or Cwelling inspected for signs of sewage back up? Was the site inspected for signs of breakout? 2 v WNera all system cc,nponents, excluding the SAS, located on site? <i u Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the,condEtion of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? -I Was the o-cility owner land occupa:;.s if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The S17C ar+d location Of tt'9E Soil Absorption System (SAS) on the site has � Een cetermined based on: existing information;. nor example, a plan at the Board of Health. !determined in the field (if any of the- ;lure c iteria related to Part C is at issue approximation of distance,is unacceotable) [310 CMR 15.302(5)) D. System Information ` Residential Flow Conditions: Number of bedrooms (design): 5 ---- Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):. >550 t5ins• /?3 ;i,a 5 Of iaai.nspexon corm:Subsurface Seviage Disposal System•Page 6 of 17 f $a- . Commonwealth of Massachusetts 67 Title 5 Official ins Form' Subsurface Sewage Disposal System Form Not for Voluntary Assessments ........... -board L;Fne 20^ Sm, Praper:,Y,Amdress 0.vne, 6ijnz3r s Nan ie is required fir every 0srerv;!'e 1 4— - -- --- — [Via. 02655 10/2 7/20 16 page. Citm'rown State, Zip Code Date of Inspection D, System Information Nu: iber of current residents: 9 Does residence have a garbage grinder? El Yes No IS IaUndry on a separate,sewage system? (include laundry system inspection information in this report.) ❑ Yes No Laundry sys-leln, inspected? 17 Yes ❑ No Seasonal use? EJ Yes R1 No ;Jl.later meter readincis, h-available (last 2 years usage(gpd)): U R p U M p? ❑ Yes No date of Occupancy: occupied Date Flow Conditions: -type of ;establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? 0 Yes F-1 No industrial waste holding' tank present? 0 Yes Tj No Noy~--saqnjitary waste discharged to the Title 5 system? El Yes El No Water meter readings. if available: 1Sins- 11 z Title 5 official;nspectior.Form:Subsurface Sewage Disposal System•Page 7 of 17 f '.�. Commonwealth of Massachusetts Title 5 Official Inspection Form ''l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 206 Slat-,card I -ne Property Adriress - -- - - - - - U F 1iiCil?E .13011�V:Z 1 Owners M2tll@ -�- - — " " — -- -- -- - •— ------ — -_—.-_----- !n'orrY:aticii is required for every OStef�`il'e _ T._ _y _ 11�a. _ 02655 10/27/2016 page. City,Te\, - State Zip Code — Date of Inspection Syz!_te-m Information (cost.) s. .ate of occupancy/use: -Date Other (describe below): General Information .:rui—aping Records: Source of inforrnadon: — -- ` .Jas system pumped as part of the inspection? ❑ Yes ® No it yes. VOIurT^e purrEped: gallons ---------- --- Htoavv was quantity pumped determined? --- --- — --- Reason for pu nping: ----- -- - Type of System: i% ? Septic tank, distribution box, soil absorption system u Single cesspool Overflow cesspool Frivy _t Spared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to'be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract Tight tank. Attach a`copy of the DEP approval. -- _ G%her(describe): Ti:e 5 C':iciai Inspe--tion Form:Subsurface Sewage Dispcsal System•Page 8 of 17 Commonwealth of Massachusefts TMe. 5 Offidal Inspection Form 1. Subsurface Sewage Disposal System Form Not for Voluntary Assessments 206 fit.ebo!?rd I ere Prep.!;;/Aciress T-U_1. �- ji i(,r a E 3) V Z: Owner S 11\jarne is required for every 02655 10/27/2016 Page. State Zip Code Date of inspection D. Si.-F-.sien Ifformation (cont.) !--,- i�xrnate, age if known)of all components, date installed and source of information: , -.p!� . I - k Wa-re sewage odcis detected when arriving at the site? El Yes No Euildling Sewer(locate on site plan), e-,ith 36" . below grade: feet -—------ _.rrial of constrLiction: cast tron 40 PVC ❑ other(explain), I'vi.z7arce from private water supply well or suction line.- feet C,ornn-,ents (on condition of ioints, venting, evidence of leakage, etc.): SepVc Tank*(locate on site plan): 24" below grade'. feet kila-zeri2l of coristruction.* .,-;,Dr!crete 1 metal ❑ fiberglass ❑[—I polyethylene F] other(explain) if tank is metal, list age: years 1�. age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Two 1AOQ_g-allon--- . Slu.dge depth: 311 :Sins' TITie 5 OffiCi31!nspect.on Form:Suosurface Sewage Dispsai System-Page 9 of 17 ' Commonwealth of Massachusetts Itle% 5, Offidal Inspection Form `�j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments % l rl 206 Wit?_hc rd Lane Proper:v cC res3 -------- Owner Owner'S�'atra — ----- - --------------- info r;•r tier;is required for every �sterwi le —y -- -- - Ma. 026_5_5_ _ 10/27/2016 page. Cityl I M- - --- - —�— - State Zip Code Date f In os pection_ __ Information (coot.) pie-tfic Tank (cone.) D•i lance from top of sludge to bottom of outlet tee or baffi - 1" Distance from top of scum to top of outlet tee or baffle aLx. 5" _ Das;:ance from bottom of scum to bottom of outlet tee or baffle apx. 12" sort were dimensions determined? sludge Judge iEY;cnts (on humping recommendations, iriet and outlet tee or baffle condition, structural integrity, lip!ir:' levels as related to cutlet invert, evidence of leakac s. etc.): :eco.nrr:8-id t;ie new owner pu":she a: ;< on a maira. plan with a local septic pumping co. l:a= d on the future :.-se of the home_The Barnstable Health Dept. has a list of local um ln�co. Grease Trap (locate on site plan): Depth below grade: feet ------- -------- i1�t `i=S"iG'I of conStRi tion: _ y concrete F-i metal ❑ fiberglass polyethylene ❑ other(explain): Scum thickness -- Di,_,tz:;nce from top of scum to top of outlet tee or baffle — -- i'ct nce from bottom o scam to bottom of outlet tee or baffle --- --- -- Date of last pumping: Date :Sins• '_ Tice 5 Officia:Inspeuon Form:Subsurface Sewage Disposes System•Page 10 of 17 COIr��; a ifealt>� of Malssacihus�tts ..: (P Title 5 Offloc'113alInspection Farm " Subsudrace Sewage Disposal System Form - Not for Voluntary Assessments T,lui. <. f icr�E' 'i.[If V'I owner ow(IerE Nat:1a - - ------ -- -- --— — - ------ inFoirnation is required for every Os'iervili� _ _ Ma._ C 26_55 10/27/2016 p ge. City€c.: - - _—_ State Zip Code Date of Inspection Siyste�.m information (cont.) ime nts (on pumping recommendations, inlet and outlet tee or baffle'condition, structural integrity, ' :evels as related to outlet invert, evidence of leakage et..): i 1f or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): I7r3t't. ,, below grace: — - i`,= of construction i ir:etal ❑ fiberglass ❑ polyethylene ❑ other(explain): ) i ensigns: ---- ;2 .citV: - ------- ---- . galic�_ Design Flow: ---- ----- gallons per day i • rnl Present: C. Yes ❑ No f.!arrn ieve:: -- ----- Alamn in working order: ❑ Yes ❑ No Gate of last pumping: Date -- -- — --- Cornmer is (condition of alarm and float switches, etc.): 'attac;? copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Title 5 Off-cis!Inspection Form:Subsurface Sewage Disposal System•page 11 of 17 i t Til ic' l Insped'on Form 1:1 �� i�; Subsunlace Sewage Disposal System Form - Not for Voluntary Assessments 205 1 :r. `Ua t. .fi!(r?e.. •I.sll Val GaYne Own r C.fY amG - - r---_ _- _- _-------_.-.-_ irtormaticil is required for every Os erviiie - -----------.— —- Ma. . 02555 10/27/2016 _ f,;ge.. Ciiy.rrcVrn Stara Zip Code Date of inspection SvLtoma information (cont.) Ds' '�butiorl Box(if?resent must be o.Pened) (locate on site plan,). 11 E:F:-n of likzluid level above outlet invert 0 =----- -- (note. It box is level and distribution to outlets equal, any evidence of solids carryover, any evicence of;eakage into or out of box, etc.): inspection there no,siq ns of solids Carr. over or evidence of past hydraulic failure. Pui— p Chanib+er(locate on site plan): Pu.rnos in working order: ❑ Yes ❑ No* l Alarms i working order: ❑ Yes ❑ No* 'an'Irrients (nota condition of pump chamber, condition of pumps and appurtenances, etc.): " l`I:urnos or rlarrns a e not in working order, system is a conditional pass. SO Absorption System (SAS) (locate on site plan, excavation not required): If-,`;\S not located, explain why: f5,ns•3113 Title 5 Of rcia.inspsc-ion Form:Subsurface Sewage Disposal System•Page 12 of 17 'y COIT-MnOnVvealth of Massachu' sa is a = 'KIce 5 Offidal Inspection For Subsu lace Sewage Disposals System Form - Not for Voluntary Assessments T-uJ ; Ai( r e " I.A Val O�.vne. Owner s iVame - - - --- --- - —-—- --- - — - inform:`Uon Is rajuirr:d for every Ostervilie - _- _ -- _Ma. 02655 10/27/2016 PEP. City" cv'r'_.__-.------_-.—_-- -- State Gip Code Date of Inspection . 8-q'sle m �nfo`?•'mation (cunt.) leaching pits number: - leaching chambers number: -- leaching galleries dumber: ---- - _ leaching trenches number, length: !ea,,hi.,.-.,g fields number, dimensions: one 37.5 x 11.3 overflow cesspool number: innovat�ve,aiternative system ypalnarne of technology: ----- -- - Cw1 irnents (no-« .:or,QJJor; Of soil, signs of hydraulic failure, level of ponding, damp soil, condition of veointation, etc.,- T.,: ;eaching fie! has 28 infiitratcrs and at the time of the inspection there were no signs of past P!`/;ar'c^.u'lIC fal!l.trc. Cvs:s!)ools, ±cesspool must be pumped as part of inspection) (locate on site.p!an): N:dr:iber and conf auration -- — .t GeL:r, --top of liquid -to inlet im,ert --- E>e-PI.- of solids layer De ".h of scum laver ----- E i,Yiensi0ns of cesspool -- --- ftes:,=rials of cons.:uction ------ ... --- II"af ::at!on of grourt-dwtiter inflow ❑ Yes ❑ No ns'Y 2 Tit.e 5 Official Insoec ion Form:Subsurface Sewage Disposal System•?age 13 of 17 t 3 -:- Camnev9f r4lassachuseft :�.... Tide 5 Offaceaj Inspect-'on Form 4" Sltsost ry ce sevragE Disposal SYSterriiYorm - Not for Voluntary Assessments 206 Owner Owners.Mane - - - - - ----- ------- - ---- �..---- -- i -!nn� ion is ;auirea for every Os:er-v.ae _02i355 10/27/2016 F's.�e• CPI,_r'`=`'1. _ _ _ -_-_- —. State Zip Code Date of Inspection lml: S fz.-em InforMation (coat.) (net-e :;onditlon of soil, signs of hydraulic failura, level of ponding, condition of vegetation, Privy 1!o ate or! &. e plat:): h'. : tt7 l cta con pion of soil; signs of hydraulic failure. level of ponding, condition of vegetation, r . i5ins•21. Title 5 Off:ciul Irspadion Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachuse-ft Title a' YI'clal �nspecfion Form ^.A ` Subsurface Sawacge Disposal System Form - Not for Voluntary Assessments 206 c -n._ Prooery Address - - ----- - - ----------- ----- --- — Owner Owners PEaame -- - -- -- -- ------ ---------- ------ I"."GG7 sClGti Ia 4Uiri: every OsLer�,`'e - -— ----.---- =_ Ma. _ 02855 10/27/2016 _ State Zip Code Date of Inspection --- , information (cunt.) Of Sewage Disposal System. Provide a view of the sewage disposal system, including ties to -ist two pe nn ;ien reference landmarks or benchmarks. Locate all wells within 100 feet. Locate wh=re p ublic v-ater supply enters the building. Check one of the boxes below: 'h= craa below r _eta: ing at~*chea separately 1 1 11-1 i ' r I • I s I I I I I t , i i i y I I • I i t 1 i5,ns•2r Title 5 Officis::Irsoecticn Form:Subsurface sewage Disposal System•Page 15 of 17 nttp:iiwww.townort)arnstabie.us/Assessing/liMdisplay.asp'lmappat=l... TOWN OF BARNSTABLE r LOCATION �Sfis 2��'j —SEWAGE# ' VILLAGE ��y+ (�,iASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PPHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)�'l0 °Arlo. (size) . NO.OF BEDROOMS OWNER PERMIT DATE: I^ + COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of any wells exist oil. " site or within 200 feet of leaching facility) •. Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I r 3 A • + �1 39 !�I GS . Gorranonweaith of Massachusetts Title 5 Official Inspection For '! Sill bISAA-1,2ice Salvage Disposal System Form -Not for Voluntary Assessments " pf0,'Jei 'AciaresS — -- — -- — ---- — T'U ' C /licr at' sl.l'Va l C.vner Owner's Nlarne IS rot;uired or every Osterwi!ie — - fvla. 02655 10/27/2016 _ page. rC +: _ _ _ _ Stata Zip Code Date of Inspection t','Sfs°tem ,nfcr !mation (coat.) >i-s> Exam: Check Slope Surface wat& I Check cellar Shallow wells E�. sn-^,red dep_ = to high ground water: _12 lus feet _ fiat !--I se indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record It necked, date of design plan reviewed: Data -- C...f xa Observed site (abutting property/observation hole'within 150 feet of SAS) 'hecked with local Board of Health -explain. Checked with. local~excavators, installers-(attach documentation) `'.cce sed USGS database -explain: You must describe how you established the high ground water elevation: 1 !, tired a at G lower elevatio i and s!-ct itwith a transit to shod five plus_feet of seperation. • Before filing this Inspection Deport, please see Repoirt Comp"eteness Checklist on nest page. '.5:ns•3l18 title 5 Off•ci_ irsoac;icn Form:Subsurface Sewage Disposal System•Page 16 of 17 OTA Corm onwealth of Massachusefts f - - , Title 5 Offie'al Inspection Form S L ace Sewage Disposal System Form Not for Voluntary Assessments 206 T-u-j A( ae v=--, OwnerMaire C"I Is ny. -1 Oster., �;e relquir�--.d fLir every 02655 10/2712016 page. State Zip Code Date of Inspection LCornplateness Checkflst Summary: A, B, C3 El. or E checked insixection SLO-nmary D (System Failu're Criteria Applicable to All Systems) completed :vs-iern mc I " rmation— Estimated depth high grouno-vvpier --ketcn of Sewage Disposal System either drawn on rage 15 or attached in separate file r 47 0 t-,ns-31'3 Title 5 off ciai lns.oe-ion Fcrm:Subsurface Sewage Disposal System-Page 17 of 17 TOWNOF BA NS'TABLE LOCATION :51671 2 be)oj-c SEWAGE VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY OZ lcg1 � �;;, tU LEACHING FACILITY: (type) *2O 9/ dzlhi o&d & (size) �2� NO. OF BEDROOMS OWNER / PERM cyIT DATE: 0 .� I � r COMPLIANCE DATE: �r 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 orf: 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) Feel FURNISHED BY 1 I� FPl> T I � VI W,- y 3i s I No.( ( l Z Fe0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_:�V/ , PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ' O."j, ftPlication for Disposal *pstpm Construction permit 4 Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ' '# S' ,4V6 /n Owner's/Name,Address,and Tel.No. Assessor's Map/Parcel 144 —5j Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type ofgilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p� Design Flow(min.required) AJ 14 gpd Design flow provided /�rl gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank f��V Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0114 C4 � i A LE LOC— 7701V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. SipeiV Date Application Approved by Date 71176 Application Disapproved by Date for the following reasons Permit No. 6V 1 3(P Date Issued I-7,& I Zm/q _.No.Z0 i kf --36 Z _ Entered in computer: -� THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplication for ]Disposal *pstern Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �(p Sf�2 /n Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Y Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of E ilding: Vi Dwelling No.of Bedrooms MA Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures , (Design Flow(min.required) M�} gpd Design flow provided N gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) N�/ �/a x(s-nAj 910 arcan c - 4A� LGr��Tio/y Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. . / Sigpe 0 �I'�—'� Date —? _A Application Approved by Date Application Disapproved by Date r for the following reasons Permit No. 2�1 3�Z Date Issued /t7 /-7 r y - ----------------------------------=------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI� that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by OG1iJ at //`//� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No " 62- dated I, Installer Designer #bedrooms N A i Approved de sign flow AM s r ry gpd The issuance of this permit shallll po1,4q Y be construeJd'a guarantee that the system will, unition as/drefsigned. r ' "( / � //"/ Inspector A> ll lll� rn Date . " , ( / v / p v v`/ -- ------------------------------------------------------------- ------------------- No. � — Z Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Bisposal *psttjn Construction Vermit Permission is hereby granted to Construct( ) Repair('/) / Upgrade( )) Abandon System ( ) System located at 2 0( )�/�;��OA 2�� L-/Z �� V((jt' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit Date � �'1 (7p �/ Approved b �____ Nolo t-- q V. � � '' A Fee W THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for BIsposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(vf Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a-o k ,UA -D L4 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel L.Fj1,70 96 Z47Anoo Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. W(A - Type of B ding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Q D/f C, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 5 sl gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. W:ZD �/29 J9 Description of Soil Nature of Repairs or Alterations(Answer when applicable) f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and rwt to place the system.in operatir„until a Certificate of Compliance has been issued by this Board of Health. ` Si ed Date Application Approved by Date V d ; 1 Application Disapproved Date for the following reasons Permit No. jp13 343 Date Issued Zo/� oz t.XW Fee THE COIVfMON1VEALTH OF MASSACyHUSETTS Entered in computer:_ ,- . .. Yes PUBLIC HEALTH DIVISION -T9WN OF BARNSTABLE, MASSACHUSETTS 2ppYitation for'Wis osai *pstem Construction 30ermit 'Application for a Permit to Construct( ) Repair 4'Upgrade(~`) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. :2 �p ,(�l/1 L� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel S3 S+ t te lqjlAb n / 4 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. t`bAeJJ` L �U6-aVOO n l cl Type of Buft�t ding: Dwelling -No.of Bedrooms Loi Size sq.ft. Garbage Grinder( ) Other jype of Building 2�&GGS G No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) s� gpd Design ftow provided gpd Ik: Plan Date Number of sheets Revision Date Title- Size / - - of Septic,Tank(2_ Type of S.A.S. I��O /�d�� 1.28 Description of Soil Nature of Repairs or Alterations(Answer when applicable) /ye(, -Tip h/� ��( m / AsGf-i� •..�, f f - Date last inspected: � / 1 Agreement: / The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code'and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ned Date Application Approved by Date Application Disapproved bye Date for the following reasons f �� q , Permit No. Zot',,"` 3H-9 Date Issued ( 7-0/3" TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFYY,that the On-site Sewage Disposal system Constructed( )" - Repaired( Upgraded Abandoned( )by h9lifeu at 0(, - has been constructed in accordance with the provisions of Title 5 d the for Disposal System Construction Permit No.�13`3LI 7 dated 91 6 f?-,o 13 Installer _ 1P Designer 4 t of Pe�,✓�F�e t,{�(� ��1� #bedrooms V Approved des' 5� gpd The issuance of th' pe it sh I not be construed as a guarantee that the system I c ion as designed. Date Inspector /,%/ //( ., , f JI,,( v J ------------�(----------(----------------------- - - - - ` No. Z �� L Feed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS , �Is�JOsaY �pstem DnstrULtlon �ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at -J0(6 and as described in the above Application for Disposal System Construction_ Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. f Provided:Construction must be completed within three years of the date of this permit Date��►3 Approved by Town of Barnstable oti�N�ram, regulatory Services Richard V. Scali, Interim Director , inRxsrnst.s, + . 9 Wa. S Public Health Division Thomas McKean, Director 200 I`►"Iain Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 5.08-790-6304 Installer & Desi2mer Certification Form Date: l I l 3 Sewage Permit# ssesser's,MapTaarcel t 1 (0 'Qe+c+. 4'1��+-Pry' �'.C�• Designer: --F L Installer: Roheu Address: p 2 . ,.�Qs_}- C',r�ss�t e (cd � Address: �/ _a S� qq k `- ✓ t stall a On � � 1 �S � was issued a permit o m (date) (installer) septic system at fi�a dd -US� based on a design drawn by �cl.e�-T-� •�•�-eQ �P_�, (address) n r, R5 WWf.�., �� dated 3 0 . Pc.0 ��-q 113 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the.septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the stem referenced above was constru oF with the terms of tJnI\A approv etters (if applicable) PETER T.WENTCE CIVIL -o No:35109� (Ins er' SA nature) �a/aT `� NAL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO.BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH TEIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LOCATION p& 271 r h CIA f^,I SE WAGE# 920 13 - VILLAGE D 57t'P f(L(`'/ ASSESSOR'S MAP.&PARCEL /Ce - G 3— INSTALLER'S NAME&PHONE NO. Jq 044? 6 S A e r SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /��Q i� _e�(�s e(/`S (size) NO.OF BEDROOMS y OWNER 0 YZN L GA/I/ S%&/ . L PERMIT DATE: 2 COMPLIANCE DATE: % Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Z Feet Private Water Supply Well and Leaching Facility(If any wells exist on' site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �fvffyCl( e TOWN OF BARNSTABLE t. LOCATION Q'�i 52�©�r� SEWAGE# OV/C? VILLAGE �. �LV t _ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. �� SEPTIC TANK CAPACITY _ IU � � LEACHING FACILITY. (type) d �,/cL4_,� (size) NO.OF BEDROOMS s OWNER PERMIT DATE: / 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 ow site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY oZ ' I• fw0 4 /o 0 0 3 3' � z ' 9® 01-77 TOWN OF BARNSTABLE .00ATIOK, to(!7o as et L h SEWAGE # !%L LAOE; 0 fer y I(l Le. ASSESSOM MM& LOT NSTAL.I.ER'S NAME&PHONE NO. 'EPM TANK-C:APACITI` Z= Ga ,EACH NG FACIUM (type) a A (size) /QOQ G4 l x 10.OF;'BF.DROOMS_,_,,,, —w W LDER OR OWNER..._ � _.. 'E1 IT®ATE: ' _ COWLIANC:E DATE; �aparation Distance Between the. naximtum Adjusted Groundwater Table to the Bottom of Leaching Facility met "rivatc Water Supply W41 and Leaching Facility (if imy wells exist on site or within 100 feet of leaching facility) eet ;dge of Wedand and LeacWng Facility(I£any wetlands exist within 300 fen caching fa i ty) 1, et urnishcd by C� 4uv� CGI�� 7 S •s}'Cr� 3 10 c ,ylS�k�a Oo x 38.36 4 7.73��_----- Engineering Works, Inc. ' — x 29 x 12 West Crossfield Road, Forestdale, MA 02644 38.82 x 39.60 `��\ �� (508) 477-5313 - o � 9 SETPTIC TANK REPLACEMENT 206 STARBOARD LANE 38.60 39.49 -- -0__ a OSTERVILLE, MA 02655 PAVED PATIO Prepared for: Michael Sullivan DRIVEWAY 206 Starboard Lane /EXISTING Osterville, MA -02655 39.23 39.62 RESIDENCE(#206) x Date: 9/5/14, Job no. 186-13 ST EXISTING H-20�SEP C 39.71 TANK TO BE REMAITI — 40.28 4 .53 x 3R,69 \ o PETER T. Gs \\\ � McENTEE K SET 41.311 \ \ x 40.84-� \\ o Clvll cn 41,36 40,8842 \ No. 35109 41.3542, \' \ 41,54 1.9_9- EXISTIN_G,_SEPTIC `TANK TO)BE REPLA��FD \ \ T �>' /42.21 41.60\\ Q 44,41�" �( 2.66 \ A REPLACE EXISITNG 00\0 GALLON H�1,0 SEPTIC TANK WITH ANEW 1000 GALL�N; . ` H-20 SEPTIC TANK. EXI�TNG PIES INWERTS�\ \\} 47.00 46.547 � as.os x 44.39 '��— oo , �0 43.36 TO REMAIN THE SAME. \\\ \ 77\\ ,�__\ � -____ 43.78 \ \\ \ �y �`''� 4 . _Y 4. \ \ \ POLE 4 4 i 0 T INSTALL H-20 RISERS, FRAM'�S AND \COVERS, PK ET -`�ET,TO FINISH GRADE, 'OVER INLET, ,TP EACH ®0,00 6,2 y� 0 TANK.--�___ x 43,73 \\ 48.38 �\ `987-0 O \ < 48.30- ` `\ O-' 47.5 .. _--_� - LT 10 W 1 s \47.98 -PARCEL 1p: I66�53 0d� \ x 41.0� 4 9e�f _ 139,897�f S.F. \ \ 46, \ Scale: 1 "=30' 47.38 Ai 16209, V \ .PAGE 1 OF 1 � _ 46.96 TD ioENNETTENVIRONMENTALAsSOCIATES, NCO LICENSED SITE PROFESSIONALS & ENVIRONMENTAL SCIENTISTS & GEOLOGISTS & ENGINEERS 1573 Main Street-P.O. Box 1743, Brewster, MA 02631 & 508-896-1706 & Fax 508-896-5109 www.benneft-ea.com BEA14-10626 March 6, 2014 Julie Hutcheson, Case Officer MA DEPARTMENT OF ENVIRONMENTAL PROTECTION(MA DEP) Southeast Regional Office (SERO) Bureau of Waste Site Cleanup (BWSC) 20 Riverside Drive Lakeville, MA 02347 RE: IMMEDIATE RESPONSE ACTION COMPLETION CLASS A-2 RESPONSE ACTION OUTCOME STATEMENT Residential Property, RTN 4-24948 206 Starboard Lane—Osterville, MA [Assessor's Map 166, Parcel 53] Dear Ms. Hutcheson, BENNETT ENVIRONMENTAL ASSOCIATES, INC. (BEA) has prepared the following Immediate Response Action Completion report, Class A-2 Response Action Outcome Statement with Supporting Documentation as a summary of release discovery, environmental assessment, remedial response and environmental assessment performed at the above referenced property. The completed response actions were undertaken to evaluate potential exposure risks and to mitigate significant environmental and human health hazards to identified receptors in accordance with the provisions of 310 CMR 40.0410. The IRA was triggered on December 23, 2013 by the discovery of gasoline impact in soil adjacent to an Underground Storage Tank (UST), based on field screening that reported soil headspace exceeding 100 ppmv. The Centerville-Osterville-Marstons Mills (COMM) Fire Department was onsite to witness the UST closure assessment and made Release Notification of the 72-Hour Reportable Condition to the MA DEP that day. Upon formal engagement by the PRP to direct the remedial response, BEA confirmed Release Notification to the Department on January 2, 2014. The subject tank was pumped, cleaned, stabilized and removed the day of Release Discovery as part of UST Closure. Environmental assessment performed the day of discovery indicated significant soil impact to approximately 8' below the bottom of the tank within a projected 10' x 10' area as substantiated by laboratory analytical. Preliminary response actions included capping the area of release with tarps and directing roof runoff away from the tank grave to prevent worsening of conditions. Aggressive soil removal was performed under MA DEP verbal authorization and resulted in the removal of approximately 20 cubic yards [22.14 tons] of gasoline contaminated soils as absolving the threat of groundwater impact and future potential vapor entry into the dwelling as currently under construction. MA Certified analyses of soil samples collected from the extent of excavation reported all volatile petroleum hydrocarbon (VPH) and target analyte (benzene/toluene/ethylbenzene/xylene) concentrations as significantly less than the applicable and strictest S-1 (GW-1/GW-3), Method 1 Risk Characterization standards. The laboratory analytical results for the end point soil samples demonstrated no EMERGENCY SPILL RESPONSE 6 WASTE SITE CLEANUP & SITE ASSESSMENT & PERMITTING t SEPTIC DESIGN&INSPECTION WATER SUPPLY DEVELOPMENT,OPERATION&MAINTENANCE WASTEWATER TREATMENT,OPERATION&MAINTENANCE MARCH 6,2014 SULLIVANBEAI4-10626 PAGE 2 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 significant residual impacts within the defined gasoline release Site as the subject of Release Tracking Number (RTN) 4-24948 as absolving potential ingestion and dermal contact exposure risks to human and environmental receptors under Method 1 Risk Characterization. Based on the remedial response measures implemented, the environmental monitoring performed and the validated laboratory analytical results evaluated under Method 1 Risk Characterization, no Substantial or Imminent Hazards are apparent under existing or anticipated conditions. Based on all end point soil samples reporting volatile petroleum hydrocarbon and target analyte concentrations as less than the applicable and strictest S-1 (GW-1), Method 1 Risk Characterization standards, laboratory analysis has demonstrated a condition of No Significant Risk at the Site in support of a Permanent Solution and completion of the IRA with a Class A Response Action Outcome. The work following engagement on December 29, 2013 has been conducted under LSP oversight in a manner consistent with the MCP Response Action Performance Standards (RAPS) pursuant to 310 CMR 40.0191 and the QA/QC policies of BENNETT ENVIRONMENTAL ASSOCIATES, INC. The facts and statements are, to the best of our knowledge, a true and accurate representation of the Site activities and environmental conditions associated with the project. The information herein serves as the technical rationale and scientific justification for the LSP Opinions rendered under the current regulations and Standard of Practice as acknowledged by the certifications on the attached BWSC-105 Immediate Response Action Transmittal Form. ENVIRONMENTAL CONDITIONS [Refer to Appendix A] The subject property at 206 Starboard Lane is noted on the Osterville Assessor's Map 166 as Parcel 53 and is located approximately %2 mile west from the intersection of Starboard Lane and Main Street (refer to Figure 1). The UTM coordinates for the Site are Northing 4610558, Easting 386332. The property contains approximately 2.65 acres of land area and is developed by a two story dwelling along the front of the property closest to Starboard Lane. The dwelling is fully outside the 100' setback to the abutting Bumps River. The surrounding area is modestly developed with similarly sized residential properties. Access to the subject property is unrestricted with low frequency/low intensity of use and children potentially present. At the time of UST removal and remedial response actions, access to the former area of release, located within the footprint of an addition currently under construction along the north end of the dwelling, was also unrestricted with low frequency/low intensity of use and children potentially present. Based on the ongoing construction and completion of the addition foundation, access to the former area of release beneath the poured concrete slab of a permanent structure will be restricted with low frequency/low intensity of use with children potentially present. The subject dwelling is presently unoccupied and has been since prior to Release Discovery to accommodate ongoing construction. As such, trespassers, visitors and workers at the property are identified as the primary potential human receptors. Topographic references indicate an elevation of some 40' NGVD (+/-) along the defined Site. Hydrologic mapping reports groundwater at approximately 2' NGVD (+/-) as projected MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 3 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 within some 37' of grade surface, and approximately 29' from the depth of significant gasoline impact. Regional groundwater contours indicate an easterly flow direction towards Bumps River (refer to Figure 2). Based on the projected local groundwater flow, Bumps River represents the primary potential environmental receptor under Method 1 —Risk Characterization. According to the MA DEP BWSC GIS mapping program, the subject property is not located within the Zone Il Protective Radius of a Public Water Supply (PWS), nor is it located within the Zone A protective radius of any surface water reservoir. There are no known private potable wells within 500' of the Site wherein the subject property and surrounding area are served by the COMM Public Water Supply. Based on the medium yield aquifer and setting, the subject property and surrounding 'area are mapped within a Potential Drinking Water Source Area (PDWSA) as part of the. designated Sole Source Aquifer for all of Cape Cod east of the canal (refer to Figure 3). Based on the current BWSC GIS mapping as well as the proximity to groundwater and hydrogeologic conditions, the GW-1 and GW-3 groundwater categories apply to Method 1 — Risk Characterization;per 310 CMR 40.0974. Based on Site conditions relative to frequency/intensity of use and the accessibility of soils, the S-2/S-3 (GW-1/GW-3), Method 1 —Risk Characterization standards are applicable per the provisions of 310 CMR 40.0975. These standards were developed in consideration of potential ingestion, inhalation, and dermal contact exposures to humans and in review of potential leaching of contaminants to groundwater (GW- 1/GW-3). Additionally, the Method 1 standards are used in screening any significant environmental impacts to resource areas. In review of risk characterization and foreseeable future uses and activities at the subject property without limitation, the most restrictive S-1 (GW- 1/GW-3), Method 1 -Risk Characterization standards are considered. The Defined Site, the area where significant gasoline impact had come to be located, is represented as an approximate 8' x 12' x 8'D (3-11' bgs) area within the footprint of the addition currently under construction along the north end of the dwelling. The Defined Site corresponds to the area of contaminated soil removal (refer to Site Plan). Based on laboratory analytical results that demonstrate significant gasoline impacts were limited to those soils excavated, the Defined Site also corresponds to the Area of Class A-2 Response Action Outcome as presented on the site plan in Appendix A. BACKGROUND/UST CLOSURE ASSESSMENT [Refer to Appendix B] As part of ongoing construction activities at the subject property, trenching for a 4' frost wall foundation was conducted along the north end of the dwelling (refer to Site Plan). During such excavation, it was reported that a previously unknown 50-gallon (+/-) UST (-3'L x 2' Diameter) was found some 3' bgs along the northeast corner of the existing garage. Excavation for the crawl space and construction of the foundation reportedly continued around the UST left in the tank grave. Tank Removal Services (TRS) of Hyannis, MA, was sub-contracted to clean, remove and dispose of the subject tank; some 60 gallons of residual gasoline and rinse water were transported by Cyn Oil Corporation to EPS of Vermont, Inc., of Glenmont, NY, under Uniform Hazardous Waste Manifest(Waste Tracking Number) STN2376 1-EPS. MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 4 OF 19 MAC,CLASS A-2 RAO,RTN 4-24948 BEA was retained by TRS to perform field screening of soils along the extent of the tank grave to qualify potential impacts in review of exposure risks to human and environmental receptors. On December 23, 2013, BEA traveled to the subject property to document tank conditions and removal operations, as well as conduct representative soil sampling and field screening as witnessed by COMM Fire Department personnel (Fire Prevention Officer Martin McNeely). Upon arrival BEA inspected the subject tank located 3' bgs and surrounded by historic and new frost walls. BEA noted holes in the top of the tank and in the associated vent pipe. t a r Figure 1: View of hole in top of UST prior to removal from tank grave. MARCH 6,2014 SULLIVANBEAI4-10626 PAGE 5 OF 19 iR AC..CLASS A-)RAO,RTN 4-24948 4 b �ma's ry � .. �', •`��. r. -T ,,,`J !1' � A Y t* e 3� Figure 2: View of hole in vent piping. Upon removal of the UST, significant corrosion and evidence of historic weeping along the bottom of the vessel was reported. X �C Figure 3: View of bottom of UST,after removal from tank grave,with significant deterioration and weeping. MARCH 6,2014 SULLIVANBEAI4-10626 PAGE 6 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 BEA collected soil samples from beneath the UST, as well as the north, west and south sidewalls of the tank grave. A representative sample could not be collected from the east sidewall due to the concrete footing abutting that end of the tank (refer to Site Plan). A distinct gasoline odor was reported in each of the tank grave samples, collected in 8 ounce glass jars and sealed with aluminum septa. The samples were then agitated to develop organic vapors and field screened with a photoionization detector (PID) [Thermo Environmental 580B OVM, 10.6 eV lamp, calibrated to a benzene standard] by jar headspace method as consistent with the Interim Soils Policy (#WSC-94-400). Field screening reported substantial headspace concentrations exceeding 100 ppmv, indicating significant impact to soil associated with underground storage of gasoline. TRS subsequently departed the subject property with the UST secured for disposal pending potential inspection under any insurance claim review. ENVIRONMENTAL ASSESSMENT [Refer to Appendix B] BEA remained on site with Officer McNeely to advance a hand boring, HB-1, through the bottom of the tank grave to qualify the extent and magnitude of significant impact. Field screening reported elevated headspace concentrations exceeding 200 ppmv in two-foot soil samples down to approximately 6' below the tank grave (-9' bgs). BEA prepared a composite stockpile sample, "Contaminated SP", from the impacted, worst-case soils adjacent to the subject tank. BEA preserved the Contaminated SP sample, as well as HB-1:6-8' (9-1l' bgs), for laboratory analyses of VPH and target analyte concentrations in review of disposal options and to substantiate the vertical extent of significant impact. BEA advised Fire Prevention Officer McNeely and the building contractor of the findings wherein the elevated headspace concentrations in soils within 10' of a UST represented a 72-Hour Reportable Condition for notification of the release to the MA DEP. BEA reported it would attempt to reach the homeowner later that day to advise of release discovery, remedial response liability and responsibility to make notification to the MA DEP. Regardless of any such contact, Officer McNeely reported that the COMM FD would make notification to the MA DEP that day. BEA capped the release area with a series of overlapping tarps against active precipitation. BEA also set a PVC pipe underneath the downspout of the gutter above the tank grave to divert roof runoff away from the release as could drive contamination deeper and exacerbate existing conditions. BEA made contact with the homeowner, Michael Sullivan, later that day and received verbal authorization to proceed with laboratory analysis and further coordinate remedial response actions as appropriate and necessary. BEA advised Mr. Sullivan, as the PRP, that the COMM Fire Department indicated it would make notification of the 72-Hour Reportable Condition to the MA DEP. BEA was formerly engaged on December 29, 2013 following the Christmas holiday. MA Certified analysis reported significant VPH and target analyte concentrations in the Contaminated SP as greater than the applicable RCS-1 Reportable Concentrations as confirming significant soil impacts under the former UST. Laboratory analysis also reported all VPH and target analyte concentrations as ND for soil sample HB-1:6-8' (9-11' bgs) wherein the reporting limits were less than the strictest RCS-1 thresholds as well as the strictest S-1 (GW-1), Method 1 Risk Characterization standards, demonstrating 6' as the vertical extent of significant gasoline MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 7 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 impact. It is noted that soil sample HB-1:6-8' (9-11' bgs) was incorrectly labeled as "HB-1:4-6' (7-9' bgs)" for submittal to the reporting laboratory. This error is further discussed in the Data Usability Assessment and Representativeness Evaluation section of this report. BEA later requested the laboratory to run analysis for VOCs (Method 5035) and Total Lead in consideration of remedial waste management for soil recycling at Aggregate Industries' South Dennis asphalt batch facility. The laboratory analytical results for waste characterization and environmental assessment are presented in Table I. TABLE I:206 STARBOARD LANE OSTERVILLE MA—IRA,RTN 4-24948 SUMMARY OF ASSESSMENT,WASTE CHARACTERIZATION ANALYSES,VPH/VOCs/LEAD,RCS-1 RC's METHOD 1 RISK CHARACTERIZATION(m ) HB-1:4-6'(7-9'BGS) CONTAMINATED' CONTAMINATED' LOCATION [6-8'(9-11'BGS)] SP STOCKPILE SAMPLINGDATE 23-DEC-13 23-DEC-1_3 16 JAN-14 _. LAB SAMPLEID L1326113-01 L1326113-02 L1401556-06 VPH+Target Anal es RCS 1-08 Units Q L1400737-02 Q Q Benzene 2 -'" mg/kg 0.112 U 93 9, .-`' p U CS-C8Aliphatics,Adjusted 1.00 mg/kg 2.81 U 19600 2.88 U C9-C10 Aromatics "100 mg/kg 2.81 ' U 12800 11 C9-C12 Aliphatics,Adjusted ?,:1000, mg/kg 2.81 U 4830 2.88 U Ethylbenzene ` 40 mg/kg 0112 U 1330 Methyl tert butyl ether a,Q 1P.- mg/kg 0.056 U _46 9 _ U Naphthalene P '4' •`t. ' mg/kg 0.225 U .375 �t o-Xylene 36* mg/kg 0.112 U 1990 p/m-Xylene 300,,;., mg/kg 0.112 U 5280 Toluene mg/kg 0.112 'U 5940 Lead,Total 300 r mg/kg 2 U 3.3 2.8 VOCs(5035 High)-HITS ONLY f 1,2,4Trimethylbenzene 1000 mg/kg 0.21 U 410 1.7 1,3,5-Trimethylbenzene 10 mg/kg 0.21 U 130 0.51 Benzene r$ 0.054 U 5.6 0.056 U Ethylbenzene x40 mg/kg 0.054 U 220 0.37 Isopropylbenzene 1000 ' mg/kg 0.054 U 14 0.056 U n-Butylbenzene s mg/kg 0.054 U 9.5 0.056 U n-Propylbenzene 100 mg/kg 0.054 U 64 0.2 Naphthalene , 4' mg/kg 0.21 U 64 0.38 o-Xylene 3001" mg/kg 0.11 U 320 0.79 p/m-X lene 300i ,, mg/kg 0.11 : U 816 1.7 Toluene �'30 /k 0.08 U 880 0.86 VPH=Volatile Petroleum Hydrocarbons,Target Analytes—Benzene,Toluene,Ethylbenzene,Xylene,Naphthalene,MtBE VOCs=Volatile Organic Compounds Shaded areas represent applicable MCP criteria. Bold indicates RCS-1 exceedance.U indicates Non-Detect concentration. Subsequent to engagement,.BEA contacted the MA DEP (Julie Hutcheson, Case Officer) on January 2, 2014 to review the circumstances of discovery and confirm release notification as originally made by the COMM FD on December 23, 2013. BEA also requested verbal authorization for the removal of 35 cubic yards of contaminated soil as the remedial strategy for the IRA. The Department granted such authorization and BEA proceeded to coordinate the remedial response with the PRP,the building contractor and sub-contracted excavator. MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 8 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 Due to the reported VOCs concentrations for the worst case contaminated soils (ie. "Contaminated SP") exceeding the Aggregate Industries' approval criteria, BEA coordinated with the building contractor to have a pair of ten yard roll-off containers delivered to the subject property for stockpile retesting following excavation. The containers would be lined and capped to secure impacted material generated by soil removal operations at the subject property pending collection and analysis of a sample representative of the generated contaminated stockpile. REMEDIAL RESPONSE [Refer to Appendix C] The building contractor and excavator, Atlantic Cape Builders and PKM, respectively, worked to demolish a portion of the existing dwelling structure on January 15, 2014 in preparation for contaminated soil removal and subsequent construction of the addition. BEA, Atlantic Cape Builders and PKM returned to the property on January 16, 2014 to conduct excavation operations. Upon arrival, BEA conducted a safety tailgate to review the Health and Safety Plan specific to the IRA and subject site. BEA subsequently lined the roll-off containers with 6 mil plastic sheeting and removed the tarps capping the release. BEA designated the area for the excavator to remove contaminated soils, beginning in the center of the tank grave as the worst case and progressing outwards to clean soils. BEA employed PID screening and Dexsil testing as technical guidance to direct soil removal operations. Upon reaching 6' (9' bgs) throughout the excavation, field screening of end-point soil samples reported elevated headspace concentrations (> 100 ppmv) as indicated significant residual contamination along the north, east and west sidewalls, as well as the bottom of hole. BEA directed the excavator to advance the area of soil removal along those areas. Upon reaching 8' below the tank grave (11' bgs), field screening reported modest headspace concentrations (< 40 ppmv) in end point soil samples collected from along the extent of excavation. Decreased headspace concentrations were substantiated by Dexsil PetroFlag testing of petroleum hydrocarbons indicating effective removal of gasoline impact in soils. The end- point soil samples were placed in appropriately preserved laboratory containers for analysis of VPH and target analyte concentrations and set on ice in a cooler. The final dimensions of the excavation were measured as approximately 8' x 12' x 8'D (3-11' bgs). Both ten yard roll off containers were filled to capacity with contaminated soils a indicating p ty s a removal volume of some 20 cubic yards (+/-). BEA personnel capped the lined roll-off containers with additional plastic sheeting against precipitation. Based on concern for the structural integrity of the dwelling and new addition foundation, the building contractor decided to have the excavation backfilled that day with flowable fill. BEA submitted the end point soil samples for MA Certified analysis of VPH and target analyte concentrations in review of remedial performance and risk characterization. The "Contaminated Stockpile" sample, representing those soils actually removed from the release area, was submitted for VPH (carbon range only), VOCs and total lead. MA Certified analyses reported the VPH/BTEX concentrations,in all end point soil samples as ND with the exception of low level concentrations of xylene and toluene in the north and east sidewall areas. In all cases the concentrations reported and the reporting limits are significantly less than the most restrictive S-1 (GW-1), Method 1 Risk Characterization standards. MARCH 6,2014 SULLIVANBEAI4-10626 PAGE 9 OF 19 IRAC,CLASS A-2 FAO,RTN 4-24948 As such, laboratory analytical under Method 1 Risk Characterization had demonstrated that effective cleanup performance resulted in conditions approaching background. The laboratory results for the second waste disposal characterization analysis of the "Contaminated Stockpile" sample are presented in Table I above. The laboratory analytical results for the end- point soil samples are presented in Table II. The significance of these results is further discussed in the Risk Characterization section of this report. TABLEII:20.6 STARBOARD LANE,O.§7pyILLF,MA-RTN 4-24948 SUMMARY OF IND_POINT SAAU LEANALYSES with EPC,VPA S-1(GW-1)SOIL CATEGORY METHOD 1 RISK CHARACTER17ATION (mg/Kg SW-N:0-8' SW-S:0-8' ME0-8' SW-W:0-8' BOB@8' PPC,O-8' LOCATION - (3-11'BGS) (3-11'BGS) (3-11'BGS) (3-11'BGS) - .QVBGS) (3-11'bgs) . ._ . SAMPLING DATE 16JAN-14 16JAN-14 16-JAN-14 16-JAN-14 16-JAN-14 [Potentially_ LAB SAMPLEID L1401556-01 L1401556-02 L1401556-03 L1401556-04 ' L1401556-05 Accessible r VPH t Target Anal es '.Sl'/G1`-0i- Units Benzene 2;,``, mg/kg 0.118 U 0.115 U 0.115 U 0.12 U 0.114 U 0.06 C5-C8 Aliphatics,Adjusted '� '100 rrg/kg 2.94 U 2.88 U 2.88 - U 3 U 2.86 U 1.46 C9-CIO Aromatics I00 i mg/kg 2.94 U 2.88 U 2.88 U 3 U 2.86 U 1.46 C9-02 Ali hatics,Adjusted 1000' .. P .N mg/kg 2.94 U 2.88 U 2.88 U 3 U 2.86 U 1.46 Ethylbenzene 40 mg/kg 0.118 U 0.115 U 0.115 U 0.12 U 0.114 U 0.06 Methyl tert butyl ether iI 01:, mg/kg 0.059 U 0.058 U 0.058 U 0.06 U 0.057 U 0.03 .. 0.235 U 0.23] U 023 U 024 Naphthalene !� di rts�/kg U 0.229 U 0.12 o-Xylene •400. mg/kg 0.118 U 0.115 U 0.115 U 0.12 U 0.114 U 0.06 p/m-Xylene 40D mg/kg - 0.216 0.115 U 0.219 0.12 U 0.114 U 0.12 Toluene 30L o/k 0.341 0.115 U 0.278 0.12 U 0.114 U 0.16 VPH=Volatile Petroleum Hydrocarbons,Target Analytes=Benzene,Toluene,Fthylbenzene,Xylene,Naphthalene,MtBE U indicates Non-Detect concentration. Shaded areas re resent a licable MCP criteria. Based on the low level residual concentrations reported along the extent of excavation as less than the strictest S-1 (GW-1), Method 1 criteria, wherein the bottom of hole reported all ND concentrations approximately 29'(+/-) above the groundwater interface, groundwater monitoring was deemed unnecessary in review of risk characterization. Laboratory analysis reported residual low level xylene and toluene concentrations along the north and east sidewalls of the excavation. The residual concentrations were reported marginally above the detection limits of the respective analyses as significantly less than the most restrictive S-1 (GW-1), Method 1 Risk Characterization standards. An Exposure Point Concentration (EPC) was considered to evaluate potential vapor intrusion. The EPC reported the averaged xylene and toluene concentrations consistent with the reporting limits of the analyses (refer to Table II). Despite the apparent de minimus concentrations of residual target analyte concentrations along the extent of excavation, soil vapor testing was conducted in review of vapor intrusion under the provisions of 310 CMR 40.0942(1)(d) and in accordance with the current policy Interim Final Vapor Intrusion Guidance (#WSC-11-435). Subsequent to the pouring of a concrete slab along the crawlspace of the proposed addition, BEA conducted a soil vapor,test in February 2014 to determine whether indoor air is a medium of concern at the subject property. BEA installed a soil vapor point, SVP-1, on February 11, 2014. A 5/8 inch diameter hammer drill was used to penetrate the concrete slab of the addition crawlspace. A brass Vapor PinTM and silicone sleeve were used to complete and seal the soil vapor point(refer to Site Plan). . A Thermo Environmental.PID with a 10.6 eV lamp, calibrated to a benzene standard, was utilized to screen the vapor point wherein a maximum concentration of 0.7 ppmv was reported during the initial measurement. The PID reported between 0.2 ppmv and 0.7 ppmv, generally r , MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 10 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 consistent with background, while purging SVP-1 for some 15 minutes to evacuate stagnant air in the interstitial space. BEA then collected a representative soil vapor sample from SVP-1 over a ten-minute exposure using a pre-cleaned Summa Canister. The soil vapor sample was submitted for analysis of APH concentrations. Laboratory analytical reported all APH concentrations at SVP-1 as less than the applicable Residential Soil Gas thresholds with the exception of the C5-C8 Aliphatics. TABLE III: 206 STARBOARD LANE, OSTERVILLE, MA -- RTN 4-24948 SUMMARY OF APH LABORATORY ANALYSIS- SOIL VAPOR RESIDENTIAL SOIL GAS SCREENING EXPOSUREPOINT RES.INDOOR SOIL GAS INDUS./COMM. SOIL GAS LOCATION RESULTS RESULTS AID RESIDENTIAL INDOOR AIR INDUS./COMM. THRESHOLD THRESHOLD GRP/m') (µg/m') (gg/m') (µPm') (µ€/m') (µP m') 2/I1/2014 2/24/2014 S VP-1 t3-Butadiene ND<20 ND<10 NA !w NA` NA NA C5-C8Aliphatics 6,200 3,500 58 * .'4,700,: 330 23,000 C9-C 12 Aliphatics ND<140 900 68 4';806 220 15,000 C 9-C 10 Aro m atic s ND<100 NDG50 10i 700J 44 3,100 MtBE ND<20 ND<10 39 f 2,7,00; 2,600 62,000 .. .. .. .. .. _.. ... _ ��r.: - .. .. Benzene ND<20 ND<10 2.3 11 770 z, Toluene ND<20 ND<10 54 3 800' {, 41400 100,000 Ethylbenzene ND<20 ND<10 7.4 �r a 520 #, 880 20,000 Xylene(to ta 1) ND<40 NDGiO 20 ]40Qi f 88 2,000 Naphthalene ND<20 ND<10 0.61 43 °�' 2.7 190 ND=Non-Detect,Shaded areas represent applicable MCP criteria. BOLD—Standard Exceeded The C5-C8 Aliphatic exceedance represented an apparent anomaly wherein prior laboratory analyses of end point soil samples reported C5-C8 Aliphatic concentrations in all end point soil samples as ND with reporting limits substantially less than the strictest S-1 (GW-1), Method 1 Risk Characterization standards. BEA consulted with Alpha Analytical towards further explanation of the soil vapor results in review of the source of the reported C5-C8 Aliphatics concentration. In the laboratory's review of the analysis, Alpha Analytical reported that the C5-C8 Aliphatic concentration was apparently associated with "isooctane" and other "methyl-substituted alkanes"present in the C5-C8 range wherein the laboratory characterized the chromatogram as "not much of a typical petroleum pattern" (refer to email from Alpha Analytical, Appendix D). Based on the information from Alpha Analytical and absence of C5-C8 compounds in end point soils, BEA investigated other potential sources. Based on the subject release and subsequent remedial response actions occurring within an area of new concrete foundation walls and footings and having recently been capped by a concrete slab, actively curing concrete and form oil were suspected as potential sources of the reported APH concentration. Alkanes are known components of form oils. Multiple MSDS identified refined mineral oils and lubricating MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 11 OF 19 MAC,CLASS A-2 RAO,RTN 4-24948 oil as significant components of concrete form oil. The MSDS provided by the concrete form company who constructed the subject foundation, A&E Forms, specifically lists paraffin oil as a component. High density overlaid concrete forms were also identified by MSDS as having "cured coatings" and "cured resin solids" as potentially contributing to interference (refer to Appendix D). Laboratory review of the soil vapor analysis and research of forms and form oil indicate that form oil is the source of C5-C8 Aliphatics (ie. alkanes) and not the underlying soils. BEA returned to the site on February 24, 2014 to collect a second soil vapor sample from SVP-1 in order to further qualify soil gas conditions and determine if vapor intrusion and indoor air is a medium of concern at the subject property. It was noted that SVP-1 was installed in close proximity to a lally column footing as would have been constructed with concrete forms treated with form oil. BEA used a PID to evacuate the stagnant air from the interstitial space around SVP-1 wherein a maximum concentration of 0.2 ppmv was reported as generally consistent with background. BEA then collected a representative soil vapor sample from SVP-1 over a ten- minute exposure using a pre-cleaned Summa Canister. The soil vapor sample was submitted for analysis of APH concentrations. The reported soil vapor concentrations were compared to the Residential Sub-Slab Soil Gas Screening Values as presented in Table III and based on the Interim Final Vapor Intrusion Guidance (WSC #11-435). No APH concentrations were reported in excess of the Residential Sub-Slab Soil Gas Screening Values. Since the reported APH concentrations were below the residential soil gas screening values, vapor intrusion is not a complete exposure pathway at the Site and therefore indoor air is not a medium of concern. Based on complete, effective source removal demonstrated by laboratory analysis of end-point soil samples, the reported APH concentrations are likely associated with the form oil used to construct the addition foundation, and not a release of oil to the environment, as considered under the provisions of 310 CMR 40.0317(12)(b) and (e) (see Table III). RISK CHARACTERIZATIONAMMINENT HAZARDS [Refer to Appendix D] Soil As presented above, the S-1/S 2/S-3 (GW-1/GW-3) soils categories are applicable to Method 1 - Risk Characterization, as consistent with the provisions of 310 CMR 40.0933. These standards were developed to evaluate potential ingestion (S-1); particulate inhalation (S-2) and environmental (S-3) exposures, and also in consideration of potential leaching of contaminants to groundwater (GW-1/GW-3). For the purposes of risk characterization, the most restrictive S-1 (GW-I/GW-3), Method I - Risk Characterization standards were considered in review of potential significant ingestion, inhalation and environmental exposures related to foreseeable future uses and activities at the Site without restriction. Subsequent to the completion of contaminated soil removal operations, laboratory analysis reported all VPH and target analyte concentrations as less than the strictest S-1 (GW-1), Method 1 Risk Characterization standards. The vast majority of VPH and target analyte concentrations were reported as ND as approaching background. As such, laboratory analytical under Method 1 Risk Characterization has demonstrated a condition of no significant risk of MARCH 6,2014 SULLIVANBEAI4-10626 PAGE 12 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 exposure to human and environmental receptors as associated with direct exposure to soils along the targeted area of petroleum hydrocarbon impacts. Groundwater Based on the mapped designation and proximity to groundwater, the GW-1 and GW-3 groundwater categories are considered in review of Method 1 Risk Characterization, as consistent with the provisions of 310 CMR 40.0932. These standards were developed to evaluate potential ingestion (GW-1) and environmental (GW-3) exposures. For the purpose of risk characterization relative to foreseeable future uses and activities at the Site, the most restrictive GW-1/GW-3 Method 1 Characterization standards were considered. Subsequent to contaminated soil removal along the identified release area within the addition footprint along the north end of the subject dwelling, laboratory analytical reported all petroleum hydrocarbon and target analyte concentrations along the extent of excavation as significantly less than the strictest S-1 (GW-1/GW-3), Method 1 Risk Characterization standards as a measure of potential leaching to groundwater. Laboratory analytical has demonstrated effective source removal wherein environmental testing indicates background conditions along the majority of the area of soil removal, including the bottom of hole area, as qualifying the vertical limit of significant impact some 29' (+/-) above groundwater. In consideration of environmental conditions, laboratory analytical under Method 1 has demonstrated a condition of No Significant Risk for the leaching of contaminants to groundwater and, as such, no groundwater impact associated with the Defined Site has been indicated. Therefore, no groundwater testing was deemed necessary to support a condition of No Significant Risk and the Class A-2 Response Action Outcome. Imminent Hazard Evaluation The subject property has been uninhabited throughout the project due to ongoing construction. No gasoline odor in indoor air has been reported by onsite workers wherein the release was outdoors. Prior to contaminated soil removal, laboratory analytical reported significant petroleum hydrocarbon concentrations in soil exceeding select applicable S-1 (GW- 1/GW-3) Method 1 Risk Characterization thresholds and Direct Contact Standards. However, the dwelling has been unoccupied and monitored throughout the project by the contractor. The area of release was capped with tarps and isolated by virtue of the trench and frost walls along the perimeter of the release area, effectively restricting access to contaminated soils. Based on the Site and environmental conditions documented, and the response actions completed, no Imminent or Substantial Hazards associated with the subject release have been reported. DATA USABILITY ASSESSMENT & REPRESENTATIVENESS EVALUATION The following presents a discussion of the Site information used to support the RAO as required by 310 CMR 40.1056(2)(k) and incorporating the guidance provided in Mass DEP Policy WSC-07-350. It provides an evaluation and demonstration of the adequacy of the spatial MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 13 OF 19 MAC,CLASS A-2 RAO,RTN 4-24948 and temporal data sets used to support the RAO and makes conclusions on the accuracy, precision and sensitivity of the data used. Conceptual Site Model A small quantity release of gasoline to sub-surface soils from an abandoned UST along the north end of the dwelling was discovered in December 2013 as attributed to vessel corrosion subsequent to abandonment with stormwater infiltration. The corrosion allowed gasoline impacted water to infiltrate soils adjacent to the frost wall foundation. Based on elevated headspace readings (> 100 ppmv) in soils adjacent to the UST, a 72-Hour Reportable Condition to the MA DEP was triggered on December 23, 2013. The COMM Fire Department was on hand to witness UST removal and closure assessment, and made notification to the Department later that day. BEA was engaged on December 29, 2013 to provide LSP Oversight towards the assessment of environmental conditions and to direct cleanup operations. Based on the soil samples collected from the tank grave, as well as a hand boring advanced through the bottom of the tank grave, and field screening and analysis, the extent of significant soil impact (>S-1/GW-1) was qualified within an approximate 10'L x 10'W x 6'D area. Based on the vertical separation qualified between the depth of significant soil impact and the water table, and with consideration of timely response actions, no groundwater sampling was performed or deemed necessary in review of risk characterization. In an effort to absolve accessible soil exposures and a source of potential groundwater impact and potential vapor intrusion, an aggressive soil removal strategy was coordinated to prevent the worsening of environmental conditions and associated potential exposure risks at the private residence. On authorization of such work, some 20 yards of significantly impacted soils were removed from the identified release area as extending to approximately 8' below the bottom of the tank (I P bgs). Soil removal was facilitated by limited demolition of the subject dwelling as planned towards construction of the addition. The excavated soils were managed as remedial waste at the Aggregate Industries asphalt batching facility in South Dennis, MA. Laboratory analysis of contaminated stockpile samples reported low level concentrations of total lead, significantly less than the applicable and strictest S-1 (GW-1/GW-3), Method 1 Risk Characterization standards. Given the initial "Contaminated SP" sample was composited from samples collected from the tank grave as representing "worst case" conditions, wherein the total lead concentration was reported as less than the strictest Method 1 criteria (3.3 ppm vs. 300 ppm), no analysis of total lead in end point samples was conducted or deemed necessary in review of remedial performance or risk characterization. This is substantiated by laboratory analysis of the soil sample collected from HB-1 which reported total lead as ND wherein the reporting limit was significantly less than the strictest S-1 (GW-1/GW-3), Method 1 Risk Characterization standard (refer to Table I). Laboratory analysis reported all VPH and target analyte concentrations as significantly less than the applicable and strictest S-1 (GW-1/GW-3), and most restrictive, Method 1 Risk Characterization standards as demonstrated effective remedial performance with a finding of No Significant Risk for soils at the Site. MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 14 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 The potential for vapor entry associated with residual soil impacts into the future structure currently under construction has been investigated. The effective removal of significant soil impacts, documented by MA Certified analyses, absolved the subject release as the source of significant residual impacts in other media. As such, the reported APH concentrations in the initial soil vapor analysis are attributed to building related materials and construction activities and not with a release to the environment. Subsequent soil gas testing under the recently poured concrete slab in the north end addition has reported concentrations below the Residential Sub- Slab Soil Gas Threshold Values, established under current policy. Given the APH concentrations were reported below the residential soil gas screening values, vapor intrusion is not a complete exposure pathway at the Site and indoor air is therefore not a medium of concern. Field Screening PID screening and observations were used to qualify significant impact in soils and to make informed decisions in the field ahead of submitting samples for MA Certified analyses. In some cases, Dexsil Petroflag testing was performed to qualify gasoline concentrations in the field. Samples with higher levels of odor or PID readings were assumed to be. more contaminated than those samples with lower levels. Comparison of visual observations and PID readings with analytical data indicates the screening data generally correlates with the analytical data with the exception of the Contaminated Stockpile sample collected January 16, 2014, as is discussed in the Data Inconsistency subsection of this report. Sampling Locations Soil samples were initially collected from close proximity to the subject UST as part of UST closure assessment. A single hand boring was advanced through the bottom of hole to qualify the vertical extent of significant soil contamination. Medium grained sands facilitated general uniform mobilization routes in all directions from the point of infiltration. Based on the magnitude of significant impact and the hand boring location, an approximate 10' x 10' x 6' (D) area of significant impact was qualified as the target of prescribed soil removal operations. Soil removal progressed from significant soil contamination within the qualified area of impact to clean soils. PID screening and Dexsil PetroFag testing were used to qualify the extent of contaminated soil removal as within an approximate 8' x 12' x 8'D (3-11' bgs) area. Confirmatory soil samples were preserved for risk-based VPH and target analyte analyses. Five soil samples were collected for analyses from the extent of soil removal. Sidewall samples were taken from the 3-11' bgs interval as corresponded to the subsurface interval along which the release occurred; a bottom of hole sample was collected from I Y bgs. The end point samples were collected and analyzed in consideration of remedial response performance and exposure risks. All applicable exposure point locations along the extent of soil removal are represented by the end point samples collected and their respective analytical results. Field duplicates or trip blanks for soil sampling were not collected nor considered necessary because the disposal Site was small, the removal operations had produced clean conditions along the vast majority of exposure points, QA/QC protocols were employed and MARCH 6,2014 SULLIVANBEAI4-10626 PAGE 15 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 documented with Method Blanks and Spikes performed by the laboratory. After collection, all soil samples were placed in appropriately preserved laboratory containers and stored on ice in a cooler, and subsequently within a refrigerator, pending shipment to the laboratory under properly executed chains-of-custody. Groundwater samples were not collected based on the substantial separation from the bottom of significant impacts to the projected groundwater interface as some 29' (+/-), and because soil removal had produced background conditions along the bottom of hole, with conditions approaching background in all sidewalls of the excavation. Temporal Data Soil data indicates that the vertical migration of gasoline extended to a maximum depth of 11' bgs (+/-) wherein laboratory analysis for all end point samples reported all VPH and target analyte concentrations as less than the strictest S-1/S-2/S-3 (GW-1/GW-3) Method 1 Risk Characterization standards. Residual VPH concentrations, significantly less than the most restrictive S-1 (GW-1), Method 1 thresholds, were reported along the north and east sidewalls from 3-11'bgs. The issue of further attenuation to achieve background conditions is discussed in the Feasibility Evaluation. This end point soil sampling following soil removal is relied upon, and not dependent on temporal data, to demonstrate a condition of No Significant Risk relative to soil at the site as inclusive of direct exposures as well as those associated with leaching of compounds to groundwater. Soil vapor sampling indicates that current and future indoor air quality will not be negatively impacted as a result of residual soil impact along the area of excavation. Based on the effectiveness of soil removal as absolving residual impacts in other media, temporal soil vapor sampling was deemed unnecessary in review of cleanup performance and risk characterization under the existing policies in effect at the time of such testing. Field Completeness The analytical data set is complete. Data from the sidewall and bottom-of-hole areas were obtained as representing the extent of contaminated soil removal. Data representing soil vapor conditions beneath the concrete slab of the new foundation met the applicable Residential Sub-Slab Soil Gas Screening Values. The complete data set supports the RAO wherein all QA/QC thresholds and Presumptive Certainty requirements were met or technically justified under the MA DEP Policy WSC-07-350 Representativeness Evaluations and Data Usability Assessment(REDUA). Data Inconsistency BEA advanced a hand boring through the bottom of the tank grave on December 23, 2013 to qualify the vertical extent of significant impact. Based on field screening the vertical extent of significant impact was qualified as some 6' below the bottom of the tank grave, corresponding to approximately 9' bgs. BEA submitted soil sample HB-1: 6-8' (9-11'bgs) for laboratory analysis of VPH, target analytes and total lead. However, the sample was incorrectly labeled as HB-1:4- MARCH 6,2014 SULLIVANBEAI4-10626 PAGE 16 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 6' (7-9' bgs). The reported background conditions for the soil sample labeled as HB-1:4-6' (7-9' _ _ bgs) are representative of the 6 8 (9 11 bgs) interval at the time of testing. BEA collected a"Contaminated SP" sample on the day of the initial response, December 23, 2013; this sample was composited from soil samples collected from the tank grave as representing "worst case" conditions. Laboratory analysis reported significant VPH and VOC concentrations in the "Contaminated SP" exceeding applicable Method 1 criteria as well as the acceptable disposal thresholds for Aggregate Industries' South Dennis facility. BEA collected a second"Contaminated Stockpile" on January 16, 2014 from the excavated material in each of the two 10 yard roll-off containers. Field screening of soil samples collected from the roll-off containers reported headspace concentrations exceeding 200 ppmv as indicating significant VPH and/or VOC impact. Based on the consistent headspace screening results, the "Contaminated Stockpile" sample was composited from the two field samples of excavated material. Laboratory analytical reported low-level VPH and VOC concentrations in the "Contaminated Stockpile" sample as less than the applicable and strictest Method 1 criteria, as well as the Aggregate Industries' disposal thresholds. The inconsistency between the laboratory analytical results for the two separate contaminated stockpile samples is due to the difference between the "worst case" impacts along the tank grave ("Contaminated SP", 12/23/13) and the actual excavated material ("Contaminated Stockpile", 1/16/14). The inconsistency between the field screening of the "Contaminated Stockpile" (1/16/14) and the associated laboratory analysis is due to the volatility of the contaminant of concern, gasoline, biasing the headspace TOV concentration. MA certified analyses of end point soil samples reported mostly background (ie. ND) conditions along the extent of contaminated soil removal. Exceptions to background along the extent of excavation were the north and east sidewalls which reported low level target analyte concentrations (xylene, toluene) as substantially less than the applicable and strictest S-1 (GW- 1/GW-3), Method 1 Risk Characterization standards (refer to Table II). Despite absolving the subject release as the source for impacts to other media, the initial soil vapor testing reported a significant C5-C8 Aliphatics concentration. Based on review of the analysis by the reporting laboratory, and considering the recent construction of a new concrete foundation, it has been determined that the reported APH concentrations in soil vapor, as inconsistent with the residual VPH/target analyte concentrations reported along the extent of excavation, were associated with off gassing of residual form oil on the fresh concrete surfaces of the new foundation. No other inconsistent data was identified. Visual observations, odors and field screening were generally well correlated. No inconsistency was identified between the field screening of the balance of end point soil samples and their respective laboratory analyses. Data Not Used The complete analytical data set associated with confirmatory end-point soil samples was considered in support the RAO as representative of Site and environmental conditions subsequent to the excavation of significantly contaminated soils. The initial APH results were deemed as biased and not representative of residual soil impact. Laboratory analysis of the soil MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 17 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 vapor samples was relied on to preclude indoor air as a medium of concern. Laboratory analysis of end point soil samples was relied on to demonstrate No Significant Risk in support of the IRAC-RAO. Data Usability The analytical data used was validated and justified as representative of environmental conditions. Soil samples from the extent of excavation were collected as representing discrete exposures in the appropriate soil category as a measure of frequency and intensity of use. The methods utilized (PID soil screening, Dexsil PetroFlag testing) respond to the contaminants of concern (VPH plus target analytes) and are appropriate for a release of gasoline. Based on the Representativeness Evaluation, the analytical data quality of the two soil samples used for assessment of significant gasoline impacts was deemed sufficient for the intended purposes of disposal characterization and qualifying the proposed area of excavation. The soil samples used for such assessment were not critical samples relied on to demonstrate "No Significant Risk" or to support the RAO. Based on the Representativeness Evaluation, the analytical data quality of all five final end-point soil samples relied on in support of the RAO has been reviewed. The analytical data provided in support of this RAO has met the method quality control requirements and performance standards for "Presumptive Certainty" (PC) as described in CAM VII A, Section 2.0 (a), (b), (c), and (d), or has been evaluated as comparable under REDUA to CAM requirements. The validity and defensibility of the analytical data used to support the findings of the RAO for this Site with respect to accuracy,precision and completeness pursuant to 310 CMR 40.1056(2)(k)have therefore been satisfied. Deficiencies associated with soil analyses relied on in support of the RAO are addressed by a preponderance of temporal, physical evidence with repeatable results. Laboratory QA/QC deficiencies were identified in connection with the "Contaminated Stockpile" sample collected January 16, 2014 wherein several VOC compounds did not meet the CAM reporting limits due to elevated concentrations of several VOCs triggering recalibration. The analytical reporting limits were deemed adequate for disposal characterization and were not relied on to support the RAO. No deficiencies associated with laboratory QA/QC or CAM were reported for critical end-point soil samples as were relied upon to support the RAO. Laboratory QA/QC deficiencies for the APH analyses were reported as associated with target analytes not meeting CAM reporting limits. These deficiencies were discounted given the reporting limits were less than the applicable Residential Sub-Slab Soil Gas Screening Values as appropriate to determine indoor air was not a medium of concern. It has been determined that the Site data is sufficiently representative of actual Site conditions and may be used to support this Class A-2 RAO. Laboratory analysis for critical samples used in exposure evaluation and risk characterization were deemed to meet the aforementioned REDUA/PC criteria in support of the RAO. I MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 18 OF 19 IRAQ CLASS A-2 RAO,RTN 4-24948 BACKGROUND FEASIBILITY EVALUATION A review of cost and feasibility to meet background conditions through additional soil removal was considered as part of this IRA, in accordance with the provisions of 310 CMR 40.1020. All residual VPH and target analyte impact in soil is reported as significantly less than the most restrictive S-1 (GW-1/GW-3), Method 1 Risk Characterization standards as supporting a condition of No Significant Risk. Based on the separation to groundwater from the bottom of hole as some 29' wherein all VPH and target analyte concentrations were reported as ND at detection limits less than the strictest S-1 (GW-1/GW-3), Method 1 Risk Characterization standards, no groundwater impact associated with the subject release was anticipated. Laboratory analyses of soil vapor reported representative APH concentrations as less than the applicable Residential Sub-Slab Soil Gas Screening Values wherein the reported APH concentrations were associated with the use of form oil in construction of the foundation. Such APH analyses demonstrate that low level residual volatile organic compounds (VOCs) along the extent of excavation and in associated soil vapor do not represent a significant threat to current or future indoor air quality degradation. Based on the testing of end point samples and soil vapor, additional soil removal is not justified wherein no significant reduction in risk would be accomplished. Additional soil removal would also increase the threat to worker safety and potential damage to physical property given the position of the excavation relative to the foundations of both the existing building and the addition. As such, current environmental conditions associated with residual target analyte concentrations in soil, as non-persistent, naturally degrading compounds, meet the "Conditions of Categorical Infeasibility" established in Section 9.3.2 of the MA DEP policy "Conducting Feasibility Evaluations Under the MCP" (WSC-04-160), as specifically pertaining to Section 9.3.2.3, "Remediation of Degradable (Nonpersistent) Contaminants". Further, residual carbon range and target analyte concentrations are located in soils along the footprint of the dwelling, and additional excavation under the foundation would compromise the integrity of the permanent structure. Therefore, additional soil removal is considered infeasible in accordance with the provisions of Section 9.3.2.1, "Excavations Under Permanent Structures" of the above referenced policy (WSC-04-160). CONCLUSIONS Remedial response actions over the course of the project have resulted in the removal of some 20 cubic yards of gasoline impacted soils. Laboratory analytical for residual soil impacts has been evaluated under Method 1 Risk Characterization and has established that there is no Substantial or Imminent Hazards present and a finding of No Significant Risk is documented herein. Environmental testing and laboratory analyses under Method 1 have substantiated the elimination of the contaminant source and the apparent mitigation of exposure risks to identified human and environmental receptors to support the IRA Completion Statement and Class A-2 P Pp P Response Action Outcome wherein a Permanent Solution has been achieved without restrictions MARCH 6,2014 SULLIVAN/BEA14-10626 PAGE 19 OF 19 IRAC,CLASS A-2 RAO,RTN 4-24948 of activities and use of the property under the current provisions of the MCP, pursuant to 310 CMR 40.0000. The findings of this investigation, as represented herein, set forth the rationale and technical justification for the LSP Opinions offered, as established by the certifications made on the attached Response Action Outcome Statement (BWSC-104) and the Immediate Response Action Transmittal Form (BWSC-105). The LSP Opinions are based on available data and regulations in effect at the time of this reporting specific to the subject Site and standard of practice. Should you have any questions regarding the project or require additional information, please contact me at your earliest convenience. Sincerely, BENNETT ENVIRONMENTAL ASSOCIATES, INC. Davk C7Wett, LSP Todd M./ verson PM President Senior Environmental Scientist Encl: Supporting Documentation [Appendices A-G] cc: Michael Sullivan—PRP, Homeowner Thomas McKean, Director—Barnstable Health Division* Thomas K. Lynch—Barnstable Town Manager * Fire Prevention Officer McNeely—COMM Fire Department* *NOTE: In accordance with our paper reduction policy,Public Notice Distribution to named parties to be limited to Title Page, Report Narrative and Site Plan only. Full report will be provided on request from BEA or is available online at the MA DEP website h!W:Hdb.state.ma.us/dep/cleanup/sites/search.asp. i IMMEDIATE RESPONSE ACTION COMPLETION CLASS A-2 RESPONSE ACTION OUTCOME STATEMENT SUPPORTING DOCUMENTATION RTN 4-24948 Residential Property 206 Starboard Lane—Osterville,MA [Assessor's Map 166,Parcel 53] MARCH 6,2014 Prepared For: MA DEPARTMENT OF ENVIRONMENTAL PROTECTION Southeast Regional Offices: Bureau of Waste Site Cleanup/Emergency Response Section 20 Riverside Drive-Lakeville,MA 02347 Julie Hutcheson, Case Officer Prepared By: BENNETT ENVIRONMENTAL ASSOCIATES,INC. 1573 Main Street-Brewster,MA 02631 David C.Bennett,LSP On Behalf Of: Michael Sullivan 448 Starboard Lane—Osterville,MA 02655 APPENDIX A:Reference Plans -Figure 1: Site Locus Plan[USGS Topographic Quad.,Barnstable,MA. 1998] (excerpt) -Figure 2:Ground-Water Resources of Cape Cod,MA[LeBlanc et al, 1986] (excerpt) -Figure 3:MA DEP BWSC GIS Map[2014] -Site Plan entitled,"Immediate Response Action Completion..."Prepared by BENNETT ENVIRONMENTAL ASSOCIATES,INC.,dated March 6,2014. APPENDIX B: Field Reports -Field Response Log APPENDIX C:Environmental Records/Permits -Tank Removal Permit/Uniform Hazardous Waste Manifest -COMM Fire Department Oil Release Form/Inspection Report -Email Communication to MA DEP -BWSC-101:Release Log Form -Aggregate Industries Soil Recycling Submittal -Waste Characterization Letter to Aggregate Industries -BWSC-112:Bill of Lading/eDEP Submittal Summary and Receipt -BWSC-112,-112A,-112B:Attestation of Shipment w/eDEP Submittal Summary and Receipt -Notice of Anticipated Delay -BWSC-103:Release Notification Transmittal Form w/eDEP Submittal Summary and Receipt -BWSC-104:Response Action Outcome Statement/eDEP Submittal Summary and Receipt -BWSC-105:Immediate Response Action Transmittal Form/eDEP Submittal Summary and Receipt APPENDIX D: Concrete Form/Form Oil Product Data Sheets and MSDS APPENDIX E:Laboratory Analysis -Env.Assessment/Waste Characterization—Soil[Alpha Analytical] (Lab#L1326113, 1/2/2014) -Supplemental Waste Characterization—Soil[Alpha Analytical] (Lab#L1400737, 1/8/2014) -Remedial Response-Soil[Alpha Analytical] (Lab#L1401556, 1/23/2014) -Environmental Monitoring—Soil Vapor[Alpha Analytical](Lab#1403392,2/19/2014) -Email Communication from Alpha Analytical -Environmental Monitoring—Soil Vapor[Alpha Analytical](Lab#L1404084,3/4/2014) APPENDIX F: Quality Assurance/Quality Control Plan APPENDIX G: Health and Safety Plan TD -oENNETTENVIRONMENTALAsSOCIATES9 INCc LICENSED SITE PROFESSIONALS & ENVIRONMENTAL SCIENTISTS b GEOLOGISTS 6 ENGINEERS 1573 Main Street-P.O. Box 1743, Brewster, MA 02631 508-896-1706 Fax 508-896-5109 www.bennett-ea.com BEA13-10626 February 21, 2014 Ms. Julie Hutcheson, Case Officer MA DEPARTMENT OF ENVIRONMENTAL PROTECTION (MA DEP) Southeast Regional Office (SERO) Bureau of Waste Site Cleanup (BWSC), Emergency Response Section 20 Riverside Drive Lakeville, MA 02347 VIA EMAIL: julie.hutchesongstate.ma.us RE: NOTICE OF ANTICIPATED DELAY IN FILING Immediate Response Action Completion/Response Action Outcome Statement Sullivan Residence, RTN 4-24948:-206 Starboard`Lane—Osterville, MA Dear Ms. Hutcheson, Per our conversation this morning, please be advised- that on behalf our client (PRP), BENNETT ENVIRONMENTAL ASSOCIATES, INC. (BEA) is providing Notice of Anticipated Delay in the statutory filing of the Immediate Response Action submittal. The.delay in filing is to accommodate the review of critical data as substantive to the report.. The review and evaluation of this critical data and the direction of the IRA should be completed within two weeks. We have filed the Release Notification Form today as having been filed through the eDEP. Soil removal has been completed and endpoint soils analysis reports all discrete concentrations significantly below the most restrictive S-1/GW-1 standards. However low-le%I res dual) concentrations of VPH target analytes were reported along two sidewall Brea t the excgatiQ",and, pursuant to 310 CMR 40.0942(d) and the current "Interim Final Vapor Intrus1o1i" policy,soilcvapofll testing was conducted as a conservative measure wherein reference to the ;;egulations�s to.`'many concentration. Laboratory for the Air Phase Petroleum (APH) testing conducted reported 41 PH' parameters as Non-Detect (ND) with the exception of the. C5-C8 aliphatic co pounds-which;were reported as greater than the applicable Residential Soil Gas Threshold. Thd preseneg of 5-C811 aliphatic compo0unds is problematic wherein the laboratory results,for the end pointrsbilsrWhich reported all C5-C8 Aliphatic concentrations throughout the extent of excavation as non-detect with reporting limits substantially less than the S-1/GW-1 criteria. In the absence of source associated with the release as the subject of the IRA, the reporting of these compounds appears to.be either erroneous or associated with materials used in construction. The subject release occurred within an addition currently under construction with new foundation walls, new Lally,column footings and a freshly poured concrete slab (<2 weeks) that was curing at the time of soil vapor sampling. Given the ongoing construction and source removal, the recent soil vapor analysis may be considered as background. Regardless without the benefit of the lab verification of results and identification of specific compounds within the C5-C8 aliphatic range, any MCP related exposure 1 EMERGENCY SPILL RESPONSE 6 WASTE SITE CLEANUP & SITE ASSESSMENT b PERMITTING 6 SEPTIC DESIGN&INSPECTION WATER SUPPLY DEVELOPMENT,OPERATION&MAINTENANCE WASTEWATER TREATMENT,OPERATION&MAINTENANCE FEBRUARY 21,2014 SULLIVANBEAI3-10626 PAGE 2 OF 2 NOTICE OF ANTICIPATED DELAY,I AC/RAO-RTN 4-24948 cannot be fully evaluated or qualified. We expect the lab to get back to us by the end of the day and have scheduled APH re-testing for early next. This delay in filing does not, and will not, compromise the review and evaluation of all potential exposures under LSP oversight. The filing delay has not deferred 'remedial performance by the PRP wherein effective contaminated soil removal has been completed. as demonstrated by the attached analytical report. The delay in filing will accommodate further evaluation of soil vapor, and associated sources of the reported APH concentrations, without redundant reporting and unnecessary costs. It is anticipated that an IRA Plan or IRA Completion with-a Class A Response Action Outcome will be submitted within two weeks from the original 60-Day deadline of February 21, 2014. Copies of the executed Release Notification Form (BWSC-103), an updated site plan (Draft) and laboratory analyses are enclosed as documenting work progress. If you have any questions or need additional information in the interim, please contact our office at your earliest convenience. S' rely yours, NVIRONMENTAL ASSOCIATES, INC. Dav` nnett, LSP siden Encl. -BWSC-103: Release Notification Form w/eDEP Submittal Summary and Receipt -Draft Site Plan entitled"Irmmediate Response Action Completion...",prepared by BENNETT ENVIRONMENTAL ASSOCIATES, INC., dated February 12, 2014. -Tables I, II, III -Env. Assessment/Waste Characterization—Soil [Alpha #L1326113 (1/2/2014)] -Supplemental Waste Characterization— Soil [Alpha Analytical] (Lab#L1400737, 1/8/2014) -Remedial Response Soil [Alpha Analytical] (Lab#L1401556, 1/23/2014) -Environmental Monitoring—Soil Vapor [Alpha Analytical] (Lab#1403392, 2/19/2014) Cc: Michael Sullivan—PRP, Homeowner Thomas McKean-Director, Barnstable Health Division* Thomas K. Lynch—Barnstable Town Manager* Fire Prevention Officer McNeely—COMM Fire Department* *NOTE: Cover Letter Only ol om O�D Health Master Detail Page 1 of 1 6 mat- Logged In As: TOWN\health Health Master Detail Thursday,May 15 2014 Application Center Parcel Lookup Selection Items Parcel ' Septic Perc I Well Fuel Tank Parcel: 166-053 Location: 206 STARBOARD LANE,OSTERVILLE Owner: SULLIVAN,MICHAEL T.K&TRUDY F Septic 5,11/13/2013 Septic 4,9/6/2013 Septic 1 I Septic 2 Septic 3 1 New Septic... Permit number: 2013446 Permit type: Upgrade - ��', Complete system r Issue date 11/13/2013 Complete date : 11/21/2013 } Septic tank size:INA Type/Size of SAS add row of biodlffusers Installer:I Fisher,Rodney D. = Card on file: rl I/A service type: Select service',, Innovative/Alternative Technology type: Select IA type II: Variance date:r Abandon complete date : Abandon permit number: Repair deadline date : ` Repair notification date : Keyword: Comments: Homeowner certification for IA - ---.._ ..-- - � Delete Septic.__I New Inspection... ............._., .. Number Inspection Date Inspector Result Select Inspector Cj Select result Received Date Comments I5/15/2014 ilJ Save Septic Changes-^ -j Return to Lookup 01 1 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=166053 5/15/2014 CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508)790-2380/FAX#(508)790-2385 OILIHAZARDOUS MATERIAL RELEASE FORM F.A.# N/A LOCATION: ADDRESS OF RELEASE: 206 Starboard Lane Osterville, MA 02655 DATE OF RELEASE• December 23, 2013 PRODUCT RELEASED: Gasoline ESTIMATED QUANTITY: Unknown CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: Notification." NOTIFICATIONS: FIRE DEPARTMENT: YESU NO( ) DATE: TIME:. 1045 NATIONAL RESPONSE CENTER YES( ) NOkj) D TE: TIME: DEPT. OF ENVIRONMENTAL PROTECTION YES(_) NO( ) DATE: In In fTy%E.'— OIL SPILL COORDINATOR: YES( ) NO DATE: TOWN BOARD OF HEALTH: YES( NON DATE: 12/23/13rIME: OW"ARBORMASTE-R.YES( Op�y--@ATE: TIMEe OTHER AGENCIES: See attached report COMMENTS: See attached report Ud .. REPORTED BY: Martin MacNeely, -Fire Prevention 06MOLAr:;- 12/23/2013 4 WHITE COPY=FIRE.DEPARTMENT - YELLOW.COPY-D.E.P.. PINK COPY-BOARD OF.HEALTH C-O-MM FORM#68 .—ra '- 'sae. ., �i.;.• . ... ._ .-- ....... _..�.._.. ....,.� gsr. COMM Fire District '9 1875 Route 28 4� CENTERVILLE, Ili 02632 192b INSPECTION REPORT Monday December 23, 2013 BAMBARA, JOHN D 206 STARBOARD IN OSTERVILLE, MA 02655 Occupancy ID: BAMB01 Date Completed: 12/23/2013 Inspection Type: INSPECTION - UST Removal On location with Tank Removal Services and Todd Everson from Bennett Environmental for removal of approximately 100 gallon UST gasoline tank. Tank was located on the B/C corrner of the existing garage in newly excavated area for new addition. Upon removal of tank and piping obvious petroleum odor in soil under tank, no obvious holes found in tank but did fine hole in vent piping that was installed u against house Initial sniff test b LSP came back positive for r � Y hydrocarbons. Additional samples taken by LSP that will be sent to lab for further analysis. . Notifications to the DEP and BOH will be made by letter 329 cleared without further incident 12/23/2013 14:08:53 mmacneely MACNEELY, MARTIN O./Senior Fire Prevention Inspector 12/23/2013 14:11 Page 1 THE Town of Barnstable..'.xBarnstable rosy Regulatory Services Department ;mjca CRY I+ BARMWABLE, • - MA,%. 0 - - Public Health Division - - �Ar ��e fn Mai 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2843 2072 March l 1, 2013 q . David Holt ; Today Real Estate -1.533 Falmouth Road/Rte 28 Centerville, MA 02632 " ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE TITLE 5 • The septic systems located at 206 Starboard Lane, Osterville, MAwere last inspected on 8/27/2012 by Shawn McElroy, a certified septic inspector for the State of Massachusetts. The inspections of these tics 'stems showed that all three 3 systems "Failed"under' P p Y O Y the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic systems 1, 2 and 3 are in hydraulic failure You were ordered to repair all three (3),systems within sixty (00) days from the date you receive this notification. However, as of this date, March 6, 2013, we have not received any indication that the construction work for replacing/repairing the Title 5 septic system has been done. Therefore you.are-again ordered to,repair or replace the septic system within sixty(60) days from the date you receive this-notification.,' You may request a hearin before the Board of Health through a writtenpetition, . Y q g � g , requesting a hearing on the matter, within seven (7) days after the day this order.is received. PER ORDER OF THE BOARD OF HEALTH '::gTomas McKean, R.S. CHO Agent of the Board of Health QASEPTIC\Letters.Septic Inspection Failures or Future Eval\206 Starboard Lane Ost Mar 2013.doc . 1 Town of Barnstable P# 1 (3 &L' ` Department of Regulatory Services . ra�►n� _ . i Public Health Division Hate /ZZ lI- 3 >uwas A +e aid' 200 Main Stmet;-Hyannis MA 02601 Date Scheduled y �r -rL UU CU - Time_—� Fee Pd. ,. Soil Suitability Assessment for Se e Disposal Performed By: ��• :l �'� Witnessed By: LOCATION.& GENERAL INFORMATION Location,Address 2_O 6 s+.,.rbmro( LcL Owner's Name A a5 Imo✓f� 1(p f� Z/ 540 e//►2era�Pe Address d)7Zo Ass.;3ser's M ;JPtrreL f tpto s d_�-3 Engineer.Name / NEW CONSTRUCTION REPAIR Telephone# SDI— -7.7 .5 3 i 3 Land Use. 1z": 4- �"�• Slopes(g'o) 1 .Surface Stones 1'J1� Distances from: Open Water Body ft Possible Wet Area 2. --ft Drinking Water Well t ft / 1 Drainage Way Aj/ / ft Property tine--t .Other` ft SKETCH:(Street name,dimensions of lot,exact locations.of test holes&perc tests,locate wetlands?n proximity to holes) 2lo.c Parent material(geologic) Q "� � Depth to Bedrock nI A u>f .p 3Y Depth to Groundwater. Standing Water in Hole: l,A- Weeping from Pit Fa r Estimated Seasonal High Groundwater / ,Z DETERMINATION FOR SEASONAL HIGH'WATER TABLE Method Used: Depth Observed standing in obs hole: _ in, Depth to soil mottles: Ccpth,a weeping fiarn aide of obs pule:--" M tn. Groundv✓ater Adjustment, Index.Well.# Reading Date: hrdex Well level Adl,factor•,,...--,� Adj.Groundwater Level �7 'PERCOLATION TEST bete . T1tae—.' Observation -�-�1 3 — f Hole# Time at 4" Depth of Pero (1 2.� Time at 6"5� cis , Start Pre-soak Time @ �. Time(9" ") �r •6 End Pre-soak r Rate MinJinch. Site Suitability Assessment: Site Passed e _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. 1 Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTIMERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#> Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,'Stones;Boulders:, COnSiStCOCY, v ,G DEEP OBSERVATION HOLE LOG Hole# P Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders., Cons' DEEP OBSERVATION HOLE LOG Hole•# Depth from.:,:::•.- Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. i toncL%'Graveli DEEP OBSERVATION HOLE LOG Hole# Depth.from Soil Horizon Soil Texture Soil Color Soil Other f Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. C - U Flood Insurance Rate Map: 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 pervio s material exist in all areas observed throughout=.the . area proposed for the soil absorption system. ~" " If not,what is the depth of naturally occurring pervious material? ..� Certification I eertify that on (date)"I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performt:d by me c.onsistent with .r the required tra n n expertise and experience described in 310 CMR,15.017. Date 2-, 2'r`l C-3 Signature T Q:4S6pTIC�?BRCFORM-DOC . 1'. Town of Barnstable Barnstable Regulatory Services Department AHmeficaCft 9BARNSTAHMr Public Health Division 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2850 9224 June 10 2013 Aurora Loan Services LLV 21 Stoneymeade Way Acton, MA 01720 RE: 206 Starboard Lane, Osterville The septic systems located at 206 Starboard Lane, Osterville, MA were last inspected • on 8/27/2012 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspections of the septic systems showed that all three (3) systems failed "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00)due to the following: • Septic#1, 2 and 3 are in hydraulic failure You are ordered to repair all three (3) systems within sixty (60) days from the date you receive this.notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. �aas ER OF T BOARD OF HEALTH cKean, R.S. CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\206 Starboard.Ln Ost.doc r , ® Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108,617-292-5500 DEVV/.AL L PATRICK RICHARD K.SULLIVAN JR. Governor Secretary i1MDTHY P MURRAY KENNETH L.KIMMELL Lieutenant Governor Commissioner August 22,2013 David Lentz Infiltrator Systems Inc. 6 Business Park Road, P.O. Box 768 Old Saybrook, CT 06475 ' Re: Massachusetts Title 5—Innovative/Alternative Technologies Program Revised General Use Certification for Alternative Soil Absorption Systems Technologies: BioDiffuser Chambers and Infiltrator Chambers DEP Transmittal Numbers: X235253 and X228042 Dear Mr. Lentz: The Department of Environmental Protection has received Dick Bachelder's email dated August 5, 2013 with attached letter requesting changes to the above referenced Approvals. After review the Department is pleased to issue the enclosed modified Approvals for both the Certification for General Use for BioDiffuser Chambers and Infiltrator Chambers. Revisions are as follows: 1. The deed notice requirement in section II condition 3 of the Spepial Conditions within the General Use Certification has been deleted. 2. Revisions have been made to the Standard Conditions far Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use,dated June 6, 2013 as follows: section II, 18(d)(ii)and section IV(1)have been deleted. section II,23(d)(ii)has been revised. Please note that the Deed Notice requirement applies for technologies with Remedial Use . Approval only and both BioDiffuser Chambers and Infiltrator Chambers are under General Use Certifications. M • r . This Information Is available In alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617.292.5751.TDD#1-866-539.7622 or 1.617-574-6868 MassDEP Website;www.mass.gov/dep Printed on Recycled Paper I Page 2of2 Revised General Use Approvals for Alternative SAS Technologies: BioDiffuser Chambers and Infiltrator Chambers If you have any questions concerning these revisions, please contact Sanh Tran at 617-556-1036 or Dana Hill at 617-292-5867 of my staff. Thank you for your attention to this matter. Sincerely, David Ferris,Director Wastewater Management Program Enclosures: 1. Revised General Use Approval for BioDiffuser Chambers;Transmittal#:X235253,dated August 22,2013 2. Revised General Use Approval for Infiltrator Chambers;Transmitta€#:X228042,dated August 22,2013 3. the Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use- Revised August 22,2013 " l . ..... ... .... .... "..:,:: . Noticel of Altgrnative Sewage DlsposaI S.ystem M:G L c:21A,§ 13 and:310 CMR I5 4287(a0) rThis Notice to be'recorded andlor:filed for;re �strahon m.the chain:of tatle:of the Propert} served b:y an Alternative Sewage Disposal System('Alternative System ).J NAMES}OF OW1\TER OF PROPERTY SERVED BY.ALTERNATIVE SYSTEM STUART WOODRTN(; ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM 206 STARBOARD 7 ANF,y n�mERUT:r� 'MA 02655 TITLE REFERENCE,FOR PROPERTY SERVED BY:ALTERNATrVE SYSTEM [check:an,d complete each that.applies]: Deed recorded:with.the Registry of Deeds in Book ;Page - Certificate of.Title No. 9 �`��issued;b. the Land Re stration Office of theBarnSt able;. Re Zstr Dzstrict - :. _ — y g _ . g ..y Source of title other than'bydeed [If Alternative System Own,er(s)isother than Property O ner(s),complete the.followui - Alternative System Owner Name I: Alternative Sysfem Owner Address. WHEREAS,`Section 15,280 of Title 5'of the State Environmental Code.:'(." al ofAppro'v Altemative Systems"),provides for the Massachusetts Department,lof Environmental Protection(the "Department")to appro"ve or certify, as.appropriate,;all,proposals io construct,u.graderor replace on-site sewage di posal systems using alternative systems; WHEREAS, owners and/or operators of approved or certified alternative,systems are subject to general conditions,as.:specified.in Section 15i287 of Title 5:f the State Env: nimntaI Code,310 CMR I5:287,aril maybe subject to special conditions,as specified in the Department's approva]s or certifications; such general and specialtonditions potentially including, without :;limitation,requirements relating the to: use,of trained operators,; in periodicspections,':maintenance:sampling,reporting:and/or - recordkeeping; WHEREAS, Sec tion.15287(10) f Ti otle 5 ofahe Env ironmental State Cod e, 310 CIvIR.. 15287(1.0),requires that:"prior_to obtaining aCertificate of:Compliance for installation:of anew or upgraded;system;the system owner shall record in the chain;of title for the property sensed by the alternative�system in the.Registry,of Deeds and/or,Land Registration Office,as applicable,a Notice disclosing':both:the existence of the alternative on;site system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the local Approvirig Authority;[;I".and WHEREAS,the Froperty is served by an alternative sewage disposal system. NOW, THEREFORE;Notice:o.f an alternative sewage disposal system is hereby;given!for the ..' above referenced Property, as..... .. 1 `Existence. An alternative system has been installed as a:new oraipgraded alternative:sewage disposal system, on.or adjacent to'the Praperty;'and serves the Property. The trade name and model numbers) of the alternative system are as follows t : Trade name,of technology Manufacturer Name - _- Model Page l:of 2 i tip;-: x: 2. ApprovaUCerEificafion On . :` [date],the Department,pursuant.to 1. its authority under the:section of Title 5-as specified below, approved or,certified the technology used i the above= referenced alternative system,under 1vlassDEP Transmittal Number ['Cransmittat Number of approval'or cert f 1. ,ii : [Check one of the following,a1.1 s ap11 piicabie:], Approved for remeial use under 310 CMR 15. 84 AP-PI OIve-d for piloting under 310 CMR 15 285 Z. .Provisionally approved under 310<CMR 15 286 Certified for'general use under 314 CMR I5.288 A copy 1.of`the Department's ApprovallCertificationis available from the 1.-.�.:..I epartment to=person or on. lme:at the Department's:website http//wviw:mass.`og v/dep �� ,j WITNESS the execution hereof under-°seal this , day of;�e t:w S';20 ,made by . the:above-nai idd Alternative System Owner(s). (Atternative Sy fem Owners}] Print Name(s). — '�(". . `li Q c`yi Q } 1 COMMo�wEALTx-O MAssACHus, .., r Ss 11 On,this dayof S fe ;20 ,before met the undersigned notary:public,personally; .: w. appeared St ��` 1�;L c rA�r,`n (name:of document signer),proved to ine through satisfactory evidence.of identification,which.were:!j''J�} (�✓b�,r i� ;�s ,to be the person whose name is signed on the'preceding or attached document, and acknowledged to )a that(he) (she)signed it voluntarily for s'stated purpose STANLEY P..NOWAK (official signature a :seal of notary) Notary Public ;. S--F a v,(N� ' - .� � chusetts Commonwealth,ofoMassa n Expires [Co.mpteteahe following Property Owner{s)Consent if Alternat►ve Sgstem(}wner(s)-is other tha roperty JUn820,2019 Owner(s):] CONSENTED TQ - _„ . .... I . Property Owner(s)] [. Print Name(s);, _. Date; . CQMMON�VEALTH OF MASS, .._ ETTS .... _ :, 1. .. 7.:ss . On lus day of ,20.: _,before me;the undersigned notary public,personally; appeared (naiiii of document signer),proved to me through satisfactory F ev dence.o.f identification,which were: , to be<the person whose name is signed on the preceding or attached document;and acknowledged tp me that(he)i(she)signed it . voluntaril-- - .its stated purpose ::-_ ... :: ... .. :. ... ".A. ,. .. .. (official ignature and seal of;natary) Upon recordzng,return to [Name andaddress of Prop:erty,Owner(s)] P49e'2 of 2 _ . . STUART D. WOODRING 21 STONEYMEADE WAY ACTON, MA 01720 September 6, 2013 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: Installation of Septic System, 206 Starboard Lane, Osterville, MA 02655 To Whom It May Concern: I am the owner of 206 Starboard Lane, Osterville, MA. I understand that a new septic system is being installed by Rodney Fisher and that he will be using plastic BioDiffuser Chambers.on the site and I do approve of said installation. Sincerely, � Ua Stuart D. Woodring r 'down of Barnstable °p1HET°� Regulatory Services' Richard V. Scali, Interim Director BMWSTABLE. Public Health Division 9 MASS. 039. s`� Thomas McKean,Director FD MA'S 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address: Assessor's Map\Parcel: Property Owners Name: In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an 'Y' in the applicable box next to each line certifying the information. Yes N\A ❑ ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ ❑ I have been provided with the Owner's Manual ❑ ❑ I have been provided with the Operation and Maintenance Manual ❑ ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval ❑ ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) ❑ ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted ❑ ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 I , agree to comply with all terms and conditions above. Property Owners printed name Property Owners Signature Date Note: This form must be submitted along with the septic system disposal works permit application for all I\A systems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certification.doe 1 1 , 6p- E i i b THE Town of Barnstable Barnstable °F T°�y Regulatory Services Department 1 mcac 1 9nA MASSaL�.g Public Health Division Q Dm Q MASS OA •t63q. �0 TED Mp,a. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler;Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6741 September 24, 2012 David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Centerville, MA 02632 I RE: 206 Starboard Lane The septic system located at 206 Starboard Lane, Osterville, MA was last inspected on 8/27/2012 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: 1. Septic #1 is in hydraulic failure 2. Septic #2 is in hydraulic failure 3. Septic #3 is in hydraulic failure You are ordered to repair all three (3) systems within'sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Documentl Commonwealth of Massachusetts r " ; {, .: . a, , /C)W -, Title 5 Official -Inspection, Form' ' Subsurface Sewage Disposal System-Form Not for Voluntary Assessments ,, • " r M 206 Starboard Lane (System 3of 3)� Property Address t Bank Owned (Contact David,Holt @.Today Real Estate 1-800-966-2448) j Tr t Owner Owner's Name information is _ � required for every Osterville ', e., MA 02655 . _ 8-2742 page. City/Town 1 =., State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not beAtered in any' way. Please see completeness checklist.at the end of the forma A. General Information 1. Inspector:' Shawn Mcelroy ^ c -- Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr r" Company Address E. Falmouth MA 02536., '« _ City/Town State Zip Code' 1 508-495-0905 S13971 r Telephone Number ` License Number _ N B. Certificationv I certify that I have personally inspected the sewage;disposal system this address and that the information reported-below-is true,,accurate and complete as of the time of,the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of _ t Title 5 (310 CMR 15.000)'.The'system: ° ❑-Passes s . �, 4.z ❑ conditionally Passes 'Fails Y ❑. Needs Further Evaluation by the,Local Approving'Authority, . ♦µ .. I1 _ ,� .y 8=27=12 Inspector's Signature _ r Date J. i w The system inspector shall submit a copy of this insPection report to.the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is ashared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the - report to the appropriate regional office of the DEP. The original should be sent to the system owner 4 and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i'Single cesspool....: _ ♦ 11 t5ins-11/10 ti Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts T Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 206 Starboard Lane (System 3of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville . MA 02655 8-27-12 a e. City(rown State Zip Code Date of Inspection P9 P P B. Certification (cont.) Inspection.Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: y �y ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is'imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it•is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N; - a❑ ND,(Explain below): , t5ins-11110 * Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts „; k Title 5 Official ,Inspection Form ; n , m Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments M 206 Starboard Lane ... (System 3of 3)' Property Address Bank Owned (Contact,David Holt @-Today Real Estate 1-800,966-2448) Owner Owner's Name +. information is µ " t required for every Osterville MA 02655 8-27-12, page. City/Town „ : State Zip Code Date of Inspection. B. Certification (cont.) B) System Conditionally Passes (cont.): ,,, ",,. t f ❑ Observation of sewage�backup or breakout or high static water level in.the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or'uneven distribution box. System will pass inspection it(with approval of Board of Health) M' �❑ broken pipe(s) are replaced r' ElY"� ❑ N El ND (Explain below): *❑• + "obstruction'is removed; ❑ Y ❑`-N ❑ ND (Explain below):- "' ❑ _ distribution box is leveled or replaced i ❑ Y'`k❑ N`- ❑ ND (Explain below)': R ❑ The system required pumping more than 4 times a year due to broken'or.obstructed pipe(s). The ' system will pass inspection if(with approval of the Board of Health): ❑ b broken.pipe(s) are replaced ❑ Y ❑ N - ❑ ND (Explain below): . ❑ obstruction isgremoved: ❑ Y ❑' N ❑ ND'(Explain below): *A C) •.Further.Evaluation is,Requirdd'by the;Board of Health: , _ ; :• ', AN. ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment: 1'.r'System will pass unless Board of Health'determines in accordance with 310 CMR bi 15.303(1)(b)that the system is not functioning in a manner which will protect public health, -iafety'and the environment:" r , x ❑ Cesspool or privy is within 50 feet of a surface water " ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt.marsh . t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 F - + Commonwealth of Massachusetts" Title 5 Official Inspection Form" Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 206 Starboard Lane (System 3of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. +' ❑ . The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ' .The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis,-performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: r _ a D) System Failure Criteria a Applicable to All Systems:ms: You must indicate "Yes"or"No to each of the following for all inspections: Yes -No El Backup of sewage into facility or system component due to overloaded or ' ® clogged SAS or cesspool El Discharge or ponding of effluent to the surface of the ground or surface waters ® due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool Is less than 6 below invert or available volume Is less ❑ ® - I than h day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Fo'rrn 1 Subsurface Sewage Disposal System,Form -Not for Vol untaryAssessments 206 Starboard Lane (System 3of 3) Property Address r A- Bank Owned (Contact David Holt Today Real Estate 1-800-966-2448) ., t Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 -' page. City/Town a;<: State Zip Code Date of Inspection B. Certification (cont.) µ Yes No:_ ,t: . El ® -Required pumping more than 4 times in the last year NOTdue to dogged or, ' .obstructed pipe(s). Number of times pumped: El ®.. Any poi ion.of the SAS, cesspool or privy is be high ground water.elevation. Any portion of cesspool or privy is within 100 feet of,a surface water supply or Ell ` ® ! tributary to a surface water"supply: -- 9 •❑ ��. ®.; , Any portion.9f a cesspool or privy is within a Zone 1 of.a-public well. ` ❑ ® Any portion of a cesspool or privy is within,50 feet of a private water supply well.. . ❑ ® Any portion of a cesspool_or privy.is less than 100 feet but greater than 50 feet from a private water supply well"with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratoryjor fecal coliform bacteria indicates absent and the presence oftammonia nitrogen and nitrate nitrogen is equal taor less than 5'ppm, provided that no otherfailure criteria are triggered.A copy,of the analysis . , x and chain of.custody must be attached to this form.] The system is a,cesspool serving a facility with a design flow of 2000gpd= 4 . .c El ® 10,000gpd. - The system fails. I have determined that one or more of the above failure ® criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be :a necessary,to correct the`failure • ' E) Large Systems: To be considered a,large.system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no to each of the following, in addition to the questions in Section!D. r<„ Yes No y. ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a,surface drinking water supply ❑. El '*Area system is located in a nitrogen sensitive area (Interim Wellhead Protection '*Area= IWPA) or a mapped Zone'll of a public water supplywell If you have answered "yes"to any question,in Section E the system is,considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should.contact the appropriate regional office of the Department. t5ins'•11110 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 3of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Osterville MA 02655 8-27-12 required for every - page. City[Town State Zip Code Date of Inspection C. Checklist Check if the followinghave been done. You must indicate "yes"or"no" as to each of the following: Y 9 . y Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health 11 , ® Were,any of the system components pumped out in the previous two weeks? w ❑ ® _ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not - available note as N/A) ,® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic fank'manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface.sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® El Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information ; Residential Flow Conditions: q • Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd;x#of bedrooms): 550 t5ins•11/10 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 P 9 P Y 9 t Commonwealth of Massachusetts fry �'ti _ ¢' z s , • { .' , _ Title 5 Official.lnspection Form is Subsurface Sewage Disposal System Form--Not for Voluntary Assessments; _, 206 Starboard-Lane (System 3of 3) Property Address _ Bank Owned (Contact David Holt @Today Real'Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville A, MA 02655 8-27-12 page. City/Town , State Zip Code Date of Inspection D. System Information. - Description: Number of current residents ,. Does residence have,a garbage grinder?" ❑ Yes ® No Is laundry on a separate sewage system?:[if yes separate inspection required], ❑ Yes ® 'No y Laundry system inspected? `'• �./ �': ❑ Yes '® No Seasonal use? �, - -A Yes ® No Water meter readings, if available last 2 ears usage d - r. *`<r 9 ( Y 9 (gp ))� . .. . Detail: 4 Sump pump? ... •„ ,,r' , • ❑ Yes '® No Last date of occupancy: 5-2011. Date Commercial/industrial Flow Conditions: -Ilk " "Type-of Establishment: ' I Design flow(based on 310 CMR 15.203):. •t . .F ;��•°,;.'Gallons per day(gPd) , Basis of design flow,(seats/persons/sq.ft,, etc.): . .+ •• ;, .. ,a:. , Grease trap.present?, .a _ t - .'j '� N• : ',❑ Yes ❑ No 4 { . Industrial.waste.holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No • Water meter readings, if available: .- t5ins-11/10 s_ Title 5 Official Inspection Form:Subsurface Sewage Disposal } �. P 9 posal System•Page 7•of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 206 Starboard Lane (System 3of 3) ` r Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) - Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): " General Information Pumping Records: N/A Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool "} Overflow cesspool ❑ Privy ❑," Shared system (yes or•no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval: ` ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts a, W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments r 206 Starboard Lane (System 3of 3) - Property Address Bank Owned (Contact.David.Holt @ Today Real Estate 1-800-966-2448).` . Owner Owner's Name information is required for every Ostewille r~ MA 02655 8-27-12,. page. City/Town State Zip Code Date of Inspection D. t { System Information (cont.) Approximate age of all components, date installed (if known) and source of,information: 1970's Were sewage odors detected when arriving at the site? ❑ 'Yes ® No Building Sewer(locate on site plan): { 2411 Depth below grade: .=f z., , • - feet Material of construction: _ , ,• r., »�.' ® cast iron 40•"PVC k- ❑-other(explain) Distance from private water supply well or suction line: - feet a' Comment&(on condition of joints,wenting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan) } Depth below grade: ;R,. feet ., Material of construction: s, ❑ concrete ❑ metal ❑.fiberglass ❑ polyethylene ❑ other(explain) ff If tank is metal; list age: years Is age confirmed by a Certificate of.Compliance?(attach a copy of certificate) ❑ Yes ❑, No Dimensions: Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 3of 3 rt _ ( Y ) Property Address P Y Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: r Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 r t Commonwealth of Massachusetts m Title 5 Official Inspection Form' 4 Subsurface Sewage Disposal System,Form Not for Voluntary Assessmentsrs 206 Starboard Lane (System 3of 3) + ,< Property Address Bank Owned (Contact David;Hoft @-Today Real'Estate 1-800-966-2448),' Owner Owner's Name t f r information is Osterville - MA 02655 8-27-12 , required for every Cit !Town page. Y _ State Zip Code Date of Inspection D. System Information (cont.) . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,,evidence of leakage,'etc.): .k. 1. y:al #-� ♦tik Tight or Holding Tank (tank must bey pumped at time of inspection) (locate on site plan): Depth below grade: - Material of construction: ❑ concrete - ❑ metal !, ❑fiberglass ❑ polyethylene ❑ other(explain): .. f Dimensions: R, , Capacity: gallons " x, Design Flow: - .'gallons per dayr � r Alarm present: ❑ Yes 0 No Alarm level: Alarm in working order:' [:]'Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ' *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 3of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Ostefville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): . Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 y Commonwealth of Massachusetts , : .,' Title 5 Official Inspectioh Fora ' Subsurface Sewage Disposal SystemForm=Not for;Voluntary Assessments--' 206 Starboard Lane (System 3of 3) Property Address ,., 441:. Bank Owned (Contact David,Holt g'Today Real Estate.1-800-966-2448) Owner Owner's Name * ,,,.• - Wit, information is „ required for every Osterville MA 02655 8 27-12' page. City/Town _ r';.. R;,e'" "State Zip Code Date of Inspection rs : D. System Information.(cont.) j r Type: ❑ leaching`pits number ❑ leaching chambers t -number: ❑ `,r leaching galleries `' _ number: -❑ leaching trenches ' a number, length; ❑` leaching fields ,- number;'dimensions: 'overflow cesspool. 'number:` ❑ innovative/alternative system i Type/name of technology: J i f Comments!(note condition of soil,:signs of hydraulic failure, level.of ponding;damp soil, condition of. vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number.and configuration 1 Depth—top of liquid to inlet invert r N/A N/A Depth of solids layer Depth of-scum layer �N/A A, Dimensions of cesspool 61x6' . Materials of construction Block' Indication of groundwater inflow ❑ Yes Z No t5ins•11/1.0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 3of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Osterville MA 02655 8-27-12 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) M + { Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Block cesspool in good condition with stain line at 24" below inlet invert. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure,:level of ponding, condition of vegetation, etc.): E `2 r , t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts -�. ... a '� ` • ' Title 5 Official Insp ectiori Form J . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments: ; 206 Starboard Lane (System 3of 3) ° y Property Address . Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Ostefville k. A - y' MA 02655 8-0-12 page. City[Town 44 State Zip Code Date of Inspection D. System Information.(cont.) =r P Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells withint100 feet. Locate where public water supply enters the building. Check one of the boxes below: : ' ,,q ® hand-sketch in the area below ❑ drawing attached separately ' - y s�~ Acrr � b'` ly r 1 d r y fill y `410-y - 7 6 t5ins•11/10 Title 5 Official Inspec8on Form:Subsurface Sewage Disposal System Page 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 206 Starboard Lane ' (System 3of 3) p Property Address, Bank Owned (Contact David Holt @ Today Real Estate-1-800'966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: a ❑ Check Slope ❑ Surface water . ❑ Check cellar ❑ Shallow wells Estimated depth to high ground,water: 20 feet Please indicate all methods used to determine the high ground water elevation: F El Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain:', ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 206 Starboard Lane (System 3of 3)_ Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville - MA 02655 8-27-12 page. Citylrown `A State Zip Code Date ofInspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,•or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file a • t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Easy Peel®Labels. 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Resto'de Sud America asistencia@averydennison.com 02010 Avery Dennison Corporation.All rights reserved.Avery,DesignPro,and all other Avery brands,product names and codes are the trademarks ofAvery Dennison Corporation.Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.Apple and Macintosh are trademarks or registered trademarks of Apple Computer,Inc. Rev 06.15.10 i v'-�'' t � . , . Commonwealth of Massachusetts , Title 5 Official Inspection Form { Subsurface,Sewage Disposal System form Not for Voluntary Assessments, M 206 Starboard Lane (System 1 of 3)7 s Property Address Bank Owned (Contact David Holt @•Today Real Estate 1-800-966-2448) •. Owner Owner's Name information is required for every Osterville MA 02655• 8-27-12 page. City/Town - State ,; Zip Code` Date of Inspection " Inspection results must be submitted on this form.. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 3R� 1. Inspector. } . Z1 g Shawn Mcelroy Name of Inspector Upper Cape Septic Services F Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State 'Zip Code 1-508-495-0905 S13974 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system atthis'address and'that the + . information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system:" ❑ Passes ❑' Conditionally_ Passes . s .Fails, ❑ Needs Further Evaluation by the Local Approvmg'Authority. , } 8-27,-12 Inspector's Signature ` ,a Date The system inspectorshall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the'inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under-the conditions of use ° at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. V t5ins-11/10 Title 5 Offici nspection Form:Subsurface Sewage D sposal System-Page 1 of 17 Commonwealth of Massachusetts b W Title 5 Official Inspection., Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 206 Starboard Lane (System 1 of 3) - Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A►) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: r B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a'complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking-and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I I L Commonwealth of Massachusetts = Title 5 Official inspection' Form' Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments ` A 206 Starboard Lane (System 1 of 3) Property Address Bank Owned (Contact David Holt @.Today Real Estate 1-800-966-2448),` r Owner Owner's Name k information is Osterville - MA 02655 8-27=12 required for every 4 ` page. City/Town State . Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): , ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): " broken pipe(s)'are replaced`' ❑ Y ❑ N"' ❑ ND (Explain below): ❑ obstruction is removed .`"' ` • , ❑ Y ❑ N ,❑ ND (Explain below): El distribution box is leveled or:replaced' ❑:'Y*.❑ N ;'❑ ND (Explain below): - .42. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ _ obstruction is removed , ❑ Y ❑ N ❑` ND (Explain below): C) Further,Evaluation is'Required by the Board of Health: - ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. -'1: System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning inra manner which will protect public health, safety and the en`vironrnent: t ` ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 r '-� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM 5 206 Starboard Lane (System 1 of 3) ' Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Osterville MA 02655 8-27-12 required for every ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 1. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other:. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to'each of the following for all inspections: Yes No , ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS.or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 J Commonwealth of Massachusetts .a; 4 Title 5 Official lnspection Form r o Subsurface Sewage Disposal System Form Not for Voluntary Assessments .. w 206 Starboard Lane (System 1 of 3) - Property Address , Bank Owned (Contact David Holt,(gToday Real Estate 1-800-966-2448) Owner Owner's Name information is Osteiville '' MA *02655 8-27=12, required for every - page. City/Town State Zip Code Date of Inspection B. Certification (cont.). Yes No • ' .�, a .,. s ,, ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ®, _, Anyportion of the SAS, cesspool or privy is below high groundwater elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑, ® Any portion of a cesspool,or privy_is within a Zone 1 of.a public well. El' ®i ' Any portion'of a cesspool or privy is 50 feet of a'private water supply well. ❑ Y ® 1" 't Any portion of a`cesspool or privy is'less than=100 feet but greater•than 50 feet from a private water supply.well with no acceptable water quality analysis. [This system passes,if the well water analysis, performed at a DEP certified . laboratory,for fecal coliform bacteria indicates absent and the presence ° of ammonia nitrogen,and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.'A copy of the analysis and chain of custody,must,be attached to this form.] El ® The system is a_cesspool,serving a facility with a design flow of 2000gpd-. t . f !0;000gpd.,' .. 't +' _ The system;fails.I have determined:that one or more of the above failure ® Elcriteria exist as described in 310 CMR 15.303,therefore.the system fails. The system owner should contact the Board of Health to determine what will be necessary,to correct the failure,, t E) Large Systems: To be considered a large system the'system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.- For large systems, you must indicate either"yes",or'"no"to each of the following, in addition to the, .,questions in Section D..,, Yes No ;. ❑ ❑ the system is within 400 feet of a surface drinking,water supply ❑ ❑ the system is within 200 feet of a.tributary,to a�surface drinking water supply the system is located in a nitrogen sensitive area.(Interim Wellhead Protection ❑' j° El :Area'', IWPA) or a mapped Zone II of a'public water supply well If you have answered."yes"to any question in,Section E the system-is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•,11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 1 of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville - f `. MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection C. Checklist f Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ` ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Y P ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ' ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System.Information Residential Flow Conditions: r Number of.bedrooms(design):{„ 5 ' Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts F Title 5 Official ]nspectildn, Form- subsurface Sewage,Disposal System Form -Not for Voluntary Assessments)' � 206 Starboard Lane (System.1 of 3) • M , Property Address Bank Owned (Contact David Holt @ Today;Real Estate 1-800-966-2448):- Owner Owner's Name • information is Osterville. a MA 02655 8-27-12 required for every ' page. City/Town '" + State Zip Code Date of,Inspection D. System Information Description: p . _ .4+. ... A Number of current residents: 0 Does residence have.a garbage grinder?r = ❑ Yes ® No Is laundry on a separate sewage system?.[if yes separate inspection required] ❑ Yes ®. No Laund s ins ' 1 rY system inspected? El Yes,® No Seasonal^use? El Yes ® No Water meter readings, if available past 2 years usage (gpd)): •v P Detail: Sump pump? t ❑ Yes ® .No Last date of occupancy: t 5-2011 Date . Commercial/industrial-Flow Conditions: Type of Establishment: Design flow(based on 310 CMR.15.203): .} f Gauons per day(gpd) r . Basis of,design flow(seats/persons/sq.ft; etc.):. Grease trap present? r El Yes ❑ No Industrial waste holding tank'present? , t ❑ Yes ❑, 'No Non-sanitary waste discharged to the Title 5 system? R. ^ ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection:Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 206 Starboard Lane (System 1 of 3) Property Address ' Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) . Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) . Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: r Source of information: • N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: ° Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ; ❑ Overflow cesspool . ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 1 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts fi Title 5 Official .Inspection- Form fy Subsurface Sewage Disposal System Form-Not for Voluntary Assessments,,,; 206 Starboard Lane (System 1,of-3) •' - _ * - '� •- Property Address : Bank Owned (Contact David Holt @,Today Real Estate 1-800-966-2448)F Owner Owner's Name information is Osterville, ; ; . MA 02655 8-2Y7-12 required for every ° page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1984 1 A -t , Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below'grade: .. , 44@ „- feet ¢ Material of construction: w *« Elcasf iron ®'40'PVC` ;, ❑other(explain): Distance from private water supply well or suction line: feet Comments,(onAcondition-of joints, venting, eviderice of leaka a`.etc.): 9 9 Good c_ ondition. Septic Tank(locate on site plan): 36„ Depth below grade: feet Material of construction: , ® concrete 'El metal ' ❑ fiberglass ❑ polyethylene ..; ~ ❑ other(explain) If tank is metal, list age: ; years Is age confirmed by a Certificate of.Compliance? (attach a copy'of certificate),,;.,.' ❑ Yes ❑ No _ Dimensions: � _ - 1000 gal , • Y 12 Sludge depth: t5ins-11/10 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 , . s F Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 206 Starboard Lane- (System 1 of 3) , Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town, State Zip Code Date of Inspection D.,System Information (cont.) - t Septic Tank(cont.) ' Distance from top of sludge to bottom of outlet tee or baffle 20" 3@1 Scum thickness 5� Distance from top p of scum to to of outlet tee or baffle b Distance from bottom of scum to bottom of outlet tee or baffle . 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed. ' Grease Trap (locate on site plan): Depth below grade: " • ' feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle ` Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System`Form,-Not for Voluntary Assessments GSM - 206 Starboard Lane (System 1 of 3) - P4 operty Address Bank Owned Contact David Holt( @Today Real Estate 1-800-966-2448) ;1 ', Owner Owner's Name. information is Osterville MA` 02655• 8-27-12 required for every 3` - page. City/Town State. Zip Code Date of Inspection D. System Information (cant.) w Comments (on pumping recommendations,,inlet and outlet the or.baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,'etc.): :: " t' ., r r. t Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Y , Material of construction: - ❑ concrete ❑ metal ❑ fiberglass [:],polyethylene ❑ other(explain): Dimensions: . Capacity: • `gallons ' 4 Design Flow: gallons'per day Alarm present: ❑ Yes ' ❑ No Alarm level: Alarm in working orders ❑ Yes ❑ No - Date of last pumping: Date . Comments (condition of-alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? Ti Yes .; ❑ No., t5ins•11/10 Title 6 Official Inspecbon'Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 1 of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is OSteNllle +' required for every '° MA' 02655 8-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: } ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on,site plan, excavation not required): If SAS not located, explain why: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection, Form ; - - Subsurface Sewage Disposal System Form•-Not for Voluntary Assessments _. t 206 Starboard Lane (System 1 of.,3) . ' Property Address . > Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) r Owner Owner's Name information is required for every Osterville MA " 02655 8-27-12 page. City/Town State Zip Code Date ofIns ection _ p D. System Information (cont.j' Type 1 , ® leaching pits. number:, 1-1000 gal ❑ leaching chambers number: ❑ Teaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields m nurriber,dimensions:.- ❑ overflow cesspool number: ❑ innovative/alternative system „ Type/name of technology:. ' Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): 4 Leach pit had clear signs of failure with stain lines into riser. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to,inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M °p 206 Starboard Lane (System 1 of 3) - Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): P . t5ins-11110 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments, . M s.° 206 Starboard Lane (System 1 of 3) Property Address w Bank Owned (Contact David Holt @.Today Real Estate 1-800-966-2448) .z Owner Owner's Name information is Osterville• . _MA 02655 8-21-12 required for every �'' page. City/Town State Zip Code Date of,lnspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate allwell§within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: , t . ® hand-sketch in the area below ❑ drawing attached separately R Ole 49 1 6>40 t5ins-11f10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 1 of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. CitylTown State Zip code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps shows groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r . Commonwealth of Massachusetts k F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments }. 206 Starboard Lane (System 1 of 3) ' Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is O required for every sterville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ,. ® Inspection Summary: A, B, C, D, or E checked , Inspection Summary�D (System Failure Criteria.Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page.15 or attached in separate file ' . t t r . ` t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ' ... r • , ,. a .. Commonwealth of Massachusetts • •.;� , ., s:; *. >, $. r Title 5 Officials Inspection , Form . ° p o Subsurface Sewage Disposal System-Form--Not for Voluntary,Assessments L ,. 206 Starboard Lane ,(System 2 of 3)7 k Property Address P Y " Bank Owned (Contact David Holt @ Today,Real Estate 1,800-966-2448),',g: ., Owner Owner's Name information is - required for every' Osterville ..,ti .MA 02655 8-27712#::; ' page. City(rown - State `Zip Code Date of-Inspection Inspection results must be submitted on this form. Inspection forms may not Rbe altered in any way. Please see completeness checklist at the end of the form. s A. General Information u 1. Inspector:, Shawn Mcelroy Name of Inspector ° Upper Cape Septic Services Company Name. , - 29 Atwater Dr , Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number Y License Number B. Certification t certify that l have personally inspectedithe sewage disposal,system at this•address`and that the information reported below is true,.accurate'.and'complete,as of the time of the inspection. The inspection was performed based on my training and experience in the':proper function`and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of . Title 5 (310 CMR 15.000).The system ❑- Passes y . f ❑ Conditionally Passes c ` ® Fails 41 ❑ 'Needs Further Evaluation by•the Local Approving,, uthority 8-27-12 ` t Inspector's Signature ti r •Date The system inspector shall submit copy of.this`inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection.if the system is a'shared system or has a design flow of 10,000 gpd or.greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions>of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Single cesspool with signs of.overflow: AID t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of.17 Commonwealth of Massachusetts Title 5 Official .Insp ection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) - - Property Address _ Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Osteryille MA 02655 8-27-12 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I`have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304'exist.Any failure criteria not evaluated are indicated below. Comments: s , B)'System Conditionally Passes: El One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system; upon completion of the replacement or repair, 'as approved by -the Board of Health,will pass. Check the box for"yes", "no"or"not determined'' (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complyingseptic tank as approved by the Board of Health. " A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND•(Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection form' ` I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) ► , s Property Address Bank Owned (Contact.David.Holt @ Today.Real Estate 1-800-966.2448)• Owner Owner's Name information is required for every Osterville �� MA 02655 I '8-27-12 - •- page. Cityrrown State . Zip Code Date of inspection B. Certification (cont:) � x My B) System Conditionally;Passes (cont.) ❑ Observation of sewage backup or.break out or high static water level'in the distribution box due to broken or obstructed pipe(s) or due to a broken,'settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): • ❑ broken pipe(s)'are replaced'. ;".` ❑ 'Y ❑'N - ❑ ND (Explain below): El obstruction is removed "` ❑ Y . ,❑ N} ❑ ND_(Explain below): El distribution box is leveled or`�eplaced '❑•Y ❑ N " 0' ND (Explain-below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ' ❑ ,Y ❑ N. ❑ ND (Explain below): ❑ ' obstruction is removed " ❑ Y ❑ N. ❑ ND (Explain_below): ♦ ' 4 t , C) -.Further Evaluation is Required by.the'Board•of Health: ❑ Conditions exist which require further evaluation by the Board of:Health in order to determine if the system is failing to protect public health, safety or the environment.''"' 1. System will pass unless Board'of Heaith determines in accordance with 310 CMR 15.303 1 b •that the system is not.functionin � n a manner which will'protect public health 1 )O .y. , 9 p safety and the�environment . . - a a t , ❑ Cesspool or privy'is within 50 feet of a surface water •, ❑ ; Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts _ ,r s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) _ r Property Address • p Y Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: , ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: . D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to'each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool r ' Discharge or ponding of effluent to the surface of the ground or surface waters Elspool ® Static liquid level in the distribution_ box above outlet invert due to an overloaded El or clogged SAS or cesspool ® '❑ Liquid depth;in cesspool is less than 6" below invert or available volume is less than %day flow- _ t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts r • r Title 5 Official Inspection Foams u . Subsurface Sewage Disposal System,Form.=Not for Voluntary Assessments 206 Starboard Lane "(System 2 of 3) " t Property Address k Bank Owned (Contact David Holt Today Real Estate 1-800-966-2448); t� Owner Owner's Name information is Osterville MA .02655 8-27-12 required for every page. CftylTown T State Zip Code`: Date of inspection' 0 B. Certification (cont..) w , Yes • No r�L *'r 1. - - .1 .a,k. . �1 p.e A:: >+,•t� ' Required pumping more than;4 times in the last year NOT due to clogged or E ' ® obstructed pipe(s). Number of times pumped: ❑ .- ® Any portion of the SAS, cesspool or,p6y is below high ground water elevation. Any portion of cesspool_or privy is within 100 feet of a surface water supply or ` ' ' �® '' tributary to a surface water supply'.'" f ' ' Any.portion of aycesspool or privy is within a Zone 1 of a�public well., ' ❑ ® `Any portion of a"cesspool or privy is within 50 feet of a'private water supply well t ❑ ` ® Any portion of a cesspool or'privy is less than 100 feet but greater than 50 feet ' d from a private water'supply well with'no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,;for fecal coliform bacteria indicates absent and the presence a of ammonia nitrogen and nitrate'nitrogen is equal to or less than 5 ppm, G provided that no other failure criteria are triggered.A-copy' of the analysis and chain of custody.must be attached to this form.]„ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10 000 9Pd• ' The system farls.,l have determined that one-or more of the above failure ® " criteddexist;as described in 310 CMR 15.303,therefore the system fails. The system.owner.sh6uld contact the Board of Health to determine what will be necessary to correct the,failurekt ' E) Large Systems:.To be considered-a large system the system must serve a facility with a , design flow of 10,000 gpd to 15,000 gpd r f For large systems, you must indicate either,"yes'.or,"no."to each of,the following, in addition to the questions in Section D. } . . • Yes No ❑ ❑r. the system is within,400 feet of a surface drinking water supply' ❑ ❑ "ithe system is within 200 feet of a tributary to a'surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection 0 E]' '' Area' *-1WPA)or a mapped Zone II of 6-public water supply well' . If you have answered "yes"to,any question in Section•E the system is considered a significant threat; or answered "yes" in Section D above the large system has failed. The owner or operator of any'large, system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 .; , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17• Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) a Property Address Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection C. Checklist a . Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ' ' ❑ ® +' Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes_ of water been introduced to the system recently or as part of this inspection? _Were as built plans of the system obtained and examined? (If they were not ❑ ® available note as N/A ® -❑ ~, Was the facility or dwelling inspected for signs of sewage back up? ® -❑ Was the site inspected for signs of break out? ® - 'El Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, f dimensions, depth of liquid, depth of sludge and depth of scum? El information the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® • ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D-System Information Residential,Flow Conditions : Number of bedrooms (design): S Y Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection 'Form o Subsurface Sewage Disposal System Form,--,Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) '" Property Address , Bank Owned (Contact David.Holt @ Today Real Estate'1-800-966-2448)-' Owner Owner's Name - information is Osterville MA 02655 8-27=12 required for every � page. City/Town State Zip Code Date of Inspection Y D. System Information r: Description: r Number of current residents: 4 Does residence have a garbage grinder? . ❑ Yes ® No Is laundry on a separate sewage system?Jif yes separate inspection required]: ❑ Yes ® :No 4 t Laundry system inspected? 4 ❑ Yes ® ' No '.: r#° Seasonal use? El Yes ® No Water meter readings, if available,(last 2 years•usage (gpd)): Detail: .•; Sump pump? ❑ Yes Z No Last date of occupancy: ,. . - ', ; " 5-2011 ` Date Commercial/Industrial Flow Conditions: �; > Type of Establishment: Design flow(based on 310,CMR.15.203) *_`"+ 'Gallons per day(god) Basis of design flow (seats/persons/sq.ft.„etc.):••,:: Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present?,- ❑ Yes ❑ No'- ` Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments tar 206 M Starboard Lane S stem 2 of 3 (S ystem ) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 Commonwealth of Massachusetts #,` p Title 5 Official, Inspection Form4 : a Subsurface Sewage Disposal System•Form-'Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) Property Address , Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) , Owner Owner's Name information is Y required for every OsteNille °_ '' MA 02655 8-27712 s page. City/Town State Zip Code Date of Inspection D. System Information (cont:) , ,. � b 4 . f -- r R Approximate age of all components, date installed (if known) and source of information: ' 1970's Were sewage odors detected when arriving at the site? c. El Yes ® No, Building Sewer(locate on site plan):, j •4 s 30' Depth below grade: . feet Material of construction: ❑ cast iron' `® 40 9'VC } "'El (explain), Distance from private o water supply well or suction line:,-' feet ,. Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): , F t Depth below grade: ,. feet Material of construction: t. ❑ concrete ❑ metal ❑ fiberglass . ❑ polyethylene, ❑ other(explain) . If tank is metal, list age: years Is age confirmed by a Certificate of;Compliance? (attach a copy of certificate), ❑ Yes ❑_ No Dimensions: r Sludge depth: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of.17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. City/Town +' State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts .t+ s • Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane .(System 2 of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate T-800=966-2448) Owner Owner's Name • r ' . information is required for every Osterville - �•` r MA 02655 t 8-27-12, r, " - page. City/Town State Zip Code Date of Inspection A D. System Information (cont.) Comments (on pumping recommendations, inlet and d outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 1 Capacity: ' gallons .r t Design Flow: gallons per day' Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑' Yes ❑ No Date of last pumping: = J -.Date Comments,(condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No thins•11/10. z Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of'17 Commonwealth of Massachusetts- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) s Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Osterville MA 02655 8-27-12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: f t5ins-11110 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I • Commonwealth of Massachusetts W Title 5 Official Inspeption F&M F ;m Subsurface Sewage Disposal System Not'for Voluntary Assessments r G Ar 206 Starboard Lane (System 2 of 3) };r F 4 - • - Property Address Bank Owned (Contact David Holt @ Today Real Estate'1-800-966-2448) Owner Owner's Name ~ information is N, required for every Osterville o. MA 02655 8-21-12 page. City/Town state Zip Code ' Date of Inspection D. System Information (cont.) a Type: . . ❑ leaching,'prts .'+'` ` number:° r` ❑ leaching chambers number: ❑ leaching galleries number:; ❑ leaching,trenches number, length: ❑ ' ,leaching fields -number;dimensions: ❑ overflow cesspool r number:,f t ❑ Innovative/alternative system . `. Type/name of technology: „ _ Comments(note condition of soil,-,signs of;hydraulic.failure, level of"ponding,damp soil, condition of vegetation,'etc.): • .l Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration` r Depth`-top?6f liquid to inlet invert` N/A Depth of solids layer ' N/A Depth of scum layer N/A Dimensions of cesspool °6'x6' Materials of construction Block Indication of groundwater inflow ❑ Yes ® No t5iris•11/10 . . �. : Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) Property Address Bank Owned (Contact David Holt @ Today.Real Estate 1-800-966-2448) Owner Owner's Name information is Osterville MA 02655 8-27-12 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Single cesspool empty at inspection with stain lines above inlet invert. Privy (locate on site plan): ,1 Materials of construction: Dimensions Depth of solids .Comments.(note condition of soil, signs of hydraulic failure, level.of ponding,-condition of vegetation, etc.): r ' t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i � r Commonwealth of Massachusetts ,w • . ;: , Title 5 Official Inspection Form Subsurface Sewage Disposal System form Not for Vol untary'Assessmpents 206 Starboard Lane (System 2 of 3) r ' Property Address n r Bank Owned (Contact David Holt @.Today,.Real:Estate 1;MO-966-2448): rr ; Owner Owner's Name information is Osterville' MA 02655 8-27-12 :..t required for every i - ' page. Clty(rown , if' State Zip code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below, ❑ drawing attached separately ` t 5444 s T i . f .irk � iy T.• x „ a + Y '' �' - % 4 & .. =`7 • �rJ��.. �, "• t ' ! .. }'_ „T;,,7 is a ` t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name . information is Osterville ' MA 02655. 8-27-12 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ,. . , ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: x El Obtained from system design plans on record If checked, date of design plan reviewed: Date ® `_ Observed site (abutting.property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: . t ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: ` You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 20'. ` d Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection,Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form t a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 206 Starboard Lane (System 2 of 3) Property Address Bank Owned (Contact David Holt @ Today"Real Estate 1-800-966-2448) Owner Owner's Name information is' Osterville MA 02655 ' 8-27-12- Y required for every - page. city/Town State Zip Code Date of Inspection ° E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System information=Estimated depth to high groundwater .. a ® Sketch of Sewage Disposal System either drawn on page-15 or attached in separate file! ''. ` ., y u. a .. °• i } t5ins•11/10 Title 5 Official Inspection Form:Sub surface bsurface Sewage Disposal System•Page 17,oi 17 a .. /0 7 10N;zz:�61 SEWAGE PERMIT NO. ,��%✓�2 43 o VILLAGE /4,G INSTALLER'S NAME i ADDRESS �� f�r�l•ry+cP I e U I L D E R OR OWNER ' JOA n 6,111,1 -131-?R�q i DATE PERMIT ISSUED 2- _ r6 - DATE COMPLIANCE ISSUED 3_ �� 5-0 �a� No..`'.. :107--- F� �1� ................... ADT E COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH V4 �;k /7 !.................. ................ .... .........----------..........----------------------------.........-- ... ,c-cppltra iou for Uiipnsal Vorko Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: /ems p� e1 p .....4.��)..L�l.1Age. ................................................................................... p Lo ion-Add ess or Lot No. c? V�......l�Ax�o► A.C ................... Owner Address a .....-•-----Csa�n -O 5z.... � A�:�.o.. Installer Address dType of Building Size Lot............................Sq. feet V g— ._...Expansion Attic ( ) Garbage Grinder ( ) Dwelling No. of Bedrooms._.._.._� ! .................... '-4 Other—Type T e of Building No. of persons............................ Showers — Cafeteria C4 YP g P ( ) ( ) a Other fixtures -----------------------------••. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W x� Septic Tank—Liquid ca ac it _I QO.. allons Length................ Width................ Diam eter_-._ :........ Depth Disposal Trench—No._ _-_-:_ _ Width.................... Total Length .•.... Total leaching .. Seepage Pit No.___1flC.Q...... Diameter................. Depth below inlet.................... Tot leachingarea_.__..._._........s . ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------•---................................---....----•---......................................................... 0 Description of Soil.....................................................................................................---------------------------------------------...........--------•- x x ----••--------- ------------•-----••------------•--••---------------•-•---------•-•-------------•-------•--•------------•-•----•----•---------•----•------------•---•-•-----•-----------•----------•--•- U Nature of Repairs or Alterations—Answer when ------------------------------......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI-E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed board of health. Application Approved B • --•--- - -------------------------•---------.....----------------------•-- V.; DDate Application Disapproved 1�*the ollowing reasons:................................................................................................................ .....................•-----.....---•---------------------------------------------•--------------.......----------....---•----------------------------------------------------------------------•-------- Date PermitNo..................................................._.._ Issued........................................................ Date Nol....................... F4........................ _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ..----......•--.....OF....................................... Appliration for Disposal Works Toustxnrtiun rrntit } Application is hereby made for a Permit to Construct ( ) or Repair (X,) an Individual Sewage Disposal System at: r. <t rt i ry Lo tion-Ad ress or Lot No. • i4� _ A.R�j ---.._..._ ............................... w Owner Address At Installer - •-• .................... Address' UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms____ 53 0-..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ---------------•----------- W Design Flow____________________________________________gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity_I90...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total,leaching area....................sq. ft. �. Seepage Pit No----400Q------- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' -•••••••---•-•-•-•--••-•------•-•••••--••-•-•---•----•••---••--••••-..._..•-•••-•-------••--------------• -•---•----------------- ••----------••---------- 0 Description of Soil............................---------------...--------•----..._....----•-----------------------------------------------------------............................. W w U Nature of}!Repairs or Alterations Answer when applicable t �cl, 6t'. ,'� ��+,•-C: s 00(- ----w tea- t341�J1 � ---------•------••-----•---- -= Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT IS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed` tR board of health. fD�t.................. Application Approved B�, r �� f} _. :........................- r ----------------- Date Application Disapproved the ollo' ng reasons_.....................................,--------.............................-................._-___.............. -•--•-•.................•-•-•-•••-•-•-••••••-•••....--•••-•......--••--•---••-••••----••---••••-••-------••••••-••----•-•••••....................................-.....................-............... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of ToutpliFatta , , THIS S�`TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired by -------------------• --------------------------------------------------•----••----- i •,.� Installer has been installed in accordance with/the provisions of TI� r 1pf�The State Sanitary Code,as des ib4e in the application for Disposal Works Construction Permit No_______________ _______.p__.____-___.___ dated___. ."___%_� _.._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU ® AS A GUARANTEE THAT THE SYSTEM W! L F NOTION SATISFACTORY. .z ,� ' DATE. / ....................... Inspector.. -•• ----...-•-•------------•--•----•------•---••---........---•------------•-•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. ......... FEE.....:.............: t rr rkn Tnnntrnrflott pantit Permission is hereby gran),-,-ed_ ' �,,;r--•-••-•-- to Construct ( ) orRe ai ( _any nd• u -Sewage Disposal System �, at No.........2---�•-.---. :_._--•l� =- `1 �.af.:�_...`-----•------•----------------------------------------•----------- Street as shown on the application for Disposal Works Construction Per ffWo..................... Dated _ __ ..__.__-______ DATE............................................................................... f Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON No. 04 Fee BOARD OF HEALTH TOWN OF BARNSTABLE Zippricatiou _for Vern Cougtruction permit Application is hereby made for a permit to Construct 4 Alter( ), or Repair O an individual well at: Location-Address Assessors Map and Parcel caner Address ptsy-AOY\ Q\\ 2"193 10(UNs -L 55 Installer-Driller Address Type of Building Dwelling v� Other-Type of Building No. of Persons Type of Well � S L�� '(� Capacity 7-5 0kVh.. Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certi cate of Compliance has been issued by the Board of Health. Signed L I L A Al W Ig Date Application Approved By Date Application Disapproved for the following reasons: '^) Date Permit No. " " b l Issued f Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well �Coinssttructed(-/), Altered( ), or Repaired( ) by \N dk ll`1,1 n�gj Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.VO-Olt —O 1 -�- Dated S-f t -/ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. : Fee t BOARD OF HEALTH TOWN OF BARNSTABLE V: ' 01ppYicatiou ,for Yell Cougtructiou Permit Application is hereby made for a permit to Construct 4 Alter( or Repair(p ( ) an individual well at: Location-Address Assessors Map and Parcel N Owner J Address t. 1 , \N0 �)SA\))mot 1 AL 01�cm� 2.)W3 ,O(Uag,)s MA o'V� Installer-Driller Address Type of Building Dwelling J Other t-'Type of Building{,t No. of Persons Type of Well om Capacity 7-• v• Purpose of Well V(C(v3ti1y\ Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. ( Signed \_-1 .� v y V6Date �s s- -�� Application Approved By f t f f Date Application Disapproved for the following reasons: C... Date yt , Permit No. 9-0 Issued. t � Date + --- e4e4__-.—. evoe_e__e____>Q..m-meame4..d_vaBOARDOFFIEALTH �-----ae__ __--------- TOWN OF BAR'N%S ;TABLE Certificate of QCompliauce THIS IS TO CERTIFY,that the individual well Constructed(�), Altered( ), or Repaired( ) by �Yrdr�� V V �1 `��ltl�e 'r c - 11 Installer at rzo�o S- oax`Dw 4 Ln l OsAy 0ll — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.WA01% 01 �- Dated 5`1 t-I W THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Yell Cou5tructiou Permit No. V" Fee 1, Permission is hereby granted to 4YY1 WV\ +Q `� br", h0 t hc- 9' Installer J to Construct(�), After( ), or Repair( an-individual well at: No. Zo(=I S- 'a-e 0.c \kp- a Street 97 as'shown..on,the appication,for.a Well Construction Permit No. �&It61 � „ Date Approved By. - .�' f � -' x 3836 ,, Eng'ineerim,Works, Inc. a x � 12 West Crossfield Road, Forestdale, MA 02644 39AZ 9 X 39,U L � (508) 477-5313 0o b ,` i SETPTIC TANK REPLACEMENT o ` • n 206 STARBOARD LANE •�L13�' 3e6o 394 -- _`-- OSTERVI.LLE, MA 02655 CDO N 0 PA170 Prepared for: Michael Sullivan w DRI WAY 206 Starboard Lane /EXISTING Osterville, MA 02655 39.23 39.62 RESIDENCE(#206) X Date: 9/5/14, Job no. 186-13 ST ti EXISTING H-20�SEP C 39.71 \ TANK TO BE REMAI - --,`, � \1 �\ \\� \V `% OF Mgss 40.29 4 53. l x 30rL69 o PETER T. Gcr `� o ✓'� \ µcENTEE C9 "� CIVIL 40 KE�9B .8 41.36 4ass 41.42 �\ No. 351a9 G, 41.35 �,� `. 211 154 EX/577NG'SE'PTIC TANK TO)3E REPLAb�D �� { \ Q 44.4 ��I \`` f y`y 4L' 7Y3 REPLACTSTICANKSWITH A11EW 100 N GALL�N H-20 SEPTIC TANK. EXItITNG ES I RTS 43.36 \ 6Z \ a7.ao 46.54 ��` 45.06 44.39 x � __ np TO REMAIN THE SAME. � � \ \ 43.78 \ \ ��7 410 _— \ P&C - INSTALL H-20 RISERS, FRAMES AND\COVERS, PK E -, �`46 ®o.no `-SE-T_TO FINISH GRADE, OVER INLET\� ,,S41 EACH-gyp 48.83 D � 3 ' s•20' `�QX 43.73 4838 �, 87 4B3o LQT 10 `47.98 W O PARCEL 1q: 166'-\ 53X 139,8 f S.F. \ it \ e`en( \ \ 11?D �i � 47.38 46. T6 \ \\ Scale: 1 =30 L 2os• \ PAGE 1 OF 1 \ 46.96 �2S \ mo TOWN OF BARNSTABLEVA UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS A F1 1� r ASSESSORS MAP NO. PARCEL NO. ADDRESS; Cl�MAIJ 1 VILLAGE: <�S+� yjk E, xn bwo, --- ak l� NAME, CONTACT PERSON �(}�� BCA 1'Y►bOl YCL.- PHONE NUMBER 4),k 3 LOCATION OF TANKS: ' CAPACITY: TYPE--OF. FUEL. AGE: TYPE: LEAK OR CHEMICAL: , DETECTION L-, `2YSTEM DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: to- �1 - TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS 'y PI;EASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. LEGEND 44 -— EXISTING CONTOUR m a \\ _`� River Road { LOCUS J, a/` / / h / \� \\� ? q c ••„�. �..,- / 9 � /' , , i �'�, �I� J A�(c' � �� e t° � moo• `1�Zo 00 \ i , , , � ,. z/ j ► , LOCUS MAP i s� NOT TO SCALE -9�_ — �� ey ��e�'� _ •�i i COS '� �`-= GENERAL NOTES: , 1+;.� •` /i. �� 1 / ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL c� / ............. � BOARD OF HEALTH AND THE DESIGN ENGINEER. '� __, 2• ALL WORK AND MATERIALS SHALL sC ONFORM TO THE REQUIREMENTS __ YV �� - 1` OF TH'E •STATE ENVIRONMENTAL CODE, TITLE V, AND ANY:APPLICABLE 0 LOT`10 '.'�� ` , -LOCAL RULES AND REGULATIONS,EXCEPT AS REQUESTED BELOW: zn BONE PARS - V: 66 �\ j \ 310 CMR- t5,405(1)(b): _. N q �t .�� FE — GS pp-e `" `�^ �: `�� 1 '9,8�2t 'S. .��, \ ,1) A 3' variance to the 3' maximum cover requirement, for 6' ' >� e \� 8 maximum cover. S:A.S. shall be H-20 and vented. F�M / ~' \ � n 3. THE SEWAGE DISPOSAL .SYSTEM SHALL NOT BE BACKFILLED PRIOR N T TO INSPECTION AND ,APPROVAL BY THE :BOARD-OF HEALTH AND THE / J _ DESIGN ENGINEER: G 1`ENHOUSE \ 3 �'; \ ��<{. � 4. ANY 'CONDITIONS ENCOUNTERED pURING• CONSTRUCTION'DIFFERING ,FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN.,ENGINEER BEFORE CONSTRUCTION CONTINUES, 5. ALL ELEVATIONS BASED ON AN 'ASSUMED DATUM (NGVD+/- • - _ 7 ,.; \ 6. THE, DESIGN ENGINEER IS NOT RESPONSIBLE. FOR' THE FAILURE OF. 36 ��~.: \ \ '. :� THE CONTRACTOR OR OWNER.TO NOTIFY THE LOCAL BOARD- OF - I 38 HEALTH 'FOR PROPER INSPECTIONS;;DURING CONSTRUCTION: - 7. WATER SUPPLY PROVIDED BY TOWN WATER' SERVICE. \ THERE ^NOz WELLS WITHIN 1 50'' OF ,THE,'.PROPOSED S.A.S. Exrs 'HOUSE 2OB ^.n `\ \ , `� I, 9. ALL AREAS CLEARED=FOR�'CONSTRUCTION SHALL BE RESTORED.AS. -� �# J ® \ 4-9PATID \ \� \� \�\� \ AGREED UPON BY OWNER AND CONTRACTOR 'OR AS OTHERWISE 4q � \ . -: DIRECTED BY THE APPROVING AUTHORITIES. . __ll 10.. IT SHALL BE`,THE RESPONSIBILITY OF THE.CONTRACTOR TO VERIFY THE LOCATION. OF ALL UNDERGROUND UTILITIES, :PRIOR TO BEGINNING CONSTRUCTION: Al 2 \ \ �, 11. WHERE REQUIRED, CONTRACTOR_SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON' ALL SIDES OF THE S',A.S. AND St8\\ \ \ � � \ �\ �\ REPLACE ;WITH CLEAN'SAND AS SPECIFIED IN -310. CMR 255(3).. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE v'6, j INSPECTED BY DESIGN ENGINEER .PRIOR TO BACKFiLL. '� _4 �� \ /• 13. THIS PLAN I5 TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND OF JS' NOT CONSIDERED TO BE A.,P.ROPERTY LINE SURVEY. , MASS9�y 14. THE ,CONTRACTOR�S HALL ,BE RESPONSIBLE FOR OBTAINING A TRENCH PERMIT FROM THE'LOCAL MUNICIPALITY IN WHICH THE WORK IS BEING ed •.. .00 .� \ � � o PETER. T.` �, PERFORMED.' v= McENTEE PLANS REVISIONS s w \\J �� w o CIVIL ' 9/9/13 ADD RESERVE AREA 76 ��_ x No. 3510o PROPOSED SEPTIC SYSTEM , UPGRADE PLAN 10/21/13 — ADJUST AS FOOTPRINT " ' f►1 ` ' A/ 2.0 �'FG/SZE� 1 3 . 9``' �'?� r � .�" 206STAR00ARD LANE, OSTERVILL-E,� MA Pre ared for: D.A. Brown, Inc. P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD L� \2g•• W P k� Engineering by: a'AURORA LOAN SERVICES LLC '' SCALE DRAWN ,ioe. No. 21 STONEYMEADE WAY \ 1"=60' P.T.M. 109-13 21 ST EY 01720 - - - FEMA FLOOD ZONE DESIGNATION Engineering WOYks,'Inc �WOODRING, STUART 30 SCALE _ _ _ FIRM Community Panel ."No. 25521 1 -001.6 D 12 West Crossfield ,Road, Forestdale,,-'MA, 02644 DATE: CHECKED SHEET N0. SEE SHEET 2 Revised July 2, 1•99,,2,. %Zones A10(EL 1 1), B & C (508) 477-5313 6/3/13 P.T.M. 1"of 3 " w , ---------------- F - 38.36 377g-- x 32.Y.1 39,29 x x 39.60 O'er. . / / .": .. ..•, . ..: Al \39.29 39:49 y��\ �\ \\ \ \ EXISTING\ CiESSPQOLS �\ �L 3B:60 PROPOSED SEPTIC TANIZ v> �;,:; \ \ \TO .BE P(Y PED, BILLED PA VED PA T�0 \ \ \ \ 1000:GALLON"CAPACITY \ \ WISH SAND A&.ABA\A(pONED. \ DRI t/EWA Y . \ � IN�ERI EX/STING \\ \ CONME��ED TO,VPGRAOE:&�E . 39:23 39,62 �l:oo \\ N \\ \\ SEPTIC SYSTEM." BENCHMARK;.ND: 1 HousE(#2os) fi' \\\\ 3971 .' T - 4f- MAGNETIC NAIL SET \\ \ \ ' 41.38: Assumed EL ,.: . , aoze' PA Tl - x 3 .69 \ \ a S�\ �.lri .00 36. \P 1.42 6' 4 7 � 42.21. \ 41 S P_ TANK \ \ \ \ EXISTING E „\ p ' 1000 GAL-'TO REMAIN \ \ \ R \\ \ \ TP TOP OF: TA .,. � ,. Q :„ \. '^ ° ' • ... 'INV. OUT —36:98f. x " \ 45,os 47.00.: 46:54, \.,. x 4 39 . 00 \\ 43,36 , . , 43,7848.83 \ ®0.00 - �. - ne 2 O. , 43.73 \' 46:30 L T-10 Y �475 \ -__ b : M ;. L ¢.. ( ' 4798 \; 0 PAR:CE =I� . 16.3 • � �5.3 . ed \\ 139,89\ f S.F. \ x 41:ob\ BENCHMARK NO. 2 9 4 MAGNETIC NAIL ::SET o \ x EL: .48.24 (Assumed), 47.8 i \\ 47.38 \\ \\ 46 09. - 33 v ; o - MS \ W' q a o PETER T. McENTEE LEGEND 44 69 \ +` � CIVIL y. .. �. " 4 v • r ' PROPOSED,,.SEPTIC . SYSTEM -UPGRADEPLAN o.. 35109 ' �.� 44 —— EXISTING CONTOUR Fp REGI STE`�- x 44.98 EXISTING SPOT GRADE .,: ��G` ` 206 STARBOARD , LANE, OSTERVILLE, MA G•, EXISTING GAS SERVICE T Prepared for: D.A. Brown, Inc. P.O. Box 145, Centerville, MA' 02632 5 1 Engineering by:, SCALE DRAWN JOB. N0 W EXISTING WATER SERVICE ( 1"=30' P.T.M. • 109-13 _ PLANS REVIsioNS 'Engineering Works, Inc. TEST PIT .r 9/13 12 West Crossfield Road,` Forestdgle, MA 02644 DATE CHECKED SHEET NO. 9/ ADD .RESERVE AREA BENCHMARK w `' m 10/21'/1.3' — ADJUST'SAS FOOTPRINT (508)'477-5313 6/3%13. P.T.M. 2 of 3 t NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL•36.7 FOR 'A DISTANCE`OF. 15' AROUND THE PORCH PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSPECTION PORTS (MINIMUM) OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER INSTALL-2 INSPE - SET TO 6" OF GRADE CHARCOAL` ij F.G. EL.=41.3t F.G. EL.=42.6(MAX.) VENT r F.G. EL,=41.0f � F.G. EL.=78.8t - MAINTAIN 27. GRADE (MIN.) OVER S.A.S. � u' l �C L 11 L S 11 (MIN.) ) 2 INSPECTION PORTS ® SCH4 (MIN.) ' ® S-1% (MIN.) O 5=1% MIN.) (MINIMUM) �p 4"SCH40 PVC _ 4"SCH40 PVC 4"SCH40(PVC s� p� 6„ c/ 10" s• 11.3" TO . 36.94 48" LIQUID i4° INVERT L ADD LEVEL ADD -'. INV.=36.58 PROPOSED INV,=36:41 4 ROWS' OF 7 U"N1TS AT. 6:25' UNIT = '43.8' GAS BAFFLE GAS BAFFLE / ----------- NV. -- - INV.=36.69 D-BO =36.30 EXISTING 4 OUTLETS (MIN.) SOIL 'ABSORPTION SYSTEM (PROFILE) P R P. S. A.S. SEPTIC TAN PROPOSED SEPTIC "TANK ESTABLISH VEGETATIVE COVER ----- ------- INV.=36.98t BACKFILL WITH-CLEAN NATIVE OR r� !�3 8' - I EXISTING(VERIFY) - PERC SAND TO TOP OF CHAMBERS' NOTES: BREAKOUT fL.=70P EL. S•A•S. LAYOUT TOP ELEV.=36.69 ::.....:.., 1) CONTRACTOR SHALL-VERIFY ALL EXISTING PIPE: INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=36.30 ' 2) SEPTIC TANK & D-BOX SHALL BE SET. LEVEL AND BOTTOM ELEV:=35.36, TRUE TO GRADE ON' A MECHANICALLY'COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED 5' MIN. ABOVE HIGH GROUNDWATER 2.83' IN 310 CMR 15,221(2). 4'(MIN.) NATURALLY OCCURING, EFFECTIVE WIDTH=11 3 3 INSTALL INLET,& OUTLET TEES AS REQUIRED. •PERVIOUS MATERIALS , - ) EXISTING SUITABLE 4) ,GAS BAFFLE''TO'BE INSTALLED ON :OUTLET=TEE BOTTOM OF -TP, EL=31.8 MATERIAL AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. (ESTIMATED GROUNDWATER, EL. 3.Ot)' 76" 4 ROWS OF 7 - 16 (H-'20) 'ADS BIODIFFUSER UNITS , PROFILE WITH NO SEPARATION>- BETWEEN':EACH ROW' & NO STONE SEPTIC ' SYSTEM PROFILE TYPICAL SECTION: N.T.S. mts 16" DESIGN CRITERIA SOIL IOG - 4' DATE: FEBRUARY 21,. 2013: (REF#13,858) 3 NUMBER OFn BEDROOMS: 5 BEDROOMS (SINGLE FAMILY) SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SECTION END CAP - SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS 'R.S.HEALTH'AGENT „ 1fi HIGH CAPACITY (H=20) BIODIFFUSER UNIT DESIGN .PERCOLATION RATE: <2 MIN/IN ELEV. TP-.�, DEPTH• ELEN._ TP-'2 DEPTH - UNITS MUST BE STAMPED H-20 DAILY I FLOW: 550 GPD - - 43.8 A 0 44:0 q 0" MODEL 16"`HICAP" DESIGN FLOW: 550 GPD SANDY LOAM SANDY'LOAM LENGTH 76" -10YR 4/2 1 OYR.4/2 NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT GARBAGE GRINDER: NO 43.3 6" 43.5 6" EFFECTIVE LENGTH 75' -TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY B B DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (550_GPD) 743.2 SF SIDE WALL HEIGHT 11.2" _ LOAMY SAND LOAMY SAND • .74 GPD/SF 10YR-5/8 10YR 5/8 OVERALL HEIGHT 16" 40.8 36" 41.3 32" 4640 TRUEMAN BLVD EXISTING SEPTIC TANK: 1000 GALLON CAPACITY C C OVERALL WIDTH 34" HILLIARD, OHIO 43026 PROPOSED SEPTIC TANK: 1000 GALLON CAPACITY PERC a ]3.6 CF- TOTAL COMBINED CAPACITY: 2000' GALLONS 36"/48" CAPACITY (101.7 GAL) ADVANCED DRAINAGE srsreMs, INC. PROPOSED D-BOX: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED MED. SAND MED. SAND` PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 4 ROWS OF 7 - 16" (H-20) ADS BIODIFFUSER UNITS 2.5Y 6/6 - 2.5Y 6/6 W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3 X 43.8' 206 STARBOARD LANE, OSTERVILLE, MA HIGH CAPACITY (H-20) INFILTRATORS MAY BE SUBSTITUTED Prepared .for: D.A. Brown, Inc. P.O. Box 145, .Centerville, MA 02632 SIDEWALL AREA: NOT APPLICABLE BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF- BIODIFFUSER) 31.8 144" 32.0 t44" Engineering by:, - SCALE ; - DRAWN JOB. N0. 28 UNITS x 6.25 LF x 4.73 SF/LF = 827.8 SF PERC RATE <2 MIN/IN. ("C" HORIZON) n.t.s. P.T.M. 109-13 )2" ONES NO GROUNDWATER ENCOUNTERED En ineerin WOYk.4, Inc. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. DESIGN FLOW PROVIDED: 0.74 GPD/SF x 827.8 SF = 612.5 GPD (ESTIMATED GROUNDWATER, !EL. 3.0f) (508) 477-5313 6/3/13 P.T.M. 2 of 3 , , , �:E'ERENCE e ¢d °m 5- BARNSTABLE ASSESSOR'S MAP I GG PARCEL 53 OSTERVILLE, - PLAN TITLED "PROPOSED SEPTIC SYSTEM UPGRADE �—� �i" MA PLAN", PREPARED BY ENGINEERING WORKS, INC., DATED f� � ` Scudder / G/3/13 ' Kirk Ln e 1 1 Y PLAN TITLED "ADDITION FOR MICHAEL � TRUDY SULLIVAN... FOUNDATION PLAN", PREPARED BY F.D. \ CIAMRIELLO ARCHITECTURAL DESIGN, DATED 1 O/1 5/13 NOTE: THIS SITE PLAN WAS NOT PREPARED FROM a EDGE OF SALT MAR`h LOCUS peat 9 \ \ ANY INSTRUMENT SURVEY AND UNDER NO 5 \\ CIRCUMSTANCES SHOULD THE DISTANCES, t'�a`,, 1441 BEARING AND/OR OTHER FEATURES SHOWN BE �` 11 USED TO ESTABLISH PROPERTY LINES. ALL 11� 11 LOCATIONS ARE APPROXIMATE. TKEY MAP II" it \ \ LEGEND \ a \ { SOIL VAPOR POINT SALT MARSH I 0- SEE DETAIL LOCU • \: G � Oy�O I I S 20G STARBOARD E ARD LAN EXISTING ODWELLING - `ti 7p0\\ rt: e �� RTN 4-24948 PROJECT: - .. !/ / - • `• �� - " • IVIICHAEL & TRUDY:SULLIVAN 448 STARBOARD LANE-OSTERVILLE,MA 02655 TITLE: / AREA OF EXCAVATION/ �� IMMEDIATE RESPONSE ACTION COMPLETION / DEFINED SITE/ . CLASS A-2 RESPONSE ACTION OUTCOME / AREA OF CLASS A-2 RESPONSE ACTION OUTCOME 206 STARBOARD LANE-OSTERVILLE,MA 02655 a'X 1 2'X 8'D BENNETT ENVIRONMENTAL EXISTING INC.DWELLING BE+A ASSOCIATES, FORMER UST S KETC I I PLAN\� LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS, DETAIL "'50 GAL GEOLOGISTS,ENGINEERS ORIGINAL 1573 MAIN STREET,P.O.BOX 1743,BREWSTER,MA 02361 FROST WALL Q 60. 120 . PHONE:(508)896-1706 www.bennett-ea.com FAX:(508)896-5109 (REMOVED) SCALE I"= 1 O' po DATE: SCALE: BY: CHECK: JOB NUMBER: SCALE I "=GO' 03/06/1, As Noted SRF THE BEA13-10626 .9N irrG' ro I . 1: .�� j�• r s ON qr RIM. r I IN V�✓ is �'srERs �o.vc.P i LT._. _.L. - . B - FD CIAMBRICHIT F,I.LQ DE SIG - i i lJEc i't- ai 00 YI a: l� .SU•y 2oo7vJ.__ El t 'o o2�co2NUs 37 /1 1T�iU-Td�i�J7�i•+r/�tZ-;.,7�70-�S�i�is/ AMAI bowl �} �`O1 �G��O.�iG¢:O�'lr9.YE�"0:��/Lct✓�tLB" M�V� �x/�'T7'N_�"— ��OQ��:�. J' �wwr„ moo'• c. -- - - J I o„ Al/.ew Smoke � y 1,� � � � e � o of• � // /�► 4 SC 2C E61. I 41 au 3�pil .�Lpri' bO � •.I�A&VWT + �� 201 D° 9LO• V 6b NaI �j , Z14^ .. 1W79a/ • N N. I�MT� Q ,6n Z11-19my —_ F! 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