HomeMy WebLinkAbout1933 SERVICE ROAD - Health 1933 SERVICE ROAD,
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B ENN]ETT ENVIRONMENTAL ASSOCIATES, INC.
LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS fir;,
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1573 Main Street,,P.O.Box 1743 (SOS)896-1906
Brewster,MA 02631 fax(508)596-5t:69
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TO: DATE: JOB N MMER:
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Jamie Goncalves,Case Officer 9/15/17 BEA17-11037
MA DEP,Southeastern Regional Office(SERO)
Bureau of Waste Site Cleanup,Emergency Response Section
20 Riverside Drive REGARDING:
Lakeville,MA 02347 IMMEDIATE RESPONSE ACTION COMPLETION STATEMENT
PERMANENT SOLUTION STATEMENT w/o CONDITIONS
RTN 4-26761
SHIPPING METHOD; ti 1 g 33 5k7(`It b e—
Jayde Corporation Roadway Release
Regular Mail ❑ Pick Up ❑ Route 6 Eastbound 1/10 mile east of Oak Street(MM 67.4)
West Barnstable,MA 02668
Priority Mail ElHand Deliver
Express Mail ❑ Other upload
Certified Mail ❑ Green Card/RR ❑
COPIES DATE (DESCRIPTION
1 9/9/17 IRAC-PSS with Supporting Documentation(Appendices A-G)
For review and comment: For approval: As requested: For your use: ❑
REMARKS:
CC(Full Report via CD):Robert Santos,Owner—Jayde Corp(PRP)
CC(Full Report via eDEP link):Frank Corp.—SARS Contractor
Tom Burnett,Safety Officer-Massachusetts Department of Transportation
CC*Abbreviated Copies: Mark S.Ells—Barnstable Town Manager
Thomas McKeon,Director—Barnstable Health Department
Joseph Maruca,Chief—West Barnstable Fire Department
*As part of Public Notice requirements,the report Title Page,Narrative,Index,Transmittal forms and Site Plan are included,pursuant to
paperwork reduction policy. The full report is available as public record on the MA DEP website database athttp://public.dep.state.ma.us/
SearchableSites/Search.asp or,upon written request to BEA,full copy(electronic or paper)will be provided.
FROM: David C.Bennett,LSP,President/Lezli Rowell,Administrative Assistant
If enclosures are not as noted,kindly notify us at once
- Lezli Rowell
From: Lezli Rowell
Sent: Friday, September 15, 201711:32 AM
To: 'thomas.burnett@state.ma.us'
Cc: David Bennett
Subject FW: BEA's Filing to DEP: RTN4-26761, Permanent Solution Statement, Re: Roadway
Release Rt. 6 E West Barnstable, MM 67.4
Attachments: BEA17-11037 Jayde PSS filing to DEP notice 9.15.17.pdf
Re-sending, bounced address used below.
From: Lezli Rowell
Sent: Friday,September 15,201711:17 AM
To:'kfranklin@frankcorp.com'<kfranklin@frankcorp.com>; 'frankcorpvp@yahoo.com'<frankcorpvp@yahoo.com>;
'Thomas Burnett@ state.ma.us'<Thomasournett@state.ma.us>
Cc: David Bennett<dbennett@bennett-ea.com>
Subject: BEA's Filing to DEP: RTN4-26761, Permanent Solution Statement, Re: Roadway Release Rt. 6 E West Barnstable,
M M 67.4
Good morning,
Please find attached Bennett Environmental Associates' Letter of Transmittal,along with BWSC forms,outlining the
distribution of the above referenced project report,filed with the Massachusetts Department of Environmental
Protection. Please find below a link to that agency's platform,to retrieve your copy of this report:
http://pubiic.dep.state.ma.us/fileviewer/Default.aspx?formdataid=O&documentid=414745
It is recommended that you download, not just view the link,to retain a copy of the IRAC-PSS. In the event that you are
unable to access this way and require copy via CD, please let me know where to mail it. If I can be of further assistance,
please let me know.
If you have any questions, please do not hesitate to contact this office.
Lezli Rowell
Administrative Assistant
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
1573 Main Street/P.O. Box 1743
Brewster, MA 02631
508-896-1706
508-896-5109 fax
http://bennett-ea.com
Please visit us on Facebook
Bennett Environmental Associates, Inc.
1
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IMMEDIATE RESPONSE ACTION COMPLETION STATEMENT
WITH PERMANENT SOLUTION STATEMENT WITHOUT CONDITIONS
SUPPORTING DOCUMENTATION
MA DEP RT N 4-26761
Jayde Corporation Roadway Incident/Diesel Release
Route 6 Eastbound— 1/10 Mile East of Oak Street Bridge
West Barnstable,MA 02668
BEA17-11037
SEPT EMMER 9,2017
TD
=-u ENN ETT ENVIRON1Vl[ENTAL AssOCIATEs9 NC.
LICENSED SITE PROFESSIONALS b ENVIRONMENTAL SCIENTISTS 6 GEOLOGISTS & ENGINEERS
1573 Main Street-P.O. Box 1743, Brewster, MA 02631 b 508-896-1706 & Fax 508-896-5109 0 www.bennett-ea.com
BEA17-11037
September 9, 2017
Jamie Goncalves, Case Officer
Massachusetts Department of Environmental Protection(MA DEP)
Southeastern Regional Office (SERO)
Bureau of Waste Site Cleanup, Emergency Response Section(BWSC/ERS)
20 Riverside Drive - Lakeville, MA 02347
RE: IMMEDIATE RESPONSE ACTION COMPLETION STATEMENT
PERMANENT SOLUTION STATEMENT WITHOUT CONDITIONS j
Jayde Corp Roadway Release RTN 4-26761
Route 6 Eastbound 1/10 mile east of Oak Street(MM 67.4)
West Barnstable, MA
Dear Mr. Goncalves,
On behalf of Robert Santos, Owner of Jayde Corporation, BENNETT
ENVIRONMENTAL ASSOCIATES, INC. (BEA) has prepared the following Immediate
Response Action Completion Statement(IRAQ with Permanent Solution Statement(PSSNC)and
Supporting Documentation, representing emergency response actions conducted in connection
with the above-referenced roadway incident of July 17,2017. This report documents the remedial
response actions undertaken and environmental assessment conducted to evaluate' potential
exposure risk to potential human and environmental receptors as the basis of a finding of No
Significant Risk, as defined within the MA Contingency Plan (MCP), regulated under 310 CMR
40.0000. A finding of No Significant Risk supports project closure without conditions, in
accordance with the provisions of 310 CMR 40.0427 and 40.1046(1),respectively.
On July 17, 2017, at approximately 12:30 p.m., the Jayde Corp. tractor trailer dump or 18
wheel dump truck went off the travel lane and the front passenger side tire went over the guard
rail, causing the saddle tanks to be torn from the vehicle. The truck ran along the guard rail and
the tanks traveled along the pavement inside the guard rail, releasing a reported 120 gallons of
diesel fuel onto the roadway. Other vehicles traveling behind the truck were also involved, with
persons taken from the vehicles for medical treatment and transport to Cape Cod Hospital.
Emergency response actions where initially undertaken by the MA State Police and West
Barnstable Fire Department,responding within 10 minutes of the initial call. Subsequent to traffic
control and medical care,the West Barnstable Fire Department applied absorbents to contain fuel
to the paved surface and dammed around the single catch basin within the affected area,to prevent
infiltration. Subsequent emergency response and cleanup was provided by Frank Corp as the on-
call SARS contractor, eventually retained by Jayde Corp. Frank Corp requested LSP Oversight
from BEA to oversee ongoing application of additional absorbents and drumming of spent
absorbents. Some fuel remaining in the tanks was pumped off by the towing company in "fuel
EMERGENCY SPILL RESPONSE b WASTE SITE CLEANUP A SITE ASSESSMENT t PERMITTING & SEPTIC DESIGN&INSPECTION
WATER SUPPLY DEVELOPMENT,OPERATION&MAINTENANCE b WASTEWATER TREATMENT,OPERATION&MAINTENANCE
SEPTEMBER 9,2017 JAYDE CORP/BEA17-11037
PAGE 2 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
caddy". Frank Corp. placed saturated absorbents recovered in eleven(11) 55-gallon DOT drums,
taken off the highway and temporarily stored at the Barnstable DPW facility. During this work
g Y p Y tY g
BEA collected a series of fifteen (15) soil samples at 12' spacing along the earthen shoulder
throughout the 200' area of release identified by the crushed guardrail and staining of the
pavement. The samples were screened in the field by a calibrated (100 ppm benzene equivalent)
photoionization detector by "Jar Headspace"method consistent with the MA DEP, WSC-94-400
Interim Soils Policy. Low level readings were recorded in several of the samples (10-15 ppmv).
However, the majority recorded readings as less than 5 ppmv, indicating minimal impact to the
earthen shoulder. These samples were transferred to a cooler and taken to the BEA office for
shipment to a MA Certified laboratory for petroleum hydrocarbon analysis, by the EPH or TPH
methods. The timing and aggressiveness of this work was effective in minimizing any release to
the environment and in mitigating potential human and environmental health hazards. Inspection
of the affected area indicates that the crushed guard rail prevented the vehicle and tanks from going
on, the earthen shoulder, wherein the tank remained on the traveled surface. The pavement in
the area of release was in good condition with no observed cracking or defects.
These results of the soil sampling along the earthen shoulder reported concentrations of
fractional EPH compounds, target analytes and TPH at concentrations significantly less than the
most restrictive S-1/GW-1 Method 1 Risk Characterization standards. To further qualify the
physical testing results, a mass balance consideration of absorbent capacity and free product
recovery were considered. In the mass balance computation with a recovery of 80 gallons of fuel
from the tanks and 4,400 lbs. of absorbents applied, recovered and drummed(1 gallon/10 lbs. of
absorbent), the volume of diesel fuel recovered is approximately the same as the estimated loss
(80 + 55 = 125 > 120 gallon loss).
In the absence of a release to the environment and the appropriate management of the
remedial waste generated, a condition of No Significant Risk is opined for all potential human
exposures and environmental hazards. As such,the sum of this information documents regulatory
compliance by the PRP and provides the technical rationale and justification for an Immediate
Response Action (IRA) Completion Statement with a Permanent Solution Statement, without
conditions, in support of project closure under the Massachusetts Contingency Plan (MCP), in
accordance with 310 CMR 40.0000.
This work has been undertaken under LSP oversight in a manner consistent with the MCP
Response Action Performance Standards, pursuant to 310 CMR 40.0191 and the QA/QC policies
of BENNETT ENVIRONMENTAL ASSOCIATES, INC. The facts and statements herein are,to
the best of my knowledge, a true and accurate representation of the Site activities, remedial
response actions and environmental conditions associated with the project.
ENVIRONMENTAL CONDITIONS [Refer to Appendix A]
The subject Site consists of a 200' (L) x 10' (W) portion of the MA Highway Route 6
Eastbound paved travel area and shoulder area near mile marker 67.4, approximately 1/10t' mile
east of the Oak Street Bridge in West Barnstable, MA [Refer to Figure 1 and the Site Plan in
Appendix A]. The elevation of the ground in the area of release was 150' +/- with groundwater
SEPTEMBER 9,2017 JAYDE CORPBEAI7-11037
PAGE 3 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
projected at more than 100' below this ground elevation.However,the diesel fuel never infiltrated
through the pavement, discharged to any catch basin, nor was any significant amount of fuel
identified in the fifteen soil borings conducted off the roadway in the area of damaged guardrail
and released fuel.
The highway runs through a sparsely developed, mixed residential use area south of the
Service Road which parallels the highway. The area of the highway where the release occurred
is restricted by fencing, with high intensity of use with low frequency and accessibility (S-3).
Highway workers and trespassers are the most likely potential human receptors, with Wequaquet
Pond the most likely potential environmental receptor [Refer to Figure 2].
According to the MA DEP Priority Resources Map the subject property is not located
within the Zone II Protective Radius of a Public Water Supply(PWS), nor is it located within the
Zone A protective radius of any surface water reservoir [Refer to Figure 3]. The area is serviced
by a municipal water supply with no private wells within 500' of the release. As based on the
physical setting along a divided state highway, through an urban area, with low permeable soil
conditions and no public water supply designation as a groundwater or surface drinking water
protection areas,the RCS-1/RCGW-2 Reportable Concentrations and Reportable Quantities would
apply, as would the S-3/GW-3 and GW-3, Method 1 —Risk Characterization standard, under the
provisions of the governing regulations for Notification and Significant Risk evaluation,
respectively. The S-1/GW-3 Method 1 Risk Characterization Standards are further considered
relative to potential foreseeable use of the property and consideration of any need for use and
activity restriction or conditions associated with Permanent Solution consideration.
BACKGROUND [Refer to Appendix B]
Around noon on July 17,2017,the Jayde Corp.tractor trailer dump or 18 wheel dump truck
was heading eastbound on Route 6 towards Hyannis in the travel land when it went off the
highway, with the front passenger side tires catching the guardrail, causing the truck to jackknife
and involving other vehicles traveling eastbound. As a result of the collisions, the saddle tanks
became detached from the truck cab and travelled along the inside of the guardrails,releasing fuel
along the way until the vehicle and the tanks came to rest on the paved surface. A 911 emergency
call was received around 12:30 p.m.,and the West Barnstable Fire Department was dispatched and
arrived on the scene within 10 minutes.
Following traffic control and treatment of injuries, the West Barnstable Fire Department
prioritized stopping the flow of diesel fuel from the tanks, damming of the area around the single
catch basin against infiltration,and spreading absorbents onto puddled fuel within the area of truck
travel along the guardrail. The West Barnstable Fire Department dispatcher notified the MA DEP
of the highway release, and a representative from the BWCS/ER Section (Jaime Goncalves) was
dispatched to the scene. MA State Police, already at the scene, notified the State Police Truck
Investigation Team for response and called Buckler's Towing for the removal of the vehicle from
the highway. Buckler's, on behalf of the Insurer, contacted Frank Corp., as an approved SARS
cleanup contractor to request assistance at the scene in the cleanup of diesel fuel. Frank Corp.
subsequently contacted BEA to provide LSP Oversight as an ongoing Immediate Response Action.
SEPTEMBER 9,2017 JAYDE CORPBEAI7-11037
PAGE 4 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
This call initially came into the BEA office around 3:15 p.m.,and BEA personnel arrived on-scene
at 3:50 p.m., delayed by shutdown of the highway and shoulder access to the scene.
y
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WErwK. i
S
Photograph 1:Photograph looking down the eastbound lane of Route 6—Mid-Cape Highway in the area of the
Jayde 'Trucking accident at the time of BEA arrival wherein remedial response for the application and
drumming of absorbents was underway. Note in foreground the skid marks,fuel staining of the pavement on
the highway and use of absorbents to contain/remove free standing diesel fuel. Note in background, location
of the crushed guardrail as location of soil testing within the earthen area between the paved shoulder and
berm and the guardrail.
Upon BEA arrival,David Bennett,LSP met with the Mass DOT supervisor(Tom Burnett)
as describing the initial scene and work conducted and then further discussed the circumstances of
release with Frank Corp. cleanup team foreman (Todd LeFrenier) and MA DEP (Jamie
Goncalves), identifying a 200' section of shoulder on south side of Eastbound lane where tanks
were sheared from truck and dragged along roadway inside the guardrails. The guardrail was
feffective in keeping the tanks and vehicle from leaving the roadway, wherein the vast majority of
the fuel released was discharge to the paved surface. A catch basin found in the area of the release
was inspected and no product or sheen noted. Frank Corp. noted that the catch basin was note
involved as having been dammed as part of the initial emergency response by the West Barnstable
SEPTEMBER 9,2017 JAYDE CORP/BEA17-11037
PAGE 5 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
Fire Department. This critical condition was independently verified with the Jaime Goncalves as
the on-scene MA DEP representative.
EMERGENCYAMMEDIATE RESPONSE ACTIONS [Refer to Appendix B & C]
The MA State Police and Mass DOT established traffic control and closed the travel lane
of the highway to accommodate emergency response actions along the paved shoulder. At the
time of BEA arrival on-scene,the estimated 30-40 bags of absorbents applied and worked into the
pavement was being swept-up and placed into 55-gallon drums, loaded onto a stake-body truck
Eor removal from the area of traffic flow for temporary storage at the Barnstable DPW facility.
BEA determined the best use their time with the State Police anxious to re-open the highway with
pending rush hour traffic worsening an already 5 mile backup, was to collect representative soil
samples from the earthen shoulder along the 200' of damaged guardrail where release to the
roadway and onto the shoulder was apparent. BEA conducted a series of fifteen(15) shallow soil
samples(0-P)at 12' spacing within this area[See Site Plan—Appendix A]. The locations of these
samples was marked along the highway for future reference to the corresponding sample,
numbering for any additional future work pending the receipt of laboratory analysis.
Photograph 3: Photograph looking west along eastbound lane of Route 6 as showing Oak Street Bridge in the
background. In the foreground,the eastern extent of the fuel oil release where the tank traveled into the center
of the highway is partially shown. In front of the drum shown in the center of the picture is the painted mark
on the curb as showing the location of soil sampling(SS-15)in the area between the pavement and the guardrail.
SEPTEMBER 9,2017 7AYDE CORP/BEA17-11037
PAGE 6 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
At around 4:30 p.m., a total of eleven(11) 55-gallon drums of absorbents were loaded for
temporary off-site storage pending pickup and the State Police requested all equipment leave the
scene such that the highway could be re-opened. BEA completed the soil sampling and put the
samples in a cooler for screening back at the office, to leave the scene with Frank Corp. such that
the highway could be opened. On return to the office the samples were screened by "jar
headspacef7 method consistent with the WSC-94-400 Interim Soils Policy using a calibrated
photoionization detector (PID 100 ppmv benzene equivalent). Low level PID readings (< 20
ppmv)where reported in all samples collected with the majority being<5 ppmv. Several samples
that reported higher PID readings (SS-9: 14.1 ppmv and SS-12/SS-6: 12.4 ppmv) were submitted
as"worst-case"conservatively high biased samples for Extractable Petroleum Hydrocarbon(EPH)
analysis of fractional compounds and target analytes. The remaining samples, were submitted for
Total Petroleum Hydrocarbon analysis as a cost saving measure,wherein high biased samples were
submitted for EPH/VPH.
The eleven (11) 55-gallons drums of remedial waste were picked up from the Barnstable
DPW facility on Jul), 19, 2017 as transported to Northland Environmental, LLC facility in
Providence, RI. The total weight of the spent absorbents was estimated as 4,400 lbs. In the mass
balance computation with a recovery of 80 gallons of fuel from the saddle tanks as re-used, and
4,400 lbs. of absorbents applied, recovered and drummed (1 gallon /10 lbs. of absorbent), the
volume of diesel fuel recovered is approximately the same as the estimated loss (80 + 55 = 125 >
120 gallon loss).
TABLE 3:SLMU RY OFANALYTIC4L RESULTS FOR 11WEPH TESTING AT THE SS-1 TO SS-15 SOIL SAINULWG LOCATIONS
dA1DE CORP R04DWAY DIESEL FOII.RF7 F e¢s•_L�Il11i:DTe'i'P RESPONSE ACTION RT'N 4-26761 '
Q.D.\T�saam rn+ -} r 65-1 65-2 65d 6S4 65S 656 6S- SSA T 6SA SS-10 � SS-li r 65-12 � SS13 SS14 r SS-15
_ I _._
SA48(.1.\GDA7£ _ �, 171LL17 - 17.1L'417_- 17.i18.17 I7JL1-17 17JN�17 17.JC417 17JLL7.17 I7.IL7.17 J I7JLL17 17JI1-17 1-17�1LL17 17.R:7_I7 1 17.1IL17 1 17JLL1_7 17.TLR.17
LAB SA3lPI.EID 1 L1724581-01 L1724581-02 11729581-03 L1729581-04 11724581-05 L1724581-06 11721583-07 1372458148 ILI724$91-09 L172458110 LI72453111 LI72458112[1172458113 L1724581-14 17 4 81-
'6vm=14SLQ-19
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ShcdgTdal 9i 921 93A 939 912 932 923 91A 94.5 ' 933 931 895 91b 926 89 � 92.2
TPH 1 1000 1000 ms*g 661 368 229 20S 503 159 o-8 777 47 935 I 363 41b
'HleacWbltPeRtl®lh'6raruD®s ,
2\ieWpin�mrelm= 300 0.7 _9_9�
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AM-P
C11-CLtkme 1000 i mg/l[8 124 Z �336 c42.8
Ql-Q2 AmmuW mgi6g , y 123 _ 268 P 4_ � 928
Q1112Ammdle�Agj¢ d...— I000 ON _S!kg --. .. 123 — .. _ .T .268 - _ I 423
C19C76A0pk!5. 3000 3000 mg0:g y 995 383 I 31A_ _
9__q AmFtml_ NO AMmg/kg__.. - 90 I 19b 1—.. _ �603_
Napkfkalme .. No 4 m _ _ _ _._..� _t_ ._. .__ _._ _
g/kg Q 03 �336 <p355
Pkemmtkrme _ 500 30 _ mgik6,
AFPgCkLIL 31/4OW-3,N ODI R6KQLIRACI8UZAII0N'8]WDAHD(
j30S7RLS"6:IL773'ES-S/G{Y1,3"lFII730D3-1IS5C Q7ARAC1FItIZA710\67AtiII4Ri1
Analytical results for the soil samples collected at the SS-1 to SS-15 locations was reported
on July 25, 2017 as shown on Table 3. The analytical results reported TPH/EPH concentrations
as Non-Detect(ND),or at concentrations as significantly lower than the applicable S-1/GW-3,and
most restrictive S-1/GW-1, Method 1 Risk Characterization standards,with one exception. In the
SS-6 sample,the reporting limit for 2-Methynaphthalene was 1.03 mg/kg and the most restrictive
S-1/GW-1 standard is 0.7 mg/kg, and applicable S-1/GW-3 standard is 300 mg/kg. It is noted in
the Data Usability section of this report that the applicable standards are met and that in
consideration of the elevated reporting limit for the SS-6 sample. By convention and current
standard of practice, 50% of the reporting limit concentration can be considered as the lowest
r
SEPTEMBER 9,2017 JAYDE CORPBEAI7-11037
PAGE 7 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
detection limit concentration, at 50% of 1.03 mg/kg (0.52 mg/kg) is less than the 0.7 mg/kg
standard, in opining a finding of No Significant Risk supporting a Permanent Solution Statement
without conditions (PSSNC).
RISK CHARACTERIZATION [Refer to Appendix D]
Soil
Soil samples were collected as representative of possible diesel fuel release to the unpaved
portion of the shoulder between the pavement and the guardrail, wherein no cracking of the
asphaltic pavement itself was observed. The photoionization screening of soils at the fifteen
samples taken at 12' along the 200' area of release is based on visual observations of staining and
the crushed guardrail. The majority of samples had a recorded PID reading as < 5.0 ppmv, with a
maximum reading of 14.1 ppmv reported in the SS-9 location. This "worst case"sample was to be
run for Extractable Petroleum Hydrocarbon (EPH) analysis along with SS-6 and SS-12 as also
having elevated PID reading (12.4 ppmv). The balance of the samples were run for Total
Petroleum Hydrocarbon (TPH) analysis as a low cost screening method and as were to be
compared to the EPH analysis for the "worst case" samples. In all cases, the reported TPH/EPH
concentrations reported, or the reporting limit concentrations were significantly less than the
applicable S-1/GW-3, Method 1 Risk Characterization standards. With the exception of an
elevated reporting limit concentration for 2-Methynaphthalene in the SS-6 sample reported as ND,
th-- reported TPH/EPH concentrations are significantly less the most restrictive S-1/GW-1
standards. In the case of 2-Methnaphthalene, 50% of the reporting limit as the lowest detection
limit is less than the most restrictive S-1/GW-1, Method 1 —Risk Characterization standard.
As such, based on the observations made and documented, the limited physical testing
conducted and the mass balance calculations made, no release to the environment is apparent
associated with the subject release, as confined to the paved roadway and immediately removed
by emergency response actions. In review of all foreseeable future uses and activities at the Site,
the S-1/GW-1 standards are considered as the strictest applicable criteria under Method 1 Risk
Characterization, and a condition of No Significant Risk is opined in support of a Permanent
Solution Statement without conditions (PSSNC), as based on the complexity and environmental
sensitivity of the Site, consistent with the provisions of 310 CMR 40.0903.
Groundwater
The area of the release was along a divided State Highway with high traffic in major
transportation corridor and as mapped as a NPDWSA outside any wellhead or surface water
protection area. Based on the finding that no diesel fuel was released to the environment or
intercepted by any drainage conveyance system, and that the roadway spill that was immediately
cleaned up prior to any rainfall event, and the depth to groundwater is greater than 100' below
grade, groundwater analysis was not undertaken or deemed necessary in support of a Permanent
Solution Statement without conditions, as based on the complexity and environmental sensitivity
of the Site as consistent with the provisions of 310 CMR 40.0903.
SEPTEMBER 9,2017 JAYDE CORPBEAI7-11037
PAGE 8 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
Indoor Air
Based on the Finding that no diesel fuel was released into the environment and the physical
setting with the release occurring within the roadway layout(Route 6), with the nearest dwellings
identified as greater than 30' away, no indoor air monitoring was performed or deemed necessary
to support Permanent Solution Statement without conditions, as based on the complexity and
environmental sensitivity of the Site as consistent with the provisions of 310 CMR 40.0903.
Imminent Hazard Evaluation
Based on the emergency response actions performed,wherein traffic control was provided
without incident and emergency response actions under the IRA were effective in eliminating any
release of diesel fuel to the environment, no Imminent Hazard has been identified. Traffic along
the roadway had to be briefly detoured as the release was within the paved shoulder of Route 6.
Subsequent to the removal of the vehicle and tanks and the application and removal of absorbent
materials from the roadway,the roadway was returned to safe use and reopened to traffic within 5
hours.
DATA USABILITY ASSESSMENT & REPRESENTATIVENESS EVALUATION
[Refer to Appendix D and El,
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 MA DEP Policy
WSC-07-350. It provides an evaluation and demonstration of the adequacy of the spatial and
temporal data sets used to support the PSSNC and makes conclusions on the accuracy, precision
and sensitivity of the data used.
Conceptual Site Model
Approximately 120 gallons of diesel fuel was released from the saddle tanks on the Jayde
Corp. tractor trailer dump or 18 wheel dump truck as a result of the holding strap failure during
the traffic accident. Sometime around 12:00 p.m. on the afternoon of July 17, 2017, the truck
driver lost control of the vehicle and ran the front passenger side tires of the tractor over the
guardrail on the south side travel lane. The incident was reported to the West Barnstable Fire
Department and MA State Police, who in turn notified the Mass Highway and the MA DEP.
Buckler's Towing was contacted and on behalf of the Insurer,Frank Corp. and BEA were engaged
for the benefit of the PRP as the cleanup contractor and LSP respectively. Emergency response
actions initiated by the West Barnstable Fire Department and Mass DOT were continued by Frank
Corp. under verbal approvals and LSP oversight. This work resulted in the recovery of all free
standing and puddled diesel fuel off pavement with the application of some 40-50 lbs. bags of
absorbents, eventually drummed and managed as remedial waste.
Inspections were made along the area where the truck stopped to the furthest extent of the
fuel migration, with no evidence of cracking or joints that would facilitate release to underlying
f
SEPTEMBER 9 2017 JAYDE CORP/BEA17-11037
PAGE 9 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
soils or to the ground underlying the bridge. Such conditions were photographically documented
and witnessed independently by Frank Corp. and MA DEP officials. Additionally, soil testing
reported no indication of significant diesel fuel impacts in the earthen area between the paved
shoulder and the guardrail. Additionally, remedial waste management records were used to
consider recovery relative to the estimated volume of release.
As a result of effective diesel fuel removal off the paved surface, observations and limited
physical testing conducted, no significant impact to the environmental is opined and a condition
of No Significant Risk exists at the Site as associated with the roadway release under RTN4-26761.
Field Screening
PID screening and observations were used to qualify significant impact in soils and to make
informed dynamic decisions in the field. Based on the contaminant of concern,PID screening was
relied on to qualify significant soil impacts and specify analytical protocols. Samples with higher
levels of odor or organic vapor concentrations were assumed more contaminated than those
samples with lower levels. Comparison of visual, PID and observations with limited analytical
data indicates the screening data correlates with the analytical data. This screening was used to
identify the "worst case" sample to run for EPH and target analyte analysis to qualify field
observations and PID screening.
Sampling Locations
Based on a visual inspection of the roadway surface, wherein the pavement was found to
be in good condition with no major cracks or holes observed that may have indicated a release to
the subsurface, no soil samples were collected along the roadway apron. Based on observed
staining of roadway, collapsed guardrail and wetted vegetation, fifteen (15) soil samples were
collected at equally spaced intervals along a 200' section of the highway.
Analytical results for all samples report EPH and target analyte or TPH concentrations are
less than the applicable S-1/GW-3, Method 1 —Risk Characterization standards and as based on
50% of the reporting limit concentration for 2-Methynaphthalene, all reporting limit
concentrations for Non-Detects, met the most restrictive S-1/GW-1 standards.
Field duplicates or trip blanks were not collected or considered necessary because the
disposal Site was small, the removal operations had produced clean conditions and QA/QC
protocols were employed and documented. The samples were placed in appropriately preserved
laboratory containers and stored on ice in a cooler and within a refrigerator pending shipment to
the laboratory under a properly executed chain-of-custody.
Temporal Data
In the absence of a release to the environment, no temporal data associated further soil
analysis or groundwater analysis was considered appropriate or necessary.
SEPTEMBER 9,2017 JAYDE CORPJBEAI7-11037
PAGE 10 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
Field Completeness
The analytical data set is complete. Disposal site photographs, documenting the condition
of the pavement and the area of release, as well field PID screening was relied upon for sampling
and analytical protocols as based on the scope and complexity of the IRA.
Data Inconsistency
No inconsistent data was identified outside the inherent error associated with acceptable
recovery and repeatability. Visual observations, odors and field screening were generally well
correlated with analytical results. No significant inconsistency was identified between the field
screening of end-point soil samples and the worst case soil sample analysis aside from the fact that
SS-6 with a PID reading of 12.4 ppmv as reported higher EPH concentrations than SS-9 with a
PID reading of 14.1 ppmv.
Data Not Used
All analytical data has been represented and no other analysis was conducted or withheld
from reporting.
Data Usability
The limited analytical data provided in support of this PSSNC is not all CAM compliant
wherein TPH analysis is not recognized as a CAM supported protocol. This non-CAM data is used
with the EPH analysis in the evaluation of a release into the environment.
In the analytical results reported for the SS-1 to SS-15 samples, an affirmative answer was
reported in the CAM narrative for questions A through F, and question H. A negative response
was listed for question G and I. Aside from the issue with the TPH data, question G refers to the
elevated reporting limit for 2-Methynaphthalene. As previously discussed, the reporting limit is
less than the applicable S-1/GW-3 standard. Additionally, in consideration of the most restrictive
S-1/GW-1 standards, consideration of 50% of the reporting limit as the lowest detection limit is
less than the S-1/GW-1 and it is noted that in other samples with higher EPH concentrations, 2-
Methlynapthalene is reported at concentrations or reporting limits less than the S-1/GW-1
standards. With regards to the negative response to question I, it is noted that not the full list of
PAH compounds was analyzed. All contaminants of concern for virgin fuel oil were tested as
prescribed in the EPH/VPH guidance policy WSC-02-411. The heavy molecular weight PAH
compounds included in the full PAH list are related to coal tars and organic combustion products,
none of which pertain to the subject release under RTN 4-26751. As such,based on the review and
validation of the analytical data as represented above, Presumptive Certainty has been met in
support of the EPH analytical results as critical data.
Additionally, a review of the TPH data indicates that all internal QA/QC has been met in
these results as critical data. Wherein the highest reported TPH concentration of 368 mg/kg as
SEPTEMBER 9,2017 JAYDE CORP/BEA17-11037
PAGE I I OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
significantly less than the 1,000 mg/kg standard and internal QA/QC for TPH has been met, all the
critical data were deemed sufficient under MA DEP Policy WSC-07-350 "MCP
Representativeness Evaluations and Data Usability Assessments"(REDUA)to meet"Presumptive
Certainty" for this non-CAM compliance data. The validity and defensibility of the data used to
support the findings of the PSSNC for this Site have therefore been satisfied, based on the nature
and complexity of the Site being investigated.
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. Wherein all representative soil samples meet the applicable S-1/GW-3 standards as
within the limited access within the two-lane divided highway within a mapped NPDWSA as a
major transportation corridor, the MCP describes a condition of No Significant Risk, further soil
removal would not reduce significant risk associate with potential ingestion,inhalation and dermal
contact exposures. Additionally, any such work along the highway is dangerous and would
represent a higher risk to the site workers and those providing traffic controls than any reduction
in risk associated with additional soil removal.
As such, current environmental conditions associated with residual low-level petroleum
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(Non-Persistent)Contaminants". As such,the cost to benefit'
of such additional soil removal cannot be justified and no further work is being considered
appropriate or necessary.
GARDENING BEST MANAGEMENT PRACTICES [Refer to Appendix F]
Laboratory analyses have reported all petroleum hydrocarbon concentrations in end-point
soil samples as less than the applicable S-1/GW-3 and strictest S-1/GW-1, Method 1 Risk
Characterization standards and as such, laboratory analytical results support a Permanent Solution
without conditions, and Gardening Best Management Practices (BMPs) are not required.
Notwithstanding the remote and overstated potential for foreseeable use of the Route 6 roadway
layout for raising of vegetables or produce for human and livestock consumption, Method 1 does
not currently consider ingestion exposure scenarios associated with vegetative uptake for exposure.
As such,regulations compel language to identify this potential exposure when Method 1 is
relied upon. Thus,the Commonwealth of MA as the property owner is hereby advised to consider
implementing BMPs to further reduce potential exposure to material in the soils for raising
homegrown produce used for human consumption or the feeding of livestock if any other use of
the highway easement is ever considered. Implementing BMPs such as those referenced in
Appendix F will.allow safer gardening and farming in a wider range of site conditions. Not every
BMP is necessary for every single site, but a combination of BMPs will help reduce the potential
for additional ingestion exposure risks at urbanized sites and/or areas of historic fill where
f -
SEPTEMBER 9,2017 JAYDE COR.P/BEA17-11037
PAGE 12 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
gardening or farming is conducted.
LIMITATIONS [Refer to Appendix G]
Our professional services have been performed, our findings obtained, and our
recommendations prepared in accordance with current, customary principles and practices in the
fields of environmental science and LSP practice. It must be recognized that environmental
investigations are inherently limited to conclusions drawn and recommendations developed from
information obtained through research and review of relevant site investigation. Additionally, the
passage of time may result in change to environmental characteristics at this site and/or
surrounding properties, changes in governing regulations and/or professional practice. This report
specifically speaks only to those regulations and policies in effect, and the standards of LSP
practice, temporal to this submittal. No guarantee or warranty of future conditions, regulations,
policies or standards of practice is expressed or implied relative to the LSP Opinions rendered
herein.
CONCLUSIONS
Based on the emergency response actions undertaken by the West Barnstable Fire
Department, MA State Police, Mass DOT and the SARS contractor, the recovery of all standing
fuel and mitigation of a significant release to the environmental was achieved. With the
management of the remedial waste a condition of"No Significant Risk"is opined in support of an
IRA Completions Statement and Permanent Solution Statement without conditions,in accordance
with the provisions of 310 CMR 40.0427 and 40.1050 respectively, based upon the complexity
and environmental sensitivity of the area.
The fmdings of this investigation,as represented herein,set forth the rationale and technical
justifications for the LSP opinions offered,as established by the certifications made on the attached
Transmittal Forms. The LSP opinions are based on the available data and regulations in effect at
the time of this reporting. Should you have any questions regarding the project or require
additional information,please contact me at your earliest convenience.
Sincerely,
B TT ENVIRONMENTAL ASSOCIATES, INC.
David ett, LSP
Presi
SEPTEMBER 9,2017 JAYDE CORPBEAI7-11037
PAGE 13 OF 13 IRA COMPLETION STATEMENT WITH PERMANENT SOLUTION:RTN4-26761
Encl. Supporting Documentation(Appendices A-G)
Cc: Robert Santos, Owner—Jayde Corp (PRP)
Frank Corp.—S'ARS Contractor
Tom Burnett, Safety Officer-Massachusetts Department of Transportation
Mark S. Ells—Barnstable Town Managerl
Thomas McKeon, Director—Barnstable Health Department'
Joseph Maruca, Chief—West Barnstable Fire Department'
1 As part of Public Notice requirements,the report Title Page,Narrative,Index, Transmittal forms and Site Plan are
included,pursuant to paperwork reduction policy. The full report is available as public record on the MA DEP website
database at hq://public.dep.state.ma.us/SearchableSites/Search.asp or, upon written request to BEA, full copy
(electronic or paper)will be provided.
IMMEDIATE RESPONSE ACTION COMPLETION STATEMENT
WITH PERMANENT SOLUTION STATEMENT WITHOUT CONDITIONS
SUPPORTING DOCUMENTATION
MA DEP RTN 4-26761
Jayde Corporation Roadway Incident/Diesel Release
Route 6 Eastbound— 1/10 Mile East of Oak Street Bridge (MM 67.4)
West Barnstable, MA 02668
BEA17-11037
SEPTEMBER 9,2017
Prepared By:
BENNETT ENVIRONMENTAL ASSOCIATES,INC.
1573 Main Street-P.O.Box 1743
Brewster,MA 02631
David C.Bennett,LSP.
Prepared For:
Massachusetts Department of Environmental Protection
Southeast Regional Offices,Bureau of Waste Site Cleanup/Emergency Response Section
20 Riverside Drive-Lakeville,MA. 02347
Jaime Goncalves, Case Officer
On Behalf Of.
Robert Santos, Owner
Jayde Corp.
13 Camelot Drive—Plymouth,MA 023 60
APPENDIX A:Reference Plans
-Figure 1: Site Locus Plan [USGS Topographic Quad.,West Barnstable,MA. 1998] (excerpt)
-Figure 2: Ground-Water Resources of the Cape Cod,MA... [LeBlanc et al, 1986] (excerpt)
-Figure 3: MA DEP BWSC GIS Map,21E Priority Resource Overlay [2016]
-Site Plan entitled, "Immediate Response Action Completion..." prepared by BENNETT
ENVIRONMENTAL ASSOCIATES,INC.,Dated September 8,2017
APPENDIX B: Field Reports
-Field Response Log
-West Barnstable Fire Department Incident Report
-Site Photographic Documentation
APPENDIX C: Environmental Records
-Uniform Hazardous Waste Manifest [#0 1623194 1 JJK(I I drums/4,4001bs. absorbents MAO1)]
-BWSC-101:Release Log Form
-BWSC-102: Release Amendment Form
-BWSC-123:Notice of Environmental Sampling
-BWSC-103: Release Notification Transmittal Form w/eDEP Submittal Summary,Receipt
-BWSC-104: Response Action Outcome Statement w/eDEP Submittal Summary, Receipt
-BWSC-105: Immediate Response Action Transmittal Form w/eDEP Submittal Summary,Receipt
APPENDIX D: Laboratory Analysis
-Assessment SS-1 to SS-15 from road shoulder [AlphaL1724581 (7/17/17)]
APPENDIX E: Quality Assurance/Quality Control Plan
APPENDIX F: Gardening Best Management Practices
APPENDIX G: MCP Limitations
f
Massachusetts Department of Environmental Protection
eDEP Transaction Copy
Here is the file you requested for your records.
To retain a copy of this file you must save and/or print.
Username: BOINC
Transaction ID: 955436
Document: BWSC103 Release Notification & Retraction Form
Size of File: 151.22K
Status of Transaction: Submitted
Date and Time Created: 9/15/2017:7:36:07 AM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy"from the Current Submittals page.
—� Massachusetts Department of Environmental Protection BWSC 103
Bureau of Waste Site Cleanup
RELEASE NOTIFICATION&NOTIFICATION Release Tracking Number
Lhl
II4 - 26761
RETRACTION FORM
oil
Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C)
A.RELEASE OR THREAT OF RELEASE LOCATION:
1.Release Name/Location Aid: 1/10 OF MILE EAST OF OAK ST OVER PASS
2.Street Address: RTE 6 EAST BOUND
3.City/Town: WEST BARNSTABLE 4.ZIP Code:
5.Coordinates: a.Latitude:N 41.68433 b.Longitude:W 70.34870
B.THIS FORM IS BEING USED TO: (check one)
�. 1.Submit a Release Notification
r— 2.Submit a Revised Release Notification
r 3.Submit a Retraction of a Previously Reported Notification of a release or threat of release including supporting documentation
required pursuant to 310 CMR 40.0335(Section C is not required)
(All sections of this transmittal form must be filled out unless otherwise noted above)
C.INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE(TOR):
1.Date and time of Oral Notification,if applicable: 7/17/2017 Time: 12:45 r AM W PM
mm/dd/yyyy hh:mm
2.Date and time you obtained knowledge of the Release or TOR:— - -- 7/17/2017 - Time: 12:28 1 AM r PM
mm/dd/yyyy hh:mm
3.Date and time release or TOR occurred,if known: 7/17/2017 Time: 12:25 r AM r,PM
mm/dd/yyyy hh:mm
Check all Notification Thresholds that apply to the Release or Threat of Release:
(for more information see 310 CMR 40.0310-40.0315)
4.2 HOUR REPORTING CONDITIONS 5.72 HOUR REPORTING CONDITIONS 6.120 DAY REPORTING CONDITIONS
a.Sudden Release r a.Subsurface Non-Aqueous Phase a.Release of Hazardous Material(s)to
Liquid(NAPL)Equal to or Greater than Soil or Groundwater Exceeding
1/2Inch(.04 feet) Reportable Concentration(s)
b.Threat of Sudden Release J— b.Underground Storage Tank UST q" b.Release of Oil to Soil Exceeding
Release Reportable Concentration(s)and
Affecting More than 2 Cubic Yards
c.Oil Sheen on Surface Water r c.Threat of UST Release c.Release of Oil to Groundwater
Exceeding Reportable Concentration(s)
t Groundwater near Water d. Subsurface Non-Aqueous Phase
d.Poses Imminent Hazard d.Releaseo G
II�" � '�` q
Supply Liquid(NAPL)Equal to or Greater than
1/8 Inch(.01 feet)and Less than 1/2 Inch
(.04 feet)
e.Could Pose Imminent Hazard e.Substantial Release Migration
r f.Release Detected in Private Well
r g.Release to Storm Drain
h.Sanitary Sewer Release
(Imminent Hazard Only)
Revised: 07/18/2013 Page 1 of 3
Massachusetts Department of Environmental Protection BWSC 103
Bureau of Waste Site Cleanup
RELEASE NOTIFICATION&NOTIFICATION Release Tracking Number
+ q� RETRACTION FORM
- 26761
Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371(Subpart C)
C.INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE(TOR): (cont.)
7.List:below the Oils(0)or Hazardous Materials(HM)that exceed their Reportable Concentration(RC)or Reportable Quantity(RQ)by the
greatest amount.
r Check here if an amount or concentration is unknown or less than detectable.
O or HM Released CAS Number, O or HM Amount or Units RCs Exceeded,if Applicable
if known Concentration (RCS-1,RCS-2,RCGW-1,
RCGW-2)
DIESEL FUEL O 120 GAL RCS-1
I�Check here if a list of additional Oil and Hazardous Materials subject to reporting,or any other documentation relating to this notification
is attached.
D.PERSON REQUIRED TO NOTIFY:
1.Check all that apply: r a.change in contact name r b.change of address P c.change in the person notifying
2.Name of Organization: JAYDE CORP
3.Conact First Name: ROBERT 4.Last Name: SANTOS
5.Street: 13 CAMELOT DRIVE 6.Title: OWNER
7.City/Town: PLYMOUTH 8.State: MA 9.Z1P Code: 023600000
10.Telephone: 508-864-8740 11.Ext: 12.Email: JAYDE45@VERIZON.NET
r 13.Check here if attaching names and addresses of owners of properties affected by the Release or Threat of Release,other than an
owner who is submitting this Release Notification(required).
E.RELATIONSHIP OF PERSON TO RELEASE OR THREAT OF RELEASE: T—Check here to change relationship
Pi 1.RP or PRP r a.Owner r b.Operator P c.Generator r d.Transporter
r e.Other RP or PRP Specify:
r 2.Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2)
r 3.Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21E,s.50))
r 4..Any Other Person Otherwise Required to Notify Specify Relationship:
Revised: 07/18/2013 Page 2 of 3
Massachusetts Department of Environmental Protection BWSC 103
Bureau of Waste Site Cleanup
1 RELEASE NOTIFICATION&NOTIFICATION Release Tracking Number
i RETRACTION FORM - 26761
g Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371(Subpart C)
F.CERTIFICATION OF PERSON REQUIRED TO NOTIFY:
1.I, ROBERT SANTOS ,attest under the pains and penalties of perjury(i)that I have personally
examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal
form,(ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information
contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii)that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal.I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,
inaccurate,or incomplete information.
2.By: ROBERT SANTOS 3.Title: OWNER
Signature
4.For: JAYDE CORP 5.Date: 9/14/2017
(Name of person or entity recorded in Section D) mm/dd/yyyy
r- 6.Check here if the address of the person providing certification is different from address recorded in Section D.
7.Street:
8.City/Town: 9.State: 10.ZIP Code:
11.Telephone: 12.Ext.: _ _ 13.Email:
YOU ARE SUBJECT TO ANNUAL COMPLIANCE ASSURANCE FEES FOR EACH BILLABLE YEAR FOR TIER
CLASSIFIED DISPOSAL SITES.YOU MUST LEGIBLY COMPLETE ALL RELEVANT SECTIONS OF THIS FORM
OR DEP MAY RETURN TBE DOCUMENT AS INCOMPLETE.IF YOU SUBMIT AN INCOMPLETE FORM,YOU
MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp(DEP USE ONLY:)
Received by DEP on 9/14/2017 4:07:17 PM
Revised: 07/18/2013 Page 3 of 3
I
'David Bennett
From: eDEPConfirmation @ massmail.state.ma.us
Sent: Thursday, September 14, 2017 4:07 PM
To: Kara Risk
Cc: David Bennett
Subject: eDEP Submittal Confirmation for DEP Transaction ID: 955436
Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection.Your
transaction is complete and has been submitted to MassDEP.
This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for
your records.
Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online
Filing, please email the EEA Help Desk at mailto:EEA.ServiceDesk@State.MA.US or call 617-626-1111.
MassDEP is interested in how we can serve you better.To help us make improvements to eDEP, please take a minute to
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**************************************************************************************
DEP Transaction ID: 955436
Date and Time Submitted:09/14/2017 04:07:16
**************************************************************************************
Form Name: BWSC103 Release Notification & Retraction Form
RTN:4-26761
Location: 1/10 OF MILE EAST OF OAK ST OVER PASS
Address: RTE 6 EAST BOUND
WEST BARNSTABLE
Person Making Submittal
JAYDE CORP
ROBERT
SANTOS
13 CAMELOT DRIVE
PLYMOUTH
MA
023600000
Person Making Certification
JAYDE CORP
Robert Santos
Additional Forms Submitted
1
EMAIL ID OF THE USER: krisk@bennett-ea.com
EMAIL ID OF THE OTHER USERS: dbennett@bennett-ea.com
2
Massachusetts Department of Environmental Protection
eDEP Transaction Copy
Here is the file you requested for your records.
To retain a copy of this file you must save and/or print.
Username: DAVIDBENNETT
Transaction ID: 955438
Document: BWSC104 Permanent And Temporary Solution Statement
Size of File: 223.00K
Status of Transaction: Submitted
Date and Time Created: 9/15/2017:7:37:35 AM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
rMassachusetts Department of Environmental Protection BWSC 104
Bureau of Waste Site Cleanup
Release Tracking Number
PERMANENT AND TEMPORARY SOLUTION STATEMENT �
ursuant to 310 CMR 40.1000(Subpart J) I T I 26761
For sites with multiple RTNs,enter the Primary RTN above.
A.SITE LOCATION:
1.Site Name/Location Aid: 1/10 OF MILE EAST OF OAK STOVER PASS
2. Street Address: RTE 6 EAST BOUND
3.City/Town: WEST BARNSTABLE 4.ZIP Code:
S.Coordinates: a.Latitude:N 41.68433 b.Longitude:W 70.34870
r 6.Check here if the disposal site that is the source of the release is Tier Classified.Check the current Tier Classification Category:
r-a.Tier I Ir b.Tier ID r c.Tier If
B.THIS FORM IS BEING USED TO:(check all that apply)
1.List Submittal Date of the Permanent or Temporary Solution Statement,
or RAO Statement(if previously submitted): mm/dd/yyyy
r 2.Submit a Permanent or Temporary Solution Statement
I- a.Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers
(RTNs).RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.
b.Provide the additional Release Tracking Number(s)covered by this 0 -I I D - I
Permanent or Temporary Solution Statement. �� I �
17 3.Submit a Revised Permanent or Temporary Solution Statement(or revised RAO Statement)
r a.Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers(RTNs),
not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or Temporary
Solution Statements.RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.
b.Provide the additional Release Tracking Number(s)covered by this -r
Permanent or Temporary Solution Statement. Il. 1— J EJ -
E__
r 4.Submit a Permanent or Temporary Solution Partial Statement
Check above box,if any Response Actions remain to be taken to address conditions associated with this disposal site having the
Primary RTN listed in the header section of this transmittal form.This Permanent or Temporary Solution Statement will record only a
Permanent or Temporary Solution-Partial Statement for that RTN.A final Permanent or Temporary Solution Statement will need to be
submitted that references all Permanent or Temporary Solution-Partial Statements and,if applicable,covers any remaining conditions
not covered by the Permanent or Temporary Solution-Partial Statements.
Also,specify if you are an Eligible Person or Tenant pursuant to M.G.L.c.21 s.2,and have no further obligation to
conduct response actions on the remaining portion(s)of the disposal site:
I" a.Eligible Person r b.Eligible Tenant — - -- --- ---^-- - - - _-
5.Submit a Revised Permanent or Temporary Solution Partial Statement(or revised RAO-Partial Statement)
T- 6.Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement
�. 7.Submit a Periodic Review Opinion evaluating the status of a Temporary Solution,as specified in 310 CMR 40.1051
(Section F is optional)
8.Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement(or RAO Statement)
(Sections E&F are not required)
(All sections of this transmittal form must be filled out unless otherwise noted above)
Revised:6/21/2016 Page 1 of 8
assachusetts Department of Environmental Protection BWSC 104
ureau of Waste Site Cleanup
Release Tracking Number
,4 ERMANENT AND TEMPORARY SOLUTION STATEMENT - 26761
ursuant to 310 CMR 40.1000(Subpart J) F4 I
For sites with multiple RTNs,enter the Primary RTN above.
C.DESCRIPTION OF RESPONSE ACTIONS:(check all that apply;for volumes,list cumulative amounts)
r 1.Assessment and/or Monitoring Only 1'2.Temporary Covers or Caps
3.Deployment of Absorbent or Containment Materials r 4.Treatment of Water Supplies
r 5.Structure Venting System/HVAC Modification System J—6.Engineered Barrier
r-7.Product or NAPL Recovery 8.Fencing and Sign Posting
r 9.groundwater Treatment Systems 10.Soil Vapor Extraction
r 11.Remedial Additives 12.Air Sparging
13.Active Exposure Pathway Mitigation System r.'14.Passive Exposure Pathway Mitigation System
15.Monitored Natural Attenuation r 16.In-Situ Chemical Oxidation
117.Removal of Contaminated Soils
r a.Re-use,Recycling or Treatment r i.On Site Estimated volume in cubic yards
fi.Off Site Estimated volume in cubic yards
iia.Facility Name: Town: State:
fib.Facility Name: Town: State:
iii.Describe:
r b.Landfill
r-i.Cover Estimated volume in cubic yards
Facility Name: Town: State:
r ii.Disposal Estimated volume in cubic yards
Facility Name: Town: State:
1 18.Removal of Drums,Tanks or Containers:
a.Describe Quantity and Amount: 11-55 GALLON DRUMS ABSORBENTS
b.Facility Name: NORTHLAND ENVIRONMENTAL,LLC Town: PROVIDENCE State: R
c.Facility Name: Town: State:
r 19.Removal of Other Contaminated Media:
a.Specify Type and Volume:
b.Facility Name: Town: State:
c.Facility Name: Town: State:
Revised: 6/21/2016 1Page 2 of 8
assachusetts Department of Environmental Protection BWSC 104
L(V
ureau of Waste Site Cleanup
Release Tracking Number
ERMANENT AND TEMPORARY SOLUTION STATEMENT
ursuant to 310 CMR40.1000(Subpart J) 4 - 26761
_ For sites with multiple RTNs,enter the Primary RTN above.
C.DESCRIPTION OF RESPONSE ACTIONS(cont.):(check all that apply;for volumes,list cumulative amounts)
r 20.Other Response Actions:
Describe:
21.Use of Innovative Technologies:
Describe:
D.SITE USE:
1.Are the response actions that are the subject of this submittal associated with the redevelopment,reuse or the major
expansion of the current use of property(ies)impacted by the presence of oil and/or hazardous materials?
,r-a.Yes 1v b.No I—c.Don't know
2.Is the property a vacant or under-utilized commercial or industrial property("a brownfield property")?
r a.Yes 1✓b.No c.Don't know
3.Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies)within the disposal site?
r.a.Yes r b.No rv-c.Don't know If Yes,identify program(s):
4.Has a Covenant Not to Sue been obtained or sought?
r a.Yes r-b.No rV c.Don't know
5.Check all applicable categories that apply to the person making this submittal: (—a.Redevelopment Agency or Authority
r,b.Community Development Corporation I ?c.Economic Development and Industrial Corporation
r d.Private Developer I e.Fiduciary r-f.Secured Lender g.Municipality
r h.Potential Buyer(non-owner) r i.Other,describe: STATE HIGHWAY
This data will be used by MassDEP for information purposes only,and does not represent or create any legal commitment,obligation or
liability on the part of the party or person providing this data to MassDEP.
E.PERMANENT OR TEMPORARY SOLUTION CATEGORY:
Specify the category of Solution that applies to the Disposal Site,or Site of the Threat of Release.Select either 1,2,or 3.
1.Permanent Solution with No Conditions(check one)
r a.A threat of release has been eliminated.
r- b.All contamination has been reduced to Natural Background levels.
17 c.A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,
assumptions,or conditions(310 CMR 40.1013).
Revised:6/21/2016 Page 3 of 8
I
assachusetts Department of Environmental Protection $WSC 104
ureau of Waste Site Cleanup
Release Tracking Number
;4 ERMANENT AND TEMPORARY SOLUTION STATEMENT 4 1 - 26761
ursuant to 310 CMR 40.1000(Subpart J)
For sites with multiple RTNs,enter the Primary RTN above.
E.PERMANENT OR TEMPORARY SOLUTION CATEGORY(coat.):
2.Permanent Solution with Conditions(check a and/or b):
* a.An AUL has been implemented pursuant to 310 CMR 1012(2)(check one)
r" i.Required pursuant to 310 CMR 40.1012(2)
Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measure
pursuant to CMR 310 40.1025?
r 1.Yes r 2.No
ii.Optionally implemented pursuant to 310 CMR 40.1012(3)
r b.Limitations or conditions apply pursuant to 310 CMR 40.1013(check all that apply):
r i.Gardening Best Management Practices(BMPs)for non-commercial gardening in a residential setting
r ii.Concentrations of Oil and Hazardous Material consistent with Anthropogenic Background
r iii.Residual contamination in a Public or Railroad Right-of-Way
r iv.Groundwater contamination would exceed GW-2 Standards except for the absence of an occupied
building or structure
r 3.Temporary Solution(check a or b/and c)
r a.Response actions to achieve a Permanent Solution are not currently feasible
r b.Response actions to achieve a Permanent Solution are feasible and are being continued toward a
Permanent Solution
r c.Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?
r i.Yes r ii.No
F.PERMANENT AND TEMPORARY SOLUTION INFORMATION:
1.Specify the Risk Characterization Method(s)used to achieve the Permanent or Temporary Solution,described above:
P'; a.Method 1 r b.Method 2 r c.Method 3
r d.Method Not Applicable-Contamination reduced to or consistent with background,or Threat of Release abated
2.Specify all Soil Category(ies)applicable.More than one Soil Category may apply at a Site.Be sure to check off all APPLICABLE
categories:
r- a.S-1/GW-1 r d.S-2/GW-1 r g.S-3/GW-1 r j.Not Applicable
r; b.S-1/GW-2 '` e.S-2/GW-2 r h.S-3/GW-2
rv. c.S-1/GW-3 r f S-2/GW-3 r i.S-3/GW-3
3.Specify all Groundwater Category(ies)impacted.A site may impact more than one Groundwater Category.Be sure to check off all
E14PACTED categories:
r: a.GW-1 r' b.GW-2 r c.GW-3 r d.No Groundwater Impacted
Revises: 6/21/2016 Page 4 of 8
assachusetts Department of Environmental Protection $WSC 104
- ureau of Waste Site Cleanup
Release Tracking Number
ERMANENT AND TEMPORARY SOLUTION STATEMENT
ursuant to 310 CMR 40.1000(Subpart T) 4 - 26761
For sites with multiple RTNs,enter the Primary RTN above.
F.PERMANENT AND TEMPORARY SOLUTION INFORMATION(cont.):
4.Check here if the risk assessment includes any changes to the groundwater category pursuant to
310 CMR 40.0932(5)(a)through(e).Check all conditions that apply:
r a.An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation(310 CMR 40.0932(5)(a))
r b.Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinking
water supply(310 CMR 40.0932(5)(b))
.r c.A Non-Potential DrinkingWater Source Area determination was made(310 CMR 40.0932(5)(c))
r- d.Existing private wells were permanently closed(310 CMR 40.0932(5)(d))
r e.Groundwater is located within a Zone A,but is not hydrogeologically connected to a drinking water supply
(310 CMR 40.0932(5)(e))
5.Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW-1 area pursuant
to 310 CMR 40.0924(2)(b)3.
6.Specify whether remediation was conducted:
f— a.Check here if soil remediation was conducted.
r b.Check here if groundwater remediation was conducted.
c.Check here if other remediation was conducted.
Specify:
APPLICATION OF ABSORBENTS ONTO PAVEMENT AND DAMMING OF CATCH BASIN
7.Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical
Methods(CAM):
r a.CAM used to support all analytical data. 1✓ b.CAM used to support some of the analytical data.
J c.CAM not used.
r: 8.Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and Data
Representativeness Evaluation pursuant to 310 CMR 40.1056..
9.Estimate the number of acres this Permanent or Temporary Solution Statement applies to: 0.05
Revised: 6/21/2016 Page 5 of 8
assachusetts Department of Environmental Protection BWSC 104
j.� ureau of Waste Site Cleanup
f ERMA Release Tracking Number
NENT AND TEMPORARY SOLUTION STATEMENT �
ursuant to 310 CMR 40.1000(Subpart J) I ' I 26761
For sites with multiple RTNs,enter the Primary RTN above.
G.LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form,including any and all
documents accompanying this submittal.In my professional opinion and judgment based upon application of(i)the standard of care in 309
CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and 309 CMR4.03(2),and(iii)the provisions of 309 CMR 4.03(3),to the
best of my knowledge,information and belief,
>if Section B indicates that either a Permanent or Temporary Solution Statement,Phase I Completion Statement and/or Periodic Review
Opinion is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in
accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the
purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000,and(iii)comply(ies)with
the identified provisions of all orders,permits,and approvals identified in this submittal.
I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I
know to be false,inaccurate or materially incomplete.
1.LSP#: 4303
2.First Name: DAVID C 3.Last Name: BENNETT
4.Telephone: 5088961706 5.Ext: 6.Email:
7.Signature: DAMD C BENNETT
8.Date: 9/14/2017 9.LSP Stamp: -
mm/dd/yyyy of
_ 7� ►
Ap
Electronic ,
Seal
H.PERSON MAKING SUBMITTAL:
1.Check all that apply: a.change in contact name r b.change of address r c.change in the person
undertaking response actions
2.Name of Organization:
3.Contact First Name: ROBERT 4.Last Name: SANTOS
5.Street: 13 CAMELOT DRIVE 6.Title: OWNER
7.City;Town: PLYMOIJTH 8.State: MA 9.ZIP Code: 023600000
10.Telephone: 5088648740 11.Ext.: 12.Email: JAYDE45@VERIZON.NET
Revised:6/21/2016 Page 6 of 8
assachusetts Department of Environmental Protection BWSC 104
ureau of Waste Site Cleanup
Release Tracking Number
ERMANENT AND TEMPORARY SOLUTION STATEMENT - 26761
1' ursuant to 310 CMR 40.1000(Subpart J) I * I
For sites with multiple RTNs,enter the Primary RTN above.
I.RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
r-Check here to change relationship
r 1.RP or PRP T-a.Owner r:b.Operator 10-c.Generator r d.Transporter
r e.Other RP or PRP Specify:
r 2.Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21E,s.2)
'": 3.Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21E,s.50))
r" 4.Any Other Person Making Submittal Specify Relationship:
J.REQUIRED ATTACHMENT AND SUBMITTALS:
r 1.Check here if the Permanent or Temporary Solution on which this opinion is based,if any,are(were)subject to any order(s),
permit(s)and/or approval(s)issued by DEP or EPA.If the box is checked,you MUST attach a statement identifying the applicable
provisions thereof.
r 2.Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail right-of-way exemption from the requirements of an
AUL.
ry 3.Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
r 4.Check here to certify that documentation is attached specifying the location of the Site,or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement.If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site,you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined,the entire Disposal Site.
r 5.Check here to certify that,pursuant to 310 CMR 40.1406,notice was provided to the owner(s)of each property within the disposal
site boundaries,or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions.(check all that apply)
r a.Notice was provided prior to,or concurrent with the submittal of a Phase II Completion Statement to the Department.
rv- b.Notice was provided prior to,or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
r c.Notice not required. d.Total number of property owners notified,if applicable: 1
r 6.Check here if you are submitting one or more AULs.You must submit an AUL Transmittal Form(BWSC113)and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement.Specify the type of AUL(s)below:(required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
r a.Notice of Activity and Use Limitation b.Number of Notices submitted:
r c.Grant of Environmental Restriction d.Number of Grants submitted:
r 7.If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form,check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP,P.0.Box 4062,Boston,MA 02211.
r 8.Check here if any non-updatable information provided on this form is incorrect,e.g.Site Address/Location Aid.Send corrections
to bwsc.edep@state.ma.us.
r 9.Check hereto certify that the LSP Opinion containing the material facts,data,and other information is attached.
Revised:6/21/2016 Page 7 of 8
I� J
assachusetts Department of Environmental Protection BWSC 104
L7�
- ureau of Waste Site CleanupRelease Tracking Number
ERMANENT AND TEMPORARY SOLUTION STATEMENT 4 - 26761
,� u ub art J)rsuant to 310 CMR 40.1000�S For sites with multiple RTNs,enter the Primary RTN above.
K.CERTIFICATION OF PERSON MAKING SUBMITTAL:
1.L ROBERT SANTOS ,attest under the pains and penalties of perjury(i)that I have personally
examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal
former,(ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information
contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii)that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal.I/the person or entity on whose behalf this submittal is made
am;is aware that there are significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,
inaccurate,or incomplete information.
2.By: ROBERT SANTOS 3.Title:
Signature
4.F-Dr: ROBERT SANTOS 5.Date: 9/14/2017
(Name of person or entity recorded in Section H) mm/dd/yyyy
r 6.Check here if the address of the person providing certification is different from address recorded in Section H.
7.Street:
8.City/Town: 9.State: 10.ZIP Code:
11.Telephone: 12.Ext.: 13.Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO$10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE.YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE.IF YOU
SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp(DEP USE ONLY:)
Received by DEP on 9/14/2017 4:52:44 PM
Revised:6/21/2016 Page 8 of 8
David Bennett
From: eDEPConfirmation@massmail.state.ma.us
Sent: Thursday, September 14, 2017 4:53 PM
To: David Bennett
Cc: jayde45@verizon.net
Subject: eDEP Submittal Confirmation for DEP Transaction ID: 955438
Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection.Your
transaction is complete and has been submitted to MassDEP.
This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for
your records.
Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online
Filing, please email the EEA Help Desk at mai Ito:EEA.ServiceDesk@State.MA.US or call 617-626-1111.
MassDEP is interested in how we can serve you better.To help us make improvements to eDEP, please take a minute to
complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts-
and-feedback.htm1.
To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm.
DEP Transaction ID: 955438
Date and Time Submitted:09/14,/2017 04:52:44
Form Name: BWSC104 Permanent And Temporary Solution Statement
RTN:4-26761
Location: 1/10 OF MILE EAST OF OAK ST OVER PASS
Address: RTE 6 EAST BOUND
WEST BARNSTABLE
Person Making Submittal
ROBERT
SANTOS
13 CAMELOT DRIVE
PLYMOUTH
MA
023600000
LSP
LSP#:4303
LSP Name: DAVID C
BENNETT
Person Making Certification
1
Robert Santos
Ancillary Document Uploaded/Mailed
BWSC-104 QUESTION.132-Perm. or Temp.Solution Stmt or RAO Report- Uploaded (BEA17-11037 IRAC-PSS 9.9.17.pdf)
EMAIL ID OF THE USER:dbennett@bennett-ea.com
EMAIL ID OF THE OTHER USERS:Jayde45@verizon.net
**************************************************************************************
2
Massachusetts Department of Environmental Protection
w eDEP Transaction Copy
iLl-
Here is the file you requested for your records.
To retain a copy of this file you must save and/or print.
Username: DAVIDBENNETT
Transaction ID: 955437
Document: BWSC105 Immediate Response Action Transmittal Form
S'ze of File: 188.31K
Status of Transaction: Submitted
Date and Time Created: 9/1512017:7:36:59 AM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
---- Massachusetts Department of Environmental Protection BWSC 105
Bureau of Waste Site Cleanup
y;q°'` Immediate Response Action (IRA) 'Transmittal Form Release Tracking Number
;Y .
' ,. . Pursuant to 310 CMR 40.0424-40.0427(Subpart D) - 26761
L1
A.SITE LOCATION:
1.Release Name/Location Aid: 1/10 OF MILE EAST OF OAK ST OVER PASS
2.Street Address: RTE 6 EAST BOUND
3.City/Town: WEST BARNSTABLE 4.Zip Code:
r- 5.Check here if this location is Adequately Regulated,pursuant to 310 CMR 40.0110-0114.
a.CERCLA r-b.HSWA Corrective Action r c.Solid Waste Management
d.RCRA State Program 21C Facilities
i� ( )
B.THIS FORM IS BEING USED TO:(check all that apply)
1.List Submittal Date of Initial IRA Written Plan(if previously submitted):
2.Submit an Initial IRA Plan.
3.Submit a Modified IRA Plan of a previously submitted written IRA Plan.
r 4.Submit an Imminent Hazard Evaluation.(check one)
t7 a.An Imminent Hazard exists in connection with this Release or Threat of Release.
rV b.An Imminent Hazard does not exist in connection with this Release or Threat of Release.-
!_c.It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release,and further assessment
activities will be undertaken.
r-d.It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release.However,response actions
will address those conditions that could pose an Imminent Hazard.
J 5.Submit a request to Terminate an Active Remedial System or Response Action(s)Taken to Address an Imminent Hazard.
j 6.Submit an IRA Status Report
7.Submit a Remedial Monitoring Report.(This report can only be submitted through eDEP.)
a.Type of Report:(check one) r i.Initial Report r ii.Interim Report r iii.Final Report
b.Frequency of Submittal:(check all that apply)
r'i.A Remedial Monitoring Report(s)submitted monthly to address an Imminent Hazard.
r ii.A Remedial Monitoring Report(s)submitted monthly to address a Condition of Substantial Release Migration.
r iii.A Remedial Monitoring Report(s)submitted every six months,concurrent with an IRA Status Report.
r iv.A Remedial Monitoring Report(s)submitted annually,concurrent with an IRA Status Report.
c.Number of Remedial Systems and/or Monitoring Programs:
A separate BWSC105A,IRA Remedial Monitoring Report,must be filled out for each Remedial System and/or Monitoring Program
addressed by this transmittal form.
Revised: 11/14/2013 Page 1 of 6
r
Massachusetts Department of Environmental Protection $WSC 105
` Bureau of Waste Site Cleanup Release Tracking Number
' Immediate Response Action (IRA)Transmittal Form
Pursuant to 310 CMR 40.0424-40.0427(Subpart D - 26761
JV 8.Submit an IRA Completion Statement.
r a.Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as part
Actions planned or ongoing at a Site that has already been Tier Classified under a different Release Tracking Number
of the Responsep g g Y
MN)
b.Provide Release Tracking Number of Tier Classified Site(Primary RTN):
These additional response actions must occur according to the deadlines applicable to the Primary RTN.Use the Primary RTN when
making all future submittals for the site unless specifically relating to this Immediate Response Action.
r 9.Submit a Revised IRA Completion Statement.
r 10.Submit a Plan for the Application of Remedial Additives near a sensitive receptor,pursuant to 310 CMR 40.0046(3).
(All sections of this transmittal form must be filled out unless otherwise noted above)
C.RELEASE OR THREAT OF RELEASE CONDITIONS THAT WARRANT IRA:
1.Media Impacted and Receptors Affected:(check all that apply) N7 a.Paved Surface 1—b.Basement r c.School
r d.Public Water Supply r e.Surface Water r f Zone 2 r g.Private Well r h.Residence rV_i.Soil
r j.Groundwater r k.Sediments r 1.Wetland r m.Storm Drain r n.Indoor Air r o.Air
r p.Soil Gas r q.Sub-Slab Soil Gas r r.Critical Exposure Pathway r s.NAPL r t.Unknown
r r.Others Specify:
2.Sources of the Release or TOR:(check all that apply) r a.Transformer TV b.Fuel Tank r c.Pipe
r d.OHM Delivery r e.AST ri f Drums r g.Tanker Truck r h.Hose r i.Line
r j.UST Describe: r k.Vehicle r 1.Boat/Vessel
r in.Unknown r n. Other:
3.Type of Release or TOR:(check all that apply) r a.Dumping r b.Fire r c.AST Removal r d.Overfill
r e.Rupture T f.Vehicle Accident r g.Leak r h.Spill r i.Test failure r j.TOR Only
r k.UST Removal Describe:
r 1.Unknown r m Other:
4.Identify Oils and Hazardous Materials Released:(check all that apply) R a.Oils r b.Chlorinated Solvents
r c.Heavy Metals r d. Others Specify:
D.DESCRIPTION OF RESPONSE ACTIONS:(check all that apply,for volumes list cumulative amounts)
r 1.Assessment and/or Monitoring Only r 2.Temporary Covers or Caps
3.Deployment of Absorbent or Containment Materials 4.Temporary Water Supplies
r 5.Structure Venting System/HVAC Modification System r 6.Temporary Evacuation or Relocation of Residents
r 7.Product or NAPL Recovery r 8.Fencing and Sign Posting
r 9.Groundwater Treatment Systems r 10.Soil Vapor Extraction
r 11.Remedial Additives r 12.Air Sparging
r 13.Active Exposure Pathway Mitigation System r 14.Passive Exposure Pathway Mitigation System
Revised: 11/14/2013 Page 2 of 6
Massachusetts Department of Environmental Protection BWSC 105
L
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form Release Tracking Number
_ 4 26761
�4 Pursuant to 310 CMR 40.0424 40.0427 (Subpart D)
D.DESCRIPTION OF RESPONSE ACTIONS:(cont.)
17 15.Excavation of Contaminated Soils.
r— a.Re-use,Recycling or Treatment j' i.On Site Estimated volume in cubic yards
ii.Off Site Estimated volume in cubic yards
iia.Receiving Facility: Town: State:
iib.Receiving Facility: Town: State:
iii.Describe:
r— b.Store i.On Site Estimated volume in cubic yards
H.Off Site Estimated volume in cubic yards
iia.Receiving Facility: Town: State:
iib.Receiving Facility: Town: State:
.r c.Landfill r i.Cover Estimated volume in cubic yards
Receiving Facility: Town: State:
J" ii.Disposal Estimated volume in cubic yards
Receiving Facility: Town: State:
ry 16.Removal of Drums,Tanks,or Containers:
a.Describe Quantity and Amount: 11-55 GALLON DRUMS
b.Receiving Facility: NORTHLAND ENVIRONMENTAL,L-C. Town: PROVIDENCE State: R
c.Receiving Facility: Town: State:
r` 17.Removal of Other Contaminated Media:
a.Specify Type and Volume:
18.Other Response Actions:
Describe:
19.Use of Innovative Technologies:
Describe:
Revised: 11/14/2013 Page 3 of 6
Massachusetts Department of Environmental Protection BWSC 105
Bureau of Waste Site Cleanup
Release Tracking Number
Immediate Response Action (IRA) Transmittal Form
�' Pursuant to 310 CMR 40.0424-40.0427(Subpart D) F - 26761
E.LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form,including any and
all documents accompanying this submittal.In my professional opinion and judgment based upon application of(i)the standard of care in
309 CMR 4.02(1),(ii)the applicable provisionsof 309 CMR 4.02(2)and(3),and 309 CMR 4.03(2),and(iii)the provisions of 309 CMR 4.03(3),
to the best of my knowledge,information and belief,
>if Section B of this form indicates that an Immediate Response Action Plan is being submitted,the response action(s)that is(are)the
sub'ect of this submittal(i)has(have)been developed in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000,
(ii)is(are)appropriate and reasonable to accomplish thepurposes of such response action(s)as set forth in the applicable provisions of
M.G.L.c.21E and 310 CMR 40.0000 and(iii)complies(y)with the identified provisions of all orders,permits,and approvals identified in this
submittal;
>if Section B of this form indicates that an Imminent Hazard Evaluation is being submitted,this Imminent Hazard Evaluation was developed
in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000,and the assessment activity(ies)undertaken to support
this Imminent Hazard Evaluation comply(ies)with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000;
>if Section B of this form indicates that an Immediate Response Action Status Report and/or a Remedial Monitoring Report is(are)being
submitted,the response action(s)that is(are)the subject of this submittal(i)is(are)being implemented in accordance with the applicable
provisions of M.G.L.c.21E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response
action(s)as set forth in the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(iii)comply(ies)with the identified provisions
of all orders,permits,and approvals identified in this submittal;
>if Section B of this form indicates that an Immediate Response Action Completion Statement or a request to Terminate an Active
Remedial System or Response Action(s)Taken to Address an Imminent Hazard is being submitted,the response action(s)that is(are)the
subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21E and
310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable
provisions of M.G.L.c.21E and 310 CMR 40.0000 and(iii)comply(ies)with the identified provisions of all orders,permits,and approvals
identified in this submittal.
I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I
know to be false,inaccurate or materially incomplete.
1.LSP#: 4303
2.First Name: DAVID C 3.Last Name: BENNETT
4.Telephone: 508-896-1706 5.Ext: 6.Email:
7.Signature: DAVID C BENNETT
8.Da--e: 9/14/2017 (mm/dd/yyyy) 9.LSP Stamp:
Of
ElectroniG
ell
Revised: 11/14/2013 Page 4 of 6
Massachusetts Department of Environmental Protection BWSC 105
L
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form �Release Tracking Number
Pursuant to 310 CMR 40.0424-40.0427(Subpart D) F I - 26761
d
F.PERSON UNDERTARING IRA:
1.Check all that apply: r-a.change in contact name r b.change of address r7 c.change in the person undertaking response
actions
2.Name of Organization: JAYDE CORP
3.Contact First Name: ROBERT 4.Last Name: SANTOS
5.Street: 13 CAMELOT DRIVE 6.Title: OWNER
7.City/Town: pLYMOUTH 8.State: MA 9.ZipCode:
023600000
10.Telephone: 508-864-8740 11.Ext 12.Email: JAYDE45@VERIZON.NET
G.RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:
r— Check here to change relationship
ry 1.RP or PRP r a.Owner T b.Operator 171 c.Generator d.Transporter
r e.Other RP or PRP Specify Relationship:
r 2.Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21E,s.2)
r 3.Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21E,s.50)) `
r— 4.Any Other Person Undertaking Response Actions: Specify Relationship:
H.REQUIRED ATTACETYIENT AND SUBMITTALS:
r 1.Check here if any Remediation Waste,generated as a result of this IRA,will be stored,treated,managed,recycled or reused at the site
following submission of the IRA Completion Statement.If this box is checked,you must submit one of the following plans,along with
the appropriate transmittal form.
Ir-a.A Release Abatement Measure(RAM)Plan(BWSC106) rb.Phase IV Remedy Implementation Plan(BWSC108)
2.Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s)and/or
approval(s)issued by MassDEP or EPA.If the box is checked,you MUST attach a statement identifying the applicable provisions
thereof.
r 3.Check here to certify that the Chief Municipal Officer and the Local Boardof Health were notified of the implementation of an
Immediate Response Action taken to control,prevent,abate or eliminate an Imminent Hazard.
17 4.Check here to certify that the Chief Municipal Officer and the Local Boardof Health were notified of the submittal of a Completion
Statement for an Immediate Response Action taken to control,prevent,abate or eliminate an Imminent Hazard.
5.Check here if any non-updatable information provided on this form is incorrect,e.g.Release Address/Location Aid.Send corrections
to BWSC.eDEP@state.ma.us.
r 6.Check here to certify that the LSP Opinion containing the material facts,data,and other information is attached.
Revised: 11/14/2013 Page 5 of 6
Massachusetts Department of Environmental Protection BWSC 105
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form Release Tr26king Number
Pursuant to 310 CMR 40.0424-40.0427(Subpart D)
I.CERTIFICATION OF PERSON UNDERTAKING IRA:
1.1, ROBERT SANTOS ,attest under the pains and penalties of perjury(i)that I have personally examined and
am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form;(ii)
that,based on my inquiry of the/those individual(s)immediately responsible for obtaining the information,the material information
contained herein is,to the best of my knowledge,information and belief,true,accurate and complete;(iii) that,to the best of my
knowledge,information and belief,I/the person(s)or entity(ies)on whose behalf this submittal is made satisfy(ies)the criteria in 310
CMR 40.0183(2);(iv)that I/the person(s)or entity(ies)on whose behalf this submittal is made have provided notice in accordance with
310 CMR 40.0183(5);and(v)that I am fully authorized to make this attestation on behalf of the person(s)or entity(ies)legally
responsible for this submittal. I/the person(s)or entity(ies)on whose behalf this submittal is made is/are aware that there are
significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or
incomplete information.
2.By: ROBERT SANTOS 3.Title: OWNBR
4.For: JAYDE CORP 5.Date: 9/14/2017 (mm/dd/yyyy)
r 6.Check here if the address of the person providing certification is different from address recorded in Section F.
7.Street:
8.City/Town: 9.State: 10.Zip Code:
11.Telephone: 12.Ext: 13.Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO$10,000 PER BILLABLE
YEAR FOR THIS DISPOSAL SITE.YOU MUST LEGIBLY COMPLETE ALL RELEVANT SECTIONS OF THIS
FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE.IF YOU SUBMIT AN INCOMPLETE
FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp(DEP USE ONLY:)
Received by DEP on
9/14/2017 4:51:09 PM
Revised: 11/14/2013 Page 6 of 6
r
David Bennett
From: eDEPConfirmation@massmail.state.ma.us
Sent: Thursday, September 14, 2017 4:51 PM
To: David Bennett
Cc: jayde45@verizon.net
Subject: eDEP Submittal Confirmation for DEP Transaction ID: 955437
Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection.Your
transaction is complete and has been submitted to MassDEP.
This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for
your records.
Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online
Filing, please email the EEA Help Desk at mailto:EEA.ServiceDesk@State.MA.US or call 617-626-1111.
MassDEP is interested in how we can serve you better.To help us make improvements to eDEP, please take a minute to
complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts-
and-feedback.htm1.
To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm.
**************************************************************************************
DEP Transaction ID: 955437
Date and Time Submitted:09/14/2017 04:51:09
Form Name: BWSC105 Immediate Response Action Transmittal Form
RTN:4-26761
Location: 1/10 OF MILE EAST OF OAK ST OVER PASS
Address: RTE 6 EAST BOUND
WEST BARNSTABLE
Person Making Submittal
JAYDE CORP
ROBERT
SANTOS
13 CAMELOT DRIVE
PLYMOUTH
MA
023600000
LSP
LSP#:4303
LSP Name: DAVID C
BENNETT
Person Making Certification
JAYDE CORP
1
r
Robert Santos
Ancillary Document Uploaded/Mailed
BWSC-105 Q.1304- Imminent Hazard Evaluation Doc- Uploaded (IHE Reference (Jayde IRAC-PSS).pdf)
BWSC-105 Q.1308- IRA Completion Report- Uploaded (BEA17-11037 IRAC-PSS 9.9.17.pdf)
EMAIL ID OF THE USER: dbennett@bennett-ea.com
EMAIL ID OF THE OTHER USERS:Jayde45@verizon.net
2
��
TOWN OFBJJARNSTABLE
CATION �� ' pp elUiCP_ L��0ak� SEWAGE #
VILLAGE W6S ASSESS 'S MAP&LOT
ors/-I�rve s 6�-K-
NAME&PHONE NOf tA,4 ��
SEPTIC TANK CAPACITY lnbo G'Ql
LEACHING FACILITY: (type) 6 (size) 1600 .C 01
NO.OF BEDROOMS
BUILDER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 fe `t of lea'chiin$fac' 'yy) n / Feet
Furnished by ' 1LJ� K/' . �'; &r1is—��6
LAJ'(!
64'
�Oa,
2
;Tall 96
BORTOLOTTI CONSTRUCTION,INC.
765 WAKEBY ROAD,MARSTONS MILLS, MA 02648
508-771=9399 508-428-8926 FAX: 508-428-9399
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
pp CERTIFICATION
Property Address: 3 U�/rJiC� oL �G`,
Date of Inspection: -/ Inspector's Name:
Owner's Name and Address:
�e4,?d0 le tit �� elm
_CERTIFICATION STATEMENT:
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true;accurate and complete as of the time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal systems. The System:
Passes
Conditionally Passes
Needs Further Ev luation By the Local Aproving Authority
Fails _
Inspector's-Signature: � � Dater
The System Inspector shall submit a copy of this inspection report to the Approving authority,within thir-
ty(30)days of completing this inspection."'If the system is a shared system or hd's 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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer,if applicable and the approving authority.
INSPECTIONSUMMARY:
A)SYST . I PASSES:
V I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR 15,303. Any failure criteria not evaluated are indicated
below. €,
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair, passes inspection.
Indicate yes;nor;or not determined(Y,N,OR ND).Describe basis of determination in all instances. If
"not determined",explain why not.
The septic tank is-metal,cracked,structurally unsound, shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
.tic tank is replaced with a conforming septic tank as approved by The Board'of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
- 1 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The.System required pumping more than four times a year due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of The Board of Health):
` Broken.pipe(s)are replaced
Obstruction is removed
C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by The Board of Health in;ordeuto:determine if=
the system,,is failing•to protect the public health, safety and the environment.
1),.SYSTEM VWL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM.IS.NOT-FUNCTIONING IN A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 Feet of a surface water
Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNERTHAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE,
ENVIRONMENT:
The system:has a septic,tank-and soil absorption,system and is within 100 Feet to a surface's`
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a Zone I of a public
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but,50;
Feet or more from a private water supply well,unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollutionlrom,
..the.facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than,5'ppm;. _
D)SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined
in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health'
should be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding,of efluent to the surface of the ground or surface waters due to an '
overloaded or clogged SAS or cesspool.
Statc:liquid level in;the distribution box above outlet invert due to an overloaded or clog-
n ged SAS.or cesspool
Liquid depth in;cesspool is less than G"below invert or available volume is less than 1/2
day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed
pipe(s). Number of times pumped
-2-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the,high groundwater
elevation.
Any portion of a 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 I 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. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant
threat to public health and safety and the environment because one or,more of the following
conditions exist:
The system is within 400 Feet of a surface drinking water supply:;
The system is within 200 Feet of a tributary to a surface drinking water supply
The system is located in a nitrogen sensitive area Interim Wellhead Protection Area
(IWPA)or a mapped Zone 11 of a public water supply well. sjr
The owner or operator of any such system shall bring the system and facility into full compliance with,the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult.the.local .O r;�
regional office of the Department for further information.
•
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done: ;
✓Pumping information was requested of the owner,occupant,and Board of Health. .
✓None of the system components have been pumped for atleast two weeks and the system.has; ,1
been receiving normal flow rates during that period. Large volumes-of water,have:not.been
introduced into the system recently or as part of this inspection.
r/As-built plans have been obtained and examined. Note if they are not available with N/A.
__4efhe facility or dwelling was.inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
r/All system components,excluding the Soil Absorption System, have been located on site.
riThe septic-tank-manholes were uncovered,opened,and the interior of the:septie tank was to •c.
spected for condition of baffles or tees,material of construction,dimensions,depth of liquid,
` depth of sludge,depth of scum.
I r/The size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
3
Ia$
ill
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(C
ontinued)
(coilimed)
� n n
provided with information o
f/The facility owner(and occupants,if different from owner)were p o
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
RESIDENTIAL*
Bedroom,
Number of Current Residents:
Design Flow: / � allows Number of _ off_
g
Seasonal Use:
r Laundry Connected To System:
Garbage Gnnie . rY
L:i_
Water Meter'Readings,'if a ailable"
Last Date of Occupancy: j/Y'er'I
COMMERCIAL/tNDUSTIZ�iAL:U
Type of Establishment:
Design'Flow: '' `"``' gallons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present::: `
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings, If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information: ",
System Pumped_as part,of inspection: X10 If yes,volume pumped: -gallons /hS Q ►�
Reason for'pumping:,
TYPE OF SYSTEM:
(/Septic TanVDistribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records, if any)
Other(explain):
APPROXIMATE'A E of all` omponents,d te:installed(if kn wn)and source of information:
Sewage odors detected when arriving at the s te:.
-4-
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK:_
Depth below grader Material of Construction: concrete metal -FRP Other
(explain)
Dimisions: ?,S5_ ,A' ,-5-' Sludge Depth: Scum Thickness: /5
Distance from top of sludge to bottom of outlet tee or baMe: 3 $
baffle:from bottom of scum to bottom of outlet tee or bae: z / 1
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation o outlet invert,structural integrity,evidence of leakage,etc.)-I-,[ S
G 60 ..4 c� elm v�
f
GREASE TRAP:
Depth Below Grade: Material of Construction: concrete metal FRP Other.
(explain),,
— — — —
Dimensions: Scunt Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid ,
level in relation to outlet invert, structural integrity,evidence of leakage,etc.)
+4
TIGHT OR HOLDING TANK:
Depth Below Grade: Material of Construction:_conerete_metal_FRP_Other(explain)
Dimensions: Capacity; gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:_Depth of liquid level above outlet invert: leUe /
Comments: (note if level and distribution ' equal, evidence of solids carryover,evidence o leak a a inptt
or gut of box,etcQk �, n lib✓` �i�i-e
PUMP CHAMBER;/(
Pump is in working order:
Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.)
-5-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
(Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive `
methods) If not determined to be present,explain:
Type
Leaching pits,:number Leaching chambers, number: Leaching galleries;number
Leaching trenches,number, length:
Leaching fields, number,dimensions:
Overflow cesspool,number:
Comments: (note condition of soil, signs of hydraulic failure 1 vel of po ng,condition of vegetation }
etc. n k�i
iiFc2Ly
i
mc° ' : sue
CESSPOOLS.:
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(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
_�__/d
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)
ry
-6-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
r�
6
DEPTH TO GROUNDWATER:
Depth to groundwater: Feet
Meth;��&.Deterrnination or Ap roxi ation:
.. 0
-7-
No.P...y-....!.. ..... ..... :..........
THE COMMONWEAL7PH OF MASSACHUSETTS
BOAR® OF HEALTH
I ...?v?:........ .....OF....... .C1�!...M.. ....................
Alipliration for UWposal Works Tonstrnrtlun Vrrmit ,ix f
Application is hereby made for a Permit to Construct ( _)1'or Repair ( ) an Individual Sewage Disposal
�j System at: `.�J �{ .. �d=••W.�C�C�o ��/�"+y.' ...............................
.
V1
Location-Address
c or Lot No.
Owner Address
............................................. .- ...:-_....------------------------...........-•----------
Installer Address
UType of Building l"- Size Lot............................Sq. feet
., Dwelling—No. of Bedrooms..............3........................... A�tic�(�3�js Garbage Grinder PQ)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ..................................
WW Design Flow............... ...................gallons per person per day. Total daily flow--------------�3_.e................gallons.--'
WSeptic Tank—Liquid"capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosin tank ( )
Xj
Percolation Test Results Performed by....b.O.AL....e* .. _ ------:�............... Date.....................................
. `
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ........................ •-•--•---•---•-•-•---••••---------•-••....----••-------•---•--•••-•._...-----••...------••..........•...............................
Descriptionof Soil........................................................................................................................................................................
W
---------------------------------------------------------------------------------------•----------------------------------------------------------...------------------------------------------........
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--------------------------------•--------------...------------------------.....-------••-•-•-----------•---•--------------------------------------------------•----------------••------•...-••••---••--.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health. vv
�g - ..........................
-
""�`--� Date
Application Approved B ......... .... ...2__-y —�
Date
Application Disapproved r the owing reasons----------------------------•------•-----------------•-------------------•-------•--------......................
---•-•-•••••--•...........................•-••----...--------•--•-•---•-•••-•----•....._......-------•--••-•••...........•--•-------•-•-••-••-------•---••--••••-•--•--•-••---••-••••---•-----•.......--
Date
PermitNo......................................................... Issued.•..-----•-----------------•--•-•--•••-•-•-••.........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
y.��.�. .^.. ...._OF.......7��.�:f:.'1..r?-.,�.. ram_ 1a S-
Appliratiun for Uiipuual Forks Tunitrnrtiun thrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
= •-• `:.... ..:`.....�== ` = �•r:---------`------_-----•-----_ ........................ ............... .
Location-Address or Lot No.
..�, rn r.. �...._....._ �..... �:^ (l•I_!L:'? 4.�'a ... ................
�,................_�... __._...
Owner
..........K`� - = r .Ly� ddress
:.._... _._.
M Installer Address
Q7i Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.............._3............................Expansion Attic (ti Garbage Grinder t(� ,)
aOther—Type of Building ____________________________ No. of persons---------------_............ Showers ( ) — Cafeteria ( )
Other fixtures
W Design Flow............... ...................gallons per person per day. Total daily flow---------------�.Q! ...............gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________________ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. r
Z Other Distribution box ( ) Dosing_tank ( )
1.4 Percolation Test Results Performed bY_.__4�__t.t k.(- Xz__-11K...---- --�.n�.................. Date........................................
Test Pit No. 1________________minutes per inch Depth of Test Pit.......... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0 1:4 .-••••••-----•••-•-•--------•••-•-...--•--•---••-••---•--•-••----•..............•--•--......--•••---........................................................
Description of Soil....................................................................................................---------...------••---------------•----••••---.........-•'-•----•-
x
W ........................................................----•-•-------•-----•--••---•-•---•-••-••----•-•---•-••••----••---•••••-••--------------••-•--••---•--•••••-•---....-----'...••-•....--••--••-
w
UNature of Repairs or Alterations—Answer when applicable................................................................................................
••.---••----------------------------------•---------------•---•-----------...------.....-----.....---------•-----------------------...--------•--------------------------------•••-••-•....._...._..__.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
r w
Date
Application Approved
Date
Application Disapprove or ths/fo�owing reasons:........................................................................................................
................•----•---.....---•---•---•--------•------.-------•--•-------•----._..._..--•---------....I---•-••-•---•-•--------------••-•-•----•••••••--------•••••-----•••••-•--•-•••----••---•-•---•-
Date
PermitNo......................................................... Issued.......................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................OF.........
�!+. ?..?.. ..:k:c::: -..�� ................._...........
Trrtifiratr of Tomplitnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (_ ,y or Repaired ( )
byn k��<.::;-� ......... ------------------------------------------------------------------------------------------------------------------------------------
t Installer _
has been installed in accordance with the provisions of T/1,�,;T F 5- fThe State Sanitary Code-,Ss d-4crib d in the
application for Disposal Works Construction Permit N,or_._ "_ �?_________________ dated_ .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE
SYSTEM WILL FUN ION SATISFACTORY.
DATE....2_/_-_!7 ....y�
Inspector----------- --- --------•-------
TF�E COMMONWEALTH OF MASSACHUSETTS
\\ BOARD OF HEALTH
N d.....................••.. _.... FEEr/)................
Disposal 10orkii Tunstrurtiun .erutit
Permission is hereby granted__._.n__ 4._n- ............ f_ >____ _______________
7. -------------•----...----•--•••--......_............-'-_..
to Construct ( xorRepair ( ) an Individual Sewage Disposal System
Street
as shown on the applicati n for Disposal Works Construction Permit No._,. ___________ Dated-_,4__ :_� .................
w mil„_ ✓ ,
DATE. L v �..................................................
Board of Health
a
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RTN 4-26761
18 x', .�'±••nLnw+.+ ..cw,..w'..... .a..wwae:r rlty�e� � s• dl�a' '�'�_'".B" �i �rc-+..w.`M'�^•,r' _ 'S,:, tV, aikd*.e?�'+va
— PROJECT:
AYDE CORP.
' � �` NKLIN, FRANK CORP.
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;�' .,. ,,, � ;».- i°•' ,� r�� ".,��s�+'A 615 TARKILN HILL ROAD-NEW BEDFORD,MA 02745
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TITLE:
7,7.. i.4?°'3 '� ; 1� • 3�° "- -
�. ,. ,'�� . � , r_4 .. � � •c �-,' � •_ � � U �,�� - �d.. � ,•J,1. � � ���:� IMMEDIATE RESPONSE ACTION COMPLETION
- SEE DETAIL 1 -} = ` �„ I - OF BARNSTABLE GIS MAPPING [20 14 AERIAL with PERMANENT SOLUTION STATEMENT
p 1 =� �. � „. H a , TOWN
VIEW] ROUTE 6 EAST OAK STREET BRIDGE
I ,z s31 � t.: �itq..r w, _ I �3 WEST BARNSTABLE,MA 02668
'+ ri gar' i..tts` ..o +�na .y `Yw"l '^-S '� ''� ,r. 7., ,Y.
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AREA OF DEFINED SITE
NOTE: THIS SITE PLAN WAS NOT PREPARED FROM BENNETT ENVIRONMENTAL
RTN 4-2G7G I `,•. ..�P;•. BEA
} ISM
IRAC/PSS NC �ml °x q'= ��' y �.• ANY INSTRUMENT SURVEY AND UNDER NO ASSOCIATES INC.
5 R51AAq, 175' X IO' ( I ,730 SF " � rCIRCUMSTANCESSHOULD THE DISTANCES, BEARING LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,
AND/OR OTHER FEATURES SHOWN BE USED TO GEOLOGISTS,ENGINEERS
1573 MAIN STREET,P.O.BOX 1743,BREWSTER,MA 02631
. : ESTABLISH PROPERTY LINES. ALL LOCATIONS ARE
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s�utl �DATE: SCALE: BY: CHECK: JOB NUMBER:
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9/8/17 As Noted SRF DCB BEA17 11037
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