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HomeMy WebLinkAbout2021Aug - eDEP 7 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: EBELAIR Transaction ID: 1298388 Document: Groundwater Discharge Monitoring Report Forms Size of File: 573.65K Status of Transaction: Submitted Date and Time Created: 8/2/2021:12:39:37 PM 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. r___ AUG 0 5 2021 HEALTH DEPT. a ✓ul GQu VI I\G./VUI I,G I I VLGUlllA I- VI VuI MI WYQIGI VW\..1 ICIIyG I I VW 0111 I. r 6111111 I UI IIVGI IL Groundwater Permit I.,47,,,,,,..., MONITORING WELL DATA REPORT 2.Tax identification Number 2021 QUARTERLY 2 3. Sampling Month&Frequency A. Facility Information Important:When filling out forms on 1. Facility name,address: the computer, use IMAYFLOWER PLACE only the tab key to a.Name move your cursor do not use the 1579 BUCK ISLAND ROAD return key. b.Street Address YARMOUTH 1MA 102673 Vrat 1:1 c.City d.State e.Zip Code 2. Contact information: 'wait MARK WEINBERGER a.Name of Facility Contact Person 2035574777 mweinberger©maplewoodsl.com b.Telephone Number c.e-mail address 3. Sampling information: 16/29/2021 IRI ANALYTICAL a.Date Sampled(mm/dd/yyyy) b.Laboratory Name NICOLE SKYLESON c.Analysis Performed By(Name) B. Form Selection 1. Please select Form Type and Sampling Month &Frequency 1 Monitoring Well Data Report-2021 Quarterly 2 ,0 7 All forms for submittal have been completed. 2. - This is the last selection. 3. CDelete the selected form. Groundwater Permit Daily Log Sheet• Page 1 of 1 gdpdls 2015 09-15.doc• rev. 09/15/15 1-,u1 COLI vi IN.co%/ul,,C I ItC LlvI I- VI%./UIIIJVvaLGI vw.,i ICI I I vyi ani I. I GI nnt I lull iuci Groundwater Permit1111111111111111111111.11111111 MONITORING WELL DATA REPORT 2.Tax identification Number 12021 QUARTERLY 2 1 • 3. Sampling Month&Frequency • C. Contaminant Analysis Information • For"0", below detection limit, less than (<)value, or not detected, enter"ND" < • TNTC=too numerous to count. (Fecal results only) • NS = Not Sampled • DRY= Not enough water in well to sample. Parameter/Contaminant MW-1 MW-2 MW-3D MW-3M MW-3S MW-4D Units Well#: 1 Well#: 2 Well#: 3 Well#:4 Well#: 5 Well#:6 NITRATE-N ND ND ND ND ND IND MG/L TOTAL NITROGEN(NO3+NO2+TK ND (ND ND ND ND ND MG/L TOTAL PHOSPHORUS AS P 0.41 0.058 0.013 ND 0.026 0.028 MG/L ORTHO PHOSPHATE ND 1 I ND ND ND ND ND MG/L mwdgwp-blank.doc•rev. 09/15/15 Monitoring Well Data for Groundwater Permit• Page 1 of 1 ✓UI GQu VI ISVOVu1 VV 1 IVICVUVII- VI VU11u YYOlcI VIJVI ICI yc 1 1 VW QIII I. r Cl lllll IlullluCl Groundwater Permit IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ' 2. Tax identification Number iL: MONITORING WELL DATA REPORT 2021 QUARTERLY 2 3. Sampling Month &Frequency C. Contaminant Analysis Information • For"0", below detection limit, less than (<)value, or not detected, enter"ND" < • TNTC=too numerous to count. (Fecal results only) • NS = Not Sampled • DRY= Not enough water in well to sample. Parameter/Contaminant MW-4M MW-4S MW-5 MW-6 MW-8D MW-8S Units Well#: 1 Well#:2 Well#: 3 Well#:4 Well#: 5 Well#:6 NITRATE-N ND ' ND ND 0.050 ND ND MG/L TOTAL NITROGEN(NO3+NO2+TK `ND j ND ND ND ND ND MG/L TOTAL PHOSPHORUS AS P IND 10.050 0.050 0.051 ND 0.17 MG/L ORTHO PHOSPHATE P ND ND ND ND ND ND MG/L mwdgwp-blank.doc• rev. 09/15/15 Monitoring Well Data for Groundwater Permit• Page 1 of 1 1 LI,,,,,,' i 1-,LAI GPU VI I\GJVUI VG I I VIGVIIVI I- VI V4114 YY CILLI ✓IJl.r11011,G I I V\,.I QI I I I I. I GI II Ill IYUIIIUGI Groundwater Permit , 2.Tax identification Number • Facility Information_ Important:When 'MAYFLOWER PLACE filling out forms on a.Name the computer, use 1 only the tab key to 1579 BUCK ISLAND ROAD move your cursor- b. Street Address do not use the 'YARMOUTH IMA 102673 return key. c.City d.State e.Zip Code Certification AMII � "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. I AI Based on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate and complete. I am aware that the are significant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations." ELIZABETH BELAIR 7/28/2021 Any person signing a.Signature b.Date(mm/dd/yyyy) a document under 314 CMR 5.14(1)or (2)shall make the Re s ortin' Packa'e Comments following QUARETRLY WELL LAB WAS NOT RECIVED ON TIME TO SUMBIT AND WAS OMMITTED FROM certification THE JUNE DMR. If you are filing electronic-ally and want to attach additional comments, select the check box. r gdpdls 2015-09-15.doc• rev. 09/15/15 Groundwater Permit• Page 1 of 1