HomeMy WebLinkAbout2021 Jul 28 - Whitewater Massachusetts Department of Environmental Protection
eDEP Transaction Copy
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Username: EBELAIR
Transaction ID: 1298109
Document: Groundwater Discharge Monitoring Report Forms
Size of File: 427.88K
Status of Transaction: Submitted
Date and Time Created: 7/28/2021:9:06:13 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.
pyuci 0 ?, 2021
HEALTH DEPT:
,
1
uuI COU VI I SGOVui UC I I I` VI Vul ILIYVOIGI 1...IJli11011,C I I J 10111 I. I GI II11111u11I/GI
1L Groundwater Permit
2.Tax identification Number
MONITORING WELL DATA REPORT
2021 QUARTERLY 2 I
3. Sampling Month&Frequency
A. Facility Information
Important:When
filling out forms on 1. Facility name,address:
the computer, use BUCK ISLAND CONDO.
only the tab key to a.Name
move your cursor-
do not use the 481 BUCK ISLAND ROAD
return key. b.Street Address
10. YARMOUTH IMA 102675
c.City d.State e.Zip Code
2. Contact information:
MAI ANDREW WHITTER
a.Name of Facility Contact Person
5087786513 Andy@fpmcapecod.com
b.Telephone Number c.e-mail address
3. Sampling information:
14/27/2021 'RI 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
I Monitoring Well Data Report-2021 Quarterly 2 1
- All forms for submittal have been completed.
2. - This is the last selection.
3. — Delete the selected form.
gdpdls 2015-09-15.doc• rev. 09/15/15 Groundwater Permit Daily Log Sheet• Page 1 of 1
"4 IJUI GQU V1 I SGJVUI.,G I I vLc,LllJl I - VI VUI IUYYQIGI VIJI,I KAI IJ.G I ILI JI 0111 I. I C111111.1141111.001Groundwater Permit
MONITORING WELL DATA REPORT
2•Tax identification Number
'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-10 MW-11 MW-12 MW-8 MW-9
Units Well#: 1 Well#: 2 Well#: 3 Well#:4 Well#: 5 Well#:6
NITRATE-N 2.1 2.8 0.83 ND ND
MG/L
TOTAL NITROGEN(NO3+NO2+TK 12.1 3.4 1.35 ND ND
MG/L
mwdgwp-blank.doc•rev. 09/15/15 Monitoring Well Data for Groundwater Permit• Page 1 of 1
/ P1 ✓U I OC1U VI I VG I I VIGIJIIIJI I- VI VUI IV VYQ1.01 V I ICU VG I I CAI I I I. I Cl IIII,1YUI 114G1
~ Groundwater Permit
•
° 2.Tax identification Number
Facility Information
Important:When
BUCK ISLAND CONDO.
filling out forms on
a.Name
the computer, use
only the tab key to 1481 BUCK ISLAND ROAD
move your cursor b. Street Address
do not use the 'YARMOUTH MA 02675
return key. c.City d.State e.Zip Code
ti
titOrqb
Certification
"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.
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 sinificant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations."
'ELIZABETH BELAIR 17/27/2021
Any person signing a.Signature b.Date(mm/dd/yyyy)
a document under
314 CMR 5.14(1)or
(2)shall make the Re r ortinPacka•e Comments
following QUARTERLY WELL LAB WAS NEVER RECEIVED ON TIME TO SUBMIT AND WAS OMITTED
certification FROM THE APRIL 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