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1387877
7/18/2022:2:23:16 PM
893.80K
DAVIDBENNETT
BWSC105 Immediate Response Action Transmittal Form
Submitted
A. SITE LOCATION:
1. Release Name/Location Aid:HOME HEATING OIL SPILL
2. Street Address:24 CHARLES STREET
3. City/Town:YARMOUTH 4. Zip Code:026640000
5. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.01100114.
a. CERCLA b. HSWA Corrective Action c. Solid Waste Management
d. RCRA State Program (21C Facilities)
B. THIS FORM IS BEING USED TO: (check all that apply)
1. List Submittal Date of Initial IRA Written Plan (if previously submitted):11/8/2021
2. Submit an Initial IRA Plan.
3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.
4. Submit an Imminent Hazard Evaluation . (check one)
a. An Imminent Hazard exists in connection with this Release or Threat of Release.
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.
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.
5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard.
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)i. Initial Report ii. Interim Report iii. Final Report
b. Frequency of Submittal: (check all that apply)
i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard.
ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration.
iii. A Remedial Monitoring Report(s) submitted every six months, concurrent with an IRA Status Report.
iv. A Remedial Monitoring Report(s) submitted annually, concurrent with an IRA Status Report.
c. Number of Remedial Systems and/or Monitoring Programs:2
A separate BWSC105A, IRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Program
addressed by this transmittal form.
8. Submit an IRA Completion Statement.
a. Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as part
of the Response Actions planned or ongoing at a Site that has already been Tier Classified under a different Release Tracking Number
(RTN)
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.
9. Submit a Revised IRA Completion Statement.
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)a. Paved Surface b. Basement c. School
d. Public Water Supply e. Surface Water f. Zone 2 g. Private Well h. Residence i. Soil
j. Groundwater k. Sediments l. Wetland m. Storm Drain n. Indoor Air o. Air
p. Soil Gas q. SubSlab Soil Gas r. Critical Exposure Pathway s. NAPL t. Unknown
r. Others Specify:CEP ELIMINATED DWELLING VACANT 1/6/22
2. Sources of the Release or TOR: (check all that apply)a. Transformer b. Fuel Tank c. Pipe
d. OHM Delivery e. AST f. Drums g. Tanker Truck h. Hose i. Line
j. UST Describe:k. Vehicle l. Boat/Vessel
m. Unknown n.Other:SUBSLAB FUEL LINE
3. Type of Release or TOR: (check all that apply)a. Dumping b. Fire c. AST Removal d. Overfill
e. Rupture f. Vehicle Accident g. Leak h. Spill i. Test failure j. TOR Only
k. UST Removal Describe:
l. Unknown m.Other:
4. Identify Oils and Hazardous Materials Released: (check all that apply)a. Oils b. Chlorinated Solvents
c. Heavy Metals d.Others Specify:200 GAL VIRGIN FUEL OIL
D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply, for volumes list cumulative amounts)
1. Assessment and/or Monitoring Only 2. Temporary Covers or Caps
3. Deployment of Absorbent or Containment Materials 4. Temporary Water Supplies
5. Structure Venting System/HVAC Modification System 6. Temporary Evacuation or Relocation of Residents
7. Product or NAPL Recovery 8. Fencing and Sign Posting
9. Groundwater Treatment Systems 10. Soil Vapor Extraction
11. Remedial Additives 12. Air Sparging
13. Active Exposure Pathway Mitigation System 14. Passive Exposure Pathway Mitigation System
D. DESCRIPTION OF RESPONSE ACTIONS: (cont.)
15. Excavation of Contaminated Soils.
a. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yards
ii. Off Site Estimated volume in cubic yards 117
iia. Receiving Facility:ONDRICK MATERIALS (17 JAN 2021)Town:CHICOPEE State:MA
iib. Receiving Facility:ONDRICK MATERIALS (100 MARCH 20 Town:CHICOPEE State:MA
iii. Describe:UNDER INITIAL IRAP (JAN 2021) AND IRA MOD (MARCH 2022)
b. Store 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:
c. Landfill i. Cover Estimated volume in cubic yards
Receiving Facility:Town:State:
ii. Disposal Estimated volume in cubic yards
Receiving Facility:Town:State:
16. Removal of Drums, Tanks, or Containers:
a. Describe Quantity and Amount:8 DRUMS OILY SAND AND 1 DRUM LNAPL/OILY WATER
b. Receiving Facility:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OH
c. Receiving Facility:Town:State:
17. Removal of Other Contaminated Media:
a. Specify Type and Volume:VACTRUCK RECOVERY OF LNAPL/OILY WATER 258 GALLONS TRADEBE AUG 2021 AND OCTOBER 2021
18. Other Response Actions:
Describe:PILOTING SSDS FOR AEPMS SHUTDOWN 1/6/2022 ON HOUSE MOVE AND FOUNDATION DEMOLITION IRA MOD
19. Use of Innovative Technologies:
Describe:2720 LBS REGENOX FOR CHEMICAL OXIDATION TREATMENT OF RESIDUAL GROUNDWATER IMPACTS MARCH 2022
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
subject 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:5087377450 5. Ext:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 (mm/dd/yyyy)9. LSP Stamp:
F. PERSON UNDERTAKING IRA:
1. Check all that apply:a. change in contact name b. change of address c. change in the person undertaking response
actions
2. Name of Organization:AMY MACISAAC REVOCABLE TRUST
3. Contact First Name:AMY 4. Last Name:MACISAAC
5. Street:24 CHARLES ST 6. Title:
7. City/Town:SOUTH YARMOUTH 8. State:MA 9. Zip Code:026640000
10. Telephone:11. Ext:12. Email:
G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify Relationship:
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. 5(j))
4. Any Other Person Undertaking Response Actions:Specify Relationship:
H. REQUIRED ATTACHMENT AND SUBMITTALS:
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.
a. A Release Abatement Measure (RAM) Plan (BWSC106)b. 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.
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.
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 nonupdatable information provided on this form is incorrect, e.g. Release Address/Location Aid. Send corrections
to BWSC.eDEP@state.ma.us.
6. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
I. CERTIFICATION OF PERSON UNDERTAKING IRA:
1. I,AMY MACISAAC , 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:AMY MACISAAC 3. Title:
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022 (mm/dd/yyyy)
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
7/18/2022 1:56:02 PM
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form
Pursuant to 310 CMR 40.0424 40.0427 (Subpart D)
BWSC 105
Release Tracking Number
4 28586
Revised: 11/14/2013 Page 1 of 6
Revised: 11/14/2013 Page 2 of 6
Revised: 11/14/2013 Page 3 of 6
Revised: 11/14/2013 Page 4 of 6
Revised: 11/14/2013 Page 5 of 6
Revised: 11/14/2013 Page 6 of 6
A. SITE LOCATION:1. Release Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. Zip Code:0266400005. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.01100114.a. CERCLA b. HSWA Corrective Action c. Solid Waste Managementd. RCRA State Program (21C Facilities)B. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of Initial IRA Written Plan (if previously submitted):11/8/20212. Submit an Initial IRA Plan.3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.4. Submit an Imminent Hazard Evaluation . (check one)a. An Imminent Hazard exists in connection with this Release or Threat of Release.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 assessmentactivities will be undertaken.d. It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release. However, response actionswill address those conditions that could pose an Imminent Hazard.5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard.6. Submit an IRA Status Report7. Submit a Remedial Monitoring Report. (This report can only be submitted through eDEP.)a. Type of Report: (check one)i. Initial Report ii. Interim Report iii. Final Reportb. Frequency of Submittal: (check all that apply)i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard.ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration.iii. A Remedial Monitoring Report(s) submitted every six months, concurrent with an IRA Status Report.iv. A Remedial Monitoring Report(s) submitted annually, concurrent with an IRA Status Report.c. Number of Remedial Systems and/or Monitoring Programs:2A separate BWSC105A, IRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Program
addressed by this transmittal form.
8. Submit an IRA Completion Statement.
a. Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as part
of the Response Actions planned or ongoing at a Site that has already been Tier Classified under a different Release Tracking Number
(RTN)
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.
9. Submit a Revised IRA Completion Statement.
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)a. Paved Surface b. Basement c. School
d. Public Water Supply e. Surface Water f. Zone 2 g. Private Well h. Residence i. Soil
j. Groundwater k. Sediments l. Wetland m. Storm Drain n. Indoor Air o. Air
p. Soil Gas q. SubSlab Soil Gas r. Critical Exposure Pathway s. NAPL t. Unknown
r. Others Specify:CEP ELIMINATED DWELLING VACANT 1/6/22
2. Sources of the Release or TOR: (check all that apply)a. Transformer b. Fuel Tank c. Pipe
d. OHM Delivery e. AST f. Drums g. Tanker Truck h. Hose i. Line
j. UST Describe:k. Vehicle l. Boat/Vessel
m. Unknown n.Other:SUBSLAB FUEL LINE
3. Type of Release or TOR: (check all that apply)a. Dumping b. Fire c. AST Removal d. Overfill
e. Rupture f. Vehicle Accident g. Leak h. Spill i. Test failure j. TOR Only
k. UST Removal Describe:
l. Unknown m.Other:
4. Identify Oils and Hazardous Materials Released: (check all that apply)a. Oils b. Chlorinated Solvents
c. Heavy Metals d.Others Specify:200 GAL VIRGIN FUEL OIL
D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply, for volumes list cumulative amounts)
1. Assessment and/or Monitoring Only 2. Temporary Covers or Caps
3. Deployment of Absorbent or Containment Materials 4. Temporary Water Supplies
5. Structure Venting System/HVAC Modification System 6. Temporary Evacuation or Relocation of Residents
7. Product or NAPL Recovery 8. Fencing and Sign Posting
9. Groundwater Treatment Systems 10. Soil Vapor Extraction
11. Remedial Additives 12. Air Sparging
13. Active Exposure Pathway Mitigation System 14. Passive Exposure Pathway Mitigation System
D. DESCRIPTION OF RESPONSE ACTIONS: (cont.)
15. Excavation of Contaminated Soils.
a. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yards
ii. Off Site Estimated volume in cubic yards 117
iia. Receiving Facility:ONDRICK MATERIALS (17 JAN 2021)Town:CHICOPEE State:MA
iib. Receiving Facility:ONDRICK MATERIALS (100 MARCH 20 Town:CHICOPEE State:MA
iii. Describe:UNDER INITIAL IRAP (JAN 2021) AND IRA MOD (MARCH 2022)
b. Store 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:
c. Landfill i. Cover Estimated volume in cubic yards
Receiving Facility:Town:State:
ii. Disposal Estimated volume in cubic yards
Receiving Facility:Town:State:
16. Removal of Drums, Tanks, or Containers:
a. Describe Quantity and Amount:8 DRUMS OILY SAND AND 1 DRUM LNAPL/OILY WATER
b. Receiving Facility:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OH
c. Receiving Facility:Town:State:
17. Removal of Other Contaminated Media:
a. Specify Type and Volume:VACTRUCK RECOVERY OF LNAPL/OILY WATER 258 GALLONS TRADEBE AUG 2021 AND OCTOBER 2021
18. Other Response Actions:
Describe:PILOTING SSDS FOR AEPMS SHUTDOWN 1/6/2022 ON HOUSE MOVE AND FOUNDATION DEMOLITION IRA MOD
19. Use of Innovative Technologies:
Describe:2720 LBS REGENOX FOR CHEMICAL OXIDATION TREATMENT OF RESIDUAL GROUNDWATER IMPACTS MARCH 2022
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
subject 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:5087377450 5. Ext:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 (mm/dd/yyyy)9. LSP Stamp:
F. PERSON UNDERTAKING IRA:
1. Check all that apply:a. change in contact name b. change of address c. change in the person undertaking response
actions
2. Name of Organization:AMY MACISAAC REVOCABLE TRUST
3. Contact First Name:AMY 4. Last Name:MACISAAC
5. Street:24 CHARLES ST 6. Title:
7. City/Town:SOUTH YARMOUTH 8. State:MA 9. Zip Code:026640000
10. Telephone:11. Ext:12. Email:
G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify Relationship:
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. 5(j))
4. Any Other Person Undertaking Response Actions:Specify Relationship:
H. REQUIRED ATTACHMENT AND SUBMITTALS:
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.
a. A Release Abatement Measure (RAM) Plan (BWSC106)b. 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.
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.
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 nonupdatable information provided on this form is incorrect, e.g. Release Address/Location Aid. Send corrections
to BWSC.eDEP@state.ma.us.
6. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
I. CERTIFICATION OF PERSON UNDERTAKING IRA:
1. I,AMY MACISAAC , 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:AMY MACISAAC 3. Title:
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022 (mm/dd/yyyy)
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
7/18/2022 1:56:02 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupImmediate Response Action (IRA) Transmittal FormPursuant to 310 CMR 40.0424 40.0427 (Subpart D)BWSC 105Release Tracking Number428586
Revised: 11/14/2013 Page 1 of 6
Revised: 11/14/2013 Page 2 of 6
Revised: 11/14/2013 Page 3 of 6
Revised: 11/14/2013 Page 4 of 6
Revised: 11/14/2013 Page 5 of 6
Revised: 11/14/2013 Page 6 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form
Pursuant to 310 CMR 40.0424 40.0427 (Subpart D)
BWSC 105
Release Tracking Number
4 28586
A. SITE LOCATION:1. Release Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. Zip Code:0266400005. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.01100114.a. CERCLA b. HSWA Corrective Action c. Solid Waste Managementd. RCRA State Program (21C Facilities)B. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of Initial IRA Written Plan (if previously submitted):11/8/20212. Submit an Initial IRA Plan.3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.4. Submit an Imminent Hazard Evaluation . (check one)a. An Imminent Hazard exists in connection with this Release or Threat of Release.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 assessmentactivities will be undertaken.d. It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release. However, response actionswill address those conditions that could pose an Imminent Hazard.5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard.6. Submit an IRA Status Report7. Submit a Remedial Monitoring Report. (This report can only be submitted through eDEP.)a. Type of Report: (check one)i. Initial Report ii. Interim Report iii. Final Reportb. Frequency of Submittal: (check all that apply)i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard.ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration.iii. A Remedial Monitoring Report(s) submitted every six months, concurrent with an IRA Status Report.iv. A Remedial Monitoring Report(s) submitted annually, concurrent with an IRA Status Report.c. Number of Remedial Systems and/or Monitoring Programs:2A separate BWSC105A, IRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Programaddressed by this transmittal form.8. Submit an IRA Completion Statement.a. Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as partof the Response Actions planned or ongoing at a Site that has already been Tier Classified under a different Release Tracking Number(RTN)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 whenmaking all future submittals for the site unless specifically relating to this Immediate Response Action.9. Submit a Revised IRA Completion Statement.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)a. Paved Surface b. Basement c. Schoold. Public Water Supply e. Surface Water f. Zone 2 g. Private Well h. Residence i. Soilj. Groundwater k. Sediments l. Wetland m. Storm Drain n. Indoor Air o. Airp. Soil Gas q. SubSlab Soil Gas r. Critical Exposure Pathway s. NAPL t. Unknownr. Others Specify:CEP ELIMINATED DWELLING VACANT 1/6/222. Sources of the Release or TOR: (check all that apply)a. Transformer b. Fuel Tank c. Piped. OHM Delivery e. AST f. Drums g. Tanker Truck h. Hose i. Linej. UST Describe:k. Vehicle l. Boat/Vesselm. Unknown n.Other:SUBSLAB FUEL LINE3. Type of Release or TOR: (check all that apply)a. Dumping b. Fire c. AST Removal d. Overfille. Rupture f. Vehicle Accident g. Leak h. Spill i. Test failure j. TOR Onlyk. UST Removal Describe:l. Unknown m.Other:4. Identify Oils and Hazardous Materials Released: (check all that apply)a. Oils b. Chlorinated Solventsc. Heavy Metals d.Others Specify:200 GAL VIRGIN FUEL OILD. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply, for volumes list cumulative amounts)1. Assessment and/or Monitoring Only 2. Temporary Covers or Caps3. Deployment of Absorbent or Containment Materials 4. Temporary Water Supplies5. Structure Venting System/HVAC Modification System 6. Temporary Evacuation or Relocation of Residents7. Product or NAPL Recovery 8. Fencing and Sign Posting
9. Groundwater Treatment Systems 10. Soil Vapor Extraction
11. Remedial Additives 12. Air Sparging
13. Active Exposure Pathway Mitigation System 14. Passive Exposure Pathway Mitigation System
D. DESCRIPTION OF RESPONSE ACTIONS: (cont.)
15. Excavation of Contaminated Soils.
a. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yards
ii. Off Site Estimated volume in cubic yards 117
iia. Receiving Facility:ONDRICK MATERIALS (17 JAN 2021)Town:CHICOPEE State:MA
iib. Receiving Facility:ONDRICK MATERIALS (100 MARCH 20 Town:CHICOPEE State:MA
iii. Describe:UNDER INITIAL IRAP (JAN 2021) AND IRA MOD (MARCH 2022)
b. Store 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:
c. Landfill i. Cover Estimated volume in cubic yards
Receiving Facility:Town:State:
ii. Disposal Estimated volume in cubic yards
Receiving Facility:Town:State:
16. Removal of Drums, Tanks, or Containers:
a. Describe Quantity and Amount:8 DRUMS OILY SAND AND 1 DRUM LNAPL/OILY WATER
b. Receiving Facility:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OH
c. Receiving Facility:Town:State:
17. Removal of Other Contaminated Media:
a. Specify Type and Volume:VACTRUCK RECOVERY OF LNAPL/OILY WATER 258 GALLONS TRADEBE AUG 2021 AND OCTOBER 2021
18. Other Response Actions:
Describe:PILOTING SSDS FOR AEPMS SHUTDOWN 1/6/2022 ON HOUSE MOVE AND FOUNDATION DEMOLITION IRA MOD
19. Use of Innovative Technologies:
Describe:2720 LBS REGENOX FOR CHEMICAL OXIDATION TREATMENT OF RESIDUAL GROUNDWATER IMPACTS MARCH 2022
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
subject 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:5087377450 5. Ext:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 (mm/dd/yyyy)9. LSP Stamp:
F. PERSON UNDERTAKING IRA:
1. Check all that apply:a. change in contact name b. change of address c. change in the person undertaking response
actions
2. Name of Organization:AMY MACISAAC REVOCABLE TRUST
3. Contact First Name:AMY 4. Last Name:MACISAAC
5. Street:24 CHARLES ST 6. Title:
7. City/Town:SOUTH YARMOUTH 8. State:MA 9. Zip Code:026640000
10. Telephone:11. Ext:12. Email:
G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify Relationship:
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. 5(j))
4. Any Other Person Undertaking Response Actions:Specify Relationship:
H. REQUIRED ATTACHMENT AND SUBMITTALS:
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.
a. A Release Abatement Measure (RAM) Plan (BWSC106)b. 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.
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.
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 nonupdatable information provided on this form is incorrect, e.g. Release Address/Location Aid. Send corrections
to BWSC.eDEP@state.ma.us.
6. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
I. CERTIFICATION OF PERSON UNDERTAKING IRA:
1. I,AMY MACISAAC , 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:AMY MACISAAC 3. Title:
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022 (mm/dd/yyyy)
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
7/18/2022 1:56:02 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupImmediate Response Action (IRA) Transmittal FormPursuant to 310 CMR 40.0424 40.0427 (Subpart D)BWSC 105Release Tracking Number428586Revised: 11/14/2013 Page 1 of 6
Revised: 11/14/2013 Page 2 of 6
Revised: 11/14/2013 Page 3 of 6
Revised: 11/14/2013 Page 4 of 6
Revised: 11/14/2013 Page 5 of 6
Revised: 11/14/2013 Page 6 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form
Pursuant to 310 CMR 40.0424 40.0427 (Subpart D)
BWSC 105
Release Tracking Number
4 28586
A. SITE LOCATION:1. Release Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. Zip Code:0266400005. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.01100114.a. CERCLA b. HSWA Corrective Action c. Solid Waste Managementd. RCRA State Program (21C Facilities)B. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of Initial IRA Written Plan (if previously submitted):11/8/20212. Submit an Initial IRA Plan.3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.4. Submit an Imminent Hazard Evaluation . (check one)a. An Imminent Hazard exists in connection with this Release or Threat of Release.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 assessmentactivities will be undertaken.d. It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release. However, response actionswill address those conditions that could pose an Imminent Hazard.5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard.6. Submit an IRA Status Report7. Submit a Remedial Monitoring Report. (This report can only be submitted through eDEP.)a. Type of Report: (check one)i. Initial Report ii. Interim Report iii. Final Reportb. Frequency of Submittal: (check all that apply)i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard.ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration.iii. A Remedial Monitoring Report(s) submitted every six months, concurrent with an IRA Status Report.iv. A Remedial Monitoring Report(s) submitted annually, concurrent with an IRA Status Report.c. Number of Remedial Systems and/or Monitoring Programs:2A separate BWSC105A, IRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Programaddressed by this transmittal form.8. Submit an IRA Completion Statement.a. Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as partof the Response Actions planned or ongoing at a Site that has already been Tier Classified under a different Release Tracking Number(RTN)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 whenmaking all future submittals for the site unless specifically relating to this Immediate Response Action.9. Submit a Revised IRA Completion Statement.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)a. Paved Surface b. Basement c. Schoold. Public Water Supply e. Surface Water f. Zone 2 g. Private Well h. Residence i. Soilj. Groundwater k. Sediments l. Wetland m. Storm Drain n. Indoor Air o. Airp. Soil Gas q. SubSlab Soil Gas r. Critical Exposure Pathway s. NAPL t. Unknownr. Others Specify:CEP ELIMINATED DWELLING VACANT 1/6/222. Sources of the Release or TOR: (check all that apply)a. Transformer b. Fuel Tank c. Piped. OHM Delivery e. AST f. Drums g. Tanker Truck h. Hose i. Linej. UST Describe:k. Vehicle l. Boat/Vesselm. Unknown n.Other:SUBSLAB FUEL LINE3. Type of Release or TOR: (check all that apply)a. Dumping b. Fire c. AST Removal d. Overfille. Rupture f. Vehicle Accident g. Leak h. Spill i. Test failure j. TOR Onlyk. UST Removal Describe:l. Unknown m.Other:4. Identify Oils and Hazardous Materials Released: (check all that apply)a. Oils b. Chlorinated Solventsc. Heavy Metals d.Others Specify:200 GAL VIRGIN FUEL OILD. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply, for volumes list cumulative amounts)1. Assessment and/or Monitoring Only 2. Temporary Covers or Caps3. Deployment of Absorbent or Containment Materials 4. Temporary Water Supplies5. Structure Venting System/HVAC Modification System 6. Temporary Evacuation or Relocation of Residents7. Product or NAPL Recovery 8. Fencing and Sign Posting9. Groundwater Treatment Systems 10. Soil Vapor Extraction11. Remedial Additives 12. Air Sparging13. Active Exposure Pathway Mitigation System 14. Passive Exposure Pathway Mitigation SystemD. DESCRIPTION OF RESPONSE ACTIONS: (cont.)15. Excavation of Contaminated Soils.a. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Receiving Facility:ONDRICK MATERIALS (17 JAN 2021)Town:CHICOPEE State:MAiib. Receiving Facility:ONDRICK MATERIALS (100 MARCH 20 Town:CHICOPEE State:MAiii. Describe:UNDER INITIAL IRAP (JAN 2021) AND IRA MOD (MARCH 2022)b. Store i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yardsiia. Receiving Facility:Town:State:iib. Receiving Facility:Town:State:c. Landfill i. Cover Estimated volume in cubic yardsReceiving Facility:Town:State:ii. Disposal Estimated volume in cubic yardsReceiving Facility:Town:State:16. Removal of Drums, Tanks, or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SAND AND 1 DRUM LNAPL/OILY WATERb. Receiving Facility:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Receiving Facility:Town:State:17. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF LNAPL/OILY WATER 258 GALLONS TRADEBE AUG 2021 AND OCTOBER 202118. Other Response Actions:Describe:PILOTING SSDS FOR AEPMS SHUTDOWN 1/6/2022 ON HOUSE MOVE AND FOUNDATION DEMOLITION IRA MOD19. Use of Innovative Technologies:Describe:2720 LBS REGENOX FOR CHEMICAL OXIDATION TREATMENT OF RESIDUAL GROUNDWATER IMPACTS MARCH 2022
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
subject 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:5087377450 5. Ext:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 (mm/dd/yyyy)9. LSP Stamp:
F. PERSON UNDERTAKING IRA:
1. Check all that apply:a. change in contact name b. change of address c. change in the person undertaking response
actions
2. Name of Organization:AMY MACISAAC REVOCABLE TRUST
3. Contact First Name:AMY 4. Last Name:MACISAAC
5. Street:24 CHARLES ST 6. Title:
7. City/Town:SOUTH YARMOUTH 8. State:MA 9. Zip Code:026640000
10. Telephone:11. Ext:12. Email:
G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify Relationship:
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. 5(j))
4. Any Other Person Undertaking Response Actions:Specify Relationship:
H. REQUIRED ATTACHMENT AND SUBMITTALS:
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.
a. A Release Abatement Measure (RAM) Plan (BWSC106)b. 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.
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.
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 nonupdatable information provided on this form is incorrect, e.g. Release Address/Location Aid. Send corrections
to BWSC.eDEP@state.ma.us.
6. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
I. CERTIFICATION OF PERSON UNDERTAKING IRA:
1. I,AMY MACISAAC , 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:AMY MACISAAC 3. Title:
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022 (mm/dd/yyyy)
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
7/18/2022 1:56:02 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupImmediate Response Action (IRA) Transmittal FormPursuant to 310 CMR 40.0424 40.0427 (Subpart D)BWSC 105Release Tracking Number428586Revised: 11/14/2013 Page 1 of 6Revised: 11/14/2013 Page 2 of 6
Revised: 11/14/2013 Page 3 of 6
Revised: 11/14/2013 Page 4 of 6
Revised: 11/14/2013 Page 5 of 6
Revised: 11/14/2013 Page 6 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form
Pursuant to 310 CMR 40.0424 40.0427 (Subpart D)
BWSC 105
Release Tracking Number
4 28586
A. SITE LOCATION:1. Release Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. Zip Code:0266400005. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.01100114.a. CERCLA b. HSWA Corrective Action c. Solid Waste Managementd. RCRA State Program (21C Facilities)B. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of Initial IRA Written Plan (if previously submitted):11/8/20212. Submit an Initial IRA Plan.3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.4. Submit an Imminent Hazard Evaluation . (check one)a. An Imminent Hazard exists in connection with this Release or Threat of Release.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 assessmentactivities will be undertaken.d. It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release. However, response actionswill address those conditions that could pose an Imminent Hazard.5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard.6. Submit an IRA Status Report7. Submit a Remedial Monitoring Report. (This report can only be submitted through eDEP.)a. Type of Report: (check one)i. Initial Report ii. Interim Report iii. Final Reportb. Frequency of Submittal: (check all that apply)i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard.ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration.iii. A Remedial Monitoring Report(s) submitted every six months, concurrent with an IRA Status Report.iv. A Remedial Monitoring Report(s) submitted annually, concurrent with an IRA Status Report.c. Number of Remedial Systems and/or Monitoring Programs:2A separate BWSC105A, IRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Programaddressed by this transmittal form.8. Submit an IRA Completion Statement.a. Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as partof the Response Actions planned or ongoing at a Site that has already been Tier Classified under a different Release Tracking Number(RTN)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 whenmaking all future submittals for the site unless specifically relating to this Immediate Response Action.9. Submit a Revised IRA Completion Statement.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)a. Paved Surface b. Basement c. Schoold. Public Water Supply e. Surface Water f. Zone 2 g. Private Well h. Residence i. Soilj. Groundwater k. Sediments l. Wetland m. Storm Drain n. Indoor Air o. Airp. Soil Gas q. SubSlab Soil Gas r. Critical Exposure Pathway s. NAPL t. Unknownr. Others Specify:CEP ELIMINATED DWELLING VACANT 1/6/222. Sources of the Release or TOR: (check all that apply)a. Transformer b. Fuel Tank c. Piped. OHM Delivery e. AST f. Drums g. Tanker Truck h. Hose i. Linej. UST Describe:k. Vehicle l. Boat/Vesselm. Unknown n.Other:SUBSLAB FUEL LINE3. Type of Release or TOR: (check all that apply)a. Dumping b. Fire c. AST Removal d. Overfille. Rupture f. Vehicle Accident g. Leak h. Spill i. Test failure j. TOR Onlyk. UST Removal Describe:l. Unknown m.Other:4. Identify Oils and Hazardous Materials Released: (check all that apply)a. Oils b. Chlorinated Solventsc. Heavy Metals d.Others Specify:200 GAL VIRGIN FUEL OILD. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply, for volumes list cumulative amounts)1. Assessment and/or Monitoring Only 2. Temporary Covers or Caps3. Deployment of Absorbent or Containment Materials 4. Temporary Water Supplies5. Structure Venting System/HVAC Modification System 6. Temporary Evacuation or Relocation of Residents7. Product or NAPL Recovery 8. Fencing and Sign Posting9. Groundwater Treatment Systems 10. Soil Vapor Extraction11. Remedial Additives 12. Air Sparging13. Active Exposure Pathway Mitigation System 14. Passive Exposure Pathway Mitigation SystemD. DESCRIPTION OF RESPONSE ACTIONS: (cont.)15. Excavation of Contaminated Soils.a. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Receiving Facility:ONDRICK MATERIALS (17 JAN 2021)Town:CHICOPEE State:MAiib. Receiving Facility:ONDRICK MATERIALS (100 MARCH 20 Town:CHICOPEE State:MAiii. Describe:UNDER INITIAL IRAP (JAN 2021) AND IRA MOD (MARCH 2022)b. Store i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yardsiia. Receiving Facility:Town:State:iib. Receiving Facility:Town:State:c. Landfill i. Cover Estimated volume in cubic yardsReceiving Facility:Town:State:ii. Disposal Estimated volume in cubic yardsReceiving Facility:Town:State:16. Removal of Drums, Tanks, or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SAND AND 1 DRUM LNAPL/OILY WATERb. Receiving Facility:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Receiving Facility:Town:State:17. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF LNAPL/OILY WATER 258 GALLONS TRADEBE AUG 2021 AND OCTOBER 202118. Other Response Actions:Describe:PILOTING SSDS FOR AEPMS SHUTDOWN 1/6/2022 ON HOUSE MOVE AND FOUNDATION DEMOLITION IRA MOD19. Use of Innovative Technologies:Describe:2720 LBS REGENOX FOR CHEMICAL OXIDATION TREATMENT OF RESIDUAL GROUNDWATER IMPACTS MARCH 2022E. 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 andall documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in309 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) thesubject 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 ofM.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 thissubmittal;> if Section B of this form indicates that an Imminent Hazard Evaluation is being submitted, this Imminent Hazard Evaluation was developedin accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and the assessment activity(ies) undertaken to supportthis 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) beingsubmitted, the response action(s) that is (are) the subject of this submittal (i) is (are) being implemented in accordance with the applicableprovisions of M.G.L. c. 21E and 310 CMR 40.0000,(ii) is (are) appropriate and reasonable to accomplish the purposes of such responseaction(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 provisionsof 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 ActiveRemedial System or Response Action(s) Taken to Address an Imminent Hazard is being submitted, the response action(s) that is(are) thesubject of this submittal (i) has (have) been developed and implemented in accordance with the applicable provisions of M.G.L. c. 21E and310 CMR 40.0000, (ii) is(are) appropriate and reasonable to accomplish the purposes of such response action(s) as set forth in the applicableprovisions of M.G.L. c. 21E and 310 CMR 40.0000 and (iii) comply(ies) with the identified provisions of all orders, permits, and approvalsidentified 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 Iknow to be false, inaccurate or materially incomplete.1. LSP #:43032. First Name:DAVID C 3. Last Name:BENNETT4. Telephone:5087377450 5. Ext:6. Email:7. Signature:DAVID C BENNETT8. Date:7/18/2022 (mm/dd/yyyy)9. LSP Stamp:
F. PERSON UNDERTAKING IRA:
1. Check all that apply:a. change in contact name b. change of address c. change in the person undertaking response
actions
2. Name of Organization:AMY MACISAAC REVOCABLE TRUST
3. Contact First Name:AMY 4. Last Name:MACISAAC
5. Street:24 CHARLES ST 6. Title:
7. City/Town:SOUTH YARMOUTH 8. State:MA 9. Zip Code:026640000
10. Telephone:11. Ext:12. Email:
G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify Relationship:
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. 5(j))
4. Any Other Person Undertaking Response Actions:Specify Relationship:
H. REQUIRED ATTACHMENT AND SUBMITTALS:
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.
a. A Release Abatement Measure (RAM) Plan (BWSC106)b. 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.
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.
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 nonupdatable information provided on this form is incorrect, e.g. Release Address/Location Aid. Send corrections
to BWSC.eDEP@state.ma.us.
6. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
I. CERTIFICATION OF PERSON UNDERTAKING IRA:
1. I,AMY MACISAAC , 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:AMY MACISAAC 3. Title:
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022 (mm/dd/yyyy)
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
7/18/2022 1:56:02 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupImmediate Response Action (IRA) Transmittal FormPursuant to 310 CMR 40.0424 40.0427 (Subpart D)BWSC 105Release Tracking Number428586Revised: 11/14/2013 Page 1 of 6Revised: 11/14/2013 Page 2 of 6Revised: 11/14/2013 Page 3 of 6
Revised: 11/14/2013 Page 4 of 6
Revised: 11/14/2013 Page 5 of 6
Revised: 11/14/2013 Page 6 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form
Pursuant to 310 CMR 40.0424 40.0427 (Subpart D)
BWSC 105
Release Tracking Number
4 28586
A. SITE LOCATION:1. Release Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. Zip Code:0266400005. Check here if this location is Adequately Regulated, pursuant to 310 CMR 40.01100114.a. CERCLA b. HSWA Corrective Action c. Solid Waste Managementd. RCRA State Program (21C Facilities)B. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of Initial IRA Written Plan (if previously submitted):11/8/20212. Submit an Initial IRA Plan.3. Submit a Modified IRA Plan of a previously submitted written IRA Plan.4. Submit an Imminent Hazard Evaluation . (check one)a. An Imminent Hazard exists in connection with this Release or Threat of Release.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 assessmentactivities will be undertaken.d. It is unknown whether an Imminent Hazard exists in connection with this Release or Threat of Release. However, response actionswill address those conditions that could pose an Imminent Hazard.5. Submit a request to Terminate an Active Remedial System or Response Action(s) Taken to Address an Imminent Hazard.6. Submit an IRA Status Report7. Submit a Remedial Monitoring Report. (This report can only be submitted through eDEP.)a. Type of Report: (check one)i. Initial Report ii. Interim Report iii. Final Reportb. Frequency of Submittal: (check all that apply)i. A Remedial Monitoring Report(s) submitted monthly to address an Imminent Hazard.ii. A Remedial Monitoring Report(s) submitted monthly to address a Condition of Substantial Release Migration.iii. A Remedial Monitoring Report(s) submitted every six months, concurrent with an IRA Status Report.iv. A Remedial Monitoring Report(s) submitted annually, concurrent with an IRA Status Report.c. Number of Remedial Systems and/or Monitoring Programs:2A separate BWSC105A, IRA Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Programaddressed by this transmittal form.8. Submit an IRA Completion Statement.a. Check here if future response actions addressing this Release or Threat of Release notification condition will be conducted as partof the Response Actions planned or ongoing at a Site that has already been Tier Classified under a different Release Tracking Number(RTN)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 whenmaking all future submittals for the site unless specifically relating to this Immediate Response Action.9. Submit a Revised IRA Completion Statement.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)a. Paved Surface b. Basement c. Schoold. Public Water Supply e. Surface Water f. Zone 2 g. Private Well h. Residence i. Soilj. Groundwater k. Sediments l. Wetland m. Storm Drain n. Indoor Air o. Airp. Soil Gas q. SubSlab Soil Gas r. Critical Exposure Pathway s. NAPL t. Unknownr. Others Specify:CEP ELIMINATED DWELLING VACANT 1/6/222. Sources of the Release or TOR: (check all that apply)a. Transformer b. Fuel Tank c. Piped. OHM Delivery e. AST f. Drums g. Tanker Truck h. Hose i. Linej. UST Describe:k. Vehicle l. Boat/Vesselm. Unknown n.Other:SUBSLAB FUEL LINE3. Type of Release or TOR: (check all that apply)a. Dumping b. Fire c. AST Removal d. Overfille. Rupture f. Vehicle Accident g. Leak h. Spill i. Test failure j. TOR Onlyk. UST Removal Describe:l. Unknown m.Other:4. Identify Oils and Hazardous Materials Released: (check all that apply)a. Oils b. Chlorinated Solventsc. Heavy Metals d.Others Specify:200 GAL VIRGIN FUEL OILD. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply, for volumes list cumulative amounts)1. Assessment and/or Monitoring Only 2. Temporary Covers or Caps3. Deployment of Absorbent or Containment Materials 4. Temporary Water Supplies5. Structure Venting System/HVAC Modification System 6. Temporary Evacuation or Relocation of Residents7. Product or NAPL Recovery 8. Fencing and Sign Posting9. Groundwater Treatment Systems 10. Soil Vapor Extraction11. Remedial Additives 12. Air Sparging13. Active Exposure Pathway Mitigation System 14. Passive Exposure Pathway Mitigation SystemD. DESCRIPTION OF RESPONSE ACTIONS: (cont.)15. Excavation of Contaminated Soils.a. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Receiving Facility:ONDRICK MATERIALS (17 JAN 2021)Town:CHICOPEE State:MAiib. Receiving Facility:ONDRICK MATERIALS (100 MARCH 20 Town:CHICOPEE State:MAiii. Describe:UNDER INITIAL IRAP (JAN 2021) AND IRA MOD (MARCH 2022)b. Store i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yardsiia. Receiving Facility:Town:State:iib. Receiving Facility:Town:State:c. Landfill i. Cover Estimated volume in cubic yardsReceiving Facility:Town:State:ii. Disposal Estimated volume in cubic yardsReceiving Facility:Town:State:16. Removal of Drums, Tanks, or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SAND AND 1 DRUM LNAPL/OILY WATERb. Receiving Facility:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Receiving Facility:Town:State:17. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF LNAPL/OILY WATER 258 GALLONS TRADEBE AUG 2021 AND OCTOBER 202118. Other Response Actions:Describe:PILOTING SSDS FOR AEPMS SHUTDOWN 1/6/2022 ON HOUSE MOVE AND FOUNDATION DEMOLITION IRA MOD19. Use of Innovative Technologies:Describe:2720 LBS REGENOX FOR CHEMICAL OXIDATION TREATMENT OF RESIDUAL GROUNDWATER IMPACTS MARCH 2022E. 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 andall documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in309 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) thesubject 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 ofM.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 thissubmittal;> if Section B of this form indicates that an Imminent Hazard Evaluation is being submitted, this Imminent Hazard Evaluation was developedin accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and the assessment activity(ies) undertaken to supportthis 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) beingsubmitted, the response action(s) that is (are) the subject of this submittal (i) is (are) being implemented in accordance with the applicableprovisions of M.G.L. c. 21E and 310 CMR 40.0000,(ii) is (are) appropriate and reasonable to accomplish the purposes of such responseaction(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 provisionsof 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 ActiveRemedial System or Response Action(s) Taken to Address an Imminent Hazard is being submitted, the response action(s) that is(are) thesubject of this submittal (i) has (have) been developed and implemented in accordance with the applicable provisions of M.G.L. c. 21E and310 CMR 40.0000, (ii) is(are) appropriate and reasonable to accomplish the purposes of such response action(s) as set forth in the applicableprovisions of M.G.L. c. 21E and 310 CMR 40.0000 and (iii) comply(ies) with the identified provisions of all orders, permits, and approvalsidentified 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 Iknow to be false, inaccurate or materially incomplete.1. LSP #:43032. First Name:DAVID C 3. Last Name:BENNETT4. Telephone:5087377450 5. Ext:6. Email:7. Signature:DAVID C BENNETT8. Date:7/18/2022 (mm/dd/yyyy)9. LSP Stamp:F. PERSON UNDERTAKING IRA:1. Check all that apply:a. change in contact name b. change of address c. change in the person undertaking responseactions2. Name of Organization:AMY MACISAAC REVOCABLE TRUST3. Contact First Name:AMY 4. Last Name:MACISAAC5. Street:24 CHARLES ST 6. Title:7. City/Town:SOUTH YARMOUTH 8. State:MA 9. Zip Code:02664000010. Telephone:11. Ext:12. Email:G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA:Check here to change relationship1. RP or PRP a. Owner b. Operator c. Generator d. Transportere. Other RP or PRP Specify Relationship: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. 5(j))4. Any Other Person Undertaking Response Actions:Specify Relationship:H. REQUIRED ATTACHMENT AND SUBMITTALS:1. Check here if any Remediation Waste, generated as a result of this IRA, will be stored, treated, managed, recycled or reused at the sitefollowing submission of the IRA Completion Statement. If this box is checked, you must submit one of the following plans, along withthe appropriate transmittal form.a. A Release Abatement Measure (RAM) Plan (BWSC106)b. 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/orapproval(s) issued by MassDEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable provisionsthereof.3. Check here to certify that the Chief Municipal Officer and the Local Boardof Health were notified of the implementation of anImmediate Response Action taken to control, prevent, abate or eliminate an Imminent Hazard.4. Check here to certify that the Chief Municipal Officer and the Local Boardof Health were notified of the submittal of a CompletionStatement for an Immediate Response Action taken to control, prevent, abate or eliminate an Imminent Hazard.5. Check here if any nonupdatable information provided on this form is incorrect, e.g. Release Address/Location Aid. Send correctionsto BWSC.eDEP@state.ma.us.
6. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
I. CERTIFICATION OF PERSON UNDERTAKING IRA:
1. I,AMY MACISAAC , 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:AMY MACISAAC 3. Title:
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022 (mm/dd/yyyy)
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
7/18/2022 1:56:02 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupImmediate Response Action (IRA) Transmittal FormPursuant to 310 CMR 40.0424 40.0427 (Subpart D)BWSC 105Release Tracking Number428586Revised: 11/14/2013 Page 1 of 6Revised: 11/14/2013 Page 2 of 6Revised: 11/14/2013 Page 3 of 6Revised: 11/14/2013 Page 4 of 6
Revised: 11/14/2013 Page 5 of 6
Revised: 11/14/2013 Page 6 of 6
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
Immediate Response Action (IRA) Transmittal Form
Pursuant to 310 CMR 40.0424 40.0427 (Subpart D)
BWSC 105
Release Tracking Number
4 28586
A. DESCRIPTION OF ACTIVE OPERATION AND MAINTENANCE ACTIVITY:
1. Type of Active Operation and Maintenance Activity: (check all that apply)
a. Active Remedial System: (check all that apply)
i. NAPL Recovery ii. Soil Vapor Extraction/Bioventing iii. Vaporphase Carbon Adsorption
iv. Groundwater Recovery v. Dual/Multiphase Extraction vi. Aqueousphase Carbon Adsorption
vii. Air Stripping viii. Sparging/Biosparging ix. Cat/Thermal Oxidation
x. Other Describe:
b. Active Exposure Pathway Elimination Measure
Active Exposure Pathway Mitigation System to address (check one):i. Indoor Air ii. Drinking Water
c. Application of Remedial Additives: (check all that apply)
i. To the Subsurface ii. To Groundwater (Injection)iii. To the Surface
d. Active Remedial Monitoring Program Without the Application of Remedial Additives: (check all that apply; Sections C, D
and E are not required; attach supporting information, data, maps and/or sketches needed by checking Section G5)
i. Reactive Wall ii. Natural Attenuation iii. Other Describe:
2. Mode of Operation: (check one)
a. Continuous b. Intermittent c. Pulsed d. Onetime Event Only e. Other:
3. System Effluent/Discharge: (check all that apply)
a. Sanitary Sewer/POTW
b. Groundwater Reinfiltration/Reinjection: (check one)i. Downgradient ii. Upgradient
c. Vaporphase Discharge to Ambient Air: (check one)i. Offgas Controls ii. No Offgas Controls
d. Drinking Water Supply
e. Surface Water (including Storm Drains)
f. Other Describe:
B. MONITORING FREQUENCY:
1. Reporting period that is the subject of this submittal:From:10/30/2021 To:1/6/2022
(mm/dd/yyyy)(mm/dd/yyyy)
2. Number of monitoring events during the reporting period: (check one)
a. System Startup: (if applicable)
i. Days 1, 3, 6, and then weekly thereafter, for the first month.
ii. Other Describe:
b. Postsystem Startup (after first month) or Monitoring Program:
i. Monthly
ii. Quarterly
iii. Annually
iv. Other Describe:
3. Check here to certify that the number of required monitoring events were conducted during the reporting period.
C. EFFLUENT/DISCHARGE REGULATION: (check one to indicate how the effluent/discharge limits were established)
1. NPDES: (check one)a. Remediation General Permit b. Individual Permit
c. Emergency Exclusion Effective Date of Permit:
(mm/dd/yyyy)
2. MCP Performance Standard MCP Citations(s):310 CMR 40.0049(3) GAC TREATMENT < 10 LBS/YEAR
3. DEP Approval Letter Date of Letter:
(mm/dd/yyyy)
4. Other Describe:
D. WASTEWATER TREATMENT PLANT OPERATOR: (check one)
1. Required due to Remedial Wastewater Treatment Plant in place for more than 30 days.
a. Name:b. Grade:
c. License No:d. License Exp. Date:
(mm/dd/yyyy)
2. Not Required
3. Not Applicable
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (check all that apply)
1. The Active Remedial System was functional one or more days during the Reporting Period.
a. Days System was Fully Functional:67 b. GW Recovered (gals):
c. NAPL Recovered (gals):d. GW Discharged (gals):
e. Avg. Soil Gas Recovery Rate (scfm):70 f. Avg. Sparging Rate (scfm):
2. Remedial Additives: (check all that apply)
a. No Remedial Additives applied during the Reporting Period.
b. Enhanced Bioremediation Additives applied: (total quantity applied at the site for the current reporting period)
i. Nitrogen/Phosphorus:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
iii. Microorganisms:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
c. Chemical oxidation/reduction additives applied: (total quantity applied at the site for the current reporting period)
i. Permanganates:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
iii. Persulfates:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (cont.)
d. Other additives applied: (total quantity applied at the site for the current reporting period)
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
e. Check here if any additional Remedial Additives were applied. Attach list of additional additives and include Name of
Additive, Date Applied, Quantity Applied and Units (in gals. or lbs.)
F. SHUTDOWNS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM: (check all that
apply)
1. The Active Remedial System had unscheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Unscheduled Shutdowns:b. Total Number of Days of Unscheduled Shutdowns:
c. Reason(s) for Unscheduled Shutdowns:
2. The Active Remedial System had scheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Scheduled Shutdowns:b. Total Number of Days of Scheduled Shutdowns:
c. Reason(s) for Scheduled Shutdowns:
3. The Active Remedial System or Active Remedial Monitoring Program was permanently shutdown/discontinued during the
Reporting Period.
a. Date of Final System or Monitoring Program Shutdown:1/6/2022
(mm/dd/yyyy)
b. No Further Effluent Discharges.
c. No Further Application of Remedial Additives planned; sufficient monitoring completed to demonstrate compliance with
310 CMR 40.0046.
d. No Further Submittals Planned.
e. Other:Describe:CEP ELIMINATED UNDER IRA MOD
G. SUMMARY STATEMENTS: (check all that apply for the current reporting period)
1. All Active Remedial System checks and effluent analyses required by the approved plan and/or permit were performed when
applicable.
2. There were no significant problems or prolonged (>25% of reporting period) unscheduled shutdowns of the Active Remedial
System.
3. The Active Remedial System or Active Remedial Monitoring Program operated in conformance with the MCP, and all
applicable approval conditions and/or permits.
4. Indicate any Operational Problems or Notes:
5. Check here if additional/supporting Information, data, maps, and/or sketches are attached to the form.
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:1
BWSC105 A
Release Tracking Number
4 28586
Revised: 11/13/2013 Page 1 of 3
Revised: 11/13/2013 Page 2 of 3
Revised: 1/13/2013 Page 3 of 3
A. DESCRIPTION OF ACTIVE OPERATION AND MAINTENANCE ACTIVITY:1. Type of Active Operation and Maintenance Activity: (check all that apply)a. Active Remedial System: (check all that apply)i. NAPL Recovery ii. Soil Vapor Extraction/Bioventing iii. Vaporphase Carbon Adsorptioniv. Groundwater Recovery v. Dual/Multiphase Extraction vi. Aqueousphase Carbon Adsorptionvii. Air Stripping viii. Sparging/Biosparging ix. Cat/Thermal Oxidationx. Other Describe:b. Active Exposure Pathway Elimination MeasureActive Exposure Pathway Mitigation System to address (check one):i. Indoor Air ii. Drinking Waterc. Application of Remedial Additives: (check all that apply)i. To the Subsurface ii. To Groundwater (Injection)iii. To the Surfaced. Active Remedial Monitoring Program Without the Application of Remedial Additives: (check all that apply; Sections C, Dand E are not required; attach supporting information, data, maps and/or sketches needed by checking Section G5)i. Reactive Wall ii. Natural Attenuation iii. Other Describe:2. Mode of Operation: (check one)a. Continuous b. Intermittent c. Pulsed d. Onetime Event Only e. Other:3. System Effluent/Discharge: (check all that apply)a. Sanitary Sewer/POTWb. Groundwater Reinfiltration/Reinjection: (check one)i. Downgradient ii. Upgradientc. Vaporphase Discharge to Ambient Air: (check one)i. Offgas Controls ii. No Offgas Controlsd. Drinking Water Supplye. Surface Water (including Storm Drains)f. Other Describe:B. MONITORING FREQUENCY:1. Reporting period that is the subject of this submittal:From:10/30/2021 To:1/6/2022(mm/dd/yyyy)(mm/dd/yyyy)2. Number of monitoring events during the reporting period: (check one)a. System Startup: (if applicable)i. Days 1, 3, 6, and then weekly thereafter, for the first month.ii. Other Describe:b. Postsystem Startup (after first month) or Monitoring Program:i. Monthlyii. Quarterlyiii. Annuallyiv. Other Describe:3. Check here to certify that the number of required monitoring events were conducted during the reporting period.C. EFFLUENT/DISCHARGE REGULATION: (check one to indicate how the effluent/discharge limits were established)1. NPDES: (check one)a. Remediation General Permit b. Individual Permitc. Emergency Exclusion Effective Date of Permit:(mm/dd/yyyy)2. MCP Performance Standard MCP Citations(s):310 CMR 40.0049(3) GAC TREATMENT < 10 LBS/YEAR
3. DEP Approval Letter Date of Letter:
(mm/dd/yyyy)
4. Other Describe:
D. WASTEWATER TREATMENT PLANT OPERATOR: (check one)
1. Required due to Remedial Wastewater Treatment Plant in place for more than 30 days.
a. Name:b. Grade:
c. License No:d. License Exp. Date:
(mm/dd/yyyy)
2. Not Required
3. Not Applicable
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (check all that apply)
1. The Active Remedial System was functional one or more days during the Reporting Period.
a. Days System was Fully Functional:67 b. GW Recovered (gals):
c. NAPL Recovered (gals):d. GW Discharged (gals):
e. Avg. Soil Gas Recovery Rate (scfm):70 f. Avg. Sparging Rate (scfm):
2. Remedial Additives: (check all that apply)
a. No Remedial Additives applied during the Reporting Period.
b. Enhanced Bioremediation Additives applied: (total quantity applied at the site for the current reporting period)
i. Nitrogen/Phosphorus:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
iii. Microorganisms:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
c. Chemical oxidation/reduction additives applied: (total quantity applied at the site for the current reporting period)
i. Permanganates:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
iii. Persulfates:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (cont.)
d. Other additives applied: (total quantity applied at the site for the current reporting period)
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
e. Check here if any additional Remedial Additives were applied. Attach list of additional additives and include Name of
Additive, Date Applied, Quantity Applied and Units (in gals. or lbs.)
F. SHUTDOWNS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM: (check all that
apply)
1. The Active Remedial System had unscheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Unscheduled Shutdowns:b. Total Number of Days of Unscheduled Shutdowns:
c. Reason(s) for Unscheduled Shutdowns:
2. The Active Remedial System had scheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Scheduled Shutdowns:b. Total Number of Days of Scheduled Shutdowns:
c. Reason(s) for Scheduled Shutdowns:
3. The Active Remedial System or Active Remedial Monitoring Program was permanently shutdown/discontinued during the
Reporting Period.
a. Date of Final System or Monitoring Program Shutdown:1/6/2022
(mm/dd/yyyy)
b. No Further Effluent Discharges.
c. No Further Application of Remedial Additives planned; sufficient monitoring completed to demonstrate compliance with
310 CMR 40.0046.
d. No Further Submittals Planned.
e. Other:Describe:CEP ELIMINATED UNDER IRA MOD
G. SUMMARY STATEMENTS: (check all that apply for the current reporting period)
1. All Active Remedial System checks and effluent analyses required by the approved plan and/or permit were performed when
applicable.
2. There were no significant problems or prolonged (>25% of reporting period) unscheduled shutdowns of the Active Remedial
System.
3. The Active Remedial System or Active Remedial Monitoring Program operated in conformance with the MCP, and all
applicable approval conditions and/or permits.
4. Indicate any Operational Problems or Notes:
5. Check here if additional/supporting Information, data, maps, and/or sketches are attached to the form.
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupIRA REMEDIAL MONITORING REPORTPursuant to 310 CMR 40.0400 ( SUBPART D )Remedial System or Monitoring Program:1 of:1 BWSC105 ARelease Tracking Number428586
Revised: 11/13/2013 Page 1 of 3
Revised: 11/13/2013 Page 2 of 3
Revised: 1/13/2013 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:1
BWSC105 A
Release Tracking Number
4 28586
A. DESCRIPTION OF ACTIVE OPERATION AND MAINTENANCE ACTIVITY:1. Type of Active Operation and Maintenance Activity: (check all that apply)a. Active Remedial System: (check all that apply)i. NAPL Recovery ii. Soil Vapor Extraction/Bioventing iii. Vaporphase Carbon Adsorptioniv. Groundwater Recovery v. Dual/Multiphase Extraction vi. Aqueousphase Carbon Adsorptionvii. Air Stripping viii. Sparging/Biosparging ix. Cat/Thermal Oxidationx. Other Describe:b. Active Exposure Pathway Elimination MeasureActive Exposure Pathway Mitigation System to address (check one):i. Indoor Air ii. Drinking Waterc. Application of Remedial Additives: (check all that apply)i. To the Subsurface ii. To Groundwater (Injection)iii. To the Surfaced. Active Remedial Monitoring Program Without the Application of Remedial Additives: (check all that apply; Sections C, Dand E are not required; attach supporting information, data, maps and/or sketches needed by checking Section G5)i. Reactive Wall ii. Natural Attenuation iii. Other Describe:2. Mode of Operation: (check one)a. Continuous b. Intermittent c. Pulsed d. Onetime Event Only e. Other:3. System Effluent/Discharge: (check all that apply)a. Sanitary Sewer/POTWb. Groundwater Reinfiltration/Reinjection: (check one)i. Downgradient ii. Upgradientc. Vaporphase Discharge to Ambient Air: (check one)i. Offgas Controls ii. No Offgas Controlsd. Drinking Water Supplye. Surface Water (including Storm Drains)f. Other Describe:B. MONITORING FREQUENCY:1. Reporting period that is the subject of this submittal:From:10/30/2021 To:1/6/2022(mm/dd/yyyy)(mm/dd/yyyy)2. Number of monitoring events during the reporting period: (check one)a. System Startup: (if applicable)i. Days 1, 3, 6, and then weekly thereafter, for the first month.ii. Other Describe:b. Postsystem Startup (after first month) or Monitoring Program:i. Monthlyii. Quarterlyiii. Annuallyiv. Other Describe:3. Check here to certify that the number of required monitoring events were conducted during the reporting period.C. EFFLUENT/DISCHARGE REGULATION: (check one to indicate how the effluent/discharge limits were established)1. NPDES: (check one)a. Remediation General Permit b. Individual Permitc. Emergency Exclusion Effective Date of Permit:(mm/dd/yyyy)2. MCP Performance Standard MCP Citations(s):310 CMR 40.0049(3) GAC TREATMENT < 10 LBS/YEAR3. DEP Approval Letter Date of Letter:(mm/dd/yyyy)4. Other Describe:D. WASTEWATER TREATMENT PLANT OPERATOR: (check one)1. Required due to Remedial Wastewater Treatment Plant in place for more than 30 days.a. Name:b. Grade:c. License No:d. License Exp. Date:(mm/dd/yyyy)2. Not Required3. Not ApplicableE. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURINGREPORTING PERIOD: (check all that apply)1. The Active Remedial System was functional one or more days during the Reporting Period.a. Days System was Fully Functional:67 b. GW Recovered (gals):c. NAPL Recovered (gals):d. GW Discharged (gals):e. Avg. Soil Gas Recovery Rate (scfm):70 f. Avg. Sparging Rate (scfm):2. Remedial Additives: (check all that apply)a. No Remedial Additives applied during the Reporting Period.b. Enhanced Bioremediation Additives applied: (total quantity applied at the site for the current reporting period)i. Nitrogen/Phosphorus:ii. Peroxides:Name of Additive Date Quantity Units Name of Additive Date Quantity Unitsiii. Microorganisms:iv. Other:Name of Additive Date Quantity Units Name of Additive Date Quantity Unitsc. Chemical oxidation/reduction additives applied: (total quantity applied at the site for the current reporting period)i. Permanganates:ii. Peroxides:Name of Additive Date Quantity Units Name of Additive Date Quantity Unitsiii. Persulfates:iv. Other:Name of Additive Date Quantity Units Name of Additive Date Quantity Units
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (cont.)
d. Other additives applied: (total quantity applied at the site for the current reporting period)
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
e. Check here if any additional Remedial Additives were applied. Attach list of additional additives and include Name of
Additive, Date Applied, Quantity Applied and Units (in gals. or lbs.)
F. SHUTDOWNS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM: (check all that
apply)
1. The Active Remedial System had unscheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Unscheduled Shutdowns:b. Total Number of Days of Unscheduled Shutdowns:
c. Reason(s) for Unscheduled Shutdowns:
2. The Active Remedial System had scheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Scheduled Shutdowns:b. Total Number of Days of Scheduled Shutdowns:
c. Reason(s) for Scheduled Shutdowns:
3. The Active Remedial System or Active Remedial Monitoring Program was permanently shutdown/discontinued during the
Reporting Period.
a. Date of Final System or Monitoring Program Shutdown:1/6/2022
(mm/dd/yyyy)
b. No Further Effluent Discharges.
c. No Further Application of Remedial Additives planned; sufficient monitoring completed to demonstrate compliance with
310 CMR 40.0046.
d. No Further Submittals Planned.
e. Other:Describe:CEP ELIMINATED UNDER IRA MOD
G. SUMMARY STATEMENTS: (check all that apply for the current reporting period)
1. All Active Remedial System checks and effluent analyses required by the approved plan and/or permit were performed when
applicable.
2. There were no significant problems or prolonged (>25% of reporting period) unscheduled shutdowns of the Active Remedial
System.
3. The Active Remedial System or Active Remedial Monitoring Program operated in conformance with the MCP, and all
applicable approval conditions and/or permits.
4. Indicate any Operational Problems or Notes:
5. Check here if additional/supporting Information, data, maps, and/or sketches are attached to the form.
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupIRA REMEDIAL MONITORING REPORTPursuant to 310 CMR 40.0400 ( SUBPART D )Remedial System or Monitoring Program:1 of:1 BWSC105 ARelease Tracking Number428586Revised: 11/13/2013 Page 1 of 3
Revised: 11/13/2013 Page 2 of 3
Revised: 1/13/2013 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:1
BWSC105 A
Release Tracking Number
4 28586
Point of
Measurement
Date
(mm/dd/yyyy)
Contaminant,
Measurement and/or
Indicator Parameter
Influent
Concentration
(where
applicable)
Midpoint
Concentration
(where
applicable)
(check one)
Discharge
GroundWater
Concentration
Pressure
Differential
Check
here, if
ND/BDL
Permissible
Concentration
or Pressure
Differential
Units Within
Permissible
Limits?
(Y/N)
Check here if any additional BWSC105 B, Measurements Form(s), are needed.
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
MEASUREMENTS
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:1
BWSC105 B
Release Tracking Number
4 28586
Revised: 11/17/2013 Page 1 of 1
For each Point of Measurement, related to concentration indicate the highest concentration detected during the reporting period, of
each oil, hazardous material and/or remedial additive.
For each Point of Measurement for pressure differentials, indicate the lowest pressure differential detected during the reporting
period.
EXTERIOR 11/18/2021 TOV 5.5 0.2 500 PPMV YES
EXTERIOR 12/15/2022 TOV 30.1 0.2 500 PPMV YES
A. DESCRIPTION OF ACTIVE OPERATION AND MAINTENANCE ACTIVITY:
1. Type of Active Operation and Maintenance Activity: (check all that apply)
a. Active Remedial System: (check all that apply)
i. NAPL Recovery ii. Soil Vapor Extraction/Bioventing iii. Vaporphase Carbon Adsorption
iv. Groundwater Recovery v. Dual/Multiphase Extraction vi. Aqueousphase Carbon Adsorption
vii. Air Stripping viii. Sparging/Biosparging ix. Cat/Thermal Oxidation
x. Other Describe:
b. Active Exposure Pathway Elimination Measure
Active Exposure Pathway Mitigation System to address (check one):i. Indoor Air ii. Drinking Water
c. Application of Remedial Additives: (check all that apply)
i. To the Subsurface ii. To Groundwater (Injection)iii. To the Surface
d. Active Remedial Monitoring Program Without the Application of Remedial Additives: (check all that apply; Sections C, D
and E are not required; attach supporting information, data, maps and/or sketches needed by checking Section G5)
i. Reactive Wall ii. Natural Attenuation iii. Other Describe:
2. Mode of Operation: (check one)
a. Continuous b. Intermittent c. Pulsed d. Onetime Event Only e. Other:
3. System Effluent/Discharge: (check all that apply)
a. Sanitary Sewer/POTW
b. Groundwater Reinfiltration/Reinjection: (check one)i. Downgradient ii. Upgradient
c. Vaporphase Discharge to Ambient Air: (check one)i. Offgas Controls ii. No Offgas Controls
d. Drinking Water Supply
e. Surface Water (including Storm Drains)
f. Other Describe:
B. MONITORING FREQUENCY:
1. Reporting period that is the subject of this submittal:From:3/16/2022 To:6/14/2022
(mm/dd/yyyy)(mm/dd/yyyy)
2. Number of monitoring events during the reporting period: (check one)
a. System Startup: (if applicable)
i. Days 1, 3, 6, and then weekly thereafter, for the first month.
ii. Other Describe:9 DAYS FOLLOWING APPLICATION MONTHLY THEREAFTER
b. Postsystem Startup (after first month) or Monitoring Program:
i. Monthly
ii. Quarterly
iii. Annually
iv. Other Describe:
3. Check here to certify that the number of required monitoring events were conducted during the reporting period.
C. EFFLUENT/DISCHARGE REGULATION: (check one to indicate how the effluent/discharge limits were established)
1. NPDES: (check one)a. Remediation General Permit b. Individual Permit
c. Emergency Exclusion Effective Date of Permit:
(mm/dd/yyyy)
2. MCP Performance Standard MCP Citations(s):
3. DEP Approval Letter Date of Letter:12/14/2021
(mm/dd/yyyy)
4. Other Describe:
D. WASTEWATER TREATMENT PLANT OPERATOR: (check one)
1. Required due to Remedial Wastewater Treatment Plant in place for more than 30 days.
a. Name:b. Grade:
c. License No:d. License Exp. Date:
(mm/dd/yyyy)
2. Not Required
3. Not Applicable
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (check all that apply)
1. The Active Remedial System was functional one or more days during the Reporting Period.
a. Days System was Fully Functional:b. GW Recovered (gals):
c. NAPL Recovered (gals):d. GW Discharged (gals):
e. Avg. Soil Gas Recovery Rate (scfm):f. Avg. Sparging Rate (scfm):
2. Remedial Additives: (check all that apply)
a. No Remedial Additives applied during the Reporting Period.
b. Enhanced Bioremediation Additives applied: (total quantity applied at the site for the current reporting period)
i. Nitrogen/Phosphorus:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
iii. Microorganisms:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
c. Chemical oxidation/reduction additives applied: (total quantity applied at the site for the current reporting period)
i. Permanganates:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
REGENOX PART A 3/15/2022 2280 LBS
REGENOX PART B 3/16/2022 440 LBS
iii. Persulfates:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (cont.)
d. Other additives applied: (total quantity applied at the site for the current reporting period)
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
e. Check here if any additional Remedial Additives were applied. Attach list of additional additives and include Name of
Additive, Date Applied, Quantity Applied and Units (in gals. or lbs.)
F. SHUTDOWNS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM: (check all that
apply)
1. The Active Remedial System had unscheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Unscheduled Shutdowns:b. Total Number of Days of Unscheduled Shutdowns:
c. Reason(s) for Unscheduled Shutdowns:
2. The Active Remedial System had scheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Scheduled Shutdowns:b. Total Number of Days of Scheduled Shutdowns:
c. Reason(s) for Scheduled Shutdowns:
3. The Active Remedial System or Active Remedial Monitoring Program was permanently shutdown/discontinued during the
Reporting Period.
a. Date of Final System or Monitoring Program Shutdown:7/5/2022
(mm/dd/yyyy)
b. No Further Effluent Discharges.
c. No Further Application of Remedial Additives planned; sufficient monitoring completed to demonstrate compliance with
310 CMR 40.0046.
d. No Further Submittals Planned.
e. Other:Describe:
G. SUMMARY STATEMENTS: (check all that apply for the current reporting period)
1. All Active Remedial System checks and effluent analyses required by the approved plan and/or permit were performed when
applicable.
2. There were no significant problems or prolonged (>25% of reporting period) unscheduled shutdowns of the Active Remedial
System.
3. The Active Remedial System or Active Remedial Monitoring Program operated in conformance with the MCP, and all
applicable approval conditions and/or permits.
4. Indicate any Operational Problems or Notes:
5. Check here if additional/supporting Information, data, maps, and/or sketches are attached to the form.
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:1
BWSC105 A
Release Tracking Number
4 28586
Revised: 11/13/2013 Page 1 of 3
Revised: 11/13/2013 Page 2 of 3
Revised: 1/13/2013 Page 3 of 3
A. DESCRIPTION OF ACTIVE OPERATION AND MAINTENANCE ACTIVITY:1. Type of Active Operation and Maintenance Activity: (check all that apply)a. Active Remedial System: (check all that apply)i. NAPL Recovery ii. Soil Vapor Extraction/Bioventing iii. Vaporphase Carbon Adsorptioniv. Groundwater Recovery v. Dual/Multiphase Extraction vi. Aqueousphase Carbon Adsorptionvii. Air Stripping viii. Sparging/Biosparging ix. Cat/Thermal Oxidationx. Other Describe:b. Active Exposure Pathway Elimination MeasureActive Exposure Pathway Mitigation System to address (check one):i. Indoor Air ii. Drinking Waterc. Application of Remedial Additives: (check all that apply)i. To the Subsurface ii. To Groundwater (Injection)iii. To the Surfaced. Active Remedial Monitoring Program Without the Application of Remedial Additives: (check all that apply; Sections C, Dand E are not required; attach supporting information, data, maps and/or sketches needed by checking Section G5)i. Reactive Wall ii. Natural Attenuation iii. Other Describe:2. Mode of Operation: (check one)a. Continuous b. Intermittent c. Pulsed d. Onetime Event Only e. Other:3. System Effluent/Discharge: (check all that apply)a. Sanitary Sewer/POTWb. Groundwater Reinfiltration/Reinjection: (check one)i. Downgradient ii. Upgradientc. Vaporphase Discharge to Ambient Air: (check one)i. Offgas Controls ii. No Offgas Controlsd. Drinking Water Supplye. Surface Water (including Storm Drains)f. Other Describe:B. MONITORING FREQUENCY:1. Reporting period that is the subject of this submittal:From:3/16/2022 To:6/14/2022(mm/dd/yyyy)(mm/dd/yyyy)2. Number of monitoring events during the reporting period: (check one)a. System Startup: (if applicable)i. Days 1, 3, 6, and then weekly thereafter, for the first month.ii. Other Describe:9 DAYS FOLLOWING APPLICATION MONTHLY THEREAFTERb. Postsystem Startup (after first month) or Monitoring Program:i. Monthlyii. Quarterlyiii. Annuallyiv. Other Describe:3. Check here to certify that the number of required monitoring events were conducted during the reporting period.C. EFFLUENT/DISCHARGE REGULATION: (check one to indicate how the effluent/discharge limits were established)1. NPDES: (check one)a. Remediation General Permit b. Individual Permitc. Emergency Exclusion Effective Date of Permit:(mm/dd/yyyy)2. MCP Performance Standard MCP Citations(s):
3. DEP Approval Letter Date of Letter:12/14/2021
(mm/dd/yyyy)
4. Other Describe:
D. WASTEWATER TREATMENT PLANT OPERATOR: (check one)
1. Required due to Remedial Wastewater Treatment Plant in place for more than 30 days.
a. Name:b. Grade:
c. License No:d. License Exp. Date:
(mm/dd/yyyy)
2. Not Required
3. Not Applicable
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (check all that apply)
1. The Active Remedial System was functional one or more days during the Reporting Period.
a. Days System was Fully Functional:b. GW Recovered (gals):
c. NAPL Recovered (gals):d. GW Discharged (gals):
e. Avg. Soil Gas Recovery Rate (scfm):f. Avg. Sparging Rate (scfm):
2. Remedial Additives: (check all that apply)
a. No Remedial Additives applied during the Reporting Period.
b. Enhanced Bioremediation Additives applied: (total quantity applied at the site for the current reporting period)
i. Nitrogen/Phosphorus:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
iii. Microorganisms:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
c. Chemical oxidation/reduction additives applied: (total quantity applied at the site for the current reporting period)
i. Permanganates:ii. Peroxides:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
REGENOX PART A 3/15/2022 2280 LBS
REGENOX PART B 3/16/2022 440 LBS
iii. Persulfates:iv. Other:
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (cont.)
d. Other additives applied: (total quantity applied at the site for the current reporting period)
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
e. Check here if any additional Remedial Additives were applied. Attach list of additional additives and include Name of
Additive, Date Applied, Quantity Applied and Units (in gals. or lbs.)
F. SHUTDOWNS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM: (check all that
apply)
1. The Active Remedial System had unscheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Unscheduled Shutdowns:b. Total Number of Days of Unscheduled Shutdowns:
c. Reason(s) for Unscheduled Shutdowns:
2. The Active Remedial System had scheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Scheduled Shutdowns:b. Total Number of Days of Scheduled Shutdowns:
c. Reason(s) for Scheduled Shutdowns:
3. The Active Remedial System or Active Remedial Monitoring Program was permanently shutdown/discontinued during the
Reporting Period.
a. Date of Final System or Monitoring Program Shutdown:7/5/2022
(mm/dd/yyyy)
b. No Further Effluent Discharges.
c. No Further Application of Remedial Additives planned; sufficient monitoring completed to demonstrate compliance with
310 CMR 40.0046.
d. No Further Submittals Planned.
e. Other:Describe:
G. SUMMARY STATEMENTS: (check all that apply for the current reporting period)
1. All Active Remedial System checks and effluent analyses required by the approved plan and/or permit were performed when
applicable.
2. There were no significant problems or prolonged (>25% of reporting period) unscheduled shutdowns of the Active Remedial
System.
3. The Active Remedial System or Active Remedial Monitoring Program operated in conformance with the MCP, and all
applicable approval conditions and/or permits.
4. Indicate any Operational Problems or Notes:
5. Check here if additional/supporting Information, data, maps, and/or sketches are attached to the form.
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupIRA REMEDIAL MONITORING REPORTPursuant to 310 CMR 40.0400 ( SUBPART D )Remedial System or Monitoring Program:1 of:1 BWSC105 ARelease Tracking Number428586
Revised: 11/13/2013 Page 1 of 3
Revised: 11/13/2013 Page 2 of 3
Revised: 1/13/2013 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:1
BWSC105 A
Release Tracking Number
4 28586
A. DESCRIPTION OF ACTIVE OPERATION AND MAINTENANCE ACTIVITY:1. Type of Active Operation and Maintenance Activity: (check all that apply)a. Active Remedial System: (check all that apply)i. NAPL Recovery ii. Soil Vapor Extraction/Bioventing iii. Vaporphase Carbon Adsorptioniv. Groundwater Recovery v. Dual/Multiphase Extraction vi. Aqueousphase Carbon Adsorptionvii. Air Stripping viii. Sparging/Biosparging ix. Cat/Thermal Oxidationx. Other Describe:b. Active Exposure Pathway Elimination MeasureActive Exposure Pathway Mitigation System to address (check one):i. Indoor Air ii. Drinking Waterc. Application of Remedial Additives: (check all that apply)i. To the Subsurface ii. To Groundwater (Injection)iii. To the Surfaced. Active Remedial Monitoring Program Without the Application of Remedial Additives: (check all that apply; Sections C, Dand E are not required; attach supporting information, data, maps and/or sketches needed by checking Section G5)i. Reactive Wall ii. Natural Attenuation iii. Other Describe:2. Mode of Operation: (check one)a. Continuous b. Intermittent c. Pulsed d. Onetime Event Only e. Other:3. System Effluent/Discharge: (check all that apply)a. Sanitary Sewer/POTWb. Groundwater Reinfiltration/Reinjection: (check one)i. Downgradient ii. Upgradientc. Vaporphase Discharge to Ambient Air: (check one)i. Offgas Controls ii. No Offgas Controlsd. Drinking Water Supplye. Surface Water (including Storm Drains)f. Other Describe:B. MONITORING FREQUENCY:1. Reporting period that is the subject of this submittal:From:3/16/2022 To:6/14/2022(mm/dd/yyyy)(mm/dd/yyyy)2. Number of monitoring events during the reporting period: (check one)a. System Startup: (if applicable)i. Days 1, 3, 6, and then weekly thereafter, for the first month.ii. Other Describe:9 DAYS FOLLOWING APPLICATION MONTHLY THEREAFTERb. Postsystem Startup (after first month) or Monitoring Program:i. Monthlyii. Quarterlyiii. Annuallyiv. Other Describe:3. Check here to certify that the number of required monitoring events were conducted during the reporting period.C. EFFLUENT/DISCHARGE REGULATION: (check one to indicate how the effluent/discharge limits were established)1. NPDES: (check one)a. Remediation General Permit b. Individual Permitc. Emergency Exclusion Effective Date of Permit:(mm/dd/yyyy)2. MCP Performance Standard MCP Citations(s):3. DEP Approval Letter Date of Letter:12/14/2021(mm/dd/yyyy)4. Other Describe:D. WASTEWATER TREATMENT PLANT OPERATOR: (check one)1. Required due to Remedial Wastewater Treatment Plant in place for more than 30 days.a. Name:b. Grade:c. License No:d. License Exp. Date:(mm/dd/yyyy)2. Not Required3. Not ApplicableE. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURINGREPORTING PERIOD: (check all that apply)1. The Active Remedial System was functional one or more days during the Reporting Period.a. Days System was Fully Functional:b. GW Recovered (gals):c. NAPL Recovered (gals):d. GW Discharged (gals):e. Avg. Soil Gas Recovery Rate (scfm):f. Avg. Sparging Rate (scfm):2. Remedial Additives: (check all that apply)a. No Remedial Additives applied during the Reporting Period.b. Enhanced Bioremediation Additives applied: (total quantity applied at the site for the current reporting period)i. Nitrogen/Phosphorus:ii. Peroxides:Name of Additive Date Quantity Units Name of Additive Date Quantity Unitsiii. Microorganisms:iv. Other:Name of Additive Date Quantity Units Name of Additive Date Quantity Unitsc. Chemical oxidation/reduction additives applied: (total quantity applied at the site for the current reporting period)i. Permanganates:ii. Peroxides:Name of Additive Date Quantity Units Name of Additive Date Quantity UnitsREGENOX PART A 3/15/2022 2280 LBSREGENOX PART B 3/16/2022 440 LBSiii. Persulfates:iv. Other:Name of Additive Date Quantity Units Name of Additive Date Quantity Units
E. STATUS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM DURING
REPORTING PERIOD: (cont.)
d. Other additives applied: (total quantity applied at the site for the current reporting period)
Name of Additive Date Quantity Units Name of Additive Date Quantity Units
e. Check here if any additional Remedial Additives were applied. Attach list of additional additives and include Name of
Additive, Date Applied, Quantity Applied and Units (in gals. or lbs.)
F. SHUTDOWNS OF ACTIVE REMEDIAL SYSTEM OR ACTIVE REMEDIAL MONITORING PROGRAM: (check all that
apply)
1. The Active Remedial System had unscheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Unscheduled Shutdowns:b. Total Number of Days of Unscheduled Shutdowns:
c. Reason(s) for Unscheduled Shutdowns:
2. The Active Remedial System had scheduled shutdowns on one or more occasions during the Reporting Period.
a. Number of Scheduled Shutdowns:b. Total Number of Days of Scheduled Shutdowns:
c. Reason(s) for Scheduled Shutdowns:
3. The Active Remedial System or Active Remedial Monitoring Program was permanently shutdown/discontinued during the
Reporting Period.
a. Date of Final System or Monitoring Program Shutdown:7/5/2022
(mm/dd/yyyy)
b. No Further Effluent Discharges.
c. No Further Application of Remedial Additives planned; sufficient monitoring completed to demonstrate compliance with
310 CMR 40.0046.
d. No Further Submittals Planned.
e. Other:Describe:
G. SUMMARY STATEMENTS: (check all that apply for the current reporting period)
1. All Active Remedial System checks and effluent analyses required by the approved plan and/or permit were performed when
applicable.
2. There were no significant problems or prolonged (>25% of reporting period) unscheduled shutdowns of the Active Remedial
System.
3. The Active Remedial System or Active Remedial Monitoring Program operated in conformance with the MCP, and all
applicable approval conditions and/or permits.
4. Indicate any Operational Problems or Notes:
5. Check here if additional/supporting Information, data, maps, and/or sketches are attached to the form.
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupIRA REMEDIAL MONITORING REPORTPursuant to 310 CMR 40.0400 ( SUBPART D )Remedial System or Monitoring Program:1 of:1 BWSC105 ARelease Tracking Number428586Revised: 11/13/2013 Page 1 of 3
Revised: 11/13/2013 Page 2 of 3
Revised: 1/13/2013 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:1
BWSC105 A
Release Tracking Number
4 28586
Point of
Measurement
Date
(mm/dd/yyyy)
Contaminant,
Measurement and/or
Indicator Parameter
Influent
Concentration
(where
applicable)
Midpoint
Concentration
(where
applicable)
(check one)
Discharge
GroundWater
Concentration
Pressure
Differential
Check
here, if
ND/BDL
Permissible
Concentration
or Pressure
Differential
Units Within
Permissible
Limits?
(Y/N)
Check here if any additional BWSC105 B, Measurements Form(s), are needed.
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
MEASUREMENTS
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:1 of:2
BWSC105 B
Release Tracking Number
4 28586
Revised: 11/17/2013 Page 1 of 1
For each Point of Measurement, related to concentration indicate the highest concentration detected during the reporting period, of
each oil, hazardous material and/or remedial additive.
For each Point of Measurement for pressure differentials, indicate the lowest pressure differential detected during the reporting
period.
UPGRADIE 07/06/2021 IRON (BASELINE 7.4 0.3 MG/L NO
UPGRADIE 07/06/2021 SULFATE (BASEL 8.2 250 MG/L YES
UPGRADIE 12/15/2021 SODIUM (BASELI 16.2 20 MG/L YES
MW3 12/15/2021 IRON (BASELINE 4.5 0.3 MG/L NO
MW3 12/15/2022 SULFATE (BASEL 20 250 MG/L YES
MW3 12/15/2022 SODIUM (BASELI 21.1 20 MG/L NO
MW4 12/15/2021 IRON (BASELINE 0.05 0.3 MG/L YES
MW4 12/15/2021 SULFATE (BASEL 10 250 MG/L YES
MW4 12/15/2021 SODIUM (BASELI 14.4 20 MG/L YES
MW7 12/15/2021 IRON (BASELINE 1.6 0.3 MG/L NO
MW7 12/15/2021 SULFATE (BASEL 10 250 MG/L YES
MW7 12/15/2021 SODIUM (BASELI 11.7 20 MG/L YES
MW3 03/25/2022 IRON 5.8 0.3 MG/L NO
MW3 03/25/2022 SULFATE 14 250 MG/L YES
MW3 03/25/2022 SODIUM 19.1 20 MG/L YES
MW4 03/25/2022 IRON 0.05 0.3 MG/L YES
MW4 03/25/2022 SULFATE 10 250 MG/L YES
MW4 03/25/2022 SODIUM 12.7 20 MG/L YES
MW7 03/25/2022 IRON 0.52 0.3 MG/L YES
MW7 03/25/2022 SULFATE 10 250 MG/L YES
MW7 03/25/2022 SODIUM 12.2 20 MG/L YES
MW3 04/28/2022 SULFATE 1.4 250 MG/L YES
MW3 04/28/2022 SODIUM 164 20 MG/L NO
MW3 04/28/2022 IRON 45.4 0.3 MG/L NO
MW4 04/28/2022 SULFATE 10 250 MG/L YES
Point of
Measurement
Date
(mm/dd/yyyy)
Contaminant,
Measurement and/or
Indicator Parameter
Influent
Concentration
(where
applicable)
Midpoint
Concentration
(where
applicable)
(check one)
Discharge
GroundWater
Concentration
Pressure
Differential
Check
here, if
ND/BDL
Permissible
Concentration
or Pressure
Differential
Units Within
Permissible
Limits?
(Y/N)
Check here if any additional BWSC105 B, Measurements Form(s), are needed.
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
IRA REMEDIAL MONITORING REPORT
MEASUREMENTS
Pursuant to 310 CMR 40.0400 ( SUBPART D )
Remedial System or Monitoring Program:2 of:2
BWSC105 B
Release Tracking Number
4 28586
Revised: 11/17/2013 Page 1 of 1
For each Point of Measurement, related to concentration indicate the highest concentration detected during the reporting period, of
each oil, hazardous material and/or remedial additive.
For each Point of Measurement for pressure differentials, indicate the lowest pressure differential detected during the reporting
period.
MW4 04/28/2022 SODIUM`13.5 20 MG/L YES
MW4 04/28/2022 IRON 0.07 0.3 MG/L YES
MW7 04/28/2022 SULFATE 10 250 MG/L YES
MW7 04/28/2022 SODIUM 12.9 20 MG/L YES
MW7 04/28/2022 IRON 0.06 0.3 MG/L YES
MW3 06/14/2022 SULFATE 37 250 MG/L YES
MW3 06/14/2022 SODIUM 57.5 20 MG/L NO
MW3 06/14/2022 IRON 0.419 0.3 MG/L NO
MW4 06/14/2022 SULFATE 10 250 MG/L YES
MW4 06/14/2022 SODIUM 12.6 20 MG/L YES
MW4 06/14/2022 IRON 0.05 0.3 MG/L YES
MW7 06/14/2022 SULFATE 10 250 MG/L YES
MW7 06/14/2022 SODIUM 16.9 20 MG/L YES
MW7 06/14/2022 IRON 0.05 0.3 MG/L YES