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1393318
7/18/2022:2:24:41 PM
225.07K
DAVIDBENNETT
BWSC104 Permanent And Temporary Solution Statement
In Process
A. SITE LOCATION:
1. Site Name/Location Aid:HOME HEATING OIL SPILL
2. Street Address:24 CHARLES STREET
3. City/Town:YARMOUTH 4. ZIP Code:026640000
5. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.18199
6. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:
a. Tier I b. Tier ID c. Tier II
B. THIS FORM IS BEING USED TO: (check all that apply)
1. List Submittal Date of the Permanent or Temporary Solution Statement,
or RAO Statement (if previously submitted):mm/dd/yyyy
2. Submit a Permanent or Temporary Solution Statement
a. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers
(RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.
b. Provide the additional Release Tracking Number(s) covered by this
Permanent or Temporary Solution Statement.
3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)
a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),
not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or Temporary
Solution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.
b. Provide the additional Release Tracking Number(s) covered by this
Permanent or Temporary Solution Statement.
4. Submit a Permanent or Temporary Solution Partial Statement
Check above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having the
Primary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only a
Permanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to be
submitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditions
not covered by the Permanent or Temporary SolutionPartial Statements.
Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to
conduct response actions on the remaining portion(s) of the disposal site:
a. Eligible Person b. Eligible Tenant
5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)
6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement
7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051
(Section F is optional)
8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement)
(Sections E & F are not required)
(All sections of this transmittal form must be filled out unless otherwise noted above)
C. 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. Treatment of Water Supplies
5. Structure Venting System/HVAC Modification System 6. Engineered Barrier
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
15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation
17. Removal 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. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MA
iib. Facility Name:Town:State:
iii. Describe:17 YARDS IRA (JANUARY 2021)
100 YARDS IRA MOD (MARCH 2022)
b. Landfill
i. Cover Estimated volume in cubic yards
Facility Name:Town:State:
ii. Disposal Estimated volume in cubic yards
Facility Name:Town:State:
18. Removal of Drums, Tanks or Containers:
a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATER
b. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OH
c. Facility Name:Town:State:
19. Removal of Other Contaminated Media:
a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68
GALLONS/OCTOBER 2021 200 GALLONS)
b. Facility Name:TRADEBE Town:STOUGHTON State:MA
c. Facility Name:Town:State:
C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)
20. Other Response Actions:
Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY
2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY
21. Use of Innovative Technologies:
Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GW
D. SITE USE:
1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major
expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?
a. Yes b. No c. Don't know
2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?
a. Yes b. No c. Don't know
3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?
a. Yes b. No c. Don't know If Yes, identify program(s):
4. Has a Covenant Not to Sue been obtained or sought?
a. Yes b. No c. Don't know
5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authority
b. Community Development Corporation c. Economic Development and Industrial Corporation
d. Private Developer e. Fiduciary f. Secured Lender g. Municipality
h. Potential Buyer (nonowner)i. Other, describe:TRUSTEE
This data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation or
liability on the part of the party or person providing this data to MassDEP.
E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:
Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.
1. Permanent Solution with No Conditions (check one)
a. A threat of release has been eliminated.
b. All contamination has been reduced to Natural Background levels.
c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,
assumptions, or conditions (310 CMR 40.1013).
E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):
2. Permanent Solution with Conditions (check a and/or b):
a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)
i. Required pursuant to 310 CMR 40.1012(2)
Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measure
pursuant to CMR 310 40.1025?
1. Yes 2. No
ii. Optionally implemented pursuant to 310 CMR 40.1012(3)
b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):
i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential setting
ii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Background
iii. Residual contamination in a Public or Railroad RightofWay
iv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied
building or structure
3. Temporary Solution (check a or b /and c)
a. Response actions to achieve a Permanent Solution are not currently feasible
b. Response actions to achieve a Permanent Solution are feasible and are being continued toward a
Permanent Solution
c. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?
i. Yes ii. No
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION:
1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:
a. Method 1 b. Method 2 c. Method 3
d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated
2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLE
categories:
a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicable
b. S1/GW2 e. S2/GW2 h. S3/GW2
c. S1/GW3 f. S2/GW3 i. S3/GW3
3. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off all
IMPACTED categories:
a. GW1 b. GW2 c. GW3 d. No Groundwater Impacted
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):
4. Check here if the risk assessment includes any changes to the groundwater category pursuant to
310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:
a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))
b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinking
water supply (310 CMR 40.0932(5)(b))
c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))
d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))
e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply
(310 CMR 40.0932(5)(e))
5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuant
to 310 CMR 40.0924(2)(b)3.
6. Specify whether remediation was conducted:
a. Check here if soil remediation was conducted.
b. Check here if groundwater remediation was conducted.
c. Check here if other remediation was conducted.
Specify:
7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical
Methods (CAM):
a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.
c. CAM not used.
8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and Data
Representativeness Evaluation pursuant to 310 CMR 40.1056.
9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12
G. LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309
CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to the
best of my knowledge, information and belief,
> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic Review
Opinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented in
accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the
purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with
the identified provisions of all orders, permits, and approvals identified in this submittal.
I am aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit information which I
know to be false, inaccurate or materially incomplete.
1. LSP#:4303
2. First Name:DAVID C 3. Last Name:BENNETT
4. Telephone:5087377450 5. Ext.:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 9. LSP Stamp:
mm/dd/yyyy
H. PERSON MAKING SUBMITTAL:
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:
I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify:
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 Making Submittal Specify Relationship:
J. REQUIRED ATTACHMENT AND SUBMITTALS:
1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),
permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of an
AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined, the entire Disposal Site.
5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposal
site boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions. (check all that apply)
a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.
b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
c. Notice not required.d. Total number of property owners notified, if applicable:
6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
a. Notice of Activity and Use Limitation b. Number of Notices submitted:
c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.
Revised: 6/21/2016 Page 1 of 8
Revised: 6/21/2016 Page 2 of 8
Revised: 6/21/2016 Page 3 of 8
Revised: 6/21/2016 Page 4 of 8
Revised: 6/21/2016 Page 5 of 8
Revised: 6/21/2016 Page 6 of 8
Revised: 6/21/2016 Page 7 of 8
Revised: 6/21/2016 Page 8 of 8
A. SITE LOCATION:1. Site Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. ZIP Code:0266400005. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.181996. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:a. Tier I b. Tier ID c. Tier IIB. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of the Permanent or Temporary Solution Statement,or RAO Statement (if previously submitted):mm/dd/yyyy2. Submit a Permanent or Temporary Solution Statementa. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or TemporarySolution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.4. Submit a Permanent or Temporary Solution Partial StatementCheck above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having thePrimary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only aPermanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to besubmitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditionsnot covered by the Permanent or Temporary SolutionPartial Statements.Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to conduct response actions on the remaining portion(s) of the disposal site:a. Eligible Person b. Eligible Tenant5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051
(Section F is optional)
8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement)
(Sections E & F are not required)
(All sections of this transmittal form must be filled out unless otherwise noted above)
C. 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. Treatment of Water Supplies
5. Structure Venting System/HVAC Modification System 6. Engineered Barrier
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
15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation
17. Removal 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. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MA
iib. Facility Name:Town:State:
iii. Describe:17 YARDS IRA (JANUARY 2021)
100 YARDS IRA MOD (MARCH 2022)
b. Landfill
i. Cover Estimated volume in cubic yards
Facility Name:Town:State:
ii. Disposal Estimated volume in cubic yards
Facility Name:Town:State:
18. Removal of Drums, Tanks or Containers:
a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATER
b. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OH
c. Facility Name:Town:State:
19. Removal of Other Contaminated Media:
a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68
GALLONS/OCTOBER 2021 200 GALLONS)
b. Facility Name:TRADEBE Town:STOUGHTON State:MA
c. Facility Name:Town:State:
C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)
20. Other Response Actions:
Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY
2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY
21. Use of Innovative Technologies:
Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GW
D. SITE USE:
1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major
expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?
a. Yes b. No c. Don't know
2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?
a. Yes b. No c. Don't know
3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?
a. Yes b. No c. Don't know If Yes, identify program(s):
4. Has a Covenant Not to Sue been obtained or sought?
a. Yes b. No c. Don't know
5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authority
b. Community Development Corporation c. Economic Development and Industrial Corporation
d. Private Developer e. Fiduciary f. Secured Lender g. Municipality
h. Potential Buyer (nonowner)i. Other, describe:TRUSTEE
This data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation or
liability on the part of the party or person providing this data to MassDEP.
E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:
Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.
1. Permanent Solution with No Conditions (check one)
a. A threat of release has been eliminated.
b. All contamination has been reduced to Natural Background levels.
c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,
assumptions, or conditions (310 CMR 40.1013).
E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):
2. Permanent Solution with Conditions (check a and/or b):
a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)
i. Required pursuant to 310 CMR 40.1012(2)
Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measure
pursuant to CMR 310 40.1025?
1. Yes 2. No
ii. Optionally implemented pursuant to 310 CMR 40.1012(3)
b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):
i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential setting
ii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Background
iii. Residual contamination in a Public or Railroad RightofWay
iv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied
building or structure
3. Temporary Solution (check a or b /and c)
a. Response actions to achieve a Permanent Solution are not currently feasible
b. Response actions to achieve a Permanent Solution are feasible and are being continued toward a
Permanent Solution
c. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?
i. Yes ii. No
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION:
1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:
a. Method 1 b. Method 2 c. Method 3
d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated
2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLE
categories:
a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicable
b. S1/GW2 e. S2/GW2 h. S3/GW2
c. S1/GW3 f. S2/GW3 i. S3/GW3
3. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off all
IMPACTED categories:
a. GW1 b. GW2 c. GW3 d. No Groundwater Impacted
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):
4. Check here if the risk assessment includes any changes to the groundwater category pursuant to
310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:
a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))
b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinking
water supply (310 CMR 40.0932(5)(b))
c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))
d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))
e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply
(310 CMR 40.0932(5)(e))
5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuant
to 310 CMR 40.0924(2)(b)3.
6. Specify whether remediation was conducted:
a. Check here if soil remediation was conducted.
b. Check here if groundwater remediation was conducted.
c. Check here if other remediation was conducted.
Specify:
7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical
Methods (CAM):
a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.
c. CAM not used.
8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and Data
Representativeness Evaluation pursuant to 310 CMR 40.1056.
9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12
G. LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309
CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to the
best of my knowledge, information and belief,
> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic Review
Opinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented in
accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the
purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with
the identified provisions of all orders, permits, and approvals identified in this submittal.
I am aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit information which I
know to be false, inaccurate or materially incomplete.
1. LSP#:4303
2. First Name:DAVID C 3. Last Name:BENNETT
4. Telephone:5087377450 5. Ext.:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 9. LSP Stamp:
mm/dd/yyyy
H. PERSON MAKING SUBMITTAL:
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:
I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify:
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 Making Submittal Specify Relationship:
J. REQUIRED ATTACHMENT AND SUBMITTALS:
1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),
permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of an
AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined, the entire Disposal Site.
5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposal
site boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions. (check all that apply)
a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.
b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
c. Notice not required.d. Total number of property owners notified, if applicable:
6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
a. Notice of Activity and Use Limitation b. Number of Notices submitted:
c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupPERMANENT AND TEMPORARY SOLUTION STATEMENTPursuant to 310 CMR 40.1000 (Subpart J)BWSC 104 12Release Tracking Number428586For sites with multiple RTNs, enter the Primary RTN above.
Revised: 6/21/2016 Page 1 of 8
Revised: 6/21/2016 Page 2 of 8
Revised: 6/21/2016 Page 3 of 8
Revised: 6/21/2016 Page 4 of 8
Revised: 6/21/2016 Page 5 of 8
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Revised: 6/21/2016 Page 8 of 8
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.
A. SITE LOCATION:1. Site Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. ZIP Code:0266400005. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.181996. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:a. Tier I b. Tier ID c. Tier IIB. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of the Permanent or Temporary Solution Statement,or RAO Statement (if previously submitted):mm/dd/yyyy2. Submit a Permanent or Temporary Solution Statementa. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or TemporarySolution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.4. Submit a Permanent or Temporary Solution Partial StatementCheck above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having thePrimary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only aPermanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to besubmitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditionsnot covered by the Permanent or Temporary SolutionPartial Statements.Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to conduct response actions on the remaining portion(s) of the disposal site:a. Eligible Person b. Eligible Tenant5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051 (Section F is optional)8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement) (Sections E & F are not required)(All sections of this transmittal form must be filled out unless otherwise noted above)C. 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. Treatment of Water Supplies5. Structure Venting System/HVAC Modification System 6. Engineered Barrier7. 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 System15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation17. Removal of Contaminated Soilsa. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MAiib. Facility Name:Town:State:iii. Describe:17 YARDS IRA (JANUARY 2021)100 YARDS IRA MOD (MARCH 2022)b. Landfilli. Cover Estimated volume in cubic yardsFacility Name:Town:State:ii. Disposal Estimated volume in cubic yardsFacility Name:Town:State:18. Removal of Drums, Tanks or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATERb. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Facility Name:Town:State:19. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68GALLONS/OCTOBER 2021 200 GALLONS)
b. Facility Name:TRADEBE Town:STOUGHTON State:MA
c. Facility Name:Town:State:
C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)
20. Other Response Actions:
Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY
2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY
21. Use of Innovative Technologies:
Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GW
D. SITE USE:
1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major
expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?
a. Yes b. No c. Don't know
2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?
a. Yes b. No c. Don't know
3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?
a. Yes b. No c. Don't know If Yes, identify program(s):
4. Has a Covenant Not to Sue been obtained or sought?
a. Yes b. No c. Don't know
5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authority
b. Community Development Corporation c. Economic Development and Industrial Corporation
d. Private Developer e. Fiduciary f. Secured Lender g. Municipality
h. Potential Buyer (nonowner)i. Other, describe:TRUSTEE
This data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation or
liability on the part of the party or person providing this data to MassDEP.
E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:
Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.
1. Permanent Solution with No Conditions (check one)
a. A threat of release has been eliminated.
b. All contamination has been reduced to Natural Background levels.
c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,
assumptions, or conditions (310 CMR 40.1013).
E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):
2. Permanent Solution with Conditions (check a and/or b):
a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)
i. Required pursuant to 310 CMR 40.1012(2)
Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measure
pursuant to CMR 310 40.1025?
1. Yes 2. No
ii. Optionally implemented pursuant to 310 CMR 40.1012(3)
b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):
i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential setting
ii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Background
iii. Residual contamination in a Public or Railroad RightofWay
iv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied
building or structure
3. Temporary Solution (check a or b /and c)
a. Response actions to achieve a Permanent Solution are not currently feasible
b. Response actions to achieve a Permanent Solution are feasible and are being continued toward a
Permanent Solution
c. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?
i. Yes ii. No
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION:
1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:
a. Method 1 b. Method 2 c. Method 3
d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated
2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLE
categories:
a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicable
b. S1/GW2 e. S2/GW2 h. S3/GW2
c. S1/GW3 f. S2/GW3 i. S3/GW3
3. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off all
IMPACTED categories:
a. GW1 b. GW2 c. GW3 d. No Groundwater Impacted
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):
4. Check here if the risk assessment includes any changes to the groundwater category pursuant to
310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:
a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))
b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinking
water supply (310 CMR 40.0932(5)(b))
c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))
d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))
e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply
(310 CMR 40.0932(5)(e))
5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuant
to 310 CMR 40.0924(2)(b)3.
6. Specify whether remediation was conducted:
a. Check here if soil remediation was conducted.
b. Check here if groundwater remediation was conducted.
c. Check here if other remediation was conducted.
Specify:
7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical
Methods (CAM):
a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.
c. CAM not used.
8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and Data
Representativeness Evaluation pursuant to 310 CMR 40.1056.
9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12
G. LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309
CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to the
best of my knowledge, information and belief,
> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic Review
Opinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented in
accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the
purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with
the identified provisions of all orders, permits, and approvals identified in this submittal.
I am aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit information which I
know to be false, inaccurate or materially incomplete.
1. LSP#:4303
2. First Name:DAVID C 3. Last Name:BENNETT
4. Telephone:5087377450 5. Ext.:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 9. LSP Stamp:
mm/dd/yyyy
H. PERSON MAKING SUBMITTAL:
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:
I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify:
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 Making Submittal Specify Relationship:
J. REQUIRED ATTACHMENT AND SUBMITTALS:
1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),
permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of an
AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined, the entire Disposal Site.
5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposal
site boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions. (check all that apply)
a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.
b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
c. Notice not required.d. Total number of property owners notified, if applicable:
6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
a. Notice of Activity and Use Limitation b. Number of Notices submitted:
c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupPERMANENT AND TEMPORARY SOLUTION STATEMENTPursuant to 310 CMR 40.1000 (Subpart J)BWSC 104 12Release Tracking Number428586For sites with multiple RTNs, enter the Primary RTN above.Revised: 6/21/2016 Page 1 of 8
Revised: 6/21/2016 Page 2 of 8
Revised: 6/21/2016 Page 3 of 8
Revised: 6/21/2016 Page 4 of 8
Revised: 6/21/2016 Page 5 of 8
Revised: 6/21/2016 Page 6 of 8
Revised: 6/21/2016 Page 7 of 8
Revised: 6/21/2016 Page 8 of 8
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.
A. SITE LOCATION:1. Site Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. ZIP Code:0266400005. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.181996. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:a. Tier I b. Tier ID c. Tier IIB. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of the Permanent or Temporary Solution Statement,or RAO Statement (if previously submitted):mm/dd/yyyy2. Submit a Permanent or Temporary Solution Statementa. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or TemporarySolution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.4. Submit a Permanent or Temporary Solution Partial StatementCheck above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having thePrimary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only aPermanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to besubmitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditionsnot covered by the Permanent or Temporary SolutionPartial Statements.Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to conduct response actions on the remaining portion(s) of the disposal site:a. Eligible Person b. Eligible Tenant5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051 (Section F is optional)8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement) (Sections E & F are not required)(All sections of this transmittal form must be filled out unless otherwise noted above)C. 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. Treatment of Water Supplies5. Structure Venting System/HVAC Modification System 6. Engineered Barrier7. 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 System15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation17. Removal of Contaminated Soilsa. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MAiib. Facility Name:Town:State:iii. Describe:17 YARDS IRA (JANUARY 2021)100 YARDS IRA MOD (MARCH 2022)b. Landfilli. Cover Estimated volume in cubic yardsFacility Name:Town:State:ii. Disposal Estimated volume in cubic yardsFacility Name:Town:State:18. Removal of Drums, Tanks or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATERb. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Facility Name:Town:State:19. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68GALLONS/OCTOBER 2021 200 GALLONS)b. Facility Name:TRADEBE Town:STOUGHTON State:MAc. Facility Name:Town:State:C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)20. Other Response Actions:Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY21. Use of Innovative Technologies:Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GWD. SITE USE:1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?a. Yes b. No c. Don't know2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?a. Yes b. No c. Don't know3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?a. Yes b. No c. Don't know If Yes, identify program(s):4. Has a Covenant Not to Sue been obtained or sought?a. Yes b. No c. Don't know5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authorityb. Community Development Corporation c. Economic Development and Industrial Corporationd. Private Developer e. Fiduciary f. Secured Lender g. Municipalityh. Potential Buyer (nonowner)i. Other, describe:TRUSTEEThis data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation orliability on the part of the party or person providing this data to MassDEP.E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.1. Permanent Solution with No Conditions (check one)a. A threat of release has been eliminated.
b. All contamination has been reduced to Natural Background levels.
c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,
assumptions, or conditions (310 CMR 40.1013).
E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):
2. Permanent Solution with Conditions (check a and/or b):
a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)
i. Required pursuant to 310 CMR 40.1012(2)
Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measure
pursuant to CMR 310 40.1025?
1. Yes 2. No
ii. Optionally implemented pursuant to 310 CMR 40.1012(3)
b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):
i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential setting
ii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Background
iii. Residual contamination in a Public or Railroad RightofWay
iv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied
building or structure
3. Temporary Solution (check a or b /and c)
a. Response actions to achieve a Permanent Solution are not currently feasible
b. Response actions to achieve a Permanent Solution are feasible and are being continued toward a
Permanent Solution
c. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?
i. Yes ii. No
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION:
1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:
a. Method 1 b. Method 2 c. Method 3
d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated
2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLE
categories:
a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicable
b. S1/GW2 e. S2/GW2 h. S3/GW2
c. S1/GW3 f. S2/GW3 i. S3/GW3
3. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off all
IMPACTED categories:
a. GW1 b. GW2 c. GW3 d. No Groundwater Impacted
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):
4. Check here if the risk assessment includes any changes to the groundwater category pursuant to
310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:
a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))
b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinking
water supply (310 CMR 40.0932(5)(b))
c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))
d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))
e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply
(310 CMR 40.0932(5)(e))
5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuant
to 310 CMR 40.0924(2)(b)3.
6. Specify whether remediation was conducted:
a. Check here if soil remediation was conducted.
b. Check here if groundwater remediation was conducted.
c. Check here if other remediation was conducted.
Specify:
7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical
Methods (CAM):
a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.
c. CAM not used.
8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and Data
Representativeness Evaluation pursuant to 310 CMR 40.1056.
9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12
G. LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309
CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to the
best of my knowledge, information and belief,
> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic Review
Opinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented in
accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the
purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with
the identified provisions of all orders, permits, and approvals identified in this submittal.
I am aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit information which I
know to be false, inaccurate or materially incomplete.
1. LSP#:4303
2. First Name:DAVID C 3. Last Name:BENNETT
4. Telephone:5087377450 5. Ext.:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 9. LSP Stamp:
mm/dd/yyyy
H. PERSON MAKING SUBMITTAL:
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:
I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify:
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 Making Submittal Specify Relationship:
J. REQUIRED ATTACHMENT AND SUBMITTALS:
1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),
permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of an
AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined, the entire Disposal Site.
5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposal
site boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions. (check all that apply)
a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.
b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
c. Notice not required.d. Total number of property owners notified, if applicable:
6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
a. Notice of Activity and Use Limitation b. Number of Notices submitted:
c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupPERMANENT AND TEMPORARY SOLUTION STATEMENTPursuant to 310 CMR 40.1000 (Subpart J)BWSC 104 12Release Tracking Number428586For sites with multiple RTNs, enter the Primary RTN above.Revised: 6/21/2016 Page 1 of 8Revised: 6/21/2016 Page 2 of 8
Revised: 6/21/2016 Page 3 of 8
Revised: 6/21/2016 Page 4 of 8
Revised: 6/21/2016 Page 5 of 8
Revised: 6/21/2016 Page 6 of 8
Revised: 6/21/2016 Page 7 of 8
Revised: 6/21/2016 Page 8 of 8
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.
A. SITE LOCATION:1. Site Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. ZIP Code:0266400005. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.181996. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:a. Tier I b. Tier ID c. Tier IIB. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of the Permanent or Temporary Solution Statement,or RAO Statement (if previously submitted):mm/dd/yyyy2. Submit a Permanent or Temporary Solution Statementa. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or TemporarySolution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.4. Submit a Permanent or Temporary Solution Partial StatementCheck above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having thePrimary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only aPermanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to besubmitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditionsnot covered by the Permanent or Temporary SolutionPartial Statements.Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to conduct response actions on the remaining portion(s) of the disposal site:a. Eligible Person b. Eligible Tenant5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051 (Section F is optional)8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement) (Sections E & F are not required)(All sections of this transmittal form must be filled out unless otherwise noted above)C. 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. Treatment of Water Supplies5. Structure Venting System/HVAC Modification System 6. Engineered Barrier7. 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 System15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation17. Removal of Contaminated Soilsa. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MAiib. Facility Name:Town:State:iii. Describe:17 YARDS IRA (JANUARY 2021)100 YARDS IRA MOD (MARCH 2022)b. Landfilli. Cover Estimated volume in cubic yardsFacility Name:Town:State:ii. Disposal Estimated volume in cubic yardsFacility Name:Town:State:18. Removal of Drums, Tanks or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATERb. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Facility Name:Town:State:19. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68GALLONS/OCTOBER 2021 200 GALLONS)b. Facility Name:TRADEBE Town:STOUGHTON State:MAc. Facility Name:Town:State:C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)20. Other Response Actions:Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY21. Use of Innovative Technologies:Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GWD. SITE USE:1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?a. Yes b. No c. Don't know2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?a. Yes b. No c. Don't know3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?a. Yes b. No c. Don't know If Yes, identify program(s):4. Has a Covenant Not to Sue been obtained or sought?a. Yes b. No c. Don't know5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authorityb. Community Development Corporation c. Economic Development and Industrial Corporationd. Private Developer e. Fiduciary f. Secured Lender g. Municipalityh. Potential Buyer (nonowner)i. Other, describe:TRUSTEEThis data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation orliability on the part of the party or person providing this data to MassDEP.E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.1. Permanent Solution with No Conditions (check one)a. A threat of release has been eliminated.b. All contamination has been reduced to Natural Background levels.c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,assumptions, or conditions (310 CMR 40.1013).E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):2. Permanent Solution with Conditions (check a and/or b):a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)i. Required pursuant to 310 CMR 40.1012(2)Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measurepursuant to CMR 310 40.1025?1. Yes 2. Noii. Optionally implemented pursuant to 310 CMR 40.1012(3)b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential settingii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Backgroundiii. Residual contamination in a Public or Railroad RightofWayiv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied building or structure3. Temporary Solution (check a or b /and c)a. Response actions to achieve a Permanent Solution are not currently feasibleb. Response actions to achieve a Permanent Solution are feasible and are being continued toward a Permanent Solutionc. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?i. Yes ii. NoF. PERMANENT AND TEMPORARY SOLUTION INFORMATION:1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:a. Method 1 b. Method 2 c. Method 3d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLEcategories:a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicableb. S1/GW2 e. S2/GW2 h. S3/GW2c. S1/GW3 f. S2/GW3 i. S3/GW33. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off allIMPACTED categories:a. GW1 b. GW2 c. GW3 d. No Groundwater Impacted
F. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):
4. Check here if the risk assessment includes any changes to the groundwater category pursuant to
310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:
a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))
b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinking
water supply (310 CMR 40.0932(5)(b))
c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))
d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))
e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply
(310 CMR 40.0932(5)(e))
5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuant
to 310 CMR 40.0924(2)(b)3.
6. Specify whether remediation was conducted:
a. Check here if soil remediation was conducted.
b. Check here if groundwater remediation was conducted.
c. Check here if other remediation was conducted.
Specify:
7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical
Methods (CAM):
a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.
c. CAM not used.
8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and Data
Representativeness Evaluation pursuant to 310 CMR 40.1056.
9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12
G. LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309
CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to the
best of my knowledge, information and belief,
> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic Review
Opinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented in
accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the
purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with
the identified provisions of all orders, permits, and approvals identified in this submittal.
I am aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit information which I
know to be false, inaccurate or materially incomplete.
1. LSP#:4303
2. First Name:DAVID C 3. Last Name:BENNETT
4. Telephone:5087377450 5. Ext.:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 9. LSP Stamp:
mm/dd/yyyy
H. PERSON MAKING SUBMITTAL:
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:
I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify:
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 Making Submittal Specify Relationship:
J. REQUIRED ATTACHMENT AND SUBMITTALS:
1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),
permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of an
AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined, the entire Disposal Site.
5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposal
site boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions. (check all that apply)
a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.
b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
c. Notice not required.d. Total number of property owners notified, if applicable:
6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
a. Notice of Activity and Use Limitation b. Number of Notices submitted:
c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupPERMANENT AND TEMPORARY SOLUTION STATEMENTPursuant to 310 CMR 40.1000 (Subpart J)BWSC 104 12Release Tracking Number428586For sites with multiple RTNs, enter the Primary RTN above.Revised: 6/21/2016 Page 1 of 8Revised: 6/21/2016 Page 2 of 8Revised: 6/21/2016 Page 3 of 8
Revised: 6/21/2016 Page 4 of 8
Revised: 6/21/2016 Page 5 of 8
Revised: 6/21/2016 Page 6 of 8
Revised: 6/21/2016 Page 7 of 8
Revised: 6/21/2016 Page 8 of 8
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.
A. SITE LOCATION:1. Site Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. ZIP Code:0266400005. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.181996. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:a. Tier I b. Tier ID c. Tier IIB. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of the Permanent or Temporary Solution Statement,or RAO Statement (if previously submitted):mm/dd/yyyy2. Submit a Permanent or Temporary Solution Statementa. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or TemporarySolution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.4. Submit a Permanent or Temporary Solution Partial StatementCheck above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having thePrimary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only aPermanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to besubmitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditionsnot covered by the Permanent or Temporary SolutionPartial Statements.Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to conduct response actions on the remaining portion(s) of the disposal site:a. Eligible Person b. Eligible Tenant5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051 (Section F is optional)8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement) (Sections E & F are not required)(All sections of this transmittal form must be filled out unless otherwise noted above)C. 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. Treatment of Water Supplies5. Structure Venting System/HVAC Modification System 6. Engineered Barrier7. 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 System15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation17. Removal of Contaminated Soilsa. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MAiib. Facility Name:Town:State:iii. Describe:17 YARDS IRA (JANUARY 2021)100 YARDS IRA MOD (MARCH 2022)b. Landfilli. Cover Estimated volume in cubic yardsFacility Name:Town:State:ii. Disposal Estimated volume in cubic yardsFacility Name:Town:State:18. Removal of Drums, Tanks or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATERb. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Facility Name:Town:State:19. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68GALLONS/OCTOBER 2021 200 GALLONS)b. Facility Name:TRADEBE Town:STOUGHTON State:MAc. Facility Name:Town:State:C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)20. Other Response Actions:Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY21. Use of Innovative Technologies:Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GWD. SITE USE:1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?a. Yes b. No c. Don't know2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?a. Yes b. No c. Don't know3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?a. Yes b. No c. Don't know If Yes, identify program(s):4. Has a Covenant Not to Sue been obtained or sought?a. Yes b. No c. Don't know5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authorityb. Community Development Corporation c. Economic Development and Industrial Corporationd. Private Developer e. Fiduciary f. Secured Lender g. Municipalityh. Potential Buyer (nonowner)i. Other, describe:TRUSTEEThis data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation orliability on the part of the party or person providing this data to MassDEP.E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.1. Permanent Solution with No Conditions (check one)a. A threat of release has been eliminated.b. All contamination has been reduced to Natural Background levels.c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,assumptions, or conditions (310 CMR 40.1013).E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):2. Permanent Solution with Conditions (check a and/or b):a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)i. Required pursuant to 310 CMR 40.1012(2)Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measurepursuant to CMR 310 40.1025?1. Yes 2. Noii. Optionally implemented pursuant to 310 CMR 40.1012(3)b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential settingii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Backgroundiii. Residual contamination in a Public or Railroad RightofWayiv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied building or structure3. Temporary Solution (check a or b /and c)a. Response actions to achieve a Permanent Solution are not currently feasibleb. Response actions to achieve a Permanent Solution are feasible and are being continued toward a Permanent Solutionc. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?i. Yes ii. NoF. PERMANENT AND TEMPORARY SOLUTION INFORMATION:1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:a. Method 1 b. Method 2 c. Method 3d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLEcategories:a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicableb. S1/GW2 e. S2/GW2 h. S3/GW2c. S1/GW3 f. S2/GW3 i. S3/GW33. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off allIMPACTED categories:a. GW1 b. GW2 c. GW3 d. No Groundwater ImpactedF. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):4. Check here if the risk assessment includes any changes to the groundwater category pursuant to 310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinkingwater supply (310 CMR 40.0932(5)(b))c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply (310 CMR 40.0932(5)(e))5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuantto 310 CMR 40.0924(2)(b)3.6. Specify whether remediation was conducted:a. Check here if soil remediation was conducted.b. Check here if groundwater remediation was conducted.c. Check here if other remediation was conducted.Specify:7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical Methods (CAM):a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.c. CAM not used.8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and DataRepresentativeness Evaluation pursuant to 310 CMR 40.1056.9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12
G. LSP SIGNATURE AND STAMP:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309
CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to the
best of my knowledge, information and belief,
> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic Review
Opinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented in
accordance with the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, (ii) is (are) appropriate and reasonable to accomplish the
purposes of such response action(s) as set forth in the applicable provisions of M.G.L. c. 21E and 310 CMR 40.0000, and (iii) comply(ies) with
the identified provisions of all orders, permits, and approvals identified in this submittal.
I am aware that significant penalties may result, including, but not limited to, possible fines and imprisonment, if I submit information which I
know to be false, inaccurate or materially incomplete.
1. LSP#:4303
2. First Name:DAVID C 3. Last Name:BENNETT
4. Telephone:5087377450 5. Ext.:6. Email:
7. Signature:DAVID C BENNETT
8. Date:7/18/2022 9. LSP Stamp:
mm/dd/yyyy
H. PERSON MAKING SUBMITTAL:
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:
I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify:
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 Making Submittal Specify Relationship:
J. REQUIRED ATTACHMENT AND SUBMITTALS:
1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),
permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of an
AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined, the entire Disposal Site.
5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposal
site boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions. (check all that apply)
a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.
b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
c. Notice not required.d. Total number of property owners notified, if applicable:
6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
a. Notice of Activity and Use Limitation b. Number of Notices submitted:
c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupPERMANENT AND TEMPORARY SOLUTION STATEMENTPursuant to 310 CMR 40.1000 (Subpart J)BWSC 104 12Release Tracking Number428586For sites with multiple RTNs, enter the Primary RTN above.Revised: 6/21/2016 Page 1 of 8Revised: 6/21/2016 Page 2 of 8Revised: 6/21/2016 Page 3 of 8Revised: 6/21/2016 Page 4 of 8
Revised: 6/21/2016 Page 5 of 8
Revised: 6/21/2016 Page 6 of 8
Revised: 6/21/2016 Page 7 of 8
Revised: 6/21/2016 Page 8 of 8
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.
A. SITE LOCATION:1. Site Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. ZIP Code:0266400005. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.181996. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:a. Tier I b. Tier ID c. Tier IIB. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of the Permanent or Temporary Solution Statement,or RAO Statement (if previously submitted):mm/dd/yyyy2. Submit a Permanent or Temporary Solution Statementa. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or TemporarySolution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.4. Submit a Permanent or Temporary Solution Partial StatementCheck above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having thePrimary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only aPermanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to besubmitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditionsnot covered by the Permanent or Temporary SolutionPartial Statements.Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to conduct response actions on the remaining portion(s) of the disposal site:a. Eligible Person b. Eligible Tenant5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051 (Section F is optional)8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement) (Sections E & F are not required)(All sections of this transmittal form must be filled out unless otherwise noted above)C. 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. Treatment of Water Supplies5. Structure Venting System/HVAC Modification System 6. Engineered Barrier7. 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 System15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation17. Removal of Contaminated Soilsa. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MAiib. Facility Name:Town:State:iii. Describe:17 YARDS IRA (JANUARY 2021)100 YARDS IRA MOD (MARCH 2022)b. Landfilli. Cover Estimated volume in cubic yardsFacility Name:Town:State:ii. Disposal Estimated volume in cubic yardsFacility Name:Town:State:18. Removal of Drums, Tanks or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATERb. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Facility Name:Town:State:19. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68GALLONS/OCTOBER 2021 200 GALLONS)b. Facility Name:TRADEBE Town:STOUGHTON State:MAc. Facility Name:Town:State:C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)20. Other Response Actions:Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY21. Use of Innovative Technologies:Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GWD. SITE USE:1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?a. Yes b. No c. Don't know2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?a. Yes b. No c. Don't know3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?a. Yes b. No c. Don't know If Yes, identify program(s):4. Has a Covenant Not to Sue been obtained or sought?a. Yes b. No c. Don't know5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authorityb. Community Development Corporation c. Economic Development and Industrial Corporationd. Private Developer e. Fiduciary f. Secured Lender g. Municipalityh. Potential Buyer (nonowner)i. Other, describe:TRUSTEEThis data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation orliability on the part of the party or person providing this data to MassDEP.E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.1. Permanent Solution with No Conditions (check one)a. A threat of release has been eliminated.b. All contamination has been reduced to Natural Background levels.c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,assumptions, or conditions (310 CMR 40.1013).E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):2. Permanent Solution with Conditions (check a and/or b):a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)i. Required pursuant to 310 CMR 40.1012(2)Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measurepursuant to CMR 310 40.1025?1. Yes 2. Noii. Optionally implemented pursuant to 310 CMR 40.1012(3)b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential settingii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Backgroundiii. Residual contamination in a Public or Railroad RightofWayiv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied building or structure3. Temporary Solution (check a or b /and c)a. Response actions to achieve a Permanent Solution are not currently feasibleb. Response actions to achieve a Permanent Solution are feasible and are being continued toward a Permanent Solutionc. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?i. Yes ii. NoF. PERMANENT AND TEMPORARY SOLUTION INFORMATION:1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:a. Method 1 b. Method 2 c. Method 3d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLEcategories:a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicableb. S1/GW2 e. S2/GW2 h. S3/GW2c. S1/GW3 f. S2/GW3 i. S3/GW33. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off allIMPACTED categories:a. GW1 b. GW2 c. GW3 d. No Groundwater ImpactedF. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):4. Check here if the risk assessment includes any changes to the groundwater category pursuant to 310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinkingwater supply (310 CMR 40.0932(5)(b))c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply (310 CMR 40.0932(5)(e))5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuantto 310 CMR 40.0924(2)(b)3.6. Specify whether remediation was conducted:a. Check here if soil remediation was conducted.b. Check here if groundwater remediation was conducted.c. Check here if other remediation was conducted.Specify:7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical Methods (CAM):a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.c. CAM not used.8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and DataRepresentativeness Evaluation pursuant to 310 CMR 40.1056.9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12G. 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 alldocuments accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to thebest of my knowledge, information and belief,> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic ReviewOpinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented inaccordance 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) comply(ies) withthe 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 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 9. LSP Stamp:mm/dd/yyyyH. PERSON MAKING SUBMITTAL:1. Check all that apply:a. change in contact name b. change of address c. change in the personundertaking response actions2. Name of Organization:AMY MACISAAC REVOCABLE TRUST3. 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:
I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:
Check here to change relationship
1. RP or PRP a. Owner b. Operator c. Generator d. Transporter
e. Other RP or PRP Specify:
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 Making Submittal Specify Relationship:
J. REQUIRED ATTACHMENT AND SUBMITTALS:
1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),
permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicable
provisions thereof.
2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of an
AUL.
3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a
Permanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.
4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of the
Disposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statement
for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,
to the extent defined, the entire Disposal Site.
5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposal
site boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the party
conducting response actions. (check all that apply)
a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.
b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to the
Department.
c. Notice not required.d. Total number of property owners notified, if applicable:
6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of each
implemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (required
for Permanent Solution with Conditions Statements where an AUL is being implemented)
a. Notice of Activity and Use Limitation b. Number of Notices submitted:
c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupPERMANENT AND TEMPORARY SOLUTION STATEMENTPursuant to 310 CMR 40.1000 (Subpart J)BWSC 104 12Release Tracking Number428586For sites with multiple RTNs, enter the Primary RTN above.Revised: 6/21/2016 Page 1 of 8Revised: 6/21/2016 Page 2 of 8Revised: 6/21/2016 Page 3 of 8Revised: 6/21/2016 Page 4 of 8Revised: 6/21/2016 Page 5 of 8
Revised: 6/21/2016 Page 6 of 8
Revised: 6/21/2016 Page 7 of 8
Revised: 6/21/2016 Page 8 of 8
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.
A. SITE LOCATION:1. Site Name/Location Aid:HOME HEATING OIL SPILL2. Street Address:24 CHARLES STREET3. City/Town:YARMOUTH 4. ZIP Code:0266400005. Coordinates:a. Latitude: N 41.67034 b. Longitude: W 70.181996. Check here if the disposal site that is the source of the release is Tier Classified. Check the current Tier Classification Category:a. Tier I b. Tier ID c. Tier IIB. THIS FORM IS BEING USED TO: (check all that apply)1. List Submittal Date of the Permanent or Temporary Solution Statement,or RAO Statement (if previously submitted):mm/dd/yyyy2. Submit a Permanent or Temporary Solution Statementa. Check here if this Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.3. Submit a Revised Permanent or Temporary Solution Statement (or revised RAO Statement)a. Check here if this Revised Permanent or Temporary Solution Statement covers additional Release Tracking Numbers (RTNs),not listed on the Permanent or Temporary Solution Statement or previously submitted Revised Permanent or TemporarySolution Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here.b. Provide the additional Release Tracking Number(s) covered by thisPermanent or Temporary Solution Statement.4. Submit a Permanent or Temporary Solution Partial StatementCheck above box, if any Response Actions remain to be taken to address conditions associated with this disposal site having thePrimary RTN listed in the header section of this transmittal form. This Permanent or Temporary Solution Statement will record only aPermanent or Temporary SolutionPartial Statement for that RTN. A final Permanent or Temporary Solution Statement will need to besubmitted that references all Permanent or Temporary SolutionPartial Statements and, if applicable, covers any remaining conditionsnot covered by the Permanent or Temporary SolutionPartial Statements.Also, specify if you are an Eligible Person or Tenant pursuant to M.G.L. c. 21 s.2, and have no further obligation to conduct response actions on the remaining portion(s) of the disposal site:a. Eligible Person b. Eligible Tenant5. Submit a Revised Permanent or Temporary Solution Partial Statement (or revised RAOPartial Statement)6. Submit an optional Phase I Completion Statement supporting the Permanent or Temporary Solution Statement7. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution, as specified in 310 CMR 40.1051 (Section F is optional)8. Submit a Retraction of a previously submitted Permanent or Temporary Solution Statement (or RAO Statement) (Sections E & F are not required)(All sections of this transmittal form must be filled out unless otherwise noted above)C. 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. Treatment of Water Supplies5. Structure Venting System/HVAC Modification System 6. Engineered Barrier7. 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 System15. Monitored Natural Attenuation 16. InSitu Chemical Oxidation17. Removal of Contaminated Soilsa. Reuse, Recycling or Treatment i. On Site Estimated volume in cubic yardsii. Off Site Estimated volume in cubic yards 117iia. Facility Name:ONDRICK MATERIALS AND RECYCLING Town:CHICOPEE State:MAiib. Facility Name:Town:State:iii. Describe:17 YARDS IRA (JANUARY 2021)100 YARDS IRA MOD (MARCH 2022)b. Landfilli. Cover Estimated volume in cubic yardsFacility Name:Town:State:ii. Disposal Estimated volume in cubic yardsFacility Name:Town:State:18. Removal of Drums, Tanks or Containers:a. Describe Quantity and Amount:8 DRUMS OILY SOIL AND 1 DRUM LNAPL/OILY WATERb. Facility Name:SPRING GROVE RESOURCE RECOVERY Town:CINCINNATI State:OHc. Facility Name:Town:State:19. Removal of Other Contaminated Media:a. Specify Type and Volume:VACTRUCK RECOVERY OF OILY WATER AND LNAPL MW1/IW1 (2X) 268 GALLONS [AUGUST 2021 68GALLONS/OCTOBER 2021 200 GALLONS)b. Facility Name:TRADEBE Town:STOUGHTON State:MAc. Facility Name:Town:State:C. DESCRIPTION OF RESPONSE ACTIONS (cont.): (check all that apply; for volumes, list cumulative amounts)20. Other Response Actions:Describe:DISPOSE OF IMPACTED LUMBER FROM FORMER TRENCH BOX: 3000 LBS NORTHLAND ENVIRONMENTAL PROVIDENCE, RI (MAY2022), THERMAL REGENERATION: 2200 LB GAC DRUMS CARBON ACTIVATED CORPORATION BLASDELL, NY21. Use of Innovative Technologies:Describe:REGENOX CHEMICAL OXIDATION TREATMENT: 2280 LBS PART A, 440 LBS PART B BOH/GWD. SITE USE:1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major expansion of the current use of property(ies) impacted by the presence of oil and/or hazardous materials?a. Yes b. No c. Don't know2. Is the property a vacant or underutilized commercial or industrial property ("a brownfield property")?a. Yes b. No c. Don't know3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies) within the disposal site?a. Yes b. No c. Don't know If Yes, identify program(s):4. Has a Covenant Not to Sue been obtained or sought?a. Yes b. No c. Don't know5. Check all applicable categories that apply to the person making this submittal:a. Redevelopment Agency or Authorityb. Community Development Corporation c. Economic Development and Industrial Corporationd. Private Developer e. Fiduciary f. Secured Lender g. Municipalityh. Potential Buyer (nonowner)i. Other, describe:TRUSTEEThis data will be used by MassDEP for information purposes only, and does not represent or create any legal commitment, obligation orliability on the part of the party or person providing this data to MassDEP.E. PERMANENT OR TEMPORARY SOLUTION CATEGORY:Specify the category of Solution that applies to the Disposal Site, or Site of the Threat of Release. Select either 1, 2, or 3.1. Permanent Solution with No Conditions (check one)a. A threat of release has been eliminated.b. All contamination has been reduced to Natural Background levels.c. A condition of No Significant Risk exists or has been achieved with no Activity and Use Limitation or other limitations,assumptions, or conditions (310 CMR 40.1013).E. PERMANENT OR TEMPORARY SOLUTION CATEGORY (cont.):2. Permanent Solution with Conditions (check a and/or b):a. An AUL has been implemented pursuant to 310 CMR 1012(2) (check one)i. Required pursuant to 310 CMR 40.1012(2)Is the AUL required because the Permanent Solution relies on an Active Exposure Pathway Mitigation Measurepursuant to CMR 310 40.1025?1. Yes 2. Noii. Optionally implemented pursuant to 310 CMR 40.1012(3)b. Limitations or conditions apply pursuant to 310 CMR 40.1013 (check all that apply):i. Gardening Best Management Practices (BMPs) for noncommercial gardening in a residential settingii. Concentrations of Oil and Hazardous Material consistent with Anthropogenic Backgroundiii. Residual contamination in a Public or Railroad RightofWayiv. Groundwater contamination would exceed GW2 Standards except for the absence of an occupied building or structure3. Temporary Solution (check a or b /and c)a. Response actions to achieve a Permanent Solution are not currently feasibleb. Response actions to achieve a Permanent Solution are feasible and are being continued toward a Permanent Solutionc. Does the Temporary Solution rely on an Active Exposure Pathway Mitigation Measure pursuant to 310 CMR 40.1026?i. Yes ii. NoF. PERMANENT AND TEMPORARY SOLUTION INFORMATION:1. Specify the Risk Characterization Method(s) used to achieve the Permanent or Temporary Solution, described above:a. Method 1 b. Method 2 c. Method 3d. Method Not ApplicableContamination reduced to or consistent with background, or Threat of Release abated2. Specify all Soil Category(ies) applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLEcategories:a. S1/GW1 d. S2/GW1 g. S3/GW1 j. Not Applicableb. S1/GW2 e. S2/GW2 h. S3/GW2c. S1/GW3 f. S2/GW3 i. S3/GW33. Specify all Groundwater Category(ies) impacted. A site may impact more than one Groundwater Category. Be sure to check off allIMPACTED categories:a. GW1 b. GW2 c. GW3 d. No Groundwater ImpactedF. PERMANENT AND TEMPORARY SOLUTION INFORMATION (cont.):4. Check here if the risk assessment includes any changes to the groundwater category pursuant to 310 CMR 40.0932(5)(a) through (e). Check all conditions that apply:a. An InterimWellhead Protection Area does not apply based on a hydrogeologic evaluation (310 CMR 40.0932(5)(a))b. Groundwater was determined not to be in a Potentially Productive Aquifer or is not feasible to be developed as a drinkingwater supply (310 CMR 40.0932(5)(b))c. A NonPotential DrinkingWater Source Area determination was made (310 CMR 40.0932(5)(c))d. Existing private wells were permanently closed (310 CMR 40.0932(5)(d))e. Groundwater is located within a Zone A, but is not hydrogeologically connected to a drinking water supply (310 CMR 40.0932(5)(e))5. Check here if the Permanent or Temporary Solution supports a finding of No Significant Risk for petroleum in a GW1 area pursuantto 310 CMR 40.0924(2)(b)3.6. Specify whether remediation was conducted:a. Check here if soil remediation was conducted.b. Check here if groundwater remediation was conducted.c. Check here if other remediation was conducted.Specify:7. Specify whether the analytical data used to support the Permanent or Temporary Solution used the Compendium of Analytical Methods (CAM):a. CAM used to support all analytical data.b. CAM used to support some of the analytical data.c. CAM not used.8. Check here to indicate that the Permanent or Temporary Solution Statement includes a Data Usability Assessment and DataRepresentativeness Evaluation pursuant to 310 CMR 40.1056.9. Estimate the number of acres this Permanent or Temporary Solution Statement applies to:0.12G. 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 alldocuments accompanying this submittal. In my professional opinion and judgment based upon application of (i) the standard of care in 309CMR 4.02(1), (ii) the applicable provisions of 309 CMR 4.02(2) and (3), and 309 CMR4.03(2), and (iii) the provisions of 309 CMR 4.03(3), to thebest of my knowledge, information and belief,> if Section B indicates that either a Permanent or Temporary Solution Statement, Phase I Completion Statement and/or Periodic ReviewOpinion is being provided,the response action(s) that is (are) the subject of this submittal (i) has (have) been developed and implemented inaccordance 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) comply(ies) withthe 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 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 9. LSP Stamp:mm/dd/yyyyH. PERSON MAKING SUBMITTAL:1. Check all that apply:a. change in contact name b. change of address c. change in the personundertaking response actions2. 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:I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAKING SUBMITTAL:Check here to change relationship1. RP or PRP a. Owner b. Operator c. Generator d. Transportere. Other RP or PRP Specify: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 Making Submittal Specify Relationship:J. REQUIRED ATTACHMENT AND SUBMITTALS:1. Check here if the Permanent or Temporary Solution on which this opinion is based, if any, are (were) subject to any order(s),permit(s) and/or approval(s) issued by DEP or EPA. If the box is checked, you MUST attach a statement identifying the applicableprovisions thereof.2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of aPermanent or Temporary Solution Statement that relies on the public way/rail rightofway exemption from the requirements of anAUL.3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of aPermanent or Temporary Solution Statement with instructions on how to obtain a full copy of the report.4. Check here to certify that documentation is attached specifying the location of the Site, or the location and boundaries of theDisposal Site subject to this Permanent or Temporary Solution Statement. If submitting a Permanent or Temporary Solution Statementfor a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,to the extent defined, the entire Disposal Site.5. Check here to certify that, pursuant to 310 CMR 40.1406, notice was provided to the owner(s) of each property within the disposalsite boundaries, or notice was not required because the disposal site boundaries are limited to property owned by the partyconducting response actions. (check all that apply)a. Notice was provided prior to, or concurrent with the submittal of a Phase II Completion Statement to the Department.b. Notice was provided prior to, or concurrent with the submittal of this Permanent or Temporary Solution Statement to theDepartment.c. Notice not required.d. Total number of property owners notified, if applicable:6. Check here if you are submitting one or more AULs. You must submit an AUL Transmittal Form (BWSC113) and a copy of eachimplemented AUL related to this Permanent Solution or Temporary Solution Statement. Specify the type of AUL(s) below: (requiredfor Permanent Solution with Conditions Statements where an AUL is being implemented)a. Notice of Activity and Use Limitation b. Number of Notices submitted:c. Grant of Environmental Restriction d. Number of Grants submitted:
7. If a Permanent Solution Compliance Fee is required for any of the RTNs listed on this transmittal form, check here to certify that a
Permanent Solution Compliance Fee was submitted to DEP, P. O. Box 4062, Boston, MA 02211.
8. Check here if any nonupdatable information provided on this form is incorrect, e.g. Site Address/Location Aid. Send corrections
to bwsc.edep@state.ma.us.
9. Check here to certify that the LSP Opinion containing the material facts, data, and other information is attached.
K. CERTIFICATION OF PERSON MAKING SUBMITTAL:
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 those individuals immediately responsible for obtaining the information, the material information
contained in this submittal is, to the best of my knowledge and belief, true, accurate and complete, and (iii) that I am fully authorized to make
this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made
am/is aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for willfully submitting false,
inaccurate, or incomplete information.
2. By:AMY MACISAAC 3. Title:
Signature
4. For:AMY MACISAAC REVOCABLE TRUST 5. Date:7/18/2022
(Name of person or entity recorded in Section H)mm/dd/yyyy
6. Check here if the address of the person providing certification is different from address recorded in Section H.
7. Street:
8. City/Town:9. State:10. ZIP Code:
11. Telephone:12. Ext.:13. Email:
YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO $10,000 PER
BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT
SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU
SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE.
Date Stamp (DEP USE ONLY:)
Received by DEP on 7/18/2022 2:00:03 PM
Massachusetts Department of Environmental ProtectionBureau of Waste Site CleanupPERMANENT AND TEMPORARY SOLUTION STATEMENTPursuant to 310 CMR 40.1000 (Subpart J)BWSC 104 12Release Tracking Number428586For sites with multiple RTNs, enter the Primary RTN above.Revised: 6/21/2016 Page 1 of 8Revised: 6/21/2016 Page 2 of 8Revised: 6/21/2016 Page 3 of 8Revised: 6/21/2016 Page 4 of 8Revised: 6/21/2016 Page 5 of 8Revised: 6/21/2016 Page 6 of 8
Revised: 6/21/2016 Page 7 of 8
Revised: 6/21/2016 Page 8 of 8
Massachusetts Department of Environmental Protection
Bureau of Waste Site Cleanup
PERMANENT AND TEMPORARY SOLUTION STATEMENT
Pursuant to 310 CMR 40.1000 (Subpart J)
BWSC 104 12
Release Tracking Number
4 28586
For sites with multiple RTNs, enter the Primary RTN above.