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HomeMy Public PortalAboutBOH7.7.21packetTown of Brewster Board of Health $ ,4 `l, ,, E `��� 5- �, 2198 Main St., Brewster, MA 02631 U '�[ I brhealth®brewster-ma.gov _ ` co 1 (508) 896-3701 • if rHCOAP.$1X'So BOARD OF HEALTH MEETING AGENDA(Revised) 2198 Main Street Board of Health Penny Holeman Annette Graczewski Joe Ford Jeannie Kampas Kimberley Crocker Pearson Health Director Amy Von Hone Assistant Health Director Sherrie McCullough Senior Department Assistant Tammi Mason July 7, 2021 at 7:00PM Pursuant to Chapter 20 of the Acts of 2421, this meeting will be conducted in psrson and via remote means, in accordance with applicable lav This means that members of the public body may access this meeting in person, or via virtual means. In person attendance will be at the meetir location listed above, and it is possible that any or all members of the public body may attend remotely. No in -parson attendance of members c the public will be permitted, and public partbcipation In any public hearing conducted during tMs meeting shall be by remote means only. Membei of the public who whish to access the meeting may do so in the Following manner: Phone, Call (301)715-8592 or (312)626.6799. Webinar Ib- 820 4394 4509 Passcode: 979174 To request to speak: Press •9 and wait to be recognized. Zoom Webinar.'htt usO2Web.zoom.vs ' 820439445997 wd=M M2kvUExKbUIR hmM 1Zb3d zo9 Passcode:979174 To request to speak: Tap Zoom "Raise Hand', then wait to be recognized. When required by law or allowed by the Chair, persons wishing to provide public comment or otherwise participate in the meeting, may do so b' accessing the meeting remotely, as noted above. Additionally, the meeting will be broadcast live, In real time, via Live broadcast (Brewste Government N Channel 18), Lives tream (lives treom.bre wster-ma.90V) or Video recording (tv.brewster-ma.gov) 1. Call to Order 2. Chairman's announcements 3. Citizens forum 4. Jeff Prall - Leaching Facility Setback Regulation variance request - 40 Daisy Lane 5. Public Hearing .- Tobacco Regulations G. Beach/pond water quality update 7. Consent Agenda: a. Cape Cod Museum of Natural History -- RetaiI Food Permit b• 181 Timberlane Drive - in-house septic variance c, Cafe Alfresco - Food Service Permit 8. Liaison reports 9. Matters not reasonably anticipated by the Chair 10. Next meeting, July 21, 2021 11. informational items: a. Monthly report for Ocean Edge - b; Monthly report for Pleasant Bay Health & Living c. Monthly report for Maplewood at Brewster d. Monthly report for Wingate e. Quarterly report for Wingate f. Monthly report for Cape Cod Sea Camps g. Consumer Confidence Report Certification - Brewster Water Department 12. Adjournment Date Posted: Date Revised: Received by Town Clerk: 7/7/2021 7/2/2021 NA-11althXBOH Agendas and Minutes and Remote SchedulelBQF) AgendaslJu[y721a.dbcx TOWN OF BR WSTER 2198 MAIN STIMET BREWSTER, MA 02631 PRONE: (508) 896-3701 ExT 1120 FAx:(508)896-4538 BRHEALTI.1 BREWSTER-MA.GOV ww W .BREW STER—NSA.GO V Received: ,- I/ Paid: A /K C Abutter Deadline: Date Ga -- I -L -- 2 Z Z - OFFICE OF HEALTH DEPARTMENT Application for Board of Health Variances ❑In -House Local Upgrade Approval Public Hearing SUBJECT PROPERTY ADDRESS: `io Dms L. /-- c Map: 5 to Parcel: Book: Page: LC Certificate: LC Plan: Lot: Name of ApOcant:rnr- 1Pt.^-LL Mailing Address: "O ' vj!L 5 u i td row MA - Telephone A,Telephone # _ �►�� G10 –Ira b% Email: Owner(s) of Record -J0;f4;LCLj V C Nltllid e'er %Q C7 la 7� � Mailing Address:'' Design Engineer/Sanitarian: Mailing Address: Telephone #: Email address: Firm/Company Name: Signature: Q� —qj tcant ❑ ngineer IQNS 0— cok-k'%CA%,T =N Fst' New Construction ❑ Voluntary Upgrade ❑Addition/Alteration ❑ Failed system ❑ Real Estate Transfer X � �'� C1a�eL. Design flow of existing system: S�L� ro PD Reason for failure: 3ta0 Design flow of proposed system:1`� ,600 Total sewage flow of site: Total lot size (sf]: Conservation Commission approval required: yes ❑ no R Order of Conditions/Det. Of Applicability attached ❑ Date of ConCom hearing: Brewster Re • #: Descri tion of Variance(s) �cc), sus p�iE wc -- xi515 � L���t� Ptd �4� irL D1�1L� Approved by: Health Department ate: M%iealth\130 H regsllnliouse Septic Local Upgrade Approval 2019Warianceapplication FINAL NONFILLABLE FORM 12.18.19.doex w [U 1 W T --FAQ J 'rLl,,V i 6A 5 E M AIL• S. • � �; � �4�t? Ul b►1�:t�1 IAI� C�r� C� �' �� Tio W ilil T (T(, V P.A s t 1 fai(, UA, -4UOu W9 f T,4 - " o -R -o u1o"LD P.4SS Y 4i A D9) + 71 by t'W4 t� tr�dwtkr�•t'�" 'P1t,6�t .�+5 i �' u1 Lo C'AAJ L T6 VV1 o w (�Qu f- kcAlt uelo lls9b a -To L�PpralN,(o (ASbO U-fi t air a I 00 -c"rt.,t. uuf. 04a - to , e-5r� n CT(0LfiNt is ���ALC-- ZOZ7L . To Doe S mor ccz�w C-wl -lQ re, (�r"a Cod S,%mofrok Wo ujq Cryisiw-uOC 0%,kCO fL 9CGVirQEP . V\A��� t�►a-cry a rl or 5izr- or- L07" kf,x 100, MID wo--. ,,Lb 100 5r,-�d& W4t--W OT -zo c's a L V Q ft -^-O E--, R ,� rt45 1r_ Q. or _ ' �� _ », •ter �• � r dF I Ir iL h- 0- 'a' 0 '' SJIrt- 3�i El ATTOOOoz.txt El ATTOO003.txt 3 c E m [0 m N 9 a i r ri K� A � m O O m W Q m m $ C O 22: 3 W 61 m � a � to �a qm lfliff!!lf _9 zg �I�IIIIEI❑❑I� ri I If Nil I If RI 00 Oo ir | | | | | | § 2 § E 2 | 2| � ! ■ z ! k }\ f§ 2 7 I 2 ■ ! $ E | § , i & ! - R • � " Town of Brewster OFFICEOF. BOARD OF HEALTH BREWSTER, MASSACHUSETTS 02631-1898 (508) 896-3701 EXT.#20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM APPENDIX BREWSTER REGULATION Map �b Lot 1. a Property Address: 40 Daisy Ln Other Address: Name of Inspector: Darrell Stone Company Name, Address, and Phone Number: Cape Cod Septic Inspection (50811-240-2500 PO Box 1466, fast Harwich MA 02845 Date of Inspection: 6-7-2021 This inspection represents (Check One) Real Estate Transfer UX Alteration/Addition A) System Passes B) System Conditionally Passes Septic tank covers are more than 12 inches below the finished grade. x C) Further Evaluation is required by the Board of Health x The leaching facility or facilities are located within Soo feet of a pond or lake. Records show excessive pumping three or more times within any eighteen (18) month period for residential or commercial property; except for required grease trap maintenance for commercial property. D) System Fails (Brewster Real Estate Transfer Regulation requirements) The system is in a state of disrepair such that it cannot function as it was originally intended: The lack of a 4 food protective zone between the bottom of the system and the groundwater; Any other problem as defined by the Board of Health or its Director; The sewage disposal system consists of a single cesspool, or cesspools. The Brewster Health Department has reviewed and accepted this report based on the information contained therein. This inspection reflects the present condition of the Sanitary System and is not any guarantee as to the life or future condition of said system. [late Approving Authority Please be advised of ADDITIONAL BOARD OF HEALTH REGULATIONS: 1. All private welts are required to be analyzed prior to approval of the Subsurface Sewage Disposal System Inspection Form, and sixty (50) days prior to transfer of property. 2. All underground tanks must be registered with Board of Health and are subject to testing requirements. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln Property Address CJ P Trust Owner Owner's Name informrequired is Brewster MA 02631 6-7-2021 required fvr every page. Cityfrown State Zip Cede Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When A. Inspector Information filling out forms on the computer, use only the tab Darrell Stone key to move your Name of inspector cursor - do not Cape Cod Septic Inspection use the return Company Name key. P.D. Box 1466 f r� Company Address Harwich Ma 02645 Cltyrrown State Zip Code �A (5013) 240-2500 514995 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 6 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Condition ly Passes 3. ® Needs urt r Evaluatio y e L Approving Authority 4. ❑ Fails �r 6-10-2021 inspe t s Signa Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5iri p.doc • rev. 712612018 TAle 5 Official bnspeclien F=: subsurface Sewage 015posak Sys€em • Page 1 of 18 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Dail Ln- property Address UP Trust Owner Owner's Name information is required for every Brewster MA 02631 6-7-2021 page. Cltyrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1 y System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ one or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. if "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5lnsp.doc • rev, 712812018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln Property Address CJP Trust Owner Owner's Name information is required for every Brewster MA 82631 6-7-2021 page, City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Heaith approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND {Explain below}: ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3] Further Evaluation Is Required by the Board of Health; ® Conditions exist which require further evaluation by the Hoard of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: t5iriap.dao - rev. X2812018 'Tile 5 oftclal InVecuan Form: Sulxsurfaoe Sewage ❑Esposal System • Page 3 of TB Ovener information is required for every page. Commonwealth of Massachusetts Title a Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Daisy Ln Property Address CJ P Trust Owner's Name Brewster CitylTown C. Inspection Summary (cont.) MA 02631 6-7-2021 State Zip Code Date of Inspection ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Hoard of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other' The leaching facility is within 300' of a pond 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5lnsp. d7c • rev. 712612018 Tile 5 of daI Inspectiarl Fa M: Subsurface 3oveage pisposaI Syslam - Paye 4 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln Property Address CJ P Trust Owner's Name Brewster C ityTrown C. Inspection Summary (cont.) MA 02531 6-7-2021 State Zip Code Date of Inspection 4) System Failure Criteria Applicable to All Systems: (cant.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 5" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool c privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must he attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails, The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 90,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well t5nsp.doo • rev. 7f2612016 TAle 5 Official Inspection kern Subsurface Sewaga ❑isposat Sys€em . Page 5 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln - Property Address CJP Trust Owner's Name Brewster Cityffown C. Inspection Summary {cont.} MA O2631 5-7-2021 State Zip Code Date of Inspection If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 314 CMR 15.304. The system owner should contact the appropriate regional office of the Department. S. You must indicate "yes" or "no" for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® [] Were all system components, Excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System DSAS] on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] fstnsp.doc • rev. 712612015 TN 5 0f idaf Inspection Fcrrn Subsurface Sewage Wsposal System • nage 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln property Address CJP Trust Owner Owner's Name information is required for every Brewster MA 02631 6-7-2021 page. City[Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.233 (for example: 110 gpd x # of bedrooms): 330 Description: 3 bedroom residential dwelling Number of current residents: Does residence have a garbage grinder`? Does residence have a water treatment unit? If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)}: Detail: 2020 - 24,000 gal 2019 - 15,000 gal ❑ Yes ® No ❑ Yes ® No ❑ Yes ® N o ❑ Yes ® No ® Yes ❑ No 53.4 gpd- - —_ Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5inap-cmc • rev- M512016 Title 5 Offldal Inspection Form: SosLxface Sewage Dlspasal System • Page 7 of 18 . �Cy - Commonwealth of Massachusetts �gTitle 5 official Inspection Form i Subsurface Sewage Disposal System form - Not for Voluntary Assessments 40 Dais Ln � Or Property Address CJP Trust Owner Owner's Name Information is Brewster MA 02831 E-7-2021 required for every page. CityrFown State Zip Code date of inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seatslpersonslsq.ft., etc.): Grease trap present? Water treatment unit present? If yes, discharges to: Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if avallab#e: Last date of occupancy/use: Other (describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ N o ❑ Yes ❑ No 912017 Discount Septic Pumping (508) 240-2500 ga ❑ Yes ® No 1151nsp.&C - rev. 7111512018 TR% 5 afflclsI Inspection Form: Subsurface Sewage Disposal System • Page 0 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form kg-lti Subsurface Sewage Disposal System Form Not for Voluntary Assessments D. System information (cont.) MA 02631 6-7-2021 State Zip Code Data of Inspection 4. Type of system: ® Septic tante, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 1995 per BoH Were sewage odors detected when arriving at the site? 5. Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): 27"+1 - feet Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Apparent good condition ❑ Yes ® No t5hsp.doc . rev. 7 12 6120 1 8 TOW 5 official Inspection Form: Subsurface Sewage Disposal System • PS90 9 of 18 40 Daisy Ln Property Address CJ P Trust Owner Owner's Dame information is Brewster required for every page. Cityrrown D. System information (cont.) MA 02631 6-7-2021 State Zip Code Data of Inspection 4. Type of system: ® Septic tante, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 1995 per BoH Were sewage odors detected when arriving at the site? 5. Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): 27"+1 - feet Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Apparent good condition ❑ Yes ® No t5hsp.doc . rev. 7 12 6120 1 8 TOW 5 official Inspection Form: Subsurface Sewage Disposal System • PS90 9 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln Property Address CJ P Trust Owner's Mame Brewster CitylTown D. System Information {cont.} 6. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal if tank is metal, list age: MA 02631 6-7-2021 State Zip Code Date of Inspection 22" feet ❑ fiberglass ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1 QOQ gallon Dimensions: 5PI Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 27" 112" 1311 16" Sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grade to inlet cover 10" Outlet 12" Normal liquid level No sign of leakage SCH 40 outlet tee Recommended next maintenance pumping within 1.5 years Recommended maintenance pumping every 2-3 years tUnsp.do-- • rev. 712 612 01 8 Title 5 Official Insgedion Frim: S4bsuffaCe Sewage I]FaposaI System • Page 10 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln Property Address CJP Trust Owner owner's Name Information is Brewster MA 02631 £-7-2021 required for every page. GityfT'own State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle feet ❑ polyethylene ❑ other (explain): Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Capacity: Design Flow: i5lnsp.doc • rev. 7126!2010 ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day Title 5 om:?el Inspection Form: swswace Sewage Msposel System • Page 11 of 18 0,Nner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Daisy Ln Property Address CJP Trust Owner's Name Brewster MA 02631 $-7-2421 City/Town State Zip Code Date of Inspection D. System Information (coat.) S. Tight or Holding Tank (cont.) Alarm present: Alarm level: Date of last pumping: [] Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). is copy attached? 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N ❑ Yes ❑ No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Grade to box 2" GK condition T outlet Normal liquid level No scum No sign of leakage No sign of failure t5d,mp.doc • rev. 712612018 Title 5 official Mspectlon Farm: Subsurface Sewage Disposal System • Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments 40 Daisy Ln Property Address COP Trust Owner Owner's Name information is required for every Brewster MA 02631 6-7-2021 Page. City/Town State Zip Code Date of Inspection D. System Information {cant.} 10. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * if pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: 1 Wimp. cloc • red. MUM 16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 16 Commonwealth of Massachusetts U Title 5 official Insp Subsurface Sewage Disposal System Icor 40 Dais Ln D. System Information {cont.} 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1, (64') pit with stone Grade to SAS 66" Cover to grade Bottom 145" Ponding 6" No sign of hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan). Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5imp.dac - rev. 712812018 iille 5 Oficial Inspeclim Form; Suhsurface Sewage disposal System - Page 14 of 18 Form m - Not for Voluntary Assessments Property Address UP Trust Owner Owner's Mame information is required for every Brewster MA 02631 6-7-2621 page, City/Town State Zip Code Date of Inspection D. System Information {cont.} 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1, (64') pit with stone Grade to SAS 66" Cover to grade Bottom 145" Ponding 6" No sign of hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan). Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5imp.dac - rev. 712812018 iille 5 Oficial Inspeclim Form; Suhsurface Sewage disposal System - Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln Property Address CJP Trust Owner Owner's Name information is Brewster MA 02639 6-7-2021 required for eery page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.); I6�nep.doo • rev. 7!2612018 Titte 5 Official Inepec[ion Form: SubBGrrace sewage DispoGal Spslem • Paga 15 of 18 Commonwealth of Massachusetts p Title 5 Official Insp Subsurface Sewage Disposal System For r 40 Daisy Ln D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet, locate where public water supply enters the building, Check one of the boxes below: ® nand -sketch in the area below ❑ drawing attached separately REAR A __2 I � 3 4 t4 d ic pond 2 l5in:T.doc • rev. 7/26/2018 7ille 5 Offiaal Inapertion Form: Subsurface Sewage Disposal System • Page 16 of 18 �Ib- D 35- iD � Sts- $ ection Form m - Not for Voluntary Assessments Property Address CJP Trust Owner Owner's Name information is required for every Brewster MA 02031 6-7-2021 page. City[Town state Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet, locate where public water supply enters the building, Check one of the boxes below: ® nand -sketch in the area below ❑ drawing attached separately REAR A __2 I � 3 4 t4 d ic pond 2 l5in:T.doc • rev. 7/26/2018 7ille 5 Offiaal Inapertion Form: Subsurface Sewage Disposal System • Page 16 of 18 �Ib- D 35- iD � Sts- $ 5- I Commonwealth of Massachusetts r 1 Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �n 40 Daisy Ln D. System information (cont.) MA 02631 6-7-2021 State Zip Code Date of Inspection 15. Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >4feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: nntg - ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: test hole results from plan dated 511311980 ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Shot elevations during the inspection Grade over pit ELV. 50.0 Assumed Bottom of SAS ELV- 37.92 Pond ELV. 32.08 Separation =5.84 Before filing this Inspection Report, please see Report Completeness Checklist on next page. ffm5p.dflc - rev- 7/26/2019 -r itle 5 ofris ad Inspeclion Form: Subsurface Soveage ❑Isposal Sy vem - Pags 17 of 15 Property Address CJP Trust Owner Owner's Name information is Brewster required for every page. CitylTown D. System information (cont.) MA 02631 6-7-2021 State Zip Code Date of Inspection 15. Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >4feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: nntg - ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: test hole results from plan dated 511311980 ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Shot elevations during the inspection Grade over pit ELV. 50.0 Assumed Bottom of SAS ELV- 37.92 Pond ELV. 32.08 Separation =5.84 Before filing this Inspection Report, please see Report Completeness Checklist on next page. ffm5p.dflc - rev- 7/26/2019 -r itle 5 ofris ad Inspeclion Form: Subsurface Soveage ❑Isposal Sy vem - Pags 17 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Daisy Ln Property Address CJP Trust Owner's name Brewster MA 02631 6-7-2021 Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® S. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank — Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc • rev. 712"18 Title 5 Official In"dico Form: Subsurface 5aws90 anspassI System • Paga 18 of 18 TOWN OF BREWSTER ADDENDUM TO DEP SEPTIC INSPECTION REPORT Inspection Location 40 Daisy Ln 1. Residential Propegy Bedrooms {incl. den, sewing room, office) 3 Family Rooms Living Rooms 1 Bathrooms 3 Dining Rooms I Kitchens 1 Other: Total: 9 2. Floor Plan: Show all floors including basement: F Map & Parcel Commercial PML* Employees Toilets Rooms with Bath Square Feet -- ir ... �:. -7 - kL_IF-4i Ilii I k Lt I- I --- 3. is the septic system, as inspected, in full compliance with either Yes X No the 1978 (X__) or 1995 (!) Title S code? If not, list deficiencies 4. Is the system in the Zone 11 (Water Resource Protection Yes No X District)? Lot size: 1 TOWN OF BREWSTER ADDENDUM TO DEP SEPTIC INSPECTION REPORT Inspection Location 40 Daisy Ln Map & Parcel 5. Is there a 4' separation (1978 code) or a 5' separation (1995 code) Yes X No between the bottom of the S.A.S. and adjusted groundwater? TOP OF FOUNDATION 6. Town Water (X) or Private Well (__) Distance from nearest septic system component: 10'+ 7. Wetlands or surface water within 100' of septic system? Yes No X Distance from nearest septic system component: 100'+ 8. Groundwater flow direction 9. Type of pipe used in system PVC X Orangeberg Other 10 Sanitary tees or baffles in place (Yes —No — NIA?) Septic tank inlet Yes Septic tank outlet Yes Pump chamber inlet nla D -box inlet if pumped system n/a Grease trap inlet nla Grease trap outlet nla Risers —1978 code within 12 inches of grade on septic tank Yes Risers —1995 code within 6 inches of grade on all components nla One inspection port on S.A.S. (1995 code) Yes K Town. of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896,3701 EXT, 1120 FAX: 508.896.4538 brlicalth@,brewster-ina.gov W W W.BREW STER-MA.GOV AGENDA ACTION ITEM FORM BOH Variance Agenda Item In -House Local Upgrade Approval ❑ Other: ❑ Board of Health Meeting Date: July 7, 2021 Project Location: 40 Daisy Lane Map & Parcel: 56179 Owner's Name & Address: Jeffrey & Cynthia Prall c/o CJP Trust 80 Hayden Rowe Street Hopkinton, MA 01748 Applicant: same as above Date Requested: June 22, 2021 Health Department Amy L, von Hone, R.S., C.H.Q. Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Title 5 Variance Request: Yes❑ No❑ Board of Health Variance Request: Yes® No❑300' Pond Setback Other: Yes ❑ No ❑ 1. Outside Zone II and Town Water 2. In ESA — existing dwelling and septic system within 140' +1- of Schoolhouse Pond 3. Real Estate Transfer Inspection June 7, 2021 for Proposed Addition Health Director's Comments and Recommendations: 1. The property consists of an existing 3 bedroom dwelling with a 1995 Title 5 septic system consisting of a 1000 gal septic tank, distribution box, and a 6' leach pit with 2' stone approved for a 3 bedroom dwelling per office records. The property borders the southeasterly side of Schoolhouse Pond. The existing septic leach pit is approximately 140' from the closest edge of the pond and approximately 5.84' +1_ above the edge of the pond elevation per the June 7, 2021 Title 5 Inspection Report. The leach pit is not showing signs of hydraulic failure (6" ponding in a 72" deep pit). 2. The applicant is proposing a 14' x 36' addition to the existing dwelling. The addition will consist of a garage and family room. No additional bedrooms are proposed. M: Health\BOH Meeting Not&BOH Hearing Notes140 Daisy Ln M56P79 AgendaNariance Action Item Form 07.07.2021.docx 3. Per the Water Table Map of Brewster and Harwich, groundwater is flowing northwesterly towards the pond. Based on the location of the leach pit, the pit is located upgradient of Schoolhouse Pond. 4. Map References: Cape Cod Water Resources Classification Map I, 5/18/2010 (Map referenced in approved BOH Regulation Regarding Variance Requests for On -Site Sewage Disposal System Applications): lot and septic system are located within the Freshwater Recharge Area. Septic System Buffers and Groundwater Flow Directions near Brewster's Ponds, 1/26/2016 (Map referenced in Draft SOH Regulation of Sewage Disposal Systems to Protect Surface Waters and Pond Water Quality, 2016): the lot and septic system are located within proposed septic system setback delineated boundary. Draft regulation not currently approved by BOH. Septic system pre-existed draft regulation and map. Water -Table Map of Brewster and Harwich, 1987 (Map referenced in approved BOH Regulation Regarding Variance Requests for On -Site Sewage Disposal System Applications): septic system located upgradient of southeasterly end of pond. 5. Title 5: no variances requested — pre-existing conditions Town of Brewster: a. SAS 140' to Pond edgelBVW, 160' variance request per Leach Facility Set Back Regulation (5) 5. Approval with the following reasons: a. Septic system has a passed Title 5 Inspection Report dated 06/07/2021 and indicates the system is properly functioning. b. The leach facility is greater than the minimum 5' separation above the pond elevation/groundwater required under Title 5 regulations. Per file records, the leach facility, is approximately 5.84' above groundwater/pond elevation. c. The proposed addition will not increase sewage flow to the existing septic system. The existing septic system is large enough to accommodate the existing 3 bedrooms and the proposed addition (non -bedroom space). The proposed addition does not meet the Title 5 Definition of New Construction: New Construction - The construction of a new building for which an occupancy permit is required or an increase in the actual or design flow to any system or an increase in the actual or design flow to any nonconforming system or an increase in the design flow to any system above the existing approved capacity. New construction shall not include replacement or repair of a building in existence as of March 31, 1995 that has been totally or partially destroyed or demolished, provided there is no -increase in design flaw, no increase in design flow above the existing approved capacity to any system, no increase in the number of dwellings or dwelling units or no increase in the number of bedrooms in any dwelling or dwelling unit. N:1Health\BOH Meeting NotesTOH Hearing NotesA0 Daisy Ln M5 6P79 Agend a. Vari ance Action ]tem Form 07.07.2021. do ex �•— _ _ � r- �����. - --- —� _ �r y � lt�Iliifl�f� it Iflfli I 1 }Il�f as #�� I f .3'x'1.�:+ b ��5 �i LAW wo z- PO es Classification Map Ieoe_ T•! 16s Regional Policy Plan (Effective January 16, 2009) Amended -- Effective July g, 2009 Amended -- EfiFeLtive June 18, 2olo _P_rirnary Resource Areas: 1 _ � WeWleadProtectivnAreas ldeWted We,l:head ProteMn. areas: (Zones of Contribution). Cepartment of Environmental Pratecticn and ECFA M 5.GIS 2010, Cape Cod CCmmTssiOn Water Resources Staff, aDd various private comulling firms. - Public Supply Wells ® Public Water Supply Well Sruall Volume lArelh, Nen Transient T Small Volume Wells, Transient r-1 ProposM Public Wates Supply Well B Surface Water Supply Locations of public cnmmunWy surface and groundwater supply sources and public Iron-commnity supply sources. Department of Environ rldrA d Protection and EDEA MassGIS 2010, and Cape Cad Commesstin Water ResGui-ces Staff. Potential Water Supply Areas Potential Public Water Supply Tracts: From the Trto ity Land Aeg7Asition Assessfmnt projed' (PLAAP), June 1999, updated BOB. Lower CWe data Rom the Lower Cape Water Quality Task Farce, 2001. Freshwater Recharge Arens Freshwater Recharge Area: Areas shown are those identified T6 DATE by the USGS (see reports 24109.5014 and 2009.5281), the Massachdseds Fstuades Project, and the Cape Calf Comrniwon Water Resources Staff, 2008. Water Quality Impaired Areas Developed Areas Development such as medium and high density residential, mull family resklential, unsewered rdsidential cels kss than 20,000 square feet, commercial and lnCvstrial areas determined from dlg,tal parcel and assessors' data and MacConneII landuse: 1999. Created by UMass-Amherst Resource Mapping Project in cooperation with the EIFA MassGIS project and the Cape Cod CcarrTAs5bri. Potential Plumes from Waste Sites Potential PfuRjas from Waste Sete Areas: Created from private consulting frets, the Air Farce Center for Engineering and the Envircomeni and the Cape Cod Ca m- 10m Water Resources Staff. Waste Site Areas Areas that atckrde landfiTs, septage, and wastewater trcatment plant discharge s tis determined from &glsal parcel and assessors' data and dlglW Macconnell land use: 1999. Created by the UMass-Amherst Resource Mapping Projed in cooperation with the EDEA MBssGIS project acrd the Cape Cod Commission. Water Quality Improvement Areas: Water Quality Impaired Areas that are located in Primary Resource Areas, Ttds Map was produoad by the[alm Cod CarrxnWaWs Ckmgtaphic ki*nraton System Deparbnent for the Reglanar Policy Plan update, effact Jammy Ik 28179, MM any amu dmmts rioted beimv: Data .xoendmenbs efrac ve 34 3, I009lrwk g PER 2Drle Hs, rrrr Njbk 5rq>prpry Weft, and On Pope Cod COMMd TOO KMP. Data amemc.nenrs EgKi vet kine 18, 2014 indud7rg Wellhead Notes m teas and DEP MCrc9ipply Wells. I -lie Cape Cod Gormatsim's a division (if Bamstable Cai*. CARectldns are iVdmme at the Cape Cad Commis5:4M o[rrce or ontact t,s�alx�a korrxn,ssiaT.oag. This map rs ilru5tratiye a0d all QepktedbOLYcdades areappm�[m7ate. Et Is intended for planrGng papDms 001y --not Site 5peaT7c pugmes. CAP[ COD COMMISSION 7 4b i. r■ ►rr�.a�:l:: 0 Z M ? '� jY r,' r 1 I �!n'{ sn!n i!i l� 'it inti 1t r ♦ ..f.. r.ti Np f f n Li I 1 1 l i [a VI rnrlF 1 }I[Y ? 1 1 x Ln z F ml AIfI 91 -<{ 1p o l 1 I i ;rtj.,61 1 e lf 0 ` f>SAl l ' Uf inpl v f� o t <(l I ry-r lay f i 1 , : �.. �.�, •: .� ir a1 y. �r ,•' u min Np uJ I 7� r S `; '�� �' / •. I I I r} I{! Pico001 U),' � ` •',•r� i 1 1 �1 � �r��` ''r LOUblur NO 1 PN m k fm N W� �• \ N C, to In e 1 yi::• V.I,•..I:-i f i lr �' :E:- IA /r' 141 �_ .j - Ca Fri to f TI 7 1 fill 0-,- TZ Z - zi;! 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G1 q Do W O Q ni >a Ilr:-Ut In )LI '0 1 r D ry 0 M� r�- m ' C � I s Z u�Q 111 p o z 0 z 0 3 C s o�tl I Cf i C • n� 0 z r.• 1�v� z,+ts,. n A o n ��qq pISTR181176ON Fr 90% CwaTreR TICtHT] NOTE:_ c)LITLET PSAE TO IaE LEVEL FoR I'! 2 FT { + Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brh eal th @brewster-mago v W W W.BREWSTER-MA.GOV Health Department Amy L. von Hone, R.S., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant BREWSTER BOARD OF HEALTH REGULATION RESTRICTING THE SALE OF TOBACCO AND NICOTINE DELIVERY PRODUCTS THIS REGULATION INCORPORATES THE FOLLOWING: 1. The minimum standards required pursuant to the United States Food and Drug Administration on the sale and distribution of cigarettes; and 2. The minimum standards required pursuant to Massachusetts state law and regulation. This includes but is not limited to M.G.L. Chapter 270 regarding sales to those under the minimum legal sales age of 21, tobacco and vaping product sales including flavored products, required signage, matching definitions and other relevant state statutes and regulations, as of September 2020. A. Statement of Purpose: Whereas there exists conclusive evidence that tobacco smoking causes cancer, respiratory and cardiac diseases, negative birth outcomes, irritations to the eyes, nose and throat/; Whereas the U.S. Department of Health and Human Services has concluded that nicotine is as addictive as cocaine or heroin' and the Surgeon General found that nicotine exposure during adolescence, a critical window for brain development, may have lasting adverse consequences for brain development,3 and that it is addiction to nicotine that keeps youth smoking past adolescence; Whereas. a Federal District Court found that Phillip Morris, RJ Reynolds and other leading cigarette manufacturers "spent billions of dollars every year on their marketing activities in order to encourage young people to try and then continue purchasing their cigarette products in order to provide the replacement smokers they need to survive" and that these companies were likely to continue targeting underage smokers 5; Center for Disease Control and Prevention, (CDC) (2012), Health Effects of Cigarette Smoking Fact Sheet. Retrieved from: http://www.ede.gov/tobacco/data_statistice/fact_sheets/health_effects/effects_ cig_smokinglindex. htm. 2 CDC (2010), How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking -Attributable Disease. Retrieved from: http://www.cdc.gov/tobacco/data—statisties/sgr/20 10/. 3 U.S. Department of Health and Human Services. 2014. The Health Consequences of Smoking— 50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, p. 122. Retrieved from: http://www.surgeongeneral.gov/library/ reports/ 50-years-of-progress/full-report.pdf. a Id. at Executive Summary p. 13. Retrieved from: http://www.surgeongeneral.gov/library/reports/50-years-of-progresslexec- summary.pdf s United Statesy. Phillip Morris, Inc., RJ Reynolds Tobacco Co., et al., 449 F.Supp.2d I (D.D.C. 2006) at Par. 3301 and Pp. 1605-07. 1 llfileserver 161rdo cum ents$lttn asonlDesktopltobac coregs2 l .doc Whereas more than 80 percent of all adult smokers begin smoking before the age of 18, more than 90 percent do so before leaving their teens, and more than 3.5 million middle and high school students smoke6; Whereas cigars and cigarillos, can be sold in a single "dose;" enjoy a relatively low tax as compared to cigarettes; are available in fruit, candy and alcohol flavors; and are popular among youth; Whereas research shows that increased cigar prices significantly decreased the probability of male adolescent cigar use and a 10% increase in cigar prices would reduce use by 3.4%8; Whereas 59% of high school smokers in Massachusetts have tried flavored cigarettes or flavored cigars and 25,6% of them are current flavored tobacco product users; 95.1 % of 12 — 17 year old's who smoked cigars reported smoking cigar brands that were flavored9; Whereas the Surgeon General found that exposure to tobacco marketing in stores and price discounting increase youth smokingt°; Whereas the U.S. Food and Drug Administration and the U.S. Surgeon General have stated that flavored tobacco products are considered to be "starter" products that help establish smoking habits that can lead to long- term addictionll; Whereas the U.S. Surgeon General recognized in his 2014 report that a complementary strategy to assist in eradicating tobacco -related death and disease is for local governments to ban categories of products from retail sale 12; Whereas the U.S. Food and Drug Administration and the Tobacco Products Scientific Advisory Committee concluded that menthol flavored tobacco products increased nicotine dependence, decreased success in smoking cessation 13; Whereas menthol makes it easier for youth to initiate tobacco usei . 5 SAMHSA, Calculated based on data in 2011 National Survey on Drug Use and Health and U. S. Department of Health and Human services (HRA). CDC (2009), Youth Risk Behavior, Surveillance Summaries (MMWR 2010: 59, 12, note 5). Retrieved from: http:www.cdc.gov/mmwr/pdf/ss/ss5905.pdf. a Ringel, J., Wasserman, J., & Andreyeva, T. (2005) Effects of Public Policy on Adolescents' Cigar Use: Evidence from the National Youth Tobacco Survey, American Journal of Public Health, 95(6), 995-998, doi: 10.2105/AJPH.2003.030411 and cited in Cigar, Cigarillo and Little Cigar Use among Canadian Youth: Are We Underestimating the Magnitude of this Problem?, J. Prim. P. 2011, Aug: 32(3-4):161-70. Retrieved from: www.nebi.nim.gov/pubmed/21809109. 9 Massachusetts Department of Public Health, 2015 Massachusetts Youth Health Survey (MYHS); Delneve CD et al., Tob Control, March 2014: Preference for flavored cigar brands among youth, young adults and adults in the USA. " U.S. Department of Health and Human Services. 2012. Preventing Tobacco Use among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, p. 508-530, Nnvw.szrr eon e�ieral. ovllibra Ire ortsl reverrtin - ozrtlr-tobacco-zrsel rtll-re or . t, d Food and Drug Administration. 2011. Fact Sheet: Flavored Tobacco Products, www. da. ovldownloadslTobaccoPr•oductslProtectin Kids romTobaccolFlavoredTobaccolUCM183214. d ; U.S. Department of Health and Human Services. 2012. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, p. 539, ivww surgeongerret•aLgovliibrarylreportslpreventing_voreth-tobacco-us!LIL?rll-reporl. d . 11 See th. 3 at p. 85. 13 www.fda.gov/downloads/ucm361598.pdf, Https:Htobacco,ucsf.edu/tpsac-gave-fda-what-it-needs-to-ban-menthol 14 www. tobaccofreekids.org/assets/factsheet/4390.pdf llfi leserver 161rdocuments$ltmasonlDesktopltobaccoregs2 1. doc Whereas use of e -cigarettes among students in Massachusetts is 20.1%, representing a 78% increase for high schoolers and a 48% increase for middle schoolers from 2017 to 201815; Whereas the Massachusetts Department of Environmental Protection has classified liquid nicotine in any amount as an "acutely hazardous waste" 16; Whereas according to the CDC's youth risk behavior surveillance system, the percentage of high school students in Massachusetts who reported the use of cigars within the past 30 days was 10.8% in 201317 Whereas data from the National Youth Tobacco Survey indicate that more than two-fifths of U.S. middle and high school smokers report using flavored little cigars or flavored cigarettes 18 ; Whereas the Massachusetts Supreme Judicial Court has held that " ... [t]he right to engage in business must yield to the paramount right of government to protect the public health by any rational means"19. Whereas Communities that are densely populated with tobacco retailers make it easier for youths to obtain tobacco products. Also, because retail outlets are a key marketing channel for tobacco products, a high density of tobacco retailers in a neighborhood creates a concentration of tobacco marketing, meaning children, youth and adults living in those neighborhoods will be exposed to multiple environmental cues designed to encourage tobacco use. Whereas Studies have shown that youth who live and go to schools in neighborhoods with the highest density of tobacco outlets (or with the highest density of retail tobacco advertising) have higher smoking rates compared to youth who live, or attend school, in neighborhoods with fewer or no tobacco outlets. Whereas Studies have also shown that limitations on the number of tobacco retailers, combined with strong licensing requirements, has a positive effect on reducing youth smoking rates. Now, therefore it is the intention of the Brewster Board of Health to regulate the sale of tobacco products. B. Authority: This regulation is promulgated pursuant to the authority granted to the Brewster Board of Health by Massachusetts General Laws Chapter 111, Section 31 which states "Boards of health may make reasonable health regulations". C. Definitions: For the purpose of this regulation, the following words shall have the following meanings: Adult -Only Retail Tobacco Store (also known as "Retail Tobacco Store" in MGL Ch. 270): An establishment that does not share space with another business, that has a separate entrance, that does not sell food or alcohol, that does not have a restaurant license or lottery license, whose only purpose is to sell or offer for retail sale tobacco products and/or tobacco product paraphernalia, in which the entry of persons under the age of 21 is zs MA YRBS 2017 16 310 CMR 30.136 17 See fn. 7. 18 King BA, Tynan MA, Dube SR, et al. 2013. "Flavored -Little -Cigar and Flavored -Cigarette Use Among U.S. Middle and High School Students." Journal ofAdolescent Health. [Article in press], iv►tinv. 'ahonline.or larticlelSI054-139XO102813%2900415- Ilabstract. is Druzik et aly. Board of Health of Haverhill, 324 Mass. 129 (1949). 3 llfi leserver 161rdocum ents$ltm asonlDesktopltobac coregs2 l . doc prohibited at all times, and which maintains a valid permit for the retail sale of tobacco products from the Brewster Board of Health and applicable state licenses. Entrance to the establishment must be secure so that access to the establishment is restricted to employees and to those 21 years or older. The establishment shall not allow anyone under the age of 21 to work at the establishment. Blunt Wrap: Any flavored tobacco product manufactured or packaged as a wrap or as a hollow tube made wholly or in part from tobacco that is designed or intended to be filled by the consumer with loose tobacco or other fillers regardless of any content. Business Agent: An individual who has been designated by the owner or operator of any establishment to be the manager or otherwise in charge of said establishment. Characterizing Flavor: A distinguishable taste or aroma, other than the taste or aroma of tobacco, imparted or detectable either prior to or during consumption of a tobacco product or component part thereof, including, but not limited to, tastes or aromas relating to any fruit, chocolate, vanilla, honey, candy, cocoa, dessert, alcoholic beverage, menthol, mint, wintergreen, herb or spice; provided, however, that no tobacco product shall be determined to have a characterizing flavor solely because of the provision of ingredient information or the use of additives or flavorings that do not contribute to the distinguishable taste or aroma of the product. Child -Resistant Package: Packaging intended to reduce the risk -of a child ingesting nicotine and that meets the minimum standards of 16 C.F.R. 1700 et seq., pursuant to 15 U.S.C. 1471 through 1476. Cigar: Any roll of tobacco that is wrapped in leaf tobacco or in any substance containing tobacco, with or without a tip or mouthpiece, that is in a readily usable state immediately when removed from its packaging without any modification, preparation or assembly required as in a kit or roll -your -own package, and is not otherwise defined as a cigarette under Massachusetts General Law, Chapter 64C, Section 1, Paragraph 1. Tobacco leaf in such kits or roll -your -own packages shall be considered "blunt wraps" for the purpose of this regulation. Component Part: Any element of a tobacco product, including, but not limited to, the tobacco, filter and paper, but not including any constituent. Constituent: Any ingredient, substance, chemical or compound, other than tobacco, water or reconstituted tobacco sheet, that is added by the manufacturer to a tobacco product during the processing, manufacturing or packaging of the tobacco product. Such term shall include a smoke constituent. Coupon: Any card, paper, note, form, statement, ticket or other communication distributed for commercial or promotional purposes to be later surrendered by the bearer so as to receive an article, service or accommodation without charge or at a discount price. Distinguishable: Perceivable by either the sense of smell or taste. Educational Institution: Any public or private college, school, professional school, scientific or technical institution, university or other institution furnishing a program of higher education. Employee: Any individual who performs services for an employer. Employer: Any individual, partnership, association, corporation, trust or other organized group of individuals that uses the services of one (1) or more employees. Uii le server 161rdocum ents$ltmason\Desktopltobac coregs2 l . doc Electronic Nicotine Delivery System: An electronic device, whether for one-time use or reusable, that can be used to deliver nicotine or another substance to a person inhaling from the device including, but not limited to, electronic cigarettes, electronic cigars, electronic cigarillos, electronic pipes, vaping pens, hookah pens and other similar devices that rely on vaporization or aerosolization; provided, however, that "electronic nicotine delivery system" shall also include any noncombustible liquid or gel that is manufactured into a finished product for use in such electronic device; provided further, that "electronic nicotine delivery system" shall also include any component, part or accessory of a device used during the operation of the device even if the part or accessory was sold separately; provided further, that "electronic nicotine delivery system" shall not include a product that has been approved by the United States Food and Drug Administration for the sale of or use as a tobacco cessation product or for other medical purposes and is marketed and sold or prescribed exclusively for that approved purpose. Flavored Tobacco Product: Any tobacco product or component part thereof that contains a constituent that has or produces a characterizing flavor. A public statement, claim or indicia made or disseminated by the manufacturer of a tobacco product, or by any person authorized or permitted by the manufacturer to make or. disseminate public statements concerning such tobacco product, that such tobacco product has or produces a characterizing flavor shall constitute presumptive evidence that the tobacco product is a Flavored Tobacco Product. Health Care Institution: An individual, partnership, association, corporation or trust or any person or group of persons that provides health care services and employs health care providers licensed, or subject to licensing, by the Massachusetts Department of Public Health under M,G.L. c. 112 or a retail establishment that provides pharmaceutical goods and services and is subject to the provisions of 247 CMR 6.00. Health care institutions include, but are not limited to, hospitals, clinics, health centers, pharmacies, drug stores, doctor offices, opticianloptometrist offices and dentist offices. Liquid Nicotine Container: A package from which nicotine or other substance in a solution or other form is accessible through normal and foreseeable use by a consumer and that is used to hold a soluble nicotine or other substance in any concentration; provided however, that "liquid nicotine container" shall not include a sealed, prefilled and disposable container of nicotine or other substance in, a solution or other form in which the container is inserted directly into an electronic cigarette, electronic nicotine delivery system or other similar product if the nicotine or other substance in the container is inaccessible through customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion or other contact by children. Listed or Non -Discounted Price: The higher of the price listed for a tobacco product on its package or the price listed on any related shelving, posting, advertising or display at the place where the tobacco product is sold or offered for sale plus all applicable taxes if such taxes are not included in the stated price, and before the application of any discounts or coupons. Non -Residential Roll -Your -Own (RYO) Machine: A mechanical device made available for use (including to an individual who produces cigars, cigarettes, smokeless tobacco, pipe tobacco, or roll -your -own tobacco solely for the individual's own personal consumption or use) that is capable of making cigarettes, cigars or other tobacco products. RYO machines located in private homes used for solely personal consumption are not Non - Residential RYO machines. Permit Holder: Any person engaged in the sale or distribution of tobacco products who applies for and receives a tobacco product sales permit or any person who is required to apply for a Tobacco Product Sales Permit. pursuant to these regulations, or his or her business agent. Uileserver 16lrdocuments$ltmason\Desktopltobaccoregs2 I .doc Person: Any individual, firm, partnership, association, corporation, company or organization of any kind, including but not limited to, an owner, operator, manager, proprietor or person in charge of any establishment, business or retail store. Self -Service Display: Any display from which customers may select a tobacco product, as defined herein, without assistance from an employee or store personnel. Schools: Public or private elementary or secondary schools. Smoke Constituent: Any chemical or chemical compound in mainstream or sidestream tobacco smoke that either transfers from any component of the tdbacco product to the smoke or that is formed by the combustion or heating of tobacco, additives or other component of the tobacco product. Smoking Bar: An establishment that: (i) exclusively occupies an enclosed indoor space and is primarily engaged in the retail sale of tobacco products for consumption by customers on the premises; (ii) derives revenue from the sale of food, alcohol or other beverages that is incidental to the sale of a tobacco product and prohibits entry to a person under 21 years of age; (iii) prohibits a food or beverage not sold directly by the establishment from being consumed on the premises; (iv) maintains a valid permit for the retail sale of a tobacco product as required to be issued by the Town of Brewster; and (v) maintains a valid permit issued by the department of revenue to operate as a smoking bar. "Smoking bar" shall include, but not be limited to, those establishments that are commonly known as "cigar bars", "hookah bars" and "vape bars". Tobacco Product Flavor Enhancer: Any product designed, manufactured, produced, marketed or sold to produce a characterizing flavor when added to any tobacco product. Tobacco Product: A product containing or made or derived from tobacco or nicotine that is intended for human consumption, whether smoked, chewed, absorbed, dissolved, inhaled, snorted, sniffed or ingested by any other means including, but not limited to, cigarettes, cigars, little cigars, chewing tobacco, pipe tobacco, snuff, electronic cigarettes, electronic cigars, electronic pipes, electronic nicotine delivery systems or any other similar products that rely on vaporization or aerosolization regardless of nicotine content in the product; provided, however, that "tobacco product" shall also include any component, part or accessory of a tobacco product; and provided further, that "tobacco product" shall not include a product that has been approved by the United States Food and Drug Administration for the sale of or use as a tobacco cessation product or for other medical purposes and is marketed and sold or prescribed exclusively for the approved purpose. Vending Machine: Any automated or mechanical self-service device, which upon insertion of money, tokens or any other form of payment, dispenses or makes cigarettes or any other tobacco products, as defined herein. D. Tobacco Sales to Persons Under Twenty -One (21) Years old: 1. No person shall sell, offer for sale or provide a tobacco product to a person under twenty-one (21) years old. 2. Required Signage: a. All retail establishments, including smoking bars and adult -only retail tobacco stores, shall conspicuously post signage inside the establishment, in the form developed and made available by the Massachusetts Department of Public Health. Such signage shall include: (i) a copy of M.G.L. c. 270, §§ 6 and 6A; (ii) referral information for smoking cessation resources; (iii) a statement that sale of tobacco products, including e -cigarettes, to someone younger than 21 years of age is prohibited; (iv) health warnings associated with using electronic nicotine delivery systems; and (v) except in the case of smoking bars, notice to consumers that the sale of flavored electronic nicotine systems are prohibited at llfileserver 161rdo cumen is $ltm ason\Desktopltobac coregs2 l . doc all times. Such signage shall be posted conspicuously in the -retail establishment or other place in such a manner so that it may be readily seen by a person standing at or approaching the cash register. The notice shall directly face the purchaser and shall not be obstructed from view or placed at a height of less than four feet or greater than nine feet from the floor. b. All smoking bars and adult -only retail tobacco stores shall post signage, in the form developed and made available by the Massachusetts Department of Public Health, on the exterior of the door providing entrance to the tobacco retail store or smoking bar and such sign shall not be obstructed from view or placed at a height of less than four feet or greater than nine from the bottom of the door. Such signage shall state that "No person younger than 21 years old is permitted on the premises at any time." c. All smoking bars and those adult -only retail tobacco stores that allow for onsite consumption of tobacco products shall post signage, in the form developed and made available by the Massachusetts Department of Public Health, on the exterior of the door providing entrance to the tobacco retail store or smoking bar and such sign shall not be obstructed from view or placed at a height of less than four feet or greater than nine from the bottom of the door. Such signage shall warn persons entering that smoking and vaping may be present on the premises, and provide information concerning the health risks associated with second hand smoke and the use of tobacco products, including electronic nicotine delivery systems. 3. Identification: Each person selling, offering for sale or distributing tobacco products, or admitting entrance into a smoking bar or adult -only retail tobacco store, shall first verify the age of the purchaser by means of a valid government -issued photographic identification containing the bearer's date of birth that the purchaser is 21 or older. 4. All retail sales of tobacco products, as defined herein, must be face-to-face between the seller and the buyer and occur at the permitted location. E. Tobacco Product Sales Permit: No person shall sell, offer for sale or otherwise distribute tobacco products, as defined herein, within the Town of Brewster without first obtaining a Tobacco Product Sales Permit issued annually by the Brewster Board of Health. Only owners of establishments with a permanent, non-mobile location in Brewster are eligible to apply for a permit and sell tobacco products, as defined herein, at the specified location in Brewster. 2. As part of the Tobacco Product Sales Permit application process, the applicant will be provided with the Brewster regulation. Each applicant is required to sign a statement declaring that the applicant has read said regulation and that the applicant is responsible for instructing any and all employees who will be responsible for tobacco product sales regarding federal, state and local laws about the sale of tobacco and this regulation. 3. Each applicant who sells tobacco products is required to provide proof of current Tobacco Retailer Licenses issued by the Massachusetts Department of Revenue, when required by state law, before a Tobacco Product Sales Permit can be issued. Applicant may be asked to provide evidence that a legitimate business transfer or business purchase has taken place. llfi leserver 16\rdo cuments$ItznasonlDesktopltobaccoregs2 I . doc 4. A separate permit, displayed conspicuously, is required for each retail establishment selling tobacco products, as defined herein. The fee shall be determined by the Brewster Board of Health annually. 5. Issuance of a Tobacco Product Sales Permit shall be conditioned on an applicant's consent to unannounced, periodic inspections of his/her retail establishment to ensure compliance with this regulation. 6. A Tobacco Product Sales Permit will not be renewed if the permit holder has failed to pay all fines issued and the time period to appeal the fines has expired and/or the permit holder has not satisfied any outstanding permit suspensions. 7. A Tobacco Product Sales Permit will not be renewed if the permit holder has sold a tobacco product to a person under the age of 21 three times within the previous permit year and the time period to appeal has expired or appeal is pending. The violator may request a hearing in accordance with subsection 6 of the Violations section. 8. Maximum Number of Tobacco Product Sales Permits. At any given time, there shall be no more than I I Tobacco Product Sales Permits issued in Brewster. No permit renewal will be denied based on the requirements of this subsection except any permit holder who has failed to renew his or her permit within thirty (30) days of expiration will be treated as a first-time permit applicant. New applicants for permits who are applying at a time when the maximum number of permits have been issued will be placed on a waiting list and will be eligible to apply for a permit on a "first-come, first-served" basis as issued permits are either not renewed, revoked, or are returned to the Board of Health. b. At any given time, of the allowed Permit number in subsection (a) above, there shall be no more than 1 Tobacco Product Sales Permits issued to Adult -Only Retail Tobacco Stores, per the definition, in Brewster. No permit renewal will be denied based on the requirements of this subsection except any permit holder who has failed to renew his or her permit within thirty (30) days of expiration will be treated as a first-time permit applicant. c. Any Tobacco Product Sales Permits that are surrendered, not renewed or revoked, will be returned to the Board of Health and will be made available to new applicants on a first-come, first serve basis, provided that any permits surrendered, not renewed or revoked at a time when there are more permits than authorized by this section shall be permanently retired. d. Applicants who purchase or acquire an existing business that holds a valid Tobacco Product Sales Permit at the time of the sale or acquisition of said business must apply within sixty (60) days of such sale or acquisition for the permit held by the Current Permit Holder if the Applicant intends to sell tobacco products, as defined herein. Such applicant may choose to apply for a Tobacco Product Sales Permit for an Adult -Only Retail Tobacco Store if the Current Permit Holder possessed the same or if a Tobacco Product Sales Permit for an Adult -Only Retail Tobacco Store is available per subsection (b). g. Setbacks a. A Tobacco Product Sales Permit shall not be issued to any applicant for a new retail location within five hundred (500) feet of a public or private elementary or secondary school. b. No new adult -only retail tobacco stores shall be located within twenty-five (25) feet of a retailer with a tobacco product sales permit. llfileserver161rdocuments$ltmason\Desktopltobaccoregs2l ,doc c. For purposes of this section, distances shall be measured by a straight line from the nearest point of the property line of the applicant's proposed location to the nearest point of the property line of the other site. F. Prohibition of Smoking Bars: Smoking Bars are prohibited in the Town of Brewster. G. Cigar Sales RcEulated: 1. No person shall sell or distribute or cause to be sold or distributed a single cigar unless such cigar is priced for retail sale at two dollars and fifty cents ($2.50) or more. 2. No person shall sell or distribute or cause to be sold or distributed any original factory -wrapped package of two or more cigars, unless such package is priced for retail sale at five dollars ($5.40) or more. 3. This Section shall not apply to a person or entity engaged in the business of selling or distributing cigars for commercial purposes to another person or entity engaged in the business of selling or distributing cigars for commercial purposes with the intent to sell or distribute outside the boundaries of Brewster. 4. The Brewster Board of Health may adjust from time to time the amounts specified in this Section to reflect changes in the applicable Consumer Price Index by amendment of this regulation. H. Sale of Flavored Tobacco Products Prohibited: No person shall possess, hold, keep, sell, offer for sale or distribute or cause to be possessed, held, kept, sold or distributed any flavored tobacco product, as defined herein, or any flavored tobacco product enhancer, as defined herein per 105CMR 665.010 (E). Manufacturers shall provide documentation certifying those products, sold by the retailer, that do not meet the definition of a flavored tobacco product flavor enhancer. 1. Nicotine Content in Electronic Nicotine Delivery Systems: No person shall sell an electronic nicotine delivery system with nicotine content greater than 35 milligrams per milliliter; provided, however, that this subsection shall not apply to adult -only retail tobacco stores Per 105 CMR 665.010(C), manufacturers shall provide documentation indicating the nicotine content of each of their products sold by the retailer, expressed as milligrams per milliliter. J. Prohibition of the Sale of Flavored Blunt Wraps: No person or entity shall sell or distribute flavored blunt wraps in Brewster. K. Free Distribution and Coupon Redem tp ion: No person shall: 1. Distribute or cause to be distributed, any free samples of tobacco products, as defined herein; 2. Accept or redeem, offer to accept or redeem, or cause or hire any person to accept or redeem or offer to accept or redeem any coupon that provides any tobacco product, as defined herein, without charge or for Mii leserver i 6lydo cumenis $ltmas onlDesktopltobaccoregs2 l . do c less than the listed or non -discounted price; or 3. Sell a tobacco product, as defined herein, to consumers through any multi -pack discounts (e.g., "buy -two - get -one -free") or otherwise provide or distribute to consumers any tobacco product, as defined herein, without charge or for less than the listed or non -discounted price in exchange for the purchase of any other tobacco product. L. Out -of -Package Sales: 1. The sale or distribution of tobacco products, as defined herein, in any form other than an original factory - wrapped package is prohibited, including the repackaging or dispensing of any tobacco product, as defined herein, for retail sale. No person may sell or cause to be sold or distribute or cause to be distributed any cigarette package that contains fewer than twenty (20) cigarettes, including single cigarettes. 2. Permit holders who sell Liquid Nicotine Containers must comply with the provisions of 310 CMR 30.000, and must provide the Brewster Board of Health with a written plan for disposal of said product, including disposal plans for any breakage, spillage or expiration of the product. 3. All permit holders must comply with 940 CMR 21.05 which reads: "It shall be an unfair or deceptive act or practice for any person to sell or distribute nicotine in a liquid or gel substance in Massachusetts after March 15, 2016 unless the liquid or gel product is contained in a child -resistant package that, at a minimum, meets the standard for special packaging as set forth in 15 U.S. C.§§1471 through 1476 and 16 CFR §1700 et. Seq." 4. No permit holder shall refill a cartridge that is prefilled and sealed by the manufacturer and not intended to be opened by the consumer or retailer. M. Self -Service Displays: All self-service displays of tobacco products, as defined herein, are prohibited. All humidors including, but not limited to, walk-in humidors must be locked. N. Vending Machines: All vending machines containing tobacco products, as defined herein, are prohibited. D. Non -Residential Roll -Your -Own Machines: All Non -Residential Roll -Your -Own machines are prohibited. P. Prohibition of the Sale of Tobacco Products by Health Care Institutions: No health care institution located in Brewster shall sell or cause to be sold tobacco products, as defined herein. No retail establishment that operates or has a health care institution within it, such as a pharmacy, optician/optometrist or drug store, shall sell or cause to be sold tobacco products, as defined herein. 10 Ilii leserver 161rd ocum ents$ltm as on\Desktopltobac coregs2 l . do c Q. Prohibition of the Sale of Tobacco Products by Educational Institutions: No educational institution located in Brewster shall sell or.cause to be sold tobacco products, as defined herein. This includes all educational institutions as well as any retail establishments that operate on the property of an educational institution. R. Incorporation of Other Laws and State Regulations: The possession, sale and distribution of tobacco products as defined and regulated herein, shall comply with all applicable federal, state and local laws, including but not limited to the following: The sale or distribution of tobacco products, as defined herein, must comply with those provisions found at M.G.L. Ch. 270, §§6, 6A, 7, 28, 29 and M.G.L. Ch, 112, §61A. 2. The sale or distribution of tobacco products, as defined defined herein, must comply with those provisions found at 940 CMR 2 1. 00 ("Sale and Distribution of. Cigarettes, Smokeless Tobacco Products, and Electronic Smoking Devices in Massachusetts") and 940 CMR 22.00 ("Sale and Distribution of Cigars in Massachusetts"), and 105 CMR 665.00 ("Minimum Standards for Retail Sale of Tobacco and Electronic Nicotine Delivery Systems"). In the event of a conflict between this regulation and any other applicable law, the more stringent requirement will apply, S. Enforcement It shall be the responsibility of the establishment, permit holder and/or his or her business agent, and not their employees, to ensure compliance with all sections of this regulation. 2. Whoever violates any provision of this Regulation may be penalized by indictment or on complaint brought in a court of competent jurisdiction. Except as may be otherwise. provided by law and as the court may see fit to impose, for violations of the sections of this regulation that incorporate state laws and state regulations, the following penalties apply: a. In the case of a first violation, a fine of one thousand dollars ($1000.00). b. In the case of a second violation within thirty-six (36) months of the date of the current violation, a fine of two thousand dollars ($2000.00) shall be issued and the Tobacco Product Sales Permit shall be suspended for seven (7) consecutive business days. c. In the case of three or more violations within a thirty-six (36) -month period, a fine of five thousand dollars ($5000.00) shall be issued and the Tobacco Product Sales Permit shall be suspended for thirty (30) consecutive business days. 3. For violations of all other sections specific to the Town of Brewster, the violator shall receive: a. In the case of a first violation, a fine of one hundred dollars ($100.00). 11 llfileserverl61rdocuments$ltmason\Desktopltobaccoregs2l ,doe b. In the case of a second violation within thirty-six (36) months of the date of the current violation, a fine of two hundred dollars ($200.00) and the Tobacco Product Sales Permit shall be suspended for seven (7) consecutive business days. c. In the case of three or more violations within a thirty-six (36) -month period, a fine of three hundred dollars ($300,00) and the Tobacco Product Sales Permit shall be suspended for thirty (30) consecutive business days. d. The sections specific to the Town of Brewster include: I . The maximum number of tobacco sales permits allowed in Brewster (§E.9); 2. No new retailers near schools (§E9); 3. The prohibition of smoking bars (§F); 4. Minimum pricing on the sale of cigars (§G); 5. The prohibition of the sale of flavored blunt wraps (§J); 6. The prohibition of self-service displays (§M); 7. The prohibition of vending machines (§N); 8. The prohibition of non-residential roll -your -own machines (§O); 9. The prohibition of the sale of tobacco products in health care institutions (§P); and 10. The prohibition of the sale of tobacco products in educational institutions (§Q) e. Each day or portion thereof shall constitute a separate offense. If more than one, each condition violated shall constitute a separate offense. 4. The Board of Health may refuse to renew, modify, suspend or revoke any permit issued pursuant to this Regulation for any violation of this Regulation, or any other applicable General Law, regulation or by-law relative to the control of tobacco. The Board shall follow the following guidelines when considering disciplinary action: ■ First Offense: Written Warning • Second Offense: Permit Suspension of up to seven (7) days • Third Offense: Permit Suspension for up to thirty (30) days • Fourth or subsequent Offense: Permit revocation • Failure to Cooperate with Inspection: Permit Suspension for up to thirty (30) days • Distribution of Tobacco Products During Suspension: Additional Suspension of up to thirty (30) days Only offenses which have occurred within the thirty-six (36) months preceding the date of violation shall be used in calculating the number of offenses for purposes of the penalty guidelines. 5. The Board of Health may enforce these Regulations or enjoin violations thereof through any lawful process, and the election of one remedy by the Board of Health shall not preclude enforcement through any other lawful means. 6. The Brewster Board of Health shall provide notice of the intent to suspend or revoke a Tobacco Product Sales Permit, which notice shall contain the reasons therefor and establish a time and date for a hearing which date shall be no earlier than seven (7) days after the date of said notice. The permit holder or its business agent shall have an opportunity to be heard at such hearing and shall be notified of the Board of 12 Mileserver 1 6trdocuments$ltmason\Desktopltubaccoregs2 t .doc Health's decision and the reasons therefor in writing. After a hearing, the Brewster Board of Health shall suspend or revoke the Tobacco Product Sales Permit if the Board of Health finds that a violation of this regulation occurred. All tobacco products, as defined herein, shall be removed from the retail establishment upon suspension or revocation of the Tobacco Product Sales Permit. Failure to remove all tobacco products, as defined herein, shall constitute a separate violation of this regulation. T. Non -Criminal Disposition: Whoever violates any provision of this regulation may be penalized by the non -criminal method of disposition as provided in Massachusetts General Laws, Chapter 40, Section 2.1 D. If noncriminal disposition is elected, then the non -criminal fine for each such violation shall be: First Offense: one hundred dollars ($100); Second Offense: two hundred dollars ($200); Third and Subsequent Offense: three hundred dollars ($300). U. Separate Violations: Each day any violation exists shall be deemed to be a separate offense. V. Enforcement: Enforcement of this regulation shall be by the Brewster Board of Health or its designated agent(s). Any resident who desires to register a complaint pursuant to the regulation may do so by contacting the Brewster Board of Health or its designated agent(s) and the Board shall investigate. W. Severability: If any provision of this. regulation is declared invalid or unenforceable, the other provisions shall not be affected thereby but shall continue in full force and effect. X. Effective Date: This regulation shall take effect on Board of Health 2021. 13 llfi leserver l 6\rdocuments$1tm ason\D esktopltobacc oregs2 l . do c F- W �Ik % 0 CO 1�i 0 fo June 8, 2021 Dear Retailer: Town of Brewster 2198 MAIN STPEET BREWSTER, MASSACHUSETTS 02631-1899 PHONE: 508.896.3701 EXT, 1120 FAX: 508.896,4538 brhcalthle,D .-,jLter-iTia-gov , bt� WWW.BREWSTER-MA.GOV Health Department Amy L von Hone, R.S., C.H.O. Director Sherrie McCullougb, R.S. Assistant Director Tammi Mason Senior Department Assistant On June 2, 2021, the Brewster Board of Health voted to approve changes to the Brewster Board of Health Regulation Restricting the sale of Tobacco and Nicotine Delivery Products to align with State Regulations. We will be holding a public meeting (Zoom meeting) on July 7, 2021, at 7:OOPM for any comments or questions yo u may have. Yo u ca n view th e reg u I ati o n s h ere: Al2proved Tobacco Regulations 6.2.2 LVd , We wi I i fo rwa rd th e zoo m i nfo rmation closer to the date of th e m eeti n g. Please do not hesitate to contact the off ice with any questions you may have. Thank you, Tammi Mason Senior Department Assistant Brewster Health Department Arnvon Hone From: Sarah McColgan <smccolgan@mhoa,com> Sent: Monday, June 28, 2021 12:50 PM Subject: Hot Tobacco Topics Below are three "hot" topics dealing with enforcement of the new state law and DPH regulation. Feel free to contact any of the Tobacco TA providers with any questions you may have. Flavored Hemp Products State law (MGL Ch. 270 §6) requires that conventional tobacco products contain either nicotine or tobacco in order to be covered by this law. However, that same "Tobacco Products" definition broadly covers vape products. Any product that relies on vaporization or aerosolization is covered by this state law regardless of nicotine or tobacco content. With that, flavored hemp products that are used by the consumer in a way that is not vaped, probably are not covered as they are unlikely to contain nicotine or tobacco. The packaging should indicate such. However, if you see a hemp vape product far sale, flavored versions are banned from safe statewide except in MA Department of Revenue -approved Smoking Bars for on-site consumption only and state -approved marijuana retailers. In that same state law, the flavored tobacco/vape product sales restriction policy has been extended to cover any "Tobacco Product Flavor Enhancer". It is defined as "any product designed, manufactured, produced, marketed or sold to product a characterizing flavor when added to any tobacco product." This is a new expansion that prior to the enactment of these state law updates in late 2019 was not found in local regulations. Under this category, flavored hemp wraps would be covered as well as any other flavored hemp product that is not readily -usable out of the package but is used with a filler to produce a usable product. A flavored hemp cigarette, cigar or chew would not be covered as it is readily -usable by the consumer. Many cities and towns ban the sale of blunt wraps, They are defined as containing tobacco. Hemp wraps are unlikely to contain tobacco so are not covered by a blunt wrap sales ban. Issuine Mandated State Fines The new state law, and accompanying DPH regulation (105 CMR 665), mandate much higher fines than local regulations provide. The graduated fining system found in MGL Ch, 270 §6, which bans the sale of tobacco/vape to anyone under 21, was $100/200/300 and now is $1000/2000/5000 with a 36 -month tolling period, The DPH regulation also provides for permit suspensions. For Repeat Offenders: The DPH regulation (105 CMR 665.045(A) provides for a range of time lengths for permit suspensions for repeat offenders unless a local regulation has longer time periods. While the fines are mandatory, the permit suspensions are at the discretion of cities and towns. If you have a local regulation that contains permit suspensions as part of a penalty, chances are good it matches or exceeds the DPH regulation minimum requirements. For First -Time Offenders: The DPH regulation (105 CMR 665.040(D), however, mandates not only a $1000 fine but also a permit suspension of up to 30 consecutive business days for sales to minors only. This exceeds most local regulations that only issue a fine for a first-time offender. With this regulatory section, at least a one -day suspension is now required. Meshing Local Fines with State Fines: It is possible to rely on previously -issued local fines to then issue higher state fine amounts for repeat offenders. For example, a retailer paid a $100 fine for a sale to a minor pre -new state law, it is acceptable to issue that retailer a $2000 fine for a second sale to a minor within the tolling period but o n ly if the potic cited on the earlier ticket cites MGL Ch. 270 §6. If your locally-issued ticket cited your health regulation, a town bylaw or a city ordinance, the latter penalty must start anew at $1000. The "clock" resets because the cited authorities do not match. This will happen in a vast majority of local enforcement and a reset of the retailer's "clock" will be required in most cities and towns. Note that in the example used, because the second violation was a sale to a minor, it will now be subject to a permit suspension of up to 30 days. Prohibited Flavor Products Found in Stores There have been instances statewide where flavored products that are prohibited for sale in Massachusetts are found at a retail establishment. State law (MGL. Ch. 270, § and 105 CMR 665.010(D)), and until recently our local sales sample, state that no person can sell, distribute, cause to be sold or distributed, or offer for sale prohibited tobacco and vape products, To avoid penalty, a retailer may attest that the prohibited product found in their store is: (1) for personal use; (2) awaiting to be returned to their distributor or to be shipped to an out-of-state retailer; and/or (3) is simply not being offered for sale If this is the case, it is advisable to nate it in your files what transpired but permit the retailer to hold onto that product until either further research is conducted to determine if there is state authority or case law to require such product be removed or your local regulation is amended thusly (corrective language in bold): Sale of Flavored Tobacco Products Prohibited: No person shall possess, hold, keep, sell or distribute or cause to be possessed, held, kept, or sold or distributed any flavored tobacco product, as defined herein, or any flavored tobacco product enhancer, as defined herein. Retailers must obtain from a manufacturer documentation certifying that products sold by the retailer do not meet the definition of a flavored tobacco product or tobacco product flavor enhancer (105 CMR 665.010). Sarah McColgan Mass. Health Officers Association Tobacco Control Program Director (413) 636-6418 Beach Result Notification -- *FDR LABORATORY USE ONLY* Please scan and email this narice to frena Draksic at MA DPN Orena.drakrsic stote.ma.us- with the information below only upon a beach closing (resulting from failure of the 2s' re -test or geomean failure) and again only after a beach hors re -opened. Do not submit this form again until the beach is re -opened. Also, please indicate if a beach is to be closed for the season after a posted closing. 1.) City/Town: 2.j Name of Beach: 3.) Type of Beach Water: 4.) PublicfSemi-Public: 5.) Event: 6.) Date of Initial Sample: Fresh Puhlil k r .Marine ElSemi-Public Elevated Bacteria Rainfall Other: z1 V2- 1 7.) Initial Sample Bacteria Count:,Q38 MPN/10DmL SC GM SC = Single Count* GM = Geomean ** )• F If the bacteria count exceeds the yeomaon limit at any time, you are required to post the beach and email/fax this farm (with the battom "Beach Posting Form" portion completed) to MA DPMI 8.) Organism: E. Call Enterococci 9.) Does this beach need to foe POSTED after just one exceedance? WC) (YES/NO)? if No, continue to items 10 and 11 and then proceed to the "Beach Posting Form" section if YES, continue to item 10. 10) Passed V Re -test? Yes No 10a) Date of 1St Re -test ■ ■ If the answers to items 9 and 10 were both YES, you do NOT need to emailffax this form to MA DPH. If the answers to ,EITHER items 9 or 10 were NO, proceed below and send the fax to MA DPH when complete. 11,) Passing Result: MPNf100mL Falling Result; 1 `} MPN/100ml (of I" re -test) (of 151 re -test) Date of 2nd fie -test Date of 3rd Re -test Date of 4th Re -test 5th Date of Re -test 6th Date.of Re -test god Re -test Result Std fie -test Result 4th Re -test Result 51h Re -test Result Re -test Result SC f GM SC f GM 5C / GM 5C f GNI 5C f Grvl *Fresh water Urnitfor E. Coll. 235 MPN/100mL **Freshwoter'Geomean Limit: MPN CFU1J00mL *Marine Water [imit for Enterococcus: 104 MPN/.100mL **Marine Geomean Limit: 35 MPN/10amL Beach PostinLy Form — *FOR TOWN IHEALTH AGENT USE ❑NLY* Date Posted: Reported by (Include organization and !nit al of authorized official): Date Re -opened: Organism for Re -test Prior to Reopening: F�E. Coli Bacteria Count of Reopening Test: � /�J%) CFUf400mL G �teroco.cd Type of Count Re -opening: Ingle Count Geomean Amy von Hone From: Donna Kalinick Sent: Monday, June 28, 2021 3:47 PM To: Select Board; townadmin Cc: Amy von Hone; Chris Miller; Griffin Ryder Subject: Update on Beaches Good Afternoon, I understand there is a lot of chatter about the algae and smell at some of the beaches, particularly on the east end of town. As you know, we had to close Ellis Landing for a bit last week. As an update, all of the beaches and ponds were tested today which is aur normal summer routine. Mandatory weekly samples are taken during the summer swimming season and are completed every Monday (water sample results take 24 hours minimum). Closure of beach is not required. unless there are two failed samples within 24 hours of each other. Health Department or DNR staff will resample immediately upon notification of a failed water sample. Additionally, Chris has asked the State to send a biologist to look at the algae mats which we believe will happen tomorrow. Depending on the outcome of their investigation and the Monday water samples, we will determine what information should be posted on the website. Some of these conditions are due to the lack of precipitation over the winter, the warm weather and the recent tides. Secondly, we had a few calls today of concern about the mat at Saint's Landing. Griffin Ryder went down and looked at the issue. DPW and DNR will be meeting on site in the morning and we will be removing the mat. In the interim, a sign will be placed this afternoon to use caution. It is not unusual for our staff to be dealing with issues at our beaches and ponds at this time of the year. Please reach out to me directly should you have any questions. As always, i thank our staff for being so responsive. Donna Donna J. Kalinick Assistant Town Administrator, Community Development & Finance Procurement Officer Town of Brewster 508-895-3701 X1130 Effective March 9, 2021, until further notice: Based on current state guidance and public health data, Brewster Town Offices are open to the public on Tuesdays and Thursdays during regular business hours. Residents and visitors are urged to continue to access town services remotely if possible. Beach and Recycle permits will not be sold in person during the 2021 season. Phone messages and email communications will continue to be answered promptly daily. Thank you for your understanding and cooperation. For the latest updates on Town services, please visit www.brewster-ma.gov Amy von Hone From: Donna Kalinick Sent: Wednesday, June 30, 2021 3:12 PM To: Select Board; townadmin; Erika Mawn Cc: Chris Miller; Amy von Hone; Griffin Ryder Subject: Update Good Afternoon, the water tests for the beaches and ponds came back and there were no areas of concern. The state biologist came out and looked at the algae mats and they are beginning to dissipate. They are essentially rotting seaweed that just needs to make its' way out of the area, likely caused from lack of precipitation, hot temperatures and tides. The smell at Ellis will likely linger for a bit. Weekly sampling will occur all summer and is monitored by the Health and Natural Resources Departments. The mat at Saint's Landing was removed yesterday and sand was added to the area by DPW staff. We will work towards a long term solution there. As a reminder, Town offices will be closed on Monday July 51h for the holiday and will be open Tuesday, Wednesday and Thursday starting July 6th. Updates to the website are in process about the change in town services. Please let me know if you have any questions or concerns. Donna Donna J. Kalinick Assistant Town Administrator, Community Development & Finance Procurement Officer Town of Brewster 508-895-3761 x1130 Beginning July 6th, Brewster Town Offices will be open to the public Tuesday, Wednesday, and Thursday from 8:30 to 4:00pm. Beach and Recycle Permits are not available in person but can be purchased online or through aur mail -in program. For the latest updates on Town services, please visit www.brewster-nna.gov .,►� ti...�a.• ,V4 NL - ;� r�- Permit #F52021-078 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BREWSTER BOARD OF HEALTH ree: pv.vu IN ACCORDANCE WITH REGULATIONS PROMULGATED UNDERLAWS, PERUTHOM IS HEREBY OF GRANT R 94,ETCTION 305A AND CHAPTER 111, SECTION S OF THE GENERAL Ca a Cod Museum of Natural Histo Whose Plate of business is: 869 Main Street of seats Type of Business: Retail Food To operate a food establishment in the Town of Brewster, Massachusetts Permit expir s on December 31, 2021 Date: Board Of o� ord. Health th Director 4. Establishment Phane #. 5.. Applicant Name & Title: Y 1�r C6Uf V01 -6. Applicant Address: .� � T" 7. Applicant Phone # 24 Hour Emergency #: • r . 1-��R 8. Owner Name & T' I (if different from ap li nt} �� 9. Owner Address (if different from applicant): 10. Establishment Owned by: 11. If a corporation or partnership; give name, title and home address of o An association officers or partner L3 A corporation o An individual N—ar—nQ Home address n A partnership other legal entity 1C, . 12. Person'directly responsible for dail Name & Title: Address: c Telephone: _Einer enc y Phone #: 13. Water Source (town or well water) 1 CJV V V 1 ons (owner, person in charge, supervisor, manager, etc. Email address: 14. Sewage Disposal: itle 5 -system ❑ Internal Grease o 'Grease trap interceptor Town of SrevvA r 3ACHE13ETT5 �2G31-1848 ET BREWSTETt91vIMAIN IiealfEallepailmenf µ ' 4 . 7y,,, A3ny I.. von Hone, R.S., C.H.o, Director Y )> PHONE: 508.896.370I EXT. 1120 �'" J �_ •� FAX: 508.895.4538 Urlteaifh brervster-ma. nv 5lterrie McCullough, R.S. Assistant Director l��fho $ a iI43��ti` WWW,iiItRWSTER-MA.GaV Tarnmi Mason Assistant 9 �i��irfi�lr,�!lilllll111111t��11���� Senior Department Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1. Establishment Name: -5i�-,. L 2. Establis meat Address:sn1�re2 r3. �f�f Establishment Mailing f different}: E ai! address: , 4. Establishment Phane #. 5.. Applicant Name & Title: Y 1�r C6Uf V01 -6. Applicant Address: .� � T" 7. Applicant Phone # 24 Hour Emergency #: • r . 1-��R 8. Owner Name & T' I (if different from ap li nt} �� 9. Owner Address (if different from applicant): 10. Establishment Owned by: 11. If a corporation or partnership; give name, title and home address of o An association officers or partner L3 A corporation o An individual N—ar—nQ Home address n A partnership other legal entity 1C, . 12. Person'directly responsible for dail Name & Title: Address: c Telephone: _Einer enc y Phone #: 13. Water Source (town or well water) 1 CJV V V 1 ons (owner, person in charge, supervisor, manager, etc. Email address: 14. Sewage Disposal: itle 5 -system ❑ Internal Grease o 'Grease trap interceptor 15, Das and hours of opera ion: ee — v w 16. # of Food employees: . V/ L.lrAY CY!?� 17. Name of Person in charge Certified in Food Protection -Mane ement: i 18. Person trained in Anti Choking procedures (if 25 seats or more): NA 9. Name of person with Aller en Awareness Certification . 20, Location (check one):' 21, Establishrrient type (Check all that apply) Permanent structure Retail (sq, ft.) ❑ Residential Kitchen: B&B Operations ❑ Mobile o Food Service.{seats] # of seats ^ n Residential Kitchen: Cottage Food ❑ Other n Food Service—Takeout Operation 4 Leased/shared cornMerclal ❑ Food Service —institution n Frozen Dessert Manufacturer kitchen # of meals= # of days ❑ Caterer ❑ Food Delivery Other (describe): 2. Length of Permit Annual ❑ SeasonaI/Dates 23.'Food Operations: (Check Definitiorls: TCS food —Tune/ternperature control for safety food — food that requires all that apply) Aime/temperature control for safety to limit pathogenic microorganism growth or toxin formation; Non -TCS food --non potentially hazardous food (no time/te-mperature controls); RTE -- ready to eat foods (Ex. Sandwiches, salads, -muffins which need no further pro cessin ) Sale of Commercially pre- n TCS Cooked to order ❑ Hot.TCS food cooked and- cooled or hot held . acka ed'Non'—TCS food for more than a single meal service ❑ Sale of Commercially pre- a Preparation of T.CS food for hot and. ' ❑ TCS food and RTE f6ods prepared for highly packaged TC5 food cold holding for single meal service susceptible population facility ❑ Delivery of packaged.TCS ❑ Sale of raw animal foods intended ❑ Vacuum Packaging/cook chill food to be prepared by consumer ❑ Reheating of commercially . n Customer self, -service ❑ Use of process requiring a variance and/or processed foods for service HACCP plan (including bare hand contact within 4 hours alternative, time as a public health control) ❑.Customer self-service of ❑ Ice manufactured and packaged for ❑ Offers raw or undercooked food of animal' non -TCS food and non- retail sale origin perishable foods only n Preparation of non -TCS o Juice manufactured and packaged n Prepares food/single meals for catered events food for retail sale br institutional food service ❑ Offers RTE TCS food in n Retail sale of -salvage, out -of—date ❑ Other (describe): bulk quafitities or reconditioned food Total permit fee: Payment is due with application I, the undersigned, attest to the accuracy of.the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590,000 and all other appl !cation. law. I have been instructed by the Board of Health on how to obtain copses of 105 CMR 590.000 and the 2093 Federal- Food Code. . 24. signature of applicant:t&�=V--no&ts Pursuant to MGI, Ch, 62C, sec. 49A, I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid taxes required under law. - r (&C 25. Signature of Individual or Corporate name:, CGS Gi M VL - r' + OC , , f -}� i.�7;> 1�►�!0111;1111h/�r/l/���...,,.; Town of Brewster W'9 2198 9SSEHealth llepartment �TTS 42631-1$98TsJASL 0 � Amy L. -von Hone, It.S., C,H2O. )]rector U 'A PHONE: 508.896.3701 EXT. 1'120 0 FAX: 508.896,4538- Sberrie McCullough, R.S. RA Y brhealth@brewster-ma.go_v Assistant Direbtor Tamrni Mason WWW.SREWSTER-MA.GOV Senior Department Assistant . lJJf1111l1111l11i1U11. • Food Establishment Plan Review Packet To be used for: ❑ New Establishments ❑ New Owners n Renovated or Altered Fstablishmerits ❑ Change in Use - Incomplete packets will riot be. accepted Name of Establishroent Locationof.1 bis ment e -- L i n -5� , M n A 2-0 �I Contac rsopyTitl � u� V� � PFtone# r� r MACIIC� � M�CJ 60 P 17 Projected Start of Project: Desired Opening Date: Category: ❑ Restaurant ❑ Institution p tetall Food o Other.- Type of Service (check all that apply): 11 ❑ Sit down meals — number of meals ❑ Meals to be served -(check all that apply): ❑ Breakfast ❑ Lunch ❑ Dinner ❑ Take Out ❑'Catering o Mobile Vendor Retail food — total square footage fl— n Residential Food Please include.the following documents: 1� L Proposed menu (including seasonal; off-site and banquet menus) s; !C Manufacturer Specification Sheets for each piece of e- ui ment shown on plan Site plan showing location of business in building: location of building onsite including alleys, streets: 1 I 1� and location of any outside a ui ment (dumpsters, septic sstem " if applicable) Plan drawn to scale of food establishment showing location of equipment, plumbipg, electrical services and mechanical ventilation (see next page) C :_ Completed review packet Content and Format of Plan and S ecifications 1, Provide plans, including the layout of the floor plan accurately drawn to a minimum scale of Y4 inch =1 foot. 2. Show the location of each piece of equipment on the plan. Submit drawings of self-service hot and cold holding units with sdeeze guards .3. Designate, clearly on the pian equipment for adequate rapid cooling, including ice baths and refrigeration and for hot holding of potentially hazardous foods. 4. Label and locate separate food pfeparation sinks, band -washing sinks, three bay sinks. 5. Clearly designate restroom areas and fixtures 5• On the plan, represent auxiliary areas such as storage rooms, garbage rooms, toilets, basements and/or cellars used for storage of food preparation. 7. include and provide: a. Entrances, exits, leading and unloading areas and docks b. Complete finish schedule for each room, including walls, ceilings, floors and coved juncture bases (use enclosed form) c, Lighting schedule with protectors d. Equipment schedule to include make and model numbers e. Flow chart demodstrating flow patterns for:. i. Food (receiving, storage,,preparation, service} ii. Food and dishes (portioning, transport, service) iii. Dishes (clean, soiled, cleaning,storage) IV. Utensll (storage, use, cleaning) V. Trash and garbage (service area, holding, storage) 0 Food Preparation Review Food Supplies: 1. -Are all food supplies from inspected and approved sources? 2. What are the projected frequencies of deliveries for; Frozen foods; Refrigerated foods ,�Qes ❑ No 3. Provide information on the amount of space [in cubic feet] allocated for:, Dry storag Refrigerat( Frozen sto Dry good:- 4. How will dry,gpQd be stored off the floor? = �1Pil IILSuxtrC i Cold Storage: 1. Is an adequate freezer and refrigeration available to store frozen food at or below 0° and refrigerated foods at 41� or below?/XYes a No 2. Will raw rneats, poultry an4 s a€ood be stored in the same refrigerators and freezers with cooked/ready to eat foods? n Yes ❑ Na 3, If yes, how will cross-contamination s� be prevented? 4. Does each refrigerator/freezer have a thermometer? es n No 5. Is there a' bulk ice -machine available? o YesXlo Cooking: 1. Will food product thermometers be used to measure final cooking/reheatifrg temperatures of ICS's? n Yes o No 2. last types of cooking equipm HotlCold Holding: 1. How will hot ICS's be maintained at 135° F or above d ing holding for service? Indicate type and number of hot holding units. j 3, How wi I I cold TC5's be maintained at A1' F or bel ow,during holding for service? Indicate type and nurnher of cold holding units Cooling: Please indicate by checking the appropriate boxes how TC$'s will be cooled to X11° F within 6 hours (135° F to 70'.F in 2 hours and Ar F to A1° F in 4 hours) Also, indicate where the cooling will take place. Coaling Method Thick -Meats Thin //Heats Thin Thick Rice/Noodles SOUPS/GravySOUPS/Gravy Sou SIGra - — Shallow Paris Ice Baths Reduce Volume/size Rapid Chill Other (describe) Reheating: 1. How will TC5's that -are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a.teinpeNture of at (east 135` F for 15'seconds? Indicate type and number of units used for reheating. 2. How will reheating food to 135` F fqr Preparation. be dine rapidly and within 2 hours? 1, Will food employees be trained as Certified Food Managers? n Yes XNo Number of employees trained: bates of completion (please enclose copies of certificates); 2. Will disposable gloves and/or utensils and/or food grade paper be used to prevent handling of ready--to-eat foods? ❑ Yes p No if no, do you have a written plan for alternative to no bare hand contact with ready -to -eat foods? ❑ Yes o No (if yes, please provide a copy ofyour plan) W 3. Is there a written policy to. exclude or restrict food workers who are -sick or have infected cuts and lesions (please enclose if applicable) ❑ Yes ❑ No 4. How -will cooking equipment, cutting boards, counter tops end other food contact surfaces which cannot be Submerged in sinks be sanitized? Chemical type: Test kit provided: S. is there a designated sink for produce washing/food preparation? ❑ Yes o No - 6• Is there a.dishwasher? ❑ Yes a No - Type of sanitization used (hot a rnrchemical type] Are the tempeiature/pressure gauges accurately working? O.Yles Are there test kits/papers for checking sanitizes concentration? u Yes u No 7. Is there a three -bay sink? ©Yes N❑ Does the largest pot fit into each co partment of the.sink? ❑ Yes ❑ No HandwashinglToilet facilities 1. Is there a handwashing sink in each food preparation and warewashing area? -o Yes Flo 2. Do all handwashing sinks, including those in the restrooms, have a mixing valve or combination faucet? XYes C]No 3. Do_self-closing-metering faucets proved a.flow of water for at least 15 seconds without the need to reactivate the faucet? ❑-Yes l0 4. is hand cleanser and drying facilities available at all handwashing sinks?�es ONO 5. Are covered waste receptacles available in each restroom?)(Yes n No. 6. Is hot and cold running water under pressure available at each handwashing sink?Xl Yes U3No T. Are all toilet room doors self-closing? Yes ❑ No 8. Are all toilet rooms equipped with adequate ventilation?�4es ❑ No g. Is handwashing signage posted in the employee restroom?es ❑ No Small equipment requirements Pleases ed -the number,.locatian and t es of each of the foilowin : E 0i menti a 7 i umber - Location Finish Schedule Applicant must indicate which materials are in place or will be used in the following areas (quarry tile, stainless steel, etc.) Floor Coining Walls Coiling Kitchen Bar Food Storage Dry Storage Toilet rooms Dressing rooms Garbageyrefuse area Equipment Storage - other Mop service area Warewashing area Walls in i.efri g erator/freexers Insect and Rodent Control 1. Will all outside doors be self-closing and rodent proof?''Yes ❑ N6 2, Are -screen doors provided on ail entrances leftopen to the outside? .)i'es n No 3. ❑o all operable windows have a minimum 416 mesh screening? es n No .4. is placement of electrocution devises identified on the plan? o Yes u No 5. Will all pipes and electrical. conduit chases.be sealed: ventilation systems exhaust, and intakes protected es u N o jj �`•• 6. Is area around building clear of unnecessary brush, Sitter and other harborage?es a No 7. Will air curtains be used? n YesXNo If yes, where: _ Garbage and Refuse 1. Do allcontainers have lids?Yes o No jw r)i SkC 2. Will refuse be store inside? o Yes a N❑ V 3. Is there an area designated for can or floor mat cleaning? ❑ YeSAO 4. Will a dumpster be used? Aes. ❑ No Number of dumpsters; ! Size of dumpsters: Frequency of Dick up: . I Y v r`--' Contractor: 5, Will there be outside garbage cans? ❑ YesIkko 6. Describe surface and location where dumpster and garbage cans will be stored 7. Describe location of grease storage receptacle 8. Is there an area to store recycled containers?. o Yes Ko If yes, location: General: 1, Where will cleaning agents be stored? 2, Are insecticides/rodenticides�stored] a arately from cieaning and sanitizing agents? `Yes ❑No location:. 3.' Area all containers of toxics clearly labeled.'es ❑ No A. Location of clean linen storage: / 5.. Location of dirty linen storage: Statement: I hereby -certify that the above information is correct, and I fully understand that any deviation fron. the above without prior permission from this Health Department may nullify ficial approval. signature Signature Date Date Approval of these plans and specifications by the Health Department. does not indicate compliance with any otl.ier code, law or regulation that may be required, . A pre -opening inspection of the, establishment with equipment in place and operations will be-riecessary to determine if it complies with the local and state laws governing food service establishments. ** All. new or revised Food Service Permit application shall be reviewed and approved In -House by the Brewster Health Director and/or the Assistant Health Director. Applications that require a Hazards Analysis Critical Control Point (HACCP) Plan or a variance will require a full Board of Health review and approval. Any applicant aggrieved by a decision of the Director or the Assistant can appeal the decision to the full Board of Health. A request for appeal shall be in writing and received by the full Board of Health within 10 days of receipt of the Director/Assistant's decision. If no request for appeal. is received within said 1O -day period, the decision of the Director/Assistant shall be final. Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhe alth (&,brewster-maxov WWW.BREWSTER-MA.GOV Health Department Amy L. von Hone, R.S., C.H.C. Director CHECK LISTMOTES FOR NEW FOOD SERVICE OPERATION DATE OPERATOR_ 2(~( , &055 CONTACT INFORMATION 00 5L LI - NAME, LOCATION & TYPE OF OPERATION SEPTIC SYSTEM INFO: CAPACITY/ COM PONENTS/1NSPECTION '1,+. - NUMBER OF SEATS NA WATER SOURCE 1 LNn ANNUALjSEASONA HOURS OF OPERATION dooi FLOOR PLANS 1 , SITE PLAN. MENU -VA n CONSUMER A15VISORY A)AJ ALLERGEN AWARENE PRODUCT LIST FOR RETAIL OPERATION I1-1-- Q, Gk Get d t KL'w ' _CJ h Sherrie McCullough, R.S: Assistant Director Tar6mi Mason Senior Department Assistant CERTIFIED FOOD MANAGER'CERT' " AJ IT ALLERGEN AWARENESS CERT IV ANTI CHOKING CERT IF OVER 25 SEATS�� EQUIPMENT SPECS t' TYPE OF WAREWASHER/TYPE OF SANITIZER N WHAT SANITIZER WILL BE USED FOR CLEANING HAND SINKS_____L_ MOP SINK 0 THREE -BAY SINK PREP SINK NUMBER & TYPES OF REFRIGERATOR & FREEZER UNITS f'U2rE 1 c r Vh, ICE MACHINE yA WASTE REM VAL V'es BATHROOM FACILITIES iL 5 DRY STORAG� 3"I"L &r-, FOLLOW-UP NEEDED WITH: BUILDING 6'& ZONINGi� PLANNNING JIIi� SELECTMAN _&4 FIRE POLICE CONSERVATIONTLj�! _ COMMENTS. 'D'1 - OA -1a,11-1 46K h] C'r7, FINAL INSPECTION DATE d REVIEW SIGN OFF DATE6� ! dJ 3 N-.\HealthlMcCulloughlFOOD\Letters\Food reviewsWew Food Establishment Check List.doc bhr1055C eC Al n _ 10117 HEALTH DEPARTMENZ Town of Brewster -Food Inspection Report 2198 MAIN STREET BREWSTER. @AA 02631 Establishment. G jLbT Type of Operation Type of EstahIIshment Address: ❑ Food Service Establishment 0 routine ❑HACCP Owner: 9 Retail Food Store ❑ re -inspection ❑ Other Person -In -Charge' ❑ Residential: Cottage Faads ❑ illness investigation Telephone: Tame In: 11 %J4 ❑ Residential: B&B ❑ Temporary Pre -operational Inspector: Time Out: ❑ Mobile/Pushcart 111 Other El General Complaint FOOD130hWE ILLNESS:RISK FACTORs�AND:PUl3UC'HEALTHi INTERVENTIONS dN x in comp Ilance OUT = out of compliance 14/0 = nit observed ;4/A =not applicah[e COS = corrected on-site during ins ectinrt R = repeat violation Compliance Status l N g u T N A H C R Campiiance5tatus a a 5 r n o s 'Su ervfsdori : Protecti tnfram;Contamination . 1 Person in charge present, demonstrates knowledge and performs duties is Food separated and protected t/ 2 Certified Foad Protection Manager l 1G Food contact surfaces; cleaned & sanitized .. ., .. .. is , Proper a ,prey u. ysery Employee hleaith:.:. :: 17 ono re urn e reconditioned & unsafe food 3 Management, food employee and conditional' empfoyee• knoowiedge, responslblllties and reporun rme/Temperature Control for Safety 4 Proper use of restr§cted and exclusion 18 Proper wokirrg tlme & temperatures 5 Procedures for responding to vomiting and diarrheal events 19 Proper reheating procedures for hot holding y Good H gieni[ Practices - ..: � .. �. � � � � � � � .: ��:: 20 Prrgrer coo mg time and temperature I/ 6 Proper eating, tasting, drinking or tobacco use 21 Proper hot homing temperature 7 No discharge from eyes, nose and mouth 2.2 Proper cold holdingtemperature ✓ P.reU6nting Cont;itniiiatp�i Hands': 23 Proper date markingand disposition g Hands clean and property washed 24 Time as a Public Health Control 9 No bare hand contact with ready to eat foods V Consumer AchAsiary_ 10 equate handwashing sinks properly supplied andi5 accessible Consumeradvisory provided for raw/undercooked food Approved Source ::... .:.:...:. -•• :..... .... .: Highly Susceptible Populations 11 Food ofnax ed from apprrned source 26 Pasteurized foods used; prohibited Fa ods not offered 12 Food received at prope rtemperature Food /Color. Additives and TWIc Substances . Food received in geed condign, safe & 27 unadulterated Food additives: approved & properly used 3A Required records available: shellstocktags, paraslte 213 destruction Toxic substances properly identified, stared & used _ Cdhfnimance with a proved Procedure3. 29 Comptlance with variancelspecial:zed processJHACCP Pian GOOD RETAIL: PRACTICES AND MASSACHUSE75i- aNLY:SECTIOHS Safe Food and WaterPhysical Facifitias 30 Pasteurized eggs used where required 50 Hot & cold water available; adequate pressure 31 Water & ice from approved source 32 Uariance obtained for specialized processing methods 53 Plumtdng Installed; proper bacMw devices 52 sewage &wastewater properiv disposed Tcllet features: properly constructed, supplied & Food Temperature Control cleaned a3 Proper cooling methods used; adequate equipment far tem rature control 54 Garbage & refuse properly disposed; facillVes rrpaintaireed 34 Plant food properly cooked for hot holding 55 Physical facilities installed, maintained & clean 35 Approved thawing methods used 56 Adequate ventilation & lighting; designated areas 36 Thermometers provided & accurate Food.identification 32 Food propedpi labeled; anginal container Addltionat Re uirerilentS L-psted iri 1d5,CMR.5'30.011. , sPrEve ntion of Food Canto mination Ml Anti -choking PTO ceduresIn food serylce establishments � 3a insects, rodents & arVnals not present P,12 Food allergy awareness 35 Contsminatron prevented duringfaod preparation, storage and dis ' Review, of.Retaif Operations.Iisted in 105 CMR 590.[110 49 Permnatcleanliness M3 Caterer 41 Wiping cloths: properly umcl & stored M4 Mobile Food operation 47Washingfrults &vegetables M5 Temporary Wad rstaWI.hmeat - Pro er USeiifUtensils SAG PubHcmarket; Farmers Market 43 in -we utensils properly stared M7 Residential Kitchen; Bed -and -Br st Operation LlterL415, equipment & Ifriens; praper!•ystcred, dried, and handled ht8 Resldentia! lUtchen; Cotta ood operation 9 45 Single-usejsFrrgl"ervice arttdes; properly stored and used M4 School Kitchen; U tiul{nion Program 45 Gloves used properly Mxo leased Comore ial IGtclvan Uterisils,'Equipment and Vending. roil lnnovatsre ope atron 47 Food & rmn-food contact so rfar-es cleanahie, properly designed, constructed & used Local Recjulrerrient : 48 Warewashing facilities; installed, maintained, & used; test strips LI Local Law or Regulation 49 Nan -fwd contact surfaces c6_=an L2 other Signature of Person -in Charge: Date: Signature of Inspector: i Date: Page 1 of 0 Town of Brewster Food Establishment inlspe AisiUT ent: CG,P-, Co -� ' Ivs£uve- a� --U' iv7J ..::.:::.:.::::-..::.:: •,::..:. _ ....emperature;phser.►iations ::.:. ,...:; Item/location Temp (°F) Item/location Temp l°F} m 1 dye 4•tnl�r� 4 I.1. P., 210 Violations cited in this report mu item Section of Number I Code Discussion with Person -in -Charge: ction Repo Date: dons and/w CorrectiVe:Actians .: withln the time frames stated he low a in Section 81 Description of Violation 1 4 ifthe Food Code Date to Correct Official order for Correction: 9ased on an inspection today, the items marked "OUT" Indicated violations of 105 CMR 5 90 .000 and applicable sectlons of the 2013 FDA Food Code. This report, when signed below by a Board of Health memher or its agent constitutes an order ofthe Board of Heatth. Failure to correct violations cited in this report may result in suspension or revocation, of the food establishment permit and cessation of food establishment operations..If you are subject to a notice of suspension, revocation, or non- renewal pursuant to 105 CMR 590.000 you may request a hearing before the Board of Health in accordance with 105 CMR 590.015 (B). Violations not corrected are subject to fines. Number of Violated Provisions Related to Number of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions [j Foodborne Illness Risk Factors and (items 1-29): Interventions (items 1-29) . of P Signature of !ns ec}tor:' JL Date: late of Re -inspection: Page �— of RECI- I ED spewaT TOWN OF BREWSTEF MAY 2 4 2021 I OFFICE OF b4 q, �,A E TH DEPARTMENT 2198 MAIN STREET n i BREWSTER,MA02631 E3REWSTER HEALTH °r =_ _" a PHoNE: (508) 896-3701 Exr 112 E)EPARTM ENT FAX: (508) 890-4538 BRHEAL-M u)BREWSI'ER-MA.GOV W %A1%V.13REWSTER-MA.C,QV Received:517.41Z l Paid: ✓ Application for Board of Health Variances Abutter Deadline: U 1-112-1 [AIn-House Local Upgrade Approval ❑Public Hearing Date: May 17, 2021 SUBJECT PROPERTY ADDRESS: 181 Timberlane Drive Neap: 144 parcel: 30 Book: 30523 Page: 194 LC Certificate: LC Plan: Lot: Name of Applicant: Paul Brian Ford & Catherine Jane Ford mailing Address: 3338 West Belmont Avenue, Phoenix, AZ 85051 Telephone # Email: Owner(s) of Record : Same above Mailing Address: Design Engineer/Sanitarian: John L. Churchill Jr. Firm/Company Name: JC Engineering, Inc. Mailing Address: 2854 Cranberry Highway, East Wareham, MA 02538 Telephone #: 508-273-0377 Email address: mpimentel aficeng.org Signature: %?�d P4",ed Applicant or Engineer New Construction ❑ Voluntary Upgrade ❑Additbn/Alteration X Failed system ❑steal Estate Transfer ❑ Design flow of existing system: 330 Design flow of proposed system: 330 Total sewage flow of site: 332.3 Conservation Commissbn approval required: yes ❑ no 19 Order of Conditions/Det. Of Applicability attached ❑ Reason for failure: Unknown Total lot size (so: 15,109 s.f. Date of ConCom hearing: I ict of nil Varianrpe fmm Statim anti i ural rndps (add sheetc if needed) TITLE 5 Sec. #: Description of Variance(s) 310 CMR 15,221(7) A 1.0' waiver (3.0'- 4.0' for the maximum cover over the H-20 distribution box. 310 CMR 15221 (7) A 1.7' waiver 3.0' - 4.7' for the maximum cover aver the H-20 SAS. 310 CMR 15.255(5) A 2,0' variance (5.0'- 3. for the excav tion of unsuitable material 5 feet laterally along south side of 5A5. 310 CM S,*fl A 70 M c Brewster Reg. #: Descri tion of Variance(s) Approved by:t-� Date:' Health Department N:IIIealthTOH rev s`1hrIlouse Septic Local Upgrade Approval 2019Warimceapplication FINAL NONFU-LABLE FORM 12,18.19.docx Z Q J n ry 0 0 J LL Z U) X LU CERTIFIED MAIL RETURN RECEIPT REQUESTED BREWSTER IN-HOUSE SEPTIC LOCAL UPGRADE APPROVAL NOTICE: Date: May 17, 2021 Re: 181 Timberlane Drive Map: 140 Lot: 30 Subject Address Dear Abutter: Please be advised that an application for septic local upgrade approvals from the regulations of the Massachusetts Department of Environmental Protection, Title 5 and/or the Town of Brewster Regulations for Subsurface Disposal of Sewage, has been submitted to the Brewster Health Department for approval. The following variances are requested: List of all variances from State and Town Codes Title 5, See # Description of Variance(s) 310 CMR 15.221 7 A 1.0' waiver 3.0' - 4.0' for the maximum cover over the H-20 distribution box. 310 CMR 15.221(7) A 1.7' waiver (3.0'- 4.7') for the maximum cover over the H-20 Soil Absorption System (SAS). 310 CMR 15.255(5) A 2.0' variance 5.0' - 3.0' for the excavation of unsuitable material 5 feet lateral ly alorig south side of SA The application and plans are available for review and comment at the Brewster Health Department, Brewster Town Offices, 2198 Main Street Brewster, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:00 pan. Sincerely, Mclaaee 714xe9&e Applicant/Representative CC: Brewster Health Department N:\Health\BflH regs`,InHouse Septic Local Upgrade Approval 2019Ninhousevarianceabutternotification NONFILLABLE FORM 12.11.19.docx gIm Wm � wsr � TOWN OF BREWSTER, MA x°; BOARD OF ASSESSORS =3 a 2198 Main Street Brewster, MA 02631 m Abutters List Within 65 feet of Parcel 144/30/0 144/60/0 144/47/0 93 WOOD. DUCK ROAD 49 VY001)- DU CIC ROAD 144/29/0 144130/6 144131/0 171 T1M8ERLAN 11kOERLA ILjBERLANE.D IVE N 2 0 0 ft Certified by. lames M. Gallagher, MAt� Deputy Assessor 511312021 Page 1 Parcel l❑ _ - Cnvner _ _ _ _ LaCalivn Mailing Slreel— MnHin�Cily _ _ QST ZiACdlCyurWr 8126 144-29-0-R SPRINGER DANIEt TRUSTEE 171 TIMBERLANE DRIVE P O BOX 73 HARWICH MA 02845 (45-98) D A N REALTY TRUST 8125 144 V -0-R FORD PAUL BRIAN & 181 T1+ABERLANE DRIVE 33W WEST BELMONT AVENUE PH)ENV AZ 85051 (45-97) FORD CATHERINE JANE 0124 144-01-0-R �KOSMACH JOAN A 191 TIMBERLANE DRIVE 191 TM,$ERLANE DRIVE BREWSTER MA 02631 (45-98) CIO KOSMACH JOAN A& BOULOS CONSTi 6085 144.42-0-R HACKETT CAROL EBBERT TRUSTEE 49 WOOD DUCK ROAD 49 WOOD DUCK ROAD BREWSTER MA 02631 (45.58.7) HACKETT FAMILY NOMINEE TRUST _ 13100 144.60-0-R IACCHERI DON M & THERESA M 93 WOOD DUCK ROAD 93 WOOD DUCK ROAD BREWSTER MA 02631 (45.58.201) Certified by. lames M. Gallagher, MAt� Deputy Assessor 511312021 Page 1 SPRINGER DANIEL TRUSTEE D A N REALTY TRUST P O BOX 73 HARWICH, FILA 02645 144-29-0-R 144-42-0-R HACKETT CAROL EBBERT TRUSTEE HACKETT FAMILY NOMINEE TRUST 49 WOOD DUCK ROAD BREWSTER, NIA 02631 144-30-0-R 144-31-0-R FORD PAUL BRIAN & KOSMACH JOAN A FORD CATHERINE JANE CIO KOSMACH JOAN A & BOULOS CONSTA 3338 WEST 13ELMONT AVENUE 191 TIMBERLANE DRIVE PHOENIX, AZ 85051 BREWSTER, MA 02631 IACCHERI DON M & THERESA M 93 WOOD DUCK ROAD BREWSTER, MA 02631 144-60-0-R Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 0263 1-1 898 PHONE: 508.896.3701 EXT. 1124 FAX: 508.896.453 8 b rhea l th @brew stet -m a. gov W W W.l3REWSTER-MA.Gt7V AGENDA ACTION ITEM FORM BOH Variance Agenda Item ❑ In -House Local Upgrade Approval Other: Board of Health Meeting Date: ❑■ Health Department Amy L. von Hone, R.S., C.H.O. Director Sherrie McCullough, R.S. Assistant Director Tammi .Mason Senior Department Assistant Project Location: 181 Timberlane Drive Map & Parcel: 144-30 Owner's Name & Address: Paul Brian Ford & Catherine Jane Ford 3338 Nest Belmont Avenue Phoenix, AZ 85051 Applicant: Paul Brian Ford & Catherine Jane Ford Date Requested: May 24, 2021 Title 5 Variance Request: Yes N No ❑ Board of Health Variance Request: Yes❑ NoN300' Pond Setback Other: Yes[R No ❑ 1. In District of Critical Planning Concern (DCPC), inside Zone II and serviced by town water. Health Director's Recommendation: Approve with following comments and conditions 1. The existing property consists of an existing 3 bedroom dwelling serviced by a 1992 Title 5 septic system with town water. The lot is approximately 15, 109 s.f. and is subject to local District of Critical Planning Concern restrictions under the Brewster Zoning Bylaws and the Title 5 Zone 11 Nitrogen Loading restrictions. 2. The existing leach trenches are currently failed and are being replaced with a proposed H2O Distribution Box and 6 H2O LC -6 Concrete Chambers with stone to service the existing 3 bedrooms. The existing 1000 gal septic tank is to remain. 3. The following variance is approved: Title 5/Town of Brewster: a. 1'-1.7' variance, proposed 3'— 4' maximum fill cover over distribution box and leach facility. hi:\Health\BOH Decision Letters%ept i c Variance ]n -House Decis ion s\Real Estate Transfer Approvals1181 Tirnberlane Dr Action Item Summary 06.44.2021.docx b. 2' variance, proposed 3' lateral removal of unsuitable soils around the proposed leach facility along the southerly side of the leach facility. c. 7' variance, proposed 3' separation between the leach facility and property line 4. Due to the existing contours of the lot, the proposed septic design requires greater than 3' of final fill over the distribution box and leach facility. The system will be vented as a mitigating measure. Removal of unsuitable soils along the southerly side of the leach facility is limited due to the location of the existing septic tank and the required minimum size of the new leach facility. Reduction of the soil removal should not negatively impact the function of the new leach facility and may not be required based on the contours of the lot and the existing soil conditions. N:1Health\BDH Decision Letters\Septic Variance In -House Dec ision s\Real Estate Transfer Approva]A181 Tamberlane Dr Action Item Summary 06.04.2021.docx June 4, 2021 Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT, 1120 FAX: 508.896.453 8 brhealthr.brewster-ma. oy WWW,BREWSTER-MA.GOV Health Department Amy L. iron Hone, R.S., C.H.O. Director Sherrie McCuIlough, It.S. Assistant Director Tammi Mason Senior Department Assistant Notice of Board of Health Variance Approval/Deed Restriction RE: 181 Timberlane Drive, Brewster, MA Map: 144 Parcel: 301 Book:30523 Page: 194 Lot: 19 Owner of Record: Paul Brian Ford and Catherine Jane Ford Dear Mr. Ford and Ms. Ford: On June 4, 2021, the Brewster Health Department reviewed and approved the fpilowing variance for the septic system upgrade at the above -address per engineered plans by JC Engineering, Inc. dated May 13, 2021: C6 Title 5: 0 310 CMR 15.221 (7) (General Construction Requirement for All System Components) a. T-1.7' variance, 3'-4.7' of final fill over Distribution Box and Leach Facility 6' 310 CMR 15.255 (5) (Construction in Fill) o a. 2' variance, 3' removal of. unsuitable soil along southerly side of Leach Facility �. 310 CMR 15.211 (Minimum Setback Distances) a. 7' variance, 3' setback between the Leach Facility and property line r N Town of Brewster: 0. I None M cv MIn granting the above variance, the Health Department imposes the following Order of Conditions: a1. The property consists of an existing three (3) bedroom dwelling. No additional bedrooms allowed In without further review by the Board of Health and the Building Department. 2. Prior to issuance -of the Certificate -of Compliance this Variance Approval Letter must be properly recorded at the Barnstable County Registry of Deeds and a recorded copy of same shall be furnished to the Brewster Health Department as proof of the recording. �i _ 3. Variances shall expire within one (1) year of the date of this approval. u Please feel free to contact me ifyou have any comments or questions -on the above. I can be reached at the 0 Health Department, 508-8963701, ext. 1120. Elf Sincerely, my L. von Hone, R.S., C.H.O. Director of Health cc: JC Engineering, Inc. 2854 Cranberry Highway, East Wareham, MA 02538 File N:`,HeaIth\G0H Decisian Le tte rs\Se ptic Variance In -House Dec! 5buns\Title 5 Brewster Approvals\181 Timberlane Drive InHouseApprnva106.04.2021.doc Paul Brian Ford Catherine Jane Ford 3338 West Belmont Avenue Phoenix, AZ 85051 RE: 181 Timberlane Drive, Brewster, MA Map: 144 Parcel: 301 Book:30523 Page: 194 Lot: 19 Owner of Record: Paul Brian Ford and Catherine Jane Ford Dear Mr. Ford and Ms. Ford: On June 4, 2021, the Brewster Health Department reviewed and approved the fpilowing variance for the septic system upgrade at the above -address per engineered plans by JC Engineering, Inc. dated May 13, 2021: C6 Title 5: 0 310 CMR 15.221 (7) (General Construction Requirement for All System Components) a. T-1.7' variance, 3'-4.7' of final fill over Distribution Box and Leach Facility 6' 310 CMR 15.255 (5) (Construction in Fill) o a. 2' variance, 3' removal of. unsuitable soil along southerly side of Leach Facility �. 310 CMR 15.211 (Minimum Setback Distances) a. 7' variance, 3' setback between the Leach Facility and property line r N Town of Brewster: 0. I None M cv MIn granting the above variance, the Health Department imposes the following Order of Conditions: a1. The property consists of an existing three (3) bedroom dwelling. No additional bedrooms allowed In without further review by the Board of Health and the Building Department. 2. Prior to issuance -of the Certificate -of Compliance this Variance Approval Letter must be properly recorded at the Barnstable County Registry of Deeds and a recorded copy of same shall be furnished to the Brewster Health Department as proof of the recording. �i _ 3. Variances shall expire within one (1) year of the date of this approval. u Please feel free to contact me ifyou have any comments or questions -on the above. I can be reached at the 0 Health Department, 508-8963701, ext. 1120. Elf Sincerely, my L. von Hone, R.S., C.H.O. Director of Health cc: JC Engineering, Inc. 2854 Cranberry Highway, East Wareham, MA 02538 File N:`,HeaIth\G0H Decisian Le tte rs\Se ptic Variance In -House Dec! 5buns\Title 5 Brewster Approvals\181 Timberlane Drive InHouseApprnva106.04.2021.doc A CP Ad Quill �0 Y � e A pp lap CP Ad Quill Y � e A pp lap v � E 6 C IH Ad Quill Y � e lap g E IH Permit #FS2021-018 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BREWSTER BOARD OF HEALTH. Fee: $85.00 IN ACCORDANCE WITH REGULATIONS- PROMULGATED UNDER AUTHORITY OF CHAPTER 94, SECTION 305A AND CHAPTER 111, SECTION 5 OF THE GENERAL LAWS, A PERMIT IS HEREBY GRANTED TO: Cafe Alfresco Whose Place of business is: 1097 Main Street Type of Business: Fo d Service of seats 25 To operate a food establishment in the Town of Brewster, Massachusetts Permitexpires on Dec b r 31, 2021 Date:- 9 "moi e Board A 4ew Of Tam Eo-Ld, Health �yvcbesr Crocker' �� Health Director DATE U f d I dU<)-1 Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth Brewster -ma. ov W WW.BREWSTER-MA.GOV Health Department Amy L, von Hone, R.S., C.H.O. Director CHECK LIST NOTES FOR NEW FOOD SERVICE OPERATION Sherrie McCullough, R.S. Assistant Director Tarrimi Mason Senior Department Assistant OPERATOR Chrl % r&M CONTACT INFORMATION NAME, LOCATION & TYPE OF OPERATION (e) SLC a 7747- ad ico Li" (let Ln )1 r SEPTICS STEM INFO: CA"CJTYICOMPONENTSIT SPECTION f(Fit 5 at 4 NUMBERbF SEATS =3 VVATER,SOURCE �U ANNUAL/SEASONAL' HOURS OF OPERATION g - -f FLOO PLANS 01-- SITE PLAN„ MENU_ C�]J�- CONSUMER ADVISORY Q1Z-- ALLERGEN AWARENESS PRODUCT LIST FOR RETAIL OPERATION CERTIFIED FOOD MANAGER CERT r ALLERGEN AWARENESS CERT," ANTI CHOKING CERT IF OVER 25 SEA EQUIPMENT SPECS 1,- _,r TYPE OF WAREWASHER/TYPE OF SANITIZER WHAT SANITIZER WILL BE USED FOR CLEANING HAND SINKS MOP SINK �-� THREE -BAY SINK_VZ[ L PREP SINK NUMBER & TYPES OF REFRIGERATOR & FREEZER UNITS 0)&J_ ICE MACHINE -j WASTE REMOVAL I)r— BATHROOM FACIL IES�1L DRY STORAGEX111 FOLLOW-UP NEEDED WITH: BUILDING ZONING PLANNNING SELECTMAN FIRE POLICE CONSERVATION COMMENTS. Ct l e re Ckr FINAL INSPECTION DATE `- REVIEW SIGN OFF N:IHea1th\McCulloughTF00W ettersTood reviewsWew Fond Establishment Check List.doc DATE TOWN OF BRFwnEi R 2198 MAjN STREET BREWsTER, MA 02631 PHoNB: (508) 896-3701 EXT 120 FAX: (508) 896 4538 BRHEALTH ![ TOWN.BREWSTBR.MA.-US Fs 2a2'1- 0 1 S/ 3UI= 0 � 2021 6ReWSTEFR HEALTH pEPARIMENT Food Establishment Permit Application (Application must be submitted at least 30 drays before the planned opening date) 1) Establishment Name: ``-- �.� et l✓ �i�e 2) Establishment Address: 3) Establishment Mailing Address (if different): 4) Establishment Telephone No: SO S/6 M ill 5) Applicant Name & Title: 6) Applicant Address: WC"7 two f 7) Applicant Telephone No: 24 Hour Emergency No: 8) Owner Name & Title (if different from applicant): 9) Owner Address (if different from applicant): 10) Establishment Owned By: ❑ An association ,• A corporation ❑ An individual El Aparinership El Other legal entity 11) If a corporation or partnership, give name, title, and home address of officers or partner. Name Title Home Address fl S Yht �cr l L. .�w++l� 4 � ',.r -r. in w fl 4Lll Dr S w , 1 tFvin L:r{L$ .i 6✓ � ir6-^7 W4 'J� L.. Si -'r . 12) Person Directly Responsible For Daily Operations (Owner, Person in Charge, Supervisor, Manager etc.) Name & Title: Address: S 1 o-ra.� t _ •31K — Telephone No: 5 S2 t t 2 41 G Fax: Emergency Telephone No: Sb- �k `I J, G o 17 13) District or Regional Supervisor (if applicable) Name & Title: Address: _ Telephone No: Fax: FOR BOARD OF HEALTH USE ONLY Date Received Date Inspected Approved by Permit # Issued WW W.TQWN.BREWSTER.MA.US Food Establishment Information 14 Water Source: Town Water ❑ Private Well Water 15) Sewage disposal: ❑ Title 5 system 11 1 Cesspools DEP Public Water Supply No: (if applicable) Grease `fta 16) Days and Hours of Operation: g , }., - cl r ,,,-, 17) No. of Food Employees: 18) Name of Person In Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CAR 590.003 Please attach copy of cert f care. 19) Person Trained in Anti -Choking Procedu❑ No 20) Location: (check ane) 122) Establishment Type(check all that apply) f Cl Retail ( Sq. Ft) F Permanent Structure Food Service - ( Seats) # of Seats 2-6 ❑ Mobile Food Service -Takeout ❑ Other Food Service - Institution Explain: # of Meals # of Days 21) Length Of Permit: (check Other (Describe) one) Annual ❑ Seasonal/batos ❑ Caterer ❑ Food Delivery ❑ Residential Kitchen for Retail Sale ❑ Residential Kitchen for Bed and Breakfast Hoene ❑ Residential Kitchen for Bed and Breakfast Establishments Q Fozen Desert Manufacturer 23) Food Operations: Definitions: PHF potentially hazardous food(timeltemperature controls required) Non-PHF's - non- potentially hazardous food (no timaltermperature controls required) (check all that apply): RTE- ready -to -eat foods (Ex. sandwiches, salads, muffins which need no further IVI Sale of Commercially Pre- 9 PHF Cooked To Order V1 Hot PHF Cooked and Cooled or Hot Held Packaged Nan PHFs 4 for More Than a Single ileal Service. ❑ Sale of Commercially Pte- In Preparation Of PHFs For Hot And ❑ PHF and RTE Foods Prepared For Highly Packaged PRFs Cold Holding For Single Meal Service Susceptible Population Facility ❑ Delivery of -Packaged PHFS ❑ Sale Of Raw Animal Foods Intended ❑ Vacuum Packaging/Cook Chill To be Prepared by Consumer. ❑ Reheating of Commercially ❑ Customer Self -Service ❑ Use Of Process Requiring A Variance And/Or Processed Foods For Service HACCP Plan (including bare hand contact Within 4 Hours. alternative, time: as a public health control) ❑ Customer Self -Service Of Non-PHF and ❑ Ice Manufactured and Packaged for ❑ Offers Raw Or Undercooked Food of Animal Non -Perishable Foods Only. Retail Sale Origin. ❑ Preparation Of Non -PRFs ❑ Juice Manufactured and Packaged ❑ Prepares Food/Single Meals for Catered fox Retail Sale Events or Institutional Food Service ❑ Offers RTE PHF in Bulk Quantities ❑ Retail Sale of Salvage, Out -of Date or Reconditioned Food ❑ Other (Describe): To he completed by the Board of Health Total Permit Fee., $ Paywent is due with application I, the undersigned, attest to the accuracy of theinformation provided in this application and I affirm that the food establishment operation will comply pith 105 CMR 590.000 and all other applicable law. I have been instructed by the board of health on how to obtain copies of 105 CMR 590.000 and the fe al Food Code. 24) Signature of Applicant: Pursuant to MGL Ch. 62C, sec. 49A, 1 certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 5 q `( 26) Signature of Individual or Corporate Name: 4 rest CCff�Sd►'z � � C+ j n�� ;E7WS Town of Brewster Y r y BREWSTFR, MASSACHUSETTS 02631-1898 •��oeaaA Ki �Q ffe.af.t5o7 FOOD ESTABLISHMENT PLAN AND SPECIFICATION REVIEW v/' NEVI! Name of Establishment: fM �rrsc REMODEL Address: 10qj t► - Phone if available S o -6 %94 1 }ail Name of owner:_C'�r, S v�lY� { �, :., >.C— r, Mailing address: S k Telephone:_.. ,� b t 5? f- 1-r 2 y Applicant's Name: C �, n "\' Zl,r G-- ts4 Mailing address: 1 \2, V- Telephoner <,2L- "(229 Title (owner, manager, architect, etc.): OMCE 4F: BOARD QT HEALTH (509) 895.3701 EXTIM We STRONGLY recommend that you visit each of the offices listed below and check if any licenses, approvals, inspections are needed. Existing buildings are not necessarily "grandfathered", and some things that were allowed before, may require changes today. Please check off that you have visited each of the following. Board of Selectmen (liquor, common victular, etc.) Zoning (signs, usage, outdoor seating, etc.) Planning Police (liquor, outdoor coolers, etc.) Building (Plumbing, electric, building, etc.) Fire (hoods, smoke detectors) Conservation Other Meals to be served: ✓ Breakfast Lunch Dinner 1-Y) v No. of seats: 2 *:) 67&t' �;- 6?�4r No. of staff: (per shift) Square Feet: Wf/K• .?-S $ A-- a021/) A. Finish Schedule Applicant fill in materials (i.e. quarry file, stainless steel, 4" plastic covered molding, etc.) Floor Coving Wails Ceiling Lighting Itchen Warewashi - - — Food Storage �JYl AI Other storage - Bathroom _ Dressing Room - --- - — _ -- - — - *Ali surfaces must be finished smooth, non-absorbent, and easy to clean B. Insect and Rodent Harbom90 Please answer yes or no, Explain all "no" answers below, r Are all outside doors self-closing with rodent proof flashing? Y_ Are screen doors provided on outside doors for use in surnmer? Are they self closing? yrs Do all operable windows have a minimum #16 mesh screening? �yr_TAre all pipes, electrical conduit chases, ventilation systems exhausts and intakes sealed? `Ic j ]s area around building clear of unnecessary brush, litter, boxes or other harborage? C. Garbage and, Refuse --Li)--Do all containers have lids? �Y o Will refuse be stored inside? If so, where? Is there a can cleaning sink or area? if so, where?—,�tG � —s Nmr , Wil€ a dumpster be used? Number i Size Frequency of Pickup.,r; f� Contractor qtp���.� j Will a compactor be used? Number Size Frequency of pickup Contractor Will cans be stored outside? Describe surface dumpsterlcompactorlcans are to be stored on: M Restrooms Restrooms must he provided for the convenient use of employees. > re soap dispensers provided? ? Is a covered trash barrel provided? -+T.Is ventilation mechanical or via a window? Is the door self closing? What method will be provided for drying hands? E. Genera ey Are storage facilities for employees` personal belongings provided? (i.e., purse, coats, boots, etc.) If so, where? 2 n cg Describe facilities for separation of storage of insecticidestrodenticides and detergentstsanitizerslcleaning agents/caustics/acids/polishes and first-aid supplies/personal medicationsfcleaning equipment? Vl F Are laundry facilities located on premises? If so, where? If so, what will be laundered? — Location of clean linen storage Location of dirty linen storage if -you -M-11 only he serving re- acka a 'nods 12roducts You migy §tophere. If you will be serving nen foods this includes but is not limited to coffee ice fountain soda prepared foods. etc.), you must completo the rem ' der of this form. F. Sinks ,o Is a separate mop sink present? (Required for all new and remodeled establishments) y ^Is a separate food preparation sink present? ^Is a separate handwashing sink present in each food preparation area? Will a dishwasher be used? What type of sanitizer used? ao, - Is a three compartment sink present? (required of all new and remodeled establishments along with all establishments which undergo a change in ownership.) I: � Does the largest pot and pan fit in each compartment? 2�re there drainboards on both ends? What type of sanitizer is used? (Chlorine, Iodine, Quaternary ammonium or Hot Water) *Please make certain the corresponding test kits are avaiiabie at the preopening inspection. *A record keeping system for maintaining 30 days records of testing, such as a calendar, must be present. *Instructions must be posted at the three bay sink which tell how to make sanitizer at the proper concentration G. Water Supply Is water supply public ( ) or private ( )? If private, has source been approved? Please attach copy of written approval. Is ice made on premises or purchased commercially ? If on premises, are spec'i'fications of machine enclosed? Will ice be served in drinks? If so, where stored? Frts zl r __.. ,—Will ice scoops or tong be provided? If so, where stored? _o _ &L, L ` L 4, w.= H. Exhaust Hoods Odor Supp. Dvicel Fire Air- Capacity *All requests for new permits must go before the Board of Health for approval. The BOH usually meets the first Tuesday of the month. All paperwork must be submitted no later than 4 P.M., one week prior to the meeting. * No work should be started until the plans are approved by the BOH. Any work done without BOH approval is done at your own risk, and may not be accepted at a later date. *You should plan an at least two inspections; one preopening to be done about I week prior to opening and; one final inspection scheduled closer to the proposed opening date. These can be scheduled once your completed application has been received. Please enclose the following documents: i/ Proposed Menu Specification sheets for each piece of equipment 6y1 �Ll 6'"ite pian showing location of business in building, location of building on site including alleys and streets, location of any outside facility (dumpsters, walk-ins) 6V Plan drawn to scale of facility showing location of M FI (T equipment, plumbing and electrical /tib AUAJ (11"4 Please make certain the following information is available on the plans. Location and size of all grease traps. * Location of employee and/or patron restrooms including lavatories, water closets and urinals. Location of employee dressing rooms and/or lockers. /i'Y * Note that ceiling, walls and floors must be suitably finished to facilitate cleaning. All studs, joists and rafters must not be left exposed. Utility service lines and pipes must not be unnecessarily exposed. * details of special operations such as salad bars, bulk foods and vacuum packing. STATEMENT: 1 hereby certify that the information contained in this application is correct, and 1 fully understand that any deviation from the above without prior permission from the office may nullify this approval. Signature(s) C// z i Date s) or responsible representative(s) Approval of these plans and specifications by this Health Department does not indicate compliance with any other code, law or regulations that may be required -- federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment), A preopening inspection of the establishment with equipment will be necessary to determine if it complies with the local and state laws governing food service establishments, Q 0y 0 U. W Vf I k, qu D L6 Z Q W u� � m LLA > D LLA N CC a F- < LI} Q CC �LLJ F- �N C� O LU C< m z ❑ z Z N 4 J r a r) Lv m sd w 0 L uz z pZ g I- M ¢ L„ O a W p� J 1 Ln 0. ¢ - 2 [n 1-- m Ln Y� J Y p w w Q U LA Ls D C7 N0. 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J m N Q m J a' A u 0 U Q3: U ¢ H C S❑ M W U a W m J Q - n c 2 m a EALTH Town of Brewster -Food Inspection Report H2198 MAIN STREET DEPARTMENT BREWSTER MA 02631 Establishment- Type of Operation Type of Establishment ss: ¢ 7 ❑ Food Service Establishment ❑routine ❑ HACCP Owner: ❑ Retail Food Store ❑ re -Inspection ❑ Other Person -In -Charge: ❑Residential: Cottage Foods 11 Illness Investigation Tele hflne: -`time In: Residential: B&13 El Temporary Pre -operational Inspector: 1 Time Out: ❑ Mobile/Pushcart ❑ Other ❑ General Complaint FOODBORNE If_lNESS.RISIC FACFQRS AIVD.P,Il13L1C HEALTH INTERVENTIONS IN=incompliance OUT =out ofcom pliance N/O=not observed N/A =not a plicahle COS =corrected on-site durn ins peCtl0n R=re eatVtolatlon CompllantiestatusN u T N I A +� / O G O 5 It Compliance Status N ❑ Ll T H y A H P c 6 8 e Supervision , . ... Protectlon from Contamination 1 Person In charge present demonstrates knowledge aad Performs duties - 1-5 Facd Separated and protected 7 Certified Fred Protection Manager itz I W16 Food contact surfaces; cfmaned & sanitized Proper Disposition of returned, pravlously served, cz Empldyee Health 17 - recandxivned &unsafe food 3 Management food employee and conditional employee; knovAedge, respanslbRitles and reporting Time/Tem erature Cditrol.forSafe P. tl:. 4 Proper use of restricted and exclusion 18 Proper caoldng time &temperatures 5 Proced res f r respondin to v mi In and diarrhea) events ig 19 Proper reheat m g12 procedures for hot holdin :.Goo H �ienic.Practkes 20 Proper cooking Vmeand temperature 6 Proper eating, tasting, drinking or tobacco use 21 Proper hot holding temperature 7 No discharge from eyes, nose and mouth 22 Proper cold holding temperature preventing CoriUrnhmtioKb Hands :.. 23 Pro per date markingaAddisposition 8 Hands clean and properly washed 24 Time as a Publd: Health Control 9 No bare hand contact with ready to eat foods ConsurnerAdvtsory:.: 10 Adequate hand'washing stinks propedysupFdied and accessible 25 Consunvar advisory provided for raw/undercooked fogad Approved Source:.....<. .:., .. Rig hly5usoe ttbie populations: . xi Foci abtained from approved source used; prohibited foods not eftwered 12 Food received at proper temperature FOA/Color Additives and Toxic Substances [2J6pastaudzedroads 13 Food received in good canciltbm, safeunadulterated Food add hives: app roved& properhy used 14 Required records available: shellsteck tags, parasite destruction Tox1: substances prope4y ddentlfled, stored & used . ` .conforrnancewith approved -Procedures 29 Compliance with variance specialized rocesslHACCP Plan GOOD'REFAIk: PRACiICES,AND MASSACHUSETTS —ONLY SECTIONS: Safe Food and water Physical Fadflitles . . 30 Pasteurized eggs used where required ressure so Hmt & cold water avalla Me, aflkll,,[[ 31 Water & Ice from approved source 31 Variance obtained for specialized processing methods 51 Phmbdng installed; proper bevices 52 Sewage & waste water propesed Food Temperature CdatroI 53 Tailetfeatures; properly consupplled & ..cleaned 33 Proper cooling methods used; adequate equipment 54 Garbage & refuse properly diacilitdasfar tem p erature control malntalned 34 Plant food properly cooked for hot holding 55 Physical faralities Installed, m & dean3s Approved thawing methods used 56Adequate ventilation & Rghtinated areas used L; 36 Thermometers provided & accurate Fuod identiflcatien. 37 Food properl•ylaheled, original container Additional Requit"6rits Ltsteclin:105 CMR 590-011' - _ PreWentiod of Food Cantaritina£ioii M1 Arui-choking procedures in foodservice establishments �z Insects, rodents & animals wt present M2 Food aTErgy awareness 39 Contamination prevented during foci d preparation, storagE and display Review of.Retail Operations listed in lOSCMR 546.016':_-_I.: 40 Personal cleanlinass M3 caterer M4 Mobile pond Operavan 41 Wipdng cloths: properky used & stored 4z Washing fruits & vegetables MS Temporary Food Establishment Pru r use of Utensils: i. r46 Public market; Farmers Market 43 In -use utensils properly stored I47 Residential Kitchen; Bed -and -Breakfast Ope 'o MS Residential Kitchen; Cottage Focd 6 44 Utensl15, equipment & linens; properly stored, dried, and handied 45 Single-uWsingle-service articles; property stored and,M9 used School Kitchen; USDA Nutri - rogram 46 Gloves used properly PAID Leased Commerdty.Kh en utensils; E ui ment and VendFng:.:. whit lnnovaWe on 47 FOC13 & non-food comactsurfaces cleanable, properly designed, constructed & used Local Requirement 48 Warewashing facilities: Installed, maintained, & used; test strips L3. Local law ar Regulation 49 Non-food co ntact surfaces clean L2 I Other Signature of Person -tri Charge: Date: �,_ 3� _ Z Signature of Inspector:zgn pate: g / F 6/f Page z of Town of Brewster Food Establishment inspection Report Establishment: Date: 6-2 Temperature Observations.... Item/location Temp (°F) Item/location Temp (`F) Item location Temp ("F) d xp 6 a r, b"servatians ail .or Gorrecti've;Aciions :: .: " violations cited In this report must be corrected within the time frames stated below or In Section 8-405. 11 of the Food Code Item Section of date to Number Code Description of ViolationDate By G�•�Ti E G,rl � � w r COV0 111-6 t YJ 4�& a�� , fir/ f VY v Y Discussion with Person-in-Charge: official order for Correction: Based on an inspection today, the Items marked "OUT" indicated violations of 105 CMR 590.000 and applicable sections of the 2013 FOA Food Code. This report, when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of the food establishment permit and cessation of food establishment operations. if you are subject to a notice of suspension, revocation, or non- renewal pursuant to 105 CMR 590.000 you may request a hearing before the Board of Health in accordance with 105 CMR 590.015 (8). Violations not corrected are subject to fines. Number of Violated Provisions Related toNumber Foodborne Illness Risk Factors and Interventions (items 1-29): of Repeat Violations Related to Foodborne Illness Risk Factors and Interventions (items 1-29) Signature of Person-in-Chang . Signature of Inspector: Z40�1yelegy-fl- Date: id — -3V — _7Z Date of Re-inspection: Page of 2— May 17, 2821 Bryan Webb (via email) Ocean Edge Resort 2987 Main Street . Brewster, MA 02631 RE: Ocean Edge Resort Wastewater Treatment Facility Monthly Operations Report —April 2021 Dear Mr, Webb: Weston& Sampson 55 WaMers Pfook Drive, Stile 100, Read hg, MA 01&67 Tel: 978.532.1 900 Enclosed please find the monthly Operations Reporting Package for the Ocean Edge Resort wastewater treatment facility (WWTF) located at 832 Village Drive in Brewster, MA. Weston & Sampson Services, Inc. would like to note the following: ■ All regulated effluent parameters of samples collected on April 15, 2021 were reported to be within their respective permissible limits. • Quarterly effluent and monitoring well .samples were collected this month. • Data was tiled with MassDEP electronically, via eDEP. A copy of the transaction is included in.this package. If you have any questions or concerns regarding this report, or the wastewater treatment facility, please feel free to contact me at wsscompliance@wseino.com. Regards, WESTON & SAMPSON SERVICES, INC. James R. Tringale Compliance Coordinator cc: Brewster Board of Health (via email) FR Mahony Associates (via email) westanandsampsen.com offices in: MA, CT, NH, VT, NY, NJ, PA, SC & FL Massachusetts Department of Environmental Protection � eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: wssiNc Transaction ID: 1280266 Document: Groundwater Discharge Monitoring Report Forms Size of File: 1603.11K Status of Transaction: Submitted Date and Time Created: 612/2021:2:2$:33 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. lmportant:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 4:1 ream Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DAILY LOG SHEET A. Facility Information Facility name, address: OCEAN EDGE CONFERENCE CTR a. Name ROUTE 6A b, Street Address 1. Permit Number 2. Tax identification Number 2021 APR DAILY 3. Sampling Month •& Frequency BREWSTER MA 02631 C, City d. State e. Zip Cade 2. Contact information: AMES R. TRINGALE a, Name of FaciNty Contact Person 9785321900 b. Telephone Number 3. Sampling information: SSCompliance@wsei nc,com c. e-mail address 41112021 JONSITE MEASUREMENTS a. Date Sampled (mmlddlyyyy) b. Laboratory Name CHRIS VIGNEAU c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency J Daily Log Sheet - 2021 Apr Daily J_ All forms for submittal have been completed. 2. r- This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 633 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit ' 2, Tax identification Number DAILY LOG SHEET 2021 APR DAILY 3. Sampling Month & Frequency C. Daily Readings/Analysis Information Date Effluent Reuse Irrigation Turbidity Influent pH Effluent Chlorine UV Flow GPD Fbw GPD Flow GPD pH Residual Intensity (mgli) (IN 7.02 7.65 2 3990 3 9284 4 9284 7.05 7.62 5 4341 7.04 7.68 fi 2941 ^� 6.98 7.55 7 3445 7.03 7.49 8 4497 7.00 7,57 9 640$ _I 10 6408 11 6408 12 6408 7.13 7.52 13 5130 7.08 7.56 14 2406 �� T.11 7.83 15 3439 7.13 7.74 16 4407 7A7 7.71 17 856T 18 8567 19 $567 7.12 7.62 20 8223 7.08 7.59 21 8217 �� 7.09 7.54 22 9463 7.03 T.80 23 $521 � 7.00 7.51 24 10222 !� 25 10222 26 10222 7.06 7.64 27 3037 7.02 7,55 28 13975 J 7.08 7.52 29 5104 �� 7.11 7.59 30 52cyg 7.07 7:66 31 gdpols.doc • rev. 09115115 Groundwater Permit Daily Lag Sheet • Page 1 of 1 LLI Important:When filling out forms on the computer, use only the tab key to move your cursor do not use the return key, Idy �rew__A� Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater discharge Program Groundwater Permit MONITORING WELL DATA REPORT A. Facility Information 633 - 1. Permit Number 2. Tax identification Number 2021 APR MONTHLY -j 3. Sampling Month & Frequency 1. Facility name, address: OCEAN EDGE CONFERENCE CTR a. Name ROUTE 6A b. Street Address BREWSTER IMA 102631 . C. City d. State e. Zip Code 2. Contact information: MES R. TR]NGALE a. Name of Facility Contact Person 9785321900 WSSCompliance@wseinc,com b. Telephone Number c. e-mail address 3. Sampling information: 4!1512021 JONSITE MEASUREMENTS a. Cate Sampled (mrnlddlyyyy) b, Laboratory Name CHRIS VIGNEAU c, Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Monitoring Wet] Data Report - 2021 Apr Monthly r All forms for submittal have been completed. 2. r This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09115115 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program I` Groundwater Permit MONITORING WELL DATA REPORT 533 1. Permit Number 2. Tax identification Number 2021 APR MONTHLY 3, Sampling Month & Frequency C. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND' • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled • DRY = Not enough water in well to sample. Parameter/Contaminant aG2 DG3 DG4 OG5 UG1 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Well #: 5 r6 60 6.90 6.70 S.U. STATIC WATER LEVEL 45.9 47.7 42.1 45.9 40.3 FEET SPECIM CONDUCTANCE 34fl 455 55� 220 290 um-i0sr- Well#:B mwdgwp-blank.doc • rev. 09115/15 Monitoring Well Data for Groundwater Permit - Page 1 of 1 Important:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. t•A6 IL r�rn Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DISCHARGE MONITORING REPORT A. Facility Information 633 +1. Permit Number i -- 2. Tax identification Number 2021 APR MONTHLY 3. Sampling Month & Frequency 1. Facility name, address: OCEAN EDGE CONFERENCE CTR a, Name ROUTE 6A b. Street Address BREWSTER IMA 102631 G. City d. State s. Zip Craze 2. Contact information: AMES R. TRINGALE a. Name of Facility Ccntact Person 97853219 Fw-sSCompliance@wseinc.com b. Telephone Number c. e-mail address 3. Sampling information: 4/1512021 JR1 ANALYTICAL a, Date Sampled (mmldd") b. Laboratory Name ARIOUS ANALYSTS c. Analysis Performed By [Name] B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Discharge Monitoring Report - 2021 Apr Monthly All forms for submittal have been completed. 2. r This is the last selection. 3.- Delete the selected form. W gdpols 2015-09-15.doe • rev. 09/15/15 Groundwater Permit Daily Lag Sheet • page 1 of 1 Massachusetts Department of Environmental Protection gag Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit DISCHARGE MONITORING REPORT 2 -Tax identification Number 2021 APR P�DNTHLY _I 3. Sampling foonth & Frequency D. Contaminant Analysis Information ■ For "D"below detection limit, less than (a) value, or not detected, enter "ND" ■ TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled 1. Parameter/Contaminant 2. Influent Units BOD 10 WIL --- TSS 140 YG I_ --- — TOTAL SOLIDS 1 540 MGL AMMONIA•N j5.5 MG1L NFTRATE-N PAGIL TOTAL NITROGEN(NO3+NO2+TKN) MG/L OIL & GREASE MGL 3. Effluent ND 3.7 — 4. Effluent Method Detection limit [10 -- — - 2.8 J 0.25 X5.0 J infeffrp-blank,doc • rev. 09/15115 Groundwater Permit discharge Monitoring Report • Page 1 of 1 Important:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DISCHARGE MONITORING REPORT A. Facility Information 533 1 1. Permit Number 2. Tax identification Number 2021 QUARTERLY 2 3. Sampling Month & Frequency 1. Facility name, address: OCEAN EDGE CONFERENCE CTR a. Name ROUTE 6A b. Street Address H REWSTER M A 102631 C. City d. State e. Zip Code 2. Contact information: JAMES R. TRINGALE a. Name of Facility Contac[ Person 9785321900 IWSSCompliance@wseinc.com b. Telephone Number 3. Sampling information: c. e-mail address 4115/2021 JR1 ANALYTICAL a. Cafe Sampled (mm/ddfyyyy) b. Laboratory Name VARIOUS ANALYSTS c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Discharge Monitoring Report - 2021 Quarterly 2 - All forms for submittal have been completed. 2. r- This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 11 of 1 Massachusetts Department of Environmental Protection 633 Bureau of Resource Protection - Groundwater Discharge PrNram 1. Permit Number Groundwater Permit LI) 2. Tax identification Number DISCHARGE MONITORING REPORT 2021 CJUARTERUY 2 3. Sampling Month & Frequency D. Contaminant Analysis Information • ,For " 0", below detection limit, less than {<} value, or not detected, enter "NO" ■ TNTC = too numerous to count. (Fecal results only) ■ NS = Not Sampled 1, Parameter/Contaminant 2. Influent 3. Effluent 4. Effluent Method Units Detection limit TOTAL PHOSPHORUS AS P MCA ORTHO PHOSPHATE[ 0.020 MG+L infeffrp-blank.doc • rev. 09115115 Groundwater Permit Discharge Monitoring Report - Page 1 of 1 Massachusetts Department of Environmental Protectionl B33 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit (dumber Ll Groundwater Permit 2. Tax identification Number MONITORING WELL DATA REPORT 202'1 QUARTERLY 2 3. Sampling Month & Frequency A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use JOCEAN EDGE CONFERENCE CTR only the tab key to a. Name move your cursor - ROUTE 6A do not use the return key. b. Street Address E3REWSTER MA 02631 I� r. City d. Slate e. Zip Code 2. Contact information: r"n IJAMES R. TRINGALE a. Name of Facility Contact Person 9785321900 WSSCompliance@wseinc.com b. Telephone Number c. e-mail address 3. Sampling information: 5/2021 IRI ANALYTICAL a, Date Sampled (mmlddlyyyy) b. Latoratccy Name ARIDUS ANALYSTS c. Analysis Performed By [Name] B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Monitoring Well Data Report - 2021 Quarterly 2 All forms for submittal have been completed. 2. r This is the last selection. 3. r- Delete the selected form. gdpdis 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit MONITORING WELL DATA REPORT 1633 I. Permit Number 2. Tax identification Number 2021 QUARTERLY 2 J 3. Sampling Month & Frequency C. Contaminant Analysis Infolrmation • For "0', below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled ■ DRY = Not enough water in well to sample. Parameter/Contaminant DG2 DG3 DG4 DG5 UGI Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Well #: 5 NITRATE -N 5.63.6 1.7 J 3.1 7,0 J MG& TOTAL NITROGEN{NO3+No2+TK F5.6 3,6 1.7 3.61 7.0 l t+l}�IL TOTAL PHOSPHORUS ASP 1 3 1.1 0.63 JOA7 MGI- ORTHO PHOSPHATE fl gg ND ND ND ND MGL Well #: 6 C mvidgwp-blank.doc • rev. 09/15/15 Monitoring Well Data for Groundwater Permit • Page 1 of 1 Important:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return. key. Any person signing a document under 314 GMR 5.14(1) or (2) shall make the following certification If you are filing electronic -ally and want to attach additional comments, select the check box. W Massachusetts Department of Environmental Protection 1633 j Bureau of Resource Protection - Groundwater discharge Program 1. Permit Number Groundwater Permit 2. Tax identification Number Facility Information OCEAN EDGE CONFERENCE CTR a. Name ROUTE 6A b. Street Address HREWSTER JIMA 102631 c. City d, State e, Zip Code Certification "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in aocardanoe with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the Infarmation, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that the are significant penalties for submitting false information, including the possfbiiity of fine and imprisonment for knowing violations," MARIANNA COOMBS 5/30!2021 a. Signature b. Date (mmlddlyyyy) gdpdIs 20 15-0 9-1 5.d oc • rev. 09/15115 Groundwater Permit • Page 1 of 1 Massachusetts Department of Environmental Protection eDEP � Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: SFARRENKOPF Transaction ID: 1286339 Document: Groundwater Discharge Monitoring Report Forms Size of File: 1426.81K Status of Transaction: In Process Date and Time Created: 619l2021:6:01:21 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection 746 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number 4 Groundwater Permit 2. Tax identification Number DAILY LOG SHEET 2021 MAY DAILY 3, Sampling Month & Frequency A. Facility Infolrmation lmportant:When filling out forms on 1. Facility name, address: the computer, use IPLEASANT BAY HEALTH CTR only the tab key to move your cursor - do not use the return key. Ise! �rw,q AAA a. Name SOUTH ORLEANS ROAD b. Street Address BREWSTER MA c. City d. State 2. Contact information: 2631 e. Zip Code JOSEPH SMITH a, Name of Facility Contact Person 7742125405 jsmith@NSUWater.com b. Telephone Number 3. Sampling information: c. e-mail address 51112021 NOT APPLICABLE a: Date Sampled (mmtddlyyyy) b. Laboratory Name BEA NSU PERSONNEL c, Analysis Performed By (Name) S. Farm Selection 1. Please select Form Type and Sampling Month & Frequency Daily Log Sheet - 2021 May Daily r All forms for submittal have been completed. 2, I- This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15115 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 746 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number +' % Groundwater Permit 4 2. Tax identification Number DAILY LOG SHEET - 2021 MAY DAILY 3. Sampling Month & Frequency C. Daily Readings/Analysis Information Date Effluent Reuse Irrigation Turbidity Influent pH Effluent Chlorine UV Flow GPD Flow GPD Flow GPD PH Residual Intensity (mgll) (°Io) 1 6740 � 0 2 6740 3 9167 7.7 66.8 4 4870 7.2 69.2 5 9196 7.0 74.3 6 9826 J 8.0 7.5 69.1 7 9311 7.3 66.6 9 9311 10 6624 7.7 169,2 11 9797 7.8 _1 66.6 12 4345 7.5 66.3 13 4891 9.3 7.4 74.2 14 7934 J 7.7 66.8 15 7934 167934 17 8399 7.4 Bfi.7 - 18 5839 7.4 69.1 19 8206 7.5 67.2 20 6400 8.8 6.8 66.8 21 799.5 22 23 24 9442 7.2 66.6 25 6292 7.0 66.5 26 9167 6.9 63.5 27 16607 8.4 7.1 69.4 28 982 �- 7.0 66.6 29 9820 J 30 9$20 -� 31 9820 !� �J gdpols.doc - rev. 09115115 Groundwater Permit Daily Log Sheet • Page 1 of 1 Important:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. !a4 Ilk At' rim Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DISCHARGE MONITORING REPORT A. Facility Information 746 1. Permit dumber 2. Tax identification Number 2021 MAY MONTHLY 3. Sampling Month & Frequency 1. Facility name, address: PLEASANT BAY HEALTH CTR a, Name 383 SOUTH ORLEANS ROAD h. Street Address B REWSTER IMA 102631 C, City d. State e. Zlp Code 2. Contact information; JOSEPH SMITH a. Name of Facility Contact Person 7742125005 jjsmith@NSUWater.com b. Telephone Number c. e-mail address 3. Sampling information: 5/6/2029 JALPHA ANALYTICAL a, Date Sampled (rnmfddlyyyy) b. Laboratory Name ALPHA ANALYTICAL PERSONNEL. c. Analysis Performed By (Name) B. Form Selection Please select Form Type and Sampling Month & Frequency Discharge Monitoring Report - 2021 May Monthly f- All forms for submittal have been completed. 2. F This is the last selection. 3. - Delete the selected form.. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Lag Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DISCHARGE MONITORING REPORT D. Contaminant Analysis Information • For "0", below detection limit, less than {<} value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS = Not Sampled 1, ParameterlContarninant Units BOD MGI_ TSS MGIL TOTAL SOLIDS MGI. AMMONIA•N MGIL NITRATE•N MGL TOTAL NITROGEN(NO3+NO2+TKN) MGL OIL & GREASE MGA. FECAL COLIFORM 1100 ML CHLORIDE MGL 1746 1. Permit Number 2. Tax identification Number 2021 MAY MONTHLY 3. Sampling Month & Frequency 2. Influent 3. Effluent 4, Effluent Method Detection limit 5.Q 460 280 1Q — 23.0 s.s a.50 _ 19.96 _ - [ ND I4.0 25 - 2.0 [:52 infeffrp-blank.doc • rev. 09115/15 Groundwater Permit Discharge Monitoring Report • Page 1 of 1 Massachusetts Department of Environmental Protection 746 _._... � IE131 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2- Tax identification Number MONITORING WELL DATA REPORT 2021 MAY MONTHLY 3, Sampling Month & Frequency A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use IPLEASANT BAY HEALTH CTR only the tab key to a. Name move your cursor - 383 SOUTH ORLEANS ROAD do not use the return key, b. Street Address BREWSTER IMA 102631 . ray c, City d. State e. Zip Code 2. Contact information: r�tu� JOSEPH SMITH a. Name of Fadilty Contact Person 7742125005 jsmith@NSLIWWater,com b. TelepMne Number c. e-mail address 3. Sampling information: 15/5/2021 SNOT APPLICABLE a. Date Sampled (mmlddlyyyy) b. Laboratory Name BEA NSU PERSONNEL c, Analysis Performed By (Name) B. Farm Selection 1. Please select Farm "Type and Sampling Month & Frequency Monitoring Well Data Report - 2021 May Monthly F All forms for submittal have been completed. 2. r This is the last selection. 3, r Delete the selected form. gdpols 2015-09-15.doe • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 - Massachusetts Department of Environmental Protection 1746 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit MONITORING WELL DATA REPORT 2. Tax identification Number 2021 MAY MONTHLY 3. Sampling Month &Freq uency C. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • N5 =Not Sampled • DRY = Not enough water in well to sample. ParameterlContaminant DG -1 DG -2 DG -4 UG -1 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Well #: 5 Well #: 6 PSI 6_59 6.42 F 75 - 7.61 _� s.u. STATIC WATER LEVEL 11.71 23,$1 111.72 112.06 r�r SPECIFIC CONDUCTANCE 117 251.4 291.6 91.2 UMHMC mwdgwp-bIank.doc • rev. 09/15115 Monitoring Well Data for Groundwater Permit • Page 1 of 1 important:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Any person signing a document under 314 CMR 5.14(l) or (2) shall make the following certification If you are filing elactronic-ally and veant to attach additional comments, select the check box. r Massachusetts Department of Environmental Protection 746 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit T4 2. Tax identification Number Facility Information ANT BAY HEALTH GTR a. Name 383 SOUTH ORLEANS ROAD b. Street Address BREWSTER MA 102631 c. City d. State e. Zip Code Certif cation "I certify under penalty of law that this document and all attachments were prepared under my d] rection or supervision In accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that the are signiticanI penallies for submitting false Information, including the possibdlity of fine and imprisonment For knowing viclationS." SAMANTHA FARRENKOPF 619!2021 a, Signature b. Date (mmlddlyyyy) ortinE Package Comments BENNETT ENVIRONMENTAL ASSOCIATES, LLC. (BEA) HAS COMPLETED THE MAY 2021 MONTHLY INFLUENT AND EFFLUENT SAMPLING OF THE AMPHIDROME WASTEWATER TREATMENT SYSTEM, MONTHLY WASTEWATER SAMPLING WAS COMPLETED ON 516121. LABORATORY RESULTS REPORTED ALL PARAMETERS WITHIN DISCHARGE PERMIT LIMITATIONS. EFFLUENT PH WAS REPORTED WITHIN THE 6.5-8.5 RANGE THROUGHOUT THE MONTH. FLOW VOLUME MEASUREMENTS WERE ASSESSED DURING THE MONTH FROM THE SYSTEM'S EFFLUENT FLOW METER. DAILY FLOW REMAINED WITHIN THE 26,500 -GPD LIMITATION THROUGHOUT THE MONTH. THE MINIMUM, MAXIMUM AND AVERAGE GPD FLOWS REPORTED OVER THE COURSE OF THE MONTH WERE 4,345 GPD, 16,607 GPD AND 8,302 GPD, RESPECTIVELY. gdpols 2015.09-15.doc • rev. 09115/15 Groundwater Permit • Page 1 of 1 Massachusetts Department of Environmental Protection 1 - � eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: 5 FARREN KOPF Transaction ID: 1288476 Document: Groundwater Discharge Monitoring Report Forms Size of File: 1029.68K Status of Transaction. in Process Date and Time Created: 6117/2021:3:32:38 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection 951 Bureau of Resource Protection _ Groundwater. Discharge Program 1. Permit Number Groundwater Permit 2, Tax identification Number DAILY LOG SHEET 2021 MAY DAILY 3. Sampling Month & Frequency 3. Sampling information: 511/2021 NOT APPLICABLE a. Date Sampled (mmlddlyyyy) b. Laboratory Name BEA NSU PERSONNEL c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency i Daily Log Sheet - 2021 May Daily f- All forms for submittal have been completed. 2. T- This is the last selection. 3.- Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15115 Groundwater Permit Daily Log Sheet • Page 1 of 1 A. Facility Information Important:When filling out farms on 1. Facility name, address: the computer, use JMAPLEWOOD AT BREWSTER only the tab key to a. Name move your cursor - 820 HARWICH ROAD do not use the return key, b. Street Address BREWSTER IMA 102631 Ids c, City d. State e, Zip Cade 2. Contact information: lin #Alj JOSEPH SMITH a, Name of Facility Contact Person 7742125005 jsmith@NSUWater.com b, Telephone Number c. e-mail address 3. Sampling information: 511/2021 NOT APPLICABLE a. Date Sampled (mmlddlyyyy) b. Laboratory Name BEA NSU PERSONNEL c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency i Daily Log Sheet - 2021 May Daily f- All forms for submittal have been completed. 2. T- This is the last selection. 3.- Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15115 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 1951 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit Ll 2. Tax identification Number DAILY LOG SHEEN 2021 MAY DAILY 3. Sampling Month & Frequency C. Daily Readings/Analysis Information Date Effluent Reuse Irrigation Turbidity Influent pH Effluent Chlorine W Flow GPD Flow GPD Flaw GPD pH Residual Intensity (trigil) NO) 15884 5884 �J 2 0 3 4302 6.9 7A 4 5412 6.8 7.1 5 8765 6.8 7.0 6 5429 6.8 7,1 k5B1 6.8 7.1 8 9 16 5581 0 6.8 7.1 11 5533 6.8 7.1 13 4428 6 8 7.0 14 6368 I 6.9 7.1 El FEE 15 6368 J �J 16 6368 17 4549 F=6.9�] 7.0 18 59 7.2 19 4608 6.9 7.1 20 6946 6.8 7.2 21 6404 6.9 7A 22 6404 23 6404 24 x,466 6.9 7.1 25 8612 26 5411 � 6.8 7.0 27 7699 6.6 6.8 28 29 5738 30 5738 31 5738 gdpols.doc - rev. 09115115 Groundwater Permit Daily Lag Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection F51 Bureau of Resource Protection - Groundwater Discharge program 1. Permit Number Groundwater Permit 2. Tax identification Number DISCHARGE MONITORING REPORT 2021 MAY MONTHLY 3, Sampling Month & Frequency A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use MAPLEWOOD AT BREWSTER only the tab key to a. Name move your cursor - 820 HARWICH ROAD do not use the return key. b. Street Address BREWSTER IMA 82631 vr�:] G. City d. State e. Zip Code 2. Contact information: JOSEPH SMITH a. Name of Facility Contact Person 7742125005 'smith@NSUWater.com b. Telephone Number c. e-mail address 3. Sampling information: 5/6/2021 ALPHA ANALYTICAL a. Date Sampled (mmfddtyyyy) b. Laboratory Name ALPHA ANALYTICAL PERSONNEL. c. Analysis Performed By (Name) B. Form Selection I. Please select Form Type and Sampling Month & Frequency Discharge Monitoring Report - 2021 May Monthly T- All forms for submittal have been completed. 2.- This is the last selection. 3. Delete the selected form. gdpols 2015-09-15.doc • rev. 09115115 Groundwater Permit Daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 165 - _J Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Li Groundwater Permit 2, Tax identification NumberDISCHARGE MONITORING REPORT 12021 MAY MONTHLY 3. Sampling Month & Frequency D. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS = Not Sampled 1. Parameter/Contaminant 2. Influent Units BOB 1[0 - MGL T55 I45 MGL TOTAL SOLIDS 1500 MG,L AMPJIONIA-N MGL NITRATE -N wo-I TOTAL NITROGEN(NO3+NO2+TKN) MGL OIL & GREASE MGIL 3. Effluent 23 -- - .� -I 116 4. Effluent Method Detection limit 5.0 — ID -= 0.1 ❑ - 6.60 - 0.450 I ND.---- -- 4.0 - -- . infeffrp-blank.doc • rev. 09/15115 Groundwater Permit Discharge Monitoring Report • Page 1 of 1 Massachusetts Department of Environmental Protection 951 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2, Tax identification Number MONITORING WELL DATA REPORT 2021 MAY MONTHLY 7L11 . . 3. Sampling Month & Frequency A. Facility Information [mportant:When filling out forms on 1. Facility name, address the computer, use JMAPLEWOOD AT BREWSTER only the tab key to a. Name move your cursor - 20 HARIgICH ROAD do not use the return key. b. Street Address BREWSTER MA 102631 t� c. City d. State e, Zip Code 2, Contact information: RUR JJOSEPH SMITH a. Name of Facility Contact Person 7742125005 'smith@NSU Water.com b, Telephone Number 3. Sampling information: c. e-mail address 5/5/2021 INOTAPPLICABLE a, Date Sampled (mmlddlyyyy) b. Laboratory Name BEA NSU PERSONNEL c. Analysis Performed By Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Monitoring Well Data Report - 2021 May Monthly F_ All forms for submittal have been completed. 2. ri This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15115 Groundwater Permit daily Log Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection I9-51 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit MONITORING WELL DATA REPORT 2. Tax identification Number — 12-021 MAY MONTHLY 3. Sampling Month & Frequency C. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" r • TNTC = too numerous to count. (Fecal results only) • N5 =Not Sampled • DRY = Not enough water in well to sample. Parameter/Contaminant MW -1 MW -2 MW -3 PAW -4 Units 'Jell #: 1 Well #: 2 Well M 3 Well #: 4 Well #: 5 Well M 6 PH 6.12 5.45 [ .p : --1 S.U. STATIC WATER LEVEL 33.79 33.03 1132.79 1 33.12 FEET SPECIFIC CONDUCTANCE �89 1 — F p q 3146 93.2 MHO51C mwdgwp-blank.doc • rev. 09115/15 Monitoring Well Data for Groundwater Permit • Page 1 of 1 ILI Important:When filling out forms on the computer, use only the tab key to move your cursor - do not use the retum key. Any person signing a document under 314 CMR 5.14(1) or (2) shall make the following certification If you are filing electronic -ally and want to attach additional comments, select the check box. r Massachusetts Department of Environmental Protection Bureau of Resource Proloction - Groundwater Discharge Program Groundwater Permit Facility Information PLEWOOD AT BREWSTER a. Name 820 HARWICH ROAD 951 1. Permit Number 2, Tax identification Number b. Street Address BREWSTER IMA 102631 C. City d. State e. Zip Code Certification 'I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that the are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations:' SAMANTHA FARRENKOPF 6/17/2021 a. Signature b, Date (mmlddlyyyy) orting Package Comments BENNETT ENVIRONMENTAL ASSOCIATES, LLC. (BEA) HAS COMPLETED THE MAY 2021 MONTHLY INFLUENT AND EFFLUENT SAMPLING OF THE BIOCLERE WASTEWATER TREATMENT SYSTEM. MONTHLY WASTEWATER SAMPLING WAS COMPLETED ON 516121. LABORATORY RESULTS REPORTED ALL PARAMETERS WITHIN DISCHARGE PERMIT LIMITS. EFFLUENT PH WAS REPORTED WITHIN THE 6.5 TO 8.5 RANGE THROUGHOUT THE MONTH. FLOW VOLUME MEASUREMENTS WERE ASSESSED DURING THE MONTH FROM THE SYSTEM'S EFFLUENT FLOW METER. DAILY FLOW REMAINED WITHIN THE 19,800 -GPD LIMITATION THROUGHOUT THE MONTH. THE MINIMUM, MAXIMUM AND AVERAGE GPD FLOWS REPORTED OVER THE COURSE OF THE MONTH WERE 4,302 GPD, 8,765 GPD AND 6,066 GPD, RESPECTIVELY. gdpols 2915-09-15.doc • rev. 09/15115 Groundwater Permit • Page 1 of 1 LiMassachusetts Department of Environmental Protection lkeDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: EeELAIR Transaction ID: 1285682 Document: Groundwater Discharge Monitoring Report Forms Size of File: 1026.59K Status of Transaction: submitted Date and Time Created: 611712021:11:52:02 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. I Massachusetts Department of Environmental Protection 599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2. Tax identification Number DISCHARGE MONITORING REPORT 1 I 2021 MAY MONTHLY L3. Sampling Month & Frequency A. Facility Information Important: When filling out forms on 1. Facility name, address: the computer, use BREWSTER MANOR only the tab key to a. Name move your cursor - 873 HARWICH ROAD do not use the return key. b. Street Address BREWSTER M A 102631 IAb C. City d. State e. Zip Code 2. Contact information: JR -W #A DAVID FELDMAN a. Name of Facility Contact Person 7817079527 Feldman@win gate health care.com b. Te6aphcne Number c, e-mail address 3. Sampling information 15/2512021 JRl ANALYTICAL a. Date Sampled (mmlddtyyyy) b. Laboratory Name NICOLE SKYLESON c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Discharge Monitoring Report - 2021 May Monthly . All forms for submittal have been completed. 2. r This is the last selection. 3. r Delete the selected form, gdpdIs 2015-09-15.doc • rev. 09115115 Groundwater Permit Daily Log Sheet • Page 1 of 1 infeffrp-blank.doc • rev. 09/15115 Groundwater Permit Discharge Monitoring Report • Page 1 of 1 Massachusetts Department of Environmental Protection 1599 J Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number i, Groundwater Permit 2. Tax identificat' n Number a DISCHARGE MONITORING REPORT 2021 MAY MONTHLY 3. Sampling month & Frequency D. Contaminant Analysis Information ■ For "0", below detection limit, less than (<) value, or not detected, enter "ND" ■ TNTC = too numerous to count. (Fecal results only) • NS = Not Sampled 1. ParameterlContaminant 2• influent 3. Effluent 4. Effluent Method Units Detection limit BOD�.5 ND - --- MGL TSS 20 MG/L TOTAL SOLIDS 180 NiG1L AMMONTA-N K46 - NIGlL NITRATE -N f 13 0.050 VG? - TOTAL NITROGEN(NO3+NO2+TKN) 13.0 0.25 MGL OIL & GREASE 0.69 MGL infeffrp-blank.doc • rev. 09/15115 Groundwater Permit Discharge Monitoring Report • Page 1 of 1 Massachusetts Department of Environmental Protection 1599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2, Tax identification Number MONITORING WELL DATA REPORT - 2021 MAY MONTHLY L1. I . 3. Sampling Month & Frequency A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use IBREWSTER MANOR only the tab key to a Narrw move your cursor - 873 HARWICH ROAD do not use the return key. b. Street Address BREWSTER MA 2631 VQ C. City d. State e, Zip Code aff 2, Contact information: DAVID FELDMAN a. Name of Facility Contact Person 7817079527 dfeldman@wingatehealthcare,com b. Telephone Number 3. Sampling information: c. e-mail address 15/2612021 FVHITEWATER a, Date Sampled (mmlddlyyyy) b. Laboratory Name DOUG MURPHY c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Monitoring Well Data Report _ 2021 May Monthly T - All forms for submittal have been completed. 1 r- This is the last selection, 3. r- Delete the selected form. gdpd€s 2915-09-15.doc • rev. 09115115 Groundwater Permit Daily Lag Sheet • Page 1 of 1 Massachusetts Department of Environmental Protection 1599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2. Tax identification Number MONITORING WELL DATA REPORT 2021 MAY MONTHLY 3. Sampling Month & Frequency C. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter 'N D" ■ TNTC = too numerous to count. [Fecal results only] • NS = Not Sampled • DRY = Not enough water in well to sample. Para meterlContarninant MW1 NIW2 MW3 MW4 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Well #: 5 Well #: 6 $.2 F S.U. STATIC WATER LEVEL 59.58 5$,g$ 59.44 26.67 FP_Er SPFCIFIC CONDUCTANCE 472 50E 226 1148 UMHG&C mwdgwp-blank.doc • rev. 09115115 Monitoring Well Data for Groundwater Permit • Page 1 of 1 Massachusetts Department of Environmental Protection 1599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit DAILY LOG SHEET 2. Tax identificatbn Number 2021 MAY DAILY 3. Sampling Month & Frequency A. Facility Information Important:When filling out farms on 1. Facility name, address: the computer, use JBIREWSTER MANOR only the tab key to a. Name move your cursor 873 HARWICH ROAD do not use the return key, b, Street Address BREWSTER IMA 102631 l� C. City d. State e, Zip Code 2. Contact information: DAVID FELDMAN a. Name of Facility Contact Person 7817079527dfeldman a@ wingatehealthcare.com b. Telephone Number c. e-mail address 3. Sampling information: 5/31/2021 WH ITEWATER a. Date Sampled (mmfddlyyyy) b. Laboratory Name DOUG MURPHY c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Daily Log Sheet - 2021 May Daily F r- All forms for submittal have been completed. 2. r- This is the last selection. 3. F Delete the selected form. gdpols 2015-09-15.doc • rev. 09115/15 Groundwater Permit Daily Lag Sheet • Page 1 of 'I Date 1 2 3 4 5 s 7 s 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Massachusetts Department of Environmental Protection 599 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit !�J' 2. DAILY LOG SHEET Tax identification Number 2021 MAY DAILY 3. Sampling Month & Frequency C. Daily Read ingslAnalysis Information Effluent Reuse Irrigation Turbidity Influent pli Flow GPD Flow GPD Flow GPD 1871 148 1421 135 '1474 113 1442 11055 184 J 1252 175 32 563 1311 3506 V3464 5626 7857 30x4 526 1074 140 102 11584 426 1Q92 1'177 72 4 1036 Effluent Chlorine UV PH Residual Intensity (mgll) (010 gdpols.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet - Page 1 of 1 Massachusetts Department of Environmental Protection 1599 - i Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2. Tax identification Number Facility Information Impartant:When BREWSTER MANOR filling out forms on a. Name the computer, use only the tab key to 873 HARWICH ROAD move your cursor - b. Street Address do not use the IBREWSTER IMA 102631 return key. C. City d. State e. Zip Code r Certillcation "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the rn information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that the are significant penalties for submitting false information, including the possibility of fine and imprisonment For knowing violations." ELIZABETH BELAIR 6/17/2021 Any person signing a document under 314 CMR 5.14(l) or (2) shall make the following certification If you are filing electronic -ally and want to attach additional comments, select the check box. r a. Signature b. Date (mmlddlyyyy) teporting Package Comments PLANT DID NOT MEET ALL DISCHARGE PERMIT REQUIREMENTS FOR MAY 2021. TN=13. THE PLANT IS NOT IN FULL OPERATION AND EXPERIENCING LOW FLOWS OF LESS THAN 100GPD. gdpdIs 2015-09-15.doc • rev. 09115115 Groundwater Permit • Page I of 1 Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: EBELAIR Transaction ID: 1277969 Document: Groundwater Discharge Monitoring Report Forms Size of File: 713.22K Status of Transaction: Submitted Date and Time Created: 5/25/2021:10:51:26 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. if you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. •� UGI U"U V11\GJVUI VU 1 IVlGVL3U11 - VI WUI IV VVU kGl V10V1101 UU 1 IU1fl 0111 1. , Gllllll IYUIIfVG1 Groundwater Permit ' M 2. Tax identification Number MONITORING WELL DATA REPORT 2021 QUARTERLY 2 3. Sampling Month & Frequency A. Facility Information lmportant:When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. r�r�a 1. Facility name, address: BREWSTER MANOR a. Name $73 HARWICH ROAD b. Street Address _ BREWSTER JMA 102631 C. City d. State e, Zip Code 2. Contact information: DAVID FELDMAN a. Name of Facility Contact Person 7817079527 b. Telephone Number 3, Sampling information: dfeldman§wingatehealthcare.com c. a -mail address 4/20/2021 JR1 ANALYTICAL a. Dake Sampled (rnmlddlyyyy) b. Laboratory Name NICOLE SKYLESON c. Analysis Performed By [Name] B. Form Selection 1. Please select Form Type and Sampling Month & Frequency Monitoring Well Data Report - 2021 Quarterly 2 Y (F All forms for submittal have been completed. 2.- This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doe • rev, 09/15/15 Groundwater Permit Daily Log Sheet - Page 1 of 1 3 Mw[�uu u[ IxGQVu[t.G 1 iuLGIumIi - Vfuu[Iu vru«+[ �+[�+v[[wlyv [ [uyl Ql[1 1, 1c11IIIL IYu1111JG1 ,:.. Groundwater Permit I 2. Tax identification Number MONITORING WELL DATA REPORT 2021 QUARTERLY 2 _ 3. Sampling Month & Frequency f C. Contaminant Analysis Information • For "0", below defection limit, less than (<) value, or not detected, enter'ND" • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled • DRY = Not enough water in well to sample. ParameterlContaminant MW1 MW2 MW3 MW4 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Well #: 5 Well #: 6 NITRATE -N 10.48 ND NQ ND PaIGIL TOTAL NITROGEN(NO3+NO2+TK Q 48 ND IND I IND MGIL mwdgwp-blan€c.doc • rev. 09/15/15 Monitoring Well Data for Groundwater Permit • Page 1 of 1 L UI UOU VI I %G�WUI VV I IULG"IVI I - VI VUl 1%.l VVPLCI L 10I,l VGLI a� I 1 Val01I It 1. 1 UI IIIIL IYUI IIUW1 I•k• • Groundwater Permit { • . 2. Tax identification Number MONITORING WELL DATA REPORT 2021 APR MONTHLY 3. Sampling Month & Frequency A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use JBREWSTER MANOR only the tab key to a. Name move your cursor - 873 HARWICH ROAD do not use the return key. b. Street Address BREWSTER IMA 102631 C. City d. State e. Zip Code VO 2. Contact information: + DAVID FELDMAN a. Name of Facility Contact Person 7817079527 dfeldman@wingatehealthcare.com b. Telephone Number c. e-mail address 3. Sampling information: 14!20/2021 ]WHITEWATER a. Date Sampled (mm/dcVyyyy) b. Laboratory Name DOUG MURPHY c. Analysis Performed By (Name) B. Form Selection I. Please select Form Type and Sampling Month & Frequency Monitoring Well Data Report - 2021 Apr Monthly T — All forms for submittal have been completed. 2. r- This is the last selection. 3. 1= Delete the selected form. gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 . NUI UqU VI I %G�VMJ L. 1 IULVVUUI I - V1 VU ILL"a LGI Vpo V11Q"J, 1 IULJ.I RI 11 1. 1 C fllll IYUI mul Groundwater Permit MONITORING WELL DATA REPORT 2• Tax identification Number 2021 APR MONTHLY � 3. Sampling Month & Frequency v C. Contaminant Analysis Information • For "0", below detection Limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled • DRY = Not enough water in well to sample. Parameter/Contaminant MW1 MW2 MW3 MW4 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Ply 16 15.9 15, 9 15.8 s.u. STATIC WATER LEVEL 59.4258.77 59.31 126.59 FEET SPECIFIC CONDUCTANCE 586 J 592 274 1145 UMHDSIC Well #:5 Well #: 6 mwdgwp-blank.doc • rev. 09/15115 Monitoring Well Data for Groundwater Permit • Page 1 of 1 WUI UUU V1 ;voauUI UU 1 IU%Ulkl411 - LJI VUIIU vvC%I I IJI.]L..I I CLI UU 1 IV.,.I 6'11 1. f GIIIIIL IYUIIIUGI Li Groundwater Kermit 12. Tax identification Number Facility Information Important:When JBREWER MANOR filling out forms on a. Name the computer, use only the tab key to 873 HARWICH ROAD move your cursor - b. Street Address do not use the BREWSTER MA 02631 return key, C. City d. State e. Zip Code Any person signing a document under 314 CMR 5.14(1) or (2) shall make the following certification If you are filing electronic -ally and want to attach additional comments, select the check box. r Certification "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible For gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that the are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." ELIZABETH BELAIR 15/2,5/2021 a. Signature b. Date (mmlddlyyyy) gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit • Page 1 of 1 d?-Ia COASTAL engineering co. TECHNICAL SERVICES 260 Cranberry Highway Orleans, MA 02653 508.255.5511 P 508.255.6700 F Orleans 1 sandwich I Nantucket coastalengine eringcom pany.com RECEIVE❑ JUN 0 12021 13REWSTER T [DEPARTM To: Brewster Town Hall Date: Board of Health Department Via. 2198 Main St Brewster, MA 02631 Subject: Cape Cod Sea Camps 3057 Main Street Brewster, MA GWDP 977-0 ❑ plans ❑ Copy of Letter We are sending the following items: Copies Date No. 1 0512021 C1684SA2 1 05/10/2021 016845.02 1 05/21/2021 C16845.02 These are transmitted as checked below: ❑for approval ®for your use ❑ Specifications 05/21/2021 SMITTAL Project No. C16845.02 ®1st Class Mail ❑Pick up ❑Certified ❑Fed Ex ® Other Description Daily Log Sheet {pH 5 GPD not recorded due to off season} Monthly Discharge Monitor Report [Hot sampled due to off season eDEP Electronic Receipt ❑as requested ❑for review & Comment ❑ Remarks: Enclosed are the recent monthly reporting forms for the system at the above referenced location under GWDP 977-0. The laundry mat has been shut down for the off season and there is currently no flow, With the laundry mat shut down for the off season no flow or pH was able to be retarded and the distribution box was not sampled. Quarterly testing indicated none of the monitoring wells exceeded the upper containment limits for any of the tested parameters. We will continue with our scheduled testing of the monitoring wells, Please do not hesitate to contact us if you have any questions or comments, JGSIacc By: John G. Schnaible, R.S. Cc: Ed Barber, Associate Director, Facilities VIA EMAIL: ed ca ecodseacam s.com VIA EMAIL: nw arran3367 mai1.c m (VOTE: if enclosures are not as noted, please contact us at (508) 255-6511 Orleans I Sandwich I Nantucket D:\DoCkEl6800116845.02\TronsmittoIs12Q21-05-21 Tronsmittnf (GWDP May 2021).dcc Massachusetts Department of Environmental Protection 977 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit 2. Tax identification Number yl_ DAILY LOG SHEET 2021 MAY DAILY L I 3, Sampling Month & Frequency C. Daily Readings/Analysis Information Date Effluent Reuse Irrigation Turbidity Influent pH Effluent Chlorine UV Flow GPI] Flow GPD Flow GPD PH Residual Intensity (m gll) N.) 1 iNS J _ 1 L�J. 1_lVS 2 NIS N5 3 INSj iNIS 1� 4 NS � � � NS � 1 5 NS ` NS 6 NS NS 7NS ! J NS IJ $ NS - I�[ NS 9 INS I J NS 10 NS NS� 11 NS Q N S 12 ,NS 13 NIS 14 NS NS �J 15 NS �� NS 16 NS NS 17 NS NS 18 18 NS [�1i. INS 19 NS I�J NNS I� 20 NSJ NS 21 JNS I N5 22 NS� NS 23 NS 1�J NS 24 NS 25 NS 26 NS 1�J L�J NS 27 N5 N5��j 28 NS NS�� I J 29 NS 30 N SN.S 31 NSI— gdpdis.doc • rev. 09115/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 File No.: C16845.02 511012021 Monitoring Wells Analytical Test Results Cape Cod Sea Camps 3057 Main Street Brewster, MA GWP SE 977-0 PARAMETER UNITS CGSC-1 MW -1 MW -4 MW -5 MW -7 TOC Elevation feet 52.27 35.82 22.7 21.19 23.95 Depth To Water feet 31.65 15.35 3.75 7.20 5.62 GW Elevation feet 20.62 20.47 18.951 13.99 18.33 PH pH units 6.34 6.05 6.11 5.92 5.78 Sp. Conductance }LSlcm 410 180 360 450 580 Nitrite -N mg/L<D 050 <0.050 X0.050 <0.050 X0.050 Nitrate -N mg/L 1.8 0.36 1.4 1.5 2.6 TCN -N mg/L 1.95 <1.50 2.55 1.65 2.71 Total -Nitrogen mg/L 3.75 0.35 3.95 3.15 5.31 Total.Phosphorus 1 mgJL 0.364 4.11 1.67 3.08 7.02 Ortho -Phosphate mgJL 0.021 <0.005 <0.005 X0.005 0.028 Surfactants mg/L <0.050 <0.050 <0.050 <0.050 <0,050 VOC's ug/L ----- ----- ----- -__ _ NOTES: All tests performed at a state -certified laboratory, except pH and Sp. Conductivity, which were performer{ onsite with handheld test meters. ND = Not Detected, below the reporting limit of the laboratory. VOC's are tested annualy during the month of August. D:\DOC1C16800\16845.021Discharge Monitoringl[2020 Monitor Well Reporting Forms.xls]05-10-2021 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit MONITORING WELL DATA REPORT i� 1. Permit Number 2. Tax identification Number 2021 QUARTERLY 2 3. Sampling Month & Frequency C. Contaminant Analysis Information • For "0" below detection limit, less than (<) value, or not detected, enter "ND' • TNTC = tan numerous to count. (Fecal results only) • NS =Not Sampled • DRY = Not enough water in well to sample. ParameterlGontaminant CCSC-1 MW -1 NEW -4 MW -5 MW -7 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Well #: 5 Well #: 6 PH 6.34 _ 6.05 6.11 5.92 15.78 S.U. NITRATE -N 1,8 0.36 1.4 1.5^^ 2.6 TOTAL N[TRdGEN(NC33+NO2+TK 3 75 0,36 3.95 3.15 5.31 MG& TOTAL PHOSPHORUS ASP D.3644.11 1.67 3.08 7.02 MGi DRTHO PHOSPHATE 0.021 NI7 ND ND 0.028 IAGIL FOAMING AGENTS (MBAS) Np ND ND ND ND MG/L mwdgwp-blank.doc - rev. 09115115 Monitoring Well Data for Groundwater Permit • Page 1 of 1 z -e ANA t Y\T ICA Z Serial—N0:0521211 0:34 ANALYTICAL REPORT Lab Number: L2124417 Client: Coastal Engineering Company 260 Cranberry Highway Route 6A Orleans, MA 02653 ATTN: Chad Simmons Phone: (508) 255-6511 Project Name: CAPE COD SEA CAMPS Project Number: C-16845.02 Report Date: 05721/21 The original project repiort/data package is held by Alpha Analytical. This reporUdata package is paginated and should be reproduced only in its entirety. Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original. Certifications & Approvals: MA (M-MA086), NH NELAP (2064), CT (PH -0574), IL (200077), ME (MA00086), M (348), NJ (M A935), NY (11148), NC (25700/666), PA (68-03671), RI (LA000065), TX (T 10470 4476), VT (VT -0935), VA (460195), USDA (Permit 4P330-17-00196). Eight Walkup Drive, Westborough, MA 0158 1 -1 01 9 508-898-9220 (Fax) 508-898-9193 800-6249220 - www.alphalab.com R -` .AI PHL A Page 1 of 21 Project Name: CAPE COD SEA CAMPS Project Number: C-16845.02 SAMPLE RESULTS Serial No:05212110:34 Lab Number: L2124417 Report Date: 05/21/21 Lab ID: L2124417-01 Date Collected: 05/10/21 12:00 Client ID: MW -1 Date Received: 05/11/21 Sample Location: BREWSTER, MA Field Prep: Not Specified Sample Depth: Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General. Chemistry - Westborough Lab Nitrogen, Nitrite ND mgll 0.056 i 05112/21 06:57 44,353.2 .. MR Nitrogen, Nitrate 6.36 mglf 0.10 -- 1 - 05112/21 06:57 44,353.2 MR Nitrogen, Total Kieidahl ND mgt! 1.50 5 05/18/21 20:00 05/20/21 12:12 121,4500Nti3-H JO Phosphorus, Total 4.11 mgt[ 0.100 - 10 05/19/21 11:00 05/20/21 13:06 121,4500P -E SD Phosphorus, Orthcphosphate ND mgIl 0.005 1 .._..... - 05/12/21 06:59 121,4500P -E _................._._. . _.................. . AW Surfactants, Mt3AS ND .............. _ mgll _.- 0.050 ....................... _........ ..._......._... -- 1 _.__._........ ................. 05/12/21 02:30 05112121 05:31 121,55 400 AW Page 6 of 21 Project Naive: CAPE COD SEA CAMPS Project Number: C-16845.02 SAMPLE RESULTS Lab ID: L2124417-02 Client ID: CCSC-1 Sample Location: BREWSTER, MA Sample Depth: Matrix: Water Serial No:05212110:34 Lab Number: L2124417 Report Date: 05/21/21 Date Collected: 05/10121 11:30 Date Received: 05/11/21 Field Prep: Not Specified N 0 Page 7 of 21 In Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry - Westborough Lab Nitrogen, Nitrite ND MO 0.050 - 1 05/12/21 08:58 44,353.2 MR Nitrogen, Nitrate 1.8 mg/l 0.10 1 05/12J21 06:58 44,353.2 MR Nitrogen, Total Kjeidah} 1.95 mgt! 1.50 5 05/18/21 20:00 05/20/21 12:13 121;4500NFi3-H JO Phosphorus, Total 0.364 mgll 0.020 - 2 05/19121 11:00 05+20/21 13:08 121,4500P -E 5Q Phosphorus, Orthophosphate 0.021 mgii 0.005 - 1 ----�._._ 05/12/21 07:00 .�_..� 121,4500P -E _..-....��— AW --- - — Surfactants, MEAS ------.... ND ---- mgA --- —0.050 - ...----.`.__..—_. _-_- ------ _.__-.-1.-.__. 05/12/21 02:30-05/12221 05:32 —121,55400 AW 0 Page 7 of 21 In Project Name: CAPE COD SEA CAMPS Project Number: C-16845.02 SAMPLE RESULTS Serial Na:05212110:34 Lab Number: L2124417 Report Date: 05/21/21 Lab ID: L2124417-03 Date Collected: 05/10121 11:00 Client ID: MW -4 bate Received: 05/11/21 Sample Location: BREWSTER, MA Field Prep: Not Specified Sample Depth: Matrix: Water Dilution bate Bate Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry - Westborough. Lab . Nitrogen, Nitrite ND mg/l 0.050 1 05/12121 06:59 44,353.2 MR Nitrogen, Nitrate 1.4 mgli 0.10 i 05/12/21 06:59 44,353.2 MR Nitrogen, Total Kjeldahl 2.55 mall 1.50 5 05'18121 20:D0 05/20/21 12:13 121,4500NH3-H JD Phosphorus, Total 1.67 mgll 0.050 5 05/19/21 11:0o 05/20/21 13:09 121,450oP-E 5D Phosphorus, Orthophosphate ND mg11 0.005 1 05/12/21 07:00 121,450DP-E ...._......................-.-.-.__.....-.. ......._....._._.... --. AW Surfactants, MBAS . ............. . .... ................ ND .................. ............................. ........... . _..._- mg/ l ............... .............._................................... 0.050 . _............... 1 05/12/21 02:30 05/12/21 05:32 5540C - _.......... ..... ..... ................. AW ... Page 8 of 21 Project Name: CAPE COQ SEA CAMPS Project Number: C-16845.02 SAMPLE RESULTS Lab ID: L2124417-04 Client ID: MW -5 Sample Location: BREWSTER, MA Sample Depth: Matrix: Water Seriai No:05212110:34 Lab Number: L2124417 Report Date: 05/21/21 Date Collected: 05/10/21 10:45 Date Received: 05/11/21 Field Prep: Not Specified Page 9 of 21 ]Dilution Date Date Analytical Parameter Result Qualifier Units RL. PBDL f=actor Prepared Analyzed Method Analyst General Chemist Wbstboiough Lab =. - Nitrogen, Nitrite ND mgll 0.050 - ( 05/12/21 07:00 44,353.2 MR Nitrogen, Nitrate . 1.5 mgli 0.10 - 1 - 05/12/21 07:00 442353.2 MR Nitrogen, Total Kjeldahl 1.65 mgll 1.50 - 5 05118/21 20:00 05/20/21 12:14 121;4500NH3-H J0 Phosphorus, Total 3.08 mgA 0.100 10 05,+18121 11:00 05/20/21 13:10 121,4500P -E so Phosphorus, Orthophosphate ND mgA 0.005 - 1 05/12/21 07:00 121,4500P -E AW Surfactants; MBAS ND mgA 0.050 - 1 05112/21 02:30 05/12121 05:32 121,5540C AW Page 9 of 21 Project Name: CAPE CCD SEA CAMPS Project Number: C-18845,02 SAMPLE RESULTS Lab ID: L2124417-05 Client ID: MW -7 Sample Location: BREWSTER, MA Sample Depth: Serial No:05212110:34 Lab Number: L2124417 Report Date: 05/21/21 Date Collected: 05/10/21 10:30 Date Received: 05/11/21 Field Prep: Not Specified Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL IVIDL Factor Prepared Analyzed Method Analyst General Chemistry. - Westborough Lab Nitrogen, Nitrile ND mgll 0.050 i 05/12/21 07:02 44,353.2 MR Nitrogen, Nitrate 2.6 mgll 0.10 _..... ...... .... . 1 - 05/12/21 07:02 4 53.2 Nitrogen, Total Kjeldahl 2.71 rn411 1.50 - 5 05/18/21 20:00 05/20/21 12:15 121,450ONH3-H JO Phosphorus, Total 7.02 mgll 0.100 10 05/19/21 11:00 0500121 13:11 121,4500P -E SD Phosphorus, Orthophosphate 0.028 mg1l 0.005 - 1 -..........._...._.._................. 05/12/21 07:01 .-._-..._.__......._.._-.........._.._......._.................... i21,4500P-E AW Surfactants, MEAS _ . ND mgA 0,050 __.......... ....................._........................_._... 1 05/1212102:30 05112/21 05:33 121,55400 AW �., 17 Page 10 of 21 Serial No:0521211C:34 CHAIN OFT Via.'1� a LB6: .I ] RLPFtR.Jot� fir x L f ❑ FAX EMnit PO:, 3vgeu>orpvylr,MA : wn-NEK VA PrgeQ-blames Gape Cod BeaCamps- [I ADEk 0 mi .1 w� vcrahles TEL! 5 -tq "77.20 1EL•504sn—D . rut S:>t.145.95PS rm5mLazi.:967 Picjurk I.acat37n: Bfe'+rs<br, MA f e�MProarnm Crflena _ CIle it. Coastal - Yrarin Co. ]M- r'ro'ed #: C -16945"a2 ill YasS: 260 Cranberry IM+3 Prn e: t fJana r..lahn Schnaioli ❑ Ye5 ETNo Me MCP Amlykzi M- ude Re per pr sans W.A OZ553 ALPHA quote M 2611601 ruO t7 Ye {p Na ATE GT RCP {Raaspc?GR4 CpnSdsrre Pfcl0t 15 [Y:rd7 i ANALYSIS Phone: 509 253.6511. i SM1W'LE 1[lFl17LiEi:S Fax: 5W 2$5-6700 1 $4ar..L 4 ❑ Rush tor+Lr is aFEaaPP toVFb ?martin UvOt Email: R iinioagfa Q afpss:ssr.�lash 4a 6=an Pfb�bi.Y §aOAxa3hY Hp&7, t Bue cae; Tfmp: Prr+ma:fan W R Lis tpa Other Projegt 5pDafic RaqvlremenWCornmehWCketecWm Ltmils; pH: IFna 5a 3pmiey ada�y 8peclGc CarA udaaae: t d � n a a w Aij;HAtab lf3 Samute 3p Cwn Semp;t sampfefs z tlato-i75e-OrJyj pate :x hlalroc 7L Irriirass O Y i 3 rrerai•��nc mw -1 MIMI 32:Gf1PAA G1'Y A[7L'� © ® ® -❑ ❑ -❑ ❑ ❑ ❑ ❑ ® © ❑ ❑ ❑ 051101I7 11:30AM GIN ACC © .© EI TO EJ FUI ❑ El ani 13:90AM GLA! ACC ® ® ® � _05 ® ® ® ❑ F1 Li Li I❑ ❑ ❑ mW -5 [i511tlrz1 1rr:d5A.Ai GW ACC . . _ _ —..... ... ® ® ❑ ❑ El ❑ ❑ E) MVV-70571wi 10:30AM GWACC ED] Li ❑ ❑ ❑❑ ❑ ©❑ IQ ❑ - I❑ 10 10 10 ❑ ❑WE10 ------------------------------- ❑ ❑ ❑ ©❑ ❑❑,❑❑ 1't EASEMSYMIt QUESTIONS ABOYEt.ilfajgoltiek7iad ifi?J is, Y Q [J R PROJECT ��� � -' Oai�l3line 'Rh}� RS 3 m s' biA LMUBM mbvii ti' nY s,un� �re� �f(A MCP or Ci RCP? MA. . AL- r�� t.;. � }vymMeS.ieefbflly: c -f •' 16`•�f �� ,e,a i k14. 1Jd�ahPavr!mlTvrn;. �a•%Eti rage �l (Az I 5121/2021 eDEP - Massr)EP'S onlineFiling System a NfassbEP's Online Filing System Receipt Summary/Receipt MassDEP !-come i Contact j Privacy Policy ickn f Forms Signature Receipt b print re�eipf Exif `aur submission is complete, Thank you for using DEP's online reporting ,ystem. You can select "My eDEP" to see a fist of your transactions. DEP Transaction [D: 1281703 Date and Time Submitted: 5/2112021 2:21:38 PM Dther Email : DEP Transaction 1D: 1281703 Date and Time Submitted: 5/2112021 2:21:38 PM Other Email : DEP Transaction ID: 1281703 Date and Time Submitted. 5/2112021 2:21:38 PM Other Email : DEP Transaction ID: 1281703 Date and Time Submitted: 5/21/2021 2:21:38 PM Other Email: Form Name: Groundwater Discharge Monitoring Report Forms Faci4ity information'. Tax identification Number: 043070847 location: 3057 MAIN STREET Address: BREWSTER ZIP: 02631 Daily Log Sheet(2021 MAY DAILY) Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 043070847 location: 3057 MAIN STREET Address: BREWSTER ZIP: 02631 Monitoring Well Data Report �l - 2021 Quarterly 2} Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 043070847 112 Massachusetts Department of Environmental Protection Bureau of Resource Protection: — Drinking Water Program Consumer Confidence Report Certification For calendar year 2020 A. PINS Information Important: When Brewster Water Department Ming out forms PWS Name on the computer, use only the tab Brewster key to move your City flown cursor - do not The community water system named above MA4041000 use the return key.hereby certifies that its Consumer Confidence P+VS ID# Report (CCR) was distributed to customers, Paul Anderson appropriate agencies, and notices of availability Name have been given in compliance with 310 CMR Superintendent 22.16A. Furthermore, the system certifies that Title the information contained in the report is correct 508-896-5454 and consistent with the compliance monitoring Phone# data previously submitted to MassDEP. 6128+202 1 certify un der penalty of law that 1 am the person pate authorized to fill out this form and the information contained herein is true, accurate, and complete to the ,best of mV knowledge and belief. ftnature of OwnerlResponsibie Party or Certified operator B. Public Notice Certification CCR delivery by newspaper or Is this system using this CCR to provide Tier 3 Public Notice? ® Yes ❑ No postings does not meet PN What PN is included? Violation ❑ UCMR3 N Other ❑ requirements. Liat other PN must be directly delivered Did you have a consultation with MassDEP ? ❑ Yes N No (by hand, land, Consultat6on date electronic), The PN can be found on page 3 of the CCR. Date of PN occurrence ❑ I am reporting multiple Tier 3 PNs. I have fisted the additional PN information at the end of this form. The public water system indicated above hereby affirms that a Tier 3 public notice has been provided within this CCR to consumers in accordance with 310 CMR 22,16(4) including: delivery, content, format requirements, notification deadlines, and that the public water system will meet future requirements for notifying new billing units and new customers of the violation. If you did not sell water to another C. For. Systems Selling Water to Other Community Water Systems community PWS skip Section C. ❑ My system delivered the applicable information required at 310 CMR 22,16A(3), to the buying system(s) no later than April 1st of this year, or by the mutually agreed upon date specifically included in a written contract between the parties. D. Annual Cross Connection Education Is this CCR being used for your system's annual cross -connection educatlon? ❑ Yes N No If no, what methods did you use to meet your annual CCCP requirements (citation)? Annual Brewster Continued an next page Rev 5-16 Page 1 of 3 ALL distribution (posting, land or e -delivery, publicatbon, and good faith efforts) must be completed on or before July 1st When email is used for delivery, any returned emails must be redelivered by land delivery ideally within 3 days but before July 1. Instructions for customers to request a hard copy must also be included in e -delivery. E. Consumer Delivery Methods -- Based on Population Served For systems serving fewer than 500 persons: (Choose #1 or 42) Date of delivery/publication ❑ 1, My system used one or more of the following methods to notify customers that the CCR would not be mailed directly to them but is available to them upon request. (A copy of the notice is attached). ❑ Land mail ❑ Door-to-door ❑ Newspaper ❑ entail ❑ Post notices Locations of posted notices ❑ 2. My system provided a copy of the CCR to each customer by the following methods(s): ❑ Published the full CCR in a local newspaper (the published report is attached), ❑ Land mailed or hand -delivered the CCR to consumers. ❑ eMailed with PDF of CCR or ❑ eMailed with embedded CCR (email is attached) ❑ Posted the CCR on the web and sent the direct URL to customers by way of mail or email (notice is attached), List URL For systems serving between 500 and 9,999 persons: (Choose #1 or #2) Date of delivery/publication ❑ 1. My system provided a copy of the CCR to each customer by ❑ Land mail ❑ eMail with PDF ❑ eMail with embedded CCR ❑ Land mailed or ❑ eMailed a notice of availability of the CCR with a direct URL When a URL is used it must be a List the URL if used. — direct link to the docurnent. ❑ 2.My system provided the CCR to each customer by publishing the full report in a newspaper (a copy of the published CCR is attached) and provided notice to consumers of this action by either: ❑ Published a notice of this in a local newspaper ❑ Land mailed a notice of this to consumers. ❑ e -Mailed a notice of this to consumers. For systems serving 10,000 or more persons: 6/28/2021 Date of deliverylpublication ® My system provided a copy of the CCR to each customer by: ❑ Land mail ❑ eMail with PDF ❑ eMall with embedded CCR ® Land mailed or [I Walled a notice of availability of the CCR with a direct URL ccr. brewster-ma. goo List the URL if used. — ❑ In addition to one of the delivery methods checked above, my system serves greater than 100,000 persons and, as required, has posted the CCR on a publicly accessible Internet site; www. List the URL used F. Good Faith Delivery Methods (minimum of 3 is required) To reach people who drink our water but are not billed customers the following were conducted in addition to the required delivery: ® Posted the CCR on a publicly accessible Internet site at the following address. (Only for systems under 100,000 population who did not use this method as their primary method) www.brewster-ma.gov List the URL used. -- — . ❑ Mailed the CCR to all postal patrons within the service area (list of zip codes used is attached). Rev 5-16 Page 2 of 3 ❑ Mailed a postcard listing the URL where the CCR can be found, to all postal patrons within the service area {fist of zip codes used is attached). Www. List the URL used. — ® Advertised availability of the CCR in the following news media (the announcement is attached): ❑ Radio ❑ Newspaper ® Television 1 cable ❑Digital signboard El Social media ❑ Published the CCR in local newspaper- (the published CCR is attached)- ® Posted the CCR in public places i -e., post office, town hall, library (a list of locations is attached) ® Delivered multiple CCR copies to single -bill addresses serving several persons i.e., apartments, businesses, large private employers (a list of locations is attached). ® Delivered multiple CCR copies to community organizations (A list of organizations is attached.) ® Posted the CCR or a notice of avallabiIity at locations within the apartment/condo complex (list of the locations is attached). ❑ Other _ Certification Form, and all the attachments check -marked in this form to your Date completed G. Mandatory Agency Delivery Requirements MassDEP regional office at: Agencies and ® 1 Delivered 1 copy of CCR and the Certification Form to local board of health. 6/2 8/2021 consumers must (Contact your board of health as to whether they would prefer land or -delivery Date receive CCR on or e of CCR,) Completed before July 1. well. No need to e - deliver to regional ® 2. Delivered 1 -copy of CCR and the Certification Form to MA Dept. of Public 6/28/2021 When emailing, scan documents Health. ❑ Hardcopy to: 250 Washington St.; Boston, MA 02108 or -- Date completed into 1 PDF file. ® PDF emailed to; d h.ccr massmail-state.ma.us Make sure Cert form ® 3. Delivered is the first 1 -copy of CCR, the Certification Farm, and all the attachments 6/28/2021 page, check -marked in this form to the MassDEP Boston Office at: ❑ Hardcopy to: CCR Program, 1 Winter St. -511 Fl.; Boston, MA 02108 or Date completed ® PDF emailed to: Pro ram.Director-DWP state.ma.us. ❑ 4. If not emailed to the MassDEP Boston Office, delivered 1 -copy of CCR, the Certification Form, and all the attachments check -marked in this form to your Date completed MassDEP regional office at: Only one emalf is necessary. If the ❑ Hardcopy to: MassDEP-WERO; Statehouse West 4th Flour; 435 Dwi ht CCR is e -delivered Street.; Springfield, MA 01103 g to the Boston office ❑ Hardcopy to: MassDEP-GERO; 8 New Bond St; Worcester, MA 01605 it will also be ❑ Hardcopy to: Mass DEP-NERO; 205-B Lowell St-; Wilmin.gton, MA 01887 accessible to the regional office as ❑ Hardcopy to: MassDEP-SERO; 20 Riverside Dr.; Lakeville, MA 02347 well. No need to e - deliver to regional office. Re,,, 5-16 Page 3 of 3 Brewster Nater Department 2020 Annual Nater Quality Report Dear Customer: We are pleased to present a summary of the quality of the water provided to you during the past year. The Safe Drinking Water Act (SDWA) requires that utilities issue an annual "Consumer Confidence" report to customers in addition to other notices that may be required by law. This report details where our water comes from, what our tests show about it, and other details you should know about your drinking water. The Brewster Water Department is committed to providing you with the highest quality and most reliable water supply possible. Informed consumers are our best allies in maintaining safe drinking water. Please read this report carefully. If you have questions about this report, please call 508-896-5454 and ask for Paul Anderson, Superintendent or Robert Crowley, Water Treatment Operator, The Brewster Water Department Public Water System identification number (PWS ID#) is MA4041000. The Brewster Water Department offices are located at 165 Commerce Park Road, Brewster, MA 02631. The phone number is 508-896-5454 and the Fax number is 508-896-4517. You can find out more about the Brewster Water Department on the internet at the Town of Brewster web site, www.town. b rewster. ma. us, We encourage public interest and Participation in the Brewster Water Department. Water Commissioners' meetings generally occur once a month at the Water Department Office. Meeting notices are posted at the Town Hall and are available at the Water Department office. For up-to-date meeting times and dates, please call the Department. The public is always welcome. YOU'RE WATER SOURCE The Town has five groundwater wells pumping water from the Monomoy Lens. The Monomoy Lens is one of the six groundwater lenses that make up the Cape Cod Sole Source Aquifer. Each of the well sites has large Town owned tracts of land surrounding them for water quality protection. Activity is restricted to passive recreation on Town wellfield acreage, Wells #1 & #2, located near Route 6, south of Freeman's Way, were constructed in 1971 and are about 76 feet deep. Well #3, near Route 6, north of Freeman's Way, was built in 1986 and is about 90 feet deep, Well #4, at the north edge of the Punkhorn Parklands, off Run Hill Road, was built in 1991 and is about 101 feet deep. Well 6 (the 51h well site) is in the southern Punkhorn area and construction was completed in 2013. It is approximately 121 feet deep and is currently providing water to Brewster residents. The Town treats the water for corrosion control and to remove iron and manganese. See page 5 & 6 for more about our treatment facilities. SOURCE WATER ASSESSMENT and PROTECTION (SWAP) REPORT A Source Water Assessment was completed in Brewster in 2003 by members of the Department of Environmental Protection (DEP), Drinking Water Program (DWP). A Source Water Assessment and Protection (SWAP) Report has been issued and contains an evaluation of the land uses, environmental vulnerabilities and protection measures around the wellfield areas of the Town. This report rates the susceptibility of the well sources, and gives recommendations for improvement in aquifer protection and other areas that affect groundwater quality. The susceptibility of the Town's wells, as determined during the Assessment, is as follows: Wells # 1-3, High; Well #4 and #6 Moderate. While these assessments are serious, the reason for the determination is the lack of underground or geological formations, such as a clay layer, that would create a hydrological barrier to possible contamination. This is not a new issue for a good part of Cape Cod, due to the sand and gravel make-up of the Cape. The Town has wellhead protection regulations and a Groundwater Protection District in place to oversee land use within that District. The report cites land uses in Brewster's Zone 11 areas, as "dominated with forest with smaller areas of residential use (approximately 7%) and a very small percentage of commercial and industrial land use." There are recommendations for further action and planning in each area of the report. Some of the recommendations include land acquisition, additional monitoring, public education and outreach for source protection and storage, handling and disposal of hazardous materials. Residents can help protect our water quality by practicing good septic system maintenance and properly disposing of household hazardous waste through Brewster's Hazardous Waste Collection Program. Contact the Brewster Health Department (508-896-3701, ext. 120) or the Brewster Water Department (508-896-5454) for information on these topics. The report is available for viewing at the Commerce Park Road Water Department offices and a copy has been placed at the Brewster Ladies Library, The Department is also placing the scanned report on the Department web page of the Town's website, mvw.town. brewster. ma. us Brewster Water Quality Data Table Compiled January 5, 2029, for the reporting period of January 111 to December 31e1, 2020. Ke — definitions to abbreviations used below are found on page #3. Alcrobiolo ical Contaminants Collection Highest # Positive Contaminant date Samples in a MCL MCLG Possible source(s) of contamination: Violation month (YIN) Total Monthly Coliform in >5%I.coliform' 2020 0 of monthly samples 0 Naturally occurring in the environment NO Contaminant # Sites Unit 90'" # Sits t Sampled 2/4/2020 Percentile Exceec Lead' NO methanes 8/19/2020 ppb Date Taken 31 ppb 3.0 0 9/12/2020 Acids 5/21/2020 ppb (HAAS) Copper wood preservatives. 11/5/2020 Range Date Taken 31 ppm 0.15 0 9/12/2020 0.37 0-0.37 Erosion of natural deposits NO Radioactive Contaminants Range Major Sources Violation Contaminant Date Tested Unit MCL MCLG Combined 9191 14 p 5 Ci1L p 0 Radium Level Found L L Major Sources j Violation Volatile Or anic Contaminants YIN <0A9 Contaminant Date Tested Unit MCL MCLG Teirachioro- 0.0054 0-0,006 Discharge of drilling wastes; discharge from ethylene2 2/24/2020 ppb 5 0 Inor anic Contaminants NO Erosion of natural deposits NO Contaminant Date Tested Unit MCL MCLG Asbestos 5/5/2013 MFL 7 MFL 7 MFL Barium 2127/20 ppm 2 na 0.21 sewage; erosion of natural deposits. 50 Manganese 5/19/2020 ppb (SMCL na Nitrate + 2/4/2020 I ppm I 10 1 10 Nitrite I 2/4/2020 1 ppm + 1 1 1 Contaminant Date Uni Violation Tested t Total 2/4/2020 AL=15 Trihalo- 5/21/2020 NO methanes 8/19/2020 ppb (TTHMs) 11/5/2020 Haloacetic 2/4/2020 AL=1.3 Acids 5/21/2020 ppb (HAAS) $11912020 wood preservatives. 11/5/2020 Range 'hlorine Monthly pp Free] 2020 m 3 ulated Contaminants MCL (AL) MCLGPossible Source of Contamination Violation YIN AL=15 0 Corrosion of household plumbing NO systems; Erosion of natural deposits. Corrosion of household plumbing systems; AL=1.3 1.3 Erosion of -natural deposits; Leaching from NO wood preservatives. Level Found Range Major Sources Violation YIN 0.37 0-0.37 Erosion of natural deposits NO Laved Found Range Major Sources Violation YIN ND ND Leaching from vinyl lined pipes, See NO additional information be law this table. Level Found Range Major Sources j Violation YIN <0A9 0-<0 19 Decay of asbestos cement water mains; NO Erosion of natural deposits 0.0054 0-0,006 Discharge of drilling wastes; discharge from NO metal refineries; erosion of natural deposits ND NO Erosion of natural deposits NO Runoff from fertilizer use; Leaching from 1.0 ND — 1.0 septic tanks, sewage; erosion of nature[ NO deposits. 0.21 ND_ Runoff from fertilizer use; Leaching from septic tanks, 0.21 sewage; erosion of natural deposits. MRDL MRDLG Resuits3 Range Major Sources Vlolatd YIN 80 nla 13.5 4.6-17 By-product of drinking water chlorination NO 60 nla 1.3 2D By-product of drinking water chlorination NO 4.0 4.0 0.11 0 — 0.11 Water additive used to control microbes nla Contaminant Date Unit I SMCL CRSG I Result or Tested Range -2. Possible source on N Water -quality Table Footnotes 1. See paragraph on this contaminant on page 4. 2. See paragraph on this contaminant on page 5. 3. This Results column represents the highest concentration upon which the system's compliance is based, nol necessarily the highest concentration found. Data presented is from the most recent testing done in accordance with the regulations. Most of the data presented in this table is from the reporting year. We monitor for some contaminants less than once per year, under DEP reduced monitoring requirements, because concentrations. for those contaminants are not expected to vary significantly from year to year. As a result, some of our data, though representative, is more than a year old. For those contaminants, the date of the last sample is shown in the table. *' Unregulated contaminants are those for which EPA has not established drinking water standards. The purpose of unregulated contaminant monitoring is to assist EPA in determining their occurrence in drinking water and whether future regulation is warranted. Water Quality Data Table and Derinitions The water quality information presented in the table is from the most recent round of testing done in accordance with State and Federal regulations. Ali data shown is based upon tests conducted in the year 2020 unless otherwise noted in the table. The Department of Environmental Protection (DEP) has granted the Brewster Water Department reduced monitoring requirements for Synthetic Organic Contaminants (SOC) and Inorganic Contaminants (IOC) because the sources have shown not to be at risk for contamination. The last full sampling for IOC and SOC was in 2011. DEFINITIONS Maximum Contaminant Level or MCL: The highest level of a contaminant in drinking water. MCLs are set as close to the MCLGs (see below) as feasible using the best available treatment technology. -3- Natural sources; runoff from use as salt on Sodium 2/11/2020 ppmnla** 20 21 9.7-20 roadways; by-product of treatment process Wells #1-3 nla Well #4 Sulfate 7130119 ppm 250 ---- 15 6.8--15 Natural sources n1a Bromodichlo- 1128119 romethane ppb na na 2.9 0-209 By-product of drinking water chlorination nla Contaminant date Tested Unit SMCL ORSG Result or Detected Range g Possible Source Violation Y/N Chlorordibro- 1128119 ppb. na na 3.5 0-3.5 By-product y -product of drinking water chlorination nla Chloroform 1128119 ppb nla** nla** 2.4 0-2A Naturally present In the environment. Also Volatile analyzed for in TTHMs nla Contaminants Contaminant Date Tested Unit MCL MCLG Level Found Range Major Sources Violation YIN Xylenes 3115113 ppb 10 10 3.1 0-3.1 Discharge from petroleum Factories; Discharge from chemical factories n/a 2014 & 2418 UCAIR Unregulated Contaminant Test Results: Unregulated Contaminant Date Collected Result or Range of Detected Average Detected Bromochloroacetic Acid (ppb) 3/26/18 0.44 0.27 Dibromoacetic Acid (ppb) 3/25/18 1.2 0.82 Bromide (ppb) 3/26/18 57.5 27.22 5trontlum (ppb) 4/28/14 15.3-44.1 19.7 Vanadium (ppb) 4/28/14 0.067-0.80 0.50 Chromium (ppb) 4/28/14 0.29-0.39 0.34 Chromiun/Hexavalent (ppb) 1 4/28/14 0.15-0.26 q.19 Water -quality Table Footnotes 1. See paragraph on this contaminant on page 4. 2. See paragraph on this contaminant on page 5. 3. This Results column represents the highest concentration upon which the system's compliance is based, nol necessarily the highest concentration found. Data presented is from the most recent testing done in accordance with the regulations. Most of the data presented in this table is from the reporting year. We monitor for some contaminants less than once per year, under DEP reduced monitoring requirements, because concentrations. for those contaminants are not expected to vary significantly from year to year. As a result, some of our data, though representative, is more than a year old. For those contaminants, the date of the last sample is shown in the table. *' Unregulated contaminants are those for which EPA has not established drinking water standards. The purpose of unregulated contaminant monitoring is to assist EPA in determining their occurrence in drinking water and whether future regulation is warranted. Water Quality Data Table and Derinitions The water quality information presented in the table is from the most recent round of testing done in accordance with State and Federal regulations. Ali data shown is based upon tests conducted in the year 2020 unless otherwise noted in the table. The Department of Environmental Protection (DEP) has granted the Brewster Water Department reduced monitoring requirements for Synthetic Organic Contaminants (SOC) and Inorganic Contaminants (IOC) because the sources have shown not to be at risk for contamination. The last full sampling for IOC and SOC was in 2011. DEFINITIONS Maximum Contaminant Level or MCL: The highest level of a contaminant in drinking water. MCLs are set as close to the MCLGs (see below) as feasible using the best available treatment technology. -3- Maximum Contaminant Level Goal or MCLG: The level of a contaminant in drinking water below, which there is no known or expected risk to health. MCLGs allow for a margin of safety. Action Level (AL) - The concentration of a contaminant that, if exceeded, triggers treatment or other requirements, which a water system must follow. Parts per million (ppm) or Milligrams per liter (mglL) - One part per million corresponds to one minute in two years or a single penny in $'10,000. Parts per billion (ppb) or Micrograms per liter (P91L) - One part per billion corresponds to ane minute in 2,000 years, or a single penny in $10,040,000. Pico Curies per liter (pCi1L) - PicoCuries per liter is a measure of the radioactivity in water. Maximum Residual Disinfectant Level (MRDL) -- The highest level of a disinfectant allowed in drinking water. There is convincing evidence that addition of a disinfectant is necessary for control of microbial contaminants. Maximum Residual Disinfectant Level Goal (MfRDLG) -- The level of a drinking water disinfectant (chlorine, chloramines, chlorine dioxide) below which there is no known or expected risk to health. MRDLG's do not reflect the benefits of the use of disinfectants to control microbial contaminants. Non -Detects (ND) - Laboratory analysis indicates that the constituent is not present. MFL- Million Fibers per Liter Treatment Technique (TT) — A required process intended to reduce the level of a contaminant in drinking water. 90' Percentile: Out of every 10 homes, 9 were at or below this level. Secondary Maximum Contaminant Level (SMCL) These standards are developed to protect the aesthetic qualities of drinking water and are not health based. Massachusetts Office of Research and Standards Guideline (ORSG) This is the concentration of a chemical in drinking wafer, at or below, which adverse health effects are unlikely to occur after chronic (lifetime) exposure, If exceeded, it serves as an indicator of the potential need for further action. What does all this mean? This report shows our water quality and what it means. The Brey^ ster Water Department routinely monitors for contaminants in your drinking water according to Federal and State laws. We have learned through our monitoring and testing that some contaminants have been detected. The y Department takes hundreds of samples for over 100 contaminants in our drinking water. Space does not allow listing all constituents here. All regulated or unregulated contaminants with sampling requirements that do not appear in the Water Quality Data Table were reported as "below the detection limit' or non-detectable (ND). A complete listing of all sampling results is available at the Water Department Office, 165 Commerce Park Road, Brewster, MA 02631. IMPORTANT INFORMATION Some people may be more vulnerable to contaminants in drinking water than the general population, immuno -compromised persons such as persons with cancer undergoing chemotherapy, persons who have undergone organ transplants, people with HIV/AIDS or other immune system disorders, some elderly, and infants can be particularly at risk from infections. These people should seek advice from their health care providers. EPA/Centers for Disease Control and Prevention (CDC) guidelines on appropriate means to lessen the risk of infection by Cryptosporidium and other microbial contaminants are available from the Safe Drinking Water Hotline, 1-800-42641791. Environmental Protection Agency Drinking Water Hotline 1-800-426-4791 In order to ensure that tap water is safe to drink, the Department of Environmental Protection (DFP) and U.S. Environmental Protection Agency (FPA) prescribe regulations that limit the amount of certain contaminants in water provided by public water systems. The Food and Drug Administration (FDA) and Massachusetts Department of Public Health (DPH) regulations establish limits for contaminants in bottled water that must provide the same protection for public health. Drinking water, including bottled water, may rcasonably be expected to contain at least small amounts of some contamination. The presence of contatninants does not necessarily indicate that water poses a health risk. More information about contaminants and potential health effects can be obtained by calling the EPA's Safe Drinking Water Hotline, 1-800-426-4791. ADDITIONAL HEALTH INFORMATION Sources of drinking water (both tap water and bottled water) include rivers, lakes, streams, ponds, reservoirs, springs, and wells. As water travels over the surface of the land or through the ground, it dissolves naturally -occurring minerals, and in -4- some cases, radioactive material, and can pick up substances resulting from the presence of animals or from human activity. Contaminants that may be present in source water include: Microbial contaminants, such as viruses and bacteria may come from sewage treatment plants, septic systems, agricultural livestock operations, and wildlife. Inorganic contaminants such as salts and metals can be naturally -occurring or result from urban stormwater runoff, industrial or domestic wastewater discharges, oil and gas production, mining, and farming. Pesticides and herbicides, may come from a variety of sources such as agriculture, urban stormwater runoff, and residential uses. Organic chemical contaminants, include synthetic and volatile organic chemicals that are by-products of Industrial processes and petroleum production, and can also come from gas stations, urban stormwater runoff, and septic systems. Radioactive contaminants can be naturally occurring or be the result of oil and gas production and mining activities. Maximum Contaminant Levels: (MCL's) are set at very stringent levels. The EPA has determined that your water IS SAFE at these levels. To understand the possible health effects described for many regulated constituents, a person would have to drink 2 liters of water every day at the MCL level for a lifetime to have a one -in -a -million chance of having the described health effect. Total Coliform detections: No maximum contaminant levels or other health standards were exceeded in any month in 2018. The Department took 435 bacteria samples in 2019 at representative locations throughout the town at regular intervals to monitor this aspect of water quality, 384 samples are required by regulation. Lead: If present, elevated levels of lead can cause serious health problems, especially for pregnant women and young children. -Lead in drinking water is primarily from materials and components associated with service lines and home plumbing. The Brewster Water Department is responsible for providing high quality drinking water, but cannot control the variety of materials used in plumbing components. When your water has been sitting for several hours, you can minimize the potential for lead exposure by flushing your tap for 30 seconds to 2 minutes before using water for drinking or cooking. If you are concerned about lead in your water, you may wish to have your water tested. f nformation on lead in drinking water, testing methods, and steps you can take to minimize exposure is available from the Safe Drinking Water Hotline or at http://www.epa.gov/safewateriJead. Tetrachloroethylene: Detections occur where vinyl lined water mains were installed in the 1970's. Vinyl -lined, asbestos - cement pipe was used in a number of subdivisions until the compound was detected in 1979. Brewster, along with other Massachusetts towns with similar piping, flushes and monitors under a DEP approved program to deal with the problem. There are 5.3 miles of the affected pipe in Brewster's 126 mile water distribution system. All locations have bleeders to control the level of the contaminant. The samples are taken after the last service on each street. This gives the "worst case scenario" for contaminant concentratiozi. Most homes served by these pipes should be well below reported levels. For specific area sample results, please call the Brewster Water Department. The following locations are served by affected pipe and had detections in ranges noted in the data table, page 2: No Locations had detections. The following streets had non-detectable results: Ambergris Circle -West, Ambergris Circle -East, Damon Road, Woodstock Drive, Bog Pond Road, Bridle Path Road, Carriage Drive, Great Fields Road -from Pine Bluff Road north to end of the water main, Harmony Lane, Highridge .Road, John Wings Lane, Linda Circle, Oakwood Road, pleasant Court, Wagon Wheel Lane, WhifPletree Avenue, Wynn Way, Gages Way -North, Puritan Drive, Stonehenge Drive, Nathan's Pasture Way. Unregulated contaminants: Those for which EPA has not established drinking water standards. The purpose of unregulated contaminant monitoring is to assist EPA in determining their occurrence in drinking water and whether future regulation is warranted. Sodium: Sodium -sensitive individuals, such as those experiencing hypertension, kidney failure, or congestive heart failure, should be aware of the sodium levels where exposures are being carefully controlled, Total Trihalomethanes (TTHM): Some people who drink water containing trihalomethanes in excess of the MCL over many years experience problems with their liver, kidneys, or central nervous systems, and may have increased risk of getting cancer. Brewster did not exceed the MCL for these contaminants. The only Volatile Organic Compound detected and reported this year is Chloroform, naturally occurring in most Cape Cod groundwaters. Haloacetic Acids(HAA5): Some people who drink water containing haloacetic acids in excess of the MCL over many Years may have increased risk of getting cancer. Brewster did not exceed the MCL for these contaminants. WATER TREATMENT - 5 - Iron & Manganese Removal (oxidation and filtration) Iron and manganese are often present in groundwater at levels that can discolor the water or cause it to take on unpleasant odors or tastes. Even though the water may still be safe to drink, it is preferable that the iron and manganese be removed. The Greensand Filtration Facility is designed to remove iron and manganese pumped from Well #4, located off Run Hill Road. Treatment includes the use of sodium hypochlorite, a liquid chlorine solution, for oxidation of the minerals. This causes the iron and manganese to form tiny particles. Once this happens, the water passes through special filters consisting of material that is specifically designed to capture iron and manganese particles. Over time, filters start to clog and need to be cleaned using a high-flow backwash process. Sodium hypochlorite is also used as a disinfectant required for water filtration processes treating the finished water to a concentration of 0.2 to 6.6 ppm free chlorine. Potassium permanganate is used periodically to activate the filter media when regeneration is necessary. Corrosion Control through pH Adjustment Many drinking water sources in New England are naturally corrosive (i.e. they have a pH of less than 7:6). So, the water they supply has a tendency to corrode and dissolve the metal piping it flows through. This not only damages pipes but can also add harmful metals, such as lead and copper, to the water. For this reason it Is beneficial to add chemicals that make the water neutral or slightly alkaline. This is accomplished by adding any one or a combination of several approved chemicals. The Brewster Water Department adds hydrated lime at two Lime Treatment Facilities located near Wells #1 & 2, and Well #3. Potassium hydroxide is used in place of hydrated lime at Well #4, for pH adjustment and corrosion control of this water source. Testing throughout the system has shown that this treatment has been effective at reducing the lead and copper concentrations. Unregulated Contaminants are those that don't yet have a drinking water standard set by LIS Environmental Protection Agency. The purpose of monitoring for these contaminants is to help US EPA decide whether the contaminants should have a standard. American Water Works Facts Sheets are available at htt :Ilwww.drinkta .or Ihomelwater- information/water-guality_lucmr3 asgx. Sodium hypochlorite, also added to the water at these facilities, as a preventative disinfectant, during system flushing. This chemical is added at a concentration of approximately 4.6 ppm free chlorine for approximately 6 weeks each spring and fall and in the summer as needed to ensure safe drinking water. All chemicals used for treatment are approved for water treatment by one of the following organizations: National Sanitation Foundation (Now known as NSF International), or UL, both accredited by the American National Standards Institute (ANSI). The chemicals also meet performance standards established by the American Water Works Association. THIS REPORT This report was prepared using information and material supplied by The Department of Environmental Protection, National Rural Water Association and New England Water Works Association. As a regulatory requirement, much of the form, information and language are mandated. We would appreciate it if you would let us know if you found the report readable and understandable. Any helpful comments will be appreciated. We will do our best to improve what can be adjusted or modified. We are always happy to answer any questions about the Brewster Water Department and our water quality. For information, call 508-898-5454. Also visit the Town of Brewster web site at: www, town. brewster. ma.us for general and Department specific information. We're proud of the quality of your drinking water, The water quality meets all Federal and State requirements. Should you, as a Brewster Water consumer, or someone you know have difficulties with sight or understanding English, please contact this office and we will make arrangements to have the report read or translated. OPERATIONS The Commonwealth of Massachusetts has very specific laws requiring licensed Drinking Water Supply Operators for water systems providing drinking water to the public. This certification is obtained by passing tests and meeting experience and training requirements. Operators must also complete continuing education requirements to retain this license. Brewster currently has nine staff members with varied levels of Drinking Water Supply Facilities Operator Certificates. The employees of the Brewster Water Department work diligently to provide top quality water to every consumer's tap. We ask everyone's help in conserving and protecting our water resources. Thank you! PROTECT YOUR DRINKING WATER FROM CROSS CONNECTIONS A cross connection occurs whenever a potable drinking water line is directly or indirectly connected to a piece of equipment or piping containing non -potable water. In the event of a backflow incident, through either backpressure or back -siphonage, an unprotected cross connection in your game could cause the water system within your home and also within the water distribution system in the street to become contaminated. The outside water tap and garden hose tend to be the most common cross connection in the home. The garden hose becomes a hazard when connected to a chemical -6- sprayer for weed killing and fertilizer applications. This cross connection can be easily protected by purchasing a small device known as a vacuum breaker, Vacuum breakers can be purchased at your local hardware store and are very inexpensive and easy to install, The vacuum breaker should be installed on all your outside faucets, Other potential cross connections can occur on lawn irrigation systems and fire protection systems. For more information on cross connections, please feel free to contact the Brewster Water Department. Hazardous Waste Collection 2021 The tri -town hazardous waste collection program, which also includes the towns of Harwich and Chatham, will continue for 2020. The tentative Saturday collection dates for this year are: May 8th, June 12th, July 10th, August 14th, September 11th, and October 9th. Collections are from 9 AM to 12 Moon at the Harwich Transfer Station, 209 Queen Anne Road, There is no fee for residents and taxpayers ❑f participating towns. Thanks to the Town of Harwich and Harwich Transfer station staff for hosting this great activity[! For more info call Barnstable County Hazardous Materials Program (508) 375-5599 2421 Summer Mandatory Voluntary Irrigation Restriction Schedule In effect until. fisrther notice Residential; Even numbered houses water on even numbered days. Odd numbered houses water on odd numbered days. Commercial, Condominium and Municipal: Assigned odd or even in writing by the Water Dept. This is not a directive to wafer every other day. When irrigation is needed. please follow the voluntary schedule above. Lawn irrigation is a significant part of our water demand during the summer months. Proper irrigation techniques conserve water and save you money. There are a number of easy steps to take that will help control water use. If you have an automatic lawn sprinkler system make sure it has a moisture sensor that is working to avoid unnecessary watering. Use a rain gauge or cat food can to monitor the amount of water you are applying to the lawn. A good soaking Once or twice a week totaling about an inch of water should be sufficient. Adjust your watering if necessary to achieve this goal. Cut the lawn higher to promote deeper roots and to help prevent weeds. Keeping mower blades sharp limits grass blade damage which leads to disease and stress. A healthy grass needs less waterll -7- PLEASE REMEMBER To. WRITE YOUR ACCOUNT NUMBER ON YOUR CHECK. IF PAYING FOR MULTIPLE PROPERTIES SUBMIT INDIVIDUAL CHECKS. Additional Contact Information; In the event of an emergency at your property, the Brewster Water Department may share your contact information with the Brewster Police and Fire Departments. Your information is not available to the public. Phone: Email; 13REWSTER WATER DEPARTMENT 165 Commerce Park Road Brewster MA 02631 Office hours are Monday through Friday 7:30 AM — 4:00 PM WATER BILLS ARE MAILED TWICE A YEAR BASED ON THE BILLING PERIODS OF JANUARY — JUNE and JULY — DECEMBER. FEES & CHARGES The Brewster Water Commissioners are in full support of the continuing efforts of the town to purchase vacant land within critical drinking water protective areas. It is in the splrit of this progressive planning that a portion of revenue collected from water rates will be set aside for future land purchases. WATER RATES: Effective Januar 1 2016 WATER USAGE: Step 1; $2.27 per 1,000 gallons from 0 to 5,000 gallons of usage per billing. Step 2: $4.86 per 1,000 gallons over 5,000 gallons of usage per billing. SYSTEM MAINTENANCE FEE - based on meter size: 5/8" or 3/4" $ 60.00 per billing. 1" $ 115.00 per billing. 1 $ 145.00 per billing. 2. $175.00 per billing, 3" $ 225.00 per billing. Please note; The System Maintenance Fee is a minimum charge regardiess of water consumption. The purpose of this minimum charge is to recover the costs associoted with the doily operation of the department. FIRE LINE FEE: 2" line $80.00 per billing 4"-8"Line $160.00perbilling SEASONAL FEE: Call-in appointment: $25.00 per removal or install service Bplancc must Be POW in fullfar seasonal turn on. Billing statements jvith estimated or zero usage indicate some type of equipment malfunction. Please contact the water department as soon as possible to have meter checked or changed out. Owners will be responsible for all usage. Payment Plans: Previous balance must be paid in full, must be established shortly after billing statements are malled out and will be divided into as many months possible up to 6 months, See website for details under FAQsectio n. PAST DU E ACCOU NTS. A 1495 annual interest charge is applied an or after the 15th of each month to past due accounts after 45 days of bili issuance. To avoid missed payments and late fees register your account through the Brewster Water Department website at the following URL: payments. brewster-ma.gcv, COMPLETE RATES, REGULATIONS & SERVICES ARE AVAILABLE AT THE WATER DEPARTMENT OFFICE AND ARE SUBIECTTO CHANGE BY VOTE OF THE WATER COMMISSIONERS. In an effort to conserve postage, the Annual Brewster Water Department Consumer Confidence Report is now available online at the following URL: ccr.brewster-ma.gnv. Cynthia Barren Susan Brown Lemuel Skidmore Board of Water Commissioners TOWN OF BREWSTER WATER DEPARTMENT Posted on Town Web site and on Community Access Channel: ZEI An Paul Anderson Superintendent In an effort to conserve postage, the 2020 Brewster Water Department Consumer Confidence Report is now available online at the following URL: ccr.brewster-ma.gov A copy can be obtained at the Brewster Water Department located at 165 Commerce Park as well as at the following locations: Town Hall, Ladies Library, Fire Department, Police Department, Council on Aging, Brewster Green Clubhouse, Ocean Edge Mansion, Ocean Edge Fitness Center, The Woodlands, Maplewood at Brewster, Kinlin Grover Sales and Rentals, Leighton Realty, Old Cape Sotheby's International, Old Sea Pines Inn. Seth Ritchie Promotion 165 Coinmerce Park Rd BREWSTER, MA 02631 508-896-5454 FAX 508-896-4517 ' Massachusetts Department of Environmental Protection Drinking Water Program Public Notification Make sure to send your regional office of the DEP Drinking Water Program and local Board of Health a copy of each type of notice and a certification that you have met all the public notice requirements within ten days after issuing the notice (3 10 CMR 22.15(3)(b)). When you certify, you are also stating that you will meet future requirements for notifying new units of the violation. PWS 1D: 4041 000 City/Town: Brewster PWS Name: Brewster Water Department 10 Community ❑ Non -community Purpose: Violation ❑ or UCMR3 Describe: Occurring on: 6/26/2018 Uaii a $1 of violation or dates of UCMR sampling The public water system indicated above hereby affirms that public notice has been provided to consumers in accordance with 310 CMR 22.16 including: delivery, content, format requirements, notification deadlines and that the public water- system will meet future requirements for notifying new billing units and new customers of the violation, ❑ Consultation with DEP on ® Notice distributed by CCR on 6/28/2021 and website on 6/28/2021 method date method date I certify under penalty of law that I am the persona authorized to fill out this forin and the iraforynation contained herein is true, accurate and complete to the best of my knowledge and belief. 6/28/2021 P I Anderson date Signature of owner or operator Rev. June 2015 COASTAL engineering co. TECHNICAL SERVICES 260 Cranberry Highway Orleans, MA 02653 508.255.6511 P 508.255.6700 F Orleans I Sandwich [Nantucket co astalengine eri ngcom pa ny. corn To: Preservation of Affordable Housing Attn: Mike Fitzgerald 40 Court Street Suite 700 Boston, MA 0210E Subject: King's Landing Apartments 3 State Street Brewster, MA Permit #934-1 Plans [Copy of Letter E]Specificatians WP ora sanding the following items: Date: Via: ®Other R E. GhIV=w JUN 112021 BRFW5TER HEALTH DEPARTMENT TRANSMITTAL 06/08/2021 Project No. WBROOTDO ®1st Class Mail EPick up []Certified EFed Ex Copies pate No. Description 1 0412021 934-1 Daily Log Sheet 1 04/30/2021 934-1 Quarterly & Monthly Monitor Well Data Report w/Laboratory Test Results 1 04/20/2021 934-1 Monthly Monitor Well Data Report (Field tested data) 1 06/08/2021 934-1 eDEP Electronic Receipt These are transmitted as checked below: Ffor approval ®far your use ®as requested for review 6 comment ❑ Remarks: Enclosed are the recent reporting forms for the wastewater treatment facility at the above -referenced location. Effluent test results show high levels of Total Nitrogen that exceed the upper discharge limit due to levels of TKN. Test results also indicate high levels of BOD that exceed the upper discharge limit. We will adjust the system settings and use of process control chemicals to help improve treatment of the system. The average daily flow was approximately 9,963 gpd. If you have any questions regarding this report or the WWTF, please do not hesitate to contact us. cc: Brewster Board of Health By: Chad A. Simmons, WWTF❑ CC Commission Horsley Witten Group, Inc. AquaPoint.3 LLC NOTE: if enclosures are not as noted, please contact us at (508) 255-6511 ❑;100C\W\WBR1007\TRANSMIrrAL5NTRANSMIrrAL (APRIL 2021),uar_ Orleans I Sandwich I Nantucket Massachusetts Department of Environmental Protection 3934 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit !. - 2. Tax identification Number '', DAILY LOG SHEET 2021 APR DAILY 3. Sampling Month & Frequency C. Daily Readings/Analysis Information Date Effluent Reuse irrigation Turbidity Influent pH Effluent Chlorine UV Flow GPD Flow GPD Flow GPD pH Residual Intensity (mgt') C/6) 1 9763 6.27 j7 33 2 9998 �J 6.95 7.30 I� 3 11335 4 10696 5 12519 6.91 7.38 6 9828 [ 6.88 7.31 7 19742 �- ] 1=6,76 $11 0943 7.Q3 9 9332 6.96 7.33 1010422 11 9442 12 9786 735 1 13 10009 L 6.90 � .43 14 9574 5.93 17.40 15 944Q 7.02 7.38 16 9665 7,0717.34 17 10132 18 9673 19 9322 7.16 7.39 24 9078 7.04 7.42 21 9824 �- 7,11 7.40 22 10655 6.96 7.38 23 8157 7A7 7.44 24 9391 25 10696 26 10129 6.93 7.38 27 8321 6,99 7.43 0 28 1101937 7.07 7.45 29 9766 7.04 7.41 30 10934 �� 7.02 7.44 31 gdpols.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1 _-- ___ ............ .......... Massachusetts Department of Environmental Protection 934 - Bureau of Resource Protection - Groundwater Discharge Program �1. Permit Number �. " Groundwater Permit f 2. Tax identification Number DISCHARGE MONITORING REPORT 2021 APR MONTHLY 3. Sampling Month & Frequency D. Contaminant Analysis Information . ■ For T", below detection limit, less than (<) value, or not detected, enter "ND" • TNTC � too numerous'to count. (Fecal results only) • NS T Not Sampled 1. Parameter/Contaminant Units BOO MGA - TSS MG& TOTAL SOLIDS rvtGlL AMMONIA -N MGAL NFFRATE•N MGAL TOTAL NrTROGEN(No3+NO2+TKN) MGA - OIL & GREASE MG/L 2. Influent 3. Effluent 4. Effluent Method Detection limit © 58 12 58 127 1390 ;17.8 1,2 0.10 1 20.38 -� 110.050 4.4 1.0 infeffrp-blank.doc • rev. 09/15115 Groundwater Permit Discharge Monitoring Report • Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DISCHARGE MONITORING REPORT D. Contaminant Analysis Information • For "0", below detection limit, less than N value, or not detected, enter "ND" • TNTC = too numerous to count, (Fecal results only) • NS =Not Sampled .934 1. Permit Number 2. Tax identification Number 2021 QUARTERLY 1 3. Sampling Month & Frequency 1. ParameterlContaminant 2. Influent 3. Effluent 4. Effluent Method Units Detection limit TOTAL PHOSPHORUS A5 P g, 110,005 MG1 ORTHO PHOSPHATE 6.41 0.005 MGIL infeffrp-blank.doc • rev. 09/15115 Groundwater Permit Discharge Monitoring Report • Page 1 of 1 HA A NALY�T! CAL ANALYTICAL REPORT Lab Number: L2122439 Client: Coastal Engineering Company 260 Cranberry Highway Route 6A Orleans, MA 02653 A77N: Chad Simmons Phone: [508] 255-6511 Project Name: KINGS LANDING BREWSTER Project Number: WBR007.00 Report Date: 05/13/21 Serial No:05132111:16 The original project report/data package is held by Alpha Analytical. This report/data package is paginated and should be reproduced only in its entirety. Alpha Analytical holds no responsibility For results and/or data that are not consistent with the original. Ce rt i I [cat lo ns & Approvals: PAA (M-MA086), NH NELAP (2064), CT (PH -0574), Il_ (200077), ME (MAO0086), MD (348), NJ (MA935). NY (11148), NC (25700/666), PA (68-03671), RI (LAC)00065), TX (T104704476), VT (VT -0935), VA (460185), USl7A (Permit #P330-17-00196). Eight Walkup Drive, Westborough, MA 01 581-1 01 9 508-898-9220 (Fax) 508-898-9193 800-624-9220 - www.alphalab.com Page 1 of 17 i r Project Marne: KINGS LANDING BREWSTER Project Number: WBR007.00 SAMPLE RESULTS Lab ID: L2122439-01 Client ID: INFLUENT(COMPOSITE) Sample Location: 3 STATE ROAD BREWSTER, MA Sample Depth: Matrix: Water Parameter Result Qualifier Units RL General Chemistty - Westborough Lab Solids, Total 390 Solids, Total Suspended 58. Nitrogen, Ammonia 173 BOD, 5 day 150 Page 5 of 17 Serial No:05132111:16 Lab Number: L2122439 Report Date: 05/13/21 Date Collected: 04/30/21 OB:00 Date Received: 04130/21 Field Prep: Not Specified Dilution date Date Analytical MDL Factor Prepared Analyzed Method Analyst mgil 20 NA 2 05,106,121 0725 121,25408 DW mgA ................. 25 NA 5 - 05/06/21 16:45 121,2540D AC mgll 0.375 -- 5 0511112112:00 05/1212121:39121,4500NH3-BH AT mg,1l 30 NA 15 05/01/21 14:30 05/06/21 09:00 121,52106 JT LZl:at-iA Project Name: KINGS LANDING BREWSTER Project Number: WBR007.00 SAMPLE RESULTS Lab ID: L2122439-02 Client ID: EFFLUENT(COMPOSITE) Sample Location: 3 STATE ROAD BREWSTER, NIA Sample Depth: Matrix: Water Serial Na05132111:1 F Lab Number: L2122439 Report Date; 05/13/21 Date Collected: 04/30/21 08:00 Date Received: 04/30/21 Field Prep: Not Specified Dilution Elate Date Analytical Parameter Result Qualifier Units RL 1J[E11. Factor Prepared Analyzed Mothod Analyst General Chemistry - Westborough Lab Solids, Total Suspended 27, mgfl 16 NA 3.3 05/06/21 16:45 121,25404 –...– AC _trog–......_..._.._._..._.._... Nienitrife _� 0.28 • mg/! __.---..._.._........_.._. 0.050 - 1 �.._..––._... . 05/01/21 06:27 ....... 44,353.2 — MR Nitrogen, Nitrate 1.2 mg/1 0.10 - 1 - 05101!21 06:27 44,353.2 MR Nitrogen, Total Kjeldahl 18.9 mgll 1.50 - 5 05/11/21 09:30 05/11/21 22:12 121,450oNH3-H AT SO17, 5 day 58. mgll 12 NA 6 05/01/21 14:30 05/06/21 08:00 121;52108 JT r Page 6 of 17 I V m Serial No: 05132111:16 4; CHAIN OF CUSTODY ALPHA Job #: L0 cl 'PHA - ❑ FAY ® PJAIL ©same as Cl cnf iso PO R: Yfeetborough, LEA Mamllem. wA PrRjeLt Name: Kfil'�5 L>sn;7[n BlENfStQi LJ APEx Li AddSlae?+rar0l� TF-�-i�Ufit9s•9:2n TEL- 3'r5322 -0b-0 _ FNC: m, FAX Pro;ecl Locafivfl: 3 Stale Road Brawster MA &IerdFesP '" cnlvza Pharta: 5133 25"S11sxlsxE IIAI:.It1G Fax- 5QS 2551E ®Sfandard .❑ %u511 taex_r IF r+n.EApPAOY�gF Rq..uvn Twne Email: esimm— ir—od.vvm i3 ku r7eEdoe ❑ rphmmoes rare bx F mdwslr2 ]iyaM tryldy u flue Date: Time: iae sd ea F, ESNk3fial1 I3 I.ftbm do Other Project Specific RequirementslCommerntEVC+election Limits: fP/YAYF fQN1y pt1: t° rs019�7 Spedfic Canriutfance: Q a ti o � n s'sl"�` kPHA Lab ID Sample iO Cotw1w Sample Ssmp�ecs o a �i :{lstrusnOr.1y} R!atu Inllwfs O 3c infiuenl40lld Sitej CiS`�3 Gw ® ® ❑ ❑ 101 Ll ❑ ~© El ❑ El ❑ ❑ ❑ {❑{--�� L ❑ ❑ ❑ Efifuanf Cvm site tl- tofa GW ❑ ® ® ❑ 00 ❑ ❑ ❑ ❑ El ❑ ❑ Ll ❑ ❑ LJ 0 l7 ❑ Ll ❑ 1 ❑ Cl ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11 0 13 ❑ ❑ ❑ ❑ 0 ❑ ❑ ;El ❑ • 10 1 Ll G 171 Ll Li -9 -m- ❑ 10ju ❑ OJE110 ❑ ❑ ❑ ❑ ❑ ❑ Ljj ❑ PLF,ASE ANSWER QUESTIONS ASOVEI CantainerTypl3 P P nvi ymrQEafy: le9kJr Pteslary llive A ° - - ro can ardy:: Su+h'ce cne ipl Mfog�d 3n an¢ nafefrsns IS YOUR PRCJECT Rerncccsbed B: Da1�Tme ved y u au�i uno u7 wn nal fan wno v�y emtipileei ore j 1-W4 � .. 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NO.: M hlA 063 8 daft Sebastian Drive Sandwich, MA 02563 (508) 888-6460 1-800-339-6450 FAX(508)888-6446 Monday, May 31, 2021 Sample Tete A W;60 Coastal Engineering Co, COmtr tY 260 Cranberry Highway Chits Orleans, t17A 02653 Date Analyzed Analyst Method RrojectAlarne: Dings Landing Comments: Project Number: T47BR007. 00 Sampled By: Chad Simmons Lab Order Number: WSW -211015 Date Deceived: 04130121 , a� mple T}pe Efftuenf Sample Tete A W;60 Saniple Date 0413[ 21 COmtr tY Parameters Chits Test Results Reportable Lindes Date Analyzed Analyst Method Di! & Grease Grab mg1L 4.4 1.0 05/16121 KB EPA 1664 Fecal Coliform CN1100 mf 90 101100m1 04/30121 JR D 12:30 5M 9222 >3 .Sample Type Effluent Sample Time B E0:15 s'ampGe bate 04130/21 Cartunerrts Parameters Units Test Results Reportable Limits Date Analyzed Analyst Merhod Total Phosphorous (P) I mg1L 6.85 0.005 0510&(21 KB I SM 4500•P-B,E Ortho Phosphorous (P) I mg1L 6.41 0,005 05/01/21 K8 I 10-115-01-1-A All samples were analyzed within lite established guidelines of US EPA approved methods with all regufrements met unless otherwise noted at the end of a given sample's urrrrlytical results. We certify that rhe follo}ping results are true and accurate to the best of aur knowledge. BRL4elmv reportable limits *'see attached By: Ronald J §a-ari Laboratory Director Page 1 of 1 1 0 Ll 0 ❑ U (LLL 0 a V co 0 CD [.fl G) Q 0 00 co co Q a n }m LL w E [6 HO }� eO Q Y O v Lupo y m r (D 76J ❑ ❑ N C C~ CJ a G m C3 C7 w p .wui � to— c _3 C7 [Ij Ln A ea cnm ❑ U jy�. uai a u U J o asm a) Z Q 0 aci ri a 09 i E � I Q (D 76J ❑ ❑ N C G r� � A ❑ U jy�. (D 7 -= LJ.. U] V) �+ t F_ j:� •�, 3 O 0 � i .-� . � "1 -� : w ca ❑ � 6[i L ` o D- o CL Cr_ C ,CF C7. o L ❑ N J ❑ LU LU Z N Q ! N m XEJ�ELU aldwes -dwoo ` m gejo CD C7 (D C7 CD a CL r C] Lr7 Vv [I} Of f!3 ❑ r rb U ❑ � r r Q1 N ❑ ❑ Z 7- Z Z ❑ (D w w LL[ LL as LL LL LL LL -1 N CL LL LL . UJ uj LL LU LL uj CD t13 C17 - cff � r CY a c 0 a� ` 2 N ) CL ?S L L C ti C 6t LIJ to Z ❑ ❑ Massachusetts Department of Environmental protection 1934 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater Permit ! I 2. Tax identification Number MONITORING VNELL DATA REPORT j2021 APR MONTHLY 3. Sampling Month & Frequency C. Contaminant Analysis Information ■ For "0", below detecfion limit, less than value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS = Not Sampled • DRY = Not enough water in well to sample. ParameterlContaminant Hl',r-1 HW -2 HW -3 HW4 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 5,85 6.42 5.98 PH[DF�Y s.u. STATIC WATER LEVEL 21.38 j 21.89 21.95 DRY FIFE SPECIFIC CONDUCTANCE 180 450 1580 DRY iJM!-�751C 0 Well #� 5 Well #: 6 mwdgwp-blank.doc • rev. 09/15/15 Monitoring Well Data for Groundwater Permit • Page 1 of 1 6!812021 Receipt etDEP - MassDEP's oniineFiling System ZEP�b�fassl7EP's online Filing System Summary/Receipt Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP" to see a list of your transactions. DEP Transaction ID: 1274092 Date and Time Submitted: 6/812021 12:54:11 PM Other Email : DEP Transaction ID: 1274092 Date and Time Submitted: 6!812021 12:54:11 PM Other Email : DEP Transaction ID: 1274092 Date and Time Submitted: 6/8/2021 12:54:11 PM Other Email : DEP Transaction ID: 1274092 Date and Time Submitted: 6/8/2021 12:54:11 PM Other Email : DEP Transaction ID: 1274092 Date and Time Submitted: 618/2021 12:54:11 PM Other Email : Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432096 location: 3 STATE STREET Address: BREWSTER ZIP: 02631 Daily Log Sheet(2021 APR DAILY) Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432496 location: 3 STATE STREET Address: BREWSTER ZIP: 02631 klassdEP Home i Contact i Privacy Policy Usemame:CASOMR Nickname: COASTAL260 Forms Signature Receipt print receipt Exit httDs://edep,dep.mass.gov/eDEP/PagesIPrintRecelpt-aspx 112 6/8/2021 eDEP - MassDEP's DnlineFiling System Discharge Monitoring Report(1 2021 Apr Monthly) Form game: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432096 location: 3 STATE STREET Address: BREWSTER ZIP: 02631 Discharge Monitoring Report(1 - 2021 Quarterly 1) Form game: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432996 location: 3 STATE STREET Address: SREWSTER ZIP: 02531 Monitoring Well Data Report(1 - 2021 Apr Monthly) Form Name: Comments My eDEP MassDEP Horne I Contact I Privacy Policy MassDEP's online Filing System ver.15.21.0.0d 2021 MassDEP https:lledep.dep.mass.gov/eDEP/Pages/PrintReceipt.aspx 212 A Group Of Parents Sent Their Kids' Face Masks to A Lab for Analysis. Here's What They Found by Scott Morefi 6117121, 8:56 AM A Group Of Parents Sent Their Kids' -Face Masks to A Lab for Analysis. Here's What They Found 50f+rce: AP PI;oig1%faryARa ffer, File JUShare YW Tweet /5✓iw�G! 15wid PlE�YS� #V&A�3a� � �- �CifaG� D6 Nwrm We've been told forwell over a year that widespread forced public masking should be implemented because, even if only moderately to slightly to negligibly effective at curbing the spread of COVlD-19, there are ZERO drawbacks. /Snnr�i- d� ;�,tiMh�h 1�e https:lltownhall.com/tipsheetiscottmorefield/202llO6J15ja-group-of-p...-face-masks-to-a-lab-for-analysis-heres-what-they-found-n2591047?178 Page 1 of 6 A Group Of Parents Sent Their Kids' Face Masks to A Lab for .Analysis. Here's What They Found by Scott Morefield "What's the harm?" they ask. "It's only a minor inconvenience," they bleat. "If it saves ONE LIFE, it's worth it!" they implore. Meanwhile, we on Team Reality have not only continued to point to real-world ( L ; that shows masking to be c ntirelyi i)effective, we've also maintained that forced public masking, especially long-term, has negative societal and even I E ,i1 1r�irinif; c J o ns that the powers -that -be are all -too -happy to ignore in subservience to their newfound face mask god. It only stands to reason that one of those health ramifications would be the fact that millions of people, particularly children, have been forced to wear and carry around pieces of cloth they've continually breathed through for hours on end. What lurking pathogens might be found on these disgusting contraptions being incessantly handled, stuck in pockets, and mindlessly tossed on books, tables, and desks? Well, one group of Florida parents sent a batch of masks worn by their children to a lab to find out. And yeah, you'll probably need to make sure you aren't eating dinner anytime soon before you digest THESE results. via press release: Gal nesvitle, FL (June 16, 2021) –A group of parents in Gainesville, FL, concerned about potential harms from masks, submitted six face masks to a lab for analysis. The resulting report found that five masks were contaminated with bacteria, parasites, and fungi, including three with dangerous pathogenic and pneumonia -causing bacteria. No viruses were detected on the masks, although the test is capable of detectingviruses, The analysis detected the following 11 alarmingly dangerous pathogens on the masks: • Streptococcus pneumoniae (pneumonia) • Mycobacterium tuberculosis (tuberculosis) • Neisseria meningitidis (meningitis, sepsis) • Acanthamoeba polyphaga (keratitis and granulornatous amebic encephalitis) • Acinetobacter baumanni (pneumonia, blood stream infections, meningitis, UTIs— resistant to antibiotics) 6117121, 8:56 AM https:JJtownhall.comitipsheetlscottmorefield12o21jo61151a-group-of-p...-face-masks-to-a-lab-for-analysis-heres-what-they-found-n2591a47?178 Page 2 of 6 A Group Of Parents Sent Their Kids' Face Masks to A Lab for Analysis. Here's what They Found by Scott Morefieid • Escherichia coli Mood poisoning) Borrelia burgdorferi (causes Lyme disease) • Corynebacterium diphtherias (diphtheria) • Legionella pneumophila (Legionnaires' disease) • Staphylococcus pyogenes serotype M3 (severe infections—high morbidity ra tes) • Staphylococcus aureus (meningitis, sepsis)+j Half of the masks were contaminated with one or more strains of l pneumonia -causing bacteria. One-third were matamiaatPrl 1 ithr�r more strains of meningr Is -causing ac erla. One-third were contaminated with dangerous, antibiotic-resistant bacterial pathogens. In addition, less dangerous pathogens were identified, including pathogens that can cause fever, ulcers, acne, yeast infections, strep throat, periodontal disease, Rocky Mountain Spotted Fever, and more, The face masks studied were new or freshly -laundered before wearing and had been worn for 5 to 8 hours, most during in-person schooling by children aged 6 through 11. One was worn by an adult. A t -shirt worn by ane of the children at school and unworn masks were tested as controls. No pathogens were found on the controls. Proteins found on the t -shirt, for example, are not pathogenic to humans and are commonly found in hair, skin, and soil. A parent who participated in the study, Ms. Amanda Donoho, commented that this small sample points to a need for more research: "We need to know what we are putting on the faces of our children each day. Masks provide a warm, moist environment for bacteria to grow." These local parents contracted with the lab because they were concerned about the potential of contaminants on masks that their children were forced to wear all day at school, taking them on and off, setting them on various surfaces, wearing them in the bathroom, etc. This prompted them to send the masks to the University of Florida's Mass Spectrometry Research and Education Center for analysis. 6117121, 8:56 AM https:lltownhall.comltipsheetlscottmorefieldl2o21jo61151a-group-cf-p...-face-masks-to-a-lab-for-analysis-hetes-what-they-found-n2591p47?178 Page 3 of 6 A Group Of Parents Sent Their Kids' Face Masks to A Lab for Analysis. Here's What They Found by Scott Morefield The below chart, put together by the group of parents, shows the potential dangers from each pathogen: -------------------------- --.-.- ..- ... ------------------------------------------- Recommended Biden Apologizes After Losing His Temper on CNN Reporter PATHOGEN TYPE DESCRIPTION 6117/21, 8:56 AM alseta hine herpesvirus 1 Virus Natural hosts primaay caw, b t Is ralal corynebacterium jelketurn Bacteria Infection In bone tna transplant palients �.,�iMn.�n.im noon. e........ �...... .... •1.1.w.n�. .M nnan�ti4.1..:.:. l Town h a I I A Group Of Parents Sent Their Kids' Face Masks to A Lab for Analysis. Here's Wha... i Most Popular NNIP�54 A Group Of Parents Sent Their Kids' Face Masks to A It Lab for Analysis. Here's What They Found ^11 CRT Can KMA ..................................... CNN Couldn't Fire jeffrey Doobin for One Simple Appetizing, eh? Of course, nothing above, or anything else, will deter the extremists in Reason the masking cult, some of whom now want to see masking in schools forever. https:lltownhall.comltipsheetfscottmorefieidl2G21106J151a-group-of-p...-face-masks-to-a-fab-for-analysis-heres-what-they-found-n25S1047?178 Page 4 of 6