HomeMy Public PortalAboutBOH1.19.22packetBoard 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
Town of Brewster Board of Health
2198 Main St., Brewster, MA 02631
brhealth@brewster-ma.gov
(508) 896•-3701
BOARD OF HEALTH MEETING AGENDA
2198 Main Street
January 19, 2022 at 7:OOPM
Pursuant to Chapter 20 of the Acts of 2021, this meeting wliI be conducted via remote means, in accordance with applicable law. This meansthat
memhers of the pubilc body may access this meeting via virtual means. No In-person attendance of memhers of the public will be permitted, and
public pa rti c [patio n In any public hearing conducted during this meetingshaII be by remote means only. Members of the public who wish to access
the meeting may do so In the following manner:
Phone: Call (301)715-8592 or (312)626-6799. Webinar U. 820 4394 4509 Passcode: 979174
To request to speak: Press *9 and wait to be recognized.
Tenm Wehinan htt s: us42Web.zcom.us/l/8 2043944509? pwd=M t PM2kvLJ ExKbLJ I R50 h mN101Zb3 doZzOg
Passcode: 979174
To request to speak: Tap Zoom "Raise Hand", then wait to be recognized.
When required by lave or a[lowed by the Chair, persons vis hing to provide public comment or otherwise participate In the meeting, may do so by
accessing the meeting remotely, as noted above. Additionally, the meeting will be broadcast live, in real time, vla Live broadcast (Brewster
Government TV Channel 18), Livestream (lives tream. brews ter -ma. gov) or video recording (tv.brewster-ma.gov)
1. Call to Order
2. Chairman's announcements
3. Citizens forum
4. Covid update
5. Mask Mandate discussion and vote to extend or modify
6. Discuss and vote on BOH Nitrogen Loading Regulations - Mark Nelson, Horsley &
Witten
7. Discuss and possibly vote about perceived need for supplemental local BOH Marijuana
Regulations
8. Discuss and possibly vote on drafting a letter opposing Pilgrim Nuclear Power Plant
radioactive water release into Cape Cod Bay
9. Liaison. Reports
10. Matters not reasonably anticipated by the Chair
11. Items for next agenda
12. Next meeting: February 2, 2022
13. Informational items.-
a.
tems:a. Monthly report for Serenity (Wingate)
b. Thank you card from Partners in Health
c. Routine inspection report for 7-9 Thousand Oaks
d. Inspection report for White Rock Commons
e. Routine inspection report for 39 McGuerty Road
14. Adjournment
Date Posted: Date Revised:
1/13/2022
N:1HealthlBOH Agendas and Minutes and itematc 5ohedulelBOH Agendasll
Received by Town Clerk:
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19.22agenda.'• cx
Town of Brewster
2198 MAIN STREET
BREWSTER, MASSACHUSETTS 42631-1898
PHONE: 508.896.3701 EXT, 1120
FAX: 508,896.4538
hrhealth �brewster-ma.goy
W W W.13REWSTER-MA.GOV
AGENDA ITEMS UPDATE
January 19, 2022
4. Update on Brewster positive COVID-19 numbers
Health Department
Amy L, Von Hone, R,S., C.H.O.
Director
Sherrie McCullough, R.S.
Assistant Director
Tammi Mason
Senior Department Assistant
a. Brewster active cases and trends
b. Age demographics
c. Vaccination rates
d. Barnstable County Data
e. Baker -,Polito Administration Secures Contract for 26 Million
Rapid Antigen Tests
f. Baker -Polito Administration Launches Tool for Residents to
Access COVID-19 Digital Vaccine Card
5. Mask Mandate Discussion
a. BOH Emergency Temporary Order Effective 12/20/21
b. Citizen Email from Mary Haaland, 510 Tubman Road, Brewster
c. CDC Mask Information
8. Discussion on Letter opposing Pilgrim Power Plant radioactive water
release into Cape Cod Bay
a. APCC Letter RE: Opposition to Pilgrim Discharge of
Radioactive Water into Cape Cod Bay 12/17/21
b. Brewster Select Board Letter of Opposition to Pilgrim Discharge
of Radioactive Water into Cape Cod Bay approved 01/10/22
Compiled by Amy von Hone, Health Director
N:1Heal1h\B0H Meeting NotesWH Hearing NotesWH Hearing Notes 01.19,22.docx
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1/12/22 Barnstable County COVID-19 Update
It is possible that new cases peaked last week.
Over the past 7 days the average number of new cases per day has been:
Barnstable County, 387/day (7 -day avg.)
Dukes County, 48/day (7 -day avg.)
Nantucket County, 48/day (7 -day avg.)
For the period 12/26/21 to 1/8/22 Barnstable County's 14 -day average percent positive rate increased from
12.7% to 18.1%. This is sorely lagging indicator and the new case numbers seen since last week will push that
percentage higher --likely close to 20%. Nearly all towns on the Cape and Islands are well above the 10%
percent positivity rate --indicative of outbreak status (according to criteria published by WHO in May 2020, a
positive rate of less than 5% is one indicator that the epidemic is under control).
Hospitalizations (3 -day average census is now at 75) have attained prior highs seen during last winter's
surge. There were 12 persons in the ICUs yesterday afternoon. Encouragingly, fatalities remain below the
peaks seen during prior surges when vaccinations were not broadly available.
Nearly 50% (73,174) of fully vaccinated Barnstable County residents (148,588) have received booster doses (as
of 1/1/22). These data will be updated tomorrow night (Thursday).
Additional public vaccination clinics have been announced and will increase that percentage
(see https://www.barnstablecountvhealth.org/newsroom/vaccination-clinics-in-barnstable-county
Additional PCR testing sites have been announced
(see htt s: www.barnstablecount health.or newsroom covid-19-testin -o ortunities-in-barnstable-
countY
The DPH updates town -specific data weekly on Thursday evenings, and the town -specific new case rates In the
table further below reflect last Thursday's (1/5/22) DPH update.
Barnstable County, 1/4/22
Fully Vaccinated
Individuals with Booster Doses
(2 Doses Pfizer, Moderna;1 Dose JNJ)
148,588
73,174 Persons
78%
38% of Total Pop
_--
49% of Fully Vaccinated
COVID-19 Epidemiological Curve --Flew Cases (Confirmed)
Cumulative
Barnstable County, as of 1/1z/22 s:oo pm
ICU Percent
Med/5urg ICU Beds
(New Cases per 3 -Day Period)
Beds Occupied Occupied
1,400
Persons in Hosp.
of Beds
(Last Report) (Last Report)
28,76S Confirmed Cases, 577 Deaths
(Med/5urg + ICU)
Occupied
1,204
1,200
1/11/2022 Cape Cod Hospital 45 8
[3prnf Falmouth Hospital 15 4
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nrst presumptive pasltive case was quarantined m 3/6/20;
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Rue 711121, to smooth reports covering Weekends and holidays, rase reports covering several days prior have been dMded by the nvmber of days to Show a daily average for the perM.
purce= V. Harik, BarnstabSe County
Hospitalizations, Last Report: Not Cumulative
Cumulative
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Beds Occupied Occupied
County Cases County
Persons in Hosp.
of Beds
(Last Report) (Last Report)
(Confirmed) Deaths
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Occupied
1/11/2022 Cape Cod Hospital 45 8
[3prnf Falmouth Hospital 15 4
60 12 28,411 573
75.3.
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18
16
14
Q
COVID-19 Epidemiological Curve --New Deaths (Confirmed + Probable)
Barnstable County, as of 1/12/22 S;oopm
(New Deaths per 3 -Day Period)
577 Deaths, 28,765 Confirmed Cases
16
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• Probable cases have not been charted sinre 1216120 and numbered 531 at that sane. Using data provided by the MA Department of Public Health
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Incubation Period =14 Days; Data presented in 3•day periods which equal '114 of the Incubation Period Source: V. Hari k, Barnstable County;
• Probable cases have not been charted sinre 1216120 and numbered 531 at that sane. Using data provided by the MA Department of Public Health
MAD PH Data Dashboard, WEEKLY REPORT of 1/6/22 (for the Period 12/19/x1 to 1/1/21, COVID Cases Confirmed by PCR)
Population
{March 2020
to Present)
Case Count
Average Daily
Relative
(March 2020
Total Tests
Positive Tests
Percent
Change in
City/Town
(2019)
Total Case
Last 14 Days
Incidence Rate
Change in
to Present)
Last 14 Days
Last 14 Days
Positivity
Percent
Count
per 100K
Case Count
Total tests
last 14 Days
Positivity
Barnstable
44,773
7,099 688 10'9.8 Higher 137,801 5,122 728 14.21% Nigher
Bourne
21,026
2,615 321 109.1 Higher 76,855 2,363 340 14.39% Higher
Brewster
9,926
988 127 91.4 Higher 32,686 1,223 135 11,04% Higher
Chatham
I 5,830
573 84 102.9 Higher 15,981 627 92 14.67% Higher
Dennis
I 130088
1,583 146 79.7 No Change 36,881 1,265 154 12.17% Higher
Eastham
II 4,603
368 37 57A Higher 10,159 335 40 11.94% Higher
Falmouth
31,190
3,024 422 96.6 Higher 1010296 3,543 433 12.22% Higher
Harwich12,589
1,428 157 89.1 Higher 35,428 1,384 172 12.43% Higher
Mashpee
15,535
1,550 186 85.5 Higher 45,054 1,862 194 10.42% Higher
Orleans
5,620
544 78 99.1 Higher 13,584 609 82 13.46% Higher
Provincetown
2,583
378 18 49.8 Higher 12,544 216 23 10.65% Higher
Sandwich
21,078
2,514 318 107.8 Higher 57,490 2,545 328 12.89% Higher
Truro
1,968
155 12 43.6 Lower 4,814 98 12 12.24% Lover
WellReet
2,760
212 27 69.9 Higher 6,401 215 27 12.56% Higher
Yarmouth
24,062
3,014 315 93.5 Higher 72,023 2,967 331 11.16% Higher
BamstableCounty
216,629
26,145 2,936 96.8 Higher 659,007 24,374 3,091 12.68% Higher
Aqulnnah
261 15 <5 27.4 Lower 828 23 1 4.35% Lower
Chilmark
759 63 c5 37.7 No Change 5,547 139 4 2.88% No Change
Edgartown
4,086 799 59 103.1 Higher 19,410 523 61 11.66% Higher
Gosnold
45 6 0 0.0 No Change 144 2 0 OD01% No Change
Oak Bluffs
5,209 633 44 60.3 Lower 13,018 397 46 11.59% Lower
Tisbury
4,174 763 105 179.7 Higher 24,637 722 108 14.96% Higher
West Tisbury
2,871 275 24 59.7 Lmver 8,528 273 25 9.16% Lower
Dukes County
17,404 2,554
232
97.1
Higher
72,112
2,079
245
11.78%
Higher
Nantucket
11,416 2,417 199 124.5
Higher
42,623 1,207
203
16.82% Higher
Dukes and Nantucket
28.820 4,971 436 108.1
Higher
114,735 3,286
448
13.63%
Higher
Counties
State of MA 6,964,383 1,135,380
147,905
151.7
Higher
36,631,691
1,045,082
157,100
15.03%
Higher
Data source: MA DPH, 1/6/22 Weekly COViD Report (https://www.mass.gov/Inlo-details/covid-l9-response-reporting); Analysis: V. Harik Barnstable County
Vaira Harik, M.S.
Assistant County Administrator
Barnstable County, PSA
Cell: 774-487-9435
Email: Dari k@ barnstablecou nty.org
Amy von Hone
From: McCarthy-Licorish, Lisa N [DPH} <Lisa.N.McCarthy-Licorish@mass.gova
Sent; Tuesday, January 11, 2022 12:09 PM
To: McCarthy-Licorish, Lisa N (DPH)
Subject: Baker -Polito Administration Secures Contract for 26 Million Rapid Antigen Tests
FOR IMMEDIATE RELEASE:
January 11, 2022
CONTACT
Terry MacCormack
to rry. m acco rm a ck@ m ass. goo
ao••n
Baker -Polito Administration Secures Contract for 26 Million Rapid
Antigen Tests
BOSTON - Today the Baker -Polito Administration announced an order was placed
with Mealth to supply the state with 26 million rapid antigen tests over the next 3
months. The tests will be prioritized to support K-12 schools and childcare settings.
The agreement allows for shipments of tests to arrive on a rolling basis in the
Commonwealth, but the Administration warns that the timing and shipment amounts
will vary depending on international shipping and production variables.
The Baker -Polito Administration also released a public health advisory this week to
advise all residents on when to seek tests for COVID-19. The advisory advises all
residents to seek COVID-19 tests when exhibiting COVID symptoms, or five days
following a known close contact with someone diagnosed with COVID pursuant to MA
DPH quarantine and isolation protocols, updated as of December 29 in accordance
with the new CDC guidance.
The new isolation protocols do not require a COVID-19 test to exit isolation after
having COVID. This general rule also applies to childcare and K-12. Additional
information on testing protocols for specific situations in childcare can be found here
and for K-12 can be found here.
The new quarantine protocols recommend, but do not require, all exposed individuals
get a test five days after exposure. Exposed individuals do not need to quarantine in
the following circumstances:
If fully vaccinated and not yet eligible to receive a booster OR
If fully vaccinated and have received their booster OR
If they had COVID and it is less than 90 days since they were diagnosed. For
more details visit here.
DPH advises that a positive COVID-19 rapid antigen does not need to be confirmed
with a PCR test.
DPH recommends individuals that have COVID symptoms and test negative with a
rapid antigen test should isolate and either repeat an antigen test or get a PCR test in
24-48 hours if they continue to exhibit symptoms. Additionally, DPH does not advise
employers, or schools and childcare, to require a test as a condition of returning to
work or school.
View the public health advisory here.
Vaccination and getting a booster remain the best possible protection against COVID,
There are almost 1,000 locations in the Commonwealth for residents to receive a
COVID-19 vaccine or booster. Visit VaxF.inder.mass.gov to book an appointment.
Massachusetts National Guard
Governor Baker also today activated 500 additional members of the Massachusetts
National Guard to support the state's health care system. This order expands the
National Guard activation of 500 members announced on December 21 to support
non -clinical functions in the Commonwealth's hospitals. Prioritized uses for the newly
activated 500 members will be to provide additional non -clinical staffing at
community hospitals and high-volume emergency departments, public hospitals,
skilled nursing facilities and dialysis centers. These guard personnel will be deployed
beginning the week of January 17.
Amy von Hone
From: McCarthy-Licorish, Lisa N (DPH) <Lisa.N.McCarthy-Licorish@mass.gov>
Sent: Monday, January 10, 2022 3:56 PM
To: McCarthy-Licorish, Lisa N (DPH)
Subject: Baker -Polito Administration Launches Tool for Residents to Access COVI❑-19 Digital
Vaccine Card
FOR IMMEDIATE RELEASE:
January 10, 2022
CONTACT
Terry MacCormick
terr .maccormack@mass.gov
an400 ne
Baker -Polito Administration Launches Tool for Residents to Access
COVID-19 Digital Vaccine Card
"My Vax Records" Provides New Option to Access Vaccine History and QR Code to Verify
COVID-19 Vaccination
BOSTON —The Baker -Polito Administration today announced a tool that gives
residents a new way to access their COVID-19 digital vaccine card and vaccination
history. The new tool, called My Vax Records, allows people who received their
vaccination in Massachusetts to access their own vaccination history and generate a
COVID-19 digital vaccine card, which would contain similar vaccination information to
a paper CDC card. The COVID-19 digital vaccine cards produced by the system utilize
the SMART Health Card platform and generate a QR code that can be used to verify
vaccination. The Administration is not requiring residents to show proof of
vaccination to enter any venue, but this tool will help residents who would like to
access and produce a digital copy of their record.
Access the new tool at MyVaxRecords.Mass. Gov.
How It Works: The new tool is easy to use: a person enters their name, date of birth,
and mobile phone number or email associated with their vaccine record. After
creating a 4 -digit PIN, the user receives a link to their vaccine record that will open
upon re-entry of the PIN.
The electronic record shows the same information as a paper CDC vaccine card:
name, date of birth, date of vaccinations, and vaccine manufacturer. It also includes a
QR code that makes these same details readable by a QR scanner, including
smartphone apps. Once the SMART Health Card is received, users are able to save the
QR code to their phone, such as the Apple Wallet, screenshot the information and
save it to their phone's photos, or print out a copy for a paper record. The system
follows national standards for security and privacy.
This system provides an optional way that residents can access their vaccination
information and a COVID-19 digital vaccine card. This will provide residents with
another tool to provide proof of COVID-19 vaccination, should it be requested by
businesses, local governments, or other entities.
The system leverages the Massachusetts Immunization Information System (MIIS),
the official database used by health care providers across the state to record
vaccination information. The system relies on hundreds of providers inputting
demographic and health information. Some users may not be able to immediately
find their record, or may find an incomplete record. Residents whose record cannot
be found or is incomplete can either contact their health care provider or contact the
MiIS team to update their records. Learn more about the tool and view frequently -
asked -questions at www.mass.gov/mVvaxrecord.
Massachusetts has worked with VCI,'" a voluntary coalition of public and private
organizations which developed the open -source SMART Health Card Framework in
use by other states. The VCI coalition is dedicated to improving privacy and security of
patient information, making medical records portable and reducing healthcare fraud.
My Vax Records is just one way residents can obtain their COVID vaccination record.
Pharmacies that administered the COVID vaccine and many health care providers also
are making SMART Health Cards available, or are providing additional options. Learn
more.
{Q)
•'amu an_ 9
SOA PD��`Sn
Town of Brewster
2 198 MAIN STREET
BREWSTER, MASSACHUSETTS 02631-1898
PHONE: 508,896.3701 EXT. 1120
FAX: 508.896.4538
bnccalth Brewster-mn.P-ov
W W W,BREW STER-MA.GOV
BREWSTER BOARD OF HEALTH
Health Department
Amy L, von Hone, R.S., C.H.Q.
Director
Sherrie McCullough, R,S,
Assistant Director
Tammi Mason
Senior Department Assistant
EMERGENCY TEMPORARY ORDER REGARDING MASK MANDATE FOR ALL
MUNICIPAL BUILDINGS
At the Brewster Board of Health Meeting on December 15, 2021, the BOH voted
unanimously to approve an Emergency Mask Order per the following motion:
To return to a temporary mask requirement for individuals working in and visiting
municipal buildings with the exception of Freemans Grill commencing on Monday
12/20/29 and continuing through the 0111912022 BOH meeting. Mask requirements to
also include individuals working in the same vehicle.
Approved by.-
Annette
y:
Annette Graczewski
Kim Crocker -Pearson
Penny Holeman, Chair
Effective; December 20, 2021
N:1HealdilCorvnavirusI VkBOH Emergency OrdersWlask Mandate 12.20,2021.doc
Promoting productive workplaces
through safety and health research
Counterfeit Respirators / Misrepresentation of
NIOSH -Approval
Notice on NIOSH ownership of respirator certification marks
NIOSH has successfully recorded the NIOSH stylized logo with and without text, as well as the certificatio
N95, N99, N100, P95, P100, and the term "NIOSH -approved", with the U.S. Patent and Trademark Office (
NIOSH, as the certifying federal entity far the N95 Respirator Approval Program, owns these certification
meaning that NIOSH controls who can use these marks, Accordingly, NIOSH will let manufacturers use tl
certification marks only if they become NIOSH -approval holders because of their products satisfying the
regulatory standards set forth in 42 C, F. R. Part 84. While these marks have historically been protected u
common law (as opposed to a trademark registration) since they were established by the program regul
marks are now registered with the USPTO as federal registrations, as well as in various foreign countries
subject to additional protections under the Lanham Act, 15 U,S.C. §§ 1051 et seq. and foreign trademark
any misuse of these marks, including on respirators that have failed to satisfy NIOSH's regulatory requir(
have not received a NIOSH approval, is a directviolation of applicable trademark laws and NIOSH may p
as necessary, This also applies to approval holders that misuse or misplace the marks or terms against t
regulations, specificaIiy outlined in 42 C.F.R. Part 84.33.
Counterfeit respirators are products that are falsely marketed and sold as being NIOSH -approved and rr
capable of providing appropriate respiratory protection to workers. When NIOSH becomes aware of cou
respirators or those misrepresenting NIOSH approval on the market, we will post them here to alert use
purchasers, and manufacturers.
How to identify a NIOSH -approved respirator:
NIOSH -approved respirators have an approval label on or within the packaging of the respirator (i.e. on i
and/or within the users` instructions). Additionally, an abbreviated approval is on the FFR itself. You can
approval number on the NIOSH Certified Equipment List {CEL] or the NIOSH Trusted -Source page to det(
respirator has been approved by NIOSH. NIOSH -approved FFRs will always have one the following design
N99, N100, R95, R99, R100, P95, P99, P100.
Signs that a respirator may be counterfeit:
■ No markings at all on the faltering facepiece respirator
• No approval (TC) number on filtering faceplece respirator or headband
• No NIOSH markings
• NIOSH spelled Incorrectly
■ Presence of decorative fabric or other decorative add-ons (e.g., sequins)
■ Claims for the of approval for children (NIOSH does not approve any type of respiratory protection fo
• Filtering facepiece respirator has ear loops instead of headbands
92 Centers for Disease
Control and Prevention
We have the tools to
Fight omicron
Vaccines & Booster Masks Testing
Types of Masks and Respirators
updated Sept. 23, 2021
Summary of Recent Changes
Updates as of September 23, 2021
• Added section on considerations for children
View Previous updates
This page describes different types of masks and respirators you can use to protect yourself and others frc
spreading COVID-19.
Masks are designed to contain your respiratory droplets and particles, They also provide you some protect
particles expelled by others.
Respirators are designed to protect you from particles, including the virus that causes COVID-19, and in do
also contain your respiratory droplets and particles so you do not expose others.
CDC continues to learn more about the effectiveness of different types of masks and respirators for prever
Masks
Cloth Masks can be made from a variety of fabrics and many types of cloth masks are available.
Wear doth masks with
• A proper fit over your nose and mouth to prevent leaks
• Multiple layers of tightly woven, breathable fabric
• Nose wire
• Fabric that blocks light when held up to bright light source
Do NOT wear cloth masks with
■ Gaps around the sides of the face or nose
■ Exhalation valves, vents, or other openings (see example)
• Single -layer fabric or those made of thin fabric that don't block light
Disposable face masks are widely available. They are sometimes referred to as surgical masks or medical
masks.
Wear disposable masks with
• A proper fit over your nose and mouth to prevent leaks
• Multiple layers of non -woven material
■ Nose wire
v
ALA
Do NOT wear disposable masks with
• Gaps around the sides of the face or nose (see example)
• Wet or dirty material
Ways to have better fit and extra protection with cloth and disposable masks
• Wear two masks (disposable mask underneath AND cloth mask on top)
• Combine either a cloth mask or disposable mask with a fitter or brace
• Knot and tuck ear loops of a 3 -ply mask where they join the edge of the mask
For disposable masks, fold and tuck the unneeded material under the edges, (For instructions, s+
following https://youtu.be/GzTAZDsNBeO [n" )
• Use masks that attach behind the neck and head with either elastic bands or ties (instead of ear loops
Knot the ear loops
Fold and tuck in
unneeded material
Check for cl
Some masks are designed and tested to ensure they perform at a consistent level. These masks are labele,
what standard they meet.
Wear masks that are labeled as
• MEETS ASTM F3502 21
• MEETS WORKPLACE PERFORMANCE
■ MEETS WORKPLACE PERFORMANCE PLUS
These are new standards. Lists of masks that meet these standards and more information on their availab
found on the National Institute for Occupational Safety and Health (NIOSH) Personal Protective Equipment
INFO) wehpage.
Do NOT wear
• If you have certain types of facial hair R
• If hard to breathe
■ Ifwet or dirty
■ With other masks
■ As a replacement for NIOSH -approved respiratory protection when required by your job
How to wear
Follow the manufacturer's instructions to wear, store, and clean or dispose of the mask properly.
Respirators
Some respirators are designed and tested to meet international standards. These respirators are labeled t
standard they meet. Respirators approved by NIOSH are evaluated by NIOSH against a specific US standar
a quality requirement. International standards do not often have quality requirements.
The most widely available respirators that meet an international standard are KN 95s.
Other examples include 1 st, DL2, DL3, DS2, DS3, FFP2, FFP3, KN 100, KP95, KP100, P2, P3, PFF2, PFF3, R95, a
Do NOT wear
• If you have certain types of facial hair
• International respirators with exhalation valves or vents
■ if hard to breathe
• If wet or dirty
• Asa replacement for NIOSH -approved respiratory protection when required by your job
Counterfeit (fake) KN95 respirators
• BE AWARE: About 60% KN95 respirators in the United States are counterfeit (fake) and DO NOT me
NIOSH requirements.
■ A webpage and a webinar are available about factors to consider when purchasing an internationa
respirator,
How to wear
Follow the manufacturer's instructions to wear, store, and clean or dispose of the respirator properly,
NIOSH approves many types of filtering facepiece respirators. The most widely available are N95, but otl
(N99, N100, P95, P99, P100, R95, R99, and R100) offer the same or better protection as an N95,
NIOSH -Approved N95 Respirators
When supplies are available, individuals may choose to use a basic disposable N95 respirator for person
instead of a mask, in some situations.
CDC recommends that specially labeled "surgical" N95 respirators should be prioritized for healthcare pE
Employers who want to distribute N95 respirators to employees shall follow an Occupational Safety and
(OSHA) respiratory protection program [, .
What to know about N95s
• Filter up to 95% of particles in the air when approved by NIOSH and proper fit can be achieved
• Seal tightly to the face when fitted properly
■ Since N95 respirators form a seal to the face, they may feel harder to breathe through than a cloth
■ N95 respirators cannot be washed. They need to be discarded when they are dirty, damaged, or dif
breathe through
• N95 respirators tend to be more expensive than masks
Wear an N95 with
• Cup, flat fold, or duckbill shape
• Two straps that go around the head
Formable wire nose bridge
Appropriate markings printed on the filter indicating the N95 respirator has been approved by NIO:
Do NOT wear an N95
• If you have certain types of facial hair
• If it is a counterfeit [fake] N95 respirator
■ If hard to breathe
■ If wet or dirty
• With a mask or second respirator
How to wear
■ Individuals who want to use a respirator for personal use should follow the user instructions exactly
■ Flt testing (a process that uses specialized equipment) is the best way to determine if the respirator
Even without fit testing, a well -fitting properly worn respirator may provide more protection than a
However, a poorly fitting or improperly worn respirator or mask may reduce its intended benefit.
NIOSH and OSHA have developed a video demonstrating how to perform a user seal check and hog
properly put on (don) and take off (doff) a respirator, as well as a NIOSH factsheet 0 .
Considerations for Children
Masks
Anyone 2 years or older who is not fully vaccinated should wear masks in indoor public spaces. This recorn
also applies to ful ly vaccinated people when they are in an area of substantial or high transmission, CDC al
recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regard
vaccination status or transmission rates. The benefits of mask -wearing are we[I-established.
Respirators
Parents and caregivers may have questions about NIOSH -approved respirators (such as N95s) for children
respirators may be available 1n smaller sizes, they are typically designed to be used by adults in workplaces
therefore have not been tested for broad use in children.
Selecting Masks:
• Masks and respirators should not be worn by children younger than 2 years old.
• Choose a well -fitting and comfortable mash or respirator that your child can wear properly. A poorly
uncomfortable mask or respirator might be worn incorrectly or removed often, which would reduce it
benefits,
- Choose a size that fits over the child's nose and under the chin but does not impair vision.
Follow the user instructions for the mask or respirator. These instructions may show hove to make sui
fits properly.
Some types of masks and respirators may feel different if your child is used to wearing a regular cloth
mask.
Safety precautions:
■ If your child has a medical condition, such as a heart or lung problem, ask their healthcare provider b3
methods to improve mask fit or use an ASTM F3502 mask or a respirator.
• If your child has a hard time breathing, gets dizzy, or has other symptoms while using methods to imr
an ASTIVI F3502 mask, or a respirator, ask them to switch to a regular cloth or disposable mask. They:
continue to follow CDC guidance to protect themselves and others. Consult your healthcare provider
symptoms do not resolve.
Alternative Masks for Special Situations
Clear masks or cloth masks with a clear plastic panel are an alternative type of mask that may be helpful
interacting with certain groups of people, such as:
• People who are deaf or hard of hearing
■ Young children or students learning to read
■ Students learning a new language
• People with disabilities
• People who need to see the proper shape of the mouth for making appropriate vowel sounds (for E
when singing)
The FDA recently approved a transparent medical mask. These transparent medical masks should be res
use by healthcare workers and patients who require them.
If you use this type of mask, make sure
• You can breathe easily
• Excess moisture does not collect on the inside of the mask
Choosing a Mask or Respirator for Different Situation
Some situations may have a higher risk of exposure to COVI❑-19 than others. So, you may want to consic
of mask or respirator to wear depending on the situation, Always choose a well -fitting and comfortable r
respirator and wear it properly (covering your nose and mouth), A poorly fitting or uncomfortable mask
may be worn improperly or taken off frequently, which may reduce its intended benefit.
These situations might include:
• Riding on planes, buses, trains, or other forms of public transportation*, especially when riding for
prolonged period of time on crowded conveyances
• Taking care of someone who is sick with COViD-19
• Working at a job where you interact with large numbers of the public, especially when public mask i
inconsistent. Examples of these jobs might include bus drivers and grocery store workers
• if you are at increased risk for severe illness, for example, older adults or people with certain under
medical conditions
• If you are immunocompromised or unvaccinated
*Note: The options listed on this page may be used to fulfill the requirements of CDC's Mask Order for p
transportation. Learn more about attributes of masks needed to fulfill the requirements of the Order at
For more information on science behind improving how your mask protects you, see:
• Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2
• Efficacy of Portable Air Cleaners and Masking for Reducing Indoor Exposure to Simulated Exhaled SAF
Aerosols — United States, 2021
• Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-Cod
Transmission and Exposure, 2021
Previous Updates
Updates from Previous Content
As of September 10, 2021
■ Made minor updates to the sections on Cloth Masks and Disposable Masks
• Updated the section on Masks that Meet a Standard
• Added section about Respirators that Meet International Standards (e.g., KN95s)
■ Added considerations for use of NIOSH -approved respirators because the availability of NIOSH -app
respirators has increased significantly over the last several months
■ Added section on Alternative Masks for Special Situations
■ Updated section on Choosing a Mask or Respirator for Different Situations
Related Pages
) Your Guide to Masks
) Improve How Your Mask Protects You
Last Opo
Centers for Disease
Control and Prevention
We have the tools to ❑ ---
Fight omicron
Vaccines & Booster Masks Testing
Your Guide to Masks
How to select, properly wear, clean, and store masks
Updated Oct, 25, 2021
• Everyone 2 years or older who is not fully vaccinated should wear a mask in indoor public places,
• In general, you do not need to wear a mask in outdoor settings.
- In areas with high numbers of COVID-19 cases, consider wearing a mask in crowded outdoor set
activities with close contact with others who are not fully vaccinated.
• People who have a condition or are taking medications that weaken their immune system may not be
even if they are fully vaccinated. They should continue to take all precautions recommended for unva
people, including wearing a well -fitted mask, until advised otherwise by their healthcare provider.
• If you are fully vaccinated, to maximize protection and prevent possibly spreading COVID-19 to others
indoors in public if you are in an area of substantial or high transmission.
Wearing a mask over your nose and mouth is required on planes, buses, trains, and other forms of public i
traveling into, within, or out of the United States and while indoors at U.S. transportation hubs such as airp
stations. Travelers are not required to wear a mask in outdoor areas of a conveyance (like on open deck a
or the uncovered top deck of a bus).
How to Select
When selecting a mask, there are many choices. Here are some do's and don'ts,
Have two or more layers of washable, breathable fabric
Completely cover your nose and mouth
f
F
40
Fit snugly against the sides of your face and don't have gaps
Have a nose wire to prevent air from leaking out of the top of the mask
Are made of fabric that makes it hard to breathe, for example, vinyl
Have exhalation valves or vents which allow virus particles to escape
0
0
iA hA
SURGICAL
N95
Are specially labeled "surgical` N95 respirators, as those should be prioritized for healthcare personnel
Special Considerations
Aft
Wear a gaiter with two layers, or fold it to make two layers
Not recommended: Evaluation of face shields is ongoing, but effectiveness is unknown at this time.
Find a mask that is made for children to help ensure proper fit
Check to be sure the mask fits snugly over the nose and mouth and under the chin and that there are no g
sides
Do NOT put a mask on children younger than 2 years old
Wear your scarf, ski mask or balaclava over your mask
Scarves, ski masks and balaclavas are not substitutes for masks
Certain types of facial hair, like beards, can make mask fitting difficult. Masks that fit well protect you bette
better fit, people with beards can shave their beards or trim their beards close to the face.
Other ways to improve fit
Use a mask fitter or brace.
L+
Wear one disposable mask underneath a cloth mask that has multiple layers of fabric. The second mask sl-
edges of the inner mask against the face and beard.
For people with beards that are not trimmed close to the face, masks may fit loosely around the beard. Ho
with beards should still wear a mask. Masks designed for people with beards are being evaluated, and info
provided when it becomes available.
People with disabilities
Certain groups of people may find it difficult to wear a mask, including some children 2years and older
any age with certain disabilities.
Appropriate and consistent use of masks may be challenging for some, including people with certain disc
Challenges may be caused by being sensitive to having material on the face, difficulty understanding wh!
mask is protective [such as those with an intellectual disability], or having difficulty controlling behavior.
When determining if children and people with certain disabilities should wear a mask, assess their ability
■ Wear a mask correctly
• Avoid frequent touching of the mask and their face
• Limit sucking, drooling, or having excess saliva on the mask
• Remove the mask without assistance
For people who cannot wear or safely wear a mask because of a disability as defined by the Americans w
Disabilities Act (ADA) (42 U.S.C. 12101 et seq.), consider reasonable accommodation for workers who are
vaccinated, who are unable to wear a mask, or who have difficulty wearing certain types of masks becau
disability.
If you are caring for children and people with certain disabilities who may need assistance with wearing F
should
• Ask your healthcare provider for advice to help the person you are caring for to wear a mask and a�
alternative ways of reducing transmission risk.
• Ensure proper mask size and fit.
■ Remove their mask before sleeping, napping, when they may fall asleep [such as in a car seat or str
situations when continual supervision is not possible.
• Consider prioritizing wearing a mask in public settings and when around people who don't live in yc
household, particularly when indoors. Masks may not be necessary when you and the person you a
are outside and away from others, or with other people who live in the same household. However,
localities may have mask mandates while out in public and these mandates should always be follov+
Masks should not be worn by:
• Children under 2 years
A person with a disability who cannot wear a mask, or cannot safely wear a mask, for reasons relatE
disability
A person for whom wearing a mask would create a risk to workplace health, safety, or job duty as d
by the workplace risk assessment C11
People who are deaf or hard of hearing and those who will interact with people who are hearing impaire
If you 1nteractwith people who rely on reading lips, you may have difficulty communicating while wearin
Consider wearing a clear mask or a cloth mask with a clear panel,
-- Generally, vinyl and non -breathable materials are not recommended for masks, However, for
reading, this Is an exception to that general guidance.
■ if you are not able to get a clear mask, consider using written communication, closed captioning, or
background noise to make communication possible while wearing a mask that blocks lips.
People with certain underlying medical conditions
Most people with underlying medical conditions can and should wear masks.
If you have respiratory conditions and are concerned about wearing a mask safely, discuss with yon.
provider the benefits and potential risks of wearing a mask.
If you have asthma, you can wear a mask. Discuss with your healthcare provider if you have any cor
wearing a mask.
Mask use and carbon dioxide
■ Wearing a mask does not raise the carbon dioxide (CO2) level in the air you breathe,
Cloth masks and surgical masks do not provide an airtight fit across the face. The CO2 escapes into
through the mask when you breathe out or talk. CO2 molecules are small enough to easily pass thr
material. In contrast, the respiratory droplets that carry the virus that causes COVID-19 are much la
CO2, so they cannot pass as easily through a properly designed and properly worn mask.
How to Wear
Wear a mask correctly and consistently for the best protection.
■ Be sure to wash your hands or use hand sanitizer before putting on a mask.
• Do NOT touch the mask when wearing it. If you have to touch/adjust your mask often, it doesn't fit yo
you may need to find a different mask or make adjustments.
• Covers your nose and mouth and can be secured under your chin.
• Fits snugly against the sides of your face.
C�
i 0
Around your neck
0 Ile—
X X -
On yourforehead
On your chin
0 • ■
"Ou
Ah.
Under your nose
A)
Dangling from one ear On your arm
Only on y4
O
Carefully, untie the strings behind your head or stretch the ear loops
Handle only by the ear loops or ties
O
Fold the outside corners together
U
Be careful not to touch your eyes, nose, and mouth when removing and wash hands immediately after ren
Hover to Clean
*go
S see f
■
Reusable masks should be washed as soon as they become dirty, or at least once a day. If you have a dispC
mask, throw it away after wearing it once. Always and wash your hands after handling or touching a used r
■ include your mask with your regular laundry.
• Use regular laundry detergent and the appropriate settings according to the fabric label.
• Wash your mask with tap water and laundry detergent or soap.
• Rinse thoroughly with clean water to remove detergent or soap.
Dry Your Mask
• Dry your mask completely in a warm or hot dryer
• HanR vour mask in direct sunlight to dry completely. If you cannot hang it in direct sunlight. hane or L
it dry completely.
How to Store
If your mask Is wet or dirty from sweat, saliva, make-up, or other liquids or substances, keep it in a sealed F
you can wash it. Wash wet or dirty masks as soon as possible to prevent them from becoming moldy, Wet
hard to breathe through and are less effective than dry masks.
You can store your mask tempo rarlly to reuse later. Remove your mask correctly and wash your hands aft(
used mask. Keep it in a dry, breathable bag (like a paper or mesh fabric bag) to keep it clean between uses
your mask, keep the same side facing out.
If you are taking off your mask to eat or drink outside of your home, you can place it somewhere safe to kE
such as your pocket, purse, or paper bag. Make sure to wash or sanitize your hands after removing your m
eating, put the mask back on with the same side facing out. Be sure to wash or sanitize your hands again a
your mask back on.
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Choosing a Mask: Dos and Donts
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How to Take Off a Mask
Please wear a mask.
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Please Wear a Mask
Last Up
From: Tammi Mason
Sent: Tuesday, January 4, 2022 11:57 AM
To: Amy van Hone
Subject: FW: Town Mask Mandate
From: Mary Haaland rbrewstergirl@hotmail,com>
Sent: Tuesday. January 4, 2022 11:52 AM
To: Tammi Mason <tmason@brewster-ma.gov>
Subject: Town Mask Mandate
Dear Amy von Hone and the Brewster Board of Health,
My name is Mary Haaland. My husband and I moved back to Brewster last April. I grew up in this wonderful town, went
off to college and worked as a nurse in Boston for 37 years. I also have participated in volunteer work in Nicaragua for
almost 20 years, mainly in the area of public health.
I am writing to you today to request that a mask mandate for indoor spaces be issued in our town. It is easy to do and is
in the interest of health for our entire community. Other Cape towns have already done this. This pandemic is out of
control and there are many folks still not "volunteering" to wear masks when around other people. I know that we can
choose not to go into businesses that don't have this requirement but we would like to support them.
Additionally, the mask requirement should be for surgical or N95 masks as the latest information shows that "face
coverings" and cloth masks are ineffective.
Please consider this request in a timely manner as Covid is out of control.
Thank you.
Respectfully,
Mary A. Haaland
617-372-2266
Sent from my T -Mobile 5G Device
Get Outlook for Android
Town
Yes
No
Date
Description
Barnstable
Not found
Brewster
12/20/21
Masks required for town buildings
Chatham
01/07/22
Masks whenever indoors in public spaces,
including common areas of multi -family
dwelling
Dennis
Not found
Eastham
08/30/21
Masks indoors except when seated for
eating and drinking
Falmouth
12/13/2021
- Discussed
future
mandates
Harwich
12/29/21
Mandated in Town buildings; issued
advisory when indoors, open to public
Mashpee
12/21/21
Advisory — wear mask when indoors and not
in own home
Orleans
01/07/22
Masks in municipal buildings
Provincetown
12/21/21
Masks in all indoor public spaces
Sandwich
Not found
Truro
12/21/21
Mask Order for all > 2 years of age, entering
public buildings or places open to public
Wellfleet
11/18/21
Mask Order when in location open to public
Yarmouth
12/07/21
Mask when indoors in all public places
Oq 1pt') Qoaa
Ezekiel J. Emanuel,
M D. PhD
Perelman School of
Medicine and
The Wharton School,
University of
Pennsylvania,
PhiladelplAa,
Michael osterholm,
PhD. MPH
[enter for Infectious
Disease Research
and Policy, M Versity
or Minaesota,
Minneapo%.
Cellne R. Gounder,
MD, scM
Grossman School of
Medicine, New York
university, New York,
New York.
11
Viewpoint
carrespond6ng
Author: EzekleIJ.
Emarrael, MD, PhD,
Medical Ethics and
Health Policy, Perelman
School of Medicine,
Universityof
Pennsylvania, 423
Guardian Or, Hlock6ey
Hall, Philadelphia, PA
19104(zemanuel@
upenn.edu).
jama.com
opinion
A National Strategy for the "New Normal" of Life With COVID
As the Omicron variant of SARS-CoV-2 demonstrates,
COVID 19 is hereto stay. In January2021, President Eiden
issued the "National Strategy for the COVID-19 Re-
sponse and Pandemic Preparedness:' Asthe US moves
f rpm crisis to central, this national strategy needs to be
updated. Policy makers need to specify the goals and
strategies for the "new normal" of life with COVID-19
and communicate them clearlyto the public.
SARS-CoV•2 continues to persist, evolve, and sur-
prlse. In July 2021, with vaccinations apace and infectlon
rates plummeting,.Biden proclaimed that "we've gained
the upper hand againstthis virus:'and the Centersfor Dis-
ease Control and Prevention (CDC) relaxed its guidance
for mask wearing and social izing,1 By September 2021, the
Delta variant proved these steps to be premature, and by
late November, the Omicron variant created concern
about a perpetual state of emergency,
In def Ineating a national strategy, humility is essen-
tial. The precise duration of immunity to SARS-CoV-2
from vaccination or prior infection is unknown, Also un-
known is whether SARS-CoV-2 will become a seasonal
infection; whether antiviral therapies will prevent Io ng
COVID; or whether even more transmissible, immune -
evading, or virulent variants vdII arise after Omicron,
Another part of this humility is recognizing that pre-
dictions are necessary but educated guesses, not math-
ematical certainty. The varus, host response, and data will
evolve. Biomedical and public health tools will expand,
a long with better understanding of their limitations. The
Without a strategic plan for the
"new normal" with endemic COVIIJ
more people., will unnecessarily
experience morbidity and mortality,
health inequities will widen, and tril
will be lost from the US economy.
incidence of SARS•CoV--2, vaccination rates, hospital ca-
pacity, tolerancefor risk, and wi I I ingness to implement dif-
ferent interventions will vary geographically, and na-
tional recommendatio ns wiI I need to be adapted locally.
It Is imperative for public health, ecenamlc, and so-
cial functioning that US leaders establish and commu-
nicate specific goals for COVID-19 management, bench-
marks for the imposition or relaxation of public health
restrictions, investments and reforms needed to pre-
pare for future SARS-CoV-2 variants and other novel vi-
ruses, and clear strategies to accomplish all of this,
Redefining the Appropriate National RisIc LeveI
The goal for the "new normal" with COVID-19 does not
include eradication or eliminatian, eg, the "zero COVID"
strategy.z Neither COVID-19 vaccination nor infection ap-
pear to can fer lifelong immunity. Current vaccines do not
offer steril izing immunityagainst SARS-CoV-2 infection. In -
factious diseases cannot be eradicated when there is I m-
ited long-term Immunity fol lowingInfection or vacci nation
or nonhuman reservalrsof infectlon. The majority of SAR5-
CoV 2 infections are asymptornaticormiklFysymptomatic,
and the SARS-CoV 2 incubation period isshort, preventing
the use of targeted strategies like "ring vaccination :' Even
"fully" vaccinated individuals are at risk for breai(through
SARS-CoV-2 infection. Consequently, a "new normal with
COVID" in January 2022 is nat livi ng without COVID 19.
The "new normal" requires recognizing that SARS-
CoV-2 Is but one of several circulating respiratory viruses
that indude influenza, respiratorys)rt4ytial virus (R5\0, and
more. COVID 19 must now be considered amongthe risks
posed by all respiratory viral illnesses combined. Many
of the measures to reduce transmission o€5AR5-CoV-2 (eg,
ventilation) will also redu ce transmission of other respira-
tory viruses. Thus, policy makers should retire previous
public health categorizations, includIngdeaths from pneu-
monia and influenza or pneumonia, influenza, and COVID-
19, and focus on a new category: the aggregate risk of all
respiratory virus infectians.
What should be the pealc risk level for cumulative vl-
ral resp lratory illnesses for a "normal"week? Even though
seasonal Inf Iuenza, RSV, and other respiratory viruses cir-
culating before SA RS-CoV-2 were harmful, the US has not
considered them a sufficle nt t hreat to impose emergency
measures in over a century. People have
lived norma llywith the threats of these vi-
ruses, even though more could have been
_19, done to reduce the irrisks,
The apprapriate risk threshold should
reflect peals weekly deaths, hospitaliza-
tions, and community prevalenceof viral
respiratory illnesses during high•severity
lions years, such as 2017-2018,3 That year had
approximately 41 ml Rion symptomatic
cases of influenza, 710 000 hospitaliza-
tions and 52 001D deaths.¢ In addition, the CDC esti-
mates that each year RSV I eads to more than 235 000 hos•
pita li za t lcns and 15 000 deaths in the US,3 This would
translate into a risk threshold of approximately 35 000
hospitalizations and 3000 deaths (e1 deathj100000
population) in the worst week.
Today, the U5 is far from these thresholds. For the
weep of December 13, 2031, the CDC reported the U5 ex-
perienced more than 900 000 COV ID•19 cases, more
than 50 000 new hospitalizations for COVID-19, and
more than 7000 deat hs.5-6 The tolerance for disease,
hospitalization, and death varies Wdelyamong individu-
als and communities. What constitutes appropriate
thresholds for hospltaIlzations and death, at what cost,
and with what trade-offs remains undetermined.
C 2022 American Medical Association. All rights reserved.
]Down Joaded From: https:lljamanetsvorh.coW by Amy von Horse on 01112/2022
JAMA Publishedonkne-lanuary 6,2022 Ell
Opinion Viewpoint
This pealcweekrislcthresholdservesatleastafundamental func- treatmentfor tuberculasis, HIV, diabetes,and otherchroniccondi -
tic ns. This risk threshold triggers poky recommendations for emer-
gency implementation of mitigation and other measures. In addi-
tion, health systems could relyon this threshold for planningon the
bed and workforce capacity they need normally, and when to insti-
tute surge measures,
Rebuilding Public Health
To copewlth pandemic, and eventually, endemic SARS-CoV-2 and to
respond to futu re publ ic heal th threats requires deploying real-time
information systems, a public health implementation workforce, flex -
tions: providing health screening and support to pregnant tndividu-
A and new parents and their newborns; and de live ri ng va ri ous other
public health services to vulnerable or homebound populations.
School nurses need to be empowered to address the large un-
met pubtic health needs of children and adolescents. As polio vac-
cination campaigns showed, school health programs are an effi-
cient and effective way to care for child re n, including preventing and
treating mitd asthma exacerbations (often caused by viral respira-
tory infections), ensuring vaccination as a condition for atten-
dance, and addressing adolescents' mental and sexual health needs.
ible health systems, trust in gave mment and public health institu- School clinics must be adequately staffed and funded as an essen-
tion s, and belief in the value of collective action for pubilc good's tial component of the nation's public health infrastructure.
First, the US needs a comprehensive, digital, real-time, integrated Third, because respiratory infections ebb and f low, institution -
data infrastructure for public health. As Omicron has reemphasized,
the US is operating with imprecise estimates of disease spread, limited
genamic surveillance, projections based an select reportingsites, and
data from other countries that may not be generalizable. These short-
comings a re th reateni ng lives and societal function.
The US must establish a modern data infrastructure thatincludes
real-time electronic collection of comprehensive information on respi-
ratory viral infections, hospitalizations, deaths, disease-specific out-
comes. and immunizations merged with soclodemographic and other
relevant varia b[es.The pubilc health data infrastructure should integrate
data from local, state, and national public health units, health caresys-
tems, public and commercial laboratories, and academic and research
insdLutlons. Using modern tech no] ogy and analytics, it is also essential
to merge nontraditional environmental (air, wastewater) surveillance
data, lncludinggenomic data. with traditional clinical and ep€demialogi-
cal data to track outbreaks and target containment.
aiizing telemedicine waivers, licensure to practice and enable bilt-
ingacross state lines, and other measures that allow the flow of medi-
cal services to severely affected regions should be a priority.
Fourth, it is essentlaI to rebuild trust in publichealth institutions
and a belief in Cal lective action in service of public health.' Corn mu-
nities with high er I eve Is of trust and reciprocity, such as DenmA, have
experienced [Ower rates of hospltalization and death from COVID-19.'
Improving public health data systems and delivering a diverse public
heal thworkforcethat can respond in real time in corn munitieswill be
important steps toward buildIng that trust more widely.
Conclusions
After previous infectious disease threats, the US quickly forgot and
failed to institute necessary reforms. That pattern must change with
the COVI❑ 19 pandemic. Without astrategic plan for the "newnor-
m al" with endemic COVtD-19, mare people in the US will unneces-
Second. the US needsa permanent publicheaIth Imp lementa- sarily experience morbidity and mortality, health inequities will
tion workforce that has the flexibility and surge capacity to man- widen, and tfillion swiII be lost from the US economy. This time. the
age persistent problems while simultaneously responding to emer-
gencies. Data collection, analysis, and technical support are
necessary, but it takes people to respond to crises. This implemen-
tationworkforce should includea pub11ic health agency -based com-
munity health worker system and expanded school nurse system.
A system of community public health workers could augment
the health care system by testing and vaccinating for SAIRS -CoV-2
and other respiratory infections; ensuring adherence to ongoing
natian must learn and prepare effectively for the future.
The resources necessary to build and sustain an effective pub-
lic health infrastructure wil16 e substantial. Pal€cy makers should
weigh not aniythe costs but also the benefits, i nclu ding fewe r deaths
and lost productivity from COVID-19 and all viral respiratory ill-
nesses. Indeed, after more than 800 000 deaths from COVID-19,
and a projected loss of $8 trillion in gross domestic product th rough
2030,8 these Interventions will be Immensely valuable.
ARTICLE INFORMATION REFERENCES
Pubrished Online: January 6.2022. 1. Remarks by Presldemt Biden celebrating
dci:10.10011jama.2021.24282 Independence Day and Independence from
Conflict of Interest Disclosures: or Emanuel COViD-19. July 4.2021.hups:llbit.lyl3mJaGnQ
reported personal fees, nonfinancial support, rx
both from compaNes, arganizaticos, and
professional heahth care meetings and being a
venture partner at Oak HC1FT; a partner at
Embedded Healthcare LLC, Recovery Partners LLC,
and COVID-19 Recovery Consulting; and an unpaid
board member of Village MD and Oncology
Analytics. 0r Emanuel awns no stock in
pharmaceutical, medical dervice companies, or
health insurers. No other dIsclasureswere
reported.
AdddtiorraI Information: Drs Emanuel, 05terholm,
and Gounder were members of the Biden-Hairris
Transition COM D-19 Advisory Board from
November 2020 to Ja nary 2021.
JAMA PublishedcnIlneJanuary 6,2022
2. Gounder C. The progress of the Polio Eradication
Initiative: what prospects for eradicating measles?
Health Policy Plon,1998;13(3):212-233,
3. COC Health Action Network. Increased
Interseasonal respiratory syncytial virus (RSV)
activity In parts of the southern United States. June
10, 2021. Accessed November 8, 2021. https:l/
e m ergency.cdc,govlhan 12021/h an 0 0443 -as p
4. National [enter for Immunization and
Respiratory Diseases, Estimated flu related
IIInesses, med I Ca I visi ts, hospla4zations, and
deaths in the United States -2017-2011 8 flu season,
SeptemLer 34, 2021. Accessed November 8, 2021,
https:llwww.cd c.gav/fI ulaboutlburdenl2017-
2018.htm
5. COVID Data Tracker Weekly Review. Reported
cases. November 5, 2021. Accessed December 30,
2021. https://www.cdc.gov/coronavirusl2019-
ncovkovi d-datalcovidvi ewli ndex-html
6. JHU Coronavirus Resource Center. Weekly
hospitaltzation trends. Updated November 8, 2021.
https,llcarona, ims.jhu.edu/data/hoF,pitalization-7-
day-trendlinpatient-rapacity
7. Maltrid]s CA, Wu C. How social capital helps
communities weather the COViD-19 pandemlc-
PtoS One. 20213601:eO245135.
8. Swagel P. Letter to Senate Majority reader
Schumer: comparison of CBO's May 2020 interim
projections of gross domestic product and its
January 2020 baseline projection. May 2420.
Accessed November 8, 2421. https llwww,cbo,gov/
system/fi les12020.06155 376 • G DP.pdf
® 2022 American Medical Association. All rights reserved.
Down landed From: ltf ps:lljantanetworlt.coml by Amy von Hone on 01/12/2022
jama.com
David Michaels, PhD,
MPH
Milken institute School
of Pub€ic Health,
George Washingtan
University,
Washington, DC.
Ezekiel J. Emanuel
MD,PhD
Peretman School of
Med mine and The
Wharton School,
Universityof
Pennsylvania,
Philadelphia,
Rick A. Bright, PhD
The Rccl efeRer
Fcundatian, New York,
New York.
0
Viewpoint
Corresponding
Author. David
FAichaeds, PhD, MPH,
Milliken Institute Schod
of PuLO_ Health,
Envircomental and
caccupatinnal Health,
Gecrge VJashingtnn
university,
950 New Hampshire
Av2 NW. Washington,
DC 20052 [dmm@
gwu.edu].
jama.com
A National Strategy for COVID-19
Testing, Surveillance, and Mitigation Strategies
At the beginning of the COVID-19 pandemic, the
response of the US federal government was seriously
flawed. For example, the Centers for Disease Control
and Prevention (CDC) erred when it came to policy
development and messaging for testing, surveillance.
mashing, and ventilation, and CDC -developed test kits
were also defective. Some policies from the Depart-
ment of Health and Human 5ervices restricted private
sector progress, further delaying availability of tests.
Early guidance on testing was mistargeted, getting
tested was a logistical nightmare, and too few tests
were performed. Once an acceptable, yet suboptimal,
testing infrastructure was established, it was marginal-
ized, thought to be superfluous because of the vac-
cines, Even now, testing results are not reliably linked
with sociodemographic data, vaccination status, or
clinical outcomes; the availability of reliable rapid tests
remains limited; and prices are too high'
Similarly, there has never been comprehensive,
geographically and population representative genomic
surveillance to effectively detect and tract[ variants of
SARS-CoV-2, leaving the US with limited and delayed
information about the emergence of new variants until
other countries identify them. In addition, from the
beginning of the pandemec until May 2021, the impor-
tance of aerosol transmission of 5AR5-CoV-2 was not
fully recognized and appreciated,' leading to incorrect,
delayed, and highly confusing recommendations on
masking, wearing high-quality respirators, and improv-
ing ventilation.
It appears that SARS-CoV-2 will persist, and the
COVID-19 pandemic will continue for some time. Con-
sequently, to achieve a sustainable "new normal" with
substantially tower virus transmission and morta lity f rem
COVID-19, testing, surveillance, masking, and ventila-
tion all need sign ifkant improvement.
Testing
First, the CDC needs to collect and disseminate accurate
real-time, population -based incidence data on COVID-
19 and all viral respiratory illnesses, The US should not
be reliant on extrapolating cases and outcomes from
data collected from a few, underrepresentative sites.
The country needs a comprehensive testing and report-
ing system for all viral respiratory illnesses. Data from
all medical and testing facilities, all emergency depart-
ment cases, and all hospitalizations, ICU admissions, and
deaths need to be reported to the CDC and linked to
anonymized sociodemographic, vaccination, and clini-
cal outcomes data. The reporting system should accom-
modatethe ability to incorporate data from at-home tests,
ensuring a simple mechanism to self-report results, and
should provide real-time reporting on a public website.
Opinion
Every person in the US should have access to low-
cost test Ing to determine if they are infected and infec-
tious. The Blden administration's plan to distribute 500
million at-home rapid tests and ramp up production
using the Defense Production Act is an important step
in the right direction but many mare are needed 3 The
federal and state governments need to ensure these
tests are in plentiful supply, free to individuals with
Medicaid coverage, and Free or low cost to the rest of
the population to help individuals who might be infec-
tious avoid transmitting the virus to others in their
homes, workplaces, schools, and other settings and to
get prompt medical care if needed. Several states cur-
rently send their residents free, rapid COVID-19 test
kits. All states and the fed era[ government should also
make tests readi ly ava i la b le.
Importantly, when the CDC tracking system re-
ceives notif ication of a positive test result f ram a health
care facility or at home, the system should automati-
cally provide c I ea r gui dance on self -isolation and treat-
ment options that may include anti-COVI❑-19 medica-
tions oran opportunity to participate in research studies
to assess thera peutic interventions, Additional effort will
be needed to ensure that testing and therapeutics are
made affordable and equally accessible to members of
underserved communities, including individuals with low
income and those in rural or other hard -to -reach areas.
Mare knowledge about disease epidemiology could
be obtained from eachcl6cal specimen. Deploying mul-
tiplexed molecular and rapid antigen tests for respira•
tory viruses that detect multiple respiratory pathogens
will distinguishSAIRS -CoV-2, influenza, respiratory syn-
cytial virus, otherviruses, and bacterial pathogens. In ad-
dition, the US should accelerate development of new
technologies, including wearables and other platforms
(such as gra phen e -based) that can rap idly test for mul-
tip]e pathogens with a single test.
Surveillance
The recent emergence of the Omicron variant has high-
lighted the need for a comprehensive, nationwide en-
vironmental surveillance system that includes waste-
water and air samplingto monitor for potential outbreaks
of viral and bacterial illnesses. TraditianaI surveillance sys-
tems are highly reactive. By the time a health system or
laboratory detects and reports a concerning pathogen
or variant, it is too late to contain its spread. Great prog-
ress has been made toward establishing environmen-
tal surveillance programs for SARS-CoV-2, but there is a
need to rapidly expand to other pathogens and reach ru-
ral and other communities that lack wastewater sys-
tems. A comprehensive national system is needed to
reach the full potential of this surveillance approach,
0 2622 American Medical Association. All rights reserved.
Dmvnloaded from: li"s.1/janianetwoi•k.com/ by Amy von Hone on 01/13/2022
JAMA Published airline January 6, 2022 El
Opinion Viewpoint
winch should empower localjurisdictionswit h rapid, actiona ble d ata
and transform pa ndem ic prevention into a more equitable and pro-
active practice.
In addition, a comprehens'Ivegenomic surveillance system for
variants is needed to provide early indications of irnmunityescape
and emergence of newvaria nts, This incl udesthe critical need to se-
quence vaccine breakthrough cases, even from mild infections. The
country needs a system organized by the CDC to sequence a far
greater and more geographically representative proportion of posi-
tive COVI D-19 tests than is currently being sequenced, with the re-
sults uploaded Into global databases in real-time. Rapid sharing of
this genomic data could facilitate a broader analysis of the emer-
gence and spread of novel variants, enabling targeted distribution
of resources to slow the spread of a new variant,
The U5 needs to establish a real-time, apt -out digital surveil-
lance system to monitor all vaccinated individuals for the fre-
quency and severity of adverse effects, postvaccination infections,
and waning immunity. Two years into the pandemic, the US is still
heavily reliant on data from Israel and the UK for assessing the ef-
fectiveness and durability of COVID-19 vaccines and rate of vaccine
breakthrough infections. In addition, when the defInitian of "fully
vaccinated" shifts to 3 doses (or perhaps mare doses) of mRNA vac-
cine, the U5 lacks a reliable way of identifying who has received only
the first 2 doses and who has received a third dose.
Mitigation Strategies
Like influenza. SARS-CoV-2 is spread by aerosols.' Well-established
public health mitigation strategies can reduce risks and complica-
tions from viral respiratory infections including 5AR5-CoV-2. Mitiga-
tion strategies should be implemented, including new enforceable
Occupational Safety and Health Administration standards, espe-
clally requ i ri ng workplace masking, distancing, and ventilation s
The most effective way t0 preve nt tf a n sm issi on of respiratory
diseases, including COV ID -19, is to eliminate exposure to poten-
tially infectious individuals, encouraging individuals who may have
illness to stay home, This requires systematic access to testing and
paid sick and family medical leave for aII US workers, especially low-
wage, temporary, Freelance, contractor, and gig economy workers.
The next most effective mitigation approach focuses on
upgrades to ventilation and air filtration systems, including increas-
Ing the intake of outside air, using efficient fl Iters (rated at mini-
mum efficienc=y reporting value of 13 or higher) and adding high-
effic6ency particulate air filtering devices. These systems will need
to be implemented in offices, schools, public transportation, and
other congregate workplace and social settings, such as restaurants
and bars. Congress has allocated tens of billions to schools for such
upgrades,a and should provide additional funding or tax incentives
for targeted high -impact upgrades. New infrastructure funds for
public transit and airport improvements should also be linked to
implementing these permanent improvements. Localities should
be incentivized to modify their building codes to require that all
new buildings integrate these upgrades,
The country needs to encourage use of high -qua lityfilteringface-
pdece respirators (FFRs), such as N 95 or ICN95s, rather than cloth
or surgical masks, to reduce transmission of respiratory viruses in-
ciudIng SARS-CoV-2 in crowded indoor settings where community
exposure risk i s elevated! To meet demand and prevent reliance on
imported products of questionable quality, there needs to be a na-
tional1nitiativetosustainably produce domestic FFRs and ensure they
are readily available to all U5 residents for Free or very low cost, The
government could mail vouchers to US households to pick up FFRs
at pharmacies, grocery sto res, schools, and other locations.
In addition, there needs to be a system for clear recommenda-
tions from trusted public health authorities, advising local govern-
ments and the public about the appropriate use of facial coverings,
depending on the setting; an individual's vaccination, immune, and
risk status; and the level of community transmission. An easily
i nterpreta bi e risk assessment map that encompasses these vari-
ables to provide immediate risk determination at the zip code
level for individuals could be developed and updated daily. Such a
system would help reduce confusion and guesswork that many
individuals face today as they make daily decisions on how to pro-
tect themselves.
Conclusions
To reduce COVID 19 transmission, achieve and sustain a "neva nor-
mal;' and preempt future emergencies, the nation needs to build and
sustain a great ly im proved public health infrastructure, including a
comprehensive, permanently funded system for testing, surveil-
lance, and mitigation measures that does not currently exist,
ARTICLE IN FORMATION
health insurers. No other disclosures were
Published oriine-January6,2022.
reporte&
ded.10.1001 jjama.2021.24168
Additional Information: Drs Michaels, Emanuel,
Conflict of Interest Disclosures: or Michaels
and Bright were members of the Aiden -Harris
reported receiving grants from the McHhattan
Transition COVPD 19 Advisory board from
Foundatbon and institute for New Economic
November 2020 to January 2021.
Thinking and personal fees from the Actors' Equity
Association, Health Action Alliance, Esthe Lauder
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1, DePIRIS L. Umansky E. Here's why rapd COViD
reported perscnaI fees, nonfinancial support, or
tests are so expensive and hard to find. Accessed
both from compan] es. organizations, and
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2. Rabin RC, Anthes E. The virus is an a]rbarne
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board member of Viliaga MD and OnccZogy
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downloaded From: https:lljamanehvork.coml by Amy von Hone on 0 1/1312022
jama.com
JermiferD. Nuzzo.
DrPH, 5M
Johns Hopkin s
61corn berg School of
Pu bk Health,
Balt rnnore, Maryland.
LawrenceO. Gostin.
JD
O'Neill Institute for
Nat"I and Global
Health Law,
Georgetown University,
Washington, DC.
Viewpoint
corresponding
Author. Lawrence o.
G ostfn. J a.
UNeMI Institute for
National and GlabaI
Health Law,
Gecegetown University
Law Center, 500 First
St NW. Office 810,
Washington, DC 20001
[gostln@georgetown.
edu).
jarna.com
The First 2 Years of COVID-19
Lessons to Improve Preparedness for the Next Pandemic
On December 31, 2019, the World Health Organization
(W HO) Country Office 1n China reported novel "viral pneu-
monias of unknown cause" in Wuhan, but China did net
confirm case clusters until January 3, 2020. Two years
later, more than 285 million cases and 5.4 million
deaths have been reported. As of December 2021.
more than 800 000 COVI❑-19 deaths have occurred in
the US, surpassing the 675446 total deaths that
occurred during the great influenza pandemic of 1918.
The COVID-19 pandemic reduced global economic
growth by an estimated 3.2% In 2020, with trade
declining by 5,3°/a; an estimated 75 million people
entered extreme poverty, with 80 million more under-
nourished compared with prepandemic levels.'
Although the COVID-19 and 1918 influenza pandemics
stand alone in morbidity and mortality, evidence sug-
gests the frequency of infectious disease emergencies
evilI increase. What lessons does COVID-19 teach to
advance preparedness, detection, and response?
Health Systems Should Become the Bedrock
of Pandemic Preparedness
Since the first reports of SARS-CoV-2, health systems
were instrumental in responding to COVID-19. Clini-
cians recognized novel viral pneumonias in Wuhan,
Clinical data offered insights on transmission and pro-
gression to severe disease. Yet COVID-19 has stressed
Oplraon
demic preparedness. That fundamental weakness
continued in the 2021 index.' These data suggest that
health system surge capacities should become the
bedrock of pandemic preparedness—adequate per-
sonnel, medical supplies, and intensive care beds to
meet acute demands, including provision of routine
diagnosis and care.
Testing Capacity Is Vital to Detect, Characterize,
and Manage Crises
The COVID-19 response was severely hampered by 1n-
suff icienttestingcapacities. Constrained capab11ities led
many countries to use travel -based algorithms to deter-
mine qualifications forSARS-CoV-2 testing. Diagnostic
testing kits issued by the Centers for Disease Control and
Prevention (CDC) were initially flawed, and a111abora-
tory results had to be analyzed at the agency. Initially,
onlyhospitaIized patients with a travel history to China
could be tested. Highly targeted and limited testing
missed infections from other regions, particularly
Europe, which seeded a major outbreak in New York City
in March 2020 while delaying recognition of tivide-
spread community transmission.
Inadequate testi rig capa bil ities persist tothis day. Al-
though more diagnostic tools now exist, the US and
many other countries still report results with higher-
than-expected test positivity, indicatirig failures tocast
a sufhicientlywide net to identify infec-
tions and limit forward transmission. Un-
even access to testing may create sur-
veillance biases and limit disease
prevention and control. Incomplete di-
agnosis and surveillance also limit the
ability to ch a ra cterize the virusas it mu-
tates, Includi ng changes intransmissibil-
ity, pathogenicity, and evasion of immu-
nity. The current Omicron variant, for
example, appears to be more transmis-
sible than the Delta variant, and also may reduce im-
mune protection from disease recovery or vaccination.
The likelihood of even more challenging
future scenarios should create urgency
to invest in and maintain resilient
health systems, testing and
surveillance, public trust, equity,
and strong global institutions.
health systems beyond their capacities. Amid surging
cases, China built 2 hospitals in Wuhan to isolate and
treat patients with CDVID-19. A global pattern emerged
of hospital admission surges, creating shortages of hos-
pital resources, such as critical care unit beds, personal
protective equipment (PPE), and ventilators. Well over
100 countries ordered "lockdowns" (closure of com-
mercial and leisure activity) by Apri12020 to preserve
health system capacities. Overcrowding led to delayed
diagnoses and treatments for many health conditions,
contributing to excess deaths that exceeded an esti-
mated 1.2 million in 2020.
These challenges were unsurprising. The 2019
Global Health Security Index found that health sys-
tems were the lowest -performing area of overall pan-
Building Public Trust and Fostering
Risk -Mitigation Behaviors
Public distrust of health agencies and lack of population -
level adherence to risk -mitigation measures proved ma-
jor impediments in the COVID-19 response. A U5 survey
of 1305 people in early 2021 found high levels of distrust:
anly 52% expressed high trust in CDC, 379 in the Food
and Drug Administration, and 41% in state health
departments.' This distrust has led to social and political
division over the utility of masks and vaccinations. Non-
pharmaceutical interventions require high levels of
population -level adherence. Even highly effective
0 2022 American Medical Association. All rights reserved.
Down loaded From. Itttps:lljamanetwork.coml by Amy von hone on 0 1113/202 2
JAMA Published online January 6,2022 E}
Opinion Viewpoint
medical countermeasures such as vaccines require population -
wide uptake to reduce disease t ra nsmissio n and progression to se-
rious disease. Building public trust in scientific recommendations,
especially through community leaders and social and religious in-
stitutions, Is vital to future preparedness.
Redressing Social VulnerabiiIties and Inequities
COVID-19 did not affect all members of society equally. The US
experienced stark racial and ethnic disparities. Age-adjusted per
capita hospitalizations among American Indian or Alaska Native,
Non -Hispanic Black, and Hispanic or Latino people were, respec-
tively, 3.2, 2.5, and 2.5 times higher than among Non -Hispanic
White people.' Similar disparities in severe disease among ethnic mi-
nority populations were reported giabaIly, including in the United
Kingd am, Brazil, and South Africa. These differences are likely due
to long-standing social determinants of health. Future prepared-
ness plans must include concrete measures to reduce disparities.
Income inequality as a barrier to adherence to public health
guidance is another important factor in pandemic preparedness.
U5 counties with greater income in equ a lity ex perlenced higher lev-
els of cases and deaths, Higher -income individuals were more likely
to report protective behaviors, whereas those wdth lower incomes
were more likely to report life circumstances that impede risk miti-
gat ian, including inability to tel ework. A study examining 22 Organ-
isation for Economic Co-operation and Development countries
found those with greater income inequality experienced higher
COVID-19 mortahty.6
Global Cooperation and Robust Institutions
The pandemic exposed inadequacies in global institutions and
international cooperation to ensure all countries have access to es-
sential medical supplles, including testing reagents, PPE, and vac-
cines. Before the pandemic, China manufactured half the world'ssup-
ply of PPE and was a major producer of other medical resources.
However, the Wuhan outbreak caused local disruption in produc-
tion and increased domestic demand to manage the crisis. These
shortages had ripple effects. Many countries responded to supply
shortages by imposing export controls for domestically produced
ARTICLE INFORMATION
Pubkshed Online: January 6.2022.
doL10.10011ja ma.2021.24394
Conflict of Interest Disclosures: None reported.
REFERENCES
1. Jackson JI(, Weiss MA, Schwwzenberg AB, eta 1,
Global economic effects of COVIO.19. Congressional
Research Service. Accessed December 16, 2021.
https:llcrsreparts-congress-govlprod uctldeta i Is?
prodcode=R46270
2. World Health Organization. The tune death toll of
COM D•19: estimating global excess morta5ity.
Accessed December 16, 2021. https:llwww.who.int/
da talstorieslth e-true-death-toll-of-covi d -19-
estimating-global-excess-mortality
3, Nuzzo JB, Bell JA, Cameroon EE. SuboptmnaI US
response to COVID-19 despite robust capabilities
E2 JAMA Published ❑nlineJanuary6, 2022
medicines, syringes, vaccines, and other essential medical goods,
which exacerbated global supply disruptions.
Today, vastglobal vaccine inequities are the most egregious ex-
ample of shortages. Although more than half the world's popula-
tion is fu I ly va cci nated, only ?%of people in low-income countries
have received at least 1 vaccine dose,' Even though countries pledged
to donate billions of vaccine doses, only millions have been deliv-
ered so far.' Many donated doses have been d el ive red wl th little ad-
vance natIce and close to their expiration dates, making it opera-
tionally diff cult for countries to use these vaccines s
Gross I n eq ualities in access to vaccines and other medicalsup-
plles during COVI D -19 should be anticipated for future events. When
nea rly eve ry cou ntry is affected at once, it creates pressureson global
response systems and weak global supply chains. With this pan-
demic reality, reliance on charitable donations for essential medi-
cal supp I! es sh ou Id be questioned. Diversified regionalmanufactur-
ingof products is more likeiytoensure countries can predictablyfulfiI
their supply needs. That would require pharmaceutical companies
to tra nsfer tech nologies to regional manufacturers, such as the WH 0 -
backed messenger RNA hub In South Africa.
Pandemic Threats Are the New Normal
Although the global toll sof COVID49 are unprecedented in the mod
ern era, navel diseases are Iikely to accelerate. Just in the last few
decades. th e world experienced multipie disease emergencies: West
Nile virus (1999), 5AR5 (2003), H5N1 avian influenza (2004), pan-
demic H1N1 influenza (2009), Middle fast respiratory syndrome
(2012), Ebola in West Africa 02014), and Zdka (2015), and more dis-
ease outbreaks should be expected. Even accounting for improved
surveillance, novel eme rgi ng d iseases have steadily increasecisince
1940,10 There are strong biological and environmental reasons to
expect epidemics as, or more, serious than COV ID 19.
The likelihood of even more challenging future scena rios should
create urgency to invest in and maintain resilient health systems, test -
i ngand surveillance, public trust, equity, and strong global institu-
tions. Failure to address clea riy observed weaknesses lnthe COVID-19
response will have preventable adverse health, social, and eco-
nomic consequences when the next novel outbreak occurs.
and resources. JAMA. 2024;324(14):1391.1392. doi:
10.1001/jam a.2020.17395
4. Simmons-Dufficn S. Poll finds pubric health has a
trust problem. NPR. Accessed December 15, 2021.
https:IJwww-npr,org12021105113199 6 3 316 9 21
pol I -f Inds -public -health -has• a-trust-prob lem
S. D I 5pa rities In COV I D-19 -associated
hospitalizatlom. Centers for Disease Control and
Prevention. Accessed December 16, 2021, https:ll
www,cdc.govicoronavi rus/2019- neovlcommunity/
hea Ith-equitylracia i-ethnic-disparitlesldispari ties•
hospital ization.htm f
6. Sepulveda ER, Brooker AS. Income Inequality
and COVID•19mortal ity: age -stratified analysis of
22 OECD countries. SSM Fopul Health. 2021:16:
100904. doi:10.10161j.ssmph-2021.100904
7. coronavirus (COVID 19) vaccinations, Our World
in Data. Accessed December 16, 2021. hUps:#
ourworld inda ta.orglcovid-vacci nations
8. Billionsc=mitted, millions delivered: the mixed
record of vaccine donatons and diplomacy. Think
Global Health. Accessed December 16, 2021.
https:llwww.thin kglobalhea lth.org/a rticlelbillions-
com m fitted -m i (lions -del ive red
9. Jaunt statemmt on dose donations of COVID-19
vaccines to African countries. world Health
Orgarmzation. Published November 29, 2021,
Accessed December 16, 2021. https:llwww.whoJnt j
newsliteml29 -11-2021-joint-statement-on-dose-
donations-of-covid49-vaccines-to-afncan
countries
10. Janes KE, Patel NG, Levy MA, et al. Global
trends in emerging Infectious diseases. Nature.
Published February21, 2008. Accessed December
17, 2021. hUps:llwww-nature.com/articies/
natureO6536
® 2022 American Medical Association, All rights reserved.
Downloaded From: https://j amanehyork cum/ by Amy Von Hone on 0 1113/20 2 2
jama.com
DRAFT BREWSTER BOARD OF HEALTH
NITROGEN LOADING REGULATION
JANUARY 13, 2021
Authority: In accordance with Massachusetts General Laws, Chapter 111, Sections 31 and 127A,
the Brewster Board of Health hereby adopts the following regulation to specify the process far
developing nitrogen loading calculations for use by the Board and for compliance with other
Town zoning articles and regulations including the Water Quality Protection District Bylaw,
(Chapter 179 Sections 53-62).
[I. Purpose: To protect public health through the protection of water resources in the Town of
Brewster, including, but not limited to public drinking water supplies, coastal estuaries and
freshwater ponds, the Board of Health has adopted this regulation to create a standardized
method to estimate the nitrogen loading impacts to water quality from new, altered, or
expanded land uses. The regulation specifies how nitrogen loading analyses are to be
conducted for the Board and for use under other town zoning articles and associated
regulations, including the Water Quality Protection District Bylaw.
This regulation includes requirements for the specific nitrogen loading factors used in the
nitrogen loading calculations and specific spreadsheets that must be used to document the
results of an analysis.
Ill. Required Inputs for Nitrogen Loading Calculations:
A. Table 1 attached to this regulation contains the nitrogen loading input parameters that must be
used for any nitrogen loading calculation conducted under the regulation. These input values
are based on standard inputs used by the Cape Cod Commission (Cape Cod Commission
Technical Nitrogen Loading Technical Bulletin 91-001, April 1992) with some additional
requirements specified by the Board of Health. Any changes to these input values must be
approved by the Health Agent or their designee. The Health Agent or the applicant can refer a
proposed change to the Board for its review and approval.
B. If a use is proposed for a property for which a nitrogen loading value is not provided in Table 1,
the applicant must request approval for an appropriate nitrogen loading rate and/or recharge
rate from the Health Agent or their designee. The Health Agent or their designee can refer the
request for approval to the Board of Health.
IV. Site Plan:
A. A site plan must be provided with the calculations to document the information used in the
nitrogen loading analysis. This includes:
- the existing or proposed lot area
- the areas of driveways
- impervious patios and roof areas
- and undisturbed natural areas
- existing and proposed lawn areas
Version 01.13.22
Lawn Area Definition: The lawn area used in the calculations should reflectthe lawn
area shown on the site plan. A lawn is defined as a ground covered with grass or other
vegetation that is mowed more than twice per year. A minimum lawn area of 1,000
square foot must be included in the nitrogen loading calculations.
Septic System: The site plan also needs to document the location and size of the existing or
proposed septic system serving the property. If an innovative alternative septic system is
proposed to reduce the concentration of nitrogen in septic system effluent, the applicant must
provide documentation that the system has been approved for pilot, provisional or general use
by the Massachusetts Department of Environmental Protection (DEP) as required by Title 5 (3 10
CMR 15.00). This documentation must include the nitrogen concentration in the treated
effluent approved by DEP. If an applicant has reason to request a nitrogen concentration in
treated effluent from an alternative treatment system that is different from that approved by
DEP, they need to receive approval for the proposed concentration from the Health Agent or
their designee.
V. Wastewater Flow:
A. Consistent with the procedures used by the Cape Cod Commission, the wastewater flow used to
calculate the nitrogen input from onsite septic systems on residential properties will be based
on an average of:
1. The Title 5 design flow for the system based on the number of bedrooms in the house (330
CMR 15:203) and
2. The average flow based on the occupancy rate provided in the most recent U.S Census data
for Brewster.
B. According to the 2020 Census, the average occupancy rate far Brewster is 2.3 people per house.
Therefore, until adjusted based on future, updated census data, using a septic system flow rate
of 55 gallons per day per person, a total of 125.5 gallons per day must be used to calculate the
average occupancy nitrogen load. Together, the Title 5 design flow volume and the average
occupancy volume will be averaged to calculate the wastewater flow.
VI. Use of Brewster Board of Health Spreadsheet for Nitrogen Loading Calculations: Nitrogen
loading calculations developed for use under this regulation must be developed and
documented on one of the nitrogen loading calculation spreadsheets attached to this regulation
and available electronically from the Health Department. The applicant should use one
spreadsheet based on the type of project they propose: either a residential,
commercial/industrial, or mixed-use project. The mixed-use spreadsheet should only be used
for a project that combines a commercial/industrial use with a residential use on the same
property. The use of the required spreadsheet ensures calculations are be done in a consistent
manner that can be reviewed and approved by the Health Agent or their designee. The
outcome of the calculation is a prediction of the average nitrogen concentration entering
groundwater from a property which can be used to confirm it will meet the performance
standards for water quality protection established by the Board of Health or included in other
Town zoning articles or regulations, including the Water Quality Protection District Bylaw.
Version 01.13.22
VII. Variances:
Variances from this regulation, if referred by the Health Agent or requested by the applicant,
may be granted by the Board of Health after a hearing at which the applicant establishes the
following:
A. The enforcement thereof would do manifest injustice;
B. Submittal of documentation and up-to-date data that supports the requested variance;
C. Approval of the variance meets the intent of the regulation and the Board's purpose of
water resources protection.
VIII. Invalidation:
If any section, paragraph, sentence, clause or phrase of the regulations shall be decided invalid
for any reason, whatsoever, such decision shall not affect the remaining portion of these
regulations, which shaft remain in full force and effect, and to this end of the provision of these
regulations are hereby declared severable.
Adopted:
Effective:
Town Clerk
Board of Health:
Penny Holeman, Chairman
Jean Kampas, Vice Chairman
Annette Graczewski
Joseph l=ord
❑r. Kimberley Crocker -Pearson
Version 01.13.22
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DRAFT Brewster Board of Health
Nitrogen Loading Calculations Spreadsheet
Nitrogen Loading Calcluations under the Board of Health Nitrogen Loading Regulation must be conducted using
the spreadsheets in this workbook.
Instructions
This workbook contains three sheets, each calculating an estimate of nitrogen loading for different types of
properties in Brewster. Navigate to the sheet ("Residential", or "Commercial I Industrial", or "Mixed Use") which
best describes your property and complete the highlighted cells to calculate.
The calculation includes two sections - Section 1 calculates the nitrogen loading from runoff on the property and
Section 2 calculates the nitrogen loading from wastewater. Nitrogen from both runoff and wastewater are
combined to calculate the total average nitrogren load from any property.
To complete section 1 (Runoff), input the areas (in square feet) of the property and of the various ground covers
(roof, impervious material, lawn) on the property.
To complete section 2 (Wastewater), first indicate if you have an innovative/advanced septic system by
completing that field with either "Yes" or "No". If yes, then input the effluent nitrogen concentration based on
the value approved by MA DEP for that system. If no, then a default value of 35 mg/L is automatically used.
For residential properties, the title 5 design flow is calculated based on the number of bedrooms on the
property. The title 5 design flow is averaged with an average nitrogen load for residential properties in the final
average nitrogen load value. For commercial/industrial properties, input the design wastewater flows according
to Title 5 section 203 (3 10 CMR 15.203), Table 3. The worksheet for mixed use properties includes room for both
of these figures.
The loading rates for any other land use associated with a property not included in this workbook must be
presented to the Brewster Health Agent or their designee for review and approval as required in the Nitrogen
Loading Regulation. The additional loading rates, once approved can be entered in the "Other" category on the
DRAFT
Version 1/13/2022
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Town of Brewster
2198 MAIN STREET
BREWSTER, MASSACHUSETTS 02631-1898
PHONE: 508.896.3701 EXT, 1120
FAX: 508.896.453 8
brhe a 1 th(cr7,bre wster- ma.rzov
W W W.BREWSTER-MA.GOV
MEMORANDUM
TO: Design Engineers and Other Interested Parties
FROM: Amy von Hone, R.S, CHO. Brewster Health Director
Mark Nelson, P.G. Horsley Witten Group, Inc
RE: Proposed Board of Health Nitrogen Loading Regulation.
DATE: January 13, 2022
Health Department
Amy L. von Hone, R.S., C.H.O.
Director
Sherrie McCullough, R.S.
Assistant Director
Tammi Mason
Senior Department Assistant
On January 19, 2022, the Board of Health will be meeting to discuss and vote on a new nitrogen loading
regulation designed to provide and clarify the procedures for developing nitrogen loading calculations.
This regulation will apply to all regulations in Brewster that use these calculations. The purpose of this
regulation and a summary of nitrogen loading calculation process is described below.
Purpose for the Regulation
This regulation was developed to clarify the process that applicants must use to calculate the nitrogen
load from their property when it is required by the Board of Health or by another Town Board. The
Water Quality Protection District Bylaw (Article 197) is one ordinance that requires these calculations
and other bylaws, or regulations may be adopted in the future. The Water Quality Protection Bylaw was
updated at the November 15, 2021 Town Meeting, primarily to update the stormwater requirements in
this bylaw to be compatible with the Stormwater Bylaw also passed at that Town Meeting. The updates
to the Water Quality Protection Bylaw included provisions that the nitrogen loading calculations
required under that ordinance must follow the procedures developed in' a new Board of Health
regulation. This proposed regulation provides those procedures.
How the Regulation Works
The regulation provides specific details on the inputs that must be used for nitrogen loading calculations.
Loading rates that must be used for all the main sources of nitrogen from a residential or commercial
property are provided, including wastewater, lawn fertilizers, road and -roof runoff, and inputs from
natural lands. Tb.e specific loading values are provided in Table 1 of the regulation and can only be
altered with prior approval of the Health Agent or their designee.
The regulation also requires the use of a specific spreadsheet to develop the calculations, so the same
process is used for each project reviewed by the Board of Health or other Town Board. Separate
spreadsheets have been created for residential land uses and for commercial/industrial uses. In addition,
a mixed-use development spreadsheet was created for properties where there is a combination of
commercial and residential uses.
Each of these spreadsheets includes the opportunity to add an additional source of nitrogen under an
"other" category. This is provided for nitrogen loads associated with a parcel that are not one of the
main nitrogen inputs on the spreadsheet. If an applicant needs to incorporate an additional source of
nitrogen in this "other" category, approval from the Health Agent or their designee on the specific
loading rate and/or recharge rate is required.
A copy of the proposed regulation, Table 1 showing the nitrogen loading input factors, and the
calculation spreadsheets that are used to comply with the regulation are attached. Your input on this
regulation is welcomed at the Board of Health Meeting on January 19, 2022 at 7 PM. A. link to this
virtual meeting is available at:
Zoom Webinax
https://us02Web.zoom.us/j 182043 944509?pwd=M_ytpM2kvUExKbU 1 RSOhmMO 1 Zb3dQZzO9
2
Q_ 19 AFCC
IMF" Association to
= Preserve Gape Cod
praeerveng lha Vsrj nalupe 0/ Cape cal
December 17, 2021
Andrew Gottllel]
An
Executive ottlIebDirectRE: Opposition to Pilgrim Discharge of Radioactive Water into Cape Cod Bay
Dear Local Leader,
BOARD OF DIRECTORS
Eliza McClennen As the Cape Cod region's leading nonprofit environmental advocacy and education
President
organization, the Association to Preserve Cape Cod is very concerned about the
Steven Koppel recent proposal by Holtec International, the owner of the Pilgrim Nuclear Power
Vice President Stations, to discharge up to one million gallons of radioactive water from the plant's
Bob Ciolek reactor vessel and spent -fuel pool into Cape Cod Bay.
Treasurer
Jack Looney
The release of this contaminated water directly threatens our region's public health,
Clerk
the environment, and our local economy. The impact such a discharge would have
on Cape Cod Bay's diverse and fragile ecosystems is unknown. Human exposure
John Cumbler
through the consumption of contaminated shellfish and finfish raises troubling
Margo Fenn
health concerns that also lead to ramifications for our coastal economy, our
commercial fisheries, and the many businesses that rely on tourism dollars.
Joshua Goldberg
DeeDee Holt
Although Holtec has walked back from its plans for near-term discharge of
contaminated water into Cape Cod Bay in 2022, APCC believes it is imperative that
Thomas Huettner
state and federal regulatory agencies and our elected officials understand that Cape
Pat Hughes
Cod communities stand in firm opposition to any future proposal by Holtec to
Elysse Magnotto-Cleary
release radioactive Water from Pilgrim into the bay.
Slue Magruder
APCC encourages your town to go on record as opposing any plan to discharge
Stephen Mealy radioactive wastewater into Cape Cod Bay. We have included a sample letter to act
Wendy Northcross as a guide in communicating to policy makers on this issue, along with the contact
Kris Ramsay information for recommended recipients,
Robert Summersgill If you have any questions, please do not hesitate to contact me.
Charles Sumner
Taryn Wilson Sincerely,
Andrew Gottlieb
Executive Director
4T, 482 Main Street I Dennis, MA 02638
rj� IOU%Recycled Paper Tel: 508-619-3185 1 info@apcc.org I www.apcc.org
Sample Letter
Dear
The (town body) voted on (date) to go on record as opposing Holtec International's plan to discharge
one million gallons of radioactive water from the Pilgrim Nuclear Power Station's reactor vessel and
spent fuel pool into Cape Cod Bay.
As a community located along Cape Cod Bay with (number) year-round residents and (number) seasonal
residents and visitors, we are very concerned about the potential adverse impacts Holtec's proposed
action would have on our residents' public health, the environment, and the local economy.
Designated as a State Ocean Sanctuary in 1970, Cape Cod Bay is recognized for its ecological diversity
and significance. Its marine and coastal habitats support many commercially important fish and shellfish
species, as well as state and federally listed birds and marine mammal species. In late winter and spring,
the bay serves as a rich feeding ground for the critically endangered North Atlantic right whale.
Yet Cape Cod Bay's ecological bounty also underscores its environmental fragility. Cape Cod Bay is
unique in that it is a semi -enclosed embayment that is not conducive to dilution and disbursement of
pollutants. The cumulative effects of radiation combined with the enclosed nature of the bay translate
into too many unknown risks to make the proposed discharge acceptable. From a human health
perspective, the potential for bioaccumulation of radiation in shellfish and f1nfish that are used as food
sources is of great concern to us. These health concerns also translate into potential threats to our
coastal economy, with ramifications for our commercial fisheries as well as the many businesses that
rely on tourism dollars.
Discharging the contaminated water into Cape Cod Bay is not the only option available to Holtec.
Instead of releasing the water into the bay, the company has other alternative actions to take that
include storing the water at the site, employing evaporation, or trucking the water to another location.
There is too much at stake to gamble with the health of the region's environment and its residents by
permitting Holtec to use Cape Cod Bay as its dumping ground simply because it is cheaper for the
company to do so.
We therefore state our strong opposition to any plans by Holtec International to discharge water
containing radiation or other contaminants into Cape Cod Bay.
Sincerely,
(Name of Town Body)
41W 482 Main Street j Dennis, MA 02638
jftt 100%RceycledPaper Tel. 508-619-3185 info@apcc.org www.apcc.org
List of Contacts
Governor Charlie Baker
Massachusetts State House
24 Beacon St.
Office of the Governor
Boston, MA 02133
Massachusetts Attorney General Maura Healey
Attorney General's Office
1 Ashburton Place, 20th Floor
Boston, MA 02108
U.S. Senator Elizabeth Warren
309 Hart Senate Office Building
Washington, DC 20510
U.S. Senator Edward Markey
255 Dirksen Senate
Office Building
Washington, DC 20510
U.S. Representative William Keating
2351 Rayburn H03
Washington, DC 20515
State SenatorJulian Cyr
State House, 24 Beacon St.
Room 312-E
Boston, MA, 02133
State Senator Susan Moran
State House, 24 Beacon St.
Room 506
Boston, MA, 02133
State Representative Sarah Peake
State House, 24 Beacon St.
Room 7
Boston, MA, 02133
State Representative Timothy WInelan
State House, 24 Beacon St.
Room 542
Boston, MA, 02133
�� 482 Main Street I Dennis, MA 02638
eJ t" 100% Recycled Paper Tel: 508-619-3185 1 info@apcc.org I vwww,apcc.org
State Representative Kip Diggs
State House, 24 Beacon St.
Boston, MA, 02133
State Representative David Vieira
State House, 24 Beacon St.
Room 167
Boston, MA, 02133
State Representative Dylan Fernandes
State House, 24 Beacon St.
Room 472
Boston, MA, 02133
State Representative Steven Hiarhos
State House, 24 Beacon St.
Boston, MA, 02133
Christopher T. Hanson, Chairman
U.S. Nuclear Regulatory Commission
Washington, DC 20555-0001
Michael S. Regan, Administrator
U.S. Environmental Protection Agency
Office of the Administrator, 1101A
1200 Pennsylvania Avenue, N.W.
Washington, DC 20460
Deborah Szaro, Acting Region 1 Administrator
U.S. Environmental Protection Agency, Region 1
5 Post Office Square - Suite 100
Boston, MA 02109-3912
Martin Suuberg, Commissioner
Massachusetts Department of Environmental Protection
1 Winter St.
Boston, MA 02108
J 482 Main Street I Dennis, MA 02638
�`F, IOU®/o Recycled Paper Tel: 508-619-3185 1 info@apcc.org I wwww.apcc.org
Kelly Trice, President
Holtec Decommissioning
1 Holtec Boulevard
Camden, NJ 08104
Dear Mr. Trice:
Town of Brewster
2198 Main Street
Brewster, MA 02631-1898
Phone: (508) 896-3701
Fax: (508) 896-8089
International
Office of:
Select Board
Town Administrator
The Town of Brewster Select Board strongly opposes any plan by Holtec to
release radioactive water from the decommissioned Pilgrim Nuclear Power Plant
into Cape Cod Bay at any time in the future.
Your published plan to release radioactive water into Cape Cod Bay, an
environmentally -fragile area, presents an ecological and economic threat to the Town of
Brewster, located on Cape Cod Bay, Brewster's residents, and visitors.
Your website states:
"Decommissioning is the process by which nuclear power plants are
safely retired from service. The progression involves decontaminating
the facility to reduce residual radioactivity, dismantling the structures,
removing contaminated materials to appropriate disposal facilities
and releasing the property for other uses. The owner remains accountable
to the NRC until decommissioning has been completed and the agency
has terminated its license."'
Your website further states:
"Contaminated materials can be disposed of in two ways: decontaminated
on site or removed and shipped to a waste processing, storage or disposal
facility."2
Your proposal to discharge radioactive water into Cape Cod Bay is inconsistent with
your own corporate assertions. Discharging radioactive water into Cape Cod Bay,
designated as a State Ocean Sanctuary in 1970, will threaten the thousands of people
who depend on Bay waters for aquaculture, recreation, business, and residential
1 htt s: holtecinternational.com com an divisions hdi our -fleet it rim
z https.//holtecinternational.com/companv/divisions hdilour-fleet EE rim
purposes, and the discharge is a threat to the Bay's animal, finfish and shellfish
populations as well as coastal and marine habitats.
We strongly oppose your proposal to discharge radioactive water into Cape Cod Bay
and urge you to determine a safe and responsible method to manage the contaminated
water at issue.
Sincerely,
Cindy Bingham, Chair
David Whitney, Vice Chair
Ned Chatelain, Clerk
Mary Chaffee
Kari Hoffmann
L11
Massachusetts Department of Environmental Protection
eDEP Transaction Copy
Here is the file you requested for your records. R E C E I V E D
To retain a copy of this file you must save and/or print.LB=RE
F1AL7�Mer,4
Username: EBELAIR
Transaction ID: 1329380
Document: Groundwater Discharge Monitoring Report Forms
Size of File: 1028.71K
Status of Transaction: Submitted
Date and Time Created: 12/27/2021:10:01:39 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.
•4 LJWIGGN VI I \UODUII,1 IULV"IVII - 4. 11 WWI tUVVQLUI 1 IWU1Cil 11 I. r Gllllll IYu111uC1
Groundwater Permit I
2. Tax identification Number
MONITORING WELL DATA REPORT 2021 NOV MONTHLY
II
3. Sampling Month & Frequency
A. Facility Information
Important:When
filling out forms on
the computer, use
only the tab key to
move your cursor -
do not use the
return key.
1. Facility name, address:
BREWSTER MANOR
a. Name
873 HARWICH ROAD
b. Street Address
BREWSTER IMA 02631
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:
11/18/2021
a. Date Sampled (mmfddlyyyy)
DOUG MURPHY
c. Analysis Performed By {Name}
S. Form Selection
dfeld man@vingatehealthcare.com
c. e-mail address
WHITEWATER
b. Laboratory Name
1. Please select Form Type and Sampling Month & Frequency
Monitoring Well Data Report - 2021 Nov Monthly
T_ All forms for submittal have been completed.
2.- This is the last selection.
3. F_ Delete the selected form.
F
gdpols 2015-09-15.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1
WUI UQU VI P%GQVU 1lU f IVLUL%IVII - CJI VUI I%AVVG LVI La1:?Ll11011 �jG 1 IVyI"I[1 1. r CI II IIL 14UJ I ILPGI
Groundwater Permit
2. Tax identification Number
MONITORING WELL DATA REPORT
' 2021 NOV 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)
• N5 =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
PH 6.1 6.2 5.9 6
S.U.
STATIC WATER LEVEL 59.55 59.84 59.82 27.62
FEET
SPECIFIC CONDUCTANCE 308 411 231 176
UMHO&C
mwdgwp-blank.dac • rev. 09115115 Monitoring Well Data for Groundwater Permit • Page 1 of 1
u
Important:When
filling out forms on
the computer, use
only the tab key to
move your cursor -
do not use the
return key.
rah
_UI UaU LI 1\GJVUII U 1 IulC"IV11 - V1 VUI IUVY 0IGI V10VI IU1 tjG I IVyl Li111
Groundwater Permit
DAILY LOG SHEET
A. Facility Information
f r OI 1 111 INUS IUGi
2. Tax identification Number
2021 NOV DAILY
3. Sampling Month & Frequency
1. Facility name, address:
SREWSTER MANOR
a. Name
873 HARWICH ROAD
b. Street Address
BREWSTER IMA 102631
C. City d. State e. Zip Code
2. Contact information:
DAVID FELDMAN
a. Name of Facility Contact Person
7817079527 dfeldman@rringatehealthcare.com
b. Telephone Number c. e-mail address
3. Sampling information:
11/30/2021
a. Date Sampled (mmJddfyyyy)
DOUG MURPHY
c. Analysis Performed By (Name)
S. Form Selection
WHITEWATER
b. Laboratory Name
1. Please select Form Type and Sampling Month & Frequency
J Daily Log Sheet - 2021 Nov Daily
r All forms for submittal have been completed.
2, T- This is the last selection.
3. r- Delete the selected form.
gdpils 2015-09-15.doo • rev. 09/15/15 Groundwater Permit Daily Lag Sheet • Page 1 of 1
uuicau vi i�c.vuuii.c ivwvu vii - v+iuuiiu vvp wi uiati.0 a�yc i IvUl ani i. r Pi ii ivunivui
Groundwater Permit
2. Tax identification Number
DAILY LOG SHEET
2021 NOV DAILY
L
3. Sampling Month & Frequency
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
C. Daily Readings/Analysis Information
Effluent Reuse Irrigation Turbidity Influent pH Effluent Chlorine UV
Flow GPD Flow GPD Flow GPD pH Residual Intensity
(mgll) V/o}
1863
1926
3683
1829
2073
3509
1932
2019
3930
1813
1928
3339
3430
3409
1889
3054
1812
26.88
1789
3798
3339
3091
2163
1744
1903
3199
2064
2869
1x86
3238
4.4
1.6
3.8
4.4
2.1
2.7
2.3
1.7
2.2
2.3
4
2.7
4.1
1.6
1.5
3.1
4.1
X3.9
I�J
3.7
1.9
2.1
gdpols.doc • rev. 09/15/15 Groundwater Permit Daily Log Sheet • Page 1 of 1
u
L UI GOU VI I%GQUUI VG 1 IVLGVLIVII - LJI VVJIUYYQLUI VIQ]VI POP yG I IV1a10111
Groundwater Permit
DISCHARGE MONITORING REPORT
I. 1 0111116 1411116 Ui I1Jc1
2. Tax identification Number
2021 NOV MONTHLY
3. Sampling Month & Frequency
A. Facility Information
Important:when
filling out forms 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 MA 102631
t C. City d. State e. Zip Code
2. Contact information:
DAVID FELDMAN
a. Name of Facility Contact Person
7817079527 dfeldman@wingatehealthcare.com
b. Telephone (dumber c. a -mall address
3. Sampling information:
11112312021 JRl ANALYTICAL
a. Date Sampled (mmlddfyyyy) 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 Nov Monthly T
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
UVI GCiV VI 1•G.]VtAI yC 1 IVLGVLIVII - VIVVIIIl YY C3lV1 U1.7y1"'!, V 1 tU&I Cit 11 1. r 61111111VV111 VVt
Groundwater Permit
2. Tax identification Number
DISCHARGE MONITORING REPORT
2021 NOV MONTHLY
L -1
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
Boo
3.9 i
ND
3.0
MGA -
TSS
29
ICED J
2A f
MGIL
TOTAL SOLIDS
2$0
MGIL
AMMONIA -N
IND -�- -
MGIL
NITRATE -N
12
0.050
MGIL
TOTAL NITROGEN(NO3+NO2+TKN)
MGIL
OIL & GREASE
ND
0.50 J
MGIL
infeffrp-blank.doc • rev. 09/15115 Groundwater Permit Discharge Monitoring Report • Page 1 of 1
L i
Important:When
filling out farms 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
electronic -ally and
want to attach
additional
comments, select
the check box.
r
L UI QVU VI I%GQN UI I+ 1 IULGLLIUII - LJ[ UUI IU VV CILLI L IQlt Int t:c 1 IWVI MIII
Groundwater Permit
Facility Information
REWSTER MANOR
I. f cl IIIIL IV UI I IUOI
2. Tax identification Number
a. Mame
873 HARWICH ROAD
b. Street Address
BREWSTER MA 102631
C. City d. State e. Zip Code
Certification
"I certify under penalty of lay that this document and all attachments were prepared under my direction or supervision in
accordance with a system dasigned 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 112/27/2021
a. Signature
b. pate [mmlddlyyyy]
gdpdis 2015-09-15.doc • rev. 09/15/15 Groundwater Permit • Page 1 of 1
c�nnlc_ r bei vok-�0�_
c I, C rU(
Dear Community Tracing Collaborative Partner --
On behalf of over 4,000 staff who have worked with Partners In Health at the CTC,
1 wish to thank you for your partnership. it has been our privilege to serve
the Commonwealth of Massachusetts during the unprecedented COVID-19 pandemic
and my honor to lead this team. As CTC activities begin to wind down,
we send you our best wishes for continued success and good health.
In Solidarity,
Dr. Jahn C. Welch
Executive Director of Community Tracing Collaborative
Partners In Health
Partners in Health is a global health organization relentlessly committed to improving the health of poor
and marginalized people. We build local capacity and work closely ovith impoverished communities to deliver
high-quality health care, address the root causes of illness, train providers, advance research,
and advocate for global policy change.
J. M. O'Reilly & Associates, Inc.
Engineering & Land Surveying Services
1.573 Main Street, 2nd Floor, P.O. Box 1773
Brewster, MA 02631
(508) 896-6601
Fax (508) 896-6602
TO:
Department of Environmental Protection
DATE
Attn: Title 5 Program
1
One Winter Street, 5th Floor
Routine Inspection Form
Boston, MA 02108
Shipping Method:
Regular Mail 0 Federal Express
71
Certified Mail F-1 UPS
Priority Mail F—] Pick Up
Express Mail n Hand Deliver
11
LETTER OF
RiECEI
JAN 10 2022
BREWSTER HEALTH
DEPARTMENT
SMITTAL
DATE: JOS NUMBER:
01/03/2022 9109W
7-9 Thousand Oaks Drive
Brewster, MA 02631
COPIES
DATE
DESCRIPTION
1
11/30/21
Routine Inspection Form
DEP Approved Inspection Farm
Lab Results
For review and comment: 1-1 For approval: F-1 As Requested: F-1 For your use: 0
REMARKS:
cc: John M. O'Reilly, P.E., P.L.S.
Board of Health
Client
From: GJB
If enclosures are not as noted, kindly not[fy us at once
A'-AvanTwe Field Maintenance Report
Proporh' 6ralediFscMrKJ +
C7rreen4
Cp&'aler
Christian Diaz
Pmvlotls
GJB - J.M. O'Reilly
eRe Addsess
4'
Contsol Phone
7-9 Thousand Oaks Drive
2AO cw..�Mdm Mt
774-216-1280
AX SU In i
County In Z P®d t
aN VULI
Osie of Lm Inspn$un
3"
61,
011
9-17-21
Retrieve O&M Info
gailyflou
Peckc ratlo,_
Timer settings:
Perform Fleld Sampling/Observations
wu (r8! MMU) p(a-A] OC {2.0
28.9 16.0 4.0 -
odor of Sampp�lell''
7yplcal Uktisty earthy ❑Moldy
Nowtypkol ❑SufCrda Dabbage away
oily film in FVU Des ONO
Foam Irk lank QYes ONO
Check Control Panel
Ae4m Amps nrseha+ge Aemps
12.E 1 NIA
Audible and vIauat alarms ❑X ❑K
Vial tare (leiemetry orely) ❑ Yes S�qu
Inapecl/Clean pump System
inspect Clean
RlsedLld ❑X
Sj*e Box, �... ...............
Float Cords .................. NX
Floats ....................... 0 ❑
Pump....................... 0 ❑
Biotube° Filter ................. ❑X ❑
Bhntuba Pump Vault , .......... 0 ❑
F[Wrculafhag Splitter Valm ..... X❑ ❑
comments
Signature
Measure Sludge/Scum
Sludge Scum
las Com.pwr men?.
C7rreen4
PmNaus
CurrH'a
Pmvlotls
Clean
2"
4'
Q
O
2AO cw..�Mdm Mt
Cvr l
Previous
Current
Prevloue
inspect/Clean Qlscharge Pump System
3"
61,
011
a„
InspeottClean Adva» Tex Filter
nlspar6ad Type
Additlonal Services Rendered
hrtspsat
Clean
Odor. ❑X Normal Dungant
Lalarals/Odifces ❑X
❑
Blamat: NNarmal ME`xcesslve
Pod Bottom ❑X
❑
e/mInor Dxcesslva
Brldging/Ponding: ❑X Nonr
hntakeyent Q
❑
inspect/Clean Qlscharge Pump System
Inspect
Inspect
Clean
AiserKid ❑X
Floats 0
❑
sp%e Box 7
Pump Q
❑
Float Cords 19
Inspeet/Servlce Other System Components
Inspect CSaan Insli—�—elct Clean
afslnleetfon Equipment ❑ El Dispersal Lateralsl4rifiaes 1J ❑
nlspar6ad Type
Additlonal Services Rendered
Dieaned texillo sheels7
[]Replaced W Hems9
❑ReplaoedfUsed other Items?
Parts Used: W = Warranty, B w IM table (I/ approprlals seleclton)
W B Item Number Deacrfptlon
Final/Safety, Inspection
QRSV relnstaliw
❑X Lids bolted an
❑X Manifold reconnected; flush valves cloaed
OConlrol pore[ reaclfvated
Summary/Recommendations
QSystem perform[ng; no further aol[on headed
❑Call for service
r—L
LJlank needs pumping
❑abler?
ent duality passed ffeki tests.
Date 1113L1'2021
Fax completed form to 1-866.384.7404
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
11
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 IIA
Treatment and Disposal Systems
A. Installation
Christian Diaz
Owner
7-9 Thousand Oaks Drive
Facility Street Address
Brewster 02631
City Zip
Mailing address of owner, if different:
Street Address/P0 Box:
City State Zip
(774) 216 -_1280 ext.
Telephone Number
B. Authorized Service Provider
J, M. O`Reilly & Associates, Inc.
O&M Firm
1573 Main Street
Street Address
Brewster MA 02631
City State Zip
(508) 896 - 6601 ext.
Telephone Number
Greg Brehm 16949
Certified Operator Name Certification Number
C. Facility/System Information
Advantex
DEP ID Manufacturer 117
unknown
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting
Seasonal Residence — used less than 6 mo./year: ❑ Yes
D. Operating Information
11/30/2021
Inspection Date
Sludge Depth (to be checked yearly)
AX20
Model Number
❑ Remedial
//
9/17/2021
Previous Inspection Date
Pumping Recommended ❑ Yes ® No
t5aiom.doc • rev. 04-11-13 Page 1 of 3
LlMassachusetts Department of Environmental Protection
B u reau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Calor: ❑ gray ❑ brown ❑ clear ® turbid
❑ Other (specify):
Odor: ® musty ❑ earthy
Effluent Solids: ® no ❑ some
❑ moldy ❑ offensive ❑ turbid
pH 6.0 SU DO 4.0 mg/L Turbidity 28.9 NTU
6 to 9 2 or greater 40 or less
Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected
per Standard Methods and analyzed for BOD and TSS.
F. Sampling Information
Samples Taken: ❑ Influent ® Effluent
Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use
nitrogen reducing systems:
gPe
Parameters sampled: ❑ pH ® BOC] ❑ CBOD ® TSS ® TN ❑ Other (list below)
see lab results
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection & during this inspection:
System isoperating correctly mechanically.
Notes and Comments:
t5aiom.doc • rev. 04-11-13 Page 2 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 1!A
Treatment and Disposal Systems
H. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, have
conducted the required Field Testing and/or sample collection In accordance with Standard Methods,
have completed this report and the attached technology operation and maintenance checklist, and
the information reported is true, accurate, and complete as of the time of the inspection. I am a
Massachusetts ert' led opeyator in accordance with 257 CMR 2.00.
01/03/2022
Operator fgn re Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health as follows for each inspection performed:
Remedial Use -- by January 31st of each year for the previous calendar year
Piloting Use - within 45 days of inspection date
Provisional Use — by March 31th of each year for the previous 12 months
General Use — by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 511' Floor
Boston, MA 02108
t5aiom.dac • rev. 04-11-13 Page 3 of 3
A.
UPrE�}Rrlrti
Jt,
JM O'ReilIy Assoc.
CUSTOMER INVOICE
Barnstable County Health Laboratory
1543 Main Street, P 0 Box 1773
Brewster, MA 02631
Invoice Bate: 12130/2021
Invoice #:
G21129746
PQ #:
Total Paid:
$0,00
Amount Due:
$122.00
Payment Terms.
Upon Receipt
3195 Main Street, PD. Sox 427, Barnstable, MA 02630 Ph: 508.375.6605
Date
Involce
Service Procedure Description
Completed
QTY
Price
Amount
Laboratory Ammonla as Nitrogen
12%07/2421
1
$20.00
$20.40
BOD, Carbonaceous
1210712021
$30.00
$30.00
Nitrate as Nitrogen
12/07/2021
1
$12.00
$12.00
Nitrite as Nitrogen
12107/202/
1
$12.00
$12.00
TKN
12107/2021
1
$28,00
$28.00
Tota[ Suspended Solids
12/07/2021
$20.00
$20.00
Grand Total:
$122.00
3195 Main Street, PD. Sox 427, Barnstable, MA 02630 Ph: 508.375.6605
J.M. O'Reilly & Associates, Inc.
Engineering & Land Surveying Services
1573 Main Street, 2nd Floor, P.O. Box 1773
Brewster, MA 02631.
(508) 896-6601
Fax (508) 896-6642
TO:
Department of Environmental Protection
Attn: Title 5 Program
One Winter Street, 5th Floor
Boston, MA 02108
Shipping Method:
Regular Mail 0 Federal Express
Certified Mail F-1 UP5 71
Priority Mail F—] Pick Up 171
Express Mail E-1 Hand Deliver ❑
DATE:
01/03/2022
u
RECEN
JAx OTP
BREWSTER HEALT1-i
DEPARTMENT
ER OF
MITTAL
JOB HUMBER:
8082W
White Rack Commons Subdivision, White Rock Road, Brewster
COPIES
DATE
DESCRIPTION
1
11129121
DEP Approved Inspectlon Form
SeptiTech Form
Lab Results
For review and comment: F7 For approval: ❑ As Requested: 1-1 Far your use:
REMARKS:
cc: John M. O'Reilly, P.E., P.L.S.
Board of Health
Client
From: GJB
If enclosures are not as noted, kindly notify us at once
Site/Address: White Rock Commons Subdivision
White Rock Road
Brewster, MA 02531
Date: 11/29/2021 Time: 8:45am Rep. Greg Brehm
1. Remove lids & covers on processor. Visually inspect media & spray pattern.
2. Exercise entire system in maintenance mode.
a. Recirculation pump(s)
b. Pumpback pump(s)
c. Discharge pump(s)
3. Perform maintenance/cleaning tasks required for proper operation of unit.
a. Spray headers
b. Media
c. Screen
4. Take effluent sample from sample tube
5. Record following values from controller read-out (Discharge Pump)
Days Runtime: 9 9
Hours Runtime: 3 2
Seconds Runtime; 792.5 21115'1
6. Record controller program version: Commercial
7. Record controller firmware version: V121
8. List parts and supplies used:
GJB (Initial)
GJB (Initial)
GJB (Initial)
GJB (Initial)
GJB (Initial)
GJB (Initial)
GJB (Initial)
GJB (Initial)
9. Return system to "run" mode GJB (initial)
10. Re -install covers and lids on processor. GJB (Initial)
11. Check air intake muffler for obstruction and proper draw. GJB (Initial)
General Notes and Remarks: The system is operating correctly mechanically. Effluent quality passed field tests.
Effluent sample collected for lab analysis.
C:Wscrs�dmlApp�awV-ncnfWlicrom111WiodonaLTe poraq Ttvmel FiteslCuntmr.Otxloaklf.Q7TPOQYkepriWh.dw
Important. When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
kkey./
II�—V
Massachusetts Department of Environmental Protection
Bureau of Resource Protection Title 5
DEP Approved Inspection and O&M Form for Title 5 l/A
Treatment and Disposal Systems
A. Installation
White Rock Commons Subdivision
Owner
White Rock Road
Facility Street Address
Brewster 02631
City
Mailing address of owner, if different:
P.O. Box 3843
Street Add resslPO Box:
New haven CT
City State
(203) 312 - 3484 ext.
Telephone Number
B. Authorized Service Provider
J. M. O'Reilly & Associates, Inc.
O&M Firm
1573 Main Street - P.O. Box 1773
Street Address
Brewster MA
City State
(508) 896 - 6601 ext.
Telephone Number
Greg Brehm
Certified Operator Name
ZIP
16149
Certification Number
05525
Zip
02631
Zip
C. FacilitylSystem Information
BREW-Soul57-Sep Septitech M3004N
DBP ID Manufacturer 1D Model Number
Unknown January 2016
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence — used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
11129/2021 0912012021
Inspection Date Previous inspection Date
Sludge Depth (to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc • rev. 04-11-13 Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field inspection:
Color: ❑ gray ❑ brown ® clear
❑ Other (specify): —
Odor: ❑ musty ® earthy ❑ moldy
Effluent Solids: ® no ❑ some
❑ turbid
❑ offensive ❑ turbid
pH 6,5 SU DO 4.0 mg/L Turbidity 1.06 NTU
6 to 9 2 or greater 40 or less
Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected
per Standard Methods and analyzed for BOD and TSS..
F. Sampling Information
Samples Taken: ❑ Influent ® Effluent
Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use
nitrogen reducing systems:
gpd
Parameters sampled: ❑ pH ® BOD ❑ CBOD ® TSS ® TN ❑ Other (list below)
See attached lab results
Other i
Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection & during this inspection:
Maintenance completed per manufacturer's checklist.
Notes and Comments:
The system is operating correctly mechanically.
t5aicm.doc • rev, 04-11-13 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and a&ill Form for Title 5 1!A
Treatment and Disposal Systems
H. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, have
conducted the required Field Testing and/or sample collection in accordance with Standard Methods,
have completed this report and the attached technology operation and maintenance checklist, and
the information reported is true, accurate, and complete as of the time of the inspection. I am a
Massachusetts certifi d op Dior in accordance with 257 CMR 2.00.
01/0312022
Operator 5igriat r ❑ate
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health as follows for each inspection performed.
Remedial Use — by January 315; of each year for the previous calendar year
Piloting Use - within 45 days of inspection date
Provisional Use -- by March 31th of each year for the previous 12 months
General Use — by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 51h Floor
Boston, MA 02108
t5aicrn.doc • rev. 04-11-13 Page 3 of 3
r.
CERTIFICATE
OF ANALYSIS
METHOD 9
Collection Address: White Rack Rd HOA,Brewster-Effluent
TESTED TWE
Sample Location: 8082W
Barnstable County Health
Laboratory (M-MA009)
EPA 300.0
ITEM RESULT
Nitrate as Nitrogen
Recipient:
BOD (5 DAY) TEST
Order No.: 021129744
I
Nitrite as Nitrogen
JM O'Reilly Assoc.
Report dated; 12/22/2021
2.2
1543 Main Street, P O Box 1773
Submitter: JM O'Reilly Assoc.
EPA 300.0
Brewster, MA 02631
Description: LAB ANALYSIS
Laboratory IN: 21129744-01
RL
Sample #:
METHOD 9
Collection Address: White Rack Rd HOA,Brewster-Effluent
TESTED TWE
Sample Location: 8082W
0.10
Test Parameters
EPA 300.0
ITEM RESULT
Nitrate as Nitrogen
9.5
BOD (5 DAY) TEST
5.0
Nitrite as Nitrogen
0.34
TKN
2.2
Total Suspended Solids
3.6
Attached please find the faboratory certified parameter Ilst.
Matrix: Water - Waste Water
Sampled: 11/29/2021 9:10 By: GJB
Received: 11/30/2021 12:00 By: Veronic
Turn Around: Standard
UNITS
RL
MCL
METHOD 9
ANALYST
TESTED TWE
mg1L
0.10
10
EPA 300.0
CL
12/01/2021
mg1L
2.0
SM 5210 B
CL
12/0112021
mg1L
0.050
1.0
EPA 300.0
CL
12/0112021
mg1L
0.25
EPA 351.2
AB
12/0712021 14:22
mg1L
2.0
SM 2540D
SL
1210212021
Approved
By:
(Lab Manager)
ND = None Detected RL n Reporting Limit MCL = Maximum Contaminant Level
3195 Main Street, Po. Box 427, Barnstable, MA 02030 Ph: 506-375.6605 Page: 1 of 1
J.M. O'Reilly & Associates,
Engineering & Land Surveying Serviet
1573 Main Street, 2nd Floor, P.D. Box I')
Brewster, MA 02631
(508) 896-6601
Fax (508) 896-6602
TO:
Department of Environmental Protection
DATE
Attn: Title 5 Program
1
One Winter Street, 5th Floor
Routine Inspection Form
Boston, MA 02108
Shipping Method:
Regular Mail 0 Federal Express
Lab Results
Certified Mail El UPS
Priority Mail F—] Pick Up
Express Mail F] Hand Deliver
❑
Inc.
RECEIVE
JAN 14 2022
BREWSTER HEALTH
DEPARTMENT
DATE:
01/06/2022
39 McGuerty Road
Brewster, MA 02631
ETTER OF
SMITTAL
JOB NUMBER:
8248BUU
COPIES
DATE
DESCRIPTION
1
11/30/21
Routine Inspection Form
DEP Approved inspection Form
Lab Results
For review and comment: 71 For approval: ❑ As Requested: El For your use: 571
RFKnARKS-
cc: John M. O'Reilly, P.E., P.L.S.
Board of Health
Client
From: GJB
If enclosures are not as noted, kindly notify us at once
FIELD INSPECTION & SERVICE REPORT
FAST& wastewater treatment systems
INSTALLATION
AUTHORIZED SERVICE PROVIDER
Installation Address 39 McGuerty Road
Namd.K O'Reilly & Associates, Inc.
Owner Name Lowell & susan outstay
Street 7573 Main Street, Brewster, MA
Mail Address 39 MCGuerty Road
city Brewster state MA zip 02631
Mail Address P.O. Box 1773
city Brewster state MA zip 02631
Phone 508-237-2106 Fax
e-mail susanbaker71 @gmail.com
Phone 508-896-6601 Fax508-896-6602
e-mail gbrehmQmoreillyassac.com
INSTALLATION INFORMATION
Model No. Serial No.
i Date of Installation Date of last purnpout
MicroFast 0.5 Unknown
unknown unknown
EQUIPMENT YES NO
MAINTENANCE PERFORMED
AND COMMENTS
Electrical Panel(s)
System is operating corredly mechanically.
Visual Alarm Operating x
Audio Alarm Operating X
if resent
Blower(s)
Air Inlet kilter Clean x
Blower Hood Vents Clear x
Excessive Noise x
Excessive Vibration x
Treatment Unit(s)
Unusual Odor x
Effluent samples collected for lab analysis.
Pum out Required:
Primary Settling Zone x
taken 6-70-21
Aerobic Treatment Zone x
LIMIT RESULT
Effluent quality passed field testing.
-EFFLUENT(options)
Estimated Daily Flow
H (Standard Units) 6-9 S.U. 6,5
Akallnily = 80, NO3 R 2.0, Not = 0.0, NH3 = 2.0
Color Clear, clear
Temperature 52.52 F
Odor Slightly
Musty odor Musty
not septic
DO= 4.0 mg/L Turbidity= 5.17 NTLI
OWNER SIGNATURE
TEC
NATURE
SERVICE DATE
1113012021
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection Title 5
DEP Approved Inspection and O&M Form for Title 5 IIA
Treatment and Disposal Systems
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key,
l�=
A. Installation
Lowell & Susan ❑utslay
Owner
39 McGuerty Road
Facility Street Address
Brewster 02631
Mailing address of owner, if different'.
8treetAddress/P0 Box:
clty
(508) 237 - 2106 ext.
Telephone Number
State
B. Authorized Service Provider
Zip
J. M. O'Reilly & Associates, Inc.
O&M Firm
1573 Main Street
Street Address
Brewster MA 02631
city State
(508) 896 - 6601 ext.
Telephone Number
Greg Brehm
Certified Operator Name
G. Facility/System Information
BREW McGG39-FAS
DEP ID
unknown
Installation Date
Bio-microbics
Manufacturer ID
16149
Certification Number
unknown
Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting
Seasonal Residence -- used less than 6 mo./year: ❑ Yes
D. Operating Information
11/30/2021
Inspection Date
taken 6-10-21
Sludge Depth (to be checked yearly)
M.:
Microfast 0.5
Model Number
❑ Remedial
M ■
09/10/2021
Previous Inspection Date
Pumping Recommended ❑ Yes ® No
t5aiom.doc • rev. 04-11-13 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other (specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: M no ❑ some
pH 6.5 SU DO 4.0 mg1L Turbidity 5.17 NTU
6 to 9 2 or greater 46 or less
Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected
per Standard Methods and analyzed for BOD and TSS,
F. Sampling Information
Samples Taken: ❑ influent ® Effluent
Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use
nitrogen reducing systems:
gpd
Parameters sampled: ❑ pH ® DOD ❑ CBOD ® TSS ® TN ❑ Other (list below)
see lab results
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection & during this inspection:
System is operating correctly mechanically,
Notes and Comments:
t5aiom.doc • rev. 04-11-13 Page 2 of 3
Lll�Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
H. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, have
conducted the required Field Testing and/or sample collection in accordance with Standard Methods,
have completed this report and the attached technology operation and maintenance checklist, and
the information reported is true, accurate, and complete as of the time of the inspection. I am a
Massachusetts a tified opi
r in accordance with 257 CMR 2.60.
01106/2022
Operator Sig at a Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health as follows for each inspection performed:
Remedial Use — by January 31St of each year for the previous calendar year
Piloting Use - within 45 days of inspection date
Provisional Use — by March 311" of each year for the previous 12 months
General Use -- by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, Stn Floor
Boston, MA 02108
t5aiom.doc • rev. 04-11-13 Page 3 of 3
Laboratory 1D#• 21129745-01
CERTIFICATE
OF ANALYSIS
OO �
Received:
11130/2021 12:00 By:
Collection Address: Outslay-39 McGuerty Rd,Brewster-Effluent
Sample Location:
2.0
Barnstable County Health
Laboratory (M-MA009)
12/01/2021
0.050
ITEM RESULT
- - Recipient:
Nitrate as Nitrogen
Order No,: 621129745
mgIL
JM O'Reilly Assoc.
Report Dated: 12/30/2021
mgIL
1543 Main Street, P O Box 1773
Submitter: JM O'Reilly Assoc.
mgfL
Brewster, MA 02631
Description: LAB ANALYSIS
Laboratory 1D#• 21129745-01
Water - Waste Water
Sampled:
Sample #:
Received:
11130/2021 12:00 By:
Collection Address: Outslay-39 McGuerty Rd,Brewster-Effluent
Sample Location:
2.0
Test Parameters
12/01/2021
0.050
ITEM RESULT
UNITS
Nitrate as Nitrogen
19
mgIL
BOD (5 DAY) TEST
49
mgIL
Nitrite as Nitrogen
0A1
mgfL
TKN
8,1
mg1L
Total Suspended Solids
9
mglt_
Attached please find the laboratory certlfied parameter list.
Matrix:
Water - Waste Water
Sampled:
11130/2021 11:00 By: GJB
Received:
11130/2021 12:00 By:
Turn Around:
Standard
RL
MCL
METHOD #
'TESTED TIME
0.10
10
EPA 300.0
12/01/2021
2.0
SM 5210 B
12/01/2021
0.050
1.0
EPA 3130.0
12101/2021
0.25
EPA 351.2
12107/2021 14:22
2,0
SM 2540D
-1210212021
Approved
By:
(Lab Director)
ND � None Detected RL = Reporting Limit MCI. = Maximum Contaminant Level
3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 548-375.6605 Page: 1 of 1