421 Inspection Landfill 6-4-18 Mabbett&Associates,
Mabbett®
Bedford,MA 01730-2318
Tel.181-275-6050
info@mabbett.com
June 4,2018 www.mabbett.com
Northampton Board of Health
Joanne Levin, M.D.,Chair
City Hall
210 Main St.
Northampton, MA 01060
Re: 2018 Third-Party Inspector Report
VA Central Western Massachusetts Healthcare System(VA CWM HCS)Landfill
Leeds,Massachusetts
DSWM File#11-214-008;FMF#131329
Dear Dr. Levin:
Mabbett&Associates,Inc.(Mabbett®)is pleased to submit the attached 2018 Third-Party Inspector(TPI)Report for the
Veterans Affairs(VA)Central Western Massachusetts Healthcare System(CWM HCS)Landfill at 421 North Main Street in
Leeds, MA.If you have any questions, please do not hesitate to contact either of the undersigned at 781-275-6050.
Very truly yours,
MABBETT&ASSOCIATES,INC.
BY: , /{
Ate
ke
Michael L. Bloom Steven A.Vetere,PE, LW, LEP
Project Geologist Senior Project Manager/Section Lead,Site Assessment and
781-275-6050 ext.327 Remediation Group
bloom@mabbett.com 781-27-6050 ext.311
veteri(dmabbett.com
Enclosures: 2018 VA CWM HCS TPI Report
cc: Robert E.Michalik,Environmental Protection Specialist/GEMS Program Manager,VA CWM HCS
MassDEP Western Regional Office—Springfield,Solid Waste Management
CERTIFIED RETURN RECEIPT NO.7016 2140 0000 9714 6187
O 2018,Mabbett&Associates,Inc
5'.\AGMINA\7062006 VAMC Leeds\001\Northampton BOH\Tel Cover Letter to Northampton BOH.doc
A US Department of Veterans Affairs Verified Service-Disabled Veteran-Owned Small Business
Scientists I Engineers I Program Managers
•
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
�L�/1�t\\•. Third-Party Inspection Report—310 CMR 19.018(8)
Operation &Maintenance
II. Third-Party Inspector
Carol Bois Bois Consulting Co., Inc.
Third-Party Inspector Name Company Name
X262116 06/01/2019
MassDEP Third-Party Inspector Identification Number MassDEP Third-Part/Inspector Expiration Date(MWDDNYYY)
508-788-9988 cb@boisconsulting.com
Telephone Number Email Address
131 Brook St.
Mailing Address
Framingham MA 01701
City/Town State ZIP Code
Construction and Demolition Waste(C&D Waste)Processing Facility or C&D Waste Transfer Station Only:
Identify the qualified indvidual that conducted the observation of incoming waste loads and collection of samples of suspect asbestos-
containing materials during the inspection[pursuant to 310 CMR 19.018(6)(f)). If the entire inspection was conducted by the third-party
inspector listed above,then check the box and enter only the Asbestos Inspector Certification Number.
❑Same as above. Provide Asbestos Certification Number► MA Dept.of Labor Standards Asbestos Inspector Certification Number
Asbestos Inspector Name Company Name
Telephone Number Email Address
Mailing Address
City/Town Stale ZIP Code
Ill. Inspection Details
A. FREQUENCY
Indicate the scheduled inspection frequency for this facility as required by 310 CMR 19.018(6)(6),or a more frequent schedule set forth
in the Facility Permit/Other Approval:
❑ Bi-Monthly 0 Quarterly ❑ Semi-Annual ® Annual ❑ Biennial
•
❑ Other(Include permit/approval type and date of issuance):
B. DATE,TIME&PERSONNEL
Inspection Date(MM/DD/YYYV): 04/26/2018
Inspection Start Time: 10 ®AM 0 P
Facility Representatives in Attendance During Inspection: Robert Michalik, Environmental Protection Specialist
C. CONDITIONS
Air Temperature: Approximately 60 degrees F. Wind Direction(direction from which the wind is blowing):
Weather: ❑ Clear ® Partly Cloudy 0 Cloudy - ❑NW ❑N ❑NE
® Dry ❑ Rain ❑ Snow ❑w • ❑E
Wand Speed: ® Calm 0 Breeze 0 Moderate 0 Strong 0 sw ❑s Et SE
MassDEP Massachusetts Department of Environmental Protection Important:When completing
Bureau of Waste Prevention /Solid Waste Management Dm lam an keuse
only the Tabeb key
computer,bb move your
Third-Party Inspection Report-310 CMR 19.018(8) cursor-ml the Return lay.
Operation &Maintenance
Instructions
Use this form to record and report the results of a Third-Party Operation and Maintenance r IrirrilaSSDEP use Only 4
Inspection conducted pursuant to 310 CMR 19.018. Be sure to obtain the most recent version RecaOafe: -
of this form. All applicable sections of the submitted form must be completed to be accepted by
MassDEP.
Pursuant to 310 CMR 19.018(8)(a),the third-party inspector and facility owner/operator must sign FMF#+
this Third-Party Inspection Report form and submit the completed report to the appropriate RO#;
MassDEP regional office and one copy of each completed report to the board of health of the
municipality in which the facility is located. Renewer::
•
In the event that this inspection report contains a recommendation for corrective action(s),the .Comments:: -
owner/operator shall also submit the information required by 310 CMR 19.018(8)(c)2. -
Forms and instructions are available online:
http://www.mass.pov/eea/agencies/massdep/recycle/approvals/solid-wasteapplicationsand-forms.html#8
Note: This form does not identify all of the requirements applicable to each solid waste
management facility;other requirements and/or policies may apply to the operation, maintenance
and monitoring for each facility. -
I. Facility Information
Facility Type(check one):
❑Transfer Station/Handling Facility 0 C&D Waste Processor or C&D Waste Transfer Station ❑ Municipal Waste Combustor
❑Active Landfill ® Closed Landfill ❑ Other:
Spedf'
Facility:
VA Central Western Massachusetts Healthcare System
Facility Name
Leeds MA 01053
City/Town State ZIP Code
413-584-4040 411588 131329
Telephone Number Regulated Object Account Number FMF Number
Operator:
VA Central Western Massachusetts Healthcare System
Operator Name(Doing Business As/Company Name)
413-584-4040
Telephone Number Email Address
421 Main Street
Mailing Address
Leeds MA 01053
City/Town State ZIP Code
Permittee:
VA Central Western Massachusetts
Permittee Name(Entity Identified on Facility Permit)
421 Main Street
Mailing Address
Leeds MA 01053
City/Town State ZIP Code
Responsible Official for the Facility:
Mr.Andrew McMahon andrew.mcmahon@va.gov
Responsible Official Name(Individual) Responsible Official Email Address
Associate Director 413-584-4040
Responsible Official Company Name Responsible Official Telephone Number
fl
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention / Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
V. Performance Standards
Examine and evaluate the facility's solid waste activities, equipment,operations, practices, procedures and records relevant to the type
of solid waste facility.
Using the tables below,identify all areas evaluated by the inspector during the inspection by checking the box in the first column.
Describe all deviations noted during the inspection in the third column. Provide recommendations for corrective action to return to
compliance with the applicable performance standard in the fourth column.
Facility Type Performance Standards
Transfer Station/Handing Facility Complete Section A.
(Including C&D Facility) If C&D Handling/Processing Facility,then also complete Section B.
Municipal Waste Combustor Complete Section A.
Active Landfill Complete Sections C. and F.
If active ash landfill,then also complete Section D.
Closed Landfill ' Complete Sections E.and F.
A. TRANSFER STATION, HANDLING FACILITY,OR MUNICIPAL WASTE COMBUSTOR(INCLUDING C&D FACILITY)
Comments/Observations and
Evaluated Performance Standard Deviation(s) Recommended Corrective
Action(s)
19.205(1)
Storm Water Controls.
19.205(2)
CI Equipment.
19.205(3)
Weighing Facilities.
0 19.207(1) Discuss in Section VI. Discuss in Section VI.
General.
19.207(2)
Supervision of Operation.
19.207(3)
D Access to Facilities.
19.207(4)
El Security.
19.207(5)
CI Posting of Handling Facility.
19.207(6)
CI Unloading of Refuse.
19.207(7)
Special Wastes.
19.207(8)
BannedlResthcted Wastes.
19.207(9)
Hazardous Waste.
19.207(10)
CI Household Hazardous Waste
and Waste Oil Collections.
19.207(11)
Bullry Waste.
19.207(12)
O Liquid Wastes.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report—310 CMR 19.018(8)
Operation &Maintenance
IV. Pre-Inspection Preparation
A. FACILITY-SPECIFIC O&M REQUIREMENTS
During each third-party inspection,the third-party inspector shall examine and evaluate the facility's solid waste activities, equipment,
operations, practices, procedures, and records relevant to the type of third-party inspection being conducted in order to determine the
facility's compliance with all applicable requirements as set forth in 310 CMR 19.018(6)(a)1.
Therefore, pursuant to 310 CMR 19.018(6)(a)1, prior to conducting a third-party facility operation and maintenance
inspection, the third-party inspector shall,without limitation,complete all of the following:
Z Review and become familiar with the regulations set forth at 310 CMR 19,000—Massachusetts Solid Waste Regulations.
® Identify, review and become familiar with all solid waste permits, plans, approvals, and orders(or other enforcement documents
issued to the facility by the Department),and the solid waste requirements applicable to the operation and maintenance of the
facility.
Relevant requirements may include,without limitation,specific practices and procedures for the operation, maintenance and
monitoring of the facility,waste acceptance/storage limits,and other requirements related to the facility's solid waste activities.
Wnhout limitation,these facility-specific requirements may be contained in the Facility Permit,Authorization to Construct
Authorization to Operate, Operation and Maintenance Plan,Closure/Post-Closure Plans and Approvals, Facility Modification
Approvals, Beneficial Use Determinations,Administrative Consent Orders, and other determinations,authorizations or
enforcement actions issued by the Department.
I, Carol do Groot Bois,have identified, reviewed and understand all of the aforementioned requirements iv CB
that are applicable to this facility and the following are my observations and recommendations related to Inspector Initials
the facility-specific requirements.
B. SOLID WASTE PERMITS, PLANS,APPROVALS&ORDERS
List all relevant solid waste permits, plans, approvals,orders or other enforcement actions issued to the facility by the Department that
contain specific practices, procedures and other requirements still in effect for the operation, maintenance and monitoring or
dosure/postclosure of the fadhty. Where applicable, provide the plan or issue date for each item. For enforcement actions,Include
the document number,effective date, and status of implementation by the facility.
Discussion: May 12,2008 MassDEP Corrective Action Design Approval; September 12,2011 MassDEP Closure Certification
Approval/Determination;no current known enforcement actions relatived to this solid waste landfill facility.
Massachusetts Department of Environmental Protection
ILL Bureau of Waste Prevention I Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
C. ACTIVE LANDFILL
Comments/Observations and
Evaluated Performance Standard Deviation(s) Recommended Corrective Action(s)
El 19.130(1) Discuss in Section VI. Discuss in Section VI.
General.
19.130(2)
Operator Supervision.
19.130(3)
0 Special Wastes.
19.130(4)
0 Banned/Restricted Wastes.
19.130(5)
0 Hazardous Waste.
19.130(6)
0 Bulky Wastes.
19.130(7)
Liquid Wastes.
19.130(8)
0 Solid Waste Handling.
19.130(9)
El Bird Hazards.
19.130(10)
Equipment and Shelter.
19.130(11)
Staffing.
19.130(12)
0 Employee Facilities.
19.130(13)
0 Accident Prevention/Safety.
19.130(14)
O Spreadng and Compacting of
Solid Waste.
19.130(15)
Cover Material.
19.130(16)
0 Vector, Dust and Odor Control.
19.130(17)
Utter Control.
,� 19.130(18)
Top Slope and Side Slopes.
19.130(19)
0 Storm Water Drainage.
19.130(20)
Erosion Control.
19.130(21)
0 Boundary/Elevation Markers.
19.130(22)
Access Roads.
19.130(23)
ID Security.
19.130(24)
0 Posting of the Landfill.
Massachusetts Department of Environmental Protection
iii.,_ Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
Comments/Observations and
Evaluated Performance Standard Deviation(s) Recommended Corrective
Action(s)
19.207(13)
Bird Hazards.
19.207(14)
Dust Control.
19.207(15)
Vector Control.
19.207(16)
D
Control of VNnd-blown Litter. •
19.207(17)
Staffing.
19.207(18)
Employee Fadlities.
19.207(19)
Accident Prevention/Safety.
19.207(20)
Fire Protection.
19.207(21)
Recycling Operations.
19.207(22)
Records for Operational and
Plan Execution.
19.207(23)
Screening and/or Fencing.
19.207(24)
Open Burning.
19.207(25)
Inspections.
19.207(26)
End-of-Life Mercury-added
Products.
B. CONSTRUCTION AND DEMOLITION(C&D)WASTE PROCESSING FACILITY OR C&D WASTE TRANSFER STATION
Comments/Observations and
Evaluated Performance Standard Deviation(s) Recommended Corrective
Action(s)
19.206(1)
Enclosed Operations.
19.206(2)
Storage.
19.206(3)
Contact Water.
D Suspect Asbestos-Containing
Material(ACM)Inspection and
Management Protocol.
0
Sample collection of suspect
ACM from incoming loads. Discuss sample results:
► 0 Attach analytical reports.
LiMassachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
E. CLOSED LANDFILL
CommentsfObservations and
Evaluated Performance Standard Deviation(s)
Recommended Corrective Action(s)
19.016
El n/a Na
Post-closure Use.
®
19.142(1) Discuss in Section VI. Discuss in Section VI.
General.
El 19.142(2) Ns Na
Post-closure Period.
® 19.142(3) Na Na
Post-closure Period Waiver.
L 19.142(4) Na Na
Post-closure Period Extension.
El 19.142(5) none observed minor areas of erosion to be repaired
Post-closure Requirements.
® 19'742(6) Inspection on 426/2018 none
Inspection Requirements.
® 19.142(7)
Additional Measures. none none
El 19.142(8) Na Na
Termination of the Post-
Closure Period.
El 19.143(1) Na There is no change in post-closure use
Applicability.
El 19.143(2) Na Na
Submission of Post-closure
Use Plans.
® 19.143(3) Na Na
Criteria for Approval of Post-
dosure Use.
El 19.143(4) Na Na
Post-closure Construction.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
Evaluated Performance Standard Deviation(s) Comments/Observations and
Recommended Corrective Action(s)
19.130(25)
0
Open Burning.
19.130(26)
Fire Protection and Control.
19.130(27)
Convenience and Recycling
Drop-off Areas at Landfills.
19.130(28)
Waste Oil Collections at
Landfills.
19.130(29)
Household Hazardous Waste
Collections at Landfills.
19.130(30)
Leachate Collection,
Treatment and Disposal.
19.130(31)
Phase Completion of the
Landfill.
19.130(32)
Disruption of Landfilled Areas.
19.130(33)
Construction of Buildings.
19.130(34)
Records for Operational and
Plan Execution.
19.130(35)
Inspections.
19.130(36)
Re-circulation of Leachate.
19.130(37) End-of-Life
Mercury-added Products.
D. ASH LANDFILL
Evaluated Performance Standard Deviation(s) Comments!observatlons and
Recommended Corrective Action(s)
19.131(1)
General. Discuss in Section VI. Discuss in Section VI.
19.131(2)
Fugitive Emissions.
19.131(3)
Ash Moisture Content
19.131(4)
Spreading/Compacting of Ash.
19.131(5)
Vehicle Washdown/
Wheelwash/Other Measures.
Massachusetts Department of Environmental Protection
ILL Bureau of Waste Prevention / Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
F. ADDITIONAL LANDFILL REQUIREMENTS—Continued •
CommentslObservations and
Evaluated Performance Standard Recommended Corrective Action(s)
19121(4) No Landfill gas monitoring is required by the permit.
Landfill Gas Recovery Operation and Maintenance
Requirements.
Is condensate generation kept to a minimum and
condensate redreulafion,if proposed, performed in
accordance with the permit?
❑YES 0N
Are the sampling and analysis of condensate conducted
on the schedule established in the permit or as otherwise
required by the Department?
❑YES ❑ NO
Are the analytical results of condensate monitoring
reported to the Department as established in the permit or
as otherwise required by the Department?
❑YES ❑ NO
Is an annual report on the operation of the landfill gas
recovery facility submitted to the Department as specified
in the permit?
CI YES CI NO
. .
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report—310 CMR 19.018(8)
Operation &Maintenance
F. ADDITIONAL LANDFILL REQUIREMENTS
Evaluated Performance Standard Comments/Observations and
Recommended Corrective Action(s)
19.132
Environmental Monitoring Requirements. Mabbett&Associates conducted the required
environmental sampling(groundwater and surface
Is the monitoring of surface water, ground water,landfill water)on April 28,2018.No landfill gas monitoring was
gas and any other media as determined by the required by MassDEP. The results will be submitted
Department,including without limitation, soil and within 60 days(on or before June 26,2018)as
sediment, being conducted on the schedule established in required.
the permit or as otherwise required by the Department?
®YES ❑ NO •
Are the analytical results of the environmental monitoring
submitted to the Department within 60 days after the date
of sample collection or as otherwise specified by the
Department?
EYES 0 N
19.133
Maintenance of Environmental Control and Monitoring Resetting of concrete seal around wells MW-3S and
MW-4S was completed by the VA as recommended by
Systems. the WI in 2017.
Are the facility operations conducted in a manner which
protects all environmental control systems as approved in
the Operation and Maintenance plan and monitoring
systems as approved in the Operation and Maintenance
plan or permit?
ElYES 0 N
Is regular maintenance of all landfill environmental control
systems performed as approved in the Operation and
Maintenance plan or permit?
®YES ❑ NO
Has the Department been notified of the existence and
extent of damaged or destroyed environmental control
systems, monitoring devices,or surface water sampling
location markers in accordance with 310 CMR
19.133(1)(c)and/or 19.133(1)(e)?
® N/A(if no damage to report) ❑YES ❑ NO
Continue to Next Page is
' ' Massachusetts Department of Environmental Protection
LC Bureau of Waste Prevention / Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
VII. Summary and Recommendations
Pursuant to 310 CMR 19.018(6)(a)4.,where a third-party inspector observes that the operation or maintenance of the facility deviates
from the aforementioned applicable requirements, he or she shall document all such deviations and recommend corrective actions for
the facility to take to return to compliance.
A. INSPECTION RESULTS
Based on the examinations and evaluations conducted in Sections V. and VI.,please summarize the inspection results by checking one
of the following determinations:
® No deviations from the applicable performance standards or additional requirements listed at 310 CMR 19.018(6)
were identified during this inspection.
If no deviations were identified during the inspection,check this box and proceed to Section VII.B.
D Deviations from the applicable performance standards or additional requirements listed at 310 CMR 19.018(6)were
identified during this inspection and are discussed further in this report.
If deviations were identified during the inspection, check this box and ensure that each deviation and the recommended
corrective actions are discussed in the applicable section(s)below.
B. STATUS OF PREVIOUS RECOMMENDATIONS FOR CORRECTIVE ACTION
If a previous inspection report identified deviations with recommendations for corrective action,please describe the action(s)taken
since the last inspection to return the facility to compliance with the applicable requirements.
Discussion: not applicable-no prior deviations in 2017
C. RECOMMENDATIONS FOR CORRECTIVE ACTION
Based on the results of this inspection, please list all deviations noted during the inspection and provide recommendations for corrective
action to return to compliance with the applicable requirement.
Recommendations: none
D. ADDITIONAL COMMENTS
Comments:When small area of erosion near MW-3S is dry,repair minor erosion.A determination should be made if the Record
Notice of September 12,2011 MassDEP Closure Certification letter was recorded in the Hampshire County Registry of Deeds.
VIII. Additional Information Checklist
Attach the following additional information, as applicable,to complete the inspection report.'
❑ Attach photographs taken during the inspection that depict the general condition and operation of the facility,as required in
Section VIA.
❑ For C8D Waste facilities only, attach the analytical results,as required in Section V.B.
*Note:Pursuant to 310 CMR 19.016(8), MassDEP may request additional information.
Continue to Certification Statement on Next Page P
•
•
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
VI. Inspection Observations
A. FACILITY CONDITION AND OPERATIONS
Examine and evaluate the facility condition and operations as observed during the inspection,including the following:
❑ Describe any evidence of the following conditions observed at the time of the inspection:
• Unpermitted discharges to air,water, land or other natural resources of the Commonwealth; and
• Dust,odors, litter, and/or other nuisance conditions.
❑ Document and discuss all deviations from any specific requirements for the facility that are not addressed in the previous section
(Section V.—Performance Standards),including without limitation,the requirements set forth in the fadlity's operation and
maintenance plan,orders or other enforcement documents, and other solid waste permits, approvals, and authorizations issued to
the facility by MassDEP.
❑ List the types and estimated quantities of all waste and materials stored at the fadlity at the time of the inspection.
® Provide a narrative that describes the overall status of the general condition,operation and performance of the facility as
observed at the time of the inspection.
bAttach photographs taken during the inspection that depict the general condition and operation of the facility. At a minimum,include
photographs, as applicable,of the waste unloading(tipping)area,waste storage areas, recyclable material storage and,for transfer
stations,the waste reloading activity.
Discussion:This is a dosed landfill that the Third Party Inspector(Ms. Carol Bois)observed to be in good condition at the time of
the site visit on 4/26/2018.The capped landfill is well maintained.The gates had locks on them(open for inspection),signs were
present;the area is fully fenced and the fence in good condition. No unusual settlement was noted. Stormwater drainage system
appeared to be functioning as intended. Groundwater monitoring wells MW-3S and MW-4S were repaired(concrete seals)as
recommended last visit(2017);this did not affect the water quality results.Some minor erosion had been repaired but an area on
the east side of the landfill,at the bottom of the slope,was noted to need some additional coverage with grass(approximately 10
feet by 10 feet area near MW-3S).The area was wet from rain the day before,so recommendation is to wait until the area has
dried a bit then repair slight erosion.
No evidence of any leachate breakout around the landfill in the nearby surface water.
This is the 3rd TPI inspection since the program was implemented by MassDEP; no prior corrective actions were noted in 2017.
Photographs not needed as this is a dosed facility.
B. RECORD REVIEW
Examine and evaluate the facility's record-keeping. Without limitation, document the status of the facility's compliance with,and any
deviations from,the record-keeping required by 310 MCR 19.000;the facility's operation and maintenance plan; orders or other
enforcement documents issued to the facility;and other solid waste permits, approvals, determinations and authorizations issued to the
facility by the Department, including the following:
EI Discuss the evaluation of the Facility's"daily log"such as, daily tonnage records.
0 List and discuss any special incidents that have occurred since the previous inspection such as exceedances of the facility's
permitted waste acceptance limits,nature and outcome of complaints reported to the facility operator(including the identity of the
complainant, if known),fires, emergencies, or other disruptions to the routine operation of the facility.
Discussion: The permit holder(VA)has been conducting the appropriate monthly inspections and documents same in their monthly
log, provided to the TPI. No complaints,fires,emergencies or other disruptions were known to the permit holder or relayed to the
TPI.
LII
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention /Solid Waste Management
Third-Party Inspection Report-310 CMR 19.018(8)
Operation &Maintenance
IX. Certification—THIRD-PARTY INSPECTOR n
"I attest under the pains and penalty of perjury that:
j4:27-5„,
// � /
l/ (�
1. I have personally examined and am familiar with the informations' umofof Thir> arty pedor
contained in this submittal,including any and all documents
accompanying this certification statement; Carol de Groot Bois
2. Based on my inquiry of those persons responsible for obtaining the Pant Full Name
information,the information contained in this submittal is,to the best of
my knowledge,true,accurate and complete; Bois Consulting Co., Inc.
3. I have been able to conduct the third-party inspection and prepare the Company
third-party inspection report without being influenced by the facility co Y Name
owner or operator and,(if I am a municipal employee)without being
influenced by my municipal employer,by any coworker or by any May 18, 2018
elected or appointed official of the municipality;and Date(MM/ODNYYY)
4. I am aware that there are significant penalties,including,but not limited
to,possible administrative and civil penalties for submitting false,
inaccurate,or incomplete information and possible fines and
imprisonment for knowingly submitting false-inaccurate-or incomplete --- — - - - - - — - -- - ---
information"
X. Certification — FACILITY OWNER/OPERATOR
Does the facility maintain a Financial Assurance Mechanism(FAM)pursuant to 310 CMR 19.051? ❑YES 0 NO
If yes: • Enter the amount of the current FAM: $
• Enter the date of the last revision of the FAM amount, pursuant to 310 CMR 19.051(6):
As a reminder,pursuant to 310 CMR 19.051(6),the estimate of the cost of closure and post-closure
maintenance must be revised every year,and every second year shall be au. Med to the Department.
"1 certify under the penalty of law:
!l1 - -
1. That I have personally examined and am familiar with the information "-gni-rd"----11
of Responsible Official
submitted in this third-party inspection report,including but not limited to •
the statements above concerning the financial assurance mechanism in Andrew McMahon
place in accordance with any facility permit and 310 CMR 19.051,and Print Full Name
all attachments and that,based on my inquiry of those individuals
immediately responsible for obtaining the information,I believe that the Associate Director
information is true,accurate and complete.I am aware that there are Title
significant penalties both civil and criminal for submitting false
information including possible fines and imprisonment. t7s4 �
2. That,in the event that this inspection report contains a recommendation Date(MM/D IYYYY)
for corrective action(s),I have completed and attached to this report a
Corrective Action Plan and Schedule*,pursuant to 310 CMR v. pursuant to 310 CMR 19.018(8)(c),a copy of each third-
19.018(8)(c)2°
party inspection report shall be maintained at the facility in
Wok:The owner wopaakrmay akcfrocarecfmNatbnsitlsnflgedfn Me Third- accordance with the requirements of 310 CMR 19.000. The
Parry Inspection Report in a manner that isdifferent gran that recommended bythe owner aridoperalorshall make third-pary inspection reports
Third-PartyInspector,so magas to&ray Is brought back inboompliance with available to personnel or authorized representatives of the
applicable requirements Department for review at the facility upon request.
Within 30days of the • Mail this completed form to the MassDEP Regional A list of municipalities and MassDEP Regional
Inspection date: Office that serves the municipalityin which the facility Offices is available online at: IIR
is located.(Attention:Solid Waste Management) hitp:/Mow.mass.gov/eea/agenciesrmassdep/about/ .
• Send one copy to the local board of health for the conta�nd-the-massdep-repional-office-for-your- PE
municipality in which the facility is located. city-or-town.html
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