HomeMy WebLinkAboutNitrogen Loading Docso G
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON, MA 02108 617-292-5500
ARGEO PAUL CELLUCCI
Governor
JANE SWIFT
Lieutenant Governor
BUREAU OF RESOURCE PROTECTION
DEP NITROGEN LOADING
COMPUTER MODEL GUIDANCE
INTRODUCTION
BOB DURAND
Secretary
LAUREN A. LISS
Commissioner
REVISED, MAY 1999
The DEP Nitrogen Loading Computer Model is a computerized mass balance nitrate -nitrogen (NO3) loading
model for hydrogeologically defined wellhead protection areas (DEP approved Zone IIs) for public supply wells.
The Commonwealth of Massachusetts, Department of Environmental Protection, funded the computerization of
this nitrogen loading model in response to the public health threat caused by the increasing number of public supply
wells that are approaching the federally mandated drinking water standard for nitrate of 10 milligrams per liter (mg/1).
At the time of this writing there are over sixty public water supply wells that exceed the stated 5 mg/l nitrate planning
goal. A planning goal that is one-half of the drinking water standard has been adopted by Massachusetts because a
consistent background concentration of 5 mg/l has been shown to correlate to isolated exceedances of the drinking water
standard.
Ingestion of water exceeding the nitrate standard has been shown to cause varying levels of methe-
moglobinemia and sometimes death in infants younger than six months. It has also been linked to birth defects and the
formation of carcinogenic compounds within the body and frequently is an indicator of the presence of other toxins in
the drinking water. Increased attention nationwide on nitrate as a contaminant has been prompted by health studies and
an increasing number of groundwater sources experiencing contamination.
It is prudent to react early to gradually increasing nitrate concentrations in public supply wells because nitrate is
one of the most expensive contaminants to remove from drinking water. Using this model, the concentration that will be
realized in the future can be estimated. Proper land use planning, zoning, and nitrogen management controls, if
employed early on, will save the community from investing millions of dollars in treatment systems to remove nitrate or
to locate and develop new sources of drinking water.
DEP recommends that all communities experiencing rising levels of nitrate in their drinking water wells utilize
this model to begin planning an approach to avoid the public health and fiscal consequences of nitrate contaminated
drinking water.
Tbis information is available in alternate format by calling our ADA Coordinator at (617) 574-6872.
DEP on the World Wide Web: htioll wvaragnet.stale.mams/dep
0 Printed on Recycled Paper
MODEL USES
Planning Tool: The model is primarily a planning tool that allows communities to quickly determine how land use
development decisions will impact water quality in their public drinking water wells. The model,
when loaded with the appropriate existing and potential land use development data, will
demonstrate how differing development scenarios translate to water quality changes.
Source Approval Due to concerns over growing numbers of public supply wells experiencing increasing nitrate
for New Wells: concentrations, use of the model may be required when developing new public supply wells
designed to pump over 100,000 gallons per day or expanding an existing source by that same
amount.Changes to Drinking Water Regulations 310 CMR 22.00 will reflect this requirement.
Water Management Communities that are required through the Water Management Act's permitting process to
Withdrawal Permits: delineate Zone Ils for their wells, may, in certain cases, also be required to conduct a nitrate
loading analysis utilizing the model.
Title 5: The revised Title 5, 310 CMR 15.216(1), Aggregate Determinations of Flows and Nitrogen Loadings, may
direct communities to use the DEP nitrogen loading model to predict the nitrate concentration they can
expect in their public wells. Flexibility from the septic system density requirement of 440 gallons per day
per acre maybe granted to communities that demonstrate that they will remain below the 5 mg/I nitrate'
planning goal assuming a zoning buildout'scenario. Accompanying the modeled results must be a
nitrogen loading plan approved by the community which demonstrates that, despite varying the density
restriction, the community has a development plan with appropriate regulatory support that will not result
in exceedances of 5 mg/I in the drinking water well.
USER FRIENDLY
The model was developed to be a user-friendly tool. It was designed for use by people with elementary
computer skills. The most time consuming part of the nitrogen loading assessment is the compilation of land use
development data within the Zone II. Once the land use development data has been obtained and entered, it takes only
seconds to query the model about how different development scenarios will affect water quality.
NITROGEN LOADING CRITERIA AND MODEL ASSUMPTIONS
To quantify model inputs and standardize the nitrogen analysis, DEP has established default values based on literature
review and our best professional judgement. These default values have been programmed into the model and will be
used automatically unless, after careful consideration and supportive documentation, the user changes these defaults.
Domestic wastewater flows are calculated based on the assumption that there are 3 occupants per residence
This assumption applies to existing residences and those to be built and occupied in the future. These assumptions
are based on extensive census and demographic research about communities in Massachusetts. This in no way
contradicts or negates the need to use Title 5 design flows when designing Title 5 systems. The census figures are
averages appropriate for use on a regional (Zone II) scale with a broad timeframe. Since households and family
sizes change frequently, septic system designs must be done in accordance with Title 5 criteria. For non-residential
land uses, nitrogen inputs should be based on metered flows, if available, or flows from similar facilities.
Extrapolations from existing flows should be used for predicting future comparable land uses. Title 5 design flows
should be used in both cases if no metered or water bill data are available.
Examples of model assumption default values are:
• 35 mg/1 nitrate concentration for on -site septic systems
• 3 lbs/1000 s.f. fertilizer application per 5000 s.f. lawn per lot at 25% leachability
• 3 persons per household
• 0.3 mg/1 nitrate concentration in precipitation and runoff (incorporating NO3 in runoff and precipitation)
MODEL ADJUSTMENTS
In order to address specific circumstances, the model has been designed to let a user change default values to
better represent site specific conditions that may apply. However, changing default values will require supportive
documentation subject to DEP approval. For example, a town may have specific census data that justifies using a
different number of persons per household.
MODEL APPLICATIONS / Hvdrogeoloeic Conditions
The model has been designed to predict the nitrate concentration at the well based on land use development in
the Zone II. The model should not be applied to Interim Wellhead Protection Areas HWPAs) which are based on a
policy definition of circles of specified radius. Therefore, a DEP approved Zone II delineation is a prerequisite for the
model application. Additionally, the nitrogen model may not be applicable in certain Zone IIs for wells in confined
aquifers.
Induced Infiltration: The amount of water pumped by a well through induced recharge from nearby surface waters
should be addressed in the Zone II report. In cases where the percent of induced infiltration is not addressed, DEP
recommends a simple mass balance calculation to estimate the quantity of water pumped by the well from induced
infiltration. For this estimate, assume a recharge rate of 20 inches per year. The volume of recharge for the Zone II
divided by the annual approved pumping volume of the well equals the percent of ground water withdrawal. Therefore,
the percent of induced infiltration from surface water will equal the annual pumping volume (100%) minus the percent
of ground water withdrawal.
Multiple Well Zone IL In cases where there is only one well in a Zone II, use of the model is very straightforward. In
more complex situations involving multiple wells in one Zone II or overlapping Zone IIs, require hydrogeologic skills.
In these situations, the preparation of a Zone II Flow Path Analysis (Appendix A) may be necessary in order to segregate
individual single well Zone IIs. A model run would be required for each segregated Zone fl along with its associated
land uses. Guidance on the Flow Path Analysis procedure and how to determine this area of recharge for a specific well
in a multiple well Zone II is provided in Appendix A in and in the Division of Water Supply's 1996 Guidelines and
Policies For Public Water Systems.
MODEL OUTPUTS
At least two model runs resulting in a modeled nitrate concentration at the wellhead will be required for the
DEP nitrate analysis study: 1) Existing Condition, and 2) Zoning Buildout.
1. Existing Condition
This model run would account for nitrogen input derived from all existing land uses. All existing development
such as residences, municipal buildings, commercial stores, treatment plants, etc. as well as other land uses such
as golf courses and agricultural uses would be incorporated into this model run along with Zone II
hydrogeologic inputs. The resulting modeled NO3 concentration, which is based on the assumption that all
sources of NO3 have had time to flow with the groundwater to the well, should be compared with the observed
nitrate monitoring data for the well. The modeled concentration should be higher than the observed NO3
concentration because equilibrated conditions may take many years to be realized.
2. Zoning Buildout
A Buildout model run for the Zone II based on current zoning must also be submitted. Based on the
dimensional lot requirements of frontage and area for each zoning district, the Buildout Analysis Table
(Appendix B) must be completed as necessary input for this model run and is also required as part of the nitrate
model submittal. The Buildout Table offers guidance for the buildout analysis which accounts for existing and
all possible future development on a parcel by parcel basis for existing and vacant lots as well as for large tracts
of land within the Zone II that may be subdivided based on current zoning.
** NITRATE PLANNING GOAL: 5 MG/L:
The modeled Zoning Buildout result will be compared to the planning goal of 5 mg/I to determine if
development impacts would pose a threat to water quality based on current zoning. If the modeled outcome is 5 mg/1 or
greater at the well, nitrogen management options should be pursued. Since the nitrogen model is based on buildout land
uses dictated by the town's zoning, the model should be rerun whenever the zoning bylaw is revised.
OTHER MODEL APPLICATIONS
1. Site -Specific Project: For planning purposes, it may be useful for a town to know the nitrogen loading
potentially contributed by a specific development project. To answer this "What if' question, the estimated nitrogen
contribution from this site -specific development can be added to the current existing development model input and the
model rerun. The nitrate difference between the two model runs would be the nitrogen contribution from the specific
project. This is a very simple exercise.
2. Alternative Development Scenarios: If the Buildout modeled result is greater than the 5 mg/1 planning
threshold, alternative development strategies are recommended to ensure safe drinking water. Such management options
could involve land acquisitions, land use regulation changes to guide future development, and nitrogen reduction
strategies such as sewering or enhanced nitrogen removal treatment for on -site septic systems for existing development
to lessen NO3 source inputs. Examples of management strategies are:
Land Use Zoning could modify commercial uses in Zone Its to require limiting nitrate -nitrogen sources on an
acreage basis.
Health Re Igu ation could further limit nitrogen loading beyond Title 5 by restricting the number of bedrooms
per dwelling or by establishing nitrogen reduction standards that would require enhanced nitrogen removal for
on -site septic systems.
Site Review Process / Subdivision Rules and Regulations could require that a nitrogen loading analysis be
conducted for the proposed site development project or subdivision and that nitrogen reducing systems be
employed on an individual basis or for community systems.
To ensure that a proposed project within a Zone II would not impact water quality
at the well, a developer may elect to go the extra mile and conduct a nitrogen
loading analysis for the Zone II. The developer gains favor for project approval by
comprehensivelypredicting nitrogen impacts beyond the proposed site and the
town benefits by acquiring a Zone II nitrogen assessment.
NITROGEN REDUCTIONS IN ZONE Us
In situations where modeled results indicate that current development or zoning buildout will exceed the
5 mg/liter planning threshold and thereby present a threat to water quality, the model may be used to demonstrate how
wastewater retrofit improvements will affect drinking water quality.
For example, the nitrogen reductions from sewering a small part of the Zone II and treating the wastewater to a
higher standard, or employing several small advanced wastewater treatment plants, or retrofitting several homes with
innovative or alternative enhanced nitrogen removal systems are easily calculated by the model and compared to the 5
mg/1 planning goal.
Changing existing local zoning bylaws and regulations in nitrogen stressed Zone IIs may be necessary to avoid
costly and dangerous water quality problems. The model can be used to determine the effectiveness of various zoning
and other nitrogen management options.
SUBMITTAL REQUIREMENTS
The nitrogen analysis, at a minimum, must include:
1. Zoning map and any relevant nitrogen -related local regulations;
2. Flow Path Analysis for the Zone II, if applicable;
3. Buildout Analysis Table;
4. Model run for Existing Condition;
5. Model run for Zoning Buildout;
6. Model run for Alternative Development Scenario, if applicable;
7. Management plan consistent with achieving the 5 mg/l planning goal.
Two copies of the Nitrogen Loading Computer Model report should be sent to the appropriate DEP Regional Office.
The DEP Nitrogen Loading Computer Model may be downloaded at no charge from the DEP website
homepage at www.state.ma.us/deo.
If you require further information on the DEP Nitrogen Loading Computer Model, please contact
Tom Lamonte, BRP/Boston, at 617 292-5532.
APPENDIX A
PREPARATION OF FLOW PATHS IN ZONE II
For DEP Nitrogen Loading Computer Model Application
The following procedure provides guidance to users of the DEP Nitrogen Loading Computer Model to "
determine the area of contribution for a particular well in a multiple well Zone II. This procedure enables the Zone II for
two or more wells to be subdivided into subzone areas which contribute recharge to each well by delineating
groundwater flow paths across the horizontal plane of the Zone II.
A flow path analysis is not necessary where a Zone H has been delineated for an individual well, or where
multiple wells have a long and narrow Zone II configuration. However, the Drinking Water Program may require
additional information in determining the flow path for a particular well in a Zone IL
This procedure requires specific information and entails certain assumptions and limitations.
1. DEP approved Zone II boundary is already delineated.
2. Groundwater contours can be drawn for the Zone II, and the groundwater elevation data used to determine the
groundwater contours can be obtained or estimated for various points within the Zone II from observation well
data, topographic elevations of streams and surface water bodies, or a combination of both.
Basic Assumptions / Limitations:
1. The aquifer is unconfined.
2. The aquifer is homogeneous and isotropic. This means the hydraulic conductivity of the aquifer material, or the
ability of the aquifer to transmit water, does not vary significantly from one place in the aquifer to another or in any
direction.
3. Use of surface water elevations to prepare the groundwater contours assumes the elevation of the surface water
represents the intersection of the groundwater with the surface water at that point on the topographic map.
Steps for Flow Path Analysis: (See illustrations on following page)
1. Obtain a copy of the map showing the approved Zone II boundary and the location of all wells for which the
Zone II was determined. This map will be at the scale of the USGS topographic map (1:25,000) or larger, but
typically the Zone II is superimposed over the relevant portion of a USGS topographic map.
2. Locate the known and/or estimated groundwater elevations on the map. The groundwater elevations may be
obtained from observation well data in the Zone II report and elevations of streams (as groundwater
intersections) as shown on the USGS topographic map. From these elevations, plot the estimated groundwater
contours across the entire Zone II. Usually the Zone II Report filed with DEP/Drinking Water Program
includes a groundwater contour map under pumping conditions.
3. If necessary, extrapolate to draw the groundwater contours at more frequent intervals and to draw a sufficient
number of groundwater flow lines so the "groundwater flow divides" between wells can be estimated.
Groundwater flows perpendicular to groundwater contours. These flow lines illustrate the path of water as
its drawn to a specific well. The entire Zone If must be covered by these subzones. Generally, there will be
one subzone for each well, although wells in close proximity may share a subzone.
4. Boundaries of each subzone are located where the groundwater flow lines diverge between the wells.
The associated land use nitrogen contributions at buildout for each well's subzone recharge delineation are then
calculated in a model run to determine the nitrate loading delivered to each well. A model run will be required for each
well's individual Zone II.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 617-292-5500
ARGEO PAUL CELLUCCI
Governor
JANE SWIFT
Lieutenant Governor
BUREAU OF RESOURCE PROTECTION
DEP NITROGEN LOADING
COMPUTER MODEL GUIDANCE
INTRODUCTION
BOB DURAND
Secretary
LAUREN A. LISS
Commissioner
REVISED, MAY 1999
The DEP Nitrogen Loading Computer Model is a computerized mass balance nitrate -nitrogen (NO3) loading
model for hydrogeologically defined wellhead protection areas (DEP approved Zone IIs) for public supply wells.
The Commonwealth of Massachusetts, Department of Environmental Protection, funded the computerization of
this nitrogen loading model in response to the public health threat caused by the increasing number of public supply
wells that are approaching the federally mandated drinking water standard for nitrate of 10 milligrams per liter (mg/1).
At the time of this writing there are over sixty public water supply wells that exceed the stated 5 mg/l nitrate planning
goal. A planning goal that is one-half of the drinking water standard has been adopted by Massachusetts because a
consistent background concentration of 5 mg/1 has been shown to correlate to isolated exceedances of the drinking water
standard.
Ingestion of water exceeding the nitrate standard has been shown to cause varying levels of methe-
moglobinemia and sometimes death in infants younger than six months. It has also been linked to birth defects and the
formation of carcinogenic compounds within the body and frequently is an indicator of the presence of other toxins in
the drinking water. Increased attention nationwide on nitrate as a contaminant has been prompted by health studies and
an increasing number of groundwater sources experiencing contamination.
It is prudent to react early to gradually increasing nitrate concentrations in public supply wells because nitrate is
one of the most expensive contaminants to remove from drinking water. Using this model, the concentration that will be
realized in the future can be estimated. Proper land use planning, zoning, and nitrogen management controls, if
employed early on, will save the community from investing millions of dollars in treatment systems to remove nitrate or
to locate and develop new sources of drinking water.
DEP recommends that all communities experiencing rising levels of nitrate in their drinking water wells utilize
this model to begin planning an approach to avoid the public health and fiscal consequences of nitrate contaminated
drinking water.
This informadon is available in alternate format by calling our ADA Coordinator at (617) 574-6872.
DEP on the World Wide Web: http://w .magnet.state.ma.us/dep
0 Printed on Recycled Paper
In order to address specific circumstances, the model has been designed to let a user change default values to
better represent site specific conditions that may apply. However, changing default values will require supportive
documentation subject to DEP approval. For example, a town may have specific census data that justifies using a
different number of persons per household.
MODEL APPLICATIONS / Hvdrogeologic Conditions
The model has been designed to predict the nitrate concentration at the well based on land use development in
the Zone II. Themodelshould not be applied to Interim Wellhead Protection Areas (IWPAs) which are based on a
policy definition of circles of specified radius. Therefore, a DEP approved Zone II delineation is a prerequisite for the
model application. Additionally, the nitrogen model may not be applicable in certain Zone Its for wells in confined
aquifers.
Induced Infiltration: The amount of water pumped by a well through induced recharge from nearby surface waters
should be addressed in the Zone II report. In cases where the percent of induced infiltration is not addressed, DEP
recommends a simple mass balance calculation to estimate the quantity of water pumped by the well from induced
infiltration. For this estimate, assume a recharge rate of 20 inches per year. The volume of recharge for the Zone II
divided by the annual approved pumping volume of the well equals the percent of ground water withdrawal. Therefore,
the percent of induced infiltration from surface water will equal the annual pumping volume (100%) minus the percent
of ground water withdrawal.
Multiple Well Zone II: In cases where there is only one well in a Zone II, use of the model is very straightforward. In
more complex situations involving multiple wells in one Zone II or overlapping Zone IIs, require hydrogeologic skills.
In these situations, the preparation of a Zone If Flow Path Analysis (Appendix A) may be necessary in order to segregate
individual single well Zone IIs. A model run would be required for each segregated Zone II along with its associated
land uses. Guidance on the Flow Path Analysis procedure and how to determine this area of recharge for a specific well
in a multiple well Zone II is provided in Appendix A in and in the Division of Water Supply's 1996 Guidelines and
Policies For Public Water Systems.
MODEL OUTPUTS
At least two model runs resulting in a modeled nitrate concentration at the wellhead will be required for the
DEP nitrate analysis study: 1) Existing Condition, and 2) Zoning Buildout.
1. Existing Condition
This model run would account for nitrogen input derived from all existing land uses. All existing development
such as residences, municipal buildings, commercial stores, treatment plants, etc. as well as other land uses such
as golf courses and agricultural uses would be incorporated into this model run along with Zone II
hydrogeologic inputs. The resulting modeled NO3 concentration, which is based on the assumption that all
sources of NO3 have had time to flow with the groundwater to the well, should be compared with the observed
nitrate monitoring data for the well. The modeled concentration should be higher than the observed NO3
concentration because equilibrated conditions may take many years to be realized.
2. Zon ag Buildout
A Buildout model run for the Zone II based on current zoning must also be submitted. Based on the
dimensional lot requirements of frontage and area for each zoning district, the Buildout Analysis Table
(Appendix B) must be completed as necessary input for this model run and is also required as part of the nitrate
model submittal. The Buildout Table offers guidance for the buildout analysis which accounts for existing and
all possible future development on a parcel by parcel basis for existing and vacant lots as well as for large tracts
of land within the Zone II that may be subdivided based on current zoning.
** NITRATE PLANNING GOAL: 5 MG/L:
The modeled Zoning Buildout result will be compared to the planning goal of 5 mg/1 to determine if
development impacts would pose a threat to water quality based on current zoning. If the modeled outcome is 5 mg/1 or
3. Buildout Analysis Table;
4. Model run for Existing Condition;
5. Model run for Zoning Buildout;
6. Model run for Alternative Development Scenario, if applicable;
7. Management plan consistent with achieving the 5 mg/l planning goal.
Two copies of the Nitrogen Loading Computer Model report should be sent to the appropriate DEP Regional Office.
The DEP Nitrogen Loading Computer Model may be downloaded at no charge from the DEP website
homepage at www.state.ma.us/den.
If you require further information on the DEP Nitrogen Loading Computer Model, please contact
Tom Lamonte, BRP/Boston, at 617 292-5532.
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EMassachusetts Department of Environmental Protection
Bureau of Resource Protection —Title 5 Permitting
IL)�11 BRP WP 58a Approval of a Nitrogen
Aggregation Loading Plan
Instructions and Supporting Materials
Table of Contents
introduction
permit fact sheet
completeness checklist
Introduction
MassDEP Permit Applications, as well as Instructions & Support Materials, are available for
download from the MassDEP Web site at mass.gov/dep in two file formats: Microsoft WordTM and
Adobe Acrobat PDFTM. Either format allows documents to be printed.
Instructions & Support Materials files in Microsoft WordTM format contain a series of documents
that provide guidance on how to prepare a permit application. Although we recommend that you
print out the entire package, you may choose to print specific documents by selecting the
appropriate page numbers for printing.
Permit Applications in Microsoft WordTM format must be downloaded separately. Users with
Microsoft Word TM 97 or later may complete these forms electronically.
Permitting packages in Adobe Acrobat PDFTM format combine Permit Applications and
Instructions & Support Materials in a single document. Adobe Acrobat PDFTM files may only be
viewed and printed without alteration. Permit Applications in this format may not be completed
electronically.
wp58ains • rev. 6/15 BRP WP 58a Introduction • Page 1 of 1
Massachusetts Department of Environmental Protection
y Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
Permit Fact Sheet
Note: When completing the Transmittal Form, write the "a" immediately after the space provided for the seven
digit character code at the top of the Form.
1. What is the purpose of this approval?
This approval is necessary to ensure that the aggregation of nitrogen loading for on -site subsurface sewage
disposal system(s) is performed in an environmentally acceptable manner and in accordance with the provisions
of Title 5 of the Environmental Code, 310 CMR 15.000.
You must obtain approval from MassDEP for the following plans:
Community plans to aggregate for nitrogen loading over a region wide area, such as Zone Its or Interim
Wellhead Protection Areas (310 CMR 15.216(4)) or in environmentally sensitive areas such as systems
serving new residential construction where the use of both on -site wastewater disposal systems and drinking
water supply wells are proposed, i.e., private well areas.
2. Who must apply?
Any municipality proposing to implement a community nitrogen aggregation plan for a community is required to
obtain MassDEP approval in accordance with 310 CMR 15.216.
If this category does not apply to you, please be advised this is not the only permit category for Title 5 on -site
sewage disposal systems or related plans. Please consult the Timely Action Schedule and Fee Provisions, 310
CMR 4.00 and Title 5 of the Environmental Code, 310 CMR 15.000, to determine whether another category may
apply to you. Note: Any and all land identified as "restricted" or "credit land" for the purposes of one application for
aggregate nitrogen loading cannot be used for another application pursuant to 310 CMR 15.216.
Note: MassDEP anticipates the preparation of a Community Plan proposing to aggregate for nitrogen loading
may require both technical (including hydrogeologic) and legal expertise.
3. What other requirements should be considered when applying?
Plans proposing nitrogen restrictions on facility and credit land(s) require prior written approval by the property
owner(s) (310 CMR 15.216(5)).
Note: These additional requirements are intended to serve as a guide to the applicant. They do not necessarily
include all additional requirements.
4. What is the application fee?
No fees charged for municipalities.
5. What is the Primary Permit Location? What is the Reserve Copy Location?
Primary Permit Location:
Department of Environmental Protection (2 copies)
* Regional Office
Title 5 Permitting Program
*Find your region http://www.mass.gov/eea/agencies/massdep/about/contacts/
There are no Reserve Copy Locations for these permits.
wp58ains • rev. 6/15 BRP WP 58a Permit Fact Sheet • Page 1 of 2
El
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
Permit Fact Sheet
6. Where can I get a copy of the timelines?
The timelines are available on the MassDEP Website:
http://www mass gov/eea/agencies/massdep/service/approvals/timely-action-fees-and-payments html
7. What is the annual compliance fee?
There is no annual compliance fee.
8. How long is the approval in effect?
This approval remains valid until MassDEP revokes or modifies the approval. A Community Plan approval is in
effect until there is a local land use regulation change or other action that would impact the MassDEP approved
nitrogen loading plan.
9. How can I avoid the most common mistakes made in applying for this approval?
a. Review application for completeness to be sure all questions are answered correctly.
b. Refer to the Department's, "Guidelines For Title 5 Aggregation of Flows and Nitrogen Loading (310 CMR
15.216)" for further guidance.
c. For a Community Plan, attach the following:
• completed application with supporting materials;
• a map for the area covered by the plan;
• buildout analysis under current zoning for the area covered by the plan;
440 gpd per acre equivalency calculations;
in the case of a Zone II, results of the MassDEP Nitrogen Loading Computer Model;
• approval from the local approving authority;
comments from the Planning Board, if any;
• a nitrogen loading management plan.
d. Submit a copy of the MassDEP Transmittal Form to:
Department of Environmental Protection
P. O. Box 4062
Boston, MA 02211.
10. What are the regulations that apply to this approval? Where can I get copies?
These regulations include, but are not limited to
a. Title 5 Regulations, 310 CMR 15.000.
b. Timely Action Schedule and Fee Provisions, 310 CMR 4.00.
These may be purchased at:
State Bookstore State Bookstore
Room 116 436 Dwight Street, Room 102
Boston, MA 02133 Springfield, MA 01103
617-727-2834 413-784-1376
MassDEP Title 5 Regulations and permit application packages also may be obtained from MassDEP's web site at
http://mass.gov/dep
wp58ains • rev. 6/15 BRP WP 58a Permit Fact Sheet • Page 2 of 2
Massachusetts Department of Environmental Protection
kiBureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen
Aggregation Loading Plan
Application Completeness Checklist
❑ The MassDEP Transmittal Form is completed:
http://www mass gov/eea/agencies/massdep/service/approvals/transmittal-form-for-payment htmI
When completing the Transmittal Form, write the "a" immediately after the space provided for the seven digit
character code at the top of the Form.
❑ A MassDEP application form for the permit category BRP WP 58a has been completed. The following
information has been provided:
❑ Completed application clearly indicating the name, address and telephone number of municipal official
and the project consultant. All supportive materials must be attached.
For the BRP WP 58a, supportive materials include:
For a Community Plan:
❑ A suitably scaled map for the area covered by the plan;
❑ A buildout analysis under current zoning;
❑ 440 gpd per acre equivalency calculations;
❑ In the case of a Zone Il, analysis from the MassDEP Nitrogen Loading Model;
❑ Comments from the Planning Board, if any;
❑ A nitrogen loading management plan.
rev. 6/15 Application Completeness Checklist • Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
Il\ BRP WP 58a Approval of a Nitrogen
Aggregation Loading Plan
Application Completeness Checklist
To submit the application package:
❑ Checklist items have been completed.
❑ Send two (2) copies of the application, along with the original of the MassDEP Transmittal Form to:
Department of Environmental Protection
Title 5 Permitting Program
Regional Office *
*Find your region http://www.mass.gov/eea/agencies/massdep/about/contacts/
❑ If applicable, send a copy of the MassDEP Transmittal Form to:
Department of Environmental Protection
P.O. Box 4062
Boston, MA 02211
MassDEP Regulations may also be obtained from MassDEP's website at http://www.mass.gov/dep.
rev. 6/15 Application Completeness Checklist • Page 2 of 2
Does the facility aggregation plan afford the same environmental
protection as a single acre residential house lot receiving 440
gallons per day of effluent in a nitrogen sensitive area?
15 216: Aggregate Determinations of Flows and Nitrogen Loadings
(1) The 440 gallons per day per acre nitrogen loading limitation
imposed by 310 CMR15.214 may be calculated in the aggregate by
using nitrogen credit land in accordance with a Department approved
Facility Aggregation Plan or Community Aggregation Plan.
All other applicants seeking aggregate determination of flows and
nitrogen loading shall prepare a Facility Aggregation Plan in
accordance with 310 CMR 15.216 and the Department's "Guidelines for
Title 5 Aggregation of Flows and Nitrogen Loading."
(2) To qualify as Nitrogen Credit Land, the land must:
(a) be within the same Nitrogen Sensitive Area as the
facility if the facility is in a Nitrogen Sensitive Area;
(b) be within the same subdivision in an area where the
use of both on -site systems and drinking water wells
are proposed to serve the facility;
(c) not have any manmade sources of nitrogen, including,
but not limited to, wastewater discharges and nitrogen
based fertilizer located thereon;
(d) not be used for raising, breeding or keeping of
animals;
(e) be pervious;
(f) be outside of Zone As, Velocity Zones and Regulatory
Floodways;
(g) not be covered by any surface water body including,
but not limited to, a river, stream, lake, pond, or
ocean;
(h) already not currently designated as nitrogen credit
land; and
(i) meet the criteria set forth in the Department's
"Guidelines for Title 5 Aggregation of Flows and
Nitrogen Loading."
Summary of Guidelines
The equivalency of the 440 gpd per acre standard noted in 310 CMR
15.214 must be met.
15,214: Nitrogen Loading Limitations
1. No system serving new construction in Nitrogen Sensitive Areas designated in 310 CMR
15.215 shall be designed to receive or shall receive more than 440 gallons of design
flow per day per acre except as set forth at 310 CMR 15.216 (aggregate flows) or 15.217
(enhanced nitrogen removal).
2. No system serving new construction in areas where the use of both on -site systems and
drinking water supply wells is proposed to serve the facility shall be designed to receive
or shall receive more than 440 gallons of design flow per day per acre from residential
uses except as set forth at 310 CMR 15.216 (aggregate flows) or 15.217 (enhanced
nitrogen removal).
3. It shall be the duty of the owner of the system or proposed system to ascertain whether
or not the facility to be constructed will be in a nitrogen sensitive area. The Department
will prepare and make available at locations generally accessible to the public maps
portraying designated nitrogen sensitive areas within the Commonwealth.
For design flows of 2000 gpd or greater, the local approving authority or
DEP may require a site -specific mass balance analysis for the area of
impact. The mass balance analysis must demonstrate that the
groundwater quality standard of 10 mg/I total nitrogen and 10 mg/I
nitrate -nitrogen will be met at the downgradient credit land property
boundary, or at the nearest downgradient sensitive receptor.
Both the facility and the credit land must be restricted in perpetuity
through either an appropriate conservation restriction or a nitrogen
loading restriction and easement.
For a facility located in a Zone II, the Board of Health or the Department
may require an assessment using the DEP Nitrogen Loading Model for
projects that could potentially result in impacts at the public supply well.
(5) Facility Aggregation Plans
(a) The local Approving Authority and the Department may approve a
Facility Aggregation Plan provided that the following conditions are met:
1. the proposed facility meets the criteria in the Department's "Guidelines
for Title 5 Aggregation of Flows and Nitrogen Loading";
2. the design flow of 440 gallons per day per acre equivalency across the
facility and other land areas for which nitrogen credit is sought, but not
necessarily on every individual acre, will be met through recorded land
use restrictions that restrict nitrogen loading on facility land and nitrogen
credit land. These land use restrictions must be substantially identical to
those contained in the Department's "Guidelines for Title 5 Aggregation of
Flows and Nitrogen Loading," run in perpetuity, be approved by the
respective land owners, run to the benefit of the municipality acting by
and through the local Approving Authority and, in the case of nitrogen
credit land, also run to the benefit of the facility
land. The applicant shall record or register such restrictions and
easements in the appropriate Registry of Deeds or Land Registration
Office within 30 days of approval of the plan by the Department or the
expiration of the Department's 60 day constructive approval period,
pursuant to 310 CMR 15.216(5)(b), whichever occurs first; and
2. any other conditions that the Department deems appropriate.
(b) A Facility Aggregation Plan shall be deemed to be approved by the
Department if, within 60 days from a determination of administrative
completeness, the Department has not, in writing:
1. requested additional information from the applicant which may
include, but is not limited to, additional measures the Department
deems appropriate to protect public health, safety, welfare or the
environment; or
2. granted a written approval, which may include any conditions the
Department deems appropriate to protect public health, safety,
welfare or the environment; or
3. denied approval.
4.
In the event the Department requests additional information from the
applicant, a new 60 day constructive approval period shall commence upon
receipt of the additional information.
4u6.27. 2012 1,09Ph1 own ci «�ao:`:i.ld Nisi flour No,3477 P, 7
- - Enter your transmittal number..�-
` �. Transmittal Numbe,
Your unique'rrunnmillei Numbor Pon tin accessed online i r_^ ,—
Massachusetts Dopaftl-AW of f nviroltmental Notection —
Transmittal Form for Permit Application and Payment
1. plosso type of
print. A separala
Transmittal Fenn
must be completed
for sash permit
application.
2. Make your
check payable to
life Cemmenw0e111)
of Massachusetts
and moil it with a
copy of this lama to;
DEP, RO. Box
4062, Boston, PM
012211.
3. Marie ooplw of
Hill; form will be
needed,
CnPY i • the
orlotnal must
accompany your
permit application.
Copy 2 must
sccnmlaarry yaes
fm: payment.
Copy 3 shm4d be
retained for your
,eroods
A. Permit hifortatlnnW—.__.,....�-_..--_---.---------------�—�__�.___.-__
Cotto, 7 or 0
m
ft, Applicant. Information - Firm or Ind!
t4- in�..itn L �L _!d_!�!� iL:; i.„ 4r j� Cc Fri !•
2 a olaf Permit Catosoiy l-Pda"rn� a/1
r
4
;,
c 2% e S ' � 010, c ell
6 Cttyrrali fp-� d 7. state 9 ZIP Corti) U. Tedophane ft -- 10, EA #
11, Gantavl Faison 12, rrnmil nddieas (aPliana I)
C. Facility, Site or Individual Requiring Approval -- —
4. Both fee paying 3. Cllyll'tewn 4. Slate L. Zfp Code 6. Telephone N 7. Ext- #
and exempt
appilcanls must a. DEP Facility Number (if known) 9. Federal I.D. Number (If Known) V 10- WX Tracking # (if Known)
mull a impy of Ibis
framsrriftaf form to:
D. Application Prepared by (if different from Section B)`
Masan@P 1\�7 ft, .7r +j td. �C'd1. )FF ..`� 'on _
o •.. (r p• V.IY— r�l,. Ih C.E•ha ..l. F. C
Boston, MA 1 Nanaa u�Fkm Or Dn0lviduxl
02211.�—
..r..� �-�� �, �g"P tom„ �( GY- j�,..f•/i;
Nate:
3. Gity7i'own 4. State S. Zip Code 6. Totopt,ona
For BW5C Pefrntts,
antes fife L8P. ;"tlriL
LW Numbee (6WsO, Permits only)
E. Aerrnit - Praject
1. Is this project subject to MOA roviriV? [-]yes 9"
If yes, enter the projcct's EOEA file number- assigned when on
Environmental Notification Form is aubmitlad to tho MBPA unit
�. lantaaarrot f3ue
DEP Usr, Only specied Provisions
1. ❑ Fee Ecempl (city, town cv muakipal housing authorily)(alale agency if fee is $100 or less).
Permit No: Thera (,it) no foe exemptions Or BWSC permits, ratiudiess at npplloanf status.
2. QRaafahipRequest, pnymonlaxtenslonsaccording to310CMR4.04(3)(a).
Hovel Date-, 3. Cl Alternative Srhodula P.cleat (N000rding to 310 CMR 4,05 and 4.10).
4, [1 Homeowner (according to 3W CMR 4.02).
Rovlewer
Check Number^� — Dollar Amount — maw
h-forrrrrr,00e • rev, Ir07 PeOe i Of 1
Enter your transmittal number No X AS' 119 9
Transmittal Number
Your unique Transmittal Number can be accessed online: l d p 1/in I ti Ia5 tifm� . nt nl
Massachusetts Department of Environmental Protection
Transmittal Form for Permit Application and Payment
1. Please type or
A. Permit Information
print. A separate
Transmittal Form
�jR Q W'p SS a
must be completed
1. Permit Code: 7 or 8 character code from permit instructions
for each permit
application.
3. Tvoe of Proiect or Activitv
�QnnroJal oFa nl,'f-roseei Aagre4«f/oei
2. a e of Permit Category Load rn� n'J '..,.
2. Make your
check payable to B. Applicant Information -Firm or Individual
the Commonwealth
of Massachusetts
and mail it with a 1. Name of Firm - Or, if party needing this approval is an individual enter name below:
copy of this form to:
DEP, P.O. Box
4062, Boston, MA 2. Last Name of Individual 3. First Name of Individual 4. MI
02211.
5. Street Address
3. Three copies of
this form will be 6. City/Town 7. State 8. Zip Code 9. Telephone # 10. Ext. #
needed.
Copy 1 - the 11. Contact Person 12. e-mail address (optional)
original must
accompany your
permit application. C. Facility, Site or Individual Requiring Approval
Copy 2 must
accompany your
fee payment. 1. Name of Facility, Site Or Individual
Copy 3 should be
retained for your 2. Street Address
records
4. Both fee -paying
3. City/Town
4. State 5. Zip Code
6. Telephone # 7. Ext. #
and exempt
applicants must
8. DEP Facility Number (if Known)
9. Federal I.D. Number (if Known)
10. BWSC Tracking # (if Known)
mail a copy of this
transmittal form to:
D. Application Prepared by (if different from Section )"'
/
�. i .. .ie fi I�Il fi t.r 1, ..
y
dtkfI r"i .1i71 P.-. Fv-fit'
IM f'FP/f (-)s �r A
P.O.MassDE
BoP
x 4062 Boston
Boston, MA
1. Name of Firm Or Individual
02211
2. Address
Note: 3. City/Town 4. State 5. Zip Code 6. Telephone # 7. Ext. #
For BWSC Permits,
enter the LSP. i 0(IA, ' fTl r!,�Gpi� p ,G„ c"P t�l�
8. Contact Person ' 9. LSP Number (BWSC Permits only)
E. Permit - Project Coordination
1. Is this project subject to MEPA review? ❑ yes gno
If yes, enter the project's EOEA file number - assigned when an
Environmental Notification Form is submitted to the MEPA unit:
EOEA File Number
F. Amount Due
DEP Use Only Special Provisions:
1. ❑ Fee Exempt (city, town or municipal housing authority)(state agency if fee is $100 or less).
Permit No: There are no fee exemptions for BWSC permits, regardless of applicant status.
2. ❑ Hardship Request - payment extensions according to 310 CMR 4.04(3)(c).
Rec'd Date: 3. ❑ Alternative Schedule Project (according to 310 CMR 4.05 and 4.10).
4. ❑ Homeowner (according to 310 CMR 4.02).
Reviewer:
Check Number Dollar Amount Date
tr-formw.doc • rev. 1/07 Page 1 of 1
F1Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
IL
Permit Fact Sheet
Note: When completing the Transmittal Form, write the "a" immediately after the space provided for the seven
digit character code at the top of the Form.
1. What is the purpose of this approval?
This approval is necessary to ensure that the aggregation of nitrogen loading for on -site subsurface sewage
disposal system(s) is performed in an environmentally acceptable manner and in accordance with the provisions
of Title 5 of the Environmental Code, 310 CMR 15.000.
You must obtain approval from MassDEP for the following plans:
Community plans to aggregate for nitrogen loading over a region wide area, such as Zone Its or Interim
Wellhead Protection Areas (310 CMR 15.216(4)) or in environmentally sensitive areas such as systems
serving new residential construction where the use of both on -site wastewater disposal systems and drinking
water supply wells are proposed, i.e., private well areas.
Facility plans to aggregate nitrogen loading for a facility, where the facility land and credit land are proposed
to be used for nitrogen aggregation (310 CMR 15.216(5)). Facility plans may apply to Zone Ils, Interim
Wellhead Protection Areas or areas of new residential construction where the use of both on -site wastewater
disposal systems and drinking water supply wells are proposed, i.e., private well areas.
2. Who must apply?
Any individual, business, organization or municipality proposing to implement a nitrogen aggregation plan for
either a community or any part thereof or a specific facility is required to obtain MassDEP approval in accordance
with 310 CMR 15.216.
If this category does not apply to you, please be advised this is not the only permit category for Title 5 on -site
sewage disposal systems or related plans. Please consult the Timely Action Schedule and Fee Provisions, 310
CMR 4.00 and Title 5 of the Environmental Code, 310 CMR 15.000, to determine whether another category may
apply to you. Note: Any and all land identified as "restricted" or "credit land" for the purposes of one application for
aggregate nitrogen loading cannot be used for another application pursuant to 310 CMR 15.216.
Note: MassDEP anticipates the preparation of either a Community Plan or a Facility Plan proposing to aggregate
for nitrogen loading may require both technical (including hydrogeologic) and legal expertise.
3. What other requirements should be considered when applying?
Plans proposing nitrogen aggregation require prior written approval by the local approving authority (310 CMR
15.216).
• Plans proposing nitrogen restrictions on facility and credit land(s) require prior written approval by the property
owner(s) (310 CMR 15.216(5)).
Note: These additional requirements are intended to serve as a guide to the applicant. They do not necessarily
include all additional requirements.
4. What is the application fee?
BRP WP 58a Nitrogen Aggregation Loading Plan $1,580
wp58ains.doc • rev.6/07 BRP WP 58a Permit Fact Sheet • Page 2 of 2
i Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
Permit Fact Sheet
5. What is the Primary Permit Location? What is the Reserve Copy Location?
Primary Permit Location:
Department of Environmental Protection (2 copies)
* Regional Office
Title 5 Permitting Program
*Find your region http://www.mass,gov/dep/abouUregion/findyour.htin
There are no Reserve Copy Locations for these permits.
6. Where can I get a copy of the timelines?
The timelines are available on the MassDEP Website: www.mass.gov/dep/service/online/fees.htm
7. What is the annual compliance fee?
There is no annual compliance fee.
8. How long is the approval in effect?
This approval remains valid until MassDEP revokes or modifies the approval. In the case of a Community Plan,
the approval is in effect until there is a local land use regulation change or other action that would impact the
MassDEP approved nitrogen loading plan.
9. How can I avoid the most common mistakes made in applying for this approval?
a. Review application for completeness to be sure all questions are answered correctly.
b. Refer to the Department's, "Guidelines For Title 5 Aggregation of Flows and Nitrogen Loading (310 CMR
15.216)" for further guidance.
c. For a Community Plan, attach the following:
completed application with supporting materials;
a map for the area covered by the plan;
buildout analysis under current zoning for the area covered by the plan;
440 gpd per acre equivalency calculations;
in the case of a Zone II, results of the MassDEP Nitrogen Loading Computer Model;
approval from the local approving authority;
comments from the Planning Board, if any;
• a nitrogen loading management plan.
d. For a Facility Plan, attach the following:
completed application with supporting materials;
approval from the local approving authority;
locus and site maps with relevant features;
a narrative description of the proposal and presenting facts;
440 gpd per acre equivalency calculations;
copies of current deeds for the facility and credit land(s);
copies of all unexecuted nitrogen deed restrictions on facility and credit land(s);
For facilities with design flow of 2000 gpd or greater, if either the local approving authority or MassDEP
requires a site -specific mass balance analysis, applicants must also attach:
• a hydrogeologic assessment;
site -specific mass balance analysis,
wp58ains.doc • rev.6/07 BRP WP 58a Permit Fact Sheet • Page 2 of 2
iLMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
- Permit Fact Sheet
a groundwater monitoring plan;
results from the MassDEP Nitrogen Loading Model, if applicable;
Planning Board comments, if any.
d. Submit fee and a copy of the MassDEP Transmittal Form to:
Department of Environmental Protection
P. O. Box 4062
Boston, MA 02211.
10. What are the regulations that apply to this approval? Where can I get copies?
These regulations include, but are not limited to:
a. Title 5 Regulations, 310 CMR 15.000.
b. Timely Action Schedule and Fee Provisions, 310 CMR 4.00.
These may be purchased at:
State Bookstore
State Bookstore
Room 116
436 Dwight Street, Room 102
Boston, MA 02133
Springfield, MA 01103
617-727-2834
413-784-1376
MassDEP Title 5 Regulations and permit application packages also may be obtained from MassDEP's web site at
http://mass.gov/dep
wpMains.doc • rev.6/07 BRP WP 58a Permit Fact Sheet • Page 2 of 2
Enter your transmittal number -X_ Zz s.1 � 19
Transmittal Number
Your unique Transmittal Number can be accessed online: if" M
Massachusetts Department of Environmental Protection
Transmittal Form for Permit Application and Payment
1. Please type or A. Permit Information
print. A separate
Transmittal Form j�j�_{� 1�/h SSa �ooro✓al oFa Alr`troaen A4 r 4f-10-
must be completed 1. permit Code: 7 or 8 character code from permit instructions �2. tea , of Permit Category Lc" r(in3 /tom
for each permit '..
application.
3. Type of Project or Activity
2. Make your
check payable to
B
the Commonwealth
F'o v, m-1
ti
t
S
I�
�)
1
Information - Firm or
needing this approval is an individual enter name
3. First Name of Individual
4. MI
7. State 8. Zip Code 9. Telephone If 10. Ext. #
12. a -mail address (optional)
Individual Requiring
4. State 5. Zip Code 6. Telephone # 7. Ext. #
applicants must 8. DEP Facility Number (if Known) 9. Federal I.D. Number (if Known) 10. BWSC Tracking # (if Known)
mail a copy of this
transmittal form to: D. Application Prepared by (if different from Section B)* _
MassDEP (.� ( �, d d!1�.1 ��r', '.. t<r!�� ,'�, � Ih1 f 'k,� Ii,Cf,, Rt„_ �p�-
P.O. Box 4062 -r
Boston, MA 1. Name of Firm Or Individual
02211
Z. H°ureb6
Note: 3. Cityfiown 4. Stale 5. Zip Code 6. Telephone # 7. Ext. #
enter thee LSP. BWSC lts, i(v T t�1 .�b0h
entSP. -
8. Contact Person 9. LSP Number (BWSC Permits only)
E. Permit - Project Coordination
1. Is this project subject to MEPA review? ❑ yes 9no
If yes, enter the project's EOEA file number - assigned when an
Environmental Notification Form is submitted to the MEPA unit:
EOEA File Number
F. Amount Due
DEP Use Only
Special Provisions:
1. ❑ Fee Exempt (city, town or municipal housing authority)(state agency if fee is $100 or less).
Permit No:
There are no fee exemptions for BWSC permits, regardless of applicant status.
2. ❑ Hardship Request - payment extensions according to 310 CMR 4.04(3)(c).
Rec'd Date:
3. ❑ Alternative Schedule Project (according to 310 CMR 4.05 and 4.10).
4. ❑ Homeowner (according to 310 CMR 4.02).
Reviewer:
Check Number Dollar Amount Date
tr-formw.doc • rev. 1/07 Page 1 of 1
XZS.;79R
ILMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen
Aggregation Loading Plan
Application Completeness Checklist
❑, The MassDEP Transmittal Form is completed: htto:!/mass govldeplservice/online/trasmfrm.shhnl When
completing the Transmittal Form, write the "a" immediately after the space provided for the seven digit
character code at the top of the Form.
❑l A MassDEP application form for the permit category BRP WP 58a has been completed. The following
information has been provided:
❑_ Completed application clearly indicating the name, address and telephone
number of applicant/owner and the project consultant. All supportive materials must be attached.
❑ Signed approval letter from the local approving authority.
For the BRP WP 58a, supportive materials include:
For a Community Plan:
❑ A suitably scaled map for the area covered by the plan,
❑ A buildout analysis under current zoning;
❑ 440 gpd per acre equivalency calculations;
❑ In the case of a Zone II, analysis from the MassDEP Nitrogen Loading Model;
❑ Comments from the Planning Board, if any;
❑ A nitrogen loading management plan.
For a Facility Plan:
A locus map (USGS 1:25,000 topographic);
A suitably scaled site map;
A detail description for the facility aggregation proposal;
❑, 440 gpd per acre equivalency calculations;
❑l Copies of current deeds for the facility and credit land,
Copies of unexecuted nitrogen deed restrictions on facility and credit land.
For facilities with design flow of 2000 gpd or greater when either the local approving authority or MassDEP
requires a site -specific mass balance analysis, additionally:
❑ A hydrogeologic assessment;
❑ A site -specific mass balance analysis;
❑ A groundwater monitoring plan;
❑ Results from the MassDEP Nitrogen Loading Computer Model, if applicable;
❑ Planning Board comments, if any.
rev. 6/07 Application Completeness Checklist • Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen
Aggregation Loading Plan
Application Completeness Checklist
To submit the application package:
❑ Checklist items have been completed.
❑ Send two (2) copies of the application, along with the original of the MassDEP Transmittal Form to:
Department of Environmental Protection
Title 5 Permitting Program
Regional Office
'Find your region http://www.mass.gov/dep/abouUregion/findyour.htm
❑ Send fee of $1,580 in the form of a check or money order made payable to Commonwealth of
Massachusetts, along with a copy of the MassDEP Transmittal Form to:
Department of Environmental Protection
P.O. Box 4062
Boston, MA 02211
MassDEP Regulations may also be obtained from MassDEP's website at http://vv,�vw.tnass.gov/dep.
rev. 6/07 Application Completeness Checklist - Page 2 of 2
Massachusetts Department of Environmental Protection
LlBureau of Resource Protection — Title 5 Permitting
BRP WP 58a Transmittal Number
Approval of a Nitrogen Aggregation Loading Plan Facility—m of known)
Please read the Instructions and Supporting Materials before filling out this form.
Note: Any and all areas identified as "restricted" or "credit land" for the purposes of one application for
aggregate nitrogen loading cannot be used for another application pursuant to 310 CMR 15.216.
DEP anticipates that preparation of nitrogen loading plans may require both technical (including
hydrogeologic) and legal expertise.
A. General Information
Important:
When filling out 1. Applicant:
forms on the
computer,
�y /
only the tab key
Name
to move your
do
cursor - not
use the return
Doing Business as (dba)
key.
`� S�C r red' 1'�.^f_
n
ii' 711 a!J" l9 e, F -�
--
_..—
Street Address
Cityrrown
4
State
Zip Code
"
Telephone --
2. Facility Address / Location (if different from Applicant):
r,
Address
r
Cityffown- — —
State-- �—
Zip Code
3. Contact Person (if different from Applicant):
Contact Parson - -----..._ .._._—
Consultant Firm
Cityrf-own State -
Zip Code Telephone
4. Does this project require a filing under 310 CMR 11.00, The Massachusetts Environmental Policy
Act?
❑ Yes ANO
If yes, has a filing been made? ❑ Yes ❑ No
If yes, EOEA File #
5. The approval letter issued by the local approving authority having jurisdiction over the aggregate
nitrogen loading plan must accompany this application.
Is the approval letter attached? Yes ❑ No
wp58aapp • 12/03 BRP WP 58a • Page 1 of 4
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
_ BRP WP 58a
Approval of a Nitrogen Aggregation Loading Plan
A. General Information (cont.)
Transmittal Number
Facility ID (if known)
6. A nitrogen aggregation application is either for a region -wide Community Plan, or for a site -specific
Facility Plan. This application is for:
❑ Community Plan (respond to Items 7 through 12)
Y--Facility Plan (respond to Items 13 through 26)
For a Community Plan:
T The Community Plan may be for either a Nitrogen Sensitive Area or for a new residential construction
where the use of both on -site systems and on -site -drinking water supply wells are proposed (private
well areas). This application is for:
1!1 A Zone II
❑ An Interim Wellhead Protection Area
❑ Private well area for new residential construction
8. A map for the area covered by the plan is required. Is the map attached?
t] Yes ❑ No
9. A buildout analysis under current zoning for the area of the community subject to the plan is required.
Is the buildout analysis enclosed?
❑ Yes ❑ No
10. The nitrogen loading limitation of 440 gpd per acre equivalency demonstration is required. Are the
calculations enclosed?
N Yes ❑ No
11. If the Community Plan is for a Zone Il, the DEP Nitrogen Loading Computer Model analysis is
required.
Is the Zone II analysis enclosed? ❑ Yes ❑ No
Are Planning Board comments attached? ❑ Yes ❑ No
12. A nitrogen loading management plan including land use regulations (e.g., zoning or health
regulations) is required. Is the management plan enclosed?
❑ Yes ❑ No
For a Facility Plan:
13. The Facility Plan may be for a site in either a Nitrogen Sensitive Area or for a new residential
construction where the use of both on -site systems and on -site drinking water supply wells are
proposed (private well areas). The facility is sited in:
`t(A Zone II
❑ An Interim Wellhead Protection Area
❑ Private well area for new residential construction
wp58aapp • 12/03 BRP WP 58a • Page 2 of 4
LAMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Transmittal Number
Approval of a Nitrogen Aggregation Loading Plan
A. General Information (cont.)
14. The legal entity which owns or will own this facility is:
❑ Individual ❑ Federal
❑ Municipality j' ❑ State / County
c
❑ Private Partnership ❑ Corporation
❑ Other (specify):
15. Owner names and addresses of land subject to the proposed facility plan:
Facility ID (if known)
16. A locus map (USGS topographic at 1:25,000) with all relevant locations (e.g. the proposed facility,
credit land, water supplies and nitrogen sensitive areas) is required.
Is the locus map attached? Yes ❑ No
17. A site map, at a suitable scale, with all relevant topographic features (e.g. the proposed facility with
discharge, area of impact, credit land, bedrock, test pits, sensitive receptors within one half mile, etc.)
is required.
Is the site map attached?
Yes ❑ No
18. The detailed description of the proposed facility including the credit land, site characteristics, the
proposed subsurface disposal system, the nitrogen sensitive area, sensitive receptors within one half
mile, etc., is required.
Is the narrative description enclosed? ` Yes ❑ No
19. The nitrogen loading limitation of 440 gpd per acre equivalency is required. Are the 440 gpd per acre
equivalency calculations enclosed?
dYes ❑ No
20. Are copies of the current deeds (and plans cited) for the facility and credit land enclosed?
O'Yes ❑ No
21. Are copies of the unexecuted nitrogen loading restrictions on facility and credit land enclosed?
6Yes ❑ No
wp58aapp • 12/03 BRP WP 58a • Page 3 of 4
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Transmittal Number
Approval of a Nitrogen Aggregation Loading Plan FaciiitylDiifknown) --
A. General Information (cont.)
For facilities with sewage design flow of 2000 gpd or greater and, when the local approving authority
or DEP requires a site -specific mass balance analysis, the following documents are required. Are
they attached?
22. A hydrogeologic assessment ❑ Yes ❑ No
23. A site -specific mass balance analysis ❑ Yes ❑ No
24. A groundwater monitoring plan ❑ Yes ❑ No
25.
Zone II nitrogen modeling, if applicable
❑ Yes
❑ No
26.
Planning Board comments, if any
❑ Yes
❑ No
B. Certification
" I certify under penalty of law that this document
and all attachments, to the best of my knowledge
and belief, are true, accurate, and complete. I am
aware that there are significant penalties for
submitting false information, including the possibility
of fine and imprisonment for knowing violations."
Applicant's signature
Print Name
Name of Preparer
Date
wp58aapp - 12/03 BRP WP 58a • Page 4 of 4
jLlMassachusetts Department of Environmental Protection
Bureau of Resource Protection —Title 5 Permitting
BRP WP 58a Approval of a Nitrogen
Aggregation Loading Plan
Instructions and Supporting Materials
Table of Contents
introduction
permit fact sheet
completeness checklist
Introduction
MassDEP Permit Applications, as well as Instructions & Support Materials, are available for
download from the MassDEP Web site at mass.00v/deo in two file formats: Microsoft WordT"' and
Adobe Acrobat PDFTM. Either format allows documents to be printed.
Instructions & Support Materials files in Microsoft WordTM format contain a series of documents
that provide guidance on how to prepare a permit application. Although we recommend that you
print out the entire package, you may choose to print specific documents by selecting the
appropriate page numbers for printing.
Permit Applications in Microsoft Word TM format must be downloaded separately. Users with
Microsoft Word TM 97 or later may complete these forms electronically.
Permitting packages in Adobe Acrobat PDFTM format combine Permit Applications and
Instructions & Support Materials in a single document. Adobe Acrobat PDFTM files may only be
viewed and printed without alteration. Permit Applications in this format may not be completed
electronically.
wp58ains.doc • rev. 6/07 BRP WP 58a Introduction • Page i of 1
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
Permit Fact Sheet
Note: When completing the Transmittal Form, write the "a" immediately after the space provided for the seven
digit character code at the top of the Form.
1. What is the purpose of this approval?
This approval is necessary to ensure that the aggregation of nitrogen loading for on -site subsurface sewage
disposal system(s) is performed in an environmentally acceptable manner and in accordance with the provisions
of Title 5 of the Environmental Code, 310 CMR 15.000.
You must obtain approval from MassDEP for the following plans:
Community plans to aggregate for nitrogen loading over a region wide area, such as Zone Ifs or Interim
Wellhead Protection Areas (310 CMR 15.216(4)) or in environmentally sensitive areas such as systems
serving new residential construction where the use of both on -site wastewater disposal systems and drinking
water supply wells are proposed, i.e., private well areas.
Facility plans to aggregate nitrogen loading for a facility, where the facility land and credit land are proposed
to be used for nitrogen aggregation (310 CMR 15.216(5)). Facility plans may apply to Zone Ils, Interim
Wellhead Protection Areas or areas of new residential construction where the use of both on -site wastewater
disposal systems and drinking water supply wells are proposed, i.e., private well areas.
2. Who must apply?
Any individual, business, organization or municipality proposing to implement a nitrogen aggregation plan for
either a community or any part thereof or a specific facility is required to obtain MassDEP approval in accordance
with 310 CMR 15.216.
If this category does not apply to you, please be advised this is not the only permit category for Title 5 on -site
sewage disposal systems or related plans. Please consult the Timely Action Schedule and Fee Provisions, 310
CMR 4.00 and Title 5 of the Environmental Code, 310 CMR 15.000, to determine whether another category may
apply to you. Note: Any and all land identified as 'restricted" or "credit land" for the purposes of one application for
aggregate nitrogen loading cannot be used for another application pursuant to 310 CMR 15.216.
Note: MassDEP anticipates the preparation of either a Community Plan or a Facility Plan proposing to aggregate
for nitrogen loading may require both technical (including hydrogeologic) and legal expertise.
3. What other requirements should be considered when applying?
Plans proposing nitrogen aggregation require prior written approval by the local approving authority (310 CMR
15.216).
Plans proposing nitrogen restrictions on facility and credit land(s) require prior written approval by the property
owner(s) (310 CMR 15.216(5)).
Note: These additional requirements are intended to serve as a guide to the applicant. They do not necessarily
include all additional requirements.
4. What is the application fee?
BRP WP 58a Nitrogen Aggregation Loading Plan $1,580
wp58ains.doc • rev.6/07 BRP WP 58a Permit Fad Sheet • Page 2 of 2
Massachusetts Department of Environmental Protection
L I Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
I_ -
Permit Fact Sheet
5. What is the Primary Permit Location? What is the Reserve Copy Location?
Primary Permit Location:
Department of Environmental Protection (2 copies)
* Regional Office
Title 5 Permitting Program
*Find your region http://www.mass.gov/dep/about/region/findyour htm
There are no Reserve Copy Locations for these permits.
6. Where can I get a copy of the timelines?
The timelines are available on the MassDEP Website: www.mass.gov/dep/seRice/online/fees.htm
7. What is the annual compliance fee?
There is no annual compliance fee.
8. How long is the approval in effect?
This approval remains valid until MassDEP revokes or modifies the approval. In the case of a Community Plan,
the approval is in effect until there is a local land use regulation change or other action that would impact the
MassDEP approved nitrogen loading plan.
9. How can I avoid the most common mistakes made in applying for this approval?
a. Review application for completeness to be sure all questions are answered correctly.
b. Refer to the Department's, "Guidelines For Title 5 Aggregation of Flows and Nitrogen Loading (310 CMR
15.216)" for further guidance.
c. For a Community Plan, attach the following:
completed application with supporting materials,
a map for the area covered by the plan;
buildout analysis under current zoning for the area covered by the plan;
440 gpd per acre equivalency calculations,
in the case of a Zone II, results of the MassDEP Nitrogen Loading Computer Model;
approval from the local approving authority,
comments from the Planning Board, if any;
a nitrogen loading management plan.
d. For a Facility Plan, attach the following:
completed application with supporting materials;
approval from the local approving authority,
locus and site maps with relevant features;
a narrative description of the proposal and presenting facts;
440 gpd per acre equivalency calculations,
copies of current deeds for the facility and credit land(s);
copies of all unexecuted nitrogen deed restrictions on facility and credit land(s);
For facilities with design flow of 2000 gpd or greater, if either the local approving authority or MassDEP
requires a site -specific mass balance analysis, applicants must also attach:
a hydrogeologic assessment;
site -specific mass balance analysis;
wp58ains.doc • rev.6/07 BRP WP 58a Permit Fact Sheet • Page 2 of 2
ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a Approval of a Nitrogen Aggregation Loading Plan
Permit Fact Sheet
a groundwater monitoring plan;
results from the MassDEP Nitrogen Loading Model, if applicable;
Planning Board comments, if any.
d. Submit fee and a copy of the MassDEP Transmittal Form to:
Department of Environmental Protection
P. O. Box 4062
Boston, MA 02211.
10. What are the regulations that apply to this approval? Where can I get copies?
These regulations include, but are not limited to:
a. Title 5 Regulations, 310 CMR 15.000.
b. Timely Action Schedule and Fee Provisions, 310 CMR 4.00.
These may be purchased at:
State Bookstore State Bookstore
Room 116 436 Dwight Street, Room 102
Boston, MA 02133 Springfield, MA 01103
617-727-2834 413-784-1376
MassDEP Title 5 Regulations and permit application packages also may be obtained from MassDEP's web site at
ht Arnassgov/deP
wp58ains.doc • rev.6/07 BRP WP 58a Permit Fact Sheet • Page 2 of 2
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a
Approval of a Nitrogen Aggregation Loading Plan
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Transmittal Number
Facility ID (if known)
Please read the Instructions and Supporting Materials before filling out this form.
Note: Any and all areas identified as "restricted" or "credit land" for the purposes of one application for
aggregate nitrogen loading cannot be used for another application pursuant to 310 CMR 15.216.
DEP anticipates that preparation of nitrogen loading plans may require both technical (including
hydrogeologic) and legal expertise.
A. General Information
1. Applicant:
L(1v15+t8n, 4 FecK Dev,. Co
Name
StaA F,�K
Doing Business as (dba)
L19H 5-fearm s ,4ve n1atis10e 0
Street Address City/Town
rnA. r7Z6Yg
State Zip Code
sus 079 oY95
Telephone
2. Facility Address / Location (if different from Applicant):
_ (�alltk� FleIJ3 �Ilege 6�� ELM S`1-
Address nre 1 /
Mc'�h5 Y d
City/Town State
c)ZGy8
3. Contact Person (if different from Applicant):
%21/Jti -E. )I9to614 l'E Clvrl
Contact Person �t-
RIM _E mrri feel-/kC co, Tit C
Consultant Firm i'`
I S`o l`lo,-th lY?arti 5-1-,
Address
Q Ma
Cityfrown State
oz0Yg 5-00- 33`) -'373 i
Zip Code Telephone
4. Does this project require a filing under 310 CMR 11.00, The Massachusetts Environmental Policy
Act?
❑ Yes No
If yes, has a filing been made? ❑ Yes ❑ No -- —
If yes, EOEA File #
The approval letter issued by the local approving authority having jurisdiction over the aggregate
nitrogen loading plan must accompany this application.
Is the approval letter attached? ❑ Yes ❑ No
wp58aapp • 12/03 BRP WP 58a • Page 1 of 4
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection — Title 5 Permitting
BRP WP 58a
Approval of a Nitrogen Aggregation Loading Plan
A. General Information (cont.)
Transmittal
Facility ID (if known)
& A nitrogen aggregation application is either for a region -wide Community Plan, or for a site -specific
Facility Plan. This application is for:
❑ Community Plan (respond to Items 7 through 12)
® Facility Plan (respond to Items 13 through 26)
For a Community Plan:
7. The Community Plan may be for either a Nitrogen Sensitive Area or for a new residential constructior
where the use of both on -site systems and on -site -drinking water supply wells are proposed (private
well areas). This application is for:
❑ A Zone II
❑ An Interim Wellhead Protection Area
❑ Private well area for new residential construction
8. A map for the area covered by the plan is required. Is the map attached?
❑ Yes ❑ No
9. A buildout analysis under current zoning for the area of the community subject to the plan is required.
Is the buildout analysis enclosed?
❑ Yes ❑ No
10. The nitrogen loading limitation of 440 gpd per acre equivalency demonstration is required. Are the
calculations enclosed?
❑ Yes ❑ No
11. If the Community Plan is for a Zone Il, the DEP Nitrogen Loading Computer Model analysis is
required.
Is the Zone II analysis enclosed? ❑ Yes ❑ No
Are Planning Board comments attached? ❑ Yes ❑ No
12. A nitrogen loading management plan including land use regulations (e.g., zoning or health
regulations) is required. Is the management plan enclosed?
❑ Yes ❑ No
For a Facility Plan:
13. The Facility Plan may be for a site in either a Nitrogen Sensitive Area or for a new residential
construction where the use of both on -site systems and on -site drinking water supply wells are
proposed (private well areas). The facility is sited in:
® A Zone II
❑ An Interim Wellhead Protection Area
❑ Private well area for new residential construction
wp58aapp • 12/03 BRP WP 58a • Page 2 of 4
Massachusetts Department of Environmental Protection
LlBureau of Resource Protection — Title 5 Permitting _
BRP WP 58a Transmittal Number
Approval of a Nitrogen Aggregation Loading Plan Facility ID (if known)
A. General Information (cont.)
14. The legal entity which owns or will own this facility is:
❑ Individual ❑ Federal
❑ Municipality ❑ State / County
❑ Private Partnership Corporation
❑ Other (specify):
15. Owner names and addresses of land subject to the proposed facility plan:
Ou,mev 9- Fec lG Dev, CovA
4134
5tearf.s
/-Ive,
lr vt5 rtcld,
MA
o zogg
514e:
9 ((rho,
Fie lds
1/ (1aIli e
bfE
EwH St KV-n54e-/I/
16. A locus map (USGS topographic at 1:25,000) with all relevant locations (e.g. the proposed facility,
credit land, water supplies and nitrogen sensitive areas) is required.
Is the locus map attached?
17. A site map, at a suitable scale, with all relevant topographic features (e.g. the proposed facility with
discharge, area of impact, credit land, bedrock, test pits, sensitive receptors within one half mile, etc.)
is required.
Is the site map attached?
18. The detailed description of the proposed facility including the credit land, site characteristics, the
proposed subsurface disposal system, the nitrogen sensitive area, sensitive receptors within one half
mile, etc., is required.
Is the narrative description enclosed? ® Yes ❑ No
19. The nitrogen loading limitation of 440 gpd per acre equivalency is required. Are the 440 gpd per acre
equivalency calculations enclosed?
® Yes ❑ No
20. Are copies of the current deeds (and plans cited) for the facility and credit land enclosed?
■
21. Are copies of the unexecuted nitrogen loading restrictions on facility and credit land enclosed?
® Yes ❑ No
wp58aapp • 12/03 BRP WP 58a • Page 3 of 4
Massachusetts Department of Environmental Protection
LlBureau of Resource Protection — Title 5 Permitting _
BRP WP 58a Transmittal Number
Approval of a Nitrogen Aggregation Loading Plan Facility to (if known)
A. General Information (cont.)
For facilities with sewage design flow of 2000 gpd or greater and, when the local approving authority
or DEP requires a site -specific mass balance analysis, the following documents are required. Are
they attached?
22. A hydrogeologic assessment ❑ Yes ❑ No
23. A site -specific mass balance analysis
❑ Yes
❑ No
24. A groundwater monitoring plan
❑ Yes
❑ No
25. Zone II nitrogen modeling, if applicable
❑ Yes
❑ No
26. Planning Board comments, if any
❑ Yes
❑ No
B. Certification
"I certify under penalty of law that this document
and all attachments, to the best of my knowledge
and belief, are true, accurate, and complete. I am
aware that there are significant penalties for
submitting false information, including the possibility
of fine and imprisonment for knowing violations."
Applicant's signature
Print Name
Name of Preparer
wp58aapp • 12/03 BRP WP 58a • Page 4 of 4
F
ATTACHMENT
Upon recording, mail to:
Bureau of Resource Protection, Wastewater Management
Department of Environmental Protection
[applicable Regional Office address]
GRANT OF TITLE 5 NITROGEN LOADING RESTRICTION AND EASEMENT
(Grantor owns and restricts both the facility land and the credit land)
310 CMR 15.216
This GRANT OF TITLE 5 Nitrogen Loading Restriction AND EASEMENT made as of this _ day
Of 12012, by Thomas P. Walsh, 60 Westgate Rd. Attleboro, Ma. 02048 ("Grantor 1" ), and
Stanley Feck of Christian & Feck Dev. Corp. 494 Stearns Ave. Mansfield Ma. 02048 ("Grantor 2")
1-:r/YK!1 VI**"1
WHEREAS, Grantor being the owner(s) in fee simple of that [those] certain parcel(s) of [vacant] land
located in Mansfield, Bristol County, Massachusetts, with the buildings and improvements thereon, pursuant to a
deed from Elms Realty Trust to Grantor I ( Walsh ), dated Feb. 10 2004, and recorded with Bristol County Registry
of Deeds in Book 13299, Page 317 and to Grantor I (Walsh) , dated Jan. 31 , 1989 from Steve and Mary P. Benoit
recorded in Book 4040 Page 64 at the Bristol County Registry District, and to Granter 2 ( Feck ) from Michael K.
and Luke N. Angelus, dated May 17, 2010 recorded with the Bristol County Registry of Deeds in Book 18750
Page 224 said parcel(s) of land being more particularly bounded and described in Exhibit A, attached hereto and
made a part hereof, and being shown on a plan entitled, "Definitive Top sheet " of Rolling Fields Village , A Cluster
Subdivision in Mansfield Ma with I 1 sheets , dated Dec. 28 2011, prepared by RIM Engineering Co. Inc , recorded
with the Bristol County Registry of Deeds in Book 486 Pages 30-40 ("Facility Land"); and (" Credit Land ") and
WHEREAS, Grantor desires to restrict the number of bedrooms as defined pursuant to 310 CMR 15.002
and/or the wastewater discharge design flow in any improvements located on the Facility Land through the use of
this Nitrogen Loading Restriction and Easement; and
WHEREAS, the Facility Land has the benefit, granted hereby, of the Restriction and Easement on the
Credit Land consisting of approximately 20.27 acres as herein provided; and
WHEREAS, the Nitrogen Loading Facility Aggregation Plan has been approved by the Mansfield Board of Health
[and, if required, the Massachusetts Department of Environmental Protection] ("MassDEP" or "Department")] in
accordance with the Department's "Guidelines for Title 5 Aggregation of Plans and Nitrogen Loading;" said
approval being based upon the agreement by Grantor to incur certain obligations regarding the number of bedrooms,
as defined in 310 CMR 15.002, and/or the wastewater discharge design flow in any improvements located on the
Facility Land and maintenance of the Restriction and Easement to ensure protection of the nitrogen loading
limitation of 440 gpd/acre discharge standard pursuant to 310 CMR 15.214 in nitrogen -sensitive areas or in areas
serving new construction where the residential use of both on -site systems and drinking water supply wells are
proposed; and to grant to the municipality acting by and through the Mansfield Board of Health a perpetual
easement to ensure maintenance of the Facility Land and the Credit Land including, but not limited to, removal of
any prohibited uses and in connection herewith a perpetual easement to pass and repass over the Facility Land and
the Credit Land for purposes of inspection of the Facility Land and Credit Land to ensure compliance with and
fulfillment of the terms of this Restriction/Easement hereafter set forth;
NOW, THEREFORE, pursuant to the provisions of 310 CMR 15.216, Grantor does hereby GRANT to
the Town/City of Mansfield, a Massachusetts municipal corporation situated in Bristol County, having an address at
6 Park Row Mansfield, Massachusetts, acting by and through its Board of Health ("Local Approving Authority") for
nominal, non -monetary consideration, with QUITCLAIM COVENANTS, a TITLE 5 NITROGEN LOADING
RESTRICTION AND EASEMENT ("RestrictiojdEasement") in, on, upon, through, over and under the Facility
Land and the Credit Land, the terms and conditions of which are as follows:
PURPOSE
The purpose of this restriction is to protect and preserve the quality and quantity of ground water resources in the
area of the public and private wells in the Town/City of Mansfield, Massachusetts in order to ensure a safe and
healthy public and private water supply for the present and future inhabitants of the area. It shall also be for the
specific purpose of limiting the introduction of nitrogen and other pollutants into, and maintaining the natural uptake
of pollutants and the recharge of the ground water which takes place on the Facility Land and the Credit Land for the
said water supply.
OBLIGATIONS AND EASEMENT:
1. Prohibitions. Grantor agrees to restrict the number of bedrooms, as defined pursuant to 310 CMR 15.002, in any
improvements on the Facility Land to 4 [insert number of bedrooms, or in cases where the design flow for the
facility is not determined by the number of bedrooms, insert the applicable wastewater discharge design flow
limitation in 310 CMR 15.2141. Grantor further agrees to maintain the Credit Land as nitrogen credit land by
prohibiting activities which have a detrimental effect on nitrogen loading on the Credit Land, including but not
limited to wastewater discharges, the use of nitrogen fertilizer, the introduction of artificial impervious surfaces, the
raising, breeding or keeping of animals, livestock or poultry for commercial purposes, and the creation or
introduction of land under water. A change in the condition of the Credit Land which results in the Credit Land or a
portion thereof being within a Velocity Zone or Regulatory Floodway will render the Credit Land or said portion
thereof ineligible for nitrogen credit pursuant to 310 CMR 15.216.
2. Easements. In creating this Restriction and Easement, Grantor hereby grants to the Local Approving Authority its
agents, contractors, subcontractors and employees a perpetual EASEMENT to enter upon and the right to bring
equipment onto the Facility Land and Credit Land to do any and all acts deemed necessary to maintain the Facility
Land and Credit Land in a manner which ensures protection of the nitrogen loading limitation of 440 gpd/acre
discharge standard pursuant to 310 CMR 15.214 together with a right to pass and repass by foot and by vehicle over
the Facility Land and Credit Land for said purposes, and for purposes of inspecting the Facility Land and Credit
Land to ensure compliance with and fulfillment of the terms of this Restriction/Easement.
3. Severability. If any court or other tribunal determines that any provision of this instrument is invalid or
unenforceable, such provision shall be deemed to have been modified automatically to conform to the requirements
for validity and enforceability as determined by such court or tribunal. In the event the provision invalidated is of
such a nature that it cannot be so modified, the provision shall be deemed deleted from this instrument as though it
had never been included herein. In either case, the remaining provisions of this instrument shall remain in full force
and effect.
4. Enforcement. Grantor expressly acknowledges that a violation of the terms of this instrument could result in the
following:
(i) upon determination by a court of competent jurisdiction, in the issuance of criminal and civil penalties, and/or
equitable remedies, including, but not limited to, injunctive relief, such injunctive relief could include the issuance
of an order to modify or remove any improvements constructed upon the Facility Land or Credit Land in violation of
the terms of this Restriction/Easement; and
(ii) in the assessment of penalties and enforcement action by the Local Approving Authority and DEP to enforce the
terms of this Restriction/Easement, pursuant to Title 5; M.G.L. c.111, §§ 17, 31, 122, 124, 125, 125A, 127A through
1270, and 129; and M.G.L. c.83, § 11.
5. Provisions to Run with the Land. This Restriction/Easement sets forth the rights, liabilities, agreements and
obligations upon and subject to which the Facility Land and Credit Land or any portion thereof, shall be left
unimproved or according to which said Facility Land and Credit Land may be improved, held, used, occupied,
leased, sold, hypothecated, encumbered, or conveyed. The rights, liabilities, agreements and obligations herein set
forth shall run with the Facility Land and Credit Land, as applicable thereto, and any portion thereof and shall inure
to the benefit of and be binding upon Grantor and all parties claiming by, through or under the Local Approving
12. Effective Date. This Restriction/Easement shall become effective upon its recordation and/or registration with
the appropriate Registry of Deeds and/or Land Registration Office.
WITNESS the execution hereof under seal this _ day of 2012.
Then personally appeared the above -named
free act and deed before me.
Grantor
COMMONWEALTH OF MASSACHUSETTS
19
and acknowledged the foregoing instrument to be
Notary Public:
My commission expires:
The [insert Local Approving Authority] hereby approves and accepts this Grant of Title 5 Nitrogen
Loading Restriction and Easement.
Local Approving Authority
Date:
ATTACHMENT
Upon recording, mail to:
Bureau of Resource Protection, Wastewater Management
Department of Environmental Protection
(applicable Regional Office address)
GRANT OF TITLE 5 NITROGEN LOADING RESTRICTION ON AND EASEMENT
(Grantor owns and restricts both the facility and the credit land)
310 CMR 15.216
This GRANT OF TITLE 5 Nitrogen Loading Restriction AND EASEMENT made as of this day
of , 20 by County,
Massachusetts ("Grantor").
WITNESSETH
WHEREAS, Grantor being the owner(s) in fee simple of that (those) certain parcel(s) of (vacant) land
located in Mansfield, Massachusetts, Bristol County Northern District, with the buildings and improvements
thereon, pursuant to a deed from Michael K. Angelus and Luke N. Angelus to Grantor, dated May 17, 2010 and
recorded with the Bristol County Northern District Registry of Deeds in Book 18750, Page 224 and being
shown on a plan entitled "Definitive Topsheet" of Rolling Fields Village, A Cluster Subdivision in Mansfield,
MA with 11 sheets dated December 28, 2011 latest revision June It, 2012 prepared by RIM Engineering Co.,
Inc. and recorded with the Bristol County Northern District Registry of Deeds in Plan Book 486 on pages 30
through 40.
WHEREAS, Grantor being the owner(s) in fee simple of that (those) certain parcel(s) of (vacant) land
located in Mansfield, Massachusetts, Bristol County Northern District, with the buildings and improvements
thereon, pursuant to a deed from Michael K. Angelus and Luke N. Angelus to Grantor, dated May 17, 2010 and
recorded with the Bristol County Northern District Registry of Deeds in Book 18750, Page 224 and being
shown on a plan entitled "Definitive Topsheet" of Rolling Fields Village, A Cluster Subdivision in Mansfield,
MA with 11 sheets dated December 28, 2011 latest revision June 11, 2012 prepared by RIM Engineering Co.,
Inc. and recorded with the Bristol County Northern District Registry of Deeds in Plan Book 486 on pages 30
through 40.
WHEREAS, Grantor desires to restrict the number of bedrooms as defined pursuant to 310 CMR 15.002
and/or the wastewater discharge design flow in any improvements located on the Facility Land through the use
of this Nitrogen Loading Restriction and Easement; and
WHEREAS, the Facility Land has the benefit, granted hereby, of the Restriction and Easement on the
Credit Land consisting of approximately 20.27 acres as herein provided; and
WHEREAS, the Nitrogen Loading Facility Aggregation Plan has been approved by the Mansfield Board
of Health (and if required, the Massachusetts Department of Environmental Protection ("MassDEP" or
"Department") in accordance with the Department's Guidelines for Title 5 Aggregation of Plans and Nitrogen
Loading;" said approval being based upon the agreement by Grantor to incur certain obligations regarding the
number of bedrooms, as defined in 310 CMR 15.002, and/or the wastewater discharge design flow in any
improvements located on the Facility Land and maintenance of the Restriction and Easement to ensure
protection of the nitrogen loading limitation of 440 gpd/acre discharge standard pursuant to 310 CMR 15.214 in
nitrogen -sensitive areas or in areas serving new construction where the residential use of both on -site systems
and drinking water supply wells are proposed; and to grant to the municipality acting by and through the
Mansfield Board of Health a perpetual easement to ensure maintenance of the Facility Land and the Credit Land
including, but not limited to, removal of any prohibited uses and in connection herewith a perpetual easement to
pass and repass over the Facility Land and the Credit Land for purposes of inspection of the Facility Land and
Credit Land to ensure compliance with and fulfillment of the terms of this Restriction/Easement as hereafter set
forth;
NOW THEREFORE, pursuant to the provisions of 310 CMR 15.216, Grantor does hereby GRANT to
the Town of Mansfield, a Massachusetts municipal corporation situated in Bristol County Northern District,
having an address at 6 Park Row, Mansfield, Massachusetts, acting by and through its Board of Health ("Local
Approving Authority") for nominal, non -monetary consideration, with QUITCLAIM COVENANTS, a TITLE
5 NITROGEN LOADING RESTRICITON AND EASEMENT ("Restriction/Easement") in, on, upon, through,
over and under the Facility Land and the Credit Land, the terms and conditions of which are as follows:
PURPOSE:
The purpose of this restriction is to protect and perserve the quality and quantity of ground water resources in
the area of the public and private wells in the Town/City of Mansfield, Massachusetts in order to ensure a safe
and healthy public and private water supply for the present and future inhabitants of the area. It shall also be for
the specific purpose of limiting the introduction of nitrogen and other pollutants into, and maintaining the
natural uptake of pollutants and the recharge of the ground water which takes place on the Facility Land and the
Credit Land for the said water supply.
OBLIGATIONS AND EASEMENT:
1. Prohibitions. Grantor agrees to restrict the number of bedrooms, as defined pursuant to 310 CMR 15.002, in
any improvements on the Facility Land to 4 bedrooms. Grantor further agrees to maintain the Credit Land as
nitrogen credit land by prohibiting activities which have a detrimental effect on nitrogen loading on the Credit
Land, including but not limited to wastewater discharges, the use of nitrogen fertilizer, the introduction of
artificial impervious surfaces the raising, breeding or keeping of animals, livestock or poultry for commercial
purposes, and the creation or introduction of land under water. A change in the condition of the Credit Land
which results in the Credit Land or a portion thereof being within a Velocity Zone or Regulatory Floodway will
render the Credit Land or said poriton thereof ineligible for nitrogen credit pursuant of 310 CMR 15.216.
2. Easements. In creating this Restriction and Easement, Grantor hereby grants to the Local Approving
Authority its agents, contractors, subcontractors and employees a perpetual EASEMENT to enter upon and the
right to bring equipment onto the Facility Land and Credit Land and do any and all acts deemed necessary to
maintain the Facility Land and Credit Land in a manner which ensures protetion of the nitrogen loading
limitation of 440 gpd/acre discharge standard pursuant to 310 CMR 15.214 together with a right to pass and
repass by foot and by vehicle over the Facility Land and Credit Land for said purposes, and for purposes of
inspecting the Facility Land and Credit Land to ensure compliance with and fulfillment of the terms of this
Restriction/Easement.
3. Severability. If any court or other tribunal determines that any provision of this instrument is invalid or
unenforceable, such provision shall be deemed to have been modified automatically to conform to the
requirements for validity and enforceability as determined by such court or tribunal. In the event the provision
invalidated is of such a nature that it cannot be so modified, the provision shall be deemed deleted from this
instrument as though it had never been included herein. In either case the remaining provisions of this
instrument shall remain in full force and effect.
4. Enforcement. Grantor expressly acknowledges that a violation of the terms of this instrument could result in
the following:
(i) upon determination by a court of competent jurisdiciton, in the issuance of criminal and civil penalties,
and/or equitable remedies, including, but not limited to, injunctive relief, such injunctive relief could include the
issuance of an order to modify or remove any improvements constructed upon the Facility Land or Credit Land
in violation of the terms of this Restriction/Easement; and
(ii) in the assessment of penalties and enforcement action by the Local Approving Authority and DEP to
enforce the terms of this Restriction/Easement, pursuant to Title 5; M.G.L. c. 111, ss 17, 31, 122, 124, 125,
1255A, 127A through 1270, and 129; and M.G.L. c.83, sl 1.
5. Provisions to Run with the Land. This Restriction/Easement sets forth the rights, liabilities, agreements and
obligations upon and subject to which the Facility Land and Credit Land or any portion thereof, shall be left
unimproved or according to which said Facility Land and Credit Land may be improved, held, used, occupied,
leased, sold, hypothecated, encumbered, or conveyed. The rights, liabilities, agreements and obligations herein
set forth shall run with the Facility Land and Credit Land, as applicable thereto, and any portion thereof and
shall inure to the benefit of and be binding upon Grantor and all parties claiming by, through or under the Local
Approving Authority or Grantor. The rights hereby granted to the Local Approving Authority and its successors
and assigns consititue their perpetual right to enforce this Restriction/Easement. Grantor hereby covenants for
himself/herself/itself and his/her/its executors, administrators, heirs, successors and assigns, to stand seized and
hold title to the Facility Land and Credit Land, as applicable thereto, and any portion hereof, subject to this
Restriction/Easement, provided, however, that a violation of this Restriction/Easement shall not result in a
forfeiture or reversion of Grantor's title to the Facility Land or Credit Land, as applicable thereto.
6. Concurrence Presumed. It being agreed that Grantor and all parties claiming by, through or under Grantor
shall be deemed to be in accord with the provisions herein set forth and to agree for and among themselves and
any parry claiming by, through or under them, and their respective agents, contrators, sub-contrators and
employees, that the Restriction/Easement herein established shall be adhered to and not violated and that their
respective interests in the Facility Land and the Credit Land and the Restriction/Easement, as applicable thereto
shall be subject to the provisions herein set forth
7. Incorporation into Deeds, Mortgages, Leases and Instruments of Transfer. Grantor hereby agrees to
incorporate this Restriction/Easement, in fall or by reference, into all deeds, easements, mortgages, leases,
licenses, occupancy agreements or any other instrument of transfer by which an interest in and/or a right to use
the Facility Land or Credit Land, or any portion therof, is conveyed.
8. Recordation. Grantor shall record and/or register this Restriction/Easement with the appropriate Registry of
Deeds and/or Land Registration Office within 30 days of the latter of: receipt from the Local Approving
Authority of the approved Restriction/Easement or the expiration of the 60-day DEP constructive approval
period pursuant to 310 CMR 15.216. Grantor shall file with the Local Approving Authority and the DEP a
certified Registry copy of this Restriction/Easement as recorded and/or registered within 30 days of its date of
recordation and/or registration.
9. Amendment and Release. This Restriction/Easement may be amended or leased only upon approval by the
Local Approving Authority. Release of this Restriction/Easement shall be granted by the Local Approving
Authority in the event the Facility Land is connected to a municipal sewer system and the septic system serving
the Facility Land is abandoned in accordance with 310 CMR 15.354 or the Facility Land is no longer located
within a nitrogen sensitive area pursuant to 310 CMR 15.215. Any such amendment or release shall be recorded
and/or registered with the appropriate Registry of Deeds and/or Land Registration Office and a certified Registry
copy of said amendment or release shall be filed with the Local Approving Authority and the DEP within 30
days of its date of recordation and/or registration.
10. Term. This Restriction/Easement shall run in perpetuity and is intended to conform to M.G.L. c 184, s26 as
amended.
11. Rights Reserved. This Restriction/Easement is granted to the Local Approving Authority in connection
with the approval of a Nitrogen Loading Facility Aggregation Plan pursuant to 310 CMR 15.216 and the
Department's "Guidelines for Title 5 Aggregation of Flows and Nitrogen Loading." It is expressly agreed that
acceptance of the Restriction/Easement by the Local Approving Authority or constructive approval of the
Nitrogen Loading Facility Aggregation Plan by DEP shall not operate to bar, diminish, or in any way affect any
legal or equitable right of the Local Approving Authority or DEP to issue any future order with respect to the
Facility Land or Credit Land or in any way affect any other claim, action, suit, cause of action, or demand which
the Local Approving Authority of DEP may have with respect thereto. Nor shall acceptance of the
Restriction/Easement serve to impose any obligations, liabilities, or any other duties upon the Local Approving
Authority.
12. Effective Date. This Restriction/Easement shall become effective upon its recordation and/or registration
with the appropriate Registry of Deeds and/or Land Registration Office.
WITNESS the execution hereof under seal this day of , 20
Grantor
COMMONWEALTH OF MASSACHUSETTS
Then personally appeared the above -named
foregoing instrument to be free act and deed before me.
20
and acknowledged the
Notary Public:
My commission expires:
The Mansfield Board of Health hereby approves and accepts this Grant of Title 5 Nitrogen Loading
Restriciton and Easement.
Local Approving Authority
ATTACHMENT 3
Upon recording, mail to:
Bureau of Resource Protection, Wastewater Management
Department of Environmental Protection
(applicable Regional Office address)
GRANT OF TITLE 5 NITROGEN LOADING RESTRICITON AND EASEMENT
(Grantor owns and restricts both the facility and the credit land)
310 CMR 15.216
This GRANT OF TITLE 5 Nitrogen Loading Restriction AND EASEMENT made as of this day
of 20 by County,
Massachusetts ("Grantor").
WITNESSETH
WHEREAS, Grantor being the owner(s) in fee simple of that (those) certain parcel(s) of (vacant) land
located in Mansfield, Massachusetts, Bristol County Northern District, with the buildings and improvements
thereon, pursuant to a deed from P. Burke Fountain, Trustee of "Elms Realty Trust" to Grantor dated February
10 2004 and recorded with the Bristol County Northern District Registry of Deeds in Book 13299, Page 317
(First Parcel) and Steve Benoit and Mary P. Benoit to Grantor dated January 31, 1984 and recorded with the
Bristol County Northern District Registry of Deeds in Book 4040, Page 64 (2nd Parcel) and being shown on a
plan entitled "Definitive Topsheet" of Rolling Fields Village, A Cluster Subdivision in Mansfield, MA with 11
sheets dated December 28, 2011 latest revision June 11, 2012 prepared by RIM Engineering Co., Inc. and
recorded with the Bristol County Northern District Registry of Deeds in Plan Book 486 on pages 30 through 40.
WHEREAS, Grantor being the owner(s) in fee simple of that (those) certain parcel(s) of (vacant) land
located in Mansfield, Massachusetts, Bristol County Northern District, with the buildings and improvements
thereon, pursuant to a deed from P. Burke Fountain, Trustee of "Elms Realty Trust" to Grantor dated February
10 2004 and recorded with the Bristol County Northern District Registry of Deeds in Book 13299, Page 317
(First Parcel) and Steve Benoit and Mary P. Benoit to Grantor dated January 31, 1984 and recorded with the
Bristol County Northern District Registry of Deeds in Book 4040, Page 64 (2nd Parcel) and being shown on a
plan entitled "Definitive Topsheet" of Rolling Fields Village, A Cluster Subdivision in Mansfield, MA with 11
sheets dated December 28, 2011 latest revision June 11, 2012 prepared by RIM Engineering Co., Inc. and
recorded with the Bristol County Northern District Registry of Deeds in Plan Book 486 on pages 30 through 40.
WHEREAS, Grantor desires to restrict the number of bedrooms as defined pursuant to 310 CMR 15.002
and/or the wastewater discharge design flow in any improvements located on the Facility Land through the use
of this Nitrogen Loading Restriction and Easement; and
WHEREAS, the Facility Land has the benefit, granted hereby, of the Restriction and Easement on the
Credit Land consisting of approximately 20.27 acres as herein provided; and
WHEREAS, the Nitrogen Loading Facility Aggregation Plan has been approved by the Mansfield Board
of Health (and if required, the Massachusetts Department of Environmental Protection ("MassDEP" or
"Department") in accordance with the Department's Guidelines for Title 5 Aggregation of Plans and Nitrogen
Loading;" said approval being based upon the agreement by Grantor to incur certain obligations regarding the
number of bedrooms, as defined in 310 CMR 15.002, and/or the wastewater discharge design flow in any
improvements located on the Facility Land and maintenance of the Restriction and Easement to ensure
protection of the nitrogen loading limitation of 440 gpd/acre discharge standard pursuant to 310 CMR 15.214 in
nitrogen -sensitive areas or in areas serving new construction where the residential use of both on -site systems
and drinking water supply wells are proposed; and to grant to the municipality acting by and through the
Mansfield Board of Health a perpetual easement to ensure maintenance of the Facility Land and the Credit Land
including, but not limited to, removal of any prohibited uses and in connection herewith a perpetual easement to
pass and repass over the Facility Land and the Credit Land for purposes of inspection of the Facility Land and
Credit Land to ensure compliance with and fulfillment of the terms of this Restriction/Easement as hereafter set
forth;
NOW THEREFORE, pursuant to the provisions of 310 CMR 15.216, Grantor does hereby GRANT to
the Town of Mansfield, a Massachusetts municipal corporation situated in Bristol County Northern District,
having an address at 6 Park Row, Mansfield, Massachusetts, acting by and through its Board of Health ('Local
Approving Authority") for nominal, non -monetary consideration, with QUITCLAIM COVENANTS, a TITLE
5 NITROGEN LOADING RESTRICITON AND EASEMENT (Restriction/Easement") in, on, upon, through,
over and under the Facility Land and the Credit Land, the terms and conditions of which are as follows:
PURPOSE:
The purpose of this restriction is to protect and perserve the quality and quantity of ground water resources in
the area of the public and private wells in the Town/City of Mansfield, Massachusetts in order to ensure a safe
and healthy public and private water supply for the present and future inhabitants of the area. It shall also be for
the specific purpose of limiting the introduction of nitrogen and other pollutants into, and maintaining the
natural uptake of pollutants and the recharge of the ground water which takes place on the Facility Land and the
Credit Land for the said water supply.
OBLIGATIONS AND EASEMENT:
1. Prohibitions. Grantor agrees to restrict the number of bedrooms, as defined pursuant to 310 CMR 15.002, in
any improvements on the Facility Land to 4 bedrooms. Grantor further agrees to maintain the Credit Land as
nitrogen credit land by prohibiting activities which have a detrimental effect on nitrogen loading on the Credit
Land, including but not limited to wastewater discharges, the use of nitrogen fertilizer, the introduction of
artificial impervious surfaces the raising, breeding or keeping of animals, livestock or poultry for commercial
purposes, and the creation or introduction of land under water. A change in the condition of the Credit Land
which results in the Credit Land or a portion thereof being within a Velocity Zone or Regulatory Floodway will
render the Credit Land or said poriton thereof ineligible for nitrogen credit pursuant of 310 CMR 15.216.
2. Easements. In creating this Restriction and Easement, Grantor hereby grants to the Local Approving
Authority its agents, contractors, subcontractors and employees a perpetual EASEMENT to enter upon and the
right to bring equipment onto the Facility Land and Credit Land and do any and all acts deemed necessary to
maintain the Facility Land and Credit Land in a manner which ensures protetion of the nitrogen loading
limitation of 440 gpd/acre discharge standard pursuant to 310 CMR 15.214 together with a right to pass and
repass by foot and by vehicle over the Facility Land and Credit Land for said purposes, and for purposes of
inspecting the Facility Land and Credit Land to ensure compliance with and fulfillment of the terms of this
Restriction/Easement.
3. Severability. If any court or other tribunal determines that any provision of this instrument is invalid or
unenforceable, such provision shall be deemed to have been modified automatically to conform to the
requirements for validity and enforceability as determined by such court or tribunal. In the event the provision
invalidated is of such a nature that it cannot be so modified, the provision shall be deemed deleted from this
instrument as though it had never been included herein. In either case the remaining provisions of this
instrument shall remain in full force and effect.
4. Enforcement. Grantor expressly acknowledges that a violation of the terms of this instrument could result in
the following:
(i) upon determination by a court of competent jurisdiciton, in the issuance of criminal and civil penalties,
and/or equitable remedies, including, but not limited to, injunctive relief, such injunctive relief could include the
issuance of an order to modify or remove any improvements constructed upon the Facility Land or Credit Land
in violation of the terms of this Restriction/Easement; and
(ii) in the assessment of penalties and enforcement action by the Local Approving Authority and DEP to
enforce the terms of this Restriction/Easement, pursuant to Title 5; M.G.L. c.111, ss 17, 31, 122, 124, 125,
1255A, 127A through 1270, and 129; and M.G.L. c.83, sl 1.
5. Provisions to Run with the Land. This Restriction/Easement sets forth the rights, liabilities, agreements and
obligations upon and subject to which the Facility Land and Credit Land or any portion thereof, shall be left
unimproved or according to which said Facility Land and Credit Land may be improved, held, used, occupied,
leased, sold, hypothecated, encumbered, or conveyed. The rights, liabilities, agreements and obligations herein
set forth shall run with the Facility Land and Credit Land, as applicable thereto, and any portion thereof and
shall inure to the benefit of and be binding upon Grantor and all parties claiming by, through or under the Local
Approving Authority or Grantor. The rights hereby granted to the Local Approving Authority and its successors
and assigns consititue their perpetual right to enforce this Restriction/Easement. Grantor hereby covenants for
himself/herself/itself and his/her/its executors, administrators, heirs, successors and assigns, to stand seized and
hold title to the Facility Land and Credit Land, as applicable thereto, and any portion hereof, subject to this
Restriction/Easement, provided, however, that a violation of this Restriction/Easement shall not result in a
forfeiture or reversion of Grantor's title to the Facility Land or Credit Land, as applicable thereto.
6. Concurrence Presumed. It being agreed that Grantor and all parties claiming by, through or under Grantor
shall be deemed to be in accord with the provisions herein set forth and to agree for and among themselves and
any party claiming by, through or under them, and their respective agents, contrators, sub-contrators and
employees, that the Restriction/Easement herein established shall be adhered to and not violated and that their
respective interests in the Facility Land and the Credit Land and the Restriction/Easement, as applicable thereto
shall be subject to the provisions herein set forth
7. Incorporation into Deeds, Mortgages, Leases and Instruments of Transfer. Grantor hereby agrees to
incorporate this Restriction/Easement, in full or by reference, into all deeds, easements, mortgages, leases,
licenses, occupancy agreements or any other instrument of transfer by which an interest in and/or a right to use
the Facility Land or Credit Land, or any portion therof, is conveyed.
8. Recordation. Grantor shall record and/or register this Restriction/Easement with the appropriate Registry of
Deeds and/or Land Registration Office within 30 days of the latter of: receipt from the Local Approving
Authority of the approved Restriction/Easement or the expiration of the 60-day DEP constructive approval
period pursuant to 310 CMR 15.216. Grantor shall file with the Local Approving Authority and the DEP a
certified Registry copy of this Restriction/Easement as recorded and/or registered within 30 days of its date of
recordation and/or registration.
9. Amendment and Release. This Restriction/Easement may be amended or leased only upon approval by the
Local Approving Authority. Release of this Restriction/Easement shall be granted by the Local Approving
Authority in the event the Facility Land is connected to a municipal sewer system and the septic system serving
the Facility Land is abandoned in accordance with 310 CMR 15.354 or the Facility Land is no longer located
within a nitrogen sensitive area pursuant to 310 CMR 15.215. Any such amendment or release shall be recorded
and/or registered with the appropriate Registry of Deeds and/or Land Registration Office and a certified Registry
copy of said amendment or release shall be filed with the Local Approving Authority and the DEP within 30
days of its date of recordation and/or registration.
10. Term. This Restriction/Easement shall run in perpetuity and is intended to conform to M.G.L. c 184, s26 as
amended.
11. Rights Reserved. This Restriction/Easement is granted to the Local Approving Authority in connection
with the approval of a Nitrogen Loading Facility Aggregation Plan pursuant to 310 CMR 15.216 and the
Department's "Guidelines for Title 5 Aggregation of Flows and Nitrogen Loading." It is expressly agreed that
acceptance of the Restriction/Easement by the Local Approving Authority or constructive approval of the
Nitrogen Loading Facility Aggregation Plan by DEP shall not operate to bar, diminish, or in any way affect any
legal or equitable right of the Local Approving Authority or DEP to issue any future order with respect to the
Facility Land or Credit Land or in any way affect any other claim, action, suit, cause of action, or demand which
the Local Approving Authority of DEP may have with respect thereto. Nor shall acceptance of the
Restriction/Easement serve to impose any obligations, liabilities, or any other duties upon the Local Approving
Authority.
12. Effective Date. This Restriction/Easement shall become effective upon its recordation and/or registration
with the appropriate Registry of Deeds and/or Land Registration Office.
WITNESS the execution hereof under seal this day of
Grantor
20
COMMONWEALTH OF MASSACHUSETTS
Then personally appeared the above -named
foregoing instrument to be free act and deed before me.
20
and acknowledged the
Notary Public:
My commission expires:
The Mansfield Board of Health hereby approves and accepts this Grant of Title 5 Nitrogen Loading
Restriciton and Easement.
Local Approving Authority
Does the facility aggregation plan afford the same environmental protection as
a single acre residential house lot receiving 440 gallons per day of effluent in a
nitrogen sensitive area?
Title 5 regulations
15.214: Nitrogen Loading Limitations
(1) No system serving new construction in Nitrogen Sensitive Areas designated in 310 CMR 15.215 shall
be designed to receive or shall receive more than 440 gallons of design flow per day per acre except as
set forth at 310 CMR 15.216 (aggregate flows) or 15.217 (enhanced nitrogen removal).
(3) It shall be the duty of the owner of the system or proposed system to ascertain whether or not the
facility to be constructed will be in a nitrogen sensitive area. The Department will prepare and make
available at locations generally accessible to the public maps portraying designated nitrogen sensitive
areas within the Commonwealth.
15.216: Aggregate Determinations of Flows and Nitrogen Loadings
(1) The 440 gallons per day per acre nitrogen loading limitation imposed by 310 CMR 15.214 maybe
calculated in the aggregate by using nitrogen credit land in accordance with an approved Facility
Aggregation Plan or Community Aggregation Plan. Applicants proposing systems to be located within a
community or region covered by a Community Aggregation Plan approved by the Department shall
calculate aggregate determinations of flows and nitrogen loadings in accordance with the Plan and the
Department's Guidelines for Title 5 Aggregation of Flows and Nitrogen Loading. All other applicants
seeking aggregate determination of flows and nitrogen loading shall prepare a Facility Aggregation Plan
in accordance with 310 CMR 15.216 and the Department's Guidelines for Title 5 Aggregation of Flows
and Nitrogen Loading.
(2) To qualify as Nitrogen Credit Land, the land must:
(a) be within the same Nitrogen Sensitive Area as the facility if the facility is in a Nitrogen
Sensitive Area;
(b) be within the same subdivision in an area where the use of both on -site systems and
drinking water wells are proposed to serve the facility;
(c) not have any manmade sources of nitrogen, including, but not limited to, wastewater
discharges and nitrogen based fertilizer located thereon;
(d) not be used for raising, breeding or keeping of animals;
(e) be pervious;
(f) be outside of Zone As, Velocity Zones and Regulatory Floodways;
(g) not be covered by any surface water body including, but not limited to, a river, stream, lake,
pond, or ocean;
(h) not be currently designated as nitrogen credit land; and
(i) meet the criteria set forth in the Department's Guidelines for Title 5 Aggregation of Flows
and Nitrogen Loading.
(5) Facility Aggregation Plans. The Approving Authority may approve a Facility Aggregation Plan
provided that the following conditions are met:
(a) The proposed facility meets the criteria in the Department's Guidelines for Title 5
Aggregation of Flows and Nitrogen Loading,
(b) the design flow of 440 gallons per day per acre equivalency across the facility and other
land areas for which nitrogen credit is sought, but not necessarily on every individual acre, will
be met through recorded land use restrictions that restrict nitrogen loading on facility land and
nitrogen credit land. These land use restrictions must be substantially identical to those
contained in the Department's Guidelines for Title 5 Aggregation of Flows and Nitrogen Loading,
run in perpetuity, be approved by the respective land owners, run to the benefit of the
municipality acting by and through the Local Approving Authority and, in the case of nitrogen
credit land, also run to the benefit of the facility land. The applicant shall record or register such
restrictions and easements in the appropriate Registry of Deeds or Land Registration Office
within 30 days of approval of the plan; and
(c) any other conditions that the Approving Authority deems appropriate.
From: Department's Guidelines for Title 5 Aggregation of Flows and Nitrogen Loading
4. A FACILITY AGGREGATION PLAN
Under the Facility Aggregation Plan,
✓ the applicant proposes to meet the 440 gpd per acre equivalency standard by establishing
nitrogen credit on nonfacility land with the consent of the owner of such land.
WIN
✓ The applicant must demonstrate how it will comply with the nitrogen standard(s) and
✓ include proposed restriction documents limiting use of both the facility land and
nonfacility credit land.
✓ The restrictions must be either a conservation restriction or a nitrogen loading
restriction and easement.
❑ Such plans must be approved by the Approving Authority.
5. NITROGEN STANDARDS
✓ (1) The 440 gpd per acre Equivalency Standard
o Proven in letter
✓ (2) The Groundwater Quality Standard: 10 mg/I total nitrogen, and 10 mg/I nitrate -nitrogen
o Only needed for design flow of 2000gpd
o This is using a total of 12 bedrooms so 1310 gpd
✓ (3) The DEP Nitrogen Loading Assessment Standard: 5 mg/I nitrate -nitrogen
o No risk indicators present, unnecessary
6. CREDIT LAND QUALIFICATIONS
If the facility is in a Nitrogen Sensitive Area, nonfacility credit land must be:
✓ located in the same Nitrogen Sensitive Area as the facility
a;et;
✓ the credit land must also be located adjacent to and downgradient from the facility's impacted
area of discharge.
Regardless of whether the facility is in a nitrogen sensitive area or private well area, the designated
nonfacility credit land: (all met because of the conservation restriction)
✓ must be restricted to prohibit man-made sources of nitrogen, including, but not limited to,
sewage discharge, nitrogen -based fertilizer or the raising and grazing of livestock;
✓ must be restricted to prohibit artificially rendered imperviousness (i.e., paved streets, paved
parking lots, buildings, structures, etc.);
✓ not within a Velocity Zone or Regulatory Floodway identified by FEMA, and
✓ not under surface water (land covered with water, including, but not limited to rivers, ponds,
oceans, streams and lakes);
✓ not already being used as nitrogen credit land.
The applicant must submit to the Approving Authority,
✓ unexecuted restriction documents with its nitrogen aggregation facility plan.
■
o The land is already restricted by the Conservation Restriction, states in quitclaim deed
that it is to be held and managed by the conservation commission
days of plan appFeval. Current restriction documents are sufficient
below.detailed guidance an nitFegen leading restrictions is pFevided in Seetien 8, Current
restriction documents are sufficient
7. SITE -SPECIFIC MASS BALANCE ANALYSIS
✓ Unnecessary because the facility does not have a flow greater than 2000 gpd
B. LAND USE RESTRICTIONS ON FACILITY AND NONFACILITY CREDIT LANDS
A. Nitrogen Loading Restriction and Easement
❑ A Title 5 Nitrogen Loading Restriction and Easement limits activities that generate nitrogen.
Restrictions on facility land must limit development to the applicable number of bedrooms or
applicable design flow. (unnecessary because Conservation Restriction is met)
B. Conservation Restriction
✓ A conservation restriction prohibiting uses and activities that result in nitrogen loading is also an
appropriate means of ensuring the continued maintenance of nitrogen loading limitations
9. REQUIREMENTS FOR THE AGGREGATION PLAN REPORT
An applicant must include the following at a minimum in the application to the Approving Authority.
A Facility Aggregation Plan report must include:
✓ Completed BRP WP 58a application, including fee payment where DEP is the Approving
Authority. (no fee required)
Board of Health letteF approviRg bath the aggFegatien plan and (unexecuted) F-StFiGtioR
✓ A locus map (USGS 1:24,000 scale topographic series sheet) indicating the location of the
proposed facility and credit land, the location of all public water supply well(s) with the
corresponding nitrogen sensitive area(s), and the location of all public water supplies within a
one-half mile radius of the proposed discharge.
✓ A description of the proposed facility
✓ site characteristics,
✓ the proposed subsurface disposal system,
✓ the relevant nitrogen sensitive area,
✓ sensitive receptors within one-half mile radius of the proposed discharge,
✓ loading calculation and aggregation proposal details.
digGugginn Af the raw data, the hydFageolagie assessment, analysis findings, ,
✓ A site map (appropriately scaled) showing
✓ the nitrogen sensitive area with the location/ identification of the public water supply,
✓ the facility property boundaries with existing and proposed improvements,
✓ credit land,
✓ sensitive receptors, and
✓ relevant topographic features, such as bedrock outcrops, streams, ponds, etc.
P if the Board of Health FequiFes an impact assessment at the downgradient eredit land
PFejaeFty baundaFy eF nearest sensitive Feeeptai� the site Fnap alse must show tepegraphie
locations f9F
+n n"S Rd AthP nln n+features, ..ti H ng � a test I
✓ Calculations to meet the 440 gpd per acre equivalency standard; and, if applieabin, site speGif'n
mass balance analysis to meet the 10 M9/l Ritregen standard at the dewngFadierit GFedit land
rF
v�Results frem the DEP AjitFegen Loading Assessment analysis and i
✓ Planning Board comments, if any.
✓ Copies of current deeds for both facility and credit land and any plans cited in those deeds.
✓ Copies of the (unexecuted) conservation restriction(s) and/or nitrogen loading restriction(s) for
both facility and credit land.
o There is already a conservation restriction on the Open Space used a Credit land.)
✓ Upon approval, the applicant must execute and record the restriction documents within 30 days
and deliver recorded copies to the Approving Authority.
e Existing documents are sufficient