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November 28, 2023 - Just Zero, et. al.

U.S. Environmental Protection Agency · from the EPA · 40 pages · 694 KB
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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
November 28, 2023
Michele Barden
EPA Region 1
5 Post Office Square
Suite 100
Boston, MA 02109 
RE: Draft National Pollutant Discharge Elimination System Permit No.
MA0103284 (MWRA Deer Island Treatment Plant) 
Thank you for the opportunity to provide comments on the Massachusetts Water
Resources Authority (“MWRA”) Deer Island Treatment Plant (“DITP”) Draft National
Pollutant Discharge Elimination System Permit No. 0103284 (“Draft Permit”) and
accompanying fact sheet. These comments are submitted on behalf of Just Zero,
and 47 environmental organizations, scientists, public health advocates, and
farmers. 1 
Located on a peninsula in Boston Harbor, the DITP is one of the largest
wastewater treatment facilities (“WWTF”) in the United States. This plant manages
approximately 360 million gallons per day of sewage from 43 communities in the
Boston metropolitan area; stormwater and other precipitation from roadways,
rooftops, parking lots, and other surfaces; as well as wastewater from industrial
users, commercial companies, manufacturers, and nearly every other conceivable
entity with a drainpipe. In heavy rain, the flow of sewage, industrial waste, and
rainwater can – and sometimes does – exceed a billion gallons in a day.
Altogether, this makes the DITP a significant source of polyfluoroalkyl substances
(“PFAS”), a wide range of toxic chemicals, and microplastic pollution in
Massachusetts, as well as the entire country.
Just Zero and the undersigned organizations are concerned with several aspects
of the Draft Permit as they fall short of the overarching goal of protecting water
quality and public health – especially when it comes to addressing the presence of
contaminants of emerging concern such as PFAS and microplastics. 2 
1 Hereinafter these organizations are collectively referred to as “Just Zero and the undersigned
organizations” or “we.” 
2 MWRA Draft NPDES Permit No. MA0103284, and Factsheet

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
To better account for the presence of these contaminants in the influent, effluent,
and sewage sludge 3 , we are calling on EPA to include the following in the final
permit:
(1) Provisions that allow the Agency to expand the list of PFAS that are subject
to quarterly sampling and monitoring requirements when additional
compounds are detectable by Method 1633 or an improved method.
(2) Increased monitoring and sampling for PFAS from industrial discharges that
utilize the DITP. The current requirement for annual monitoring and
sampling is insufficient to provide a clear picture of the concentrations of
PFAS in the influent from industrial and other dischargers.
(3) A requirement that landfill leachate must be pretreated to remove and/or
reduce the concentration of PFAS in the leachate prior to being sent to the
DITP. Many states are considering and exploring landfill leachate
pretreatment technologies and systems to reduce the concentration of
PFAS entering the environment from this known source.
(4) A prohibition on the land application of sewage sludge generated at the
DITP. This prohibition must apply to all sludge, regardless of how it is
processed and whether it is identified as a fertilizer by DITP or any other
entity. Should EPA fail to include this requirement in the final permit, the
Agency must, at a minimum, include robust tracking and reporting to better
understand where this material is being applied.
(5) Quarterly monitoring and sampling for microplastics in the influent, effluent,
and sewage sludge. The results of this sampling must be made available to
the public.
(6) Assurance that EPA will continue to maintain the Outfall Monitoring Science
Advisory Panel (“OMSAP”).
These requirements are necessary to better understand the sources and
concentrations of PFAS and microplastics in the influent entering the DITP, as well
as to reduce the release of these contaminants into the environment, thereby
better protecting water quality and public health. 
I. EPA Should Strengthen the Draft Permit to Minimize the Release of
PFAS from the DITP. 
The Draft Permit acknowledges PFAS as chemicals of concern. This is a welcome
addition to the permit; however, EPA should go further and use this permit 
3 “Sewage sludge,” “sludge,” and “biosolids” are used interchangeably in these comments.

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
renewal as an opportunity to take a more active and protective approach to
minimize the release of PFAS from this facility.
The undersigned urge EPA to address the significant environmental and public
health threats posed by the release of PFAS from the DITP by: 1) expanding the
list of PFAS compounds subject to quarterly monitoring and sampling
requirements as they become detectable by Method 1633 or other EPA approved
methods; 2) increasing monitoring and sampling requirements for PFAS from
industrial discharges that utilize the DITP; 3) requiring in the permit that landfill
leachate must be pretreated to remove or reduce the concentration of PFAS in the
leachate prior to being sent to the DITP; and 4) prohibiting the land application of
sewage sludge generated at the DITP.
Individually and collectively, these requirements will better protect the water
quality of the receiving waters, as well as the health of those who live, work, and
recreate near the DITP and the areas where effluent is released and contaminated
sludge is spread.
A. PFAS Pose a Serious Threat to Public Health and the Environment.
PFAS are a group of approximately 15,000 synthetic chemicals. 4 A 2001 class
action lawsuit against DuPont involving perfluorooctanoic acid (“PFOA,” one of the
most well-studied PFAS) released into the environment from its West Virginia
Washington Works Plant resulted in a settlement that established a large
epidemiological study of PFAS-exposed residents near the plant. 5 Blood samples
from 69,000 people found that the PFOA exposure was linked to kidney cancer,
testicular cancer, thyroid disease, ulcerative colitis, high cholesterol
(hypercholesterolemia), and pregnancy-induced hypertension and preeclampsia. 6 
The U.S. Department of Health and Human Services’ National Toxicology Program
has confirmed PFAS’ toxicity to the immune systems of both human and non-
human animals. 7 A sister agency, the Agency for Toxic Substances and Disease 
4 U.S. Environmental Protection Agency, CompTox Chemicals Dashboard. 
5 Leach v. E.I. Du Pont de Nemours Co., et al., No. 01-C-608, 2002 WL 1270121, at *1. (W.Va. Cir.
Ct. April 10, 2002). 
6 
Id. 
7 Division of the National Toxicology Program, Monograph on Immunotoxicity Association with
Exposure to Perfluorooctanoic Acid (PFOA) or Perfluorooctane sulfonate (PFOS), U.S. Department
of Health and Human Servies. (Sept. 2016).

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
Registry (“ATSDR”), published toxicological profiles of PFAS in 2021. 8 It presented
strong evidence that PFAS are harmful to human health, reflecting the evidence
from a large number of studies that show PFAS linked to increased cholesterol
levels, decreased vaccine response in children, liver disease, preeclampsia in
pregnant women, decreases in infant birth weights, and increased risk of kidney
or testicular cancer. 9 The Interstate Technology Regulatory Council (“ITRC”) has
similarly recognized that PFAS exposure carries numerous and significant human
and ecological effects, including liver effects, increased serum cholesterol,
immunological effects, cardiovascular effects, and cancer. 10 
In 2023, EPA acted on the vast amount of research that shows the profound harm
to human health from PFAS exposure by proposing new regulations for the
National Primary Drinking Water Regulation (“NPDWR”) for six PFAS: PFOA, PFOS,
perfluorononanoic acid (“PFNA”), hexafluoropropylene oxide dimer acid (“HFPO-
DA”, also known as “GenX”), perfluorohexane sulfonic acid (“PFHxS”), and
perfluorobutane sulfonic acid (“PFBS”). 11 This proposed rulemaking would
establish legally enforceable levels in drinking water, called Maximum
Contaminant Levels (“MCLs”) for these compounds. The MCLs for PFOA and
PFOS are 4 parts per trillion (“ppt”). 12 The other four PFAS will be regulated as a
PFAS mixture and their MCLs determined by a Hazard Index set at 1.0. 13 
Additionally, the Maximum Contaminant Levels Goals (“MCLGs”) for both PFOA
and PFOS are zero, meaning there is no safe level of contamination in drinking
water. 14 
The Commonwealth of Massachusetts moved faster than EPA on PFAS regulation
in drinking water. In 2020, the Massachusetts Department of Environmental
Protection (“MassDEP”) published drinking water standards for PFOS, PFOA,
PFHxS, PFNA, PFHpA, and PFDA, with an MCL of 20 ppt for the combined six
PFAS and an MCLG of zero. 15 
8 Agency for Toxic Substances and Disease Registry, Toxicological Profile for Perfluoroalkyls, U.S.
Department of Health and Human Services. (May 2021) 
9 
Id. 
10 Interstate Technology Regulatory Council, Human and Ecological Health Effects and Risk
Assessment of PFAS. (Sept. 2023). 
11 U.S. EPA, Perfluorooctanoic Acid and Perfluorooctanesulfonic Acid National Primary Drinking
Water Regulation Rulemaking, Docket ID: EPA-HQ-OW-2022-0114. (Mar. 14, 2023). 
12 
Id. 
13 
Id. 
14 
Id. 
15 310 CMR § 22.07G(3)(d).

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
EPA has also proposed regulating PFOA and PFOS under the Comprehensive
Environmental Response, Compensation, and Liability Act of 1980, (“CERCLA” or
“Superfund”), designating both as hazardous substances. 16 EPA states that these
chemicals “may present substantial danger to the public health or welfare or the
environment.” 17 Importantly, MassDEP, unlike other commenters, did not include
any carveout for PFAS in sludge or sludge derived products. 18 
There is no question that PFAS chemicals pose a serious threat to public health
and the environment. Through this permit and others like it, EPA must begin
implementing requirements that will help identify the source of PFAS into
WWTFs and reduce the release of these chemicals into the environment. 
B. Wastewater Treatment Facilities, Including the DITP, are Significant
Sources of PFAS.
PFAS enter the DITP from a variety of commercial and industrial sources such as
wastewater from metal finishers and other manufacturing plants, electronic
industries, and landfill leachate. 19 WWTFs, including the DITP, are not designed or
equipped to remove or destroy these compounds, especially synthetic
petrochemicals. As a result, effluent containing these chemicals is discharged into
the receiving waters where it can bioaccumulate and threaten the environment
and public health. A significant portion of the PFAS in the influent is also
transferred to the sludge generated at these facilities. 20 
Moreover, growing evidence demonstrates that WWTFs actually generate
additional PFAS in both effluent and sewage sludge, rather than simply serving as 
16 EPA, Designation of Perfluorooctanoic Acid (PFOA) and Perfluorooctanesulfonic Acid (PFOS) as
CERCLA Hazardous Substances, Proposed Rule, 87 Fed. Reg. 54415 (Sept. 6, 2022). 
17 
Id. 
18 Massachusetts Department of Environmental Protection, Comments on the Designation of
Perfluorooctanoic Acid (PFOA) and Perfluorooctanesulfonic Acid (PFOS) as CERCLA Hazardous
Substances, EPA-HQ-OLEM-2019-0341. (Nov. 9, 2022). 
19 Heidler, J., & Halden, R. U. (2008). Meta-analysis of mass balances examining chemical fate
during wastewater treatment. Environmental Science & Technology, 42(17), 6324–6332.
https://doi.org/10.1021/es703008y 
20 Lenka, S.P., Kah, M., Padhye, L.P., 2021. A review of the occurrence, transformation, and
removal of poly- and perfluoroalkyl substances (PFAS) in wastewater treatment plants. Water Res.
199, 117187. doi.org/10.1016/j.watres.2021.117187.

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
a conduit. 21 Studies have shown that the PFAS in the effluent at WWTFs can be 19
times greater than the PFAS in the influent. 22 Discharges into the DITP also contain
precursors (chemicals that eventually become PFAS) such as perfluorooctane
sulfonamide, fluorotelomer-based compounds, fluorinated surfactants, and
fluorotelomer alcohols. 23 
Precursors in the sewage sludge can also transform into other PFAS. 24 This occurs
during composting, heat treatment, lime treatment, anaerobic digestion, and when
land applied. 25 Therefore, PFAS levels in sludge will change depending on when,
where, and how the sludge is tested. 26 As a result, although it is clear that sludge
contains PFAS, the PFAS levels are likely underrepresented in monitoring and
sampling. 27 
When this sludge is either land applied or processed to create a “fertilizer,”
contaminants – including PFAS - can bioaccumulate in the soil and mobilize and
enter groundwater. Given that PFAS and their precursors enter WWTFs as influent, multiply, and
leave WWTFs via the effluent and sewage sludge in even greater amounts than
previously documented, additional, stricter regulation, and more
comprehensive testing of WWTFs is overdue and necessary to protect public
health and the environment. 
C. EPA Should Expand the List of PFAS That Are Subject to Quarterly
Sampling and Monitoring Requirements When Additional Compounds
Are Detectable.
The Draft Permit requires quarterly influent, effluent, and sludge sampling PFAS
and annual sampling for “certain industrial users” with the stated purpose to 
21 Helmer, R. W., Reeves, D. M., & Cassidy, D. P. (2022). Per- and polyfluorinated alkyl substances
(PFAS) cycling within Michigan: Contaminated sites, landfills and wastewater treatment plants.
Water Research, 210, 117983. https://doi.org/10.1016/j.watres.2021.117983 
22 
Id. 
23 
Id. 
24 Thompson, J., Robey, N., Tolaymat, T., Bowden, J., Solo-Gabriele, H., & Townsend, T. (2023).
Underestimation of Per- and Polyfluoroalkyl Substances in Biosolids: Precursor Transformation
During Conventional Treatment.. Environmental science & technology.
https://doi.org/10.1021/acs.est.2c06189 
25 Id
. 
26 
Id. 
27 
Id.

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
“better understand potential discharges of PFAS from this facility and to inform
future permitting decisions.” 28 We support these requirements.
Quarterly monitoring of the 40 PFAS parameters detectable by Method 1633 is a
strong starting point and necessary contribution to our understanding of PFAS
entering and leaving the DITP. However, given the dynamic regulatory, scientific,
and public health related landscape for PFAS, the Draft Permit should require that
when other PFAS compounds are detectable by Method 1633 or an improved EPA
method (such as total organic fluorine), they too should be monitored and
reported quarterly. This is especially important given that the permit the DITP is
currently operating under is over twenty years old. 29 EPA cannot wait another
twenty years to require testing for additional PFAS compounds.
EPA published Method 1633 this year. It was developed in a four-year
collaboration with the Department of Defense. EPA has confirmed this is not the
end of the road in terms of developing testing methodology for PFAS. 30 EPA has
stated that there are “hundreds” of PFAS and that it needs to test for more than
40 of them in drinking water and in waste matrices such as sewage sludge and
landfill leachate and that it is also developing new methods for detecting organic
fluorine, a useful indicator of PFAS. 31 
Given that 22 states have MCLs for PFAS that add several PFAS concentrations
together, such as Massachusetts’ regulation that adds six PFAS concentrations to
determine whether they surpass the MCL of 20 ppt, it is not unreasonable to
assume that as testing expands, additional PFAS will be added to state and
federal drinking water and other health-related regulations. 32 These regulations
will be informed by expanded PFAS measurements at major sources of the
chemicals, like the DITP. Therefore, when other PFAS compounds are detectable by Method 1633 or an
improved EPA method, the newly detectable compounds should also be subject
to the permit’s monitoring and reporting requirements. 
28 NPDES Permit No. MA0103284, Fact Sheet. Pg. 90. 
29 U.S. EPA, Authorization to Discharge Under the National Pollutant Discharge Elimination System
– Massachusetts Water Resources Authority, Permit No. MA0103284. (July 10, 2000). 
30 U.S. EPA, Clean Water Act Analytical Methods for Per- and Polyfluorinated Alkyl Substances. 
31 
Id. 
32 National Conference of State Legislatures, Per- and Polyfluoroalkyl Substances (PFAS) | State
Legislation and Federal Action. (Mar. 23, 2023)

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
D. EPA Should Require Increased Monitoring and Sampling for PFAS
From Industrial Discharges That Utilize the DITP.
The Draft Permit currently requires annual monitoring of various industrial
discharges to quantify the PFAS from these sources. 33 The list of industrial
discharges includes, among others, landfill leachate. 34 Although this is a welcome
addition to the permit, it does not go far enough. More frequent testing is
necessary to better understand and quantify the PFAS from these sources.
This is especially true for discharges such as landfill leachate that are known to
have high concentrations of PFAS. 35 It is estimated that 750 kg of PFAS leave U.S.
municipal solid waste in landfill leachate annually. Moreover, the concentration of
PFAS in landfill leachate is likely significantly underestimated because of limited
analyte testing. 36 For example, one study of PFAS at a Vermont landfill found that
approximately 7% of the PFAS load entering the landfill is released via leachate. 37 
However, the study only tested for 24 PFAS compounds of the thousands
contained in landfill leachate. 38 National surveys have found that as much as 11%
of the PFAS may be released via leachate. 39 Moreover, observed PFAS
concentrations in landfill leachate, as well as those in the influent, effluent, and
sewage sludge from WWTFs, can vary significantly by season. 40 This is likely true
for other industrial discharges as well. 
33 Draft Permit Part I.G.4 
34 
Id. 
35 Tolaymat, T., Robey, N., Krause, M., Larson, J., Weitz, K., Parvathikar, S., Phelps, L., Linak, W.,
Burden, S., Speth, T., & Krug, J. (2023). A critical review of perfluoroalkyl and polyfluoroalkyl
substances landfill disposal in the United States.
Science of the Total Environment, 905, 167185.
https://doi.org/10.1016/j.scitotenv.2023.167185 
36 
Id. 
37 Estabrooks, M., Zemba, S., PFAS Waste Source Testing Report – New England Waste Services of
Vermont, Inc., Sanborn Head & Associates. (Oct. 2019). 
38 
Id. 
39 Tolaymat, T., Robey, N., Krause, M., Larson, J., Weitz, K., Parvathikar, S., Phelps, L., Linak, W.,
Burden, S., Speth, T., & Krug, J. (2023). A critical review of perfluoroalkyl and polyfluoroalkyl
substances (PFAS) landfill disposal in the United States. Science of The Total Environment, 905,
167185. https://doi.org/10.1016/j.scitotenv.2023.167185 
40 
See, Tavasoli, E., Luek, J. L., Malley, J. P., & Mouser, P. J. (2021). Distribution and fate of per-and
polyfluoroalkyl substances (PFAS) in wastewater treatment facilities. Environmental Science:
Processes & Impacts, 23(6), 903-913. Thompson, K. A., Mortazavian, S., Gonzalez, D. J., Bott, C.,
Hooper, J., Schaefer, C. E., & Dickenson, E. R. (2022). Poly- and perfluoroalkyl substances in
municipal wastewater treatment plants in the United States: Seasonal patterns and meta-analysis
of long-term trends and average concentrations. ACS ES&T Water, 2(5), 690–700.
https://doi.org/10.1021/acsestwater.1c00377

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
To better understand the dangerous, significant concentrations of PFAS
entering the DITP from industrial users, EPA should require more frequent and
standardized testing. This will provide a clearer understanding of the major
sources of PFAS into the facility. 
E. EPA Should Prohibit Acceptance of Landfill Leachate That Has Not
Been Pretreated to Remove or Reduce PFAS.
WWTFs and landfill leachate are two of the greatest contributors to PFAS pollution
in the United States. 41 Because many landfills in the U.S. send their leachate to
WWTFs, they add a considerable PFAS burden to these publicly owned treatment
works, like the DITP.
To reduce the quantity of PFAS entering the DITP, EPA should require all landfill
leachate discharged into the facility to be pretreated to address PFAS. The
pretreatment process or processes should utilize the Massachusetts MCL for
PFAS in drinking water as the benchmark for successful pretreatment. Given that
the DITP is not equipped or required to treat landfill leachate to reduce or remove
PFAS, this pretreatment requirement is necessary to reduce the spread of PFAS
into the receiving waters from a discharge source that is known to consistently
contain high levels of these harmful chemicals.
States across the country, including states in New England, are beginning to
evaluate and require pretreatment of landfill leachate to reduce the release of
PFAS into the environment. Currently, Vermont is in the process of reviewing a
pilot project that will treat landfill leachate to minimize the concentration of PFAS
before it is sent to publicly owned treatment facilities. 42 The pilot project will be
used to determine the design conditions of a pretreatment system that can
manage all leachate generated in the state. 43 The development of the pilot project
is a direct result over growing concern about the environmental and public health 
41 Andrews, D. Q., Hayes, J., Stoiber, T., Brewer, B., Campbell, C., & Naidenko, O. V. (2021).
Identification of point source dischargers of per‐ and Polyfluoroalkyl Substances in the United
States. AWWA Water Science, 3(5). https://doi.org/10.1002/aws2.1252 
42 Vermont Department of Environmental Conservation, Pretreatment Discharge Permit No. 3-1406
– New England Waste Management Services, Inc. Section 5. (Dec. 21, 2022). 
43 
Id.

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impacts associated with exposure to PFAS, and the failure of WWTFs to address
these compounds in landfill leachate. 44 
Additionally, the Maine Legislature recently commissioned a report to evaluate
and assess treatment methods for reducing PFAS in leachate from state-owned
landfills. 45 The report, which was finalized in January 2023, found that there are
four readily available treatment technologies that can considerably reduce the
concentrations of PFAS in landfill leachate. 46 
There is clear interest at the state level to find solutions to the known
concentrations of PFAS in landfill leachate and the inability of publicly owned
treatment works to address the presence of these compounds in this material.
Failure to include a pretreatment requirement would essentially allow for the
continued spread of PFAS into both the receiving waters and onto farmlands
across the region through land application of sewage sludge. In effect this would
permit the continued contamination of surface water, soil, and groundwater with
these highly dangerous compounds. EPA can and should bolster these state-level efforts by only allowing landfill
leachate to be sent to the largest WWTF in the region if it is first treated to
address the presence of PFAS. 
F. EPA Should Take Action to Address PFAS Contamination Arising from
the Land Application of Sewage Sludge and Sludge Derived Products.
The Agency should – at a minimum – require robust tracking and reporting to
identify where sewage sludge is being applied. This information should be
recorded in a publicly available database which includes the date of application,
amount of material land applied, and the address of the land application. The
database should also include the address and name of all sludge and sludge-
derived product storage facilities. The database should also include a monthly
accounting of how many bags of sludge were sold and to whom. Although this
tracking and reporting will not help reduce the release of PFAS into the 
44 Emma Cotton, State Requires Casella to Build a Pilot Project to Reduce PFAS in Leachate,
Vermont Digger. (Dec. 21, 2022). 
45 State of Maine, Resolve to Address PFAS Pollution at State-Owned Solid Waste Landfills.
(Enacted - May 2, 2022) 
46 State of Maine Bureau of General Services, Study to Assess Treatment Alternatives for Reducing
PFAS in Leachate From State-Owned Landfills. (January 2023).

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
environment, it will help track where the releases occur which is important for
remediation efforts and to limit further contamination.
However, it is more important that EPA amend the Draft Permit to prohibit the land
application of DITP’s sludge and any products derived from this sludge, thereby
reducing the spread of PFAS onto farmland throughout the region. Enough is
known about the concentration of PFAS in sewage sludge and products derived
from this material to warrant protective action to prevent the land application of
this highly contaminated material. 47 
The DITP generated 27,263 dry metric tons of sewage sludge (equivalent to
60,104,627 pounds, which would fill 2,147 large dump trucks) in 2022. 48 The
majority of the sludge from DITP is either directly land applied or land applied
after processing which does not reduce or remove the concentration of PFAS.
Some of the sludge generated by the DITP is bagged and sold at retail as “Bay
State Fertilizer.”
Since August 2020, MassDEP has required quarterly monitoring of PFAS in sludge
generated at the DITP. For two of the most concerning PFAS compounds, PFOS
and PFOA, the combined average concentration is 15,000 parts per trillion. 49 This
is more than ten times the PFAS concentration threshold that Connecticut
recommends for farmers, and Connecticut is combining five specific PFAS
chemicals, not two. 50 It would be irresponsible and egregious for EPA to continue
to allow for the land application of this material. 
47 The most recent EPA report determined that “a total of 739 chemicals have been identified in
biosolids to date; of which about 250 of these are dioxins, furans, and PCBs.” Others include
plastics (such as polyethylene terephthalate), pesticides (such as DDT), pharmaceuticals (such as
fentanyl), and industrial chemicals (such as trichlorobenzene). United States Environmental
Protection Agency, Office of Science and Technology, Office of Water, “Biosolids Biennial Report
No.9 (Reporting Period 2020–2021), December 2022.”
https://www.epa.gov/system/files/documents/2022-12/2020-2021-biennial-report.pdf 
48 NPDES Permit No. MA0103284, Fact Sheet. Pg. 22. 
49 Barbara Moran, Our Sewage Sludge Often Becomes Fertilizer. Problem Is, It’s Tainted with PFAS,
WBUR. (Mar. 30, 2023). 
50 Connecticut Department of Agriculture, PFAS in Biosolids Guidance. The Connecticut
Department of Agriculture advises farmers not to apply any sludge that has a combined PFAS
concentration of 1.4 ppb to farmland.

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Land application of sewage sludge presents a significant threat of PFAS migration
to surface and groundwater. 51 A 2022 study showed PFAS from land application of
sewage sludge migrating as far as 17 meters to underlying groundwater. 52 Once
spread, the PFAS that does not move to water can remain for years, adding to the
PFAS burden in the soil from multiple land applications. 53 
EPA can look to the approach taken by Maine as instructive. In 2019, reports
regarding PFAS contamination at Stoneridge Farm in Maine became public. In
response, the Maine Department of Environmental Protection (“Maine DEP”)
halted the spread of sludge until it was tested for three types of PFAS (PFOA,
PFOS, and PFBS). 54 When Maine DEP began testing sludge for those three PFAS,
over 95% of the sludge tested exceeded the Department’s screening levels. 55 The
results of the testing coincided with additional findings of extremely high levels of
PFAS contamination in areas where sludge application was routine. 56 Importantly,
PFAS contamination was not limited to farmland and soil. Over 200 wells and
water sources have been identified as contaminated. 57 Additionally a “do not eat”
advisory was issued for deer harvested in the Fort Fairfield area where sludge
was previously land applied. 58 
As a result, In 2022, Maine became the first state to ban the spreading of sludge
as a fertilizer after statewide sampling and testing of areas where the practice
had occurred found extremely high concentrations of PFAS in both the soil and
groundwater. 59 The contamination was so significant, Maine also included $60
million in its budget to help impacted farmers whose farmland whose 
51 Scearce, A. E., Goossen, C. P., Schattman, R. E., Mallory, E. B., & MacRae, J. D. (2023). Linking
drivers of plant per- and polyfluoroalkyl substance (PFAS) uptake to agricultural land management
decisions. Biointerphases, 18(4). https://doi.org/10.1116/6.0002772 
52 Johnson, G. R. (2022). PFAS in soil and groundwater following historical land application of
biosolids. Water Research, 211, 118035. 
53 Venkatesan, A. K., & Halden, R. U. (2014). Loss and in situ production of perfluoroalkyl chemicals
in outdoor biosolids–soil mesocosms. Environmental research, 132, 321-327. 
54 Maine DEP. Requirement to Analyze for PFAS Compounds. March 22, 2019. 
55 Tom Perkins, I Don’t Know How We’ll Survive: The Farmers Facing Ruin in America’s Forever
Chemicals Crisis, The Guardian. (Mar. 22, 2022). 
56 
Id. 
57 Kevin Miller, Maine DEP Identifies 34 Towns with High-Priority Sites PFAS Chemical Testing,
Maine Public. (Oct. 22, 2021). 
58 Meaghan Bellavance, MDIFW Reduces Size of PFAS Do Not Eat Advisory Area in Fairfield, News
Center Maine. (Apr. 24, 2023). 
59 38 M.R.S.A. §1304(20).

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contaminated land is now unusable and unsellable. 60 Several other states are
expected to follow Maine’s leadership and seek similar bans.
The draft permit simply requires the DITP to comply with the standards for
sewage sludge use or disposal under Section 405(d) of the Clean Water Act, and
its implementing regulations. The implementing regulations were finalized in
February 1993. 61 These rules are out of date and fail to protect water quality, soil
quality, farmer, farmland, and public health.
Moreover, although the draft permit does require sampling to evaluate the
presence and concentrations of PFAS in the sludge generated at the DITP, the
sampling is also based on outdated guidance. The draft permit requires sludge
sampling to be representative based on the POTW Sludge Sampling and Analysis
Guidance Document. 62 This guidance is from 1989 and does not include the
science and methods needed to address EPA and other’s concerns about PFAS
and other toxicants in sewage sludge. For example, as explained above, PFAS
concentrations and compounds can change depending on where and when the
sludge sample is taken. PFAS concentrations and compounds will be different in
sewage sludge than in sludge-derived compost made from the same sludge.
Testing standards and methodology should be updated to reflect our improved
understanding of PFAS compounds. Given the high concentrations of chemicals such as PFOA and PFOS in the DITP
sludge, EPA should no longer allow the sludge generated by the DITP to be land
applied or sold and used as fertilizer. Alternatively, should EPA fail to include
this necessary prohibition, the Agency must – at a minimum – include
requirements which monitor and track where the material is land applied. 
II. EPA Should Require Monitoring for Microplastics in the DITP’s Influent,
Effluent, and Sludge to Better Understand the Presence and Release
of These Materials. 
In addition to strengthening the Draft Permit to better address PFAS, EPA must
also amend the permit to address microplastics. Specifically, we urge EPA to 
60 Penelope Overton, State Adopts $70 Million Plan to Help Farmers Deal with PFAS Contamination,
Portland Press Herald. (Jul. 13, 2023). 
61 U.S. EPA, Standards for the Use or Disposal of Sewage Sludge, 40 CFR § 257. 
62 NPDES Permit No. MA0103284 – Footnote 22.

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
require the quarterly monitoring of the influent, effluent, and sludge to provide an
understanding of the presence of microplastic in each of these materials.
Microplastics are plastic particles less than 5 mm. They can be directly
manufactured and used – for example, as microbeads in cosmetics – or they can
form from the degradation of plastic. They can enter municipal wastewater
treatment plants from the wash water from the laundering of synthetic clothing,
such as polyester and nylon, and from other sources such as landfill leachate, and
stormwater.
Because WWTFs concentrate microplastics and discharge them in effluent and
sludge, they are a significant source of microplastics in the environment. 63 Most
microplastics in a WWTF accumulate in the sewage sludge. 64 However, some
microplastics are released into receiving waters through the effluent. 65 
A 2021 study on microplastics in sludge stated that “the land application of
biosolids in the U.S. alone could annually release 785-1080 trillion microplastics
and that the concentration of microplastics in biosolids could be significantly
underestimated.” 66 Another study showed the microplastic load in sludge from
one WWTF ranging from 37.7–97.2 microplastics/g of sludge (dry weight). 67 This
would translate to the DITP releasing between 34 million and 97 million
microplastics per day in its sewage sludge (at 100 tons per day). Other research
demonstrated that a WWTF collecting the sewage from 650,000 people released
65 million microplastics into the receiving water every day. 68 DITP treats the 
63 Sun, J., Dai, X., Wang, Q., Loosdrecht, M., & Ni, B. (2019). Microplastics in wastewater treatment
plants: detection, occurrence and removal. Water Research, 152, 21-37.
https://doi.org/10.1016/j.watres.2018.12.050 
64 Gatidou, G., Arvaniti, O. S., & Stasinakis, A. S. (2019). Review on the occurrence and fate of
microplastics in Sewage Treatment Plants. Journal of hazardous materials, 367, 504-512. 
65 
Id. 
66 Koutnik, V. S., Alkidim, S., Leonard, J., DePrima, F., Cao, S., Hoek, E. M., & Mohanty, S. K. (2021).
Unaccounted microplastics in wastewater sludge: Where do they go? ACS ES&T Water, 1(5),
1086–1097. https://doi.org/10.1021/acsestwater.0c00267 
67 Harley-Nyang, D., Memon, F. A., Jones, N., & Galloway, T. (2022). Investigation and analysis of
microplastics in Sewage Sludge and biosolids: A case study from one wastewater treatment works
in the UK. Science of The Total Environment, 823, 153735.
https://doi.org/10.1016/j.scitotenv.2022.153735 
68 Murphy, F., Ewins, C., Carbonnier, F., & Quinn, B. (2016). Wastewater Treatment Works (WwTW)
as a Source of Microplastics in the Aquatic Environment.. Environmental science & technology, 50
11, 5800-8. https://doi.org/10.1021/acs.est.5b05416.

15 
ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
sewage from not only commercial and industrial facilities, but from 2.3 million
people per day.
When sludge is land applied, these microplastics are distributed in the soil and
make their way to plants, surface water, and groundwater. 69 Once in the
environment, microplastics can negatively affect the health of animals and marine
species. 70 They can interact with terrestrial organisms that mediate essential
ecosystem services and functions, such as soil dwelling invertebrates, terrestrial
fungi, and plant-pollinators. 71 Microplastics can also affect the abundance and
diversity of soil fauna, including soil microarthropods and nematodes. 72 
Microplastics also pose a threat to human health. Humans are primarily exposed
to microplastics through ingestion, inhalation, and dermal contact. 73 A recent
review of potential health risks of microplastics on the human body included
findings that exposure could lead to cytotoxicity, disruption of homeostasis and
metabolism, disruption of immune function, neurotoxicity, and inflammation. 74 
Prolonged exposure to microplastics is also connected with tissue damage,
fibrosis, and cancer. 75 
69 Machado, A., Kloas, W., Zarfl, C., Hempel, S., & Rillig, M. (2018). Microplastics as an emerging
threat to terrestrial ecosystems. Global Change Biology, 24(4), 1405-1416.
https://doi.org/10.1111/gcb.14020 
70 Sana, S. S., Dogiparthi, L. K., Gangadhar, L., Chakravorty, A., & Abhishek, N. (2020). Effects of
microplastics and nanoplastics on marine environment and human health. Environmental Science
and Pollution Research, 27, 44743-44756. 
71 
Id. 
72 Lin, D., Gao, Y., Dou, P., Qian, S., Zhao, L., Yang, Y., … & Fanin, N. (2020). Microplastics
negatively affect soil fauna but stimulate microbial activity: insights from a field-based microplastic
addition experiment. Proceedings of the Royal Society B: Biological Sciences, 287(1934),
20201268. https://doi.org/10.1098/rspb.2020.1268 
73 Prata, J. C., da Costa, J. P., Lopes, I., Duarte, A. C., & Rocha-Santos, T. (2020). Environmental
exposure to microplastics: An overview on possible human health effects. Science of The Total
Environment, 702, 134455. https://doi.org/10.1016/j.scitotenv.2019.134455 
74 Prata, J. C., da Costa, J. P., Lopes, I., Duarte, A. C., & Rocha-Santos, T. (2020). Environmental
exposure to microplastics: An overview on possible human health effects. Science of The Total
Environment, 702, 134455. https://doi.org/10.1016/j.scitotenv.2019.134455 
75 See, e.g., David Azoulay et al., Plastic & Health: The Hidden Costs of a Plastic Planet (Feb. 2019),
available at
https://www.ciel.org/wp-content/uploads/2019/02/Plastic-and-Health-The-Hidden-Costs-of-a-
Plastic-PlanetFebruary-2019.pdf

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
Additionally, given their relatively large surface area, microplastics can absorb a
variety of pollutants. 76 They essentially act as transportation vehicles for metals
and toxicants. 77 Microplastic degradation can trigger the release of additives in
plastics (e.g. phthalates) and absorbed contaminants (e.g. persistent organic
pollutants) which can concentrate on the microplastics, up to a million times
stronger than levels in the surrounding environment. 78 
Although recent research has indicated that microplastic concentrations from the
DITP were “significantly lower” than concentrations from the New Bedford WWTF,
this is misleading. 79 The study only evaluated microplastics in the effluent and did
not include sampling of the sewage sludge. 80 More and consistent research is
necessary to understand the full scope of microplastics entering and leaving the
facility.
Routine monitoring of microplastics in the influent, effluent, and sludge at the DITP
will help identify the quantity of microplastics entering the facility, where these
microplastics are concentrating, and where they are being released. This
information is critical to informing a better understanding of potential regulatory
action to reduce the release of these contaminants.
The Draft Permit indicates that there are no National Recommended Water Quality
Criteria for microplastics, and therefore, no basis for establishing effluent
limitations. 81 We strongly support the development of Water Quality Criteria for
microplastics. 
Until Water Quality Criteria are developed, EPA must require
monitoring of wastewater treatment facilities to understand how microplastics
are entering the facilities, and where they are ultimately being discharged and
aggregated. 
76 Chang, X., Fang, Y., Wang, Y., Wang, F., Shang, L., & Zhong, R. (2022). Microplastic pollution in
soils, plants, and animals: a review of distributions, effects and potential mechanisms. Science of
The Total Environment, 850, 157857. 
77 Xiong, X., Wang, J., Liu, J., & Xiao, T. (2023). Microplastics and potentially toxic elements: A
review of interactions, fate and bioavailability in the environment. Environmental Pollution, 122754. 
78 Rolsky, C., Kelkar, V., Driver, E., & Halden, R. U. (2020). Municipal sewage sludge as a source of
microplastics in the environment. Current Opinion in Environmental Science & Health, 14, 16-22. 
79 NPDES Permit No. MA0103284 Fact Sheet. Section 5.1.14.2 
80 Outfall Monitoring Science Advisory Panel, Annual Review of the MWRA Outfall Monitoring
Program. (Feb. 10, 2023). 
81 NPDES Permit No. MA0103284 Fact Sheet. Section 5.1.15.

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
III. EPA Should Maintain the Outfall Monitoring Science Advisory Panel. 
The Draft Permit eliminates the Outfall Monitoring Science Advisory Panel
(“OMSAP”). 82 We strongly oppose the elimination of this independent scientific
body and urge EPA to maintain the OMSAP.
The 2000 permit created the OMSAP to advise both EPA and MassDEP on issues
related to the effects of the DITP on the surrounding environment. 83 Specifically,
the OMSAP was charged with reviewing and providing recommendations for
revisions of the outfall monitoring program, to ensure that it is capable of
detecting changes at an early enough stage to allow action to prevent any
unacceptable impacts on public health or on the marine environment and its biota,
and to advise EPA and MassDEP when there are any permit or contingency plan
threshold exceedances and provide advice on any actions that may be needed to
protect human health and ecosystem health. 84 These tasks remain vitally
important today, especially as it relates to better understanding contaminants of
emerging concern including PFAS and Microplastics.
In 2018, MIT Sea Grant, Save the Harbor/Save the Bay and OMSAP identified
PFAS, pharmaceuticals and personal care products (PPCPs), and microplastics, as
needing further investigation. 85 OMSAP reiterated this need in its 2022 Framework
for Understanding Contaminants of Emerging Concern in Marine Waters. 86 
EPA apparently eliminated OMSAP in the Draft Permit because “[w]hile OMSAP
served a very important role in the design and implementation of the Ambient
Monitoring Plan and Contingency Plan, data collected over the past 30 plus years,
including the 20 years since the outfall was completed, has indicated to EPA that
the primary questions OMSAP was tasked with responding to (regarding the
impact of the discharge on aquatic life in the vicinity of the outfall) have been
answered.” 87 We disagree with this assessment and concur with OMSAP that
PFAS and microplastics need further assessment for the reasons cited in these
comments. 
82 
Id. at Section 5.14 
83 
Id. at Section 5.12 
84 
Id. 
85 Judith Pederson, Executive Summary of the Outfall Monitoring Science Advisory Panel
Workshop. (Nov. 13, 2018). 
86 Outfall Monitoring Science Advisory Panel, Framework for Understanding Contaminants of
Emerging Concern. (July 7, 2022). 
87 MWRA Deer Island Fact Sheet; MA0103284.

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
The research value of the OMSAP is invaluable. This is especially true when it
comes to contaminants of emerging concern such as PFAS and microplastics. As
the Draft Permit notes, several subcommittees of the OMSAP have since authored
white papers for various categories of contaminants of emerging concern. 88 In
fact, all research related to microplastics and the DITP has been conducted by the
OMSAP. Now is not the time for the elimination of this necessary independent
scientific body. EPA should not eliminate this critical actor – instead, it must expand the scope
of the OMSAP to better understand and address contaminants of emerging
concern and this impact on the marine environments. 
IV. Conclusion 
Thank you for the opportunity to provide comments on the Draft Permit. WWTFs,
including the DITP, are known to release both PFAS and microplastics into the
environment. These contaminants are highly concerning and must be more
comprehensively addressed in this permit.
Although PFAS and microplastics pollution must ultimately be reduced at their
source, in the meantime, the flow of these toxic contaminants into the
environment can and must be reduced. The DITP cannot get a pass when it
comes to its role in releasing these contaminants. The recommendations we have
made will both provide a greater understanding of how these contaminants enter
the DITP, and how they can be reduced. We strongly urge EPA to make these
targeted changes.
Thank you for your time and consideration of these comments.
Peter Blair, Laura Orlando,
Policy and Advocacy Director Senior Scientist 
Just Zero Just Zero 
Judith Enck Eileen Ryan
President Leader 
Beyond Plastics Beyond Plastics Greater
Boston 
88 NPDES Permit No. MA0103284 Fact Sheet. Section 5.1.15.

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
James Buckle Yayoi Koizumi
Owner Co-Founder 
The Buckle Farm BYO – US Reduces 
Thomas Linzey Emily Norton
Senior Legal Counsel Executive Director 
Center for Democratic Environmental Rights Charles River Watershed
Association 
Tracy Frisch Elizabeth Saunders
Chair Massachusetts Co-Director 
Clean Air Action Network of Glens Falls Clean Water Action 
Mara Shulman Adam Nordell
Senior Attorney Campaign Manager 
Conservation Law Foundation Defend Our Health 
Don Mills Patricia Wood
VP Board of Directors Executive Director 
Foundation for Agricultural Integrity Grassroots Environmental
Education 
Kate Melges Jason Grostic
Plastics Project Leader Member 
Greenpeace USA Grostic Cattle Company 
Nell Finnigan and Justin Morace Jan Dell
Owner Independent Engineer 
Ironwood Farm The Last Beach Cleanup 
Janet Kern Heather Spalding
Board Vice President Deputy Director 
Lexington Zero Waste Collaborative Maine Organic Farmers
and Gardeners Association 
Scott McCormick Katia Holmes
Owner Owner 
McCormick Family Farm Misty Brook Farm

20 
ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
Miranda Dotson Adrienne Lee
Co-Coordinator Co-Owner 
Mothers Out Front, Jamaica Plain Chapter New Beat Farm 
Doug Adams Susan Gordon
Owner Farmer 
New Brooklyn Farms New Roots Farm 
Robert Oneal Jeanne Krieger
Owner Director 
ONeal Farms Progressive Democrats of MA 
Kyla Bennett Linley Dixon
Director, Science Policy Co-Director 
Public Employees for Environmental Real Organic Project
Responsibility 
Abby Rockefeller Ted Schettler
President Science Director 
Resource Institute for Low Entropy Systems Science and Environmental
Health Network 
Anne Gero Yvonne Taylor
Senior Advisor Vice President 
Seaside Sustainability Seneca Lake Guardian 
Stephanie Blumenthal Vickash Mohanka
President Acting Chapter Director 
Sheffield Saves Sierra Club Massachusetts
Chapter 
Mireille Bejjani Adam Nordell
Co-Executive Director Co-owner 
Slingshot Songbird Farm 
Fred and Laura Stone Alex T Vai
Owners Campaigns Coordinator 
Stoneridge Farm, Inc. Surfrider Foundation
Massachusetts Chapter

21 
ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
Elaine Leahy Yayoi Koizumi
Executive Director Founder 
Sustainable Marblehead Zero Waste Ithaca 
Susan Hunter Henry Perkins
Owner Owner 
Hunter Farm Bison Ridge Farms 
Fritz Jon Anderson Michael O'Heaney
Member Executive Director 
No Safe Level The Story of Stuff Project 
Louise Bowditch Elizabeth Turnbull Henry
Zero Waste Team Leader President 
Mothers Out Front, Brookline Chapter Environmental League of
Massachusetts 
Neva Goodwin
Trustee 
Ecological Health Network

22 
ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
Appendix – Selected Studies
I. PFAS Impact on Ecosystems and Human Health
General toxicity 
Agency for Toxic Substances and Disease Registry (ATSDR). 2021. Toxicological
profile for Perfluoroalkyls. Atlanta, GA: U.S. Department of Health and Human
Services, Public Health Service. DOI: 10.15620/cdc:59198
Brunn, H., Arnold, G., Körner, W.
et al. PFAS: forever chemicals—persistent,
bioaccumulative and mobile. Reviewing the status and the need for their phase
out and remediation of contaminated sites.
Environ Sci Eur 35, 20 (2023).
https://doi.org/10.1186/s12302-023-00721-8
Pearson, T. W., & Renfrew, D. (2023). When toxic heritage is forever: Confronting
pfas contamination and toxicity as lived experience.
Toxic Heritage, 50–61.
https://doi.org/10.4324/9781003365259-6
Pelch, K.E., Reade, A., Kwiatkowski, C.F., Merced-Nieves, F.M., Cavalier, H.,
Schultz, K., Wolffe, T., Varshavsky, J. (2022). The PFAS-Tox Database: A
systematic evidence map of health studies on 29 per- and polyfluoroalkyl
substances. Environment International, 167, 107408.
https://doi.org/10.1016/j.envint.2022.107408.
PFAS-Tox Database available online at https://pfastoxdatabase.org 
Immunotoxicity 
Division of the National Toxicology Program, NTP Monograph on immunotoxicity
associated with exposure to perfluorooctanoic acid (PFOA) or perfluorooctane
sulfonate (PFOS) (2016). Research Triangle Park, NC.
Ehrlich, V., Bil, W., Vandebriel, R.
et al. Consideration of pathways for
immunotoxicity of per- and polyfluoroalkyl substances (PFAS).
Environ Health 22,
19 (2023). https://doi.org/10.1186/s12940-022-00958-5
Wang, L. Q., Liu, T., Yang, S., Sun, L., Zhao, Z. Y., Li, L. Y., She, Y. C., Zheng, Y. Y.,
Ye, X. Y., Bao, Q., Dong, G. H., Li, C. W., & Cui, J. (2021). Perfluoroalkyl substance
pollutants activate the innate immune system through the AIM2 inflammasome.
Nature Communications, 12, 2915. https://doi.org/10.1038/s41467-021-23201-0

23 
ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
Woodlief, T., Vance, S., Hu, Q., & DeWitt, J. (2021). Immunotoxicity of Per- and
Polyfluoroalkyl Substances: Insights into Short-Chain PFAS Exposure. Toxics, 9(5),
100. https://doi.org/10.3390/toxics9050100
Zhang, Y., Mustieles, V., Sun, Y., Oulhote, Y., Wang, Y. X., & Messerlian, C. (2022).
Association between serum per- and polyfluoroalkyl substances concentrations
and common cold among children and adolescents in the United States.
Environment International, 164, 107239.
https://doi.org/10.1016/j.envint.2022.107239 
Liver toxicity 
Costello, E., Rock, S., Stratakis, N., Eckel, S. P., Walker, D. I., Valvi, D., Cserbik, D.,
Jenkins, T., Xanthakos, S. A., Kohli, R., Sisley, S., Vasiliou, V., La Merrill, M. A.,
Rosen, H., Conti, D. V., McConnell, R., & Chatzi, L. (2022). Exposure to per- and
Polyfluoroalkyl Substances and Markers of Liver Injury: A Systematic Review and
Meta-Analysis. Environmental Health Perspectives, 130(4), 46001.
https://doi.org/10.1289/EHP10092
Ducatman, A., & Fenton, S. E. (2022). Invited Perspective: PFAS and Liver Disease:
Bringing All the Evidence Together. Environmental Health Perspectives, 130(4),
41303. https://doi.org/10.1289/EHP11149
Roth, K., Yang, Z., Agarwal, M., Liu, W., Peng, Z., Long, Z., Birbeck, J., Westrick, J.,
Liu, W., & Petriello, M. C. (2021). Exposure to a mixture of legacy, alternative, and
replacement per- and polyfluoroalkyl substances (PFAS) results in sex-dependent
modulation of cholesterol metabolism and liver injury. Environment International,
157, 106843. https://doi.org/10.1016/j.envint.2021.106843
Sen, P., Qadri, S., Luukkonen, P. K., Ragnarsdottir, O., McGlinchey, A., Jäntti, S.,
Juuti, A., Arola, J., Schlezinger, J. J., Webster, T. F., Orešič, M., Yki-Järvinen, H., &
Hyötyläinen, T. (2022). Exposure to environmental contaminants is associated
with altered hepatic lipid metabolism in non-alcoholic fatty liver disease. Journal
of Hepatology, 76(2), 283–293. https://doi.org/10.1016/j.jhep.2021.09.039 
Cancer 
Alsen, M., Leung, A. M., & van Gerwen, M. (2023). Per- and polyfluoroalkyl
substances (PFAS) in Community Water Systems (CWS) and the risk of thyroid
cancer: An ecological study.
Toxics,
11(9), 786.
https://doi.org/10.3390/toxics11090786

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
Bartell, S. M., & Vieira, V. M. (2021). Critical review on PFOA, kidney cancer, and
testicular cancer. Journal of the Air & Waste Management Association, 71(6), 663–
679. https://doi.org/10.1080/10962247.2021.1909668
Cao, L., Guo, Y., Chen, Y., Hong, J., Wu, J., & Hangbiao, J. (2022). Per-
/polyfluoroalkyl substance concentrations in human serum and their associations
with liver cancer. Chemosphere, 296, 134083.
https://doi.org/10.1016/j.chemosphere.2022.134083
Goodrich, Jesse A. et al. (2022). Exposure to perfluoroalkyl substances and risk of
hepatocellular carcinoma in a multiethnic cohort. JHEP Reports, 4(10), 100550.
https://www.jhep-reports.eu/article/S2589-5559(22)00122-7/fulltext
Liu, H., Sun, Y., Ran, L., Li, J., Shi, Y., Mu, C., & Hao, C. (2023). Endocrine-
disrupting chemicals and breast cancer: A meta-analysis.
Frontiers in Oncology,
13. https://doi.org/10.3389/fonc.2023.1282651
Messmer, M. F., Salloway, J., Shara, N., Locwin, B., Harvey, M. W., & Traviss, N.
(2022). Risk of Cancer in a Community Exposed to Per- and Poly-Fluoroalkyl
Substances. Environmental Health Insights, 16.
https://doi.org/10.1177/11786302221076707
Singh, N., & Hsieh, C. (2021). Exploring Potential Carcinogenic Activity of Per- and
Polyfluorinated Alkyl Substances Utilizing High-Throughput Toxicity Screening
Data. International Journal of Toxicology, 40(4), 355–366.
https://doi.org/10.1177/10915818211010490
Velarde, M. C., Chan, A., Sajo, M., Zakharevich, I., Melamed, J., Uy, G., Teves, J.,
Corachea, A., Valparaiso, A. P., Macalindong, S. S., Cabaluna, N. D., Dofitas, R. B.,
Giudice, L. C., & Gerona, R. R. (2022). Elevated levels of perfluoroalkyl substances
in breast cancer patients within the Greater Manila Area. Chemosphere, 286(Pt 1),
https://doi.org/10.1016/j.chemosphere.2021.131545
Xie, M. Y., Sun, X. F., Wu, C. C., Huang, G. L., Wang, P., Lin, Z. Y., Liu, Y. W., Liu, L.
Y., & Zeng, E. Y. (2023). Glioma is associated with exposure to legacy and
alternative per- and polyfluoroalkyl substances.
Journal of hazardous
materials,
441, 129819. https://doi.org/10.1016/j.jhazmat.2022.129819 
Metabolic toxicity 
Birru, R. L., Liang, H. W., Farooq, F., Bedi, M., Feghali, M., Haggerty, C. L., Mendez,

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
D.D., Catov, J. M., Ng, C. A., & Adibi, J. J. (2021). A pathway level analysis of PFAS
exposure and risk of gestational diabetes mellitus. Environmental Health, 20(1),
63. https://doi.org/10.1186/s12940-021-00740-z
Canova, C., Di Nisio, A., Barbieri, G., Russo, F., Fletcher, T., Batzella, E., Dalla
Zuanna, T., & Pitter, G. (2021). PFAS Concentrations and Cardiometabolic Traits in
Highly Exposed Children and Adolescents. International Journal of Environmental
Research and Public Health, 18(24), 12881.
https://doi.org/10.3390/ijerph182412881
Chen, J., Li, H., Yao, J., Guo, H., Zhang, H., Guo, Y., Sheng, N., Wang, J., & Dai, J.
(2021). Chronic exposure to PFO4DA and PFO5DoDA, two perfluoroalkyl ether
carboxylic acids (PFECAs), suppresses hepatic stress signals and disturbs
glucose and lipid metabolism in male mice. Journal of Hazardous Materials, 411,
124963. https://doi.org/10.1016/j.jhazmat.2020.124963
Liu, X., Zhang, L., Chen, L., Li, J., Wang, J., Zhao, Y., Liu, L., & Wu, Y. (2021).
Identification and prioritization of the potent components for combined exposure
of multiple persistent organic pollutants associated with gestational diabetes
mellitus. Journal of Hazardous Materials, 409, 124905.
https://doi.org/10.1016/j.jhazmat.2020.124905
Yu, G., Jin, M., Huang, Y., Aimuzi, R., Zheng, T., Nian, M., Tian, Y., Wang, W., Luo,
Z., Shen, L., Wang, X., Du, Q., Xu, W., Zhang, J., & Shanghai Birth Cohort Study
(2021). Environmental exposure to perfluoroalkyl substances in early pregnancy,
maternal glucose homeostasis and the risk of gestational diabetes: A prospective
cohort study. Environment International, 156, 106621.
https://doi.org/10.1016/j.envint.2021.106621 
Cardiovascular toxicity 
Ding, N., Karvonen-Gutierrez, C. A., Mukherjee, B., Calafat, A. M., Harlow, S. D., &
Park, S. K. (2022). Per- and Polyfluoroalkyl Substances and Incident Hypertension
in Multi-Racial/Ethnic Women: The Study of Women's Health Across the Nation.
Hypertension, 79(8), 1876–1886.
https://doi.org/10.1161/HYPERTENSIONAHA.121.18809
Dunder, L., Salihovic, S., Lind, P. M., Elmståhl, S., & Lind, L. (2023). Plasma levels
of per- and polyfluoroalkyl substances (PFAS) are associated with altered levels
of proteins previously linked to inflammation, metabolism and cardiovascular

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ADVANCING COMMUNITY-CENTERED ZERO WASTE SOLUTIONS 
disease.
Environment International,
177, 107979.
https://doi.org/10.1016/j.envint.2023.107979
Schillemans, T., Donat‐Vargas, C., & Åkesson, A. (2023). Per‐and polyfluoroalkyl
substances and cardiometabolic diseases: a review.
Basic & Clinical
Pharmacology & Toxicology.
https://doi.org/10.1111/bcpt.13949 
Developmental toxicity 
Blake, B. E., Rickard, B. P., & Fenton, S. E. (2022). A High-Throughput Toxicity
Screen of 42 Per- and Polyfluoroalkyl Substances (PFAS) and Functional
Assessment of Migration and Gene Expression in Human Placental Trophoblast
Cells. Frontiers in Toxicology, 4, 881347.
https://doi.org/10.3389/ftox.2022.881347
Cope, H. A., Blake, B. E., Love, C., McCord, J., Elmore, S. A., Harvey, J. B.,
Chappell,
V.A., & Fenton, S. E. (2021). Latent, sex-specific metabolic health effects in CD-1
mouse offspring exposed to PFOA or HFPO-DA (GenX) during gestation. Emerging
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