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HomeMy WebLinkAbout0611 SKUNKNET ROAD - Health 611 SKUNKNET ROAD, CENTERVILLE A= 169 011.008 J llll UPC 12543 No.53LOR " . 'rr' � HASTINGS, HN t No. 90 1. l Cilk Fee (,10 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplitation for Vsposal *pstem ConstL'urtion Vrrmit Application for a Permit to Construct( ) Repair(z_)-Upgrpde(l�Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S k d / All r:,^ A4 Owner's Npane,4ddress,and Tel.No. 13. -6(4 ,JOYCr_ Assessor's Map/Parcel r(�, [9� &� C/ rr�'���/ 1:� In taller's N me,Addre s,and Tel. o.S0$-1f2 0-r773 $ Designer's Name,Address,a d T 1.No. SOS-360--3 c os c��j f7� ��Nros s 'M2 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) " T�/ — /dI U P 'a".7 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date V^ r Application Approved by Date (0 d —� Application Disapproved by Date for the following reasons Permit No. Date Issued t�' tT 4 , No. �aQ� � ,�. "� '�._•".";,w:t4 �»� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zfpplicatiou;for M`isposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(G) Upgrade(/'Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /� S k C/ /�/ =1" ? Owner's N e, ddress,and Tel.No. 13rr oyc r_ Assessor's Map/Parcel/(a _©///p p �/ �/ Installer's N me,Addre s,and Tel.No.fpG -yZ O-9 7� rj Designer's Name,Address,and Tel.No.S%6 966)- 3_5 dos c/� U �f^✓Os / M_% /=/` ti<Svw�'s" IT Al Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building K No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided `7 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) J/,/ T1�I� / C C�Gf/��/ r2, Date last inspected: - n Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / Signed '1�1 ' -' rL-rlT/' Date lj �C!— Application Approved by f —` Date (O` 1O } Application Disapproved by Date for the following reasons Permit No. (;� _M)b Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance A THIS IS TO/CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( G)-� Upgraded Abandoned( )by �//OS e104 2.e ` at -e T �C�il f/,NT./�V/11/_ has been constructed in accordance with the provisions of/Tittle 5 and the for Disposal System Construction Permit No. dated Installer,k_S�j�� ,U-E 6f•;1,`"y Designer #bedrooms ZC Approved design-flop y �� gpd The issuance of this permit shall not be construed as a guarantee that the system w6ll function&,d, wed. Date 7f // 2 Inspector -(---------- -------------------- -------------------------------------------------------------------------------- Fee i �d( qrt I�Q ` f THE COMMONWEALTH OF MASSACHUSETTS ('�j7V) PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade(/-)` Abandon/( ) System located at - ...•- Cr�iTi�--ram�/ //��_ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must�be'co leted within three years of the date of this permit. U— r , 0 Date I Approved by 0'7/07/2017 07: 22AM 17744139468 MEVER AND KtIS PAGE 0 1 01 Town of Barnstable Regulatory Services Richm-d V.ScaI4 Interim Director lit Public Health Division awe Tbowas'McKenn,Director 200 Main Street,Uyaaalh%MA 02601 Offte: 509-8021-4644 Fax: 508-790-6304 installer&Desi er Certification Form Date-, sawage Perwit#20—.�t--L9�(—oAssessor's MapTarcel_ it /009 Designer. F�� _4�_�_l '0 5z lustaller: Address: PO Address- JkA4 oil —was issued apcnait to install a (installer) septic system at tj k+j based on a design drawn by (address) C-/- datcd 5111 (designer) '�ke yst= re ere=ed above was iwaalled substantially acooiRfi.ne,To f—Certify that septicl, PC the design, which may include minor W.proved changes such as lateral relocation cA the -tank :rod the. soils, distribution box and/or septic Strip out (if required.) was inspected were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. givater d=10' lateral relocation of the SAS or any veyfical relocation of any component of the septic system)but in accordance with State& Local Regulations, Plan revision or cortifted as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I ceftify ttzt the system referenced above was construct e with the terms of the T\A approval letters(if applicable) er's Signature) glier s ipa e (A c IJesi er Here) PLEASE RETM TO ARN A_BLF-JUBLIC HEA_LTH D CERTIEF1 OF C ]LANCE WILI NOT BE LSS AS- BUIL, BY 'STABLE rjKK WEALTH DM_5I_0N, C:=fifiojjton JFom R&%,8-1 4-134m TOWN OF BA�/RNSTABLE LOCATION&& ,�/�-q A�1� r� SEWAGE# 20/7 — / VILLAGEef,,--W�l�'�////,�- ASSESSOR'S MAP&PARCEL/6(7— 00 —60'9 INSTALLER'S NAME&PHONE NO.,�09--y2a-ZZ3 , 0.5r, 4,Oe dae,62S SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) �S�.L!✓ �T/^�rO�S' (size) 715d X NO.OF BEDROOMS e OWNER �"�l��� PERMIT DATE: COMPLIANCE DATE: 7.5"- V 7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ` k food A 14 J3 9 Qu c Commonwealth of MassachuBetts RD Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 Charles D.Baker Matthew A.Beaton Governor Secretary Karyn E. Polito Martin Suuberg Lieutenant Governor Commissioner Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use Revised: February 3, 2016 These Standard Conditions apply to Alternative Soil Absorption System(Alt. SAS) technologies for disposal-only as well as for technologies providing both treatment and disposal. Currently these approved alternative technologies include the following, Alt. SAS Disposal-Only, • Contactor,Field Drain Contactor, and Recharger Chambers,by Cultec,Inc. • Biodiffuser&ARC Chambers,by Infiltrator Systems,Inc. • Infiltrator Chambers,by Infiltrator Systems,Inc. • Eljen Mantis M5,by Eljen Corp. Alt. SAS Treatment with Disposal -Patented Sand Filters, • Eljen GSF Geotextile Sand Filter System,by Eljen Corp. • Enviro-Septic Wastewater Treatment System,by Presby Environmental,Inc. • Advanced Enviro-Septic System,by Presby Environmental, Inc. • Simple-Septic Wastewater Treatment System,by Presby Environmental,Inc. An alternative SAS may be appropriate for new construction, increases in flow, or for the upgrade of an existing failing,failed,or nonconforming system where reducing the disturbance of the site is desired. Alternative Disposal-Only technologies approved by the Department may be substituted for conventional SAS's allowed under Title 5. The alternative Chamber technologies,when compared to conventional Title 5 chambers,provide options from some of the Title 5 requirements such as offering plastic instead of concrete chambers and eliminating the need for stone aggregate around the chamber while allowing higher loading rates and reduced effective leaching area. Other options include Chambers installed with aggregate meeting the requirements of Title 5,however Alternative Chambers used with aggregate are not allowed higher loading rates which must remain the same as required by Title 5 for conventional chambers with aggregate. In addition to alternative Chambers, disposal-only approved Alt. SAS technologies also include the Mantis M5 pipe and sand System design. This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper Standard Conditions for Alternative Soil Absorption Sysiems Page 2 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 Alternative Treatment with Disposal technologies approved by the Department refer to alternative leaching systems that have demonstrated higher removal of organics and suspended matter prior to the percolation of wastewater into underlying unsaturated pervious soils when compared to conventional leaching systems. Higher loading rates are allowed than would be permissible with a conventional design and additional relief from other design standards is permissible for upgrades. A System approved under these Standard Conditions consists of a septic tank conforming to the requirements of Title 5, either conventional or I/A approved, followed by the Alt. SAS which may provide for a reduced effective leaching area. The use of an approved Alt. SAS, subject to these Standard Conditions,requires among other things: • A Disclosure Notice in the Deed to the property for installed Systems according to the following: • when installing an Alt. SAS Disposal-Only System(chambers or Eljen Mantis M5) a Disclosure Notice in the Deed to the property is not required; • when installing an Alt. SAS Treatment with Disposal-Patented Sand Filters System under the General Use Certificate a Disclosure Notice in the Deed to the property is not required; • when installing an Alt. SAS Treatment with Disposal-Patented Sand Filters System under the Approval for Remedial Use a Disclosure Notice in the Deed to the property is required in accordance with 310 CMR 287(10); • Certifications by the Designer and the Installer(310 CMR 15.021(3)); • Notification within 24 hours by the System Owner to the Local Approving Authority (LAA) of any System failure; • When System requires pumping prior to the SAS, 24-hour emergency wastewater storage capacity above the elevation of the high level alarm; • System Owner Acknowledgement of Responsibilities, in accordance with these standard conditions and the Technology Approval's Special Conditions. This Approval does not address the use of the following alternative SAS's,which are covered under separate Title 5 I/A Program Approvals: a) Drip Dispersal Systems b) Bottomless Sand Filters Definitions and References The term"System"refers to the approved technology in combination with the other components of an on-site treatment and disposal system that may be required to serve a facility in accordance with 310 CMR 15.000. The term"Approval" or"Certification"refers to these Standard Conditions;the Special Conditions contained in the Technology Approval,the General Conditions of 310 CMR 15.287, and any Attachments. r i Standard Conditions for Alternative Soil Absorption Systems Page 3 of 15 General Use and Remedial Use Approvals 1 Last revised February 3,2016 i The phrase"new construction" always refers to construction of a new facility or any increase in actual or design flow to any existing system above the approved capacity. The phrase "upgrade of a system" or the term"upgrade" or the term"remedial site" refers to any repair,modification, or replacement of a whole system or a component of an existing failing, failed or nonconforming,system,where there is no increase in the actual or design flow to the system. The Conditions contained herein MUST be read in conjunction with any Special Conditions that are technology-specific. I. Purpose i 1. These Standard Conditions shall apply to all Alt. SAS technologies identified in a General Use Certification or a Remedial Use Approval as either a Disposal-Only technology or a Treatment with Disposal technology as listed above. In addition to the Special Conditions contained in the technology-specific Approvals,the System shall comply with all these "Standard Conditions for Alternative Soil Absorption Systems", except where stated otherwise in the Special Conditions. 2. The sale, design, installation, and use of the System shall be subject to these requirements for all systems that submit a complete Disposal System Construction Permit(DSCP)application after the effective date of these Standard Conditions. Existing systems stems ands stems for which a complete DSCP application was submitted Y p Pp prior to the effective date of these requirements shall not be subject to the design and installation requirements,however,the System Owner,the Service Contractor, and the Company shall be subject to all other requirements contained herein. 3. With the other applicable permits or approvals that may be required by Title 5,the Approval authorizes the installation and use of the System in Massachusetts. All the provisions of Title 5,including the General Conditions for Alternative Systems (310 CMR 15.287), apply to the sale, design,installation, and use of the System, except those provisions that specifically have been varied by this Approval. 4. Provided that the Local Approving Authority(LAA)approves the System in conformance with the Department's Approval for the System, Department review and approval of the site-specific System design and installation is not required unless the Department determines on a case-by-case basis, pursuant to its authority at 310 CMR 15.003(2)(e),that the proposed System requires Department review and approval. II. Design and Installation Requirements 1. Where any contradiction may exist in design standards between the Company guidance and the requirements of Title 5 or this Approval,the design shall meet the standards of Title 5 and this Approval unless the Company guidance is more stringent. 11( 1 . Standard Conditions for Alternative Soil Absorption Systems Page 4 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 t 2. In accordance with 310 CMR 15.240(6), absorption trenches should be used whenever possible. Accordingly, approved Disposal-Only and Treatment with Disposal Alt. SAS Systems shall be used in trench configuration whenever possible, unless a different configuration is allowed by the Approval(s) Special Conditions. e 3. The Alternative System shall include'a properly sized and constructed septic tank, designed in accordance with 310 CMR 15.223-15.229 or approved as an Alternative technology per 15.280-15.288, connected to the building sewer and followed in series by the approved Alternative Soil Absorption System. A 1,000 gallon septic tank may be allowed in accordance with the provisions of 310 CMR 15.404(3)(a). 4. The Alternative System shall be installed in a manner which does not intrude on, replace, or adversely affect the operation of any other component of the subsurface sewage disposal system. 5. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. 6. For new construction or increases in flow,the System shall be subject to the following: a The System ma y only be installed in soils with a percolation rate of u to 60 Y Y Y P P minutes per inch(MPI); b) A site evaluation, in compliance with 310 CMR 15.100 through 15.107, must be approved by the Approving Authority and the site must meet the siting requirements for new construction; c) The record drawings, approved by the LAA, must clearly indicate an area for a full- sized conventional primary SAS and a full-sized conventional reserve area that are for the sole purpose of on-site sewage disposal; d) Where the System has reduced the effective leaching area, as allowed by the Standard Conditions,the installation shall not disturb the site in any manner that would preclude the future installation of the conventional full-sized primary SAS without encroaching on the reserve area; and e) Except for the installed SAS,the System Owner shall not construct any permanent buildings or structures or disturb the site in any manner that would encroach on the area approved for a full-sized conventional primary SAS or the area approved for a full-sized conventional reserve SAS. 7. For the upgrade of a system,the installation of the proposed System shall be subject to the following: a) The System may only be installed in soils with a percolation rate of up to 90 minutes per inch(MPI); b) Prior to approving the installation of the System,the LAA must determine there is no increase in the actual or proposed design flow; Standard Conditions for Alternative Soil Absorption Sysxems Page 5 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 c) Prior to Local Approval of the System,the Designer shall show on the plans the maximum available area for a conventional system(without reserve) designed in accordance with the standards of 310 CMR 15.100 through 15.255. d) The proposed System must include the approval by the LAA for the upgrade or replacement of all other existing components, as necessary,to comply with the standards of Maximum Feasible Compliance (MFC)of 310 CMR 15.404; e) The record drawings, approved by the LAA,must clearly indicate an area for the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection; f) When evaluating the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection,the Designer shall consider these options in the following order: i. a conventional system designed in accordance with the standards of 310 CMR 15.100 through 15.255 that can be built feasibly,with the exception of providing a reserve area(15.248); ii. a conventional system that can only be built feasibly under a Local Upgrade Approval(LUA); iii. where a conventional system cannot be built feasibly under a LUA, a Bottomless Sand Filter, in conjunction with a Secondary Treatment Unit; iv. where a System can only be built feasibly with variances, a System that has been demonstrated to vary the design requirements of 310 CMR 15.000 to the least degree necessary and have the least effect on public health, safety, welfare and the environment(the System may be an Alternative System with variances);or v. a tight tank. f) The installation of the proposed System shall not disturb the site in any manner that would preclude the future installation of the best feasible replacement system that could be installed to replace the proposed System. Components of the proposed System may be sited in an area for the future installation of the best feasible replacement system,provided that it does not render the area unusable for a potential future replacement system; and g) Except for the installed SAS,the System Owner shall not construct any permanent buildings or structures in the area for the best feasible replacement system that could be installed to replace the proposed System and the System Owner shall not disturb the site in any other manner that would preclude the future installation of the best feasible replacement system. 8. Alternative Design Standard to 310 CMR 15.242(1)(a)Effluent Loading Rates For new construction or increases in flow,the required effective leaching area may be reduced up to 40 percent when using the loading rates for gravity systems of 310 CMR 15.242(1)(a),provided: Standard Conditions for Alternative Soil Abs9rption Systems Page 6 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 a) no variance is granted for a reduction in depth to groundwater; b) no variance is granted for a reduced depth of pervious material; and c) a minimum of 400 square feet of effective leaching area shall be installed if any proposed reduction in the leaching area would result in less than 400 square feet of effective leaching area; (Facilities with small flows that would not require 400 sq.ft. of effective leaching area, when designed in accordance with Title 5,may be built with less than 400 sq. ft. provided that no reduction in effective leaching area is taken). 9. Alternative Design Standard to 310 CMR 15.242(1)(a) and 15.245(4). Effluent Loading Rates For the upgrade of a system,the System shall be subject to the following: i a) For soils with a percolation rate of 60 minutes or less per inch,the size of the SAS may be sized with 40 percent less effective leaching area than required when using the loading rates for gravity systems of 310 CMR 15.242(1)(a); b) For soils with a percolation rate of between 60 and 90 minutes per inch,the size of the SAS may be sized with 40 percent less effective leaching area than required when using the loading rate of 0.15 gpd/square foot as specified by 310 CMR 15.245(4); c) Unless allowed under the Special Conditions for the Technology, no additional reduction in the effective leaching area is allowed under an LUA or a variance that r would result in a reduction greater than 40%of that which would be required under 310 CMR 15.242(1)(a)and 15.245(4), respectively. Any other deviations to design standards, except the effective leaching area,may be granted under LUA or a variance; and d) A minimum of 400 square feet of effective leaching area shall be provided if any proposed reduction in the leaching area would result in less than 400 square feet of effective leaching area. Where 400 square feet of effective leaching is not feasible, the greatest effective leaching area shall be installed provided that no more than a 40 percent reduction is taken. 10. Specific Conditions for Treatment with Disposal Alt. SAS Technologies a) The use of aggregate as specified in 310 CMR 15.247 is not allowed with Patented Sand Filters. b) Unless determined necessary by the Designer or Company,the System shall not be used with pressure distribution for any design flow. When installed for a facility with a design flow of 2,000 gpd or greater, approved Patented Sand Filter Systems are exempt from the requirement for pressure distribution under 310 CMR 15.231. c) Patented Sand Filters shall not be installed in a Nitrogen Sensitive Area(NSA)to serve facilities with actual or design flows of 2,000 GPD or greater since those facilities require installation of a Recirculating Sand Filter(RSF) or equivalent technology. Patented Sand Filters may be installed as a disposal-only alternative Standard Conditions for Alternative Soil Abs9rp0on Systems Page 7 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 technology when used in addition to an approved Secondary Treatment Unit (reduction of BOD/TSS). When a Patented Sand Filter is used in this type of septic system design,pDly the reductions permitted in the Secondary Treatment Unit's(STU) alternative technology approval, such as a reduction in SAS size, depth of naturally occurring pervious material or depth to groundwater, are allowed. d) For upgrades only, a reduction in the depth to groundwater and/or a reduction in the pervious material may be taken in accordance with Section Il,paragraph 5 of the Standard Conditions for Secondary Treatment Units Approved for Remedial Use. In no case, shall the reductions allowed under the Standard Conditions for Secondary Treatment Units be combined with any reduction provided by this Approval,the alternative technology's Remedial Use Approval Special Conditions or with any reduction that may be allowed under the procedures of Local Upgrade Approval or variance procedures of 310 CMR 15.401-415. 11. Specific Conditions for Disposal-Only Alt. SAS Technologies a) In a NSA, as defined in 310 CMR 15.215,Alternative Systems serving facilities with actual or design flows of 2,000 GPD or greater must include treatment with a RSF or equivalent technology, as required by 310 CMR 15.202(1). Under this Approval, Disposal-Only Alt. SAS technologies shall not be installed in an NSA to serve facilities with actual or design flows of 2,000 GPD or greater unless installed in conjunction with a RSF or equivalent technology. b) For new construction or up rg ades, a reduction in the effective leaching area may be taken in accordance with the conditions and limitations imposed by the approval of the Secondary Treatment Unit employed. (approved Alternative Chambers may be installed with or without aggregate for the disposal of effluent from an approved Secondary Treatment Unit, see paragraph I I(e)below.) For upgrades only, a reduction in the depth to groundwater and/or a reduction in the pervious material may be taken in accordance with the conditions and limitations imposed by the Remedial Use Approval of the Secondary Treatment Unit employed. In no case, shall the reductions allowed under the Secondary Treatment Unit approval be made less stringent. In no case, shall the reductions allowed under the Secondary Treatment Unit approval be combined with any reduction provided by this Approval or combined with any reduction that may be allowed under the procedures of Local Upgrade Approval or the variance procedures of 310 CMR 15.401-415. c) For the upgrade of a system, installations without secondary treatment are entitled to reductions in depth to groundwater or depth of naturally occurring pervious material only to the limits that may be allowed by the LAA under the procedures of Local Upgrade Approval or the variance procedures of 310 CMR 15.401-415. d) The use of aggregate as specified in Title 5, 310 CMR 15.247 is not required. z Standard Conditions for Alternative Soil Absorption Systjms Page 8 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 Chambers Specific Standard Conditions, e) The installation of approved Alternative Chambers with aggregate is allowed provided that it complies with the aggregate requirements of 310 CMR 15.247. However, when approved Alternative Chambers are installed with aggregate the reduction in effective leaching area provided by Standard Conditions II (8) and (9) is not allowed. Only when upgrading a system, approved Alternative Chambers installed with aggregate may be allowed a reduction in effective leaching area(up to 25%)under the limitations and procedures of a Local Upgrade Approval (310 CMR 15.401-405). f) Effluent pressure distribution shall be provided for actual or design flows of 2,000 gpd or greater and shall be designed in accordance with Department guidance. The effluent loading rates provided in 310 CMR 15.242(1)(b) for pressure distribution may be utilized,but no reduction in the effective leaching area as may be provided under this Approval may be taken when using the loading rates for P pressure distribution, as stated in the regulation. I 12. All System control units,valve boxes,distribution piping, conveyance lines and other f ' System appurtenances shall be designed and installed to prevent freezing. 13. When pumping is required to a distribution box or to a SAS pressure distribution tank, the System pump chambers/tanks shall be equipped with sensors and high-level alarms to protect against high water due to pump failure,pump control failure, loss of power, system freeze ups,backups, etc. Emergency storage shall be provided when pumping to discharge is employed, including but not limited to,pressure distribution. Emergency storage capacity for wastewater above the high level alarm shall be provided equal to the daily design flow of the System including an additional allowance for the volume of all drainage which may flow back into the System when pumping has ceased. 14. System control panel(s) including alarms and controls shall be mounted in a location always accessible to the operator(Service Contractor). Any System malfunction and high water alarms shall be readily visible and audible for the facility occupants and the Service Contractor and shall be connected to circuits separate from the circuits serving the operating equipment and pumps. 15. The System shall not include any relief valve or outlet for the discharge of wastewater to prevent flooding of the system, back up or break out. 16. Any System structures with exterior piping connections located within 12 inches of or lower than the Estimated Seasonal High Groundwater elevation shall have the connections made watertight with neoprene seals or equivalent. 17. In compliance with 310 CMR 15.240(13), a minimum of one (1)inspection port shall be provided within the SAS consisting of a perforated four inch pipe placed vertically down to the elevation of the SAS interface with the underlying unsaturated pervious soils to enable monitoring for ponding. The pipe shall be capped with a screw type f Standard Conditions for Alternative Soil Absorption Systgms Page 9 of 15 General Use and Remedial Use Approvals a Last revised February 3,2016 cap and accessible to within three inches of finish grade. (A locking cap at-grade is preferred) Facilities with multiple SAS's shall have an inspection port in each. 18. Upon submission of an application for a Disposal System Construction Permit (DSCP),the Designer shall provide to the Local Approving Authority: a) proof that the Designer has satisfactorily completed any required training by the Company for the design and installation of the Technology; b) certification of the design by the Company for any residential system with a design of 2,000 gpd or more or for any proposed non-residential system or if required by the Special Conditions for an approved Technology; c) certification by the Designer that the design conforms to the Approval,any Company Design Guidance, and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: i. has been provided a copy of the Title 5 I/A technology Approval,the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; ii. for Systems installed under a Remedial Use Approval,the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); iii. if the design does not provide for the use of garbage grinders,the restriction is understood and accepted; and iv. whether or not covered by a warranty,the System Owner understands the requirement to repair, replace,modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. 19. The System Owner and the Designer shall not submit to the LAA a DSCP application for the use of a Technology under this Approval if the Approval has been revised, reissued, suspended, or revoked by the Department prior to the date of application. The Approval continues in effect until the Department revises,reissues, suspends, or revokes the Approval. 20. The System Owner shall not authorize or allow the installation of the System other than by a locally approved Installer and, if required by the Company, a person certified or trained by the Company to install the System. 21. Prior to the commencement of construction,the System Installer must certify in writing to the Designer, the LAA, and the System Owner that(s)he is a locally approved System Installer and, if required by the Company, is certified by or has received appropriate training by the Company. 22. The Installer shall maintain on-site, at all times during construction, a copy of the approved plans,the Owner's manual,the O&M manual, and a copy of the Approval. Standard Conditions for Alternative Soil Absorption Systgms Page 10 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 f 23. Prior to the issuance of a Certificate of Compliance the following shall be provided: a) the System Installer and Designer must provide certification in writing to the LAA that the System has been constructed in compliance with the terms of the Approval; and b) For System upgrades installed under a Remedial Use Approval the System Owner shall provide a copy of record and/or register the Deed Notice required by 310 CMR 15.287(10),to the LAA. The Deed Notice shall be completed as follows: i. a certified Registry copy of the Deed Notice bearing the book and page/or document number; and ii. if the property is unregistered land, a copy of the System Owner's deed to the property as recorded at the Registry,bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department. 24. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sanitary sewer system. a) If it is feasible to connect a new or existing facility to the sewer,the Designer shall not propose an Alternative System to serve the facility and the facility Owner shall not install or use an Alternative System; and b) When a sanitary sewer connection becomes feasible after an Alternative System has been installed, the System Owner shall connect the facility served by the System to the sewer within 60 days of such feasibility and the System shall be abandoned in compliance with current Code requirements, unless a later time is allowed in writing by the Department or the LAA. III. Operation and Maintenance l. For Systems with design flows of 2,000 gpd or greater where the effective leaching area installed is less than 75% of that required by Title 5 (310 CMR 15.240(4)), measurement of the depth of ponding within the SAS above the interface with the underlying unsaturated pervious soils shall be performed once per year by means of the inspection port(s) and any other available access to the distribution system. Inspector must be an Approved System Inspector. 2. Whenever an Alt. SAS system's inspection port ponding depth is measured and indicates the ponding level within the SAS is above the invert of the distribution system, an additional measurement shall be made 30 days later. If the subsequent reading indicates the elevation of ponding within the SAS is above the invert of the distribution system,the System Owner shall be responsible for the submittal to the LAA within 60 days of the follow-up inspection, a written evaluation of the System with recommendations for changes in the design, operation, and/or maintenance. The Standard Conditions for Alternative Soil Absorption Systems Page 11 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 written evaluation with recommendations shall be prepared by a Designer and the submission shall include all monitoring data and inspection reports for the previous 3 years. Recommendations shall be implemented, as approved by the LAA, in accordance with an approved schedule, provided that all corrective measures are implemented consistent with the limitations described in Paragraph IVA. 3. For Systems less than 2,000 gpd or facilities where the effective leaching area r installed meets the requirements of Title 5,the System shall not be required to be inspected at any greater frequency than would be required if the facility was served by a conventional system, unless the LAA, Company, or Designer requires more frequent inspection. 4. If at any time a septic system with an Alt. SAS is inspected by a System Inspector, the following shall be recorded, at a minimum: a) date,time, air temperature, and weather conditions; b) observations for objectionable odors; c) observations for signs of breakout of sanitary sewage in the vicinity of the Alternative System; d) depth of ponding within the SAS; e) identification of any apparent violations of the Approval; f) since the last inspection, whether the system had been pumped with date(s) and volume(s)pumped; g) sludge depth and scum layer thickness, if measured; h) when responding to alarm events,the cause of the alarm and any steps taken to address the alarm and to prevent or reduce the likelihood of future similar alarm events; i) field testing results when performed as part of the site visit; j) samples taken for laboratory analysis and results of previous samples, if any k) any cleaning and lubrication performed; 1) any adjustments of control settings, as recommended or deemed necessary; m) any testing of pumps, switches, alarms, as recommended or deemed necessary; n) identification of any equipment failure or components not functioning as designed; o) parts replacements and reason for replacement, whether routine or for repair; and p) further corrective actions recommended, if any. 5. The System Owner shall maintain copies of any service records or inspection reports and all reports and notifications to the LAA for a minimum of three years. 6. Unless directed by the LAA to take other action,the System Owner shall immediately cease discharges or have wastewater hauled off-site, if at any time during the e Standard Conditions for Alternative Soil Absorption Systems Page 12 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 operation of the Alternative System the system is in failure as described in 310 CMR 15.303(l)(a), items 1 or 2(sewage backing up into facilities or breaking out to the surface). IV. Additional System Owner Requirements 1. For System upgrades installed under Remedial Use Approval, prior to signing any agreement to transfer any or all interest in the property served by the System, or any portion of the property, including any possessory interest,the System Owner shall provide written notice, as required by 310 CMR 15.287(5), of all conditions contained in the Approval to the transferee(s). Any and all instruments of transfer and any leases or rental agreements shall include as an exhibit attached thereto and made a part of thereof a copy of the Approval for the System. The System Owner f shall send a copy of such written notification(s)to the LAA within 10 days of giving such notice to the transferee(s). 2. The System Owner shall not install,modify, upgrade, or replace the System except in accordance with a valid DSCP issued by the LAA which covers the proposed work. 3. Upon determining that the System is failing to protect public health and safety and the environment, as defined in 310 CMR 15.303,the System Owner shall be responsible for the notification of the LAA within 24 hours f o s o such determination. 4. In the case of a System that has been determined to be failing to protect public health and safety and the environment, an equipment failure, alarm event, components not r functioning as designed, components not functioning in accordance with manufacturers' specifications, or violations of the Approval,the System Owner shall provide written notification within five days,describing corrective measures to the local board of health and the Company and may only propose or take corrective measures provided that: a) all emergency repairs, including pumping, shall be in accordance with the limitations and permitting requirements of 310 CMR 15.353; b) the design of any repairs or upgrades are consistent with the System Approval; c) the design of any repairs or upgrades requiring a DSCP shall be performed by a Designer who is a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian,provided that such Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. d) the installation of any repairs or upgrades requiring a DSCP shall be done by an Installer with a currently valid Disposal System Installers Permit and, if training is required,the Installer shall be certified by the Company as qualified to install the System. 5. To determine whether cause exists for modifying,revoking, or suspending the Approval or to determine whether the conditions of the Approval have been met,the System Owner shall furnish the Department any information that the Department requests regarding the System,within 21 days of the date of receipt of that request. Standard Conditions for Alternative Soil Absorption Systems Page 13 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 6. The Approval shall be binding on the System Owner and on its agents, contractors, successors, and assigns, including but not limited to the Designer, Installer, and Service Contractor. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities, respectively, shall constitute violation of the Approval by the System Owner unless the Department determines otherwise. V. Company Requirements 1. The Approval shall only apply to the model unit(s)with the same model designation(s) specified in the System Approval and meet the same specifications, operating requirements, and plans, as provided by the Company or its authorized agent at the time of the application. Any proposed modifications of the unit(s), installation requirements, or operating requirements shall be subject to the review of the Department for inclusion under a modification of the Approval. The Designer shall be responsible for the selection of the appropriate model unit(s) as applicable. The Company shall be responsible for verification of the appropriate model unit(s) as part of any review of proposed installations that may be required by Paragraph V.3 of these Standard Conditions or the Special Conditions in the Approval. 2. Prior to submission of an application for a DSCP, the Company or its authorized agent shall provide to the Designer and the System Owner: a) All design and installation specifications and requirements; b) An owner's manual and, if alarms are provided, including response procedures; c) A copy of the Company's warranty; and d) If training or certification is required by the Company, lists of qualified Designers,Installers, and Service Contractors. 3. Prior to the submission of an application for a DSCP, for all nonresidential Systems and any System with a design flow of 2,000 gpd or greater, the Company shall submit to the Designer and the System Owner, a certification by the Company or its authorized agent that the design conforms to the Approval and all Company requirements and that the proposed use of the System is consistent with the Technology's capabilities. The authorized agent of the Company responsible for the design review shall have received technical training in the Company's products. 4. If the Company requires trained or certified Designers, Installers, or Service Contractors,the Company or its authorized agent shall make available programs of training and continuing education, as necessary. The Company or its authorized agent shall maintain, annually update, and make available by February 151h of each year, lists of trained or certified Designers, Installers, and Service Contractors. If training or certification is required,the Company shall not sell the Technology to an Installer unless the Installer is trained or certified to install the System by the Company. Similarly, if training is required,the Company shall ensure distributors and resellers of the Technology shall not sell the Technology to an Installer unless the Installer is trained or certified to install the System by the Company. Standard Conditions for Alternative Soil Absorption Systems Page 14 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 t 5. As part of any training programs for Designers, Installers, or Service Contractors,the Company or its authorized agent shall provide each trainee with a copy of this Approval with the design, installation, O&M, and owner's manuals that were submitted as part of the Approval. 6. The Company shall provide, in printed or electronic format, the System design, installation, O&M, and Owner's manuals, and any updates associated with this System Approval,to the System Owners,Designers, Installers, Service Contractors, vendors, resellers, and distributors of the System. Prior to publication or distribution in Massachusetts,the Company shall submit to the Department for review a copy of any proposed changes to the manual(s) with reasons for each change, at least 30 days prior to issuance. The Company shall request Department approval for any substantive changes which may require a modification of the Approval. 7. Prior to its sale of any System that may be used in Massachusetts,the Company shall provide the purchaser with a copy of this Approval with the System design, installation, O&M, and Owner's manuals. In any contract for distribution or sale of the System,the Company shall require the distributor or seller to provide the purchaser of a System for use in Massachusetts with copies of these documents,prior to any sale of the System. 8. To determine whether cause exists for modifying,revoking, or suspending the Approval or to determine whether the conditions of the Approval have been met,the Company shall furnish the Department any information that the Department requests regarding the Technology within 21 days of the date of receipt of that request. 9. Within 60 days of issuance by the Department of these Conditions and any other revisions to the Approval,the Company shall provide written notification of changes to the Approval to all distributors and resellers of the System. 10. The Company shall provide written notification to the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the technology for which this Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership, responsibility, coverage and liability between them. All provisions of this Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 11. The Company shall maintain copies of: a) the Approval; b) the installation manual specifically detailing procedures for installation of its System; c) an owner's manual and, if alarms are required, including alarm response procedures; d) a copy of the Company's warranty; and a Standard Conditions for Alternative Soil Absorption Systems Page 15 of 15 F General Use and Remedial Use Approvals Last revised February 3,2016 e) if training or certification is required, lists of qualified Designers and Installers. 12. The Company shall maintain the following additional information for `Treatment with Disposal' Systems installed in Massachusetts, and make it available to the Department within 30 days of a request by the Department: a) the address of each facility where the System was installed,the Owner's name and mailing address(if different),the type of use (e.g. residential,commercial, institutional, etc.),the design flow, the model installed; and b) the installation date, start-up date, current operational status. 13. The Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns, including but not limited to dealers, distributors, and resellers. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities,respectively, shall constitute violation of the Approval by the Company unless the Department determines otherwise. 1 Vl. General Requirements r 1. Any System for which a complete Disposal System Construction Permit("DSCP") Application is submitted while the Approval is in effect, may be permitted, installed, and used in accordance with the Approval,unless and until: a) the Department issues modifications or amendments to the Approval which specifically affect the installation or use of a System installed under the Approval for the System; or b) the Department, the local approval authority, or a court requires the System to be modified or removed or requires discharges to the System to cease. 2. All notices and documents required to be submitted to the Department by the Approval shall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street- 5th floor Boston, Massachusetts 02108 3. The Department may suspend, modify or revoke the Approval for cause, including, but not limited to,non-compliance with the terms of the Approval, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety,welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to the Approval and/or the System against the Company, a System Owner, a Designer, an Installer, and/or Service Contractor. D Commonwealth of Massachusetts 5 Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 Charles D. Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Infiltrator Water Technologies,LLC. P.O. Box 768 6 Business Park Road Old Saybrook,CT 06475 Trade name of technology and model: High Capacity chamber, High Capacity H-20 chamber`, Quick4 High Capacity chamber, Quick4 High Capacity HD chamber, Quick4 Plus High Capacity chamber (8- inch invert), Quick4 Plus High Capacity chamber (13-inch invert), Standard chamber, Quick4 Standard chamber, Quick4 Standard HD chamber, Quick4 Plus Standard chamber (5.3-inch invert), Quick4 Plus Standard chamber (8.0-inch invert), Quick4 Plus Standard LP (Low Profile) chamber (3.3-inch invert), Quick4 Plus Standard LP (Low Profile) chamber (8-inch invert), Infiltrator 3050 (Storm Tech SC-740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP(Low Profile)chamber(6 inch invert), and Quick4 Equalizer 24 LP (Low Profile) chamber(2 inch invert) (hereinafter the "System"). Schematic drawings of the System and a design and installation manual are a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: X259183 Date of Revision: February 19,2015,modified June 12,2015 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000,the Department of Environmental Protection hereby issues this Certification to: Infiltrator Water Technologies, LLC., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the Company"), for General Use of the System described herein. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. 0j June 12,2015 David Ferris,Director Date Wastewater Management Program Bureau of Water Resources This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper Infiltrator Chamber,Infiltrator Water Technologies. Page 2 of 6 i Approval for General Use—June 12,2015 I� I. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1: Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches Equalizer 24 15 x 100 x 11 6 Quick4 Equalizer 24 16 x 48 x 11 6 Quick4 Equalizer 24 LP (6-inch invert) 16 x 48 x 8 62 Quick4 Equalizer 24 LP (2-inch invert) 16 x 48 x 8 2 Equalizer 36 22 x 100 x 13.5 6 Quick4 Equalizer 36 22 x 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 Quick4 Standard HD 34 x 48 x 12 8 Quick4 Plus Standard 5.3-inch invert 34 x 48 x 12 5.3 Quick4 Plus Standard(8-inch invert) 34 x 48 x 12 8 Quick4 Plus Standard LP (3.3-inch invert) 34 x 48 x 8 3.3 Quick4 Plus Standard LP 8-inch invert) 34 x 48 x 8 83 Infiltrator 3050 or StormTech SC-740 51 x 85.4 x 30 22.254 High Capacity Chamber 34 x 75 x 16 11 High Capacity H-20'Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 Quick4 High Capacity HD 34 x 48 x 16 11.5 Quick4 Plus High Capacity 8-inch invert 34 x 48 x 14 8 Quick4 Plus High Capacity (13-inch invert) 34 x 48 x 14 135 ' This approval allows the use of the high capacity H-20 chambers but makes no determination as to the chambers meeting the H-20 loading requirements. 3 Includes Infiltrator MultiportTM invert adapter attached to the side of the end cap. 3 Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All-in-One 8 Endcap. 4 Only systems installed with this invert height shall be allowed to use the effective leaching area associated with this model in Table 2. 5 Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All-in-One 12 Endcap. 2. The System is an open-bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench or as a bed or field. If the System is installed with stone aggregate then the "Effective Leaching Area" in Tables 2 and 3 is not applicable, and must be designed in accordance with the provisions of 310 CMR 15.000. Infiltrator Chamber,Infiltrator Water Technologies. Page 3 of 6 Approval for General Use-June 12,2015 ti 3. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. 4. For new construction or upgrades,the applicant can size the System in a trench configuration, using the effective leaching areas presented in Table 2. Table 2: Effective Leaching Area in Trench Configuration for New Construction and Remedial Sites" Effective Effective Model Leaching' Leaching$ Area Area SF/LF SF/LF Equalizer 24 3.76 N/A Quick4 Equalizer 24 3.90 N/A Quick4 Equalizer 24 LP 6-inch invert) 3.90 N/A Quick4 Equalizer 24 LP 2-inch invert) 2.78 N/A E Equalizer 36 4.73 N/A Quick4 Equalizer 36 4.73 N/A 1 Standard Chamber 6.53 NIA Quick4 Standard 6.96 N/A Quick4 Standard HD 6.96 N/A Quick4 Plus Standard 5.3-inch invert 6.20 N/A ` Quick4 Plus Standard(8-inch invert) 6.96 N/A ` Quick4 Plus Standard LP (3.3-inch invert) 5.65 N/A Quick4 Plus Standard LP (8-inch invert) 6.96 N/A Infiltrator 3050 or StormTech SC-740 N/A 6.71 High Capacity Chamber 7.79 N/A High Capacity H-20' Chamber` 7.79 N/A Quick4 High Capacity 7.93 N/A Quick4 High Capacity HD 7.93 N/A Quick4 Plus High Capacity(8-inch invert) 6.96 N/A 2uick4 Plus High Capacity(13-inch invert) 7.93 N/A '. Effective April 21,2006,310 CMR 15.251(1)(b)maximum trench width is 3 feet. '.Effective leaching area is equal to 1.67(bottom width+(2x invert height))for Systems 3 feet or less in width. 8. Effective leaching area is equal to 1.0(3 +(2x invert Height))for Systems with a width greater than 3 feet. 9. The maximum trench width allowed to calculate effective leaching area is 3 feet. 5. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Tables 2 or 3, or additional reductions in soil absorption system may be allowed. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 1 Infiltrator Chamber,Infiltrator Water Technologies. Page 4 of 6 Approval for General Use—June 12,2015 6. For new construction or an upgrade,the applicant can size the System in bed or field configuration,using the effective leaching areas presented in Table 3. Table 3: Effective Leaching Area for Bed or Field Configuration New Construction and Remedial Sites Effective Model Leaching10 Area SF/LF Equalizer 24 2.09 Quick4 Equalizer 24 2.23 Quick4 Equalizer 24 LP 6-inch invert 2.23 e Quick4 Equalizer 24 LP (2-inch invert 2.23 E Equalizer 36 3.06 Quick4 Equalizer 36 3.06 Standard Chamber 4.73 Quick4 Standard 4.73 Quick4 Standard HD 4.73 Quick4 Plus Standard 5.3-inch invert 4.73 Quick4 Plus Standard 8-inch invert 4.73 Quick4 Plus Standard LP (3.3-inch invert) 4.73 Quick4 Plus Standard LP (8-inch invert) 4.73 Infiltrator 3050 or StormTech SC-740 7.10 High Capacity Chamber 4.73 s, High Capacity H-20' Chamber 4.73 Quick4 High Capacity 4.73 uick4 Hi h Capacity HD 4.73 Quick4 Plus High Capacity(8-inch invert) 4.73 Quick4 Plus High Capacity (13-inch invert) 4.73 10.Effective Leaching area is equal to 1.67 times bottom width only. 7. When the System is used with a secondary treatment unit approved in accordance with 310 CMR 15.284 or 15.288, additional reductions in soil absorption system may be allowed. In these situations the reduction in the SAS cannot exceed the maximum allowed under the secondary treatment units approval. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. II. Special Conditions 1. The System is an approved Alternative Chamber for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval,the System shall comply with the "Standard Conditions for Alternative SAS with General Use Certification and/or Approved for Remedial Use"(the I Infiltrator Chamber,Infiltrator Water Technologies. Page 5 of 6 Approval for General Use—June 12,2015 i k 'Standard Conditions'), except where stated otherwise in these Special Conditions. 2. New Construction This Certification is for the installation of a System to serve { new construction or an existing facility with a proposed increase in flow, for `i which a site evaluation in compliance with 310 CMR 15.000 has been approved by the Approving Authority and the site meets the siting requirements for new construction, as provided in Paragraph 6 in section II Design and Installation Requirements of the Standard Conditions. 3. Remedial Site This General Use Certification also applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system,provided that the facility meets the siting requirements for upgrades, as provided in Paragraph 7 in section I1 Design and Installation Requirements of the Standard Conditions 4. The System shall be exempt from the minimum inlet spacing requirements of 310 CMR15.253. 5. The System shall have a minimum of one inspection port through the top of one of the chambers. The inspection port shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. When the System is installed in trench configuration,then the system shall comply with these requirements: a) Length(each trench) 100 feet maximum(310 CMR 15.251(1)(a)); b) Width(each trench) 2 feet minimum to 3 feet maximum(310 CMR 15.251(1)(b)). - Chambers greater than 3 feet wide, when specifically approved, are subject to other Special Conditions and limitations; c) The minimum separation distance between any two trenches shall be two times the effective width or depth of each trench, whichever is greater, or where the area between trenches is designated as reserve area, three times the effective width or depth of each trench, whichever is greater(310 CMR 15.251(1)(d)); d) The effective leaching area shall be calculated using the bottom area and a maximum of two feet(per side) of side wall area for each trench(310 CMR 15.251(1)(e)); e) Trenches shall be situated,where possible,with their long dimension perpendicular to the slope of the natural soil. Where possible they shall follow the contour lines(310 CMR 15.251(2)); f) Trenches constructed at different elevations shall be designed to prevent effluent from the higher trench(es) flowing into the lower trench(es) (310 CMR 15.251(3)); g) The area between trenches may be designated as system reserve area only where the separation distance between the excavation sidewalls of the primary trenches is at least three times the effective width or depth of each trench, whichever is greater(310 CMR 15.251(4)) - Chambers greater than 3 feet R Infiltrator Chamber,Infiltrator Water Technologies. Page 6 of 6 Approval for General Use—June 12,2015 f wide, when specifically approved, shall be separated by three times the actual width and are subject to other Special Conditions and limitations; and h) Effluent distribution lines exceeding 50 feet in length shall be connected and venting provided in accordance with 310 CMR 15.241 (3 10 CMR 15.251(11)). 7. When installed in trench Configuration, approved Alternative Chambers greater than 3 feet wide: a) shall be installed with a minimum separation distance between any two trenches of two times the actual width of the chamber, or where the area between trenches is designated as reserve area,three times the actual width of the chamber; and 4 b) shall only be entitled to a maximum effective width of 3 feet for the purposes 4 of calculating total effective leaching area. t 8. When installed in a bed or field configuration,the System may be installed without distribution piping, but must comply with the following requirements in .i' 310 CMR 15.252: a) the use of leaching beds or fields is restricted to systems with a calculated design flow of less than 5,000 gpd per leaching bed or field(3 10 CMR 15.252(1)); b) the maximum length of chambers in series shall be 100 feet(3 10 CMR 15.252(2)(b)); c) separation distance between adjacent beds/fields shall be ten feet(3 10 CMR 15.252(2)(f)); and P F d) the effective leaching area shall include only the bottom area, not the sidewalls(3 10 CMR 15.252(2)(i)). 9. For Systems constructed in fill and installed,the System shall be installed as specified in 310 CMR 15.255 Construction in Fill, except the minimum 15 foot horizontal separation distance to be provided between the soil absorption area and the adjacent side slope shall be measured horizontally from the top of the chamber. 10. The System is exempt from 310 CMR 15.287, specifically items: (5)requiring written notification of alternative system prior to property transfer, (6)need for a certified operator, (9)need for an operation and maintenance contract with an operator and(10)deed notice requirement. I Town pf,Barnstable °FTME wti Regulatory Services Richard V. Scali, Interim Director B ^B Publk Health Division 7 MASS. �A i639' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Svstems Property Address: bl ( 120 Assessor's Map\Parcel: 1611 006 Property Owners Name: 4 In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ �I havc'beenprovided with the-Owner_'_s_Manual__.____.._-.__`_`��___._ _------- --- - - ------"---- - � - _ ❑ Y I have been provided with the Operation and Maintenance Manual ❑ 'IYFor Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) nd the Approval ❑ - For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) ❑ iIf the design does not provide for the use of garbage grinders, the restriction is understood and accepted �'❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify Y or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the ti environment, as defined in 310 CMR 15.303 I ,�✓'u U agree to comply with all terms and conditions above. Property Owners printed name / L 7 Property OVners Signature Date Note: This form must be submitted along with the septic system disposal works permit I application for all I\A systems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certitication.doc S TOWN O-FTBARNSTABLE kr LOCATION��� 52gn ITV- � SEWAGE# 2a/7 4 : VILLAGECC ASSESSOR'S MAP&PARCEL/6 9- Ojf j-60� INSTALLER'S NAME&PHONE NO. ,/O�T 62f SEPTIC TANK CAPACITY /0 U 0 LEACHING FACILITY.(type) : y,'IJ / (size) 7,5 O X // 32 NO.OF BEDROOMS y OWNER&—J�N'an �11,elec PERMIT DATE: -2 O"/ COMPLIANCE DATE: 7'.5"- 17 r Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leacr' �hiinJg facility) Feet � FURNISHED BY A I i 1 l L ACIA 13 23 14-4LJ3 1 t 3 I I Town of BA astable. P# Department of Regulatory Services Public 11ealih DivisionDate Kxsa �• � ,b;y. ems$ �L'; �� =200 Main Street;Hyannis MA 02601 E Date Scheduled+ 5�q� / Time _ Fee TI r it Suitability Asses ment for Se a Disposal Performed By: `"' �v` Witnessed By: I i I LOCATION& GENERAL INFORMATION _ Location Address .�1 1 S�CtJa/I{G N `1' ,�jy ow„er''s Name 62t fl �� Assessor's Map/P4rcel: bR J 0 11 d ® i Engineer's Name Ail&yam &'Z/"S NEW CONSTRUt,ON REPAIR Telephone# 3 60 — 11 Land Use _ `��> lfl V Slopes m) Surface Stones �. Distances from: Open Water Body`_(deft • Possible Wet Area��ft Drinking Water Well i P ft d Drainage Way_ d ft. Property Line Other 4 y, SKETCH:($treet name,dimensiods'of lot,exact locations of test holes&per tests locate wetlands in proximity to holes) �t &el Jtv'v �2,1117 I • d ' Yr'Y5"/ Depth.toBedrock N. Parent material(gedl0gic / I -/ Depth to Groundwakdr. S ding Water in Hole' N i Weeping from Pit Face /„ Estimated Seasonal iE#igh Groundwater tjgERM�NtMON FOR SEASONAL HIGH WATER TABLE Method Used: — - _ id: Depth to snll tots Depth db erved standingnobs.hole: . in, timundweter AdJuetment tt. Depth toiweeping from side of obs.hole: , A ,factor �-Adj.OnvundwaterLevel,,,,m, Index Well# Reading Date index We1110e1 PERCOLATION TEST - Drop �v 't't. .. [Observation I Time ttt 9" le# I Time at V -- Depth of Perc ,) /►� ------- Start Pre-soak Time. End Pre-soak Rate MinAnch Site Failed: ` . Site Suitability Asse�smeot: Site Passed Additional Testing Needed(Y/N), Original:.Public Health Division Observation Hole DataVTo Be Completed on Back-- ***If percolaAiOn test is to be conducted within 100' of wetland,you must first notify the Barnstable C44Servation Division at least one(1)wedk prior to beginning- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel - O 2/ 4j l / q r1. �1 ��,ry /p�-I N ; ,I-Iv2" CL lt4eo ,sue 2, 7/4- !02"_In" Cs, A�►cSand 2. 7 DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil -Other Surface(in J (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) Ll- o2-/ 2" Z DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color $oil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gra I F Flood Insurance Rate May: Above 560 year flood boundary No— Yes Within 500 year boundary Nov Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least-four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring p vious material? Certification I certify that on �� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required 1" i ,,expertise and experience described in 3.10 CMR 15.017. Signature Y v Date t Q:\,SEPTICIPERCFORM.DOC Commonweaith of Massachusetts Executive Office of Environmental Affairs 00r SCE/��49 Department 'of ° 1996 Environmental Protection Wllllam F.Weld C,onmor Trudy Coxe Saentary,EOEA ' David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION �.5��tif�.,�- mil/Q Property Address: L Address of Owner: Date of Inspection: �G_ Q �i Of different) Name of Inspector: S p rVI C,2 r w Company Name, Address and Telephone Number: r1i r e/X� �/,c_S CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _(,Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: `\ � fZ "�i Date: ld - g S The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or'D: A] SYSTEM PASSES: � I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street a Boston,Massachusetts 02106 • FAX(617)SS6.1049 a TWephone(611)292-5500 0 PMnted on Reeyded Pape e r I i► SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout`gr high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, sethked or uneven distribution box. The system wifl pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruct(on is removed distribution box is levelled or replaced The system required pumping more than four times a year due' to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of-Health): broken pipe(s) are.replaced../ obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF'HEALTH Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE.IBOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. _ The system has aseptic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system ha;`a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. . _ The system)as a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply wgll, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from'pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A E CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil 4sorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool o privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or p v\y is within a Zone I of a public well. Any portion of a cesspool or privy�s within 50 feet of a private water supply well. Any portion of a cesspool or privy is fb' ss than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the`-well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is'10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 f, !4P f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST �( S�i v►''' -ff-- Property Address: Owner: t 6/!I IVIV&2 Date of Inspection: Check if the following have been done: �f/pumping information was requested of the owner, occupant, and Board of Health. t---I�lone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. A built plans have been obtained and examined. Note if they are not available with N/A. _facility or dwelling was inspected for signs of sewage back-up. _hehe system does not receive non-sanitary or industrial waste flow _- hhee site was inspected for signs of breakout. 'All components, excluding the Soil Absorption System, have been located on the site. 4, he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _L-The size and location of the Sail Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. �facilit) ovne: (and occupants, if different from o�%ner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 �3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �--e.v4v- Owner: �O r'j U) t N Ng'e Date of Inspection: /C)✓ �` FLOW CONDITIONS RESIDENTIAL: Design flow:_j,KO__.gallons Number of bedrooms:— Number of current residents: Garbage grinder (yes or no):,& Laundry connected to system (yes or no):_z Seasonal use (yes or no):-4-/ Water meter readings, if available: /)D 0 /`l 9 1; !!3 OCJ Last date of occupancy: U),I? � COMMERCIAUI NDUSTRIAL: Type of establishm t: Design flow: ns/day Grease trap present: (yes o �- Industrial Waste Holding Tank pr ( es or no)_ Non-sanitary waste discharged to the Title 3`system (y�,•-n-6j Water meter readings, if available: Last date of occupancy:— OTHER: (Describe) Last date of occup GENERAL INFORMATION PUMPING RECORDS and source f infor on: Ay- 8 ' System pumped as part of inspection: (yes or no)_ If yes, volume pumped /VGJ gallons Reason for pumping: r44aA;n1Z TYPE 0 SYSTEM /S� eptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) ACTXIMATE AG of all components, date installed (if known) and source of information: //�e4'S Sewage odors detected when arriving at the site: (yes or no)4L--'� (revised 8/15/95) S b �l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: _'concrete _metal _FRP—other(explain) Dimensions: e,4 '1 Sludge depth: 2-i Distance from top of slud4e to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler Comments: (recommendation for pumping, condition let and outlet tees or,baffles, depth of liquid level,,,,p' i relation to outlet inve , structural integrity, evidence of leakage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: -concrete _metal _FRP —other(explain) Dimensions: -- ------ Scum thickness: Distance from top of scum to top of outlet tee or baffle:. Distance from bottom ni crom t- hottOm of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evident—f-lea'&age. etc.) (revised 8/15/95) 6 1` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete metal _FRP—other(explain) Dimensions: Capacity: Rallons Design flow: Qalloris/day- Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:V (locate on site plan) Depth of liquid level above outlet invert: Comments: (note tLeel and & ibuticr. i� equal, ev n e of solids car�•ever, evidence of aka into or out of box, etc.) PUMP CHAMBER: — --—- (locate on site plan) Pumps in working order.(yes o) Comments:. .-�•f_—� (note condition of pump chamber, condition of-pum appurtenances, etc.) (revised 8/15/95) 7 i 1 1A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): c� (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, si ns of hydr ulic failure, level of po ing, co dition of vegetation,et .) o CESSPOOLS: _ (locate on site plan) l Number and configuration: / Depth-top of liquid to inlet inve Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: _ Indication of groundwater. inflow (cesspool must be pum as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (n in of soil, signs of hydraulic failure, I of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C f SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspectioo SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' � o � ti DEPTH TO GROUNDWATER Depth to groundwater: /511" feet method of determination or 4p proximation: 52 J-"W (revised 8/15/95) 9 0 No.....................J • • ��;� s �� '��- 4 Fps ............... THE COMMONWEALTH- OF MASSACHUSETTS BOARD OF HEALTH ........ ---------......................OF........ :...........--.... .X jiplirFatiou for Disposal Works Toustrurtion frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal r System at: ' ................-__............................................................................ -•-, 38....s �I<.&e k� Z............................ Location-Address• or LA No. ................................... .. ®. .` f�..4VO. �%6.Y!!V--_-��:.!-•--.........-•-•-- Owner Address W lZi— Installer Address d Type of Building Size Lot.-p-%Q..da.......Sq. feet V Dwelling—No. of Bedrooms......... .............................Expansion Attic (-/) Garbage Grinder (U) W`4 Other—T e of Building ............. No. of ersons....._.................._._. Showers YP g --------------- P ( ) — Cafeteria ( ) Otherfixt res ---------------•-------•------••----------------------.------------------------------------...._...--•-------------------...----------....•-••-_------ W Design Flow............V�.5.................._ gallons llons per person per day. Total daily flow........................................................__ llons. WSeptic Tank—Liquid capacity-_ ..gallons Lengthpl._.._. Width.-S.." ---. Diameter--__--__--___- Depth. 13..... x Disposal Trench—No..................... .Width-_-_. ------------.. Total Length___...._... ....... Total leaching area..._....-__-.._.....s ft, Seepage Pit No.......I------------ Diameter...../0....... Depth below inlet....6j__._.___. Total leaching area.._c ._. -€ Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY----------------------------------------------;---...------------•----- Date....................................... � Test Pit No. 1....`V_.........minutes per inch Depth of Test Pit..1.2............ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ......................................................... 0 Description of Soil....................................................................................................................------------....-----------------•---------_----- V ------------------------------------------•--------••-------•--------------------•------•-•-•---------..........................------------------------------------.....--------------------------- W -------------------------------------------------------------------------------------------------------------------------------------------------------------......................................... U Nature of-Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------- --------------------------------•--•-----------------------•------------------------....--•-----------------••--------------------------------------------------------•--------------....---•--••--•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'L U 5 of the State Sanitary Code— e undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ' ue y the board of health. SignedP-----------------------------•--------_---- � �� ate ApplicationApproved BY......... '------...- -- ..................................... ---------------------------------------- Date Application Disapproved for the following reason -------------------------------------------------------------------------------............................ Date PermitNo......................................................... Issued....................................................... Date LO1-.,AT10N SEWAGE PERMIT NO. �16 VILLLLAGEE�- INSTA LER'S % NAME i ADDRESS L s UI.I R OR OWNER P DA T E P ERMIT ISSU E D DAT E COMPLIANCE ISSUED LOT NO. : ' 6 ADDRE S S OWNERS NAME SEWAGE PERMIT NO. NEW: REPAIR: s DATE ISSUED: DATE INSTALLED: Zko INSTALLERS NAME: ��� �.• ww� (060 a w INSTALLATION OF: et WATER TABLE: Uo FINAL INSPECTION BY: ems, . DRAWING OF INSTALLATION ON REVERSE SIDE. v No................_....... ............................_. THE COMMONWEALTH OF MASSACHUSETTS r�. BOAR® OF HEALTH --------------------------------- .....OF..................................... Appliratiuu for Bispviial Works Tousiruriiuu 1hrutif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .................................................k------------------- ...... ------•...... Location-Address or Lot No. ......................—.......................................................................... ................................................................................................. Owner Address -•------ ........................... Installer Address UType of Building Size Lot............................Sq. feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building� YP g C--.------------------------- No. of persons............................ Showers ( ) — Cafeteria-(----_)- Otherfixtures -- -----------._...-•-------•--•-------------••-----••-•••-•-•----•-••••----•-••- Desi' Flow____________________________________________gallons per person per day. Total daily flow..__._._____.______________._____ ___gallons. l� g P P P Y• Y ---•-- C4� Septic Tank—Liquid capacity............gallons Lengtfi.,_._._r_._____ Widtfi________________ Diameter----------_..... Depth................ W ` Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total.leaching area....................sq. ft. x - Seepage Pit No..................... Diameter.................--- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2..._............minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------------------------------------------------------------------------------------------------------------••----•••. ODescription of Soil......................................................................................................................................................................... x V -------------------------------------- •---------------------------- •------------------ --•-------------- _-------------- --------------- _----------------------------------- •-----------_----•-•--•.. UW --•---••----•----•---------------•-.....•---------------------------•---•._._....-•---.....•-----•••-•••-•-•-•••--------•--------------•--•-•--•----•••---•-•••-••••-----•----•••-••------._.._.......-- Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ----------------------•-------------------------------------------•---------------------•-----•-----------......._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code .— e undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ue y the board of health. Signed--- . ...... .......................+•--•-•-•••-•--------•-•-----•••-••-•----••-- /" -,- ••-- ate Application Approved By____.____„......» ........ :...._..._.. Date Application Disapproved4or, the following reaso :__-•--------------•------------•-----------------•-----•----------............................................. ........................................=................................................................................................................................................................ f Date PermitNo......................................................... Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :.........................................OF......,......_.........................__.........................._......•••.......... Tntif iratr of Tompliattrr THIS IS TO RTIFY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------- s: .. ,+ c�rui,..-•--•-•---•--------- ------------------------------•---•----------- -•---_-__--•-•------•--•---______-__ i,- Insta ptr af._:.. J- �f �� -r -------------------------------------- has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...._ " _9.441.y______. dated................................................ THE ISSUAN E OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM ZZ F N� OI� SATISFACTORY. DATE..... . Inspector •---•--------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH joy ��1(fl + ...........................................OF............................................_........................................ FEE. •............... �Iiu�rruatl urk� �Dtu��rltr�i�u rruti# Permission is hereby granted........... z^...'r............................................................................ to Construct ( .ff,;N�R, it ( } an I div' al Se rags • posal System atNo. _ 0.... � ---------•--•-------•----------- ..... Street as shown on the application for Disposal Works Construction Permit Dated.......................................... �__t_DATE. -- Board of Health ,1 - .Z '` �J ............ FORM 1255 A. M. SULKIN, INC., BOSTON i • ¢SSS i _ t I 1 1 i i : _. . _ r� .. s i I , , , p , T ', `� � j , Y t j i .i i .i � � � I f ��.. ._%s_..� f ,•i{_ ....�... ....r 1 I .1.. , i � I , — P s : i : j j : I ' r .�_..;.._...i. ....._j._..__.._.r_ � � � I 1 1 I ' h3-4 Y T�X'�J' •f�• —5 I 0 i j ) 7 TI I i I 1 ' ...... - - - I I I i — — — I , 1 : t 1 I ' i I , I I I i i Q 1 � t I i i i f i I , s ) i r i , • i I 7 , I : { Y i i i 1 i .._ f. . _ .. . t.. . __ ._.._._ ._.._. 1 _ ! I i 1 I 1• _. .. ..�._....._.. _._.._.._..... __.._ _.. — .... r._........__j. ......._...g.-._... +.__...__..� ._._...__.. i i i y I 1 f , I ( : .,( i : i 1 " • � ! I : i f i , f i - G CONVENTIONAL , 5 FT SOIL REMOVAL LEGEND CENTERVILLE LEACHING FOOTPRINT (NOTE 17) n 35 PLAN PROPOSED CONTOUR 34 1 00.00' 33 3? - i ® PROPOSED SPOT GRADE __T----- ` -- SCALE; 1 in = 20 ft - —— gg —— EXISTING CONTOUR 0 0 20 40 + 96.52 EXISTING SPOT GRADE �p 15 ft ` \ -1 \� `� \32 C 10 20 40 W— EXISTING WATER SERVICE =�<v Y -------- ,p_ 15 ft t9` TEST PIT �U,yQ ERT C Rp• Y SCALE: 1"=20'- SPRPMP N } LOCUS FAI TH RD. � i ' LOCUS MAP � LEACH PIT 1 O ; OG � LOCUS INFORMATION I I • E T TANK I PLAN REF: 8K 364 P 2 TITLE REF: BK 9938 PG236 PARCEL ID: MAP 169 PAR. 011/008 FLOOD ZONE: "X" I i COMMUNITY PANEL: 25001CO563J DATED:07/16/14 I ' SEPTIC SYSTEM N I' o REPAIR PLAN 0 LOCATED AT: , I 611 SKUNKNET ROAD �0p 036.53k BENCH MARK CENTERVILLE, MA PAINT SPOT ON PATIO CORNER PREPARED FOR >�l I 34.8.1, BARNSTABLE GIS DATUN B R EN D A JO YCE MAY 21, 2017 , OF yAss9 I I I I D IR E M. �✓� I 1 I 140 / w STE �' NITAR�P� i I I �V S�}- o Q 0� 8p00 I / 100.00' w PREP -36� PP�� 2 - poP' B00PP169 Pc` 11 MEYER & SONS . INC. w P.O. Box 981 1 PAVED DRIVEWAY O z E. SANDWICH , . MA 02537 3 % 200.00' - - - - z PH. (508)360=3311 • � fax (774)413-9468 meyerandsonstitle50gmail.com r - u� SHEET 1 OF 2 J 1680 t NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:32.0 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE DESIGN CRITERIA INSTALL RISERS & COVERS OVER INLET & PROPOSED D=BOX PERIMETER OF THE S.A.S. - T.O.F. EL.=36.53t OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PROPOSED S,A. # NUMBER OF BEDROOMS: 4 EDROOM DESIGN INSTALL LOCKING COVERS IF AT FINISH GRADE " INSTALL A 4" DIAMETER INSPECTION PORT OVER SET TO 6 OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. DESIGN FLOW: RESIDENTIAL 4 EDROOMS ® 110 GPD/BR = 440 GPD fF.G. EL.=35.30t F.G. EL.=35.Ot F.G. EL: 35.1 Of DESIGN PERCOLATION RATE: <2 MIN/IN -�9 l F.G. EL: 35.0-34.0(MAX.) SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) 9" MIN COVER/ y GARBAGE GRINDER: NO not designed for garbage grinder) 36" MAX COVER L = 40' L = 15'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) DISTRIBUTION BOX: USE DB-5 (H20) 0 S=1% (MIN.) EL.=34.47f ® S=1% (MIN.) 0 S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC SEPTIC TANK: 440 gpd x' 200% = 880 gpd USE EXIST. 1,000G SEPTIC TANK t0. " LEACHING AREA REQUIRED: (440)/.74 = 594.59 S.F. 6" 11.3" TO \INV,=33.40 �"LIQUID' 14" INVERT PRIMARY S.A.S. kNV.=33.15 INV.=31.61 t Gas BAFFLE LEVEL PROPOSED 4 ROWS OF 6 UNITS,AT 6.25'/UNIT = 37.5'/Row USE 4 ROWS OF 6 - HI-CAP INFILTRATOR H-20 UNITS-NO STONE D-BOX INV.=32.55 INV.=32.75 DB-5 SOIL ABSORPTION SYSTEM (PROFILES BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) EXISTING 1.000 GALLON SEPTIC TANK H 0 # (CHAMBER) 24 UNITS x 6.25 LF x 4.73 SF/LF = 709.5 SF EXIST. SEWER OUTLET }RESTORE VEGETATIVE COVER BACKFILL WITH CLEAN PERC SAND TOTAL AREA = 709.5 SF TO TOP OF CHAMBERS DESIGN FLOW PROVIDED: 0.74GPD/SF(709.5SF) = 525.03 GPD>440GPD req'd NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING " PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=32.0 _ 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 31.61 MADEP APPROVAL COMPLIANCE: GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.= 30.67 EXISTING SUITABLE INCH CRUSHED STONE BASE, AS SPECIFIED IN MATERIAL 37.5' L x 1 1.32' W = 424 sq ft. > 400 sq ft. required 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W: EFFECTIVE WIDTH = 4 x 2.83' WITH 1500 GALLON SEPTIC TANK IF FAILED, (5.25' PROVIDED) USE 4 ROWS OF 6-HIGH CAPACITY DAMAGED, OR UNDERSIZED. ADJUSTED GROUNDWATER: EL:25.42 = INFILTRATOR (H20) UNITS 4) INSTALL INLET & OUTLET TEES W/ GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. N.M GENERAL NOTES: II 75" I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL ; LOGS P#: 15347 BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: MAY 9, 2017 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. SOIL EVALUATOR: DARREN M. MEYER, RS, CSE 1614 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DON DESMARAIS, BARNSTABLE HEALTH TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Elev. TP-1 Depth Elev. TP-2 Depth FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 33.80 0/A 0" 33.75 0/A o" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND • LOAMY SAND 16" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF ��� OF MASS 33.05 10YR 3 2 9" 33.00 10YR 3 2 9" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF LOAMY SAND B LOAMY SAND HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 10YR 6/8 t " 10YR 6/8 R.D E �n 7. DWELLING IS SERVICED BY TOWN WATER. �, - PERC ® 3� C 1 FINE SAND 37 30.67 C 1 37" o � FINE SAND 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 1140 EL 29.39 1OYR 6/6 10YR 6/6 2830 SECTION TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 28,25 66 INVERT 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE C2 MEDIUM 66" C2 MEDIUM HEIGHT END CAP LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. SAND SAND SAND 10. EXISTING LEACH PR TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. a 2.5Y 7/4 2.5Y 7/4 INFILTRATOR - HI CAPACITY (H2O) CHAMBER 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION sANITA ) 25.30 C3 102" 25,25 / C3 102" 12 EENEUPURPOSES ONLY FINE 7D FINE SAND AND IS NOT TO BE CONSIDERED A PROPERTY SURVEY 25Y /4 Y /4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 22.80 132" 22.75 132" tr 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. ) 61 1 SKUNKNET ROAD, CENTERVILLE, MA 15. THE DESIGN OF THIS SYSTEM GOES NOT ALLOW PERC RATE<2 MIN/IN. (*Cl" HORIZON) Prepared for: Jo ce FOR THE USE OF A GARBAGE GRINDER. NO GROUNDWATER OBSERVED NO MoTrUNG ® 100" (EL 25.42) System Design and Site Plan by: SCALE DRAWN DATE 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 17. REMOVE UNSUITABLE SOILS 5 FT. AROUND LEACHING TO ELEV. OR TOP , Meyer&Sons,Inc. N.T.S. DMM 05/21/17 . I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX 981 OF C1 LAYER AND REPLACE WITH CLEAN MEDIUM SOILS PER TITLE 5. to conduct soil evaluations and that the above analysis has been performed by me consistent with the E4STSANDWICH,A2402537 CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I hove passed the Soil Eval. Exam in October, 1999. Spg2-2922 DMM 2 Of 2 .. a .:�. --•--.• _...i. - V- 'PiTGt-� At.�,. �...i�aE� p Mt i�J t r�tU►•� o#x yb",f�' ; , �..� h1.1 t,.�SS► G7T't~••{E��tS� .'�4�CsCi F�fe�"'•tJ. !i �3�--- A L.�.. 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