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C APS r)c r,T. aog o�q Y) i 10 .. - f t^ I capeTRegency Nursing r. r. Home/ Centerville 3' e n dC r Massachusetts Department of Conservation and Recreation Mas Ao..,etts- Office of Water Resources Well Completion Report 20-JUN-07 14:48:16 WELL LOCATION. 250307 GPS North: 410 38.97' GPS West: 700 20.5051 Address: 120, South Main Street Property Owner/Client: Radius Management Subdivision Name:Centerville Mailing Address: 1671 Worcester Road City/Town:Barnstable City/Town, State:Framingham MA , Assessors Map: Assessors Lot #: Permit Number: Board of Health permit obtained: N Date Issued: Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Monitoring - 2 wells at this location. Auger CASING From (ft) To (ft) Type Thickness Diameter .00 -26.00 PVC Schedule 40 2.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -26.00 -36.50 Slotted PVC .010 2.00 WELL SEAL / FILTER PACK/ ABANDONMENT MATERIAL From (ft) To (ft) Material Description Purpose 7-21.00 9 az..r.r -23a.�!s Bentonite Chips/Pellets Seali' -25 00; 36%5° ., Sand ', Filter ,. ..x '. ....+.r u+. .r.. .a... .v......v..u-..v.......�..... ...x..r ._......a ..v ...... +.........a...... ..... .. �� � � 1 •• ��... � ��' ^�z. WELL-TEST-DATA (ALLw SECTIONS MANDATORY FOR PRODUCTION WELLS) Date Method Yield ''Time Pumped Pumping Level Time to Recover Recovery (GPM) (hrs & min) (Ft. BGS) (Hrs & Min) (Ft. BGS) STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) Date Depth Below Ground Pump Description: Measured Surface (ft) Type: Intake Depth: 06/12/2007 31.5 ' Nominal Pump Capacity: Horsepower: WELL DRILLER'S STATEMENT ADDITIONAL WELL INFORMATION Driller: Patrick Desmond Developed: No Fracture Enhancement:No Supervisor: Patrick Desmond Rig #: 28 Disinfected:NO Well Seal Type:Concrete Firm: Desmond We11 Drilling Inc. Total Well Depth: 36.500 Depth to Bedrock: Registration #: 877 Date Complete:06/12/2007 Comments: MW2: 34.5'/29 , 2 "F. OVERBURDEN d"x IC «. ae From To Description��: , ' Color Comment { Water i° Loss/Add Drill Drill ... ...•.:MP ..F .L ». a. :.t ... ra: r._ �. (ft) (ft) Zone of Fluid Stem Drop Rate .00 23.00 Sand & Gravel Brown No N/A 23.00 28.00 Siltyr Sand Brown No k. .N/A 28.00 36.50 Sand &,Gravel Brown ,+.::, t<; + Yes •`N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac Droo per ft 1/1 1 1 h� II Intl SZ NnC LOOZ All Waste WateT .Ser"Ces Inc. Barnstable ABOH 2019 Pumping Log Date Locations Address Town Waste Quantity Disposal Location 8/3/2019 Whole Foods 990 lyannough Rd Hyannis Grease 2,700 Rutland 8/14/2019 Whole Foods 990 lyannough Rd Hyannis . Grease 2,000 Rutland .8/16/2019 Cape Regency 120 S Main St Centerville Septic 5,000 New Bedford WWTP 8/24/2019 Whole Foods 990 lyannough Rd Hyannis Grease 1,500 Rutland 8/27/2019 Whole Foods 990 lyannough Rd Hyannis Grease 750 Rutland Wastewater Services Inc. 1997 Bedford Street Bridgewater, MA 02324 Ph 608-697-9974 Fax 508-697-9979 iordanlotterhand(a wwsiofma.com t; ? - R.1: ANAL xYTICAL ;, _ N 0 Sp®eEtaltsts_tn Envlwnmanbal 9Brvloaa N Z N U0 M! s � s• t � �' .. a+ F 4 O N C � m Z � v CHAIN OF�CVSTODY RECORD °� � �, >z - w O n b o Z v rn iD 41 Illinois Avenue 131 Coolidge St.,Suite 105 c , £ _ z z m g Warwick,RI 02888-3007 Hudson,MA 01749-1331 UI V o b = rn r°n °� a: o Y Z q o o �a _ L° = E m 800 937-2580•Fax 401-738-1970 800 937-2580-Fax 978-568-0078 o U U m ►°- o z z 9 o O Dnte Tune -o �. i ~ i i i i i Collected :'Collected Field;5ampie`Idenhticahon C71 P. m � z z z o � 'fLy'.CJ C 1P NP WW X X X E 3�o Influent c 1P s WW X C 1P NP WW X X X X C 3 C U Effluent C 1P S WW X X .- 7 3Z,6 Effluent-Grab G 2AG S I WW X 'L 13Z,5 �S G- 5iIx Field Kits Inf pH: Eff pH: Eff NO3: Eff NH3: Client'Informati On. u ... ,. ;: ;ProfectInformatio Company Name: Whitewater, Inc. Project Name: Cape Regency— Monthly Wastewater Monitoring Address: 253B Worcester Road, Building 2 P.O.Number: Project Number: City/State/Zip: Chariton, MA 01507 Report To: David Boucher Phone: 508-864-0840 Fax: 508-248-2*�. Telephone: 508-248-2892 Fax: 508-248-2895 Sampled by: lab.reports@rhwhite.com o 10310 Email address: janderson@rhwhite.com W Contact Person: David Boucher Quote No: ebelaire@rhwhite.com Relnquis. Date '., Time ed< e` Trme Turn Around Time:: 'C I ' p Normal EMAIL Report X 5 Business days. Rush—Date Due: r.,. ", '., , :;Y '.1 S`:`..:. ...,x..•.. �... �.._ 4 '� r'oject`Coents.,, Use;OWy...: ;i le if applicable: GW-1, GW-2, GW-3, S-1, S-2, S-3 MCP Data Enhancement QC Package? No S ple Pick Up Only �T, RIAL sampled;attach field hours Temperature Upon Receipt' C S ipped on ice • o o er No: ontainers:P=Poly,G=Glass,AG=Amber Glass,V=val,St=Sterile Preservatives:A=Ascorbic Acid,NH4=NHaCI,H=HCI,M=MeOH,N=HNOs,NP=None,S=HZSO,,SB=NaHS ,,S NaO I =Naz sOs. =Zn /�C n Page 2 of 3 R.I.Analytical Laboratories,Inc. Laboratory Report Whitewater,Inc. Work Order#: 1 709-2 1 1 73 Project Name: PROJECT#70017706 CAPE REGENCY-MONTHLY WW MONITORING Sample Number: 001 Sample Description: INFLUENT Sample Type : COMPOSITE Sample Date/Time : 9/29/2017 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST BOD 5 160 60 mg/I SM5210B 21ed 9/30/2017 11:32 ERG Total Suspended Solids 190 2.0 mg/1 SM2540D 18-2led 10/3/2017 12:31 TAC Total Solids 610 10 mg/1 SM2540B 18-2led 10/4/2017 7:06 TAC Ammonia(as N) 20 0.20 mg/I EPA 350.1 10/4/2017 9:05 KLE Sample Number: 002 Sample Description: EFFLUENT Sample Type : COMPOSITE Sample Date/Time : 9/29/2017 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST BOD 5 <3.0 3.0 mg/I SM5210B 21ed 9/30/2017 11:54 ERG Total Suspended Solids <2.0 2.0 mg/1 SM2540D 18-21ed 10/3/2017 12:31 TAC Nitrite(as N) <0.25 0.25 mg/1 EPA 300.0 9/29/2017 21:43 JJG Nitrate(as N) 7.8 0.25 mg/I EPA 300.0 9/29/2017 21:43 JJG TKN(as N) <0.50 0.50 mg/I SM4500NOrg-D 18-2led 9/30/2017 8:00 APD Total Nitrogen(as N) 7.80 0.50 mg/I CALCULATION 9/29/2017 21:43 JJG Sample Number: 003 Sample Description: EFFLUENT-GRAB Sample Type : GRAB Sample Date/Time : 9/29/2017 @ 13:20 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Oil&Grease Gravimetric <0.5 0.5 mg/I EPA 1664A 10/3/2017 23:16 AM Sample Number: 004 Sample Description: MLSS GRAB Sample Type : GRAB Sample Date/Time : 9/29/2017 @ 13:25 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Total Suspended Solids 8700 2.0 mg/l SM2540D 18-21 ed 10/4/2017 12:51 TAC Page 1 of 3 R.U. ANALY70CAL Specialists in Environmental Services LABORATORY REPORT Whitewater, Inc. Date Received; 9/29/2017 Attn: Mr. David Boucher D ate:Repo rt-d 10/10/2017 Wastewater Division P.O Number 253B Worcester Rd., Bldg 2 - - - : Charlton, MA 01507 Work Order#: 1709-21173 Project Name: PROJECT#70017706 CAPE REGENCY MONTHLY WW MONITORING Enclosed are the analytical results and Chain of Custody for your project referenced above. The sample(s) were analyzed by our Warwick, RI laboratory unless rioted otherwise.�:When applicable, indication of sample analysis at our Hudson; MA laboratory and/or subcontracted results are noted:and subcontracted reports are enclosed in their entirety. All samples were analyzed within the established:guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results or in a case narrative. The Detection Limit is defined as the lowest level that can be reliably achieved during routine laboratory, conditions. These results only pertain to the samples submitted for this Work Order# and this report shall not be reproduced except in its entirety. We certify that the following results are true and accurate to the best of our knowledge. If you have questions or need further assistance,please contact our Customer Service Department. Approved by: :Kelly Pereira :Project Manager Laboratory Certification Numbers(as applicable to sample's origin state): Warwick RI *RI LAI00033,MA M-RI015,CT PH-0508,ME RI00015,NH 2O70,NY 11726 Hudson MA*M-MA1117,RI LA000319 131 Coolidge Street,Suite 105, Hudson,MA 01749 41 Illinois Avenue,Warwick, RI 02888: 15 Lark Industrial Drive,Smithfield, RI 02828 P:978-588-0041 F`.978-568-0078 P-401-737-8500 F::401-738-1;970 P:401-737-8500 F:401-349-0844 www:rianalytical.com I t Permit Number: 847-1 Massachusetts Department of Environmental Protection Bureau of Resource Protection-Groundwater Discharge Permit Program Facility:Cape Regency Frequency:Monthly Groundwater Permit Sampling Date:9/29/17 DISCHARGE MONITORING REPORT Contaminant Analysis Information For"0"below detection limit,or not detected,enter"ND" TNTC=too numerous to count. NS=Not Sampled Effluent Method Parameter/Contaminant Units Influent Effluent Detection Limit BOD mg/I 160 ND 3 TSS mg/I 190 ND 2 TS mg/I 610 Ammonia-N mg/I 20 Nitrate-N mg/1 7.8 0.25 Total Nitrogen(NO3+NO2+TKN) mg/I 7.8 0.5 Oil&Grease mg/I ND 0.5 Groundwater Permit-Discharge Monitoring Report Massachusetts Department:of Environmental:ProtectionPermit:Number: 847-1 Bureau of Resource Protection Groundwater Discharge;Permit Program Facility:Cape Regency Monthly Frequency:M hly Groundwater Permit , 9/5/2017 MONITORING WELL DATA REPORT Contaminant Analysis Information For"0"below detection limit,or not detected,enter"ND" TNTC=too numerous to count. NS=Not Sampled DRY Not Enough water in well to sample Parameter/Contaminant Units " :.: ;MW 3 MW 6' MW 7 pH $U 6.3 :. 6.2 6.2 Static Water Level Feet 33.27:.: 33.4 30:43 Specific Conductance umhos/c 488 " 275 266 Monitoring:Well Data for Groundwater Permit w - Massachusetts Department of Environmental Protection Permit Number: 847-0 Bureau of Resource Protection-Groundwater Discharge Permit Program Ll Facility: Cape Re enc Groundwater Permit Sampling Date: 9-2017 Daily Readings/Analysis Information Date Effluent Reuse Irrigation Turbidity Influent Effluent Chlorine UV Flow Flow Flow pH pH Residual Intensity GPD GPD GPD (mg/1) (%) 1 8,532 6.8 7.2 4.48 2 9,316 3 8,510 4 9,842 5 8,621 6.9 7.2 4.42 6 9,913 6.9 7.2 4.5 7 10,385 6.8 7.2 4.44 8 10,710 6.9 7.1 4.52 9 9,002 10 11,394 11 11,942 6.9 7.3 4.46 12 9,528 6.9 7.3 4.48 13 10,107 6.8 7.2 4.39 14 8,669 6.9 7.3 4.4 15 10,050 6.9 7.2 4.36 16 8,333 17 7,524 18 8,700 6.8 7.2 4.28 19 9,237 6.8 7.2 4.32 20 10,254 6.9 7.3 4.22 21 8,841 6.9 7.3 4.28 22 10,300 6.7 7.4 4.32 23 8,564 24 7,706 25 9,744 6.8 7.2 4.2 26 9,424 6.7 7.1 4.18 27 8,434 6.8 7.2 4.26 28 9,274 6.8 7.1 4.32 29 9,979 6.9 7.1 4.5 30 6,228 31 :sluewwoo F J 10/15/17 Jeffrey Gould Southeast Regional Office 20 Riverside Drive Lakeville, MA 02347 Enclosed is the Sept 2017 Discharge Monitoring Report for Permit# 847 Month/Year for CAPE REGENCY HEALTHCARE CENTER in BARNSTABLE The following reports are included in submittal: FVI Daily FV] Monthly Eff F-I Semi Annual Eff El Annual Inf/Eff VOC Weekly Eff F-I Quarterly Eff Semi Annual Eff VOC EJ Annual Inf/Eff F1Bi Weekly Eff F] Quarterly Eff(p) Semi Annual Well Annual Eff Bi Weekly Well F-I Quarterly Eff VOC F-I Semi Annual Well VOC Annual Well VOC Bi Monthly Inf/Eff Quarterly Well Monthly Well For questions on this report please contact: David Boucher Name At: 508.864.0840 dboucher@rhwhite.com Phone Email I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system design to assure that qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information.The information submitted is to the best of my knowledge and belief,true,accurate and complete.I am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations. David Boucher 10/15/17 Signature Print Name Date cc: Wastewater Management Program/DEP, One Winter St/5th floor, Boston, Ma. 02108 Joe Colosuonno (Email) R:I: ANAI.YTICAL . ' �, Z = o 9pao1s11atsA Envlronmantsl8arVlcss E lA Z Z o U) ` U CHAIl�T OF CT7STODY RECORD a °� b CM N 41 Illinois Avenue 131 Coolidge St.,Suite 105 0 � 9 0 z z m Warwick,RI 02888-3007 Hudson,MA 01749-1331 VI o °' Vj (n c —�§ z 800 937 2580-Fax:401 738-1970 800 937 2580 Fax:978 568 0078 o 0 t°6 o z z ¢ 0 0 Date: Time" s, ,� '� i �- i i i i Collected. Collected Fleld SampleTIderitificatton �I ° m z z z o _ . ... . .: Zb 20l7 �$5° Influent C 1P NP WW X X X C 1P S WW X Effluent C 1P NP WW X X X X C 1P S WW X X O 8 g b Effluent-Grab G 2AG S WW X Field Kits 9 Eff pH: '7, Eff NO3: 7.6 Eff NH3: C, 'Client InformstIon Project liaformation„< Company Name: Whitewater, Inc. Project Name. Cape Regency— astewater Monitoringu Address: 253B Worcester Road, Building 2 P.O.Number: Project Number: 7 Z®®)7 City/State/Zip: Charlton, MA 01507 Report To: David Boue er Phone: 508-864-0840 Fax: 508-248-2895 Telephone: 508-248-2892 Fax: 508-248-2895 Sampled by: lab.reports@rhwhite.com Contact Person: WWIO31O38 Email address: janderson@rhwhite.com David Boucher Quote No: ebelaire@rhwhite.com ReLnquls By; s' ate Trine 00 Rec B Date Time Turn=Around Tlme d I ®6 Normal IX I EMAIL Re rt x 5 Business days. w Rush-Date Due: Project'Comme Lab.Use Only cle if a licable: GW-1, GW-2, GW-3, S-1, S-2, S-3 MCP Data Enhancement QC Package? NO Sample Pick Up Only RIAL sampled;attach field hours Temperature Upon Receipt /�C hiPPed on ice 0 order No: j �b— Containers:P=Poly,G=Glass,AG--Amber Glass,V=Vial,St--Sterile Preservatives:A=Ascorbic Acid,NH4=NH4CI,H=HCI,M=MeOH,N=HNO3,NP=None,S=H,SOo.SB=N SO4,SH=NaOH,T=NazSz03,Z=ZnOAc ^ ^--- - _... .. . _.. ... - - Page 2 of 3 V R.I.Analytical Laboratories,Inc. Laboratory Report Whitewater, Inc. Work Order#: 1710-23388 Project Name: PROJECT#70017706 CAPE REGENCY-QUARTERLY WW MONITORING Sample Number: 001 Sample Description: INFLUENT Sample Type: COMPOSITE Sample Date/Time : 10/26/2017 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST BOD 5 170 60 mg/I SM5210B 2led 10/27/2017 11:36 ERG Total Suspended Solids 49 2.0 mg/I SM2540D 18-2led 10/27/2017 14:01 MFH Total Solids 490 10 mg/l SM2540B 18-2led 10/31/2017 8:00 KMH Ammonia(as N) 23 1.0 mg/1 SM4500-NH3 B;H 10/27/2017 21:00 LAA BOD 5-Glucose-Glutamic Acid standard recovered slightly below criteria at 79%. Samples were not reset outside of holding time,and are reported with a potential low bias, however the Matrix Spikes demonstrated acceptable recovery. Sample Number: 002 Sample Description: EFFLUENT Sample Type: COMPOSITE Sample Date/Time : 10/26/2017 SAMPLE DET. DATE/TIIVIE PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST BOD 5 <3.0 3.0 mg/I SM5210B 2led 10/27/2017 11:46 ERG Total Suspended Solids 2.7 2.0 mg/I SM2540D 18-21 ed 10/27/2017 14:01 MFH Nitrite(as N) <0.25 0.25 mg/I EPA 300.0 10/26/2017 18:43 MMM Nitrate(as N) 2.4 0.25 mg/I EPA 300.0 10/26/2017 18:43 MMM TKN(as N) 0.59 0.50 mg/I SM4500NOrg-D 18-2led 10/27/2017 9:15 APD Total Nitrogen(as N) 2.99 0.50 mg/l CALCULATION 10/27/2017 9:15 APD BOD 5-Glucose-Glutamic Acid standard recovered slightly below criteria at 79%. Samples were not reset outside of holding time,and are reported with a potential low bias, however the Matrix Spikes demonstrated acceptable recovery. Sample Number: 003 Sample Description: EFFLUENT-GRAB Sample Type: GRAB Sample Date/Time: 10/26/2017 @ 08:40 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Oil&Grease Gravimetric 0.8 0.5 mg/1 EPA 1664A 10/31/2017 8:00 AM Page 1 of 3 R.D. AN AL Y u DC AL Specialists In Environmental Services LABORATORY REPORT Whitewater, Inc. Date Received: 10/26/2017 Attn: Mr. David Boucher Date Reported: 11/3/2017 Wastewater Division P.O. Number 253B Worcester Rd., Bldg 2 Charlton, MA 01507 Work Order#: 1710-23388 Project Name: PROJECT #70017706 CAPE REGENCY - QUARTERLY WW MONITORING Enclosed are the analytical results and Chain of Custody for your project referenced above. The sample(s) were analyzed by our Warwick, RI laboratory unless noted otherwise. When applicable, indication of sample analysis at our Hudson, MA laboratory and/or subcontracted results are noted and subcontracted reports are enclosed in their entirety. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a g_ven sample's analytical results or in a case narrative. The Detection Limit is defined as the lowest level that can be reliably achieved during routine laboratory conditions. These results only pertain to the samples submitted for this Work Order# and this report shall not be reproduced except in its entirety. We certify that the following results are true and accurate to the best of our knowledge. If you have questions or need further assistance,please contact our Customer Service Department. Approved by: Dawne E. Smart Data Reporting Manager Laboratory Certification Numbers(as applicable to sample's origin state): Warwick RI*RI LAI00033,MA M-RI015,CT PH-0508,ME RI00015,NH 2O70,NY 11726 Hudson MA*M-MA1117,RI LA000319 131 Coolidge Street,Suite 105,Hudson,MA 01749 41 Illinois Avenue,Warwick, RI 02888 15 Lark Industrial Drive, Smithfield, RI 02828 P:978-588-0041 F: 978-588-0078 P:401-737-8500 F:401-738-1970 P:401-737.8500 F:401.349-0844 www.rianalytical.com �,�,��\'��� t ,��5pec1®Hsts in Environm®ntai�,Serwices� +- � � 11 ;r HAINx }F ST a DYRECQRD \,.t„ �, U F 41 Illinois Avenue 131 Coolidge St.,Suite 105 UI o o Warwick,RI 02888-3007 Hudson,MA 01749-1331 ,. o U eV' 800 937-2580•Fax 401 738 1970 800 937 2580•Fax 978 568 0078 U Date Time Field Sample Identification �I ° p; �L,Collected Collected ' �, f PdP7fa e) YYYIi t .: 3 :Client Information >� _ � Pro'et:t`Liforniahon Company Name: Project Name: r aQ j '7'7 6 Address: , 5?- 0 4. P.O.Number. Pro ect Number: City/State/Zip: - _ :; y Report To: fQ�:� Phone: Fax Telephone: ¢+,— L. Fax: Sampled By: Email report j�r U I e • Contact Person: y Quote No: to these +✓ h i Lt. co) �� Q addresses: feA%— }, _., elfin. wished Bp.,S>I a �, Date Time eceived° a Da Time lttrn ::d..14 Normal EMAIL Rep 7 X 5 Business days.Possible surchaj Rush—Date Due: LabUse.Only .1 it le if applicable: GW-1, GW-2, GW-3, S-1, S-2, S-3 MCP Data Enhancement QC Package? Yes NO Sample Pick-Up Only 2,,_) -z RIAL sampled;attach field hours l Y�o Shipped on ice Temp.Upon Receipt C Workorder No:- t c>- D:3 Containers:P=Poly,G=Glass,AG=Amber Glass,V=Vial,St=Sterile Preservatives:A=Ascorbic Acid,NH4=NH4CI,H=HCI,M=MeOH,N=HNO3,NP=None,S=H2SO4,SB=NaHSO,SH=NaOH,T=Na2S203,Z=ZnOAC Matrix Codes:GW=Groundwater,SW=Surface Water,WW=Wastewater,DW=Drinking Water,S=Soil,SL=Sludge,A=Air,B=Bulk/Solid,WP=Wipe,0= Page, of to Page 2 of 3 R.I.Analytical Laboratories,Inc. Laboratory Report. Whitewater, Inc. Work Order#: 1710-22392 Project Name: PROJECT#70017706 CAPE REGENCY Sample Number: 001 Sample Description: MLSS Sample Type: GRAB Sample Date/Time : 10/13/2017 @ 10:10 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Total Suspended Solids 8700 2.0 mg/l SM2540D 18-2led 10/18/2017 14:15 MFH Sample Number: 002 Sample Description: EFF-NO3 Sample Type: GRAB Sample Date/Time: 10/13/2017 @ 10:00 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Nitrate(as N) 12 0.25 mg/I EPA 300.0 10/14/2017 1:40 MMM of . Page 1 3 �n Retie A ALYTOCALn � Specialists in Environmental Servlcea LABORATORY REPORT :Whitewater, Inc: Date Received:. 10/13/20.17 Attn: Mr. David Boucher . Date:Reported: 10/20/2017 Wastewater Division P.O Number 253B Worcester Rd.; Bldg 2 :Charlton, MA 0:1507 Work Order#: 1710-22392 Project Name: PROJECT #70017706 CAPE REGENCY Enclosed are the analytical results.and Chain of Custody for your project referenced above. The samples) Were analyzed by our Warwick,RI:laboratory unless noted:otherwise. .When applicable, indication of sample analysis at our Hudson; MA laboratory:and/or subcontracted results are noted:and subcontracted.: reports:areenclosed in their P ' entirety.. All samples were analyzed within the established:Ruidelines of US EPA approved methods with all requirements met, unless otherwise'noted'at the:end of a given.sample's,analytical results or in a case narrative. The Detection Limit is defined as the lowest•level.that can be reliably achieved during:routine laboratory :conditions. These results only pertainAto'the samples submitted for this Work Order# and this report shall not be reproduced except in its entirety. We certify.-that the following results are true.arid-accurate to:the best.of our knowledge..If you have uestions or need further assistance artment.lease contact.our Customer Service.De: q �p p Approved:by: ell Dawne E. Smart Data Reporting Manager Laborato Certification Numbers as a hcable to sample's origin state ry _ f PP,. Pstate):. J&4-.�e4 Warwick RI*RI LAI00033,;MA M-RIO15,CT-PH 0508,ME RI000,15;NH.2070,NY 11726 Hudson MA*M-MA 11.17,RI LA00031:9 131 Coolidge Sfreat.Suite 105,Hudson;MA01749 41 IIImoIs.Avenue.Warwick RI 02888 15 Lark Industrial Drive,Smithfield,RI`02828 P:678 588 0041 F;978-568 0078 P.401�-737.8500 F4 401-73 .1970 Pi 401-737.8500 F:.401.349-0844 wwwAanalytical.com u c R:1:�ANALYTICAIL �, Z �peolallats In Envira man" 8a,%id, Z y O 7 - m Z> c �^ c f x wY y U TODY RECORD 41 Illinois Avenue 131 Coolidge St.,Suite 105 0 5 a 0 Z' z m Y Warwick,RI 02888-3007 Hudson,MA 01749-1331 UI o o m _ ° z 800-937-2580•Fax:401-738-1970 800-937-2580•Fax:978-568-0078 0 0 ' U = � 2 1O U zz �- Collected Collected Meld Sample Idenhficahon C'Jl z z Y z G� MW-3 G 1P NP GW X X'�"17 ,��•a(� G 10 S GW X X G 1fl NP GW X X MW-7(UG) G 1P S GW X X G 1P NP GW X X � yd MW-6(DG) G 1P S GW X X ent Information. _ Project Information`:( CompanvName: Whitewater, Inc. Project Name: Cape Regency—Quarterly Ground Water Monitonn Address: 253E Worcester Road, Building 2 P.O.Number: Project Number: 7aO@@M 700 7 City/State/zip: Charlton, MA 01507 Report To: avid Boucher Phone: 508-864-0840 Fax: 508-248-2895 Telephone: 508-248-2892 Fax: 508-248-2895 Sampled by: lab.reports@rhwhite.com Email address: janderson@rhwhite.com Contact Person: David Boucher Quote NIAA1031038 ebelaire@rhwhite.com Relln wished By" '` Date Time R d Dat Time TuraAround:Time _ f Normal I X I EMAIL Reggrt X 5-7 Business days, °n Rush—Date Due: Pro'ecf Comm s:: Lab J Use;Only C cle if applicable: GW-1, GW-2, GW-3, S-1, S-2, S-3 MCP Data Enhancement QC Package? No Sample Pick Up Only TRIAL sampled;attach field hours Temperature Upon Receipt hipped on ice or rder No: 7710i2 Containers:P=Poly,G=Glass,AG=Amber Glass,V=Vial,St--Sterile Preservatives:A=Ascorbic Acid,NH4=NH4CI,H=HCI,M=MeOH,N=HNO,,NP=None,S=1112S X,SB-Na SO ,SH=NaOH,T=Na2S203,Z=ZnO c Matrix Codes:GW=Groundwater.SW=SurfacP Watar WW=Wnefu ,o}or n1A/=111,;oWnn IAI.fe• Page 2 of 3 !� R.I.Analytical Laboratories,Inc.' Laboratory Report Whitewater, Inc. Work Order#: 1710-21689 Project Name: PROJECT#70017706 CAPE REGENCY.-QUARTERLY GROUNDWATER.MONIT. Sample Number: 001 Sample Description: Mw-3 Sample Type : GRAB Sample Date/Time : 10/05/2017 @ 09:20 SAMPLE DET., DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Nitrite(as N) <0.25 0.25 mg/1 EPA 300.0 10/5/2017 20:36 MMM Nitrate(as N) 0.56 0.25- mg/I EPA 300.0 10/5/2017 2036 MMM TKN.(as N) 0.67 0.50 mg/1 SM4500NOrg-D 18-21ed 10/10/2017 16:45 LAA Total Nitrogen(as N) 1.23 0.50 mg/1 CALCULATION 10/5/2017 20:36 MMM Sample Number:, 002 Sample Description: MW-7(UG) Sample Type GRAB Sample Date/Time : 10/05/2017 @ 09:30 SAMPLE DET. DATE/TIME PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Nitrite(as N) <0.25. 0.25 mg/I EPA 300.0 10/5/2017 20:51 MMM Nitrate(as N) 0.39 0.25 mg/1 . EPA 306.0 10/5/2017 20:51 MMM TKN(as N) 0.61 0.50 mg/1 SM4500NOrg-D 18-2led 10/10/2017 16:45 LAA Total Nitrogen(as N) 1.00 0.50 mg/1'. CALCULATION 10/5/2017 20:51 MMM Sample Number: 003 Sample Description: MW-6(DG) Sample Type GRAB Sample Date/Time : 10/OS/2017 @ 09:40 SAMPLE DET. DATE/TIME. PARAMETER RESULTS LIMIT UNITS METHOD ANALYZED ANALYST Nitrite(as N) <0.25 0.25 mg/I EPA 300.0 10/5/2017 21:05 MMM Nitrate(as N) 1.0 0.25 mg/I EPA 300.0 10/5/2017 21:05 MMM TKN(as N) 1.2 0.50 mg/1 SM4500NOrg-D 18-21ed 10/10/2017 16:45 LAA Total Nitrogen(as N) 2.20 0.50, mg/l CALCULATION 10/5/2017 21:05 MMM Page 1 of 3 Specialists in Environmental Services LABORATORY REPORT Whitewater, Inc. Date Received: 10/5/2017 Attn: Mr. David Boucher Date Reported: 10/16/2017 Wastewater Division P.O. Number 253B Worcester Rd., Bldg 2 Charlton, MA 01507 Work Order#: 1710-21689 Project Name: PROJECT #70017706 CAPE REGENCY -QUARTERLY GROUNDWATER MONIT. Enclosed are the analytical results and Chain of Custody fir your project referenced above. The sample(s) were analyzed by our Warwick, RI laboratory unless noted otherwise. When applicable, indication of sample analysis at our Hudson, MA laboratory and/or subcontracted results are noted and subcontracted reports are enclosed in their entirety. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results or in a case narrative. The Detection Limit is defined as the lowest level that can be reliably achieved during routine laboratory conditions. These results only pertain to the samples submitted for this Work Order#and this report shall not be reproduced except in its entirety. We certify that the following results are true and accurate to the best of our knowledge. If you have questions or need further assistance, please contact our Customer Service Department. Approved by: Dawne E. Smart Data Reporting Manager Laboratory Certification Numbers(as applicable to sample's origin state): * H- ME RI00015 NH 2O70 NY 11726 Warwick RI RI LAI00033,MA M-RI015,CT P 0508, , Hudson MA*M-MA 1117,RI LA000319 131 Coolidge Street,Suite 105,Hudson,MA 01749 41 Illinois Avenue,Warwick, RI 02888 15 Lark Industrial Drive,Smithfield, RI 02828 P:978-568-0041 F:978-568-0078 P:401-737-8500 F:401-738-1970 P:401-737.8500 F:401.349-0844 www.rianalytkcal.com Massachusetts Department of Environmental Protection.Permit:Number: 847-1 Bureau.of Resource Protection.-Groundwater Discharge:Permit Program Facility:Cape Regency r F equency:.Quarterly: Groundwater Permit SarriplingDate: 10/5/17 MONITORING WELLDATA REPORT Contaminant Analysis Information For"0"beilow detection limit,or not detected,enter"ND" TNTC=too numerous to count. INS=Not Sampled DRY=Not Enough water in well to sample: .. Parameter/Contaminant Units :. MW 3 MW 6' ;.: :: MW 7 Nitrate-N ..: .. mg/I : .. 0.56 . . Total Nitrogen(NO3+NO2-TKN): .. :. :.m9/1 . . ...:.: .. 1:23 :.: . . 2.2.: .. : .. :. :�. ...:.: .. .. .. .. .. .. :. :. : t t. ... ... Moni oring:lNell Data for Groundwa er.Perniit Massachusetts Department of Environmental Protection Permit Number: 847-1 Bureau of Resource Protection-Groundwater Discharge Permit Program Facility:Cape Regency Frequency:Monthly Groundwater Permit Sampling Date:10/26/17 DISCHARGE MONITORING REPORT Contaminant Analysis Information For"0"below detection limit,or not detected,enter"ND" TNTC=too numerous to count. NS=Not Sampled Effluent Method Parameter/Contaminant Units Influent Effluent Detection Limit BOD mg/I 170 ND 3 TSS mg/I 49 2.7 2 TS mg/I 23 Ammonia-N mg/I 23 Nitrate-N mg/I 2.4 0.25 Total Nitrogen(NO3+NO2+TKN) mg/I 2.99 0.5 Oil&Grease mg/I 0.8 0.5 Groundwater Perm t-Discharge Monitoring Report Massachusetts Department of Environmental:Protection.Permit Number: 847-1 Bureau of Resource Protection. Groundwater Discharge;Permit Program Facility:Cape Regency Frequency:Monthly Groundwater Permit 10/5/2017 _. _ ... MONITORING WELL DATA REPORT Contaminant Analysis Information For"0"below detection limit,or not detected,enter"ND" TNTC=too numerous to count. NS=Not Sampled; DRY=Not Enough water in well to sample: .. -Parameter/Contaminant ': Units :. ;MW 3 MW 6 `,.; ;; MW 7 pH. . ,. ... $U I . Static Water Level Feet 33.04 .: 33.1 30.13. Specific Conductance umhos/c 342 189 206 pq Monitoring Well Data for Groundwater Permit Massachusetts Department of Environmental Protection Permit Number: 847-0 Bureau of Resource Protection-Groundwater Discharge Permit Program Ll Facility:Cape Re enc Groundwater Permit Sampling Date: 10-2017 Daily Readings/Analysis Information Date Effluent Reuse Irrigation Turbidity Influent Effluent Chlorine UV Flow Flow Flow pH pH Residual Intensity GPD GPD GPD (mg/1) (%) 1 7,539 2 6,642 6.7 7.2 4.48 3 6,925 6.8 7.3 4.36 4 7,522 6.7 7.2 4.42 5 8,142 6.8 7.4 4.34 6 6,850 6.9 7.4 4.3 7 6,576 8 7,563 9 6,825 7.3 4.36 10 7,726 7.4 4.18 111 7,950 7.1 7.5 4.24 112 8,241 7.1 7.4 4.32 113 5,483 14 6,941 1.5 7,835 1'6 8,392 7.2 4.36 17 7,240 7.2 4.55 1$ 7,137 6.6 7.4 4.31 19 6,326 6.9 7.4 4.65 20 7,866 6.8 7.2 4.52 21 9,121 22 9,909 23 9,296 6.8 7.5 4.78 24 6,226 6.8 7.4 4.68 25 8,079 6.9 7.4 4.62 26 9,806 6.9 7.4 4.74 27 8,217 6.9 7.5 4.7 28 8,234 29 7,695 30 9,893 7.5 4.76 31 9,016 6.8 7.3 4.58 f :s}uewwoo : t 11/15/17 Jeffrey Gould Southeast Regional Office 20 Riverside Drive Lakeville, MA 02347 Enclosed is the October 2017 Discharge Monitoring Report for Permit# 847 Month/Year for CAPE REGENCY HEALTHCARE CENTER in BARNSTABLE The following reports are included in submittal: FVI Daily FV] Monthly Well F-I Semi Annual Eff E] Annual Inf/Eff VOC Weekly Eff a Quarterly Eff Semi Annual Eff VOC Annual Inf/Eff Bi Weekly Eff Quarterly Eff(p) Semi Annual Well Annual Eff aBi Weekly Well Quarterly Eff VOC Semi Annual Well VOC Annual Well VOC aBi Monthly Inf/Eff Quarterly Well For questions on this report please contact: John Aprea Name At: 508.248.2892 JAprea@Rhwhite.com Phone Email I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system design to assure that qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information.The information submitted is to the best of my knowledge and belief,true,accurate and complete.I am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations. John Aprea 11/15/17 Signature Print Name Date CC. Wastewater Management Program/DEP,One Winter St/5th floor, Boston, Ma. 02108 Joe Colosuonno (Email) ® Commonwealth of Massachusetts �`� Executive Office of Energy &Environmental Affairs S Department of Environmental Protection Southeast Regional.Office-20 Riverside Drive, Lakeville MA 0c347.508-946 2700 Charles.D.Baker Matthew'DBeaton Governor Secretary Karyn E.Polito Mart~uuberg Lieutenant.Governor Cormssioner . June 21, 2016 David Laakso RE: BARNSTABLE: Cape Regency Rehabilitation Cape Regency RHCC and Health_ Care Center Wastewater Treatment 120 South Main Street Facility Centerville, Massachusetts 02632 Permit No.: 847 - 1. Transmittal No. X268672' Dear Mr. Laakso r In response to your applicatiort for,a permit to discharge into the ground a treated effluent from the treatment works at 120.South Main Street,Centerville; Massachusetts, and after due public notice, I hereby issue the attached final permit. Since no comments were received by the Department during the public comment period related to.the terms.of the permit;.in accordance with 310 CMR 2.08,the permit becomes effective at issuance: Parties aggrieved by the issuance of this permit are hereby advised.of their right,to request.an Adjudicatory Hearing under the provisions of Chapter 30A of the Massachusetts General.Laws and 314 CMR 1.00;Rules for the Conduct of AdjudicatoryProceedings. Unless the person requesting the adjudicatory hearing requests and is granted a stay of the terms and conditions of the permit, the permit shall remain fully effective: If.you should have any questions on any,information provided with this letter please contact Chnstos:Dimisioris at(508) 94672736. Sincerely, Q Brian A:Dudley. Bureau of Water Resources This information is available in alternate format.Ca II Michelle Waters-Ekanem,Diversity Director;at 617-292-5751.TTY#Mass Relay Service 1-800439-2370.: MassDEP Website:'www.mass.gov%dep Printed on Recycled Paper D/CD/ _a Enclosure '�7. cc: David Formato s Onsite Engineering, Inc. 279 East Central Street, #241 Franklin, Massachusetts 02038 y., (with enclosure) Thomas McKean Barnstable Health Department 200 Main Street Hyannis, Massachusetts 02601 (with enclosure) Ecc: DEP/Boston DEP/SERO: Cheryl Bump P:\12\847 - 1 -Barnstable - Cape Regency permit cover letter.docx ® e Commonwealth of Massachusetts Executive Office of Energy&Environmental Affairs } Department ofEnvironmental Protection z..: Southeast Regional`Office•20 Riverside Drive, Lakeville MA 02347.508-946-2700 Charles D.`:Baker Matthew A.Beaton Governor: Secretary. Karyn E.Polito Martin Suuberg:; Lieutenant Governor Commissioner - Individual Groundwater.. Discharge Permit Fact Sheet L APPLICANT,FACILITY INFORMATION,and DISCHARGE LOCATION Name and Address of Applicant: Cape Regency Rehabilitation and Health Care Center, 120 South Main Street, Centerville, MA 02632 Name and Address of Facility,where discharge occurs: r Cape Regency Rehabilitation and Health Clare Center WWTF -120 South Main Street, Centervlle,.MA 02632 Discharge Information: Groundwater'Discharge.Permit Number: 847-1 The Groundwater Discharge Permit will allow the applicant to continue to discharge 22,350 gallons Ter day,of treated sanitary wastewater from-a 149 bedroom healthcare facility to groundwaters of the Commonwealth. The discharge is not within the Zone H wellhead protection area of a public water supply. II. LIMITATIONS AND CONDITIONS' Discharge permit limitations are listed in the ground water permit and are in conformance with 314 CMR 5.00;'the.Groundwater Discharge Permit Program. III. PERMIT BASIS AND EXPLANATION OF EFFLUENT LEMTATIONS An Individual Groundwater Discharge permit is required for this discharge in accordance with the Massachusetts Clean Water Act',M.G.L.'c:'21, s. 26753 and 314-CMR 5.03. 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 i � J 2 Effluent limitations are based upon the location of the discharge,the level of treatment, consideration of human health protection criteria and protection of the groundwaters of the Commonwealth. IV. COMMENT PERIOD,HEARING REQUESTS,AND PROCEDURES FOR FINAL DECISIONS The public comment period for this permit is thirty(30)days following public notice in The Environmental Monitor. The public notice for this Individual Groundwater Discharge Permit occurred on May 11,2016. Requests for an adjudicatory hearing must be submitted within thirty(30) days of the issuance/denial of the permit;by any person Who is aggrieved by such issuance/denial. A final decision on the issuance/denial of this permit will be made after the public notice period, and review of any comments received during this period. V. STATE CONTACT INFORMATION Additional information concerning the draft permit may be obtained between the hours.of 9:00 a.m. and 5:00 p.m. Monday through Friday excluding holidays,from: Christos Dimisioris DEP/SERO 201Zverside Drive Lakeville, MA 02347 (508) 946-2736 A. Dudley Date ''Bureau of Water Resources PA12\847 - 1 Barnstable - Cape Regency fact sheet.docx GWDP Fact Sheet Ver. 1/12/10 Commonwealth of Massachusetts Executive Office of Energy &Environmental:Affairs_ Department of Environmental Protection 1 . Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347-'508-946-2700 Charles D.Baker Matthew X Beaton Governor ',`, Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner INDIVIDUAL GROUNDWATER DISCHARGE PERMIT Name and Address oftApplicant Cape RegencyRehab'ditation and Health Care Center, 120 South. Main Street, Centerville MA 02632 _ Date of Application: Jan`6, 2016 Application/Permit No. <..847 1 ' Date of Issuance:' June 21 2016 . Date of Expiration:: June 21, 2021 Effective Date: June 21;2016 A v AUTHORITY FOR ISSUANCE Pursuant.to authority granted by Chapter 21, Sections.26-53 of the Massachusetts General Laws,'as amended, 314�CMR 2.00, and 314 CMR 5.00,-the Massachusetts Department of Environmental Protection(the Department)hereby issues the following permit to: Cape` Regency Rehabilitation and Health Care Center(hereinafter called "the permittee") authorizing discharges from the:on-site wastewatevtreatment facility to the<grouiid located at Cape'Regency . I Rehabilitation and Health Care Center WWTF', .120 South Main Street, Centerville;MA 02632 (a 149 bedroom Healthcare Facility),:such authorization being expressly conditional on compliance by the permittee with all terms and conditions of the permit hereinafter set forth. 2 2 J 6 B an A.-Dudley Date Bureau of Water Resources go LI-) , Thisinformation 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.govldep Printed on Recycled Paper Cape Regency Healthcare Center 847—1 I. SPECIAL CONDITIONS A. Effluent Limits The permittee is authorized to discharge into the ground from the wastewater treatment facilities for which this permit is issued a treated effluent whose characteristics shall not exceed the following values: Effluent Characteristics Discharge Limitations - Flow 22,350 GPD Oil and grease 15 mg/l Total Suspended Solids (TSS) 30 mg/1 Total Nitrogen(NO2+NO3 +TKN) 10 mg/1 Nitrate-Nitrogen 10 mg/1 Biochemical Oxygen Demand, 5-day @20°C 30 mg/1 (BODs) a) The pH of the effluent shall not be less than 6.5 nor greater than 8.5 at any time or not more than 0.2 standard units outside the naturally occurring range. b) The discharge of the effluent Shall not result in any demonstrable adverse effect on the groundwater or violate any water quality standards that have been promulgated. c) The monthly average concentration of BOD and TSS in the discharge shall not exceed 15 percent of the monthly average concentrations of BOD and TSS in the influent into the permittee's wastewater treatment facility. d) When the average annual flow exceeds 80 percent of the permitted flow limitations,the permittee shall submit a report to the Department describing what steps the permittee will take in order to remain in compliance with the permit limitations and conditions, inclusive of the flow limitations established in this permit. 2 Cape Regency Healthcare Center 847.- 1 B. Monitoring and Reporting 1) INFLUENT: The permittee shall monitor and record the quality of the influent waste.stream to the facility.according to the following schedule and other provisions. ". Parameter Minimum Frequency . Sample Type. ..of Analysis BOD5`` Monthly 24-Hour Composite Total Suspended Solids` 'Monthly• 24=Hour Composite Total Solids Monthly 24-Hour Composite Ammonia Nitrogen Monthly 24 Hour Composite EFFLUENT: The permittee'shall monitor and record the quality and quantity of effluent prior to discharge to the leaching facilities according to the following schedule and other provisions Parameter.- ) Minimum Frequency Sample:'Type of Analysis Flow Daily Meter reading -Report: Min—Max Average pH Daily Grab Total Suspended Solids Monthly 24-Hour Composite Oil &Grease Monthly Grab BODS Monthly. 24-Hour Composite Nitrate Nitrogen Monthly` 24-Hour Composite Total Nitrogen(NO2+Nq3+ Monthly 24-Hour Composite IJV Intensity Daily Meter Reading r 3 Cape Regency Healthcare Center 847—1 Total Phosphorus(as P) Annually Grab Orthophosphate (as P) Annually Grab Volatile Organic Compounds' Annually Grab USEPA Method#624 a) The Department reserves the right to resume more frequent monitoring of phosphorus,if the Department determines that phosphorus levels are impacting downgradient receptors. 2) The permittee shall sample the three approved monitoring wells (MW-7 upgradient, MW- 3 and MW-6 downgradient) as shown on a plan titled"Proposed Monitoring Well Matrix Map"prepared by "Northeast Geosc ence Inc",and dated April 11, 2007. Labels identifying each monitoring well's identification in accordance with the above-referenced approved plan shall be affixed to the steel protective casing of each monitoring well. The permittee shall monitor,record and report the quality of water in the monitoring wells according to the following schedule and other provisions: Parameter Frequency of Analysis Static Water Level Monthly Specific Conductance Monthly pH Monthly Total Nitrogen(NO2+NO3+TKN) Quarterly Nitrate-Nitrogen Quarterly Total Phosphorus (as P) Annually Orthophosphate(as P) Annually Volatile Organic Compounds' Annually USEPA Method#624 a) Static Water Level shall be expressed as an elevation and shall be referenced to the surveyed datum established for the site. It shall be calculated by subtracting the depth to the water table from the surveyed elevation of the top of the monitoring well's PVC well casing/riser. b) The Department reserves the right to resume more frequent monitoring of phosphorus if the Department determines that phosphorus levels are impacting downgradient receptors. 4 Cape Regency Healthcare Center 847—1 3) Any grab."sample or composite sample required to be taken less frequently than daily :: .shall be taken during the period of Monday through.Friday inclusive. .All composite samples shall'be taken over the operating day: 4) The permittee.shall submit all monitoring reports within.30 days of the last day of the reporting month.Reports shall'be on an acceptable"form,properly filled and signed and shall be sent to the Department of Environmental Protection,Southeast Regional Office, 20 Riverside Drive; Lakeville,MA02347, and to the Department of Environmental Protection, Bureau of Water Resources-Wastewater Management,Program, One Winter . Street/5th Floor;Boston, MA 02108, and to Barnstable Board of Health,200 Main Street, HyannisMassachusetts 02601. . a._ Submission of monitoring reports in electronic'format is available through eDEP and serves as.nata submission`to both the'Regional'and Boston offices. To register for electronic submission go to http:•llvo-v4.mass. og .vldep/servicelcomplianceledeponl htm C. Financial Assurance Mechanisms a. The;permittee shall establish and,mamtain a:financial assurance mechanism that provides for the continued availability of an immediate repair and replacement account to be.used by the permittee solely for the immediate repair and replacement of any failing components of.the PWTF: To create an immediate repair and replacement account,the permittee shall deposit at least 1.5%of the estimated construction.cost of the PWTF into an interest bearing escrow account in accordance.with the financial assurance mechanism and 314 CMR 5.15.: b: �The permittee shall also establish nd. . ...maintain a financial assurance mechanism in accordance with 314 CMR 5.15,that provides for the accumulation in a capital reserve account of sufficient funds to make any necessary modifications to the:PWTF and other related equipment within twenty years from the date the PWTF commenced operation or such other period determined.to be appropriate by the Department based on the age and { condition of the PWTF. The financial assurance mechanism shall provide for the accumulation in the capital reserve account of an amount equal to at least 25%of the estimated construction cost of the PWTF. c. On or before January 31"of each year,the permittee'shall submit an annual financial report identifying the initial and current balances in the immediate repair and replacement account and the capital reserve account and confirming the continuing availability of the. funds in said,account for the purposes.`specified m—the permit and 314 CMR 5.15.• Said report shall be prepared in accordance.with generally accepted accounting principles.'` Reports.pertaining to the required financial assurance mechanism(s) shall be sent to the, Wastewater Managemerif.Section Chief at the appropriate Regional Office 2. The permittee shall meet the obligation to establish all required financial assurance mechanisms by using Department-approved form documents and shall submit said Department-approved form documents to the Department for its review and approval as follows: - a Cape Regency Healthcare Center 847— 1 a. A permittee that constructs the wastewater treatment facility after the issuance of the Individual permit may submit the financial assurance mechanism(s)to the Department for its review and approval no later than ninety(90) days prior to the start-up of the facility. Such a permittee shall not operate the facility unless and until the Department has approved the required financial assurance mechanism(s),the financial assurance mechanisms are in full force and effect, and the permittee has made all contributions required thirty (30) days prior to the start-up of the facility. b. A permittee with a wastewater treatment facility in existence prior to the submission of the individual permit renewal application may submit the financial assurance mechanisms to the Department for its review and approval no later than ninety (90) days from the date of submission of the individual permit renewal application. Said permittee shall be in compliance with the provision of each approved financial assurance mechanism requiring contributions to the immediate repair and replacement account and the capital reserve account no later than thirty (30) days prior to the date on which the renewal is issued. 3. The permittee shall maintain the current form documents evidencing all required financial assurance mechanisms approved by the Department. The permittee shall perform all its obligations under the required financial assurance mechanisms as approved by the Department. 4. For purpose of the financial assurance mechanism requirement,the estimated construction cost of the wastewater treatment facility shall include the cost of constructing the wastewater treatment plant, collection system,associated mechanical equipment, but not including the land, ground and disposal area. A Supplemental Conditions l. The permittee shall notify the Department at least thirty (30) days in advance of the proposed transfer of ownership of the facility for which this permit is written. Said notification shall include a written agreement between the existing and new permittees containing a specific date for transfer of permit, responsibility, coverage and liability between them. 2. •A staffing plan for the facility shall be submitted to the Department once every two years and whenever there are staffing changes. The staffing plan shall include the following components: a. The operator(s)'s name(s), operator grade(s) and operator license number(s); b. The number of operational days per week; c. The number of operational shifts per week; d. The number of shifts per day; e. The required personnel per shift; f. Saturday, Sunday and holiday staff coverage; g. Emergency operating personnel 6 Cape Regency Healthcare Center 847— 1 3: The permittee is responsible for the operation and.maintenance of all sewers, pump stations;and treatment units for the permitted:facility;.which shall be operated and maintained under the_direction of a properly certified wastewater operator. 4.- Operation.md maintenance of the proposed facility must.be in accordance with 314 CMR 12.00, "Operation and Maintenance and Pretreatment Standards for Wastewater Treatment Works`and Indirect Discharges", and, 257.CMR 2.00, Rules and Regulations for Certification of Operators of Wastewater Treatment Facilities".. a. The facility has been:rated(iii accordance with 257 CMR"2.00),to be a Grade 4 facility. Therefore,the perrnittee shall provide for oversight by.a Massachusetts Certified Wastewater Treatment plant operator(Chief Operator).Grade 4 or higher. The permittee will also provide for a backup operator who shall possess at least a valid.Grade 3 license. 'b. .The date and time of the operator'sin spection along with the operator's name and certification shall be recorded inrthe•log book on�location at the treatment facility. All daily inspection logs consistent with the O&M Manual requirements shall be kept at the facility for a period of three(3)years C. Records of operation of wastewater treatment facilities or disposalsystems required by the Department shall be submitted on forms supplied"by the Department or on other forms approved by the-Department for such;use. Monthly reports shall be certified by the . wastewater treatment plant operator in charge and shall,be included in the discharge .- monitoring reports submitted each month. 5. _ If the operation and:maintenance.of the facility,is contracted to a private concern,the permittee shall,submit,a copy of the contract,consistent with what is required by the approved.Operation&Maintenance manual and signed only by the contractor,to the appropriate MassDEP Regional Office within thirty(30)days of permit issuance Along. with the contract, a detailed listing_of all'contract operation obligations of the proposed contractor at other facilities shall also be submitted. g 6. Any additional connections to the sewer system,beyond the facility as described on page 1 of this permit shall be approved by MassDEP'and the local Board of Health prior to.the connection: 7 All tests or analytical determinations to determine compliance with permit standards and 'requirement's shall be"done=using tests and�procedures fou id•in the most recent version of Standard Methods for the Examination of Water and Wastewater and shall,be performed t by a Massachusetts Certified laboratory.' 8. The permittee shall nofify the appropriate MassDEP Regional Office, m writing, within thirty-Y(30) days of the following events: a. Any interruption of the treatment system•operation, other than routine maintenance. b. Final shutdown of the treatment system; -9. The permittee contract to have any and all solids and sludges generated by the treatment system for which.this.permit is issued removed off site by a properly licensed waste Hauler for disposal at an EPA/MassDEP approved facility. The name and license number of the hauler along with the quantity of wastes removed and the date(s) of removal shall be reported by the permittee in writing to the appropriate MassDEP " Regional Office. Cape Regency Healthcare Center 847— 1 16. Simultaneously with the permit renewal application at year fifteen (2026) following the initiation of plant operations,the permittee shall.submit two reports to the Department for its review and approval: a. An engineering report,prepared by a registered professional engineer,that outlines in sufficient detail what modifications (if any)to the facility or other changes are required to insure that the facility can remain in compliance with its GWDP and other applicable requirements through the next 5 year permit term (year 2031) and beyond; and, b. A financial plan that contains the cost estimates for implementing the facility modifications or other changes identified in the engineering report, and describes and demonstrates, how and when the permittee will finance the needed facility modifications or other changes. 11. In the event that effluent limits are not met, or the discharge is determined to impair groundwater qualityin accordance with 314 CMR-5.16(1), the permittee maybe obligated to modify, supplement or replace the permitted treatment process so as to ensure that the discharge does not impair the ability of the groundwater to act as an actual or potential source of potable water. 12. Pursuant to M.G.L. Chapter 21A, section 18(a), and 310 CMR 4.03, holders of this Permit may be subject to annual compliance assurance fees as assessed each year on July 1 st and invoiced by MassDEP. Failure of the Permit holder to pay applicable annual compliance assurance fees shall result in the automatic suspension of the permit by operation of law under the statute. If fee non-payment continues for sixty days or more, MassDEP has the statutory option of revoking the Permit, denying any other pending permit applications filed by the Permit holder or taking other enforcement action. Permit holders are required to notify MassDEP in writing if they wish to relinquish or transfer a permit. Failure to do so will result in the continued assessment of fees. E. Appeal Rights During the thirty(30) day period following issuance of this permit, a Notice of Claim for an Adjudicatory Appeal may be sent by any person aggrieved (the "Petitioner") by the issuance to: Case Administrator Office of Appeals and Dispute Resolution Department of Environmental Protection One Winter Street/2°d Floor Boston, MA 02108 310.CMR 1.01(6)(b) requires the Notice of Claim to: include sufficient facts to demonstrate aggrieved person status; state the facts which are grounds for the appeal specifically, clearly and concisely; and, state relief sought. The permit shall become or remain effective at the end of the 30 day appeal period unless the person filing the Notice of Claim requests, and is granted, a stay of its terms and conditions. If a permit is modified under 314 CMR 2.10, only the modified terms and conditions may be subject to an Adjudicatory Appeal. All other aspects of the existing permit shall remain in effect during any such Adjudicatory Appeal. 8 Cape Regency Healthcare Center 847-1 Per 310 CMR'4.06,the hearing request to the Commonwealth will.be dismissed if the filing fee is not paid. Unless the Petitioner is exempt or,granted a waiver, a valid check payable to the . Commonwealth to Massachusetts in the amount of$100.00 must be mailed.to: Commonwealth of Massachusetts' Department.of Environmental Protection: P.O. Box 4062 Boston;MA 02211 The.filing fee is not required if the Petitioner is a city;town, county, or district of the Commonwealth, federally recognized Indian tribe housing authority effective January 14, 1994, or any municipal housing authority; or,per MGL.161A s:..24,the Massachusetts Bay Transportation Authority. The Department may waive;the adi:udicatory hearing`filing fee for a Petitioner who Shows that paying the fee will�create anundue.fmancial hardship. A Petitioner seeking a waiver must file;'along with the hearing request., an affidavit setting forth the facts believed to support the claim of undue financial hardship. II.,GENERAL PERMIT CONDITIONS The following'conditions apply to all individual and general permits: (1)No discharge authorized in the pemut shall`cause or contribute to a violation of-the 1Vlassachusetts.curface Water Quality Standards-(314 CMR�4.00) or any amendments thereto. Upon promulgation of any amended standard, this permit may be revised or amended in accordance with such standard and 314 CMR 110 and 3.13 or 5..12. Except as otherwise provided in 31,4 CMR 5.10 (3)(6), 310 CMR 5.I0(4)(a)2:and 314 CMR 5.10(9), no discharge. . authorized.in the permit shall:impair the ability of the ground water to act as an actual or potential.source of potable water.` Evidence,that a discharge impairs the ability of the ground water to act as an actual or potential source of potable water includes, without limitation, analysis of samples taken in a downgradient well that shows one or more exceedances of the applicable water quality based effluent limitations set forth in 314 CMR 5.10. In those cases Where it is-shown that a measured parameter exceeds the applicable water quality based effluent limitations set forth in 314 CMR 5.10 at the upgradierit monitoring well1evidence that a discharge impairs the ability,of the ground water to act as an actual or potential source of potable water is deemed to exist if a measured parameter in any downgradient well exceeds the level of that same measured parameter in the upgradient well for the same sampling period. . A statistical procedure approved by the Department shall be used in determining when a measured parameter 'exceeds the allowable level. (2) Duty to comply. The permittee shall comply.at all.times with the terms and conditions of the permit, 314 CMR 5.0.0, M.G.L. c.:21, §§ 26 through:53 and all applicable state and federal.- statutes and regulations. (3) Standards and prohibitions for toxic pollutants., he permittee shall comply with effluent standards or prohibitions established under § 307(a) of the Federal Act,.33 U.S.0 § 1317(a), ,for toxic pollutants within`the time provided in the.regulations that establish these standards or prohibitions,.even if the.permit*has not yet been modified.-to incorporate the requirement. 9 . Cape Regency Healthcare Center 847—1 (4) Proper operation and maintenance. The permittee shall at all times properly operate and maintain all facilities and equipment installed or used to achieve compliance with the terms and conditions of the permit, and the regulations promulgated at 314 CMR 12.00 entitled"Operation and Maintenance and Pretreatment Standards for Wastewater Treatment Works and Indirect Discharges, and 257 CMR 2.00, Rules and Regulations for Certification of Operators of Wastewater Treatment Facilities". (5) Duty to halt or reduce activity. Upon reduction, loss, or failure of the treatment facility,the . permittee shall,to the extent necessary to maintain compliance with its permit, control production or discharges or both until the facility is restored or an alternative method of treatment is provided. It shall not be a defense for a permittee in an enforc ement action that it would have been necessary to halt,or reduce the permitted activity in order to maintain compliance with the conditions of the permit. (6)Power Failure. In order to maintain compliance with the effluent limitations and prohibitions of this permit, the permittee shall either: (a)provide an alternative power source sufficient to operate the wastewater control facilities; or (b) halt,reduce or otherwise control production and/or all discharges upon the reduction, loss, or failure of the primary source of power to the wastewater control facilities. (7)Duty to mitigate. The permittee shall take all reasonable steps to minimize or prevent any adverse impact on human health or the environment resulting from non-compliance with the permit. (8)Duty to provide information. The permittee shall furnish to the Department within a reasonable time as specified by the Department any information which the Department may request to determine whether cause exists for modifying,revoking and reissuing, or terminating the permit, or to determine whether the permittee is complying with the terms and conditions of the permit. (9) Inspection and entry. The permittee shall.allow the Department or its authorized representatives to: (a)Enter upon the permittee's premises where a regulated facility or activity is located or conducted, or where records required by the permit are kept;. (b) Have access to and copy, at reasonable times, any records that must be kept under the conditions of the permit; (c) Inspect at reasonable times any facilities, equipment,practices, or operations regulated or required under the permit; and (d) Sample or monitor at reasonable times for the purpose of determining compliance with the terms and conditions of the permit. (9A) The permittee shall physically secure the treatment works and monitoring wells and limit access to the treatment works and monitoring wells to those personnel required to operate, inspect and maintain the treatment works and to collect samples. 10 Cape Regency Healthcare Center ', 847— 1 (M,The permittee shall identify each monitoring well by permanently affixing to the steel protective.`casing of the well a tag with the identification number listed in the permit: ; (10)Moriitorin : Samples and measurements taken for the purpose of monitoring shall be representative of the monitored'activity. Molmii rig.mus be,:conducted according to test procedures approved under 40 CFR Part 136 unless"other test procedures are specified in the permit. Recordkeepmg. The permittee shall retain records of all monitoring information, including all calibration and maintenance records and all original strip chart recordings for continuous monitoring instrumentation;copies of all reports required by the permit and all records of all data used to complete;the application for the permit,.for a.period of at leastthree years from the date of the-sample, measurement, report or application; This period may be extended byrequest of the Department at any time. Records.of monitoring information,shall include: (a)The:date"ex act place, and time:of sampling or measurements; (b) The iridividual(s):who performed the sampling or measurement; (c)The dates)analyses were performed; t �` (d)"The' individual(§)who performed the analyses, (e)The analytical techniques or methods used; and (f)The.-results'of such analyses. (12)Prohibition of bypassing Except as provided in 3,14 CMR 5.16(13),bypassing is prohibited, and the Department may,take enforcement action against a pennittee for.bypassing.unless:,, (a):The bypass was"unavoidable to prevent loss of life,personal injury, or:severe property damage; v (b) There were no,feasible al bypass; such as the use of auxiliary treatment facilities, retention of untreated wastes; or maintenance during normal periods of equipment downtime This condition is:not.satisfied if the permittee could have" . _bypass which occurred during normal installed-.adequate backup'equipment to prevent a b periods of equipment downtime or preventive maintenance;and (e) The'permittee submitted notice of the bypass to the Department: I.,In the event of an anticipated bypass, at leastten days in advance if possible; or 2. In the event of an unanticipated bypass, as soon as the permittee has knowledge of the bypass and no later than 24'hours after its first occurrencc. wY (13)By a.ss not exceeding limitations: The permitte.e may allow a bypass to occur which does. not cause'effluent limitations:to be exceeded. but only if necessary for the performance of essential maintenance or to assure efficient operation of treatment facilities. (14)Permit actions. The permit may,be modified suspended, or revoked for.cause. The filing.of a request by the permittee for�a permit modification,reissuance, or tennination, or a notification of planned changes or anticipated-:non-compliance does not stay any permit condition. (15)Duty to fea ly.Ifl e per mittee wishes to continuevan activity regulated by the permit,'after " the expiration date of the permit;the permittee must apply for and obtain a new permit. The permittee shall submit a new application at least 180 days before the expiration date of the existing permit,unless permission:for a later date has been granted by the Department in writing. 11 Cape Regency Healthcare Center 847- 1 (16) Property rights. The permit does not convey any property rights of any sort or any exclusive privilege. (17) Other laws. The issuance of a permit-does not authorize any injury to persons or property or invasion of other private rights, nor does it relieve the permittee of its obligation to comply with any other applicable Federal, State, and local laws and regulations. (18) Oil and hazardous substance liability. Nothing in the permit shall be construed to preclude the institution of any legal action or relieve the permittee from any responsibilities, liabilities,or penalties to which the permittee is or may be subject under § 311 of the Federal Act, 33 U.S.C. § 1321, and M.G.L. c. 21E. (19) Removed substances. Solids, sludges, filter backwash, or other pollutants removed in the course of treatment or control of wastewaters shall be disposed in a manner consistent with applicable Federal and State laws and regulations including, but not limited to, the Massachusetts Clean Waters Act, M.G.L. c. 21, §§ 26 through 53 and the Federal Act, , 33 U.S.C. § 1251 et seq; the Massachusetts Hazardous Waste Management Act, M.G.L. c. 21C, and the Federal Resource Conservation and Recovery Act, 42 U.S.C. § 6901, et seq., 310 CMR 19.000 and 30.000, and other applicable regulations. (20) Reporting requirements. (a) Monitoring reports. Monitoring results shall be reported on a Discharge Monitoring Report (DMR) at the intervals specified elsewhere in the permit. If the permittee monitors any pollutant more frequently than required by the permit, the results of this monitoring shall be included in the calculation and reporting of the data submitted in the DMR. (b) Compliance schedules. Reports of compliance or non-compliance with, or any progress reports on, interim and final requirements contained in any.compliance schedule of the permit shall be submitted no later than 14 days following each schedule date. (c) Planned changes. The permittee shall give notice to the Department as soon as possible of any planned physical alterations or additions to the permitted facility or activity which could significantly change the nature or increase the quantity of pollutants discharged. Unless and until the permit is modified, any new or increased discharge in excess of permit limits or not specifically authorized by the permit constitutes a violation. (d) Anticipated non-compliance. The permittee shall give advance notice to the Department of any planned changes in the permitted facility or activity which may result in non-compliance with permit requirements. (e) 24 hour reporting. The permittee shall report any non-compliance which may endanger health or the environment. Any information shall be provided orally within 24 hours from the time the permittee becomes aware of the circumstances. A written submission shall also be provided within five days of the time the permittee becomes aware of the circumstances. The written submission shall contain a description of the non-compliance, including exact dates and times, and if the non-compliance has not been corrected,the anticipated time it is expected to continue; and steps taken or planned to reduce, eliminate, and prevent reoccurrence of the non-compliance. The following shall be included as information which must be reported within 24 hours: 1. Any unanticipated bypass which exceeds any effluent limitation in the.permit. 2. Violation of a maximum daily discharge limitation for any of the pollutants listed by the Department in the permit to be reported within 24 hours. 12 {-Cape Regency Healthcare Center 847— 1 ;(f) Other non-compliance. The permittee,':shal report all instances of non-compliance not reported`under 314 CMR 5.16(20)(a), (b), or(e) at the time monitoring reports are s= n submitted. The reports shall:contain the' in in 314 CMR'5.16(20)(e).. (g) Toxics. All;manufacturing, commercial, mining, or silvicultural`dischargers must notify the Department as soon as they. hey know or have reason.to believe , l.'That any activity has occurred or-will.occur:which would result in the discharge of any . toxic pollutant listed iir314 CNM3.17 which is not'limited.in the permit, if that discharge.: will exceed the highest,of the following notification levels: a 100:microgr'ams per liter(100 ug/1); r M P _ b. 20.0 micrograms'per liter(200 ug/1) for acrolein and acrylonitrile; 500 micrograms per liter(500 ug/1)`for2,4-dimtrophenol acid for 2-methyl-4,6-dinitrophenol; and one milli gram er liter 1 m 1 for antimony- c: Five times the maximum.'concentration value-reported for that pollutant Min.the,perm t app�lication_or 2. That they have begun or expect to begin to use or manufacture as an intermediate-or final product or,byproduct any toxic pollutant which was not reported in the permit application.; (h) Indirect dischar eis.,A11 Publicly Owned Treatment Works�shall provide adequate`. , notice to the:Departnient of the following. l_:Any"new mtroductionof pollutants into the` POTW`f in an indirect discharger which would be subject to § 301 or 306 of the Federal Act;:33.U.S.C. §:1311 or,1316, if it were directly discharging those pollutants; an >_ 2. Ariyaubstantial change in.the volume on6baractef ofpollutants being introduced into the P,OTW by a source introducing pollutants into the,POTW,at the.time ofissuance of , the permit _f . (i).,Information Where the.permittee becomes aware that it failed to submit any relevant facts in a-perimit application,or submitted incorrect,information in a permit application or in any'report'to the-Department, it shall promptly submit`such facts or information. (21) Si ng atory requirement.%All applications;reports,For information submitted to the Department shall be signed and certified in accordance with 314 CMR 3.15 and-5.14.'. (22) Severability: The provisions of the pennit aie'severable and if any provision of the permit', or the application of.ariy provision ofahe perniif to.,Yany;circumstance, is held invalid,the w application of such provision.to,6ther.circumstances, and the remainder of the,permit', shall not be affected thereby (23) Reopener clause. The'Department reserves'the right to make appropriate revisions to the permit in order to establish any`appropriate effluent limitations;schedules of compliance, or other provisions which'maybe'authorized under'the Massachusetts Clean Waters Act,M.G.L. C. 21, §§ 26 through 53 or the Federal Act, 33 U.S.C. §1251 et seq in order to bring all discharges into compliance with said statutes. (24)Approval of treatment works..A11 dscharges`'and associated treatment works authorized '. herein shall be consistent with the terms and conditions of this permit. Any modification to'.the approvedareatment works.shall require.written approval of the Department prior to the construction of the modification.',; Cape Regency Healthcare Center 847—1 (25) Transfer of Permits. (a) RCRA facilities. Any permit which authorizes the operation of a RCRA facility which is subject to the requirements of 314 CMR 8.07 shall be valid only for the person to whom it is issued and may not be transferred. (b) Transfers by modification. Except as provided in 314 CMR 5.16(25)(a) and(c), a permit may be transferred by the permittee to a new owner or operator provided that the permit has been modified or revoked and reissued or a minor modification is made to identify the new permittee in accordance with 314 CMR 5.12(3) and (4). (c)Automatic transfers. For facilities other than Privately Owned Wastewater Treatment Facilities (PWTFs) that treat at least some sewage from residential uses, hospitals, nursing or personal care facilities, residential care facilities, and/or assisted living facilities, PWTFs that have been required to establish financial assurance mechanism(s) pursuant to 314 CMR 5.15(6), and RCRA facilities subject to the requirements of 314 CMR 8.07, a permit may be automatically transferred in accordance with 314 CMR 5.12(5). (26) Permit Compliance Fees and Inspection Information. Except as otherwise provided, any permittee required to obtain a surface water or ground water discharge permit pursuant to M.G.L. c. 21, § 43 and 314 CMR 3.00 and 5.00, shall be required to submit the annual compliance assurance fee established in accordance with M.G.L. c. 21A, § 18 and 310 CMR 4.00 as provided in 314 CMR 2.12. The requirement to submit the annual compliance fee does not apply to any local government unit other than an a-athority. Any permittee required to obtain a surface water or ground water discharge permit pursuant to M.G.L. c. 21, §43 and 314 CMR 3.00 and 5.00 may be required to submit inspection ir_formation annually as a condition of the permit as provided in 314 CMR 2.12. P:\12\847 - 1 -Barnstable - Cape Regency.d.Dcx 14 Massachusetts Department of Environmental Protection One Winter Street, Boston MA 02108 • Phone: 617-292-5751 Communication For. Non-English Speaking Parties -310 CMR 1.03(5)(a) i1 English: ; This document is important and should be translated.immed.iately.'lf you need this document _ �translated, please contact MassDEP's Diversity Director at the telephone numbers listed below. 2 Espalnol{Spanish): Este documento es importante y debe ser traduzido inmediatamente. Si necesita este s doc,umento traducido, por favor pongase en,contacto con el Director de Diversidad MassDEP a los n6meros de telefono que.aparecen mas abajo. - �3 Portugues (Portuguese):: Este documento e-importante e deve ser traduzida imediatamente. Se voce precisa deste _ _< idocumento traduzido, par favor, entre em�contato com Direto,r.de Diversidade da MassDEP para os nOmeros de telefone listados abalxo. 4(a) 0 ARt) .(Chinese (Traditional); k X� , . RI� o ' p�M AIMassD - -' EP��Jg 'hlyNo 4(b) (Chinese (Simplified) ANMT_ �gffiR, -lit 43'jMassD r. 10 ;5 Ayisyen (franse kreyol.) (Haitian).(F.rench Creole): 4"1 fDokiman sa-a se you baggy en'potan epi yo to dwe tradui imedyatman Si ou bezwen __. ___ _ ;dokiman sa a tradui,tanpri kontakte Divesite'Direkte MassDEP a nan nimewo.telefon ki nan lis pi ba a. : 16 Viet (Vietnamese): . Tal lieu nayaa rat quart trong va Gan dtxac dich ngay.lap t&c. Neu ban can dic'h tM lieu nay, xin vui.16ng.lien.he voi Giam doc MassDEP da dung tai cac s6 dien thoai duac liet.ke d.u&i day. i7 LfJt9hjF;i-3�1 (Kmer (Cambodian): � �i�t .__:��€,�r��o€������.��t���n�e��'MassDEP 018:Kriolu Kabuverdianu :(Cape Verdean) `Es documento e importante e deve ser traduzido imidiatamente. Se bo precisa des: documento traduzido, por favor conta.d6 Director de Diversidade na MassDEP's pa es numero indicode i d'boche.. 9 pycCKHH A361K (Russian): 3T0T.A0KyMeHT S1BJ1AeTCA Ba>KHbIM Vl AQ'J1>KH0,6bITb nepeBegeHO Cpb3y. ECJ1V1 BaM HY>KeH 3TOT AoKyMeHT nepeBegeHHUO, n0>Ka1lywCTa, CBA>KMTeCb.C,gmpeKTOpOM pa3H006pa3VIA MassDER no a,gpeCy TeneCpOHHUX HOMepOB,_yKa3aHHbIX Hmwe. Contact Michelle Waters-Ekanem Diversity_Director/Civil Rights: 617-292=575,1 TTY# MassRelay Service 1-.8007439 2370. http://www:.mass.gov/eea/agencies/massdep/service/ibstice/ ;;. .(Version 3.30.15), 10 (Arabic): I� �_gl _).�.IA JLa,yl "z,� aU LJ ;�l O:A L�l 4 ICI �?jii J c ?'.'9 4.�Lg11 4"siiyll oLL o>;�i a���Il a;lygll J -MassDEP 11 E-r;01 (Korean): v ` 01 M t=- 2812 CAI 1,:11 °,oHOkdl-ICf. o��i01 ' °� 01 �l�i7F �oF°� OFzH�I �14F -- -- ��� MassDEP21 CF°oko� o1�0il 22 M)\171 WEILIQ. 12 hwjhlihtu (Armenian): �uju i�-uutnuulanulpLl 21.uui 4taulihLn1i k hL ulhtnp k puipqdlulk tu1i42iuighu. blab Qhq ut-hjtutdh2tn k Lulu q uiutnuilanu1pLi 1au�-11gtfut114hL r1�-LfhL MassDEP ptugtlutgwtMLlalnL'g1 ulhofihtz k hhnutlunuuthtutfuilahh1a i pgiu1i4q-Lu6 htu uuinlihL. 13 (Farsi (Persian): L;U LAo-)L �� MassDEP >� li t I cos u y wl a� �tv lA,� ,S► ;14 Frangais (French): . ICe document est important et devrait etre traduit immediatement. Si vous avez besoin de ce .1document traduit, s'il vous plait communiquer avec le directeur de la diversite MassDEP aux numeros de telephone indiques ci-dessous. -- ---- -;15 Deutsch (German): IDieses Dokument ist wichtig and sollte sofort ubersetzt werden. Wenn Sie dieses Dokument ubersetzt benotigen, wenden Sie sich bitte Diversity Director MassDEP die in den unten aufgefuhrten Telefonnummern. 116 EAArIviKr (Greek): 'To tyypacpo auTO sivai unpavTIK6 Kai 6a TrpsTrci va psTacppaQTouv apt(jws. Av Xpsia�sQTc _ !auto To syypacpo psTacppa�sTai, TrapaKcAoups cmKoivwvr CYTc Diversity Director MassDEP KaTa TouS apiApouS TgAFcpc;.wvou Trou avaypacpcTai Trio Karw. 117 Italiano (Italian): ` Puesto documento e importante e dovrebbe essere tradotto immediatamente. Se avete _.ibisogno di questo documento tradotto, si prega di contattare la diversite Direttore di MassDEP ai numeri di telefono elencati di seguito. 18 Jgzyk Polski (Polish): Dokument ten jest wazny i powinien byc natychmiast przetfumaczone. Jesli potrzebujesz tego_ dokumentu tfumaczone, prosimy o kontakt z Dyrektorem MassDEP w roznorodnosci na numery telefonow wymienionych ponizej. 19 f (Hindi): ,zr 3T�3��f-zrr�T� . 3TFT.T;art�� ��f , ----- ci 4 rb� qT MassDEP f f`dfq a f�tt21F##4 z5t. Contact Michelle Waters-Ekanem, Diversity Director/Civil Rights:61.7-292-5751 TTY# MassRelay Servicel-800- 439-2370 hftp://www.mass.gov/eea/agencies/massdep/service/justice/ f. B` Commonwealth of Massachusetts Executive.Office of Energy &Environmental Affairs Department of Environmental Protectio I . Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347*508-946-2700 Charles D:Baker Matthew Beaton Governor ecr'etary Karyn E. Polito Marti ruuberg Lieutenant Governor Commissioner April 12;2016 :. s David Laakso RE. BARNSTABLE: Cape Regency Rehabilitation Cape Regency RHCC Zand Health.Care Center Wastewater Treatment 120 South Main Street Facility; Centerville Massachusetts 02632 Permit No. 8477 1 Transmittal No. X2268672 i r. Dear Mr. Laakso.: The Massachusetts Clean Water.Act(M..G L. c.21;s.21-53)was amended by Chapter 246 of the Acts of 1973 to authorize the Massachusetts Department of.Environmental Protection.(the MassDEP),to regulate discharges into all waters ofthe'Commonwealth, including groundwaters. The MassDEP regulates discharges"through the-issuance of discharge permits, which impose limitations on,the amount of pollutants that may be discharged in the effluent,together with.: monitoring and reporting requirements.and,other:conditions to insure adequate treatment of all liquid wastes prior to discharge p. The MassDEP has completed its technical review of your''application submitted on behalf of Cape Regency:Reliabilitation and Health Care Center to�discharge treated wastewater from the facility located at120 South Main Street,,Centerville;Massachusetts to the ground;and has developed the conditions contained in the enclosed draft permit. Within fourteen(14) days of receipt of the draft permit, you should indicate to this agency, in writing,either the acceptability of the permit conditions or any problem areas: The proposed_draft permit can only be considered in draft form because of provisions in the Law regulating public notice of the proposed.issuance;of the permit and opportunity for public comments and public hearing1 Following receipt of comments.on the public notice, and public hearing, if held,the MassDEP will issue its,final determination to issue or deny the permit. Enclosed herewith is a copyof the public notice for.your groundwater discharge,permit. If you have no cominents,concerning the draft permit,the enclosed public notice should be published to start the thirty,(30) day public.comimnt:period. This information is available in alternate format:Call MichellerWaters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Serviced-800-439-2370 MassDEP Website:www.mass.gov/dep . Printed on Recycled Paper t r In accordance with 314 CMR 2.06(4) and M.G.L. c.30A, the applicant or permittee, as ,.applicable, shall publish public notice of the permit proceedings in The Environmental Monitor, „'a publication of the Massachusetts Executive Office of Energy and Environmental Affairs. For "-instructions on filing this notice with MEPA please refer to MEPA's website at http://www.env.state.ma.us/mepa/submittirignotices.htm The applicant or permittee shall submit to the Department a copy of the public notice as published in the Environmental Monitor, within seven days after the date of publication or at such other time as the Department requires. This information should be sent to the attention of Christos Dimisioris at the above letterhead address. The mandatory thirty day public comment period will commence with the date of publication of the public notice. If you should have any questions on any information provided with this letter please contact Christos Dimisioris at(508) 946-2736. Sincerely, Brian A. Dudley Bureau of Water Resources D/CD/ Enclosure cc: David Formato Onsite Engineering, Inc. 279 East Central Street, #241 Franklin, Massachusetts 02038 (with enclosure) Thomas McKean Barnstable Health Department 200 Main Street Hyannis, Massachusetts 02601 (with enclosure) DEPBoston P:\12\847 - 1 - Barnstable - Cape Regency public comment letter.docx li . . PUBLIC NOTICE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF WATER RESOURCES/WASTEWATER'MANAGEMENT PROGRAM ..20 RIVERSIDE DRIVE. ` LAKEVILLE,MASSACHUSETTS 02347 TEL# (508) 946-2736 Notice is hereby given that the following application for.an;Individual Groundwater Discharge Permit is being processed and the following actions being proposed`thereon pursuant to Section 43 of Chapter 21 of the General,Laws, and 314.CMR 5.00 and 2.06: •CITY/TOWN: Barnstable ' PROJECT NAME: Cape Regency Rehabilitation and Health Care.Center APPLICANT: Cape Regency Rehabilitation and Health Care.Center FACILITY LOCATION 120 South Main-Street,.:Centerville TYPE OF DISCHARGE: Treated'sanitdry.wastewater' QUANTITY OF DISCHARGE: 22,350 Gallons per day PERMIT NO: 847 , 1 TRANSMITTAL'NO: X2268672 .PROPOSED ACTION: Tentative determination to.issue individual groundwater ' discharge permit A copy of the application, draft permit, and statement of basis or fact sheef relative to the draft permit may be obtained'.from'the MassDEP's Wastewater Management Program at the above' address and telephone number or online at: http://www.mass.kov/eea/ag6ncies/inassdep/news/comment/ Comments on the proposed.action.or requests for a public,hearing thereon pursuant to 314 CMR 2.07 must be'filed with MassDEP at the above''address within thirty (30) days of this notice. For information on the-process for formally intervening in adjudicatory proceedings,please refer to 310 CMR 1.00: Adjudicatory Proceedings,Section(7) Intervention and Participation. http://www.mass.gov/eed/agencies/massdep/water/regulations/310-emr-1-00-adjudicator proceedin sg ht'riil Brian A. Dudley. Bureau of Water Resources r . e Commonwealth of Massachusetts F Executive Office of Energy &Environmental Affairs Department of Environmental Protection Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347.508-946-2700 Charles D.Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner Individual Groundwater Discharge Permit Fact Sheet I. APPLICANT,FACILITY INFORMATION,and DISCHARGE LOCATION Name and Address of Applicant: Cape Regency Rehabilitation and Health Care Center, 120 South Main Street Centerville MA p g Y , 02632 Name and Address of Facility where discharge occurs: Cape Regency Rehabilitation and Health Care Center WWTF, 120 South Main Street, Centerville, MA 02632 Discharge Information: Groundwater Discharge Permit Number: 847-1 The Groundwater Discharge Permit will allow the applicant to continue to discharge 22,350 gallons per day of treated sanitary wastewater from a 149 bedroom healthcare facility to groundwaters of the Commonwealth. The discharge is not within the Zone H wellhead protection area of a public water supply. II. LIMITATIONS AND CONDITIONS Discharge permit limitations areas listed in the ground water permit and are in conformance with 314 CMR 5.00,the Groundwater Discharge Permit Program. III. PERMIT BASIS AND EXPLANATION OF EFFLUENT LIMITATIONS An Individual Groundwater Discharge permit is required for this discharge in accordance with the Massachusetts Clean Water Act,M.G.L. c. 21, s. 26-53 and 314 CMR 5.03. This information is available in alternate format.Call Michelle Waters-Ekarem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper _ ,2 Effluenf limitations are.based upon the location of the discharge,'the level of treatment, consideration of human:health protection criteria and protection of the groundwaters of the Commonwealth. , „ IV. COMMENT PERIOD;HEARING REQUESTS,AND PROCEDURES FOR FINAL DECISIONS y The public comment period for this permit is thirty(30)days following public.notice in The Environmental Monitor. The public notice for this Individual Groundwater Discharge Permit occurred on {DATE} Requests for an adjudicator y heanng must be submitted within thirty;(30)days of the issuance/denial of the perrriit;by'anyperson who'.is'aggrieved by such issuance/denial A final decision on the issuance/denial of.this permit will be made after the public notice period;and review of any comments received during this`'period - V. :STATE CONTACT INFORMATION - - Additional information concerning the draft permit maydbe obtained between the hours of 9:00 a.m.and 5:00 p.m.Monday through Friday'ekcluding holidays, ffrom: Christos Dimisioris DEP/SERO 20 Riverside Drive Lakeville;MA 02347 (508) 946-2736 RAFT. DRAFT Brian A::Dudley. Date Bureau of Water Resources P:\Adekunle\Work\847 -'l -Barnstable Cape Regency fact sheet:;docx ' GWDP Fact Sheet Ver. 1/12/10 r + lCommonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection Southeast Regional Office-20 Riverside Drive, Lakeville MA 02347-508-946-2700 Charles D. Baker Matthew A. Beaton Governor Secretary Karyn E. Polito Martin Suuberg Lieutenant Governor Commissioner INDIVIDUAL GROUNDWATER DISCHARGE PERMIT Name and Address of Applicant: Cape Regency Rehabilitation and Health Care Center, 120 South Main Street, Centerville ALL 02632. Date of Application: Jan 6, 2016 Application/Permit No. 847- 1 Date of Issuance: DRAFT Date of Expiration: DRAFT Effective Date: DRAFT AUTHORITY FOR ISSUANCE Pursuant to authority granted by Chapter 21, Sections 26-53 of the Massachusetts General Laws, as amended, 314 CMR 2.00, and 314 CMR 5.00,the Massachusetts Department of Environmental Protection(the Department)hereby issues the following permit to: Cape Regency Rehabilitation and Health Care Center (hereinafter called "the permittee") authorizing discharges from the on-site wastewater treatment facility to the ground located at Cape Regency Rehabilitation and Health Care Center WWTF, 120 South Main Street, Centerville, MA 02632 (a 149 bedroom Healthcare Facility), such authorization being expressly conditional on compliance by the permittee with all terms and conditions of the permit hereinafter set forth. DRAFT DRAFT Brian A. Dudley Date 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 of Recycled Paper Cape Regency Healthcare Center, DRAFT 847— 1 I, SPECIAL CONDITIONS . A. Effluent Limits The pennittee is authorized.to discharge into the ground from the wastewater treatment facilities for which this permit is issued a treated effluent;whose characteristics shall not exceed the following values: . Effluent Characteristics Discharge Limitations Flow. 22,350 GPD Oil and grease 15 mg/l Total Suspended Solids(TSS)" : 30 mg/1 Total Nitrogen(NO2+NO3+TKN) 10 mg/1 Nitrate-Nitrogen 1`0 mg/1 Biochemical Oxygen Demand,,5-day @20°C 30 mg/l. (BOD5) a) The p1j of the effluent shall notbe less than 6.5'nor greater than 8.5 at any tune or, not more than 0.2 standard units outside the naturally occurring range. b) : The discharge"of the'effluent shall not result in any demonstrable adverse effect on the groundwater or violate any water quality;standards that have been` promulgated. c) The monthly average concentration of BOD and TSS in.the dischaxge shall'not' exceed 15 percent of the monthly average concentrations of BOD.and TSS in`the irifluent into the permittee's wastewater treatment facility. d)' .: When the average annual flow exceeds'80 percent'of the permitted flow limitations;:the perrnittee'shall submit a report fo the Department describing what steps the permittee will take m order to remain in compliance with the permit- limitations and conditions, inclusive of the flow limitations established in this permit. : 2. r o Cape Regency Healthcare Center DRAFT 847—1 B. Monitoring and Reporting 1) INFLUENT: The permittee shall monitor and record the quality of the influent waste stream to the facility according to the following schedule and other provisions: Parameter Minimum Frequency Sample Type of Analysis BOD5 Monthly 24-Hour Composite Total Suspended Solids Monthly 24-Hour Composite Total Solids - Monthly 24-Hour Composite Ammonia Nitrogen Monthly 24-Hour Composite EFFLUENT: The perinittee shall monitor and record the quality and quantity of effluent prior to discharge to the leaching facilities according to the following schedule and other provisions: Parameter Minimum Frequency Sample Type of Analysis Flow wily Meter reading Report: Min—Max - Average pH Daily Grab Total Suspended Solids Monthly 24-Hour Composite Oil & Grease Monthly Grab BOD5 Monthly 24-Hour Composite Nitrate Nitrogen Monthly 24-Hour Composite Total Nitrogen(NO2+NO3 + Monthly 24-Hour Composite TKN) UV Intensity Daily Meter Reading 3 I� Cape Regency Healthcare Center DRAFT 847—1 .Total Phosphorus(as P) Annually ; Grab Orthophosphate .(as P) Annually Grab Volatile Organic Compounds) Annually. Grab ' USEPA"Method#624 - a) The Department reserves the right to resume more frequent monitoring of phosphorus if the,.Department determines that phosphorus levels are impacting down gradient receptors. 2) :.,-:The permittee shall sample the three approved monitoring wells (MW-7 upgradient, MW- 3 and MW-6 downgradient) as shown on a plan titled"Proposed Monitoring Well Matrix Map"prepared by"Northeast Geoscience Inc".and dated April 11,2007. Labels identifying each monitoring well's identification in accordance with the above-referenced approved plan shall be affixed to the steel protective casing of each monitoring well. The permittee;shall monitor,record and report the quality of water in the monitoring <: wells"according to the followmg schedule.and other.provisions: Parameter Frequency of Analysis Static Water Level,, Monthly % Specific Conductance Monthly pH 1Vlonthly Total Nitrogen(NO2+NOi-.4KN)' Quarterly Nitrate-Nitrogen " Quarterly Total Phosphorus (as P)` _ Annually Orthophosphate(as P) Annually _. Volatile Organic Compounds) Annually USEPA Method#624` a) Static Water Level shall be expressed as an elevation and shall be referenced to.the surveyed datum established for the sit6.:At.shall be calculated by subtracting the depth to 99 the water table from`the surveyed elevation of the top'of the monitoring well's PVC well casing riser. b) The Department reserves the right to"resume more frequentmonitoring of phosphorus if the Department determines that phosphorus levels Lare impacting downgradient receptors 4. • C 1 Cape Regency Healthcare Center DRAFT 847— 1 3) Any grab sample or composite sample required to be taken less frequently than daily shall be taken during the period of Monday through Friday inclusive. All composite samples shall be taken over the operating day. 4) The permittee shall submit all monitoring reports within 30 days of the last day of the reporting month. Reports shall be on an acceptable form,properly filled and signed and shall be sent to the Department of Environmental Protection, Southeast Regional Office,20 Riverside Drive, Lakeville,MA 02347, and to the Department of Environmental Protection, Bureau of Water Resources, Wastewater Management Program,One Winter Street/5th Floor,Boston, MA 02108, and to Barnstable Board of Health,200 Main Street, Hyannis, Massachusetts 02601. a. Submission of monitoring reports in electronic format is available through eDEP and serves as data submission to both the Regional and Boston offices. To register for electronic submission go to http://www.mass.gov/dep/service%ompliance%deponl .htm C. 'Financial Assurance Mechanisms 1. a. The permittee shall establish and maintain a financial assurance mechanism that provides for the continued availability of an immediate repair and replacement account to be used by the permittee solely for the immediate repair and replacement of any failing components of the PWTF. To create an immediate repair and replacement account,the permittee shall deposit at least 15%of the estimated construction cost of the PWTF into an interest bearing escrow account in accordance with the financial assurance mechanism and 314 CMR 5.15. b. The permittee shall also establish and maintain a financial assurance mechanism in capital reserve ca in a cumulation accordance with 314 CMR 5.15 that provides for the accumulation p account of sufficient funds to make any necessary modifications to the PWTF and other related equipment within twenty years from the date the PWTF commenced operation or such other period determined to be appropriate by the Department based on the age and condition of the PWTF. The financial assurance mechanism shall provide for the accumulation in the capital reserve account of an amount equal to at least 25%of the estimated construction cost of the PWTF. c. On or before January 31St of each year,the permittee shall submit an annual financial report identifying the initial and current balances in the immediate repair and replacement account and the capital reserve account and confirming the continuing availability of the funds in said account for the purposes specified in the permit and 314 CMR 5.15. Said report shall be prepared in accordance with generally accepted accounting principles. Reports pertaining to the required financial assurance mechanism(s) shall be sent to the Wastewater Management Section Chief at the appropriate Regional Office 2. The permittee shall meet the obligation to establish all required financial assurance mechanisms by using Department-approved form documents.and shall submit said Department-approved form documents to the Department for its review and approval as follows: 5 Cape Regency Healthcare Center DRAFT 847- 1 a —A ermittee that constructs the wastewater treatment facility after the issuance of the Individual permit may submit the financial assurance mechanism(s)to the Department for its reviewand approval.no later than'ninety.'.(90) days prior to the start-up of the facility: Such a permitte'e shall not operate the facility unless and until the Department has approved the required financial assurance me'6 anism(s), the financial assurance mechanisms are in full for'ce`and effect; and the permittee has made all contributions required thirty(30) days prior to'the start-lip of the.facility. _ b. A permittee with a wastewater treatment'facility in existence prior to the.sub mission of the individual permit renewal application may submit the financial assurance mechanisms to`.the`Department'for its review and approval no later:than ninety(90) days from the date of submission of the individual permit renewal application. Said permittee shall be in compliance with the provision of each approved financial.assurance mechanism requiring' contributions'to the immediate repair and replacement account and the capital reserve account no later than thirty (30) days prior to the date on which the renewal is issued. 3. The permittee shall maintain the current`form documents evidencing all.required financial assurance mechanisms approved by the Department. The permttee shall perform'all its obligations under the required financial assurance'mechanisms as approved by the-Department. v 4: Fo""r purpose of the,financial assurance mechanism"requirement, the estimated construction cost of the wastewater treatment facility hall include he cost of constructing the wastewater treatment plant, collection system, associated mechanical equipment; but not including he land, ground and disposal area D. Supplemental Conditions 1. ' The permittee shall notify.the Department at least thirty (30) days in,advance of the proposed transfef ownership_of the facility for which this permit is written. Said . notification shall include avritten agreement.between the existing and new permittees containing a specific date for transfer`of permit; responsibility, coverage"and liability betweenthem. A staffing an-for the:facility shall be submitted to the Department once every two years and;whenever there are staffing changes.The staffing plan,shall include the following components: a. The operator(s)_'s name(s), operator grade(s) and operator license number(s); b. The number of operational days per.week; c. The number of operational shifts perweek; d. The number of shifts per day; e. The required personnel per shift; f. Saturday, Sunday and holiday staff coverage, g. Emergency operating personnel ; 6 ` Cape Regency Healthcare Center DRAFT 847— 1 3. The permittee is responsible for the operation and maintenance of all sewers,pump stations, and treatment units for the permitted facility, which shall be operated and maintained under the direction of a properly certified wastewater operator. 4. Operation and maintenance of the proposed facility must be in accordance with 314 CMR 12.00, "Operation and Maintenance and Pretreatment Standards for Wastewater Treatment Works and Indirect Discharges", and, 257 CMR 2.00, 'Rules and Regulations for Certification of Operators of Wastewater Treatment Facilities". a. The facility has been rated(in accordance with 257 CMR 2.00),to be a Grade 4 facility. Therefore,the permittee shall provide for oversight by a Massachusetts Certified Wastewater Treatment plant operator(Chief Operator) Grade 4 or higher. The.permittee will also provide for a backup operator who shall possess at least a valid Grade 3 license. b. The date and time of the operator's inspection along with the operator's name and certification shall,be recorded in the log book on location at the treatment facility. All daily inspection logs consistent with the O&M Manual requirements shall be kept at the facility for a period of three (3)years. c. Records of operation of wastewater treatment facilities or disposal systems required by the Department shall be submitted on forms supplied by the Department or on other forms approved by the Department for such use. Monthly reports shall be certified by the wastewater treatment plant operator in charge and shall be included in the discharge monitoring reports submitted each month. 5. If the operation and maintenance of the facility is contracted to a private concern,the permittee shall submit a copy of the contract, consistent with what is required by the approved Operation&Maintenance manual and signed only by the contractor,to the appropriate MassDEP Regional Office within thirty(3 0) days of permit issuance. Along with the contract, a detailed listing of all contract operation obligations of the proposed contractor at other facilities shall also be submitted. 6. Any additional connections to the sewer system, beyond the facility as described on page 1 of this permit shall be approved by MassDEP and the local Board of Health prior to the connection. 7. All tests or analytical determinations to determine compliance with permit standards and, requirements shall be done using tests and procedures found in the most recent version of Standard Methods for the Examination of Water and Wastewater and shall,be performed by a Massachusetts Certified laboratory. 8. The permittee shall notify the appropriate MassDEP Regional Office, in writing, within thirty (30) days of the following events: a. Any interruption of the treatment system operation, other than routine maintenance. b. Final shutdown of the treatment system. 9. The permittee shall contract to have any and all solids and sludges generated by the , treatment system for which this permit is issued removed off site by a properly licensed waste hauler for disposal at an EPA/MassDEP approved facility. The name and license number of the,hauler along with the quantity of wastes removed and the date(s) of removal shall be reported by the permiaee in writing to the appropriate MassDEP Regional Office. 7 I Cape Regency Healthcare Center DRAFT 847- 1 10. Simultaneously with the permit renewal application at year fifteen'(2026) following the initiation of plant operations,-the permittee shall submit two reports to the Department for its review and approval; a An engineering report, prepared by a registered„professional engineer, that`outlines in sufficient detail what modifications(if.any)jo the facility or other changes are required to insure that the facility can remain in compliance with its GWDP and other applicable requirements through the next 5 year permit term (year 2031) andbeyond and b. A financial plan that contains the cost estimates for implementing the facility modificationsor other changes identified in the engineering report,and describes and demonstrates, how and.when the permittee Will firiance the needed facility modifications or other changes 11. In the event that effluent limits are not met, or the discharge is determined to impair groundwater'quality in accordance°'with 3;14 @MR 5.16(1) the pernittee may be obligated to modify, supplement or replace the peri itted treatment process so as to ensure that.the discharge does not impair the ability of the groundwater to'act as an actual or potential source of potable water., 12. Pursuant to M.G.L.'Chapter'21A, section 18(a), and 3.10 CMR 4.03 holders of this Permit maybe subject'to annual compliance assurance fees as assessed each year on s July l st and invoiced by MassDEP ' Failure:of the Permit holder to pay applicable annual compliance assurance fees shall result in the automatic suspension of the permit by operation of Taw under the statute:If fee non payment continues for sixty,days or more, "Mai ssDEP has the statutory option:of revoking the Permit;denying''any other pending permit applications`filed by.the Permitholder oftalcing other enforcement action.•Permit holders are required to notify MassDEP in writing'if they wish to relinquish or transfer..a permit. Failure`to do"so.will result in the continued assessment of fees. .. E. APpeal Rights. During`the thirty (30)'day period following'issuance of this permit; allotice of Claim for an Adjudicator y Appeal maybe sent by any person aggneved(the"Petitioner")by the issuance to. Case Administrator Off-66.of Appeals and Dispute Resolution: Department of Environmental Protection One Winter Street/2r'd Floor Boston, MA 02108 310 CMR 1.01(6)(b) requires the Notice of Claim to: include sufficient facts to demonstrate aggrieved person status; state the facts which are,grounds for the appeal specifically, clearly and concisely;and;state relief sought: The permit shallbecomeor remain effective atthe erid'of the 30 day appeal period unless the person filing the Notice of Claim requests;and is granted;a stay of its terms and conditions. If a permit is modified under 314,CMR 2.10, only the modified terms and conditions may be subjectto an AdjudicatoryAppeal. All other aspects of the existing, ermit shall remain in effect during an .such'Adudicator A eal. . p g' y J, Y pp 8 Cape Regency Healthcare Center DRAFT 847—1 Per 310 CMR 4.06,the hearing request to the Commonwealth will be dismissed if the filing fee is not paid. Unless the Petitioner is exempt or granted a waiver, a valid check payable to the Commonwealth to Massachusetts in the amount of$100.00 must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston, MA 02211 The filing fee is not required if the Petitioner is a city, town, county, or district of the Commonwealth, federally recognized Indian tribe housing authority effective January 14, 1994, or any municipal housing authority; or, per MGL 161A s. 24,the Massachusetts Bay Transportation Authority. The Department may waive the adjudicatory hearing filing fee for a Petitioner who shows that paying the fee will create an undue financial hardship. A Petitioner seeking a waiver must file,along with the hearing request, an affidavit setting forth the facts believed to support the claim of undue financial hardship. II. GENERAL PERMIT CONDITIONS The following conditions apply to all individual and general permits: (1)No discharge authorized in the permit shall cause or contribute to a violation of the Massachusetts Surface Water Quality Standards 314 CMR 4.00 or any amendments thereto. Q tY ( ) Upon promulgation of any amended standard, this permit may be revised or amended in accordance with such standard and 314 CMR 2.10 and 3.13 or 5.12.•Except as otherwise provided in 314 CMR 5.10 (3)(c), 310 CMR 5.10(4)(a)2 and 314 CMR 5.10(9), no discharge authorized in the permit shall impair the ability of the ground water to act as an actual or potential source of potable water. Evidence that a discharge impairs the ability of the ground water to act as an actual or potential source of potable water includes, without limitation, analysis of samples taken in a downgradient well that shows one or more exceedances of the applicable water quality based effluent limitations set forth in 314 CMR 5.10. In those cases where it is shown that a measured parameter exceeds the applicable water quality based effluent limitations set forth in.314 CMR 5.10 at the upgradient monitoring well, evidence that a discharge impairs the ability of the ground water to act as an-actual or potential source of potable water is deemed to exist if a measured parameter in any downgradient well exceeds the level of that same measured parameter in the upgradient well for the same sampling period. . A statistical procedure approved by the Department shall be used in determining when a measured parameter exceeds the allowable level. (2)Duty to comply. The permittee shall comply at all times with the terms and conditions of the permit, 314 CMR 5.00,M.G.L. c. 21, §§ 26 through 53 and all applicable state and federal statutes and regulations. (3) Standards and prohibitions for toxic pollutants. The permittee shall comply with effluent standards or prohibitions established under § 307(a) of the Federal Act, 33 U.S.0 § 1317(a), for toxic pollutants within the time provided in the regulations that establish these standards or prohibitions, even if the permit has not yet been.modified to incorporate the requirement. 9 Cape Regency Healtheare Center DRAFT 847-1 (4) Proper operation and maintenance. The permittee shall'at all times properly operate and maintain all facilities`and equipment installed`or used to achieve compliance with the terms and conditions of the permit, and the regulations promulgated`at.314 CR 12.O0 entitled"Operation and Maintenance and Pretreatment Standards for Wastewater TMreatmentWorks and Indirect Discharges,"and 257 CMR 2.00,Rules and.Regulations for Certification of Operators of Wastewater Treatment Facilities (5)Di ty t0 halt or reduce activity. Upon reduction, loss; or failure of the treatment facility,the pernUttee shall,to the extent necessary to maintain compliance with its permit, control production.or discharges or both until the facility.is,restored or an alternative method of treatment'is provided.,It shall not be'a defense for a permittee in an enforcement action that it would have been.necessary to halt or reduce the permitted activity in order to maintain compliance wit6 the..conditions of the permit (6)Tower Failure.h order to,maintain compliance with the effluent limitations and prohibitions of this permit,the permittee shall either: (a)provide an alternative power source sufficient to operate the wastewater control facilities;.or (b)halt, reduce or otherwise control production and/or all discharges upon the reduction, doss, or failure.of the primary source of power to the wastewater control facilities .(7) Duty to mitigate.'The permittee shall take all reasonable steps to minimize or prevent any adverse impact on human health or`the environment resulting from non-compliance with the permit. (8) Duty to provide information.`'The pen'ittee shall`Rimish'to'the Departmerit within a reasonable time as specified by the Department any information.which the Department may request to.determine whether cause exists for modifymg,`rpvoking and reissuing,or termmatii' , the pertriit, or to,determine whether the perinittee is complying with the terms and conditions'of. the permit. " (9) Inspection and entry. The permittee shall allow the Department or its authorized representatives to (a) Eriter upon the'permittee's premises where a regulated facility or activity is located or conducted, or where records required by the permit are kept; (b)Have accessao and copy; at reasonable times; any records that must be kept under the conditions of the permit, .41 (c)'Inspect at reasonable times any facilities, equipment,practices;or'operations' regulated:or required under the'permit; and (d) Sample or monitor at reasonable.times for the purpose.of determining compliance_ with the terms and conditions of the permit. " (9A) The permittee shall physically ecure'the treatment works and monitoring wells and limit . access to the treatment works and:monitoring wells to those personnel required to operate, inspect and maintain the treatment works and to collect samples. 10 Cape Regency Healthcare Center DRAFT 847—1 (913) The permittee shall identify each monitoring well by permanently affixing to the steel protective casing of the well a tag with the identification number listed in the permit. (10) Monitoring. Samples and measurements taken for the purpose of monitoring shall be representative of the monitored activity. Monitoring must be conducted according to test procedures approved under 40 CFR Part 136 unless other test procedures are specified in the permit. (11) Recordkeeping. The permittee shall retain records of all monitoring information, including all calibration and maintenance records and all original strip chart recordings for continuous monitoring instrumentation, copies of all reports required by the permit, and all records of all data used to complete the application for the permit, for a period of at least three years from the date of the sample, measurement, report or application. This period may be extended by request of the Department at any time. Records of monitoring information shall include: (a)The date, exact place, and time of sampling or measurements; (b) The individual(s)who performed the sampling or measurement; (c) The date(s) analyses were performed; (d) The individual(s) who performed the analyses; (e) The analytical techniques or methods used; and (f)The results of such analyses. (12)Prohibition of bypassing. Except as provided in 314 CMR 5.16(13), bypassing is prohibited, and the Department may take enforcement action against a permittee for bypassing unless: ' (a) The bypass was unavoidable to prevent loss of life, personal injury, or severe property damage; (b) There were no feasible alternatives to the bypass, such as the use of auxiliary treatment facilities, retention of untreated wastes, or maintenance during normal periods of equipment downtime. This condition is not satisfied if the permittee could have installed adequate backup equipment to prevent a bypass which occurred during normal. periods of equipment downtime or preventive maintenance; and (c) The permittee submitted notice of the bypass to the Department: 1. In the event of an anticipated bypass, at least ten days in advance, if possible; or 2. In the event of an unanticipated bypass, as soon as the permittee has knowledge of the bypass and no later than 24 hours after its .first occurrence.,. (13) Bypass not exceeding limitations. The permittee may allow a bypass to occur which does not cause effluent limitations to be exceeded, but only if necessary for the performance of essential maintenance or to assure efficient operation of treatment facilities. (14) Permit actions. The permit may be modified, suspended, or revoked for cause. The filing of a request by the permittee for a permit modification,reissuance, or termination, or a notification of planned changes or anticipated non-compliance does not stay any permit condition. (15) Dut. t�pply. If the permittee wishes to continue an activity regulated by the permit after the expiration date of the permit, the permittee must apply for and obtain a new permit. The permittee shall submit a new application at least 180 days before the expiration date of the existing permit,unless permission for a later date has been granted by the Department in writing. 11 it I Cape_Regency Healthcare.Center' DRAFT 847 1 (16) Property rights. The permit does not conveyanyproperty rights of any sort or any exclusive privilege: (17) Other laws:The issuance of a permit does riot authorize any injury to persons or property or invasion of other private rights, nor:does it relieve the"permittee of its so gation:t' comply with any other applicable Federal; State; and local laws and regulations: .(18) Oil.and hazardous substance liability. Nothing in the permit shall be construed to preclude the.institution of any'legal action or relieve the permittee from any.responsibilities;`liabilities, or + penalties to which the permittee is or maybe subject under § 311' of the Federal Act, 33 U.S.0 § 1321, andMG.L. c.;21E. (19) Removed substances.Solids' .filier.backwash, or.other.pollutants^removed-in the,; course of treatment or control of wastewaters shall be disposed in a manner consistent with applicable-,Federal and.State.laws and regulations including;but not limited to,the Massachusetts ` Clean Waters Act, M.G.L: c..21, §§'26 through 53 and the Federal`Act, ; 33 U.S.C. § 1251 et,< seq; he Massachusetts Hazardous Waste Management Act, MI.G.L". c. 21C, and the Federal Resource Conservation.and Recovery Act; 42,U S.C. §`06f;`wt eq.,310 CMR 19.O0O and 30.000, and other applicable regulations. ; (20) Reporting requirements.' (a)Monitoring reports. Mo toring results shall be reported on a Discharge Monitoring Report (DMR)at the intervals'specified'elsewhere inahe permit. If the.permittee monitors any pollutant more frequently than required bythe'permit, the results of this monitoring shall be included iri the calcilatiori and'reportulg of tfie data submitted'in the DMR (b) Compliance schedules. Reports of compliance or non-compliance with;'or any, , progress,reports on;interim and final requirements`contained in any compliance schedule of the permit shall be submitted no later'than 14'days.following each schedule date. (c)Planned cha yes:The permittee shall*giv6 notice to,the Department as,soon as :possible of any planned physical alterations or additions to the permitted .facility or. activity which could significantly change the nature or increase the quantity of pollutants discharged. Unless and until the permit is modified' any new or increased discharge in excess of' limits or not specficallyauthorized by the permit constitutes a'violation ;.. .w (d)Anticipated non-'compliance. The permitteefshall give advancenotice to the Department of any planned changes in the permitted facility or activity which may result, in.non=compliance with permit requirements: (e)24 hour reportinla: The permittee shall;report any non-compliance which may endanger health or the'environment. Any information shall be provided•orally within 24 liours.from thetime the permittee becomes aware of the circumstances. A written submission shall also be provided Within,five days of the time the permittee becomes , aware of the circumstances:1 e written:submission`shall contain a description of the' non-compliance; including exact dates and times, and if the non-compliance has not been corrected,the".anticipated lime it is expected'to:continue;.and steps taken or.planned to reduce,eliininate, and prevent reoccurrence of the non-compliance:The following shall be inc luded'as infornation which mu be i6poftb&w thin`24 hours: } 1. Anyunanticipated bypa"ss which exceeds any effluent limitation in the permit,:. Cape Regency Healthcare Center DRAFT 847—1 2. Violation of a maximum daily discharge limitation for any of the pollutants listed by the Department in the permit to be reported within 24 hours. (f) Other non-compliance. The permittee shall report all instances of non-compliance not reported under 314 CMR 5.16(20)(a), (b), or(e) at the time monitoring reports are submitted. The reports shall contain the information listed in 314 CMR 5.16(20)(e). (g) Toxics. All manufacturing, commercial,mining, or silvicultural dischargers must notify the Department as soon as they know or have reason to believe: 1. That any activity has occurred or will occur which would result.in the discharge of any toxic pollutant listed in 314 CMR 3.17 which is not limited in the permit, if that discharge will exceed the highest of the following notification levels: a. 100 micrograms per liter (100 ug/1); b. 200 micrograms.per liter(200 ug/1) for acrolein and acrylonitrile; 500 micrograms per liter (500 ug/1) for 2,4-dinitrophenol and for 2-methyl-4,6- dinitrophenol; and one milligram per liter(1 mg/1) for antimony; c. Five times the maxirzum concentration value reported for that pollutant in the permit application; or 2. That they have begun or expect to begin to use or manufacture as an intermediate or final product or byproduct any toxic pollutant which was not reported in the permit application. (h) Indirect dischargers. All Publicly Owned Treatment Works shall provide adequate notice to the Department of the following: 1. Any new introduction of pollutants into the POTW from an indirect discharger which would be subject to § 301 or 306 of the Federal Act, 33 U.S.C. § 1311 or 1316, if it were directly discharging those pollutants; and 2. Any substantial change in the volume or character of pollutants being introduced into the POTW by a source introducing pollutants into the POTW at the time of issuance of the permit. (i)Information. Where the permittee becomes aware that it failed to submit any relevant facts in a permit application, or submitted incorrect information in a permit application or in any report to the Department, it shall promptly submit such facts or information. (2 1) Signatory requirement. All applications, reports, or information submitted to the Department shall be signed and certified in accordance with 314 CMR 3.15 and 5.14. (22) Severability. The provisions of the permit are severable, and if any provision of the permit, or the application of any provision of the permit to any circumstance, is held invalid, the application of such provision to other circumstances, and the remainder of the permit, shall not be affected thereby. (23)Reopener clause. The Department reserves the right to make appropriate revisions to the permit in order to establish any appropriate effluent limitations, schedules of compliance, or other provisions which may be authorized under the Massachusetts Clean Waters Act, M.G.L. c. 21, §§ 26 through 53 or the Federal Act, 33 U.S.C. §1251 et seq in order to bring all discharges into compliance with said statutes. (24) Approval of treatment works. All discharges and associated treatment works authorized herein shall be consistent with the terms and conditions of this permit. Any modification to the 13 Cape Regency Healthcare Center DRAFT 847— 1 approved treatment works shall require written approval of the Department prior to the construction of the modification (25) Transfer`of Permits.' (a)'RCRA facilities.Any perinrt'wlucli`authorizes the'operation of a RCRA°facility which I s subj ect to the requirements of 3 P4 CMR 8 07aha11 be valid only for the person to whom itis.issued and.may not be transferred (b)Transfers by modification. Except as provided in 314 CMR 5.16(25)(a) and (c), a permit may be transferred by permittee to.a new owner or operator provided that the permit has been modified or revoked and reissued or a minor modification is made to identify the new permittee in-accordance with 314 CMR 5.12(3) and (4). (c)`Automatic transfers.For facilities other than Privately Owned Wastewater Treatment Facilities (PWTFs)that treat at least some sewage from residential uses;hospitals, nursing or personal care facilities,residential care facilities, and/or assisted living . `"'facilities, PWTFsthat have bean required'to establish financial assurance mechanism(s) pursuant to 314 CMR 5:15(6), and RCRAfacilities subject to the requirements of 314 CPR`8.07, a`permit may be automatically transferred in accordance.with 314 CMR (26)Permit Compliance Fees and Inspection4nformation Except as otherwise provided, any permittee,required to obtain a surface water or ground water discharge permit pursuant to M.G.L. c;.21, §°43 acid 3.1-4 CMR 3:00 and 5.00,shall be'required'to submit the annual compliance assurance fee established in accordance with M.G.L. c. 21A,:§,,18 and 310 CN4R 4.00.as provided in 314 CMR 2.12:'The requirement toisubmit the ar nual`compliance fee does not apply,- to any local'government unit other than wdiithority-�-Any'per iittee required to obtain a surface water or groundwater discharge permit pursuant'to'M.G.L. C. 21 §43 and 314 CMR 3.00 and 5.00 maybe required'to submit inspection information annually as a eondition`of the permit as provided in 314 CIVIR 2 12. P:\12\847 - 1 =Barnstable - Cape Regency.doex 14 (Ilk COMMONWEALTH COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS IV DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 508-946-2700 MITT ROMNEY STEPHEN R.PRITCHARD Governor Secretary KERRY HEALEY ROBERT W.GOLLEDGE,Jr. Lieutenant Governor Commissioner August 31, 2005 Mr. Stanley Szczurko RE: BARNSTABLE—Subsurface Sewage SS Designs Disposal-Proposed Repair for Cape 24.Woodland Heights Drive Regency Nursing Home, 120 South Main West Boylston, Massachusetts 01583 Street(Centerville) Dear Mr. Szczurko: The Department of Environmental Protection is in receipt of your letter dated August 12, 2005 which included a plan consisting of one (1) sheet titled: SS DESIGNS 24 WOODLAND HEIGHTS DRIVE W. BOYLSTON, MA (508) 615-7826 PROJECT: CAPE.REGENCY NURSING HOME- SEPTIC SYSTEM#2 REPAIRS 120 SOUTH MAIN STREET CENTERVILLE, MASSACHUSETTS DATE: .7/15/05. The plan proposes a temporary repair to System #2 at the Cape Regency Nursing Home and will consist of replacement of the existing distribution box and replacement of the distribution line to Leach Pit#5. The Department approves the proposed repair with the following conditions: 1. This is a temporary repair only and shall be limited to System#2. 2. There is to be no increase in the current 120 bed capacity of the facility. This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. DEP on the World Wide Web: http://www.mass.gov/dep 104 Printed on.Recycled Paper - CI +4 2 3. A new subsurface sewage treatment and disposal system, including enhanced treatment, serving the entire facility shall be installed by October 31, 2006. 4. The Department shall inspect the proposed repair prior to backfilling any replacement component. If you have any questions,please contact me at(508)946-2753. Very truly yours, Brian A. Dudley Bureau of Resource Protection cc: Thomas McKean, Director Health Division 200 Main Street Hyannis, MA 02601 Thomas Lavallee Radius Management Services 1671 Worcester Road, Suite 300 Framingham, MA 01702 P:\bdudley\large systems\cape regency temp approval.doc 3 /�� �� Fee ' No. � V � .., o a THE COM ONWEALTH OF MASSA TS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pphLAtion for jBisposaY 6pstem Construttivn 30Ermit Application for a Permit to Construct( ) Repair V l Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. yaD M.� �Q er' 'Name,Address,and Tel.No. Assessor's Map/Parcel c Installer1 N Address,and Tel.No. Designer's ame,Address,and Tel.No. L' 6&VII-4/114 _Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures y Design Flow(min.required) w 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) C e IP OL 1M CL l l" 36t to a Date last inspected: Agreement: The undersigned agrees to ensure the con ruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E i rim ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar Signed Date 6 2i0)3 Application Approved by Date — Application Disapproved by Date for the following reasons , (,,Permit No. Date Issued �< 0®0 Fee l M No. I� I�-�. •�". i "`• vO // a � THE COMMONWEALTH OF MASS TS Entered in comput ACFi Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSA-'HUSETTS ftplitatiou for Disposal *pstrm ConstCurtion Permit Application for a Permit to Construct( ) Repair V) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 120 S. Al A 2 Q &neA Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name Address,and Tell..No.// `Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms py Lot Size sq.ft. Garbage Grinder( ) 3 Other Type of Building No.of Persons Showers( ) Cafeteria( , ) Other Fixtures Design Flow(min.required) 1 1 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, 0. Nature of Repairs or Alterations(Answer when applicable) rQ( OL �' VV'�-C-, UA SQw y) 4 A a Date last inspected: Agreement: „'f The undersigned agrees to ensure the con ruction and maintenance of the afore described on-site sewage disposal system in 1" accordance with the provisions of Title 5 of the E i 6nm'ntal Code and not to place the system in operation until a Certificate of 1` e Compliance has been issued by this Boar Signed Date cS 6 2 0%3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. aid Date Issued s - -----------------=------- ------------ Th F: COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V�_ Upgraded( ) - Abandoned( )by y / M at ✓1 S7► J1 rrl Q V 1 tQ," has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.A01�i "1 dated v " Installer 4 Designer #bedrooms Approved design flow gpd The issuance of this permit shall not bbVconstrued as a guarantee that the syste will fun ion designed. Date // Inspector - _ - -------------------------------- No. a O� � ' Fee �C/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction i3ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at �? 6,4 A) C C y KQV i) �'►�. �F 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 completed within three years of the date of this permit. \ Date I Approved by 1 (� f6.L SS DESIGNS - - ENVIRONMENTAL CONSULTANTS `ice May 25,2009 Brian Dudley Mass DEP—Southeast Region,Cape Cod 973 Iyannough Road(Route 132) Hyannis,Ma 02601 Re:Centerville-Cape Regency Rehab and Nursing Center Permit No:SE#0-847 Dear Mr. Dudley: This letter is written in behalf of our clients,Radius Management Services,Incorporated (RMS), to address one of the two conditions required in the Department's May 11, 2009 approval letter. One of the conditions in the letter requires the confirmation that the third leaching field for the facility has been constructed, inspected by DEP and has been backfilled.This condition has been satisfied on May 14,2009. The second condition requires a UV intensity meter be installed on the UV disinfection unit. We are in the process of ordering the meter. We will notify the Department when it is installed and ready for your inspection. Should you have any further requests or comments;please do not hesitate to contact me. F Sincerely, Mt- J � r Stanley Szczutkq Jr. �q��'� 6 cc do Environmental Engineer S.fa N $� C3 I— C.J ►� Cc Radius Management Services,Inc,1671 Worcester Road,Framingham,Ma 01702 attn:Christine Bassett,President, Thomas G LavaDee,Director S.E.Regioffii Ops. Jon Truslow,Owner's Representative Thomas McKeon,Directom Barnstable B O.H.,200 Main St Barnstable,Ma 02601 He-SS Designs DEPapprovaMadius09-0523 24 WOODLAND HEIGHTS DRIVE. - WEST BOYLSTON/MA - 01583 PHONE: 508-835-3406, CELL 508-615-7826- FAX: 508-835-3408 Town of Barnstable 9 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufinan,MSPH Paul Canniff,D.M.D. January 11, 2007 Mr. Stan Szczurko \ S.S. Designs �\ 24 Woodland Hgts. Drive West Boylston, MA 01583 $�REk GapeRege ncy Rehab andNursing Center, x1�20 South M eta Cemterv=illeoryrt h` a' '245 024 Dear Mr. Szczurko, 1` During the public meeting of the Board of Health held on November 14, 2006, the Board reviewed the proposed wastewater treatment system for the proposed construction of a 29 bed Alzheimer ward to the existing 120 bed nursing home known as the Cape Regency Rehab and Nursing Center, located at 120 South Main Street, Centerville, Massachusetts. The wastewater system will consist of a 2,500 gallon grease trap, 8,000- and 9,000 gallon septic tanks, 14,000 gallon pre-equalization tank, 20,000 gallon membrane bio-reactor for tertiary treatment, 2,500 gallon final discharge pump chamber, and a pressure distributed soil absorption system. The Board of Health has no objections to this proposal. The Board approves this proposal with the following condition: • The applicant shall obtain the approval of the Massachusetts Department of Environmental Protection. The applicant shall obtain any necessary permits for the construction of the wastewater treatment system from the Massachusetts Department of Environmental Protection prior to any wastewater treatment facility construction work onsite. Sinc rely your , Wayne iller, M.D. Chairman Q:wp/SzczurkoCapeRegency07 f 120 South Main,Centerville-Subsurface Disposal System upgrade SS DESIGNS ENVIRONMENTAL CONSULTANTS 24 WOODLAND HEIGHTS DRIVE BOYLSTON, MA 508-615-7826 TRANSMITTAL September 26, 2006 Town of Centerville Board of Health RE: Cape Regency Rehab and Nursing Center proposed Wastewater Treatment Facility 120 South Main Street, Centerville Dear Board Members: Per your request, we are submitting draft plans for a wastewater treatment facility to accommodate the Regency Rehab and Nursing Center at the above referenced address. I have attached a design narrative and a copy of the draft plans for your review. If you have any questions, please feel free to contact Stan Szczurko, or Thomas Ryder at 508- 246-9328. Respectfully Submitted, Thomas A Ryder, PE CU S '! Cape Regency Rehab and Nursing Center 120 South Main Street Centerville,MA Groundwater Discharge Document: DRAFT Wastewater Treatment and Groundwater Discharge Codes, Standards and References: 1. DEP Groundwater Discharge Guidance; 2. Title 5, 310 CMR 15.000; 3. TR 16. System Design Criteria: 1. Existing 120-Bed Nursing Home, Title 5 Flow rate 150 GPDBed= 18,000 GPD; 2. Proposed Additional 29-Bed Alzheimer Ward. Total Design Flow--22,350 GPD 3. Grease Trap sizing 15 GPD/Bed=2,235 Gal. 4. BODea=30 mg/1, TSSeff=30 mg/1, TNeff=10 mg/l, Design & Construction: Existing- 2,500 Gal Grease trap, and 5,000 Gal., 8,000 Gal., & 9,000 Gal. Septic Tanks Proposed: 1- Grease Trap modification for additional hydraulic detention time; 3- Effluent tee filters for fine screening pretreatment tank effluent; 1- 14,000 Gal. Pre-Equalization Tank; 1- 20,000 Gal Membrane Bio-Reactor(MBR) for tertiary treatment; 1- 2,500 Gal. Final Discharge Pump Chamber; 3-Pressure distributed Soil absorption Systems with reserve. Attachments: 1. Design Summary 2. Design plans 'S t 120 South Main,Centerville-Subsurface Disposal System upgrade Design History: The existing septic system for the Regency Rehab and Nursing Center is comprised of 3 separate systems designed under the Title 5 1977 Code. The current water records indicate that the facility currently uses approximately 9,800 GPD The Total Design Flow for the facility based on The 1977 Code at 100 GPD/bed is 12,000 GPD. During the last Title 5 Inspection,the septic system was determined to be in failure and Changes in 1995 to Title 5 increased the design flow to 150 GPD/bed or 18,000 GPD total design flow for the facility. The Department of Environmental Protection has determined that the Cape Regency's failed Septic System may be upgraded under the provisions set forth in Tile 5 as a Large Septic System as long as there are no additional design wastewater flows. However, at this time the Regency Rehab and Nursing Center are proceeding with plans to add an Alzheimer ward unit that will create 29 more Beds to the existing Facility. The addition additional design flow requires an upgrade under 314 CMR 5.00 Groundwater Discharge Requirements. Summary of proposed treatment process for Centerville Cape Regency Nursing and Rehab Center 4 Existing_System 1 Located at the South(front) side of the building receives wastewater flow to a 9,000 gallon septic tank for primary treatment and discharges effluent to a series of leaching pits. Existing System Located on the West side of the building receives flow to an 8,000 gallon septic tank for primary treatment and discharges effluent to a series of leaching pits. Existing System Located on the North(rear) side of the building and it primarily receives laundry and kitchen wastewater flow. Flow from the kitchen enters a 2,500 gal grease trap and discharges to a 5,000 gallon septic tank mixing with the laundry wastewater. Wastewater then discharges into a series of leaching pits. The proposed new system will utilize the same primary treatment components as the existing system with modifications incorporated to enhance final treatment. The existing leach pits will be abandoned after start up of the wastewater treatment facility. Proposed upgrade includes: 1. Effluent tee filters will be added to each septic tank to provide a greater degree of primary treatment; 2. Wastewater from the 3-separate systems with combine into a 14,000 gallon equalization tank; 3. Laundry wastewater flow will be disconnected from the septic tank at system 3 and directly discharge to the proposed 14,000 gallon equalization tank. Flow from the kitchen will solely utilize both the 2,500 gallon and 5,000 gallon tanks as a grease trap. A vent will be added to the second Grease Trap tank to promote cooling through the tanks. This will greatly reduce the amounts of Fats, Oils and Grease from the proposed treatment works. i i 120 South Main,Centerville-Subsurface Disposal System upgrade 4. Flow from the equalization tank will be time dosed to a 6,900 gallon equalization compartment of a proposed Membrane Bioreactor. 5. Flow will be pumped from the equalization compartment into a 5,700 gallon anoxic compartment and mix with returned wastewater from the aeration tank. 6. Overflow of the anoxic chamber will discharge into a 6,700 gallon aeration tank with flat plate membranes (0.08 micron). A filtrate pump will pump effluent to a 1,750 gallon clear well that discharges to a 2,500 gallon pump chamber for final disposal into the ground. A return pump will recycle wastewater from the aeration tank back into the anoxic tank to mix with the influent wastewater. 7. The pump chamber will alternately discharge effluent to three equally sized soil absorption systems for final disposal. f = Alov Lys 6 . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONM DEPARTMENT OF ENVIRONMENTAL PROTECT j j CAPE COD OFFICE ®P 1 973 Iyannough Road, Route 132, Hyannis, MA 02601 Phone: 508-771-6003 FAX: 508-771-6155N DEVAL.L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner June 15,2007 I Ms. Chris Bassett,President RE: BARNSTABLE—BRPWP06, Cape _ Radius Regency Operating, LLC Regency, 120 South Main Street, "� r 1671 Worcester Road, Suite 300 Groundwater Discharge, _ Framingham, Massachusetts 01702 Permit#SE 0-847 Transmittal No. W102133 Dear Ms. Bassett: In response to your application for a permit to discharge into the ground a treated effluent from the proposed treatment works at the`Cape Regency in'Barnstable, Massachusetts, and after due public notice, I hereby issue the attached final permit. No comments objecting to, the issuance or-terms of the permit were received by.the Division of Wastewater Management during the public comment period; therefore, the permit is effective upon issuance. Parties 'aggrieved by the issuance of this permit are hereby advised of their right to request an Adjudicatory Hearing under, the provisions of Chapter 30A of the Massachusetts General Laws and 314 CMR 1.00; Rules for the Conduct of Adjudicatory Proceedings. Unless the person requesting the adjudicatory hearing requests and is granted a stay of the terms and conditions of the permit, the permit shall remain-fully effective. If you have any questions, please contact me at(508)771-6047. �- Very truly yo rs, co Brian A. Dudley Bureau of Resource Protectio c M BAD/ Enclosure (1 Permit) This information is available in alternate format.Call Donald M.Goines,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. MassDEP on the World Wide Web: http://www.mass.gov/dep Printed on Recycled Paper 2 cc: Thomas McKean, Health Agent Board of Health 200 Main Street Barnstable,MA 02601 Enclosure (1 Permit) Stanley Szczurko SS Designs 24 Woodland Heights Drive West Boylston, MA 01583 Enclosure (1 Permit) ecc: DEP/Boston Wastewater Management Section Attn: Marybeth Chubb Enclosure (1 Permit) DEP/SERO Attn: Jeffrey Gould . Laura Patriarca (Enclosure- 1 Permit) P:\bdudley\gwdp\barnstable\cape regency final permit ltr.doc DISCHARGE PER MIT Name and Address of Applicant: RadiusRegency nnerating T.T.0 Date of Application: Octnher 10, 7006 Permit No.: RF#0- R47 Effective Date: .Tune 15,2007 Date of Issuance: Tune 15, 7007 Date of Expiration: Tune 15, 201 AT TTTTORTTY FOR TRST TANC:R Pursuant to authority granted by Chapter 21, Sections 26-53 of the Massachusetts General Laws,as amended,the following permit hereby issued to: Radius Regencv_�ink T.T.0 (hereinafter called "the.permittee), authorizing discharges from a proposed on-site wastewater treatment facility serving a 149 bed senior care facility to the ground located at 120 South Main Street, Barnstable, MA, such authorization being expressly conditional on compliance by the permittee with all terms and conditions of the permit hereinafter set forth. i sb Brian A. Dudley ate Bureau of Resource Protection 2 I. SPECIAL CONDITIONS A. Effluent Limits The permittee is authorized to discharge into the ground from the wastewater treatment facilities for which this permit is issued a treated effluent whose characteristics shall not exceed the following values within one month of startup and continuing thereafter: Effluent Characteristic D)isrha_rge Limitations Flow 77,150 Gallons ner D . (file & Grease ' 15 mu/1 Total .Suspended Solids in mP/l Biochemical Oxygen Demand, 5-day n70y -n mu/1 Total Nitrogen n')+NO +TKNI 10 ma/1 Nitrate_Nitmgen 1 n mn/1 -a FPcal Cnlifnrm Inn colonies/1 nnmT, (a) The pH of the effluent shall not be less than 6.5 nor greater than 8.5 at any time. (b) The discharge of the effluent shall not result in any demonstrable adverse effect cn the ground water or violate any water quality standard that has been promulgated. (c) The monthly average concentration of BOD5 and total suspended solids in the discharge shall not exceed 15 percent of the monthly average concentrations of BOD5 and total suspended solids in the influent into the permittee's wastewater treatment facilities. (d) When the effluent discharged for a period of 90 consecutive days exceeds 80 percent of the permitted flow limitations, the permittee shall submit to the permitting authorities projected loadings and a program for maintaining satisfactory treatment levels consistent with approved water quality management plans. 3 B. Monitoring and Reporting (1) The permittee shall monitor and record the quality of the influent waste stream to the facility according to the following schedule and other provisions: Minimum Frequency Parameter of Analysis is Sample Tvne nH naily Crrah ROD,, Monthly U-Hnur CmmDncite Total CiIsnended Snlidc Mnnthly 24-14nur Cmmpncite Total Solids Month]: 74-14 ite Oil and CTreace Monthly CTrah Ammnnia Nitrogen Monthly 9.4-14nur CmmDnsite Total Nitrngen ?+NO +TKN) Monthly 74-14our Cmml3ncite (2) The permittee shall monitor and record the quality and quantity of effluent at the effluent pump chamber to the leaching area according to the following schedule and other provisions: Minimum Frequency Parameter of Analysis Sample Tune Flow Daily Max—Min—Ave. ITV intensity Daily Meter Reading nH Daily Crrah Tntal SnsDended Snlidc Monthly 74-14nur Cmml)nsite Tntal i kgnlved Snlidc Monthly 24-14our Cnm snow Total Snlidc Monthly 24 ,)cite Chlorides Monthly Crrah nil Xc CTreace Mnnthly CTrah Fecal Coliform Mnnthly` CTrah Bonn Monthly 2.4-Hour CmmDnsite Nitrate Nitrogen Monthly U-Hnur Cmm:pnsite Total Nitrogen (NO?+Nog+TKNI Mnnthly, 74-H �nur Cmmnsite sm Total Phohnnjc Monthly 74-14nur Composite Orthn-Y hombonis Monthly 24-Hour Cmm�nsite n Volatile organic Comnunds* „ 2.x Annually Crrah* *(USEPA METHOD#624) 4 (3) The permittee shall monitor, record and report the quality of water in upgradient monitoring well MW-7 and downgradient monitoring wells MW-3 and MW-6 as shown on the plan titled "Proposed Monitoring Well Matrix Map, Hydrogeologic Assessment, Cape Regency, 120 South Main Street, Centerville, Massachusetts" dated April 11, 2007 according to the following schedule and other provisions: Parameter Frequency of Analysis Ctat;n Water Level Quarterly c C,.onifir (`nnrinrtancn Ona nH Quarterly (hlnride.q mart .rly Tntal Nitrngen ?+NO3+TKN) quarterly Nitrates-Nitrngen Ouarterly Tntal Phnenhnnis OuarterlV Orthn_phosphnruc Diarterly Tntal Vnlatile Organic Cmmj)nunrlc* Annually * (USEPA Method#624) (4) Any grab sample or composite sample required to be taken less frequently than daily shall be taken during the period of Monday through Friday inclusive. Grab samples shall be taken between 8:00 a.m. and 6:00 p.m. All samples shall be taken over the operating day. The permittee shall submit all monitoring reports within 30 days of the last day of the reporting month. Reports shall be on an acceptable form, properly filled and signed and shall be sent to the Department of Environmental Protection, Southeast Regional Office, 20 Riverside Drive, Lakeville, Ma 02347, and to the Director of Watershed Permitting, Department of Environmental Protection, Division of Wastewater Management, One Winter Street, Boston, MA 02108, and to the Board of Health,Town Hall, 260 Commercial Street,Provincetown,MA 02675. Submission of monitoring reports in electronic format is available through eDEP and serves as the data submission to both the Regional and Boston offices. To register for electronic submission go to: httn /hxnxnx�.macc_aov/den/cervice/cmm�liance/edennnl£htm C. Supplemental Conditions 1) The permittee shall notify the Department at least thirty (30) days in advance of the proposed transfer of ownership of the treatment works for which this permit is written. Said notification shall include a written agreement between the existing and new permittees containing a specific date for transfer of permit, responsibility, coverage and liability between them. 5 2) A staffing plan for the treatment works shall be submitted to the Department once every two years or whenever there are staffing changes. 3) The permittee shall contract to have any and all solids and sludges generated by the treatment works for which this permit is issued removed off site by a properly licensed waste hauler for disposal at an EPA/DEP approved facility. The name and license number of the hauler along with the quantity of wastes removed and the date(s) of removal shall,be reported by the permittee in writing to the Department. 4) The facility shall maintain a financial security amount in the sum of at least$52,500. This source of funding shall be used by the permittee solely for the immediate replacement and/or repair of any failing wastewater treatment units. Such security shall be provided by means of an interest-bearing escrow account and/or a letter of credit from a financial institution having a place of business in Massachusetts and be in a form satisfactory to the Department. The permittee and/or its successors shall replenish and maintain the required dollar amount thereof in full within ninety days of any disbursement. The facility shall establish and maintain a capital reserve account in order to accumulate sufficient capital to make any necessary modifications to the wastewater treatment facility and other related equipment or changes within 20 years from the date of commencement of plant operations. The permittee shall make annual contributions in equal installments j of $5;834 to accumulate the necessary funds within the 20-year period. Such funding shall be provided by means of an interest bearing account and/or a letter of credit from a financial institution having a place of, business in Massachusetts and be in a form satisfactory to the Department., Simultaneously with the permit renewal application at year fifteen (15) following the initiation of plant operations, the permittee shall submit two reports to the Department for its review and approval: a. an engineering report, prepa N red by a registered professional engineer, that ,,,- .outlines in sufficient detail what modifications (if any) to:the facility or other changes are required to insure that the facility can remain in compliance with its GWDP and other applicable requirements through the next 5 year permit term (year 20) and beyond; and b. a,financial plan that contains the cost estimates for implementing the facility modifications or other changes identified in the engineering report, and describes and demonstrates, how and when the permittee will finance the.needed facility modifications or other changes by no later than year 20. c. Permittees shall submit an annual financial report, prepared in accordance with generally accepted accounting principles, to the Department on January 31 of each year. This report shall, as a minimum, identify the initial and current balances of both the security amount and the capital reserve account and confirm the continuing availability of the funds for the purposes described in the Permit.. 6 D. Right to Appeal This Permit is an action of the Department. Any person aggrieved by this action, may request an Adjudicatory Hearing. A request for a hearing must be made in writing and postmarked within thirty(30)days of the Permit issuance date. Under 310 CMR 1.01(6)(b), the request must state clearly and concisely the facts, which are the grounds for the request, and the relief sought. The Hearing request along with a valid check payable to the Commonwealth of Massachusetts in the amount of one hundred dollars($100.00)must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston,MA 02211 ' be dismissed if the filing fee is not aid unless the appellant is exe mpt t The request will g p pp P or granted a waiver as described below. The filing fee is not required if the appellant is a city or town(or municipal agency), county, or district of the Commonwealth of Massachusetts, or a municipal housing authority. The Department may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file, together with the hearing request as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship. 5 . 7 PART TT C'TFNF.R A T.PF.R MIT CONDITIONS The following conditions apply to all permits: 1. No discharge authorized in the permit shall result in a violation of the Massachusetts Surface Water Quality Standards (314 CMR 4.00) or the Massachusetts Ground Water Quality Standards (314.CMR 6.00), or any amendments thereto.. Upon promulgation of any amended standards, this permitmay be revised or amended in accordance with such standard and 314 CMR 2.10 and 3.12 or 5.12. ,For purposes of determining compliance with,ground water quality standards, a violation of the ground water quality standards, and the discharge permit, will be determined to occur when any parameter measured'in any downgradient well exceeds the applicable criteria listed in 314 CMR 6.06. In those cases where it is shown that a measured parameter exceeds the applicable criteria listed in 314 CMR 6.06 at the upgradient monitoring well, a violation of the ground water quality standards and the discharge permit will be determined to occur when it is shown that a measured parameter in any downgradient_ well exceeds the level of that same measured. parameter in the upgradient well for the. same sampling period. A statistical procedure approved by the Director shall be used in determining when a measured parameter exceeds the allowable level. 2. D11ty to cmmply. The permittee shall comply at all times with the terms and conditions of the permit, 314 CMR, M.G.L. c. 21, §§26 through 53 and all other applicable state and federal statutes and regulations. 3. Standards and prohibitions for toxic nnll� upnts. The permittee shall comply with effluent standards or, prohibitions established under PL. 92-500 § 307(a) for toxic pollutants within the time provided in the regulations that establish these standards. or prohibitions, even if the permit has not yet been modified to incorporate the requirement. 4. Proper oneratinn and maintenance_ The permittee shall at all times properly operate and maintain all facilities and equipment installed or-used to. achieve compliance with the terms and conditions of the permit, and in accordance with 314 CMR 12.00. 5. DIA3v to halt or reduce activity. Upon reduction, loss, or failure of the treatment facility, the permittee shall, to the extent necessary to maintain compliance with its permit, control production or discharges or both until the facility is restored or an alternative method of treatment is provided. It shall not be a defense for a permittee in an enforcement action that it would have been necessary to halt or. reduce the permitted activity in order to maintain compliance with the conditions of the permit. 6. Power Faihrre.In order to maintain compliance with .the "effluent limitations and prohibitions of this permit, the permittee shall`either: (a) provide an alternative power source sufficient to operate the wastewater control 8 facilities; or (b) halt, reduce or otherwise control production and/or all discharges upon the reduction, loss, or failure of the primary source of power to the wastewater control facilities. 7. Dilty to mitigate. The permittee shall take all reasonable steps to minimize or prevent any adverse impact on human health or the environment resulting from non- compliance with the permit. g. 'Djj4 to provide information. The permittee shall furnish to the Department within a reasonable time any information which the Department may request to determine whether cause exists for modifying, revoking and reissuing, or terminating the permit, or to determine whether the permittee is complying with the terms and conditions of the permit. 9. Inspection and entry. The permittee shall allow the Department or its authorized representatives to: (a) Enter upon the permittee's premises where a regulated facility or activity is located or conducted, or where records required by the permit are kept; (b) Have access to and copy, at reasonable times, any records that must be kept under the conditions of the permit; (c) Inspect at reasonable times any facilities, equipment, practices, or operations regulated or required under the permit; and (d) Sample or monitor at reasonable times for the purpose of determining compliance with the terms and conditions of the permit. 10. Monitnring. Samples and measurements taken for the purpose of monitoring shall be representative of the monitored activity. Monitoring must be conducted according to test procedures approved under 40 CFR Part 136 unless other test procedures are specified in the permit. 11. Record keening, The permittee shall retain records of all monitoring information including all calibration and maintenance records and all original strip chart recordings for continuous monitoring instrumentation, copies of all reports required by the permit, and all records of all data used to complete the application for the permit, for a period of at least three (3) years from the date of the sample, measurement, report or application. This period may be extended by request of the Department at any time. Records of monitoring information shall include: 9 (a) The date, exact place, and time of sampling or measurements; (b) The individual(s) who performed the sampling or measurement; (c) The date(s)analyses were performed; (d) The individual(s) who performed the analysis; (e) The analytical techniques or methods used; and (f) The results of such analyses. 12. Prohibition of h=nscing. Except as provided in 314 CMR 5.19(13), bypassing is prohibited and the Department may take enforcement action against a permittee for bypassing, unless the discharge is to a surface water and: (a) The bypass was unavoidable.to prevent loss of life,personal injury, or severe property damage; (b) ,There were no feasible alternatives to the bypass, such as the use of auxiliary treatment facilities, retention or untreated wastes, or maintenance during normal periods `of equipment downtime. This condition is not satisfied if the permittee could have installed adequate, backup equipment to prevent a bypass which occurred during normal periods of equipment downtime or preventive maintenance; and (c) The permittee submitted notice of the bypass to the Department: 1. In the event of an anticipated bypass at least ten (10) days in advance, if possible; or 2. In the event of an unanticipated bypass as soon as the permittee has knowledge of the bypass and no later than twenty-four (24) hours after its first occurrence. 13. Bypass not exceeding limitations. The permittee may allow a bypass to occur which does -not cause effluent limitations to be exceeded, but only' if necessary for the performance of essential maintenance or to assure efficient operation of treatment facilities. 14. Permit actions, The permit may be modified, suspended, or revoked for cause. The filing of a request by the permittee for a permit modification,reissuance, or termination, or a notification of planned changes or anticipated non-compliance does not stay any permit conditions. 15. Du to r�hy.. If the permittee wishes to continue an activity regulated by the permit after the expiration date of the permit, the permittee must apply for.and obtain a new .permit. The permittee shall submit a'new application at least one hundred and eighty (180) days before the expiration date of the existing permit, unless permission for a later date has.been granted by the Department. 10 16. Propertyghts. The permit does not convey any property rights of any sort or any exclusive privilege. 17. Other laws. The issuance of a permit does not authorize any injury to persons.or property or invasion of other private rights, nor does it relieve the permittee of its obligation to comply with any other applicable Federal, State and local laws and regulations. 18. Oil and hazardons substance liability. Nothing in the permit shall be construed to preclude the institution of any legal action or relieve the permittee from any responsibilities, liabilities, or penalties to which the permittee is or may be subject under PL 92-500,§ 311, and M.G.L. c.21E. 19. Removed snbstances. Solids, sludges, filter backwash, or other pollutants removed in the course of treatment or control of wastewaters shall be disposed in a manner consistent with applicable Federal and State laws and regulations including, but not limited to, the Massachusetts Clean Waters Act, M.G.L. c. 21, §§ 26 through 53 and the Clean Water Act, PL 92-500, as amended by PL 95-217 and PL 95-576, 33 U.S.C. 1251 et seq., the Massachusetts Hazardous Waste Management Act, M.G.L. c.21C, and the federal Resource Conservation and Recover Act, 42 U.S.C. § 6901, et seq., 310 CMR 19.00 and 30.000, and other applicable regulations. 20. Ren�orting requirements: (a) Monitnring Reports. Monitoring results shall be reported on a Discharge Monitoring Report(DMR) at the intervals specified elsewhere in the permit. If the permittee monitors any pollutant more frequently than required by the permit, the results of this monitoring shall be included in the calculation and reporting of the data submitted in the DMR. (b) Campliance. schedules, Reports of compliance or non-compliance with, or any progress reports on, interim and final requirements contained in any compliance schedule of the permit shall be submitted no later than fourteen (14) days following each schedule date. (c) Planned changes, The permittee shall give notice to the Department as soon as possible of any planned physical alterations or additions to the permitted facility or activity which could significantly change the nature or increase the quantity of pollutants discharged. Unless and until the permit is modified, any new or increased discharge in excess of permit limits or not specifically authorized by the permit constitutes a violation. (d) Anticipated non-compliance. The permittee shall give advance notice to the Department of any planned changes in the permitted facility or activity which may result in non-compliance with hermit requirements. (e) Twenty-four (9.4Thou�rung, The permittee shall report any non-compliance 11 which may endanger health or the environment. Any information shall be provided orally within twenty-four (24) hours from the time the permittee becomes aware of the circumstances. A written submission shall also be provided Within five (5) days of the time the permittee becomes aware of the circumstances. The written submission shall contain a description of the non-compliance, including exact dates and times, and if the non-compliance has not been corrected, the anticipated time it is anticipated to continue; and steps taken or planned to reduce, eliminate, and prevent reoccurrence of the non-compliance. a The following shall be included .as information which must be reported within twenty-four(24)hours: 1. Any anticipated bypass which exceeds any effluent limitation in the permit. 2. Violation of a .maximum daily discharge limitation for any of the pollutants listed by,the Department in the permit to be reported within twenty-four(24) hours. (fl Other non-compliance. The permittee shall report all instances of non-compliance not reported under 314 CMR 3.19(20)(a), (b) or (e) at the time monitoring reports are submitted. The reports shall contain the information listed in 314 CMR 3.19(20)(e). (g) Toxics. All manufacturing, commercial, mining, or silvicultural dischargers must notify the Department as soon as they know or have reason to believe: 1. That any activity has occurred or will occur which would result in the discharge of any toxic pollutant listed in 314 CMR 3.16 which is. not limited in the permit, if that discharge will exceed the highest of the following notification levels: a. One hundred micrograms per liter(100 ug/1); b. Two hundred micrograms per liter (200 ug/1) for acrolein and acrylonitrile; five hundred micrograms per liter (500 ug/1) for 2,4- dinitrophenol and for 2-methyl-4,6-dinitrophenol; and one milligram per liter 1 mg/1) for antimony; c. Five (5) times the maximum concentration value reported for that pollutant in the permit application; or 2. That they have begun or expect to begin to use or manufacture as an intermediate or final product or byproduct any toxic pollutant which was not reported in the permit application. 12 (h) Indirect discharges. All Publicly Owned Treatment Works shall provide adequate notice to the Department of th-- following: 1. Any new introduction of pollutants into the POTW from an indirect discharger which would be subject to PL 92-500,§§ 301 or 306 if it were directly discharging those pollutants; and 2. Any substantial change in the volume or character of pollutants being introduced into the POTW by a source introducing pollutants into t1e POTW at the time of issuance of the permit. 3. For purposes of 314 CMR 5.19, adequate notice shall include information on the quality and quantity of effluent introduced into the POTW, and any anticipated impact of the change on the quantity or quality of effluent to be discharged from the POTW. (i) Information. Where the permittee becomes aware that they failed to submit any relevant facts in a permit application, or submitted incorrect information in a permit application or in any report to the Department, they shall promptly submit such facts or information. 21. Signatnry requirement. All applications, reports, or information submitted to the Department shall be signed and certified in accordance with 314 CMR 3.14 and 5.14. 22. Sever. The provisions of the permit are severable, and if any provision of the permit, or the application of any provision of the permit to any circumstance, is he'd invalid, the application of such provision to other circumstances, and the remainder of the permit, shall not be affected thereby. 23. Rennener clause. The Department reserves the right to make appropriate revisions to the permit in order to establish any appropriate effluent limitations, schedules of compliance, or other provisions which may be authorized under the Massachusetts Clean Waters Act, M.G.L. c. 21, §§ 26 through 53 and the Clean Water Act, PL 92-500, as amended by PL 95-217 and PL 95-576, 33 U.S.C. 1251 et seq. in order to bring all discharges into compliance with said statutes. 24. Annrnrval nfof plans and specifications for treatment works. All discharges and associated treatment works authorized herein shall be consistent with the terms and conditions of this permit and the approved plans and specifications. Any modification to the approved treatment works shall require written approval of the Department. 25. Transfer of nermits. (a) RC:RA facilities. Any permit which authorized the operation of a RCRA facility which is subject to the requirements of 314 CMR 8.07 shall be valid only for the person to whom it is issued and may not be transferred. 13 (b) Transfers by modification. Except as provided in 314 CMR 5.19(25)(a) and (c) a . permit may be transferred by the permittee to a new owner or operator only if the permit has been modified or revoked and reissued or a minor modification made to identify the new permittee. ' (c) Automatic transfers. As an alternative to transfers under 314 CMR 5.19(25)(b), any permit may be automatically transferred to a new permittee if: 1. The current permittee notifies the Department at least thirty (30) days in advance of the proposed transfer date in 314 CMR 5.19(25)(c)2. 2. The notice includes a written agreement between the existing and new permittees containing a specific date'for transfer of permit responsibility, coverage, and liability between them;and 3. The Department does not notify the existing permittee and the proposed new permittee of his.intent to modify or revoke and reissue the permit. A modification under 314 CMR 5.19(25)(c) may also be a minor. modification. If this notice is not received, the transfer is effective on the date specified in the agreement mentioned in 314 CMR 3..19(25)(c)2. 26. Permit Fees. Any permittee, other than a public entity, required to obtain a surface water or ground water discharge permit pursuant to M.G.L. c. 21, §43 and 314 CMR 3.00 and 5.00, shall be required annually to obtain an inspection certificate from the Department, and submit the information and fee associated herewith in accordance with 314 CMR 2.12. a � Massachusetts Department of Environmental Management, r Office of Water Resources , 1 4 7 1 4?.*. TYPE OR PRINT ONLY Well COfllpletio'n Report 1. WELL LOCATION GPS (OPTIONAL) LATITUDE S ° --�a.Q7 LONGITUDE jam° —2-0- lz DATUM Address at Well.Location.. - 54 1�� '� ��, L ' .Property Owner/Client: t ' 2 %, 'ck 6 1(At _ L Subdivisn Name r1. ;' Mailing Address ?.fl io City/Tovvne vtti `�' City/Tovvn. 1 i C315ft� �f`r"" ' Assessors Map Assessors Lot#: NOTE::Assessors Map and Lot# mandatory if no street address available - _ Board of Health permit obtained: Yes ❑' -�ot Required:E� Permit Number Date.lssued` 2.WORK PERFORMED n- am 3,'PROPOSED USE,, 4. DRILLING,METHOA' E2%New Well ❑.Abandon ,E Domestic ❑ Irrigation ❑ Cable , E Auger ❑ Deepen ❑ Recondition Monitoring ❑ Municipal ❑ Air Hammer` ,JD Direct Push ❑ Replace ❑ Other P� ;❑ Industrial ❑ Other ❑ Mud1R8ta"` ,❑ Other 5. WELL LOG _ Water m_ Unconsolidated Consolidated. 6.SITE SKETCH (use permanent landmarks with distances) Bearing' >' > Other Rock Type _ From (ft) To (ft), Zones � 0 mn Material _ Description77 7:WELL:CONSTRUGTIO"N 8,wCASINO Total Depth Dnlletl > # From (ft) To (ft) Casin Type`and Material' Size fD..(in) _ Well-Seal,Type. x. Date-Complete �.. SC C m' a 9. SCREEN From (ft) To (ft).. Slot Size Screen Type and Material Screen Diameter 10. FILTER=PACK/'GROUT?ABANDONMENT MATERIALS 11 ADDITIONAL WELL INFORMATION Developed? ElYes ER No From (ft) To (ft) Material Description`,.,,, Purpose Fracture. -- - - - = -:Zy� E �` Enhancement? .,❑.Yes No ', ,4 y Method <� Y Disinfected? ❑ Yes ER No 12.WELL TEST DATA(ALL,SECTIONS MANDATORY FOR PRODUCTION WELLS) 13. STATIC'WATER LEVEL(ALL WELLS) ,- Yield d Time Pumped Drawdown to Ame to Recover Recovery to " Depth Below Date Method (GPM) _1,':(his&min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured 'Ground Surface"(FT) f f< ANETPUMP S14. PERM , AO Pump Description Horsepower E 1. Pump lntake-Depth (ft)` rr Nominal Pump Capacity (gpm) 16. COMMENTS r .. 17.•WELL DRILLER'S'STATEMENT' j This well was drilled, altered, and/or abandoned under my supervision, according to applicable rules and regulations, and this report is complete and correct to the best of my knowledge. Driller: itv tAf" ° } Supervising Driller Signature: /�ld�,><+� "; I.� ( � Registration #: Firm: Date: g- Rig Permit#: 2I. 4 NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH COPY - Massachusetts Department of Environmental Management - Office of Water Resources 147141 - TYPE OR PRINT ONLY _ w - Well Completion Report 1. WELL.L..00ATION GPS (OPTIONAL) LATITUDE&L° j`� LONGITUDE026 2=•432. DATUM Address at Well;Location:. 1 Property Owner/Client: C yrA "'krT Qtxc�sc+ Subdivision Name Mailing Address. CitylTown $n ¢c t��a ltY �., ' C /Town Assessors Map 19 Assessors Lot'#: '�I NOTE Assessors Map and Lot#mandatory'it no street add ss available`_ 1 Board of Health permit obtained: Yes Not Required [A Permit Number Date,lssued 2. WORK PERFORMED -s 3. PROPOSED USE 4..`DRILLING METHOD '`/ CA New Well ❑ Abandon ❑ Domestic ❑ Irrigation ❑ Cable E ,Auger ❑ Deepen ❑ Recondition 19 Monitoring ❑ Municipal `J ❑ Air Hammer',,❑ Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud Rota ,J ;❑ Other 5 WELL LOG-_t Water Unconsolidated Consolidated 6.SITE SKETCH.(use p menert landmarks with distances) Bearing - C > CD Other Rockand From (ft) To (ft) Zones o m Material Description 7.WELL CONSTRUCTION 9. CASING Total Depth Drilled ` From (ft) To (ft) Casing Type Arid Material Size I.D.(in) Well Seal Type r Date Complete �. 1 s q v V77 1, 3e r''ro ?pern�- ., ��b! �- 9. SCREEN From (ft) To (ft) Slot Size Screen.Type and Material Screen Diameter 10.FILTER PACK/GROUT/ABANDONMENT MATERIAL 11.ADDITIONAL WELL INFORMATION _ / Developed? ❑ Yes C No From (ft) To (ft) Material Description . Purpose Fracture Enhancement?- ❑ Yes q No ` _SQa-1 Method �a y,d, �� <. } Disinfected? ❑ Yes Cq No 12. WELL,TEST DATA(ALL SECTIONS MANDATORY,FOR PRODUCTION WELLS) 13:STATIC WATER LEVEL(ALL WELLS) Yield/,, -,,Time Pumped Drawdown to Time to Recover Recovery.to Depth Below Date- Method (GPM),", _jRs-&min) (Ft. BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (FT) t • ��►0 14.PERMANENT PUMP(IF AVAILABLE) _= Y 15,NAME(ADflFIESS OF PUMP INSTALLATION COMPANY Pump Description °`� Horsepower Pump Intake.Depth (ft) Nominal Pump Capacity (gpm) 16-COMMENTS 17.WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandoned under my supervision,according to applicable rules and regulations, and this report is complete and correct to the best of my knowledge. Driller: t ir�rJ' 0.SY+br Supervising Driller Signature: o�+�n f �1_-.rt��_Registration #: Firm: Date: `r r c a s Rig Permit#: I ( I I NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD.OF HEALTH COPY, ®�a� 24 WOODLAND HEIGHTS DRIVE WEST BOYLSTON,MA.01583 T 508 835 3406 CELL 508 815 7826 CONSMMarch 22,2006 BRIAN DUDLEY DEPARTMENT OF ENVIRONMENTAL PROTECTION S. E. REGIONAL OFFICE 20 RIVERSIDE DRIVE R LAKEVILLE, MA. 02347 Re:Centerville=Cape�R7egerfq20 Souti� Soil Evaluation Dear Mc Dudley, We.are submitting.to the Department the Form 11 and Form 12 for the soil evaluation and testing - performed at the referenced facility on January 17, 2006. The testing Was witnessed by Chdstos Dimisioris of the Departments Southeast Regional Office. ' The information provided is being used in,our design for the new wastewater treatment plant upgrade. We will provide to you the design drawings for your approval when they become available. If there are any further questions or comments please contact me. Stanley Szczurko,Jr R.S.857 Environmental Engineer CC:Barnstable 13.0.1-1.,200 Main'Street,Hyannis;Ma.02601 Attn:Tom Mdcean,Diredor Thomas Lavallee,Regional Manager,Cape Regency Nursing Home,120 South St,Centerville,Ma.02632 C:1..1 DEPCapeRegencysoillogs06.03-22 f , i CO C FORM 11 - SOyL EVALUATOR FORM Page 1 of 3. 7 Commonwealth of Massachusetts ��✓s�t dl , Massachusetts Soil Suat z'ditX Assessment for -On4ft .Serme- Dispmd Performed By: nt i 7-��' �� /� Date: p lonti�Ad�a�s. 10 ..�O toi �}'�./4 l N n: o.r.er9 Nnme.= p?i4 N A S{Q A4/r• .:'�._. I/G �2e�ST�r' �2d-Swte3«0 71 .. . . - " � �A,r►ry s.11 f4tw,.r►'IA. D( �D z.• - , Sb �E0-5 ew cons ruction : ❑ Repair J ,IA He .Ofce Review Published Soil•Survey.Available:No FIj Yes Year Publ'Ished Publication Scale f� _ p Ar(/Qw 3 on Unit Soil Drainap Clas �SSi✓eI Soil Limitazions �r'Ta .tt� �1x'�,J'_ .. ? Sr�, 2,�:.... Surficial Geologic Report Available. No .Q Yes Year Published' Publication Scale r Geologic Material(MeP nit} t � . .LY3W�Rate � • a7. _ ......«....«................»........ ............ _ «... 100, Above 500year flood boundary No 01res r . . P Ns r,441e 1 p 9 7- Within 500 year flood boundary No Yes'' Within 100.year,flood boundary No ElYes .. Q ' Wetland.Area: - 'National Wetland Inventory Map(map ) WetlandsC onservancy-Program Map(map unit} Cumnt Water Resource-Conditions(USGS): Momh Range:Above Normal [ONormal OBelow Normal. " Q Odici References Reviewed: MW APPROVED 7OF24-I2/07r15 i FORM 11 - SOIL EVALUATOR FORM Fags 2 of 3 t '{ Location Addressor Lot No. p_o �o P7,410' S-6eUr Wre r,V t It e— © -site Review Deep Hole Number Date• , 7 a� Timer Weather Location C entify on site plan) Land Use Slope M �'� � Surface Stones r Is d-� 3 0 °•� ^re T nQ e Vegetation . - .�w...............-..:...,.......:.._...... Landfocm 0 & Position on landscape {sketch on the back) Distances from: Open Water Body -34V feet Drainage wey �! feet . Possible Wet Area•2 feet Property Line feet Danking Water Wleil feet Other DEEP OBSERVATION HOLE LOGS Depth from Sol Horizon Sod Texture Sol Color Sol Other Surface Inches) (USDA) (Munsell) Mottling (Structure.Stones,Boulders..Consistency,Grave % o lb'( Ar,,r iqf i :5 Vie- /0 yR z/Z 9.4 Parent Material(eeobgica Depthooeedrodcs > l� Oeoth to Groundwater: Standng Water in the Hole: W O Weeping from pft Face: 4 Estfred 5 Kig+ Grmnid s DW APMVM FORM-1=19S ' FORM 11 - SOIL EVALUATOR FORM Page 3 of 3_ Location Address or Lot No. 'I A a N' . ' 3 Determin6n for Seas a high- Water Table Method Used: Depth observed standing in observation hole- inches ❑ Depth weeping from side of-observation hole--. inches ri Depth to soil mottles inches. b . Z x ©lGround water adjustment ::... .. feet Index Well Number M1,,_,!� "2 Reading DatJA N ?o04 Index.well level Adjustment factor L Adjusted ground water level ..._�.l 21 . �.�_.........._. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in II ar as t observed throughout the area proposed-for-the soil absorption system? If not, what is the depth of.naturally occurring pervious material? Certification 1 certify that on (date)"f 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 training,expertise and experience described in. 310 CMR 15.017. Signature . , Date DES APPROVED FORK-12 V19S ., yr _ .... . FORM 11 - SOS/ ]EVALUATOR FORM Page 1 of 3. No. Z„ Date: 7 'Commonwealth of Massachusetts j r-W9Tr4l e. , MaSsaChuse tS ,Soil Assessment for On-site -So= -I3isoos Pero By: �" �P S z�� Ns ice2U Witnessed Di f . f o t-s S:. ,ixdn eako-a t o -57 rdxs � , WWT w►errneAsr/r,4#�^+P artwvd So"►A yr e3aso c exyr l A_.. TdW0=Iee�,? - - - - Sid►. $-�9 - Mew Construction ❑ -Repair , ,� t y"'z)e - office Review Published Soil Survey Available:No f Yes f.q.I........... Publication Scale > Map Year Pnbl�shed - 3 �°�� - � Class f% SS v2 Soil Limitations odr t S ted �' ' ,,�s...� ..JP4716— ` _ .� Surficial Geologic Report Available:No .0 Yes r Year Published Publication Scale Geologic.11 t riai(Map Unit) - I:aadform .n� .e LA � .. .................._...:. _..��._..._.... 'Flood Insurance Rate Map: r: Above 500 yew flood boundary No OYes 0 � �5?h�/.e /49 4 Within 500 year flood boundary No DYes �3R Within 100 year flood boundary No' 0 Yes ❑ "National Wetland'Inventory Map(map unit) Wetlands Consrvan Trogram Map(map unit) .----._-..__ ` Current Water Resource Conditions(USGS): Month Range:Above Normal BNormal ❑Below Normal., (died Refaces Reviewed: f' 'FORM 11 - SOIL EVALUATOR FOR fie 2 of 3 Location Address or Lot No. / �` k 'T 4.v v; / ' On-site review Deep Hole Numben�d_—Z Date: / Time: . Weather Su iv v X Z Location (identify on situ Land Us. pe (%1 "' Surface Stones �._�. .w.:M. Vegetation :... _ .�. Landform. _ _ _...._�_. ... Position on landscape (sketch on the back) Distances from: Open Water Body sl°in feet' Drainage way2 feet . Possible Wet Area. Zan feet = Property Line > a feet w Drinking Water Wei !,Ld- . feet 'Other DEEP OBSERVATION HALE LOG' Depth from Soil Horizon Soil Texture . Soil Color Soil Other 1 n - Surfacs(Inches) � (USDA) ' (Mansell) Mottling (Structure.Stones,Boulders..Consists cY. 96 Gravel) 6 10,. /� �S�mdy/ca� ���/d 2/ n/�t�e� 0 i\ , tu&-n60-td-, P� cl C 6 9d - - r , Parent Matirial DeWmBedroda .Depth to Groundwater.L Stand'ing Water in the Hole: : aU 0 Weeping from Fit Face: Seasonal NO Ground)Nate: L_-r.? MW ArMVW FORM 1=195 r FORM 11 - SOIL EVALUATOR FORM } - Page 3 of 3_ �} Location Address or Lot No. lib -96 M41&4 ,C a,r'71er V l 11,F 4n A. DetemiLgadon for Seasonal -High- Water Table Method Used: " ❑ Depth observed standing in observation hole.----. inches ❑ Depth weeping from side of observation'hole _ _ inches Depth to soil mottles inches -Ground water adjustment '_ '.. feet , Index Well Numbers-z r _ Reading Date a&✓_'?-emu G Index well-level ....... Adjustment factor_ '�! -Adjusted groundwater level ... L...?:�. _'..............._: 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? 3 If,not, what is the depth of.naturally occurring pervious material? Certification I certify that onToll MIS (date) 1 have passed, the soil evaluator examination approved by the Dep rtment of Environmental.Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described.in.-310 CMR.15.017...: ` Signature Date ? 9V AMOMFOPM-I= FORM 11 - SOIL:EVALUATOR FORM Page 1 of 3. No. 1914-3 Date: j /&L.4 Commonwealth of Massachusetts Massachusetts Soil Su&bility Assessment for On-site .SeN Disposal Performed By:;5 :� _ J 2- z..v_R �o....' ?_. _: Dater �!� ��,... Witnessed By: !`!S� ,f!!�l.S.l d r 5. .: _...................... _..._.__............. :.. c ,+ Q ,Aa So .014P4 ST—" . o.m•.Nwa./1,rad�vs" /�tn>v���wnT �arrics teN�•Gt►VI1/,e�it?q. v ZG,3.z.•- lnlaitGST« Ad Sates 3Qd Fr"R1ilt�tJ �QJWt New Construction ❑•Repair" Lam" �T'w; rl I.A•t Jl e e Office Review Published Soil.Survey Available:No ❑ Yes" ®. Year Published /.� Q� . . Publication Scale "I>3/4,t.� Soil Map Unit i��t�✓t r Drainage Class -,ir icy_..Soil Limitations .... . ._..........:..:. 1 ...._..._.......P.._......_.... d�,f � "..... E 3urficial Geologic Report Available:NO .❑ Yes ❑ Year Published Publication Scale` •. - Geologic Material (Map nit) ��y►f i�C rq.�., D w,�.5�........._.......�............................................ Landform _ e9 C tin w4.. :C�_ r�17v A��G _ - .......................... Flood Insurance Rate Map: 2 S- . Above 500 year flood boundary No ❑Yes Ar r✓¢��9'6 l'e /9 Z ` . WithinDyes ❑J 500 year.flood boundary No Within 100 year flood boundary No, 0Yes ❑ Wetland Area: .-National Wetland Inventory Map(map Unit) ................_._.............................:_... ...... Wetlands Conservancy Program Map"(map'imit) ---------------_._....� ` Current Water Resource Conditions(USGS): Month * _ Range:Above Normal CKNormal. ❑Below Normal.. ❑ Other References Reviewed: DEP APPROVED FORM-UW195 • . o w FORM it - SOIL EVALUATOR FORM Page 2 of 3 . f E ._e Location Address or Lot No'. 1 :Ors-site Review D 41L24-0�'. Tme. 3D 7_d eep Hole Number Date. � Weather Location ffdent1W on site plan) . Land Use Slope M 0_a Surface Stones; Vegetation a O r ......_.,... :.. - Landform " .: :..._. Position on landscape (sketch on-the back) .. Distances froini Open Water Body feet. Drainage Way; S;- feet . Possible Wet Area. ZJ feet-: Property Line .a feet r Drinking Water..Well —&, feet Other DEEP' OBSERVATION. HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color, Soil Other Surface unches) (USDA) (MunselU ' Mottling (Structure..Stones..Boulders.-Consistency,.95 Graveli 1 3 13 7yh C7" f6 MHOMUM OF Z HOLES REQUIRED AT EVERY PRO AREA Patent Material( wc) ( De Bedrock:- f�+ Depth to Groundv+rater. Standing Water in the Hole: �jt L� Weeping from Pit Pace: l No Estitrgod Seasonal Kig+ Ground Waco: DZP APPROVED FORM-VJ07193 w FORM 11 - SOM EVALUATOR FORM Page 3 of 3. Location Address or Lot No PIA Ce NTer ✓t Determination -for Seasonal -H h Wdter Fable - . Method Used: Q Depth.observed standing in observation hole..___...... . inches ❑"Depth weepinq from side of observation hole____. inches 0 Depth to soil mottles inches Ground water adjustment: -' feet Index Well Numbed .►_.w'Zg Reading Date Index well-level .. .......... Adjustment factor . Adjusted ground.water level�� .....�'�...............•.•..... Depth of Naturally Occurring PervibusMaterial f Does at least four feet of naturally occurring pervious material exist in all areas j observed throughout the area.pro posed.for-the soil absorption system? S - If not'. what is the, depth of.naturally occurring pervious material? Certification 1'certify that on �y tdate) I have"passed the soil evaluator examination approved by the Dep rtment of Environmental.Protection and that the above analysis was performed by me consistent with the required training,expertise and'expenence described-irr 310 CMR 15.017. .Signature � -Date DE?APPROVED FORM. 12W S Commonwealth of Massachusetts City/Town of Percolation Test Form 12 ' Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,check with the local Board of Health to determine the form they use. Im portant: When filling out A. Site Information hen { •- ` forms on the computer,use � d�vS gN RV)rVW -10,P 01 U5. only the tab key Owner Name to move your &>a7A cursor-do not Street Address or lot# use the return , key. re AAe r V i Cilfown Ar l�A o a �3 L ty Zip Code 4 P '1�� �zczd✓�2ko 'n . �� �tS- Contact Perso (if drfferent from Owner) Telephone Number B. Test Results Date Time Date _ Time Observation Hole# PY ^ 1 Depth of Perc 41 '' Cj `r Start Pre-Soak End Pre-Soak Time at 12" Time at 9" Time at 6° Time(V-W) r Rate(MinJlnch) Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ S'1�i9)I2 y '! e? * � �Y1. Test Pgrformed By. h Witnessed By. ' Comments: � 7o�RVae> -N C" i NT' e'L yNab!/t" t5lbrm12.doc-06/03 Perc Test•Page 1 of 1 ca HP HP i \ ao \ 19 . 5 4± 3 AO /IH / Aft OOD \ GAZER C s� \ SUBSURFACE - 5 Y- SEPTIC AREA 9 � 3 c'� ° ° 0 ° SS++ 24 WOODLAND HEIGHTS DRIVE DESIGNS WEST BOYLSTON,MA.01583 CGNS�. itL,r> M 508-835-3406 CELL 508-615-7826 January 4,2006 BRIAN DUDLEY ' DEPARTMENT OF ENVIRONMENTAL PROTECTION S.E.REGIONAL OFFICE " 20 RIVERSIDE DRIVE LAKEVILLE, MA 02347 _ Re:Centerville-Cape Regency 120 South Street—"as-built'Plan Dear Mr. Dudley, We are submitting to the Department an"as-buitr drawing and certification of the repairs performed in accordance with the repair plan dated July 15,2005 and approved by the Department in its August 31, 2005 approval letter to SS Designs. The work completed on December 2, 2005, was inspected by you and was issued a Certificate of Compliance by the Barnstable B.O.H.on December 2,2005.A copy of the Certificate is enclosed. if you have any further questions,please contact me. Stanley Szczurko,Jr. R.S.857 Environmental Engineer Cc Barnstable B.O.H.,200 Main street,Hyannis,Ma.02601 Attn:Tom Mckean,Director Thomas Lavallee,Regional Manager,Cape Regency Nursing Home,120 South St,Centerville,Ma.02632 CA..\DEPCopeRegemyas-bu ftletrer9-04-06 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS certifiwe of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by_ G Iv- at �},C cr ,y has been constructed in cordance with the provisions°Title 5 and the for Disposal System Construction Permit No.C=- 5 5 ��dated Installer �`�T-C-- !-� Designer The issuance of this pe t sh not be construed as a guarantee s a sys In a 'Ind n as designed. pec Date I No. v"��' S � c R Fee L y y' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: J Yes C UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,. MASSACHUSETTS \ - application for Digpogar *pgtem Com5truction 30ermit Application f r a Permit to Construct( )Repair(le-) pgrade( )Abandon( ) ❑Complete System Z<dividual Components . Location dr s oer Lot No. n�v A.-7 er Q v Y /� Owner's e,Address Tel.No. Assessor's Map/Parcel ., �OKI Qo I C7 Installer's Name,Address,and Tel.No, Designer's Name,Address and Tel.No. � 3 � �- 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alteratio s(Answer when applicable) /2 N /.1 /.4 e-x Se X /3 j✓�,N 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 lace the system in operation until a Certifi- cate of Compliance has been is this.Board h. Date Application Approve _ Date Application Disapproved for the following reasons Permit No. Date Issued V,A Llo�v No. ' —� — 5 l Fee ` / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes V`�`� ricatfon for iooml *r5tem Construction Permit Application for a Permit to Construct( )Repair(/')Upgrade( )Abandon( ) El Complete System . Individual Components Location Addr ss or Lot No. Owner's Name,Address and Tel.No. b t 20' Assessgr.'s Map/Parcel U$`?-ool S `O c7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. 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) /tea c .F 0 o X .14 eve:_ � r 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 Certifi- cate of Compliance has been issued-by this Board of edh. Signed_ �'`� Date Application Approved J'f Date �`1 . S Application Disapproved for the following reasons Permit No. c S U Date Issued 1 ------- ————————————————— — ————— _-- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comptiance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded ( ) Abandoned( )by /0 P,Z at /., !>i ,.� i �� L" -v /— has been constructed in accordance with the provisions o Title 5 and the for Disposal System Construction Permit No. 5 5 ' dated Installer 1c V-1 Designer The issuance of this permit shraal not be construed as a guarantee thatrt eh—sy m wil cti n as designed. Date / �— / � Inspec or --—- ------------------------------------ l No. co Ss -7 Fee < U C) . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigoat *pttem Construction permit f Permission is hereby granted to Construct( ),Repair(f`')Upgrade( )Abandon( ) System located at s/Q 49 ""J and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be completed within three years of the date of this e r` Date:_,_ Approved by Search for MaplParcel a 278006001 Town of Barnstable a F Parcel Nu 3tlil 27800600 �; Rental T?ro a �YIN3 �9 p t } 6Busk�ess Na„e Zone of Co0tributton( } y Area ember � � � �" � � Co taminant el�Y/ } gay Ph 000 0000000 Fuel Storage Tank Permit yy%' y 3Ferc Test WeII Permit ons �v C tructi i \1 FiTelPermrtNo' 2005570 1 Issuance Date;: 11/09/2005 C mpietiorn�Date F 12/02/2005 ` , Sizejof.'°°S'e�c,. y �WMWSASjfj WSAS ffltel Tanl� `Comments REPAIR.92 438 new d box , m'appar 278006001 Ow erg LIVINGSTON ROBERT G proploc 120 PINE LANE l ,3 Innovative/Alternative I echnol gy Septic Systems S ngl or sL Clustered Service Type �� delete er cords .M 1 COMMONWEALTH OF MASSACHUSETTS �f�2 �` .��€L�� l�= fir,+.�lr�• A r EXECUTIVE OFFICE OF EN�K(�N1VIEIV'i' �FAIRS DEPARTMENT OF ENVIn #Ef�T+L.P,I QTECTION SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 508-946-2700 MITT ROMNEY DIVISION Governor ELLEN ROY HERZFELDER KERRY HEALEY Secretary�`�j` Lieutenant Governor ROBERT W.GOLLEDGE,Jr. Commissioner May 17, 2005 Mr. Stanley Szczurko RE: BARNSTABLE-Subsurface Sewage SS Designs Disposal—Cape Regency Nursing Home 24 Woodland Hcights Drive West Boylston, Massachusetts 01583 Dear Mr. Szczurko: The Department of Environmental Protection is in receipt of your report titled "Evaluation of Subsurface Sewage Disposal System for Cape Regency Nursing Home". The Centerville Nursing Home is a 120 bed facility .served by three separate subsurface sewage disposal systems, two of which have failed. The facility was originally permitted under Title 5 as promulgated in 1978 (the 1978 Code based on a sewage flow estimate of 100 gpd/person for a total design flow of 13,500 gpd (120 beds at one person per bed and 15 staff). Under the current version of Title 5, 310 CMR 15.000 (the 1995 Code); the design flow would be calculated based on 150 gpd/bed for a total design flow of 18,000 gpd. Under the 1995 Code, any flow over 15,000 gpd requires a Groundwater Discharge Permit pursuant to 314 CMR 5.00. However, since Cape Regency Nursing Home has not expanded beyond its originally permitted flow, the Department will , consider the facility as a large system and continue to permit it under the.1995 Code provided that there is no increase in sewage flow. The Department will require enhanced treatment capable of meeting secondary standards (30 mg/L/30 mg/L BOD/TSS and 15 mg/L Oil and Grease) and replacement of all,three existing systems. Generally failed systems must be upgraded within two years of failure. The Department recognizes that the existing failed systems need immediate attention and is prepared to develop a compliance schedule which addresses both immediate needs and the longer term upgrade. Accordingly, the Department is willing to meet with you to discuss the details of such a compliance plan. This information is available in alternate format.Call Donald A Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. DEP on the World Wide Web: http://www.mass.gov/dep Q* Printed on Recycled Paper ,j 2 If you have additional questions or require further information, please contact me at (508)946-2753. Very truly yours, Brian A. Dudley , Bureau of Resource Protection BAD/ cc: Radius Management Services, Inc. 1671 Worcester Road, Suite 300 ' Framingham, MA 01702 Attn: Erik Jones Cape Regency Nursing Home 120 South Main Street Centerville, MA 02632 Attn: T. Lavallee Board of Health 200 Main Street Hyannis,MA 02601 Attn: Thomas McKean PAbdudleyuarge systems\Barnstable\cape regency ltr.doc 1 rt l ?A IZT Y;AP RECE:-IVED :.PARCE. . LOT NOV 1 6 2004 TOWN OF BARNSTABLE HEALTH DEPT. DATE 10128104 PROPERTY ADDRESS 120 South Ila.in St., 5 S y PROP l • Cent e2v i fie, Ma., . 02632 On the above date, the peptic system at the address above was Inspected. This system consists of the following: 1.- 1-.5000 ga$.eon zept.ic tank 2.4-d.izta.igut.ion fox. 3.- 5- ee' ach.ing p.itz.. Based on inspection, I certify the following conditions: 4. 7h.i.3 .ins a t.it ee Live zept.ic 4yhtem., (78code) 5.-7he zept.ic :system .iz .in p2ope/z woak.ing oadea at the 12aeaent t.ime., SIGNATURE _ Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc . Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 C P. MACOMBER & SON, INC.. an ks-Cesspools-LeachfieldsPumped &.InstalledTown Sewer Connections 66 Centerville, MA 026.32-0066 775 3338 775-641 2, �� ,\ COMMONWEALTH OF MASSACHUSETTS EX-ECUTWE OFFICE OF ENVIR(VUBNTAL AFFAIRS DEPARTMENT OF RNVIAONMENTAIPROTUTION Y 4 • r TITLE 5 OFFICIAL INSPECTION FORM—.NQ.T FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART.A CERTIFICATION Property Address:1a 0 So u I h qqMain .0 f- Confonu'iYlei9oII r Owner's Name: nn k jo o d Owner's Address: „„ -r,o wa — . Date of Inspection: 1012 810 4 Nance of Inspector: (please print) 12.04k Company Name: P- ,,NacomAP_A Mailing.Address: C2n e2vc e, mAzZ.026, 32 Telephone Number: 5 0 8—7 7 :3 3 3 8 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 the inspection.The inspection-was performed based on my -training and experience in-the proper function and maintenance of on.gite sewage disposal systems.I am a DEP approved system inspector pursuant to�Saection.15:340.of- itle 5(310 XR,I5:a00). The system: xx Passes -Conditionally Passes Needs Parther Evaluation by the Local Approving.Authority F s Inspector's Signature: Dater 10. ju 0V The system inspector shall submit a copy of this inspection reporCto the.Approving Authority.(Board of Health or DEP)within 36 days of completing this inspection.If the system:is.a.shared syatern or has a design flow of 10,000 gpd or greater,the inspector and the syste6owner.shall submit the report to the appropriate regional•offiee of the DEP.The original should be sent to3he system owner and copies sentto the buyer,if Applicable,and fire approving authority. Dotes and Comments ****This`report only describes conditions at the time of inspection-and under the conditions of use at that ^ time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 1_ Y - Page 2 of 11 - OFFICIAL INSPECTION FORM—NOT1 FORNOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � PART`A CERTIFICATION(continued) Property Address:120 South Main S.t., Owner: orj&1�nr1 „( l u ng ('on4v213 Date of Inspection: 10.128 L0.4 Inspection Srimma•ry: Chia A;B C;D or.E/A.-WiA SS:Kwmplete'aH of Section;D A. System Passes: �g I have not found any information which indibates`th&f any of the failure criteria described in 310 CMR 15.303.or in 310 CMR 15.304 exist.,Any failure criteria not evaluated are indicated below. Comments: The .6ei2.t.ie 3tiztem "i, in Ra'ope2 wo2k.ing o/tde2 al- .the . nan.�nn# .t"ime. B. System Conditionally Passes: no One or more system components.as described in the"Conditional�Pass"=section.need to be replaced:or. repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. r Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please explain. no The septic tank is metal and.over20 years old*or the septic-,-tank.(whether metal.or:not)is stracturally unsound,exhibits substantial7infiltration or exfiltration.or tank failure.isjmminent: System.will pass inspection if the existing tank is replaced with'a complying septic-tmik.as-approyed by.the:Boasd of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available.. ND explain: n ry Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due.to a broken,settled-or uneven distribution box.System will pass inspectinn..if(with approval of Board of Health): broken.pipe(s).are replaced: . obstruction is removed distriba ion box is leveled or.replaced ND explain: n o The system required pumping,more than 4 times a year due to broken or obstructed pipe(s):The system will pass inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL)igECTION 'ORNI-NOT 'OR V fJI�UN'FATt� ASSESSMENTS SUgg 'A E S�EV�A'CE DISFO s ' SYSTELVi 1�18PtCTION,�ORM PART A . . CER7MCA'R0N"(6on inued) : Property Address:j ^^ ; m a in `S ' Owner:. C ene2h Date of Inspection: a_iac� C. Further Evaluation-is.Required by the Board of Health: Conditions.exist whichrequire further..evaluationb .the Buard:of Healthiin•order.:toAdtermine if-the system is failing to protect public•health, safety or the environment. _ .. 1. System will pass unless Board'of Heer•which-which erote t public health,safety•ith 310.Cand•tile enxiropment the system is.not functioning in. 15. a•marltt p Cesspool or privy is-within,50 feet of a.surface water It marsh. ua Cesspool or privy is within 50.feet of•a bordering vegetated wetland or a sa 2. System will fail unless the Board•of Health(and Public Water Supplier$-if any),datermines.-that the system is functioning in a manner that protects the public health,safety and environment: [� on system(SAS).:and the SAS is within 100 feet.of a The system has a septic tank and soil absorpti surface water supply or--tributary to asurfface water supply. na The system-has-a.septic-tank and SAS and the.SAS is�witA. a Zone 1 of a public water-supp}y. rab The system has a septic tank and.$AS:andthe SAS is within=.50 feet of a private water.supply well. The system has a septic tank and SAS and the7SAS is less than 100 feet.bitt 50 feet of more front a private water supply well" Method used to determine distance• **This system passes if the well water analysis,performed at a DEP certified laboratory,for at colfacility bacteria and volatile organic compounds indicates that the well is o eeefrom-pollution provided that no they the presence of ammonia nitrogen and nitrate nitrogen is equal to .1 PP failure`criteria are triggered.'A copy of the analysis must be attached to this form. 3, Other: Page 4 of 11 OFFIC AL•IINSP.ECTIONF.ORM-NOT'FORVOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSE SSYS'TE1VI INSPECTION:FORM PART A CERTIFICATION(continued) Property Address: 120 South Plain St., Cen.teay.iiiz, Na.- Owner: 0eikwo or/ /-i-v Sys Date of Inspection: D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to.each.of.the:followirig,forail inspections: Yes No . —.� Backup.of sewage,:intcFAChitv,or system.-component due_lo overloaded:or clogged SAS...Qr.cesspool �. Discharge:or ponding of effluent to the.surface of the:,ground or..surface:waters due to.an overloaded or clogged SAS or cesspool x Static liquid level in the distribution box above.outlet invert due to an Dverleaded or clogged SAS or cesspool ' _ z hiquid depth in-cesspool is less thank"below invert or.available volume is less than'h day flow x Required pumping more•tham4 times in the last year NOT due to clogged of obstructed pipe(s).Number of times pumped x Any portion of.the SAS;cesspool or privy is below high ground water elevation. _ x Any-portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface T water supply. x Any portion.:of a cesspool-or privy_is within a*Zone!1.ofa.public.well.. _ x Any portion of a cesspool or privy is within 50 feet of a private water supply well. x Any portion of a•cesspool or-privy is less than 100 feet but greater.than 5,0 feet from a-private water supply well with no acceptable_water quality analysis..[T•,his.syste.m.passes if the well water:analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compounds -indicates:that the well is.free from polluttoq:from:..Ibot:facility and.the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than.5-ppm,provided that no other failure criteria are-triggered.A copy of the analysis niust be attaehed.to this€oriq.) n b -(Yes/No)The system falls.I have determined that one or:more-of:the:$bove,failure}criteria exist as described in 310 CM 15.303,therefore the.system-.fails.The system owner.should contact the Board of Health-to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the:system must.serve.a<faeility,with a design flow of 1.0;00.0 gpd to 15i000, gpd, .. • You must indicate either"yes"or."no"to,each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no , x the-system is within°400 feet of a surface drinking water supply _ x 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 If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner-or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional.office of the Department. 4 Page 5 of I 1 OFFI'CL4,L INSPECTION FORM—NOT FOR V—t3EUNTARY ASSESSMENTS �— AtSURFACE-SEWAGE DISPOSATJ SYSTEM INSPECTION FORM PART 8 CHECKLIST Property Address:120 So.u.th lain' St. Owner: naAjU ocl Ldi� Cenie2!s Date of Inspection: /(7/ R&/�4 Check'if the following have been do.ne You'must indicate"yes°'or"ne as-.to each.of tl;e following: Yes N x _ Pumping information was prpvided'by the Qwner,occupant,or Board-of Health x Were any of the system components pumped out in the previous two weeks? x Has the system received normal flows in the previous two week period? - , , _ x Have large volumes of water been introduced to the system recently or as-part of thsanspection? x _ Were as built plans of the system obtained and examined?(If they were not available tote is N/A) x Was the facility.or-dwelling inspected for signs of sewage back up? x Was the site inspected for signs of break out? x• _ Were all system components,excluding the SAS;located on site.? x• _ Were the septic tank manholes uncovered)opened;and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and Aepth of scum? z Was.the facility'owner(and occupants if diff6rent from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and locatfoti of the Soil Absorption System(SAS)on the site.has been detetmined based on: Yes no .. x Fxisting information:For example,a plan at the Board of.Health. x Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance _ is unacceptable)[310 CMS 15.302(3)(b)] I Page 6 of 11 OFFMIA.L.•jNSP]$CTj:() !1.-V-QRM'-NOT FOR-VOL U.NT:A►RY ASSESSN"T 'S SUB UltFACE SMAGE OIS'ROSAd1r;+SYS'TSM., SPEETION FORM . PART•C . 'SYSTEM:INF'OPMATION Property Address: 9 7n c.,;,f h mn i n St Owner: o a& , .ti'.._i� i n r—�- Date of Inspection: 90 2 A l n/ NDITIONS , RESIDENTIAL Number of bedrooms{actual): Number of bioroAms(des)g�: . DL'SIGN flow Biased on 310 CM MiO '(for exaiiipYe:'l ID`gpd z�ofbedrooms)`: `. " Number of current residents:.. I7oestegidence have a garbage gnnsier(yes br no):_ Is laundry on a separate sewage.system(yes or-no):. [if Ps separate a e,tion required] Laundry system inspected(yes or no): Seasonal use,(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pumR(yes or no): Last date of occupancy: COMMERCI�hfll' USTRLA'L Type of e ,. Desk flRw -on 310 CMR.15.203):. 12 0 X 9 B0 ;pd' Basis.ofc] i8i'-low(seats/.persons/sgft,etc.):.120 �ed�, 60e�/�2.o:yee.� 18, OOOg?d Grease trap•present(yes or no):"r L,3 Industrial waste holding tank present•(yes or no):an_ Non-sanitary waste discharged to the Title 5 system es or no)•.r�. Water.meter readings,if available: 1'46&0'oo�0 C Last date of occupancy/use:, — OTHER•(descrihe):: O r QXNERAX1NFQ9MAP0N - pumping Records - Source of information. a�' �'Mac o m e2 . and o n, Inc.- Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped deteranined? Reason for.pumping: TYPE OF SYSTEM ' x Septic tank,distribution box,soil absorption.system • . Single cesspool Overflow cesspool Privy Shared system.(Yes or no)(if yes,attach previous inspection pe�0usrre orderationyand maintenance contract(to be _Innovative/Alternative technology.Attach a COPY P obtained from system owner) _Tight tank Attach a.copy.of the DEP:approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when-arriving at the site(yes or no):_JW Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:120 South Na.in Si-., _Cente2y.iiie, 17a. Owner: 0¢kwood Living Centeorz Date of Inspection: 1 n/2 R 0 4 BUILDING SEWER(locate on site plan) Depth below grade: 3 2" Materials of construction: cast iron 40 PVC_other(explain): Distance from private water supply_W61,or suction line: 10' f Comments(on condition of joints,venting,evidence of leakage,etc.): ��inf.z annv�in Li aht -In Pet and outiet tees aize in 12.ea6e., Syztem vented thorough 9uiid.ing ventz.1 SEPTIC TANK:_(locate on site plan) ,r Depth below grade:co v e or to gor a d e Material of construction:xx concrete —metal,—fiberglass_polyethylene _other(explain) If tank is metal list age:?o Is age confirme certificate) d by a Certificate of Compliance(yes or no): (attach a copy of Dimensions: 17'.e o n gl7' 7 0"wide/9'2"h.i gh Sludge depth: tor a c e Distance from top of sludge to bottom of outlet tee or baffle: 3' Scum thickness: 10 Distance from top of scum to top of outlet tee or baffle: R" Distance from bottom of scum to bottom of outlet tee or baffle: ?' How were dimensions determined; m o n A a R n_d Comments(on pumping recommendations,inlet and outlet tee or baffle conditio structural irate as related to outlet invert,evidence of leakage,etc.): n' grity,liquid levels .tank 20,, i2a aori5 -6t1zu0uora2ey sound ,No evidence oZ eaka ore GREASE TRAP:_(locate on site plan). Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene_other (expo): —' Dimensions: 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-baffle: m Date of last Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): ------------ •7 .. r Page 8 of I I OFFICIAL IN-SFECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 120 South Main St -- Owner*•�i r te2b Date of Inspection: 1,0,,28,10 4 . w A TIGHT or HQ.IrDING TANK:n o (tank must be pumped at time of inspettion)(locate on site plan) Depth below grade: na Material of construction: concrete metal fiberglass Tpolyethylene other(explain): Dimensions: 110 Capacity:^ n,__gallons Design Flow: _ n n gallons/day Alarm present(yes or no): n r Alarm level:_ Alarm'tn working.order(yes or no): Dote of last pumping:_ a rz_ Comments(condition of alarm and float-switches,etc,): T 7iaht na hnOr1jna Inn&A nat �nlzpAani DISTRIBUTION BOX-.Ye�s (if present must be opetted)(locate on site plan) Depth of liquid level above outlet invert: no Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) B x ha,3 5 iateita.Ph No evidence o-ZTX akacre .into oa out ^0.1 gox N . evid6zca Q,-& zoiidz caltItuoyea., PUMP CHAMBER: no (locate on sife.plan) Pumps in working order(yes or.no): nn Alarms in working order(yes or no):mna - Comments(note condition of pump chamber,condition of pumps and appurtenances,ett.): Ptimrn r•hnm0on not nno.tont ! - • • • � � } ill Page 9 of 1 I OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART-C SYSTEM INFORMATION(continued). Property Address: 120 South Main St:, , Owner:. Cente2z Date of Inspection: T?R L(L SOIL ABSORPTION SYSTEM(SAS):_.(locate on site plan,excavation not-required) If SAS not:located explain why: Located ee 12a e. 90 Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovativehalternative'system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation; etc.): h dltaatic a i�uae --•�. So.i.�z a eat d2 .�No evidence o� y ai. CESSPOOLS: no (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n a Depth—top of liquid to inlet invert: na Depth of solids layer: n n Depth of scum layer: a a Dimensions of cesspool: n Materials of construction: Indication of groundwater.inflow(yes or no): na Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 2e•sen.t. PRIVY:no (locate on site plan) Materials of construction::. n a Dimensions: na Depth of solids: na Comments(note condition of soil,signs of hydraulic failure,level ofponding,condition of vegetation,etc.): g4gnt,, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFORMATION(continued) Prop-tyAddresa:120 South' Main Street Centerville ,Mass . Own" Oakwood Living Centers Date of Inspection: 10128104 , SKETCH OF SEWAGE DISPOSAL SYSTEM: Include t)es to at Fast two permanent reference landmarks or benchmarks locate all wells wlthln 100' (Locate where public water supply comes Into house) t .^\ y �Z ,:may.''',. _ - • , O o ry . ) 7 Ay r� 'to Paze 10 of 11 r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . OSTBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 120 C „f h Nni_n- St_.,. . Owner: �Cente2h Date of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells "f` F: Estimated depth to ground watergS feet Please indicate.(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan Mviewed: Observed site(abutting propertylobservationhnle within 150 feet of SAS) Checked with local Board of Health-explain: Checked:with local excavators,installers-(attach documentation) Accessed USGS database:explain: �—. You must describe how you established the high ground water elevation: water used;Giaherty & Miller model 12 1 used•UTG— observation w used-'Technical bull — — wa er a eva ions. Leaching Pit "cet , Groundwater: Feet Below.Bottom-of Pit High Groundwater Adjustment 1.8 ft per Vntptej Method 3�� Therefore,the vertical.separation distance between the bottom of the /leac©ping pit and the adjusted groundwater table is r 6W •.�-mr^^^�"^'�'r"""""r""Tf "�' � � WARD OF HEALTH >•„rr,..,.-rt,•r�- rr q,OWN OF INSPECTION FORM - .PART D - CERTIFICATION Sl1I1SU11'FACF 9FHAGF p18POSA4 SYSTEM ••se•t-T•;•::•--a�-r•-n:rsren'rt:rnrns:n'e'era+r:end'rr.Krtvtrryarr+..TypZ .. 7YPE OR OR pR1N7 CLEARLY- PROPERTY INSPECTED 1.20 South Main St.t STREET ADDRESS ASSESSORS MAP , DI.&QCK AND PARCEL # , OWNER i s NAME Oak.wood .tivin �. t PART D CERTIFICATION _ 1 NAME OF INSPECTOR J COMPANY NAME Joseph P. Macomber &'Son COMPANY ADDRESS Box 6 Cent soxn or city $tit' Lip screec COMPANY TELEPHONE ( 508 } 775 - 3338 FAX 508 7 0 - 1 7 amrIFICATION STATEMENT ' I certify that I have personally .inspected i'sthe truesewage accurategaandsystem at this address and that t}i.e information reported inspection was performed and any omplete as of the time of �insp,ection , recommendations regarding upgrade , repair are maintenance ofon- . With my 'trainitst.gosad systemsnce in the P sews a ,di p site E Check one: System PASSED The inspection which I have con 'fails to9protectducted ha not found any information n adequately public which indicates that the system health or the enviro:pment as defineed in the FAI LURE 3CRITERIA fsection of criteria.-not evaluated are as sta this, form. \A�ot c System FAILED* system fails t The. inspection which I hllvand�the' en1001 vironmen.t has nintaccordance with Title protect the jiublic healt specifically noted on PAET� -�1ILURE 5 , 310 CMR 15 . 303, and as CftITERIA of this i Pectio form, L e elo Z/ Inspector Signature Oecopy of this certtficationRDus be p ovided 'to the QWNER, the BUYER n where applio'able ) and th . * If the inspection FAILED , thvthenns°FectionQtor unlesslall.owed upgrade ortrequi.redm within o'ne year of tl)e date of otherwise as provided in 310 CKR partd .dc -- -1r eRCEL • So_0kw\...,.. FAILED INSPECTION ®� wy�y- d Nov 1 2004 TOWN OF BARNSTABLE HEALTH DEPT. DATE W28104 Sy J PROPERTY ADDRESS120 South -Ma.in _St., Cent eav i Q Qe, Na. 02632 On the above date, the4eptic system at the address above was inspected. This system consists of the following: 1.- 1-2500 gaiioa g2eaze t zap.t'-5000 gazion g2eaze . tzap. 1-d.izia iaut.ion kox and `5 iedch.ing '12,itz.- 2.. 1-5000 gaii?on zept.ic .tank., 1-d.izsbzigut.ion Sox, 5-eeach.ing 12.it6., Based on inspection; I certify the following conditions: 3.•7hzze ate .t.i.t.Re rive hept.ic zyztemz.. (78 code) 4.,Both zyhtem! aae .in hyd¢auLic la:iiu2e.. SIGNATURE _ Name: Robert A. Paolini- Company: Joseph P. Macomber & Son Inc,. Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 vim JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 • i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE`OF EI - MaNWNTAL AFFAIRS DEPA tTMENT OFONMgNTAL PR MOTION "- TITLE 5 OFFICIAL INSPECTION FORM—•N ATO FOR.VOLUNTAtRY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A; CERTIFICATION Property Address: outh (7a-.n St. p n n n T)J Y Y 0, 117r/ Owner's-Nan*. k w o o .n u Owner's Address:1L2d n n )n Date of Inspection: 10128104 Name of Inspector: (please print)�ko&eat-fl:a o:2<1_.i ' Company Name: , !.:m¢com�e2 .S>Arz Znc. Mailing Address: - Cen, eay.c e„ czs7.•02632 . Telephone Number: 5 0 8—7 7 ' 3 3 3 8 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 the inspection.The inspection was performed based on my training and experience in-the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant taSection.15340.of-Title 5(31.6 CMR45:000). The system: Passes Conditionally Passes Needs Further Evaluation.by the Local Approving.Authority Fa Inspector's Signature: G Dater The system inspector shall submit a copy of this inspection report-to the.Approving.Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system:zs 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 DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ` Notes and Comments ****This report only describes conditions at the time of inspection-and under the conditions of use at that '~ time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION:FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 120 South Main S t • �nnfva»iP1/o� l�In . Owner: Qakwo nd /1»i n q ( o n t e2b Date of Inspection: n i 2 R./a 4 Inspection Summary: Check AB C,D or.V complete-all of Section;D A. System Passes: _ye, I have not found any information which indicates;t At-any of the failure criteria described in 310 CMR 1 35 03.or in 310 CMR 15.304 exist.,Any failure criteria not evaluated are indicated below. Comments: Oi�no ref fho .svni The ����e ���em '� .%n h��lanu .i,,. r �� � �� time., B. System Conditionally Passes: no One or more system components as described in the"Conditional Pass"::section.need to be replaced:or repaired.The system,upon completion of-the replacement or repair,as approved by the Board of Health,will pass. . .determined Y N ND in the for the following statements.If"not determined"please Answer es,no or.not ( _> ) Y explain. no- The septic tank is metal and.over 20 years old*or the septic-tank(whether metal.or not).is:structurally en S: stem.will ass inspection if the unsound;exhibits substantial.ainfiltrati�an or exfiltrahon.ar-tank failure.is.,imm>n ,t y P P existing tank is replaced with'a complying septictank.as-approved by the'.Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n o Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection.if(with approval of Board of Health): broken.pipe(s).are replaced. . obstruction is removed distri>itition box b leveled-arteplaced ND explain: no The system required pumping more than 4 times a year due to broken or obstructed pipe(s):The system will pass inspection if(with approval of the.Board of Health): .a broken pipe(s)are replaced obstruction is removed ND explain: r Page 3 of 11 NTS 0171CIA.L E%Mp.--ECTION FORM-'NOT:I'OR V'fiJLUNTARC IONFORSSMM SUB��JRFA E S�'WA6E]XSROSALAYSTEN INSP`ECTI�N,= 'OI I PART A . . : Property Address:120 South n �zte2/3 Owner:. a Date of Inspection: C. FurtberFwaluabon•fsRequired by'the Board.ofHealtb;.. no Co nditions. which require further..eualuatiMby.the•Board:of,-Health;in order:to:detertriine ifthesystem is failing to protect public,health, safety or the environment.- nes�jjl::..ince b that the 1, System will;pass unless B a a madtealth icth-wlll protect public health,safety.atYtl tbt environment: system is.not functioning i n o Cesspool or privy is within,SO feet of a surface water vegetated wetland or a salt marsh. n o Cesspool or privy is within 50.feet of-a bordbitering will fafl unless the Board•of Health(and Public Water Sue plandif any)d . tintues that the 2. Systemroteets the tiblic health,safety system is functioning in a manner.that p P ILO The system has a septic tank and soil absorption system{SAS).:and the$AS is with-in feet.of a surface water supply or.-tributary to a.surface water-Supply no The s stem tank and SAS and the;SAS isVilhin a Zone 1 of a-public water-supply. y well. no The system has a septic tank and.SAS andthe SA'S'is within,50 feet of a private water.supply n o The system has a septic tank and SAS and the-SAS is less than 100 feet.but 50 feet or:ltiore front a private water supply well".Method used to determine distance- for c0lifOrm **This,system passes if the well water analysis,performed at a is free from-pollution ution from laboratory, that facility and bacteria and volatile organic compounds indicates that the provided that no other d nitrate the presence of ammoniaed A co nitrogen ylof the analysis must b;attached t this eD is equal to or less then m m, failure criteria are tri- P 3, Other: f Page 4 of 11 OFFICIAL-INSPECTION FORM NOT'FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION:FORM PART A CERTIFICATIOI`l(continued) Property Address: 120 Soa;th Na'.in St., Con.to3.tla:P.Po„ l'l�i:"' Owner:Oakwood L _Cn� ic�5' Date of Inspection: D. System Failure Criteria applicable to all systems:. You must.indicate-"yes"or"no"to.each.ofthe:following,for all.,inspections: Yes No z. Backup of sewA e,:into-fat?lit .:or system-'component.dueto overloade&or clo gged SAS..or.cesspool X. Discharge:or-ponding of effluent to the.surface bfthe:.gound or...surface:waters due to:an�overloaded or clogged SAS or cesspool x _ Static liquid level in the distribution box above.outlet invert due.to an overloaded or clogged SAS or cesspool ' x Liquid depth in-cesspool is less thank"below invert or,available volume is less than'%.day flow x Required pumping more-than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped x Any portion of.the SAS;cesspool or privy is below high ground water elevation. x Ariy,portion of cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface water supply. x Any portion,ofa cesspool ror.privy is within a:Zone I ofa.public.well.. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. x Any portion of a"cesspool or-privy is less.than 100 feet but greater.than 50 feet from a.private water supply well with no acceptable water quality analysis...[This.system,passei if the well water:analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compounds indicates:that the well is.free from pollution;:from:-Ihat.facility and.thq presence of ammonia nitrogen and nitrate nitrogen is equal to or less than.5 ppm,provided that no other failure criteria -are-triggered.A copy of the analysis niust be attache&to this foriQ..] ye-3 (Yes/No)The system falls.I have determined that.one or:more-of:the:above.failure criteria exist as ! described in 310 CMR 15.303,therefore the.syster.n-fails.The system owner.should contact the Board of Health-to determine what will be necessary to correct the failure. E. Large Systems; . . -To i e considered a large system the:system must.serve.a facility,with a.design flow of 10,00.0 gpd to 15j000. gpd• .. You must indicate either"yes"or"no"tq each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no x the-system is within 400 feet of a surface drinking water supply z the system.is within 200 feet of a tributary to a surface drinking water supply x the:system is located in a nitrogen sensitive area(Ipterim Wellhead Protection Area_IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered . "yes"in Section D above the large system has failed.The owner,or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional.office of the Department. 4 Page 5 of I I OFFICIAE INSPECTION FORM—NOT FOR-VOLUNTARY ASSESSMENTS AtRSURFACE-SEWAGE DISPOSAUSYSTEM INSPECTION FORM PART CHECKLIST Property Address: 120 South Mai. S.t:• •• renfon>»OOo1, No- owner: Cent e z.3 Date of Inspection:4 22!g z n i Check if the following have been.dpne.You must indicate'yes"or"na"as=to each.of the following: Yes No -� x — Pumping information was provided-by the Owner,occupant,or Board-of Health x Were any of the system components pumped out in the previous two weeks? x Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as-part of th,sinspection? x Were as built plans of-he system'obtained and examined?(If they were not availabWhote is N/A) x Was the facility.or•dwelling inspected for signs of sewage back up? x — Was the site inspected for signs of breakout? x Were all system components,excluding the SAS; located on site.?- x _ Were the septic tank manholes uncovered;itopened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and.depth of scum? x Was.the facility'owner(and occupants if diff6rent from owner)provided with information on the proper Maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS).ony the site.has been determined based on: Yes no x Existing information:For example,a plan at the Board of.HeaM. _ x Determined in the field(if any of the failure criteria related to Part C is at issue approxirMion•flf distance is unacceptable) [310 CMR 15.302(3)(b)) a. l �: Page 6 of 11 OFFICIAL INSPTC.TION.,F,,}RM;71 NOT•FOR-VOLU-NTA;RY ASSESSMENTS SjMSUgFACE.Si9WAGE OISPOSAj,,SYSTUK,1 SPEETIO..N_FORM PART.0 SYSTEM-INFORMATION Property Address: 12 c„i,f h M/7 I n Sf,, Owner:.-6rra ivaaad--L.�zL�n r n n o it A y Date of Inspection: FLOW CONDITIONS` RESIDENTIAL Number of bedroonts(des}gn):,,, . dumber of:bedrooms..(actual): DESIGN flowbased on310 C1V'1�15.203�(for example:1IO gpd x i�ol'bedrootns)': '. Number of current residents: .: Doesresidence have a garbage grinder(yes or no): Is laundry on a separate sewage.system•(yes or.no):._ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump puu(yes or no): Last date of occupancy: COMMERCI4l�USTRIAL Type of esta tVV r L n t.l n U H.o m e ' Design flgw �""on 310 CMR.15.203) 120X 1,80 apd- Basis.of digtiflow(se 1 20 &e d z, 6 0 e�/� °. 18, O O O gad Grease trapVresent(yes or no):-4tz.6. Industrial waste holding tank present.(yes or no): Non-sanitary waste discharged to the Title 5 system- yes or no):r o. Water.meter readings,if available: '. • 4�(�,�o�� � �� Last'dite of occupancy/use: _ OTHER(describe):. V . GENERAL INFORMATION Pumping Recprds Source of information: I.,P.'flacomeelt , and, .son, Znc.- Was system pumped as part of the inspection(yes or no):_ If yes;volume pumped:_____gallons- How was quantity pumped determined? Reason for.pumping: TYPE OF SYKEM • x Septic tank,distribution box,soil'absorption system —Single cesspool _Overflow cesspool —privy _Shared system.(yes or no)(if yes,attach previous inspection records,if army) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank. Attach a.copy c!f the DEP.approval , Other(describe): Approximate age of all components,date installed(if known)and source of information: 19.81 Were sewage odors detected when arriving at the site(yes or no):_aD Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL`SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 120 Soal_h gain St Owner: Ra Cent e/zz Date of Inspeetion• 4 BUILDING SEWER4(locate on site plan) . p Depth below grade: /Qe at h,3 arc y t Materials of construction:_yeast iron _X_40 PVC_other(explain): Distance from private water supply_ym.4 or suction line:" '101 t Comments(on condition of joints,venting,"evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) 1-5 0 0 0 gr�Y 2 o n 1120 Depth below grade: Material of construction: x concrete ._metal;' fiberglass'_ Uolyethylene _other(explain) If tank is•metal list age: n n Is age confirmed by a Certificate of Co hence es or no ; (Y ) - (attach a copy of certificate) . Dimensions:_17' iorz'g/9' 2"h.igh/7' 10'w4.de Sludge depth: h Distance from top of sludge to bottom of outlet tee or baffle: 7' Scum thickness: Distance morn top of scum to top of outlet tee or baffle: Distance from bottom of scum to Bottom of outlet tee or baffie " How were dimensions determined; Comments(on pumping recommendations, et an outlet tee or baffle condition,structural integrity,liquid levels 4 as related to outlet invert,evidence of leakage,etc.): /)ljm.,J APRI.i.cank .tw-ice Reg Pump gaeaze bzapzeve2y month GREASE TRAP:_(locate on site plan) DT/t I a jeon 1/5000, gaieon �. ep eo gra e: , covezz •to?-'gzade ' Material of construction: -concrete.—metal_fiberglass(explain): ._ _other other Dimensions2500/12'.eong/6. 9"w-ide `7g .bong/7' 10'w.icle/9'2"h.igh Scum thickness.- Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or-baffle: 2' 4" Date of last pumping: on in ( Pumping Comments recommendations;inlet and outlet tee of baffle condition,structural integrity,liquid levels - as related to outlet invert,evidence of leakage,etc.): gump ease tea z month , Page 8 of OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS :90SUR '7A:CE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• SYSTEM INFORMATION(continued) P.roperty Address:120 South 17a.in S t.- �onfon»i0�'��/. Owne6akwood L.ivi-n Cente2�s. Date of lispection: 9 0/ 8/0 4 ' TIGHT or HOIrDING TANK: n o (tank must be primped at time of inspection)(locate on site plan) Depth below grade: na " Material of construction: concrete metal fiberglassjolyethylene other(explain)- Dimensions: ha Capacity: na gallons Design Flow: na gallons/day Alarm present(yes or no): _n n Alarm level:na Alarm•in working-order(yes orno):na Date of last pumping:_a Comments(condition of alarm and float.switches,,etc,): 'T;-A4 6oCcj ny fnnkA nnl''/ o•5ernt. DISTRIBUTION BOX:yeh (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:de s oe s.t U ing and wean gaeahe taa/2 Comments(note if box is level and distribution to outlets equal,any evidence of solids.carryover,any evidence of leakage into or out of box, etc.) ino nce o 2eaka e. evidence o� 3o•.Ud3 caazy oven. ldnfv2 �21 rove .invea4�s on go bye em�sr PUMP CHAMBER: no (locate on sife.plan) Pumps in working order(yes or.no): Alarms in working order(yes or no): Comments(note condition of pump,chamber;condition of pumps and appurtenances,ett.); Pt M.12 Cham9elz not 122ehent. - Page 9 of 11 OFFICIAL INSPECTION)FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE—SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 120 South Main St., • en e2v.t e, a•' Owner:0akw6 ocl L iv�n c[ Cent e2h Date of inspection: 9 n Z 2 R/0 4 SOIL ABSORPTION SYSTEM(SAS): .(locate on site plan,excavation.not.required) If SAS not located explain why.,. go 10 Type -L—PLhleaching pits,number:10 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions, _overflow cesspool,number: _innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 6ign o� hydnauiie �aiiaae.-on�g� wing ai 2ea ou on eac Ong R wah CESSPOOLS: no (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: . Depth of scum layer: 1 Dimensions of cesspool: Materials of construction: I Indication of groundwater.inflow(yes or no): s of hydraulic failure,level of ponding,condition of vegetation,etc.): Comments(note condition of soil,sip Cezzs ooiZ not aeoent.l PRIVY: no (locate on site plan) Materials of construction: Dimensions: 1. Depth of solids: signs of hydraulic failure,level,ofponding,condition of vegetation,etc.): Comments(note condition of soil, l 2�v no 2ez nt. f dvl� .. n= r r ' ti• ;��• �+��..�x`� �„,:S.`1S URFACESEWAGE DISPOSAL SYSTJd INSPECTIO N FORM s" PART C 'x SYSTFJd LNFORMAY10N(con -ed) DISPOSAL SYSTFJd Ji► ty �:t)es to at least-two permanent ra(etence landmarks or benchmarks e 4 T Y,tel�s'-within 100 (LocAu where public water supply comes Into house) t•. 41,1 t .. .... ... .... p V � t y _ � o '' `-N Ca ll � • 1-7 J ' rervi,�ad 9,AV-M ; . Page to or it I Page 11 of 11 OF CIAL INSPECTION FORM—NOT FOR VOLUNTARYASSESSMEN INSPECTION FORM TS „✓ , SUOSV FACE SEWAGE DISPOSAL SYSTEM PART C SYSTEM INFORMATION(continued) Address: 120 'South (lain St. . Property Cen.te2v�..eee na ",Qd (i»1_n� Cent eab Owner: , Date of inspection: SITE EXAM Slope Surface water Check.cellar. Shallow wells - Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan rgviewed: Observed site(abutting property/observation hole within.150 feet of.SAS) Checked with local Board of Health-explain: Checked:with local excavators,installers-(attach documentation) Accessed USGS database:explain: You must describe how you established-the model high g2 un d water elevation: used;Gahert & Miller used;USGS observation w 1 nila used• Technical bull — wa er a eva ions. 10 Leaching Pit ;eet Groundwater: feet Below Bottom.of Pit Nigh Groundwater Adjustment 1.8 ft peineptejMethod Therefore,the vertical.separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet:, a r, DATE: ,3/1.9/.99 PROPERTY ADDRESS: ,120 -South Main* Street Centerville ,Mass . 02632 ' L On the above date, I Inspected the "ptic systom at the above address. Thls system conalsts of the following: 9— OF OF ?, ® � � 1 . 1-250Q gallo'n grease tr'ap , 1-5000 gallon grease trap and on•e distribution box , 5—leaching pits . 2 . 2-5000 .gallon septic, tanks , 2—distribution boxes and 12 10 ' Pits eased bn my Info- ctlon, I certify the following condltlona: 3 . This is a ti.t_le__f_iv.e_-sep_tic, syst6ffi':' t` •7� Code ' ) 4 , The septic and" water sysCem is in proper �wbrking order at the present time . - 5.. Grease traps are pumpedinonflily, Septic atnks are pumped every 6 ; months . 81GNATUR 7; Name J P. H'acomber Jr:•,. i J Company: J. P , HacoiQber 6 $om '7nc , Address : g _66---..__.:.�___---7 � APR 02 1999 . r __Len Epry 1 Le �K.�.7.i_Q2b3.2 D'yCRTLNBN"TABLE DEPT Phone:___' Sea L7S-JZ a___---_ --I THIS CERTIFICATION GOES HOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P, MACOMBER '& SON, INC, TinkpCoupoolpt.sichllsIda . Pump+-d L Instsllr,d ' • Town $iwir Connoctloni P.O. Box 66 ' Ctntervllle, MA 02632.0066 775-3 3 19 7)54412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 120 South Main Street NameofO,,,. Oakwood Living Centers Centerville ,Mass . 02632 Address of Owner: Data of Inspection: 3/19/9 9 Name of Inspector:(Please Print) Lloqeph P Macomber Jr . I am a DEP approved system irupettor pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: J. P Macomber & Son T n c . MairuVAddress: Box 66 Centerville-,Mass . 02632 Telephone Number: 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-sites age disposal systems. The system: Passes '`—•_-'Conditionally Passes _ Needs Further Eval tion By the Loca pproving Authority Fails Inspectors Signature: d Date: The System Inspect all submit a copy of this insp tion report to the Approving Authority (Board of Health or DEP)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 otrEnvironmental Protection. The original should be.sent tom system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 11 �� Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Data of Inspection: INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTl7d PASSES: I have not found any Information which Indicates that any of the failure conditions described In 310 CMR 1-6.303 exist. Any failure /criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: 1 One or more system components as described in the 'Conditional Pass- section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was Installed within twenty(20) years prior to the date of the Inspection: or the septic tank, whether or not metal, Is 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 complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass Inspection If (with approval of the Board of Health). broken pipe(s) are replaced obstruction Is removed distribution box Is levelled or replaced The system required pumphtg•mare than-fourtfines m yeardue to broken or obstructed pipe(s). The system wilt-pnss-- Inspection If(with approval of the Board of Health): broken pips(s) are replaced obstruction is removed System ! 1 . The grease traps are pumped monthly - � 2. The septic tanks are pumped every six months f `3 . Cape Regency Nursing Home & Rehab center operates at 118 bed occupancy . revised 9/2/98 Page 2ofll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (cor kajed) PropertyAddresa: 120 South Main Street Centerville ,Mass . Own" : Oakwood Living Centers Date of kupectkm: 3/19/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ✓6 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTI IS NOT FUNCTIONING IN A MANNER WWCH.]AfiLLPRQIFCT THE PUBLIC HEALTKAND SAFETY AND THE EM1480NMENTs j Cesspool or privy Is within 60 feetvf surface water Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBUC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEA FUNCTIONING IN A L&ANNER THAT PROTECTS THE PUBUC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS Is within 100 feet of a surface water supply c tributary to a surface water supply. rt The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 60 feat of a private water supply well. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or more from a private water supply wall,unless a well water analysis for collform bacteria and volatile organic compounds indicates that well Is free from pollution from that facility and the press Vce of ammonia nitrogen and nitrate nitrogen is equal to of less than 6 ppm. Msthod used to determine distance (approximation not valid).- 31 OTHER revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop,,nyAd&ess:120 South Main Street Centerville ,Mass . Owner: Oakwood Living Centers . Date of Inspection: 3/19/9 9 D. SYSTEM FAILS: You rrlust indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes No Backup of-sewage intoiacili"usyetem component,dueqo en overloaded or�clegged-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. Static liquid level in the disR,5than ' ution box above outlet invert due to an overloaded or clogged SAS or cesspool. �,.... t p� I Liquid depth.in��f�Ys 6" below invert or available volume is less than 1!2 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 Absorption System, cesspool or privy is below the high groundwater elevation. 7 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. (I Any portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. 7 Any portion of a cesspool or privy is less 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 r•coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: ` The following criteria apply to large systems in addition to the criteria above: "The system serves a facility with a design flow of 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: Yes Ny / the system is within 400 feet of a surface drinking water supply ✓ the system is-within 200 feet at•a-Hibutary-toa surfsoo-dr"ing•water-supply Jthe 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforpation. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAI,SYSTEM INSPECTION FORM PART B CHECKLIST ± PTopertyAddrass: 120 South Main Street Centerville ,Mass . Owner: Oakwood Living Centers Darts of ln4>"cti4": 3/1 9/9 9 Check If the following have been done:You must indicate either'Yes' or'No' as to each of the following: Yes No Pumping Information was provided by the owner, occupant,or Board of Health. _ Nona of the aystemcon*oavnta pair►pad4oPatJaaattwo•waak4aadt4a•rystom hasbaacascsia:wgwra■al flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. _ As built plans have been obtained and examined. Note If they are not available with N/A. _ The facility or dwelling was Inspected for signs of sewage back-up. The system does not recelva non-sanitary or Industrial waste flow. _ The site was Inspected for signs of breakout. All system components,yiFat:luding the Soil Absorption System, have been located on the site. _ The 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 Uquld,depth of sludge, depth of scum. The size and location of the Soil Absorption System orr the site has been determined based on:- _ Existing Information. For example, Plan at B.O.H. _ Determined In the field(If any of,the failure criteria related to Part C Is at Issue, approximation of distance is unacceptable) (15.302(3)(b)) The facility owner.(and. cam+=,Jf di.tleraut froc>.aurnarl.orate�cnutdad with ininunasioaon p:orag mai'Qt=n of SubSurface Disposal Systems. revised 9/2/98 Page 5ofII l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION p,•.partyAdr,,,: 120 South Main Street Centerville ,Mass . Owner: Oakwood Living Centers . Date of Inspection: 3/19/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: A19 g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual):&,4 Total DESIGN flow__ Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or no):&1-11-1 If yes, separate Inspection,required Laundry system inspected (yes or no) Seasonal use(yes or no):-&& [� Water meter readings,if av�afilable(last two year's usage(gpd): IV* Sump Pump(yes or no): Last date of occupancy: COMMERCLALANDUSTRIAL: t aa Type of establishment: C ld *fV Design flow: ( a ad on 15 203 -J Basis of design flow �� 9 ��� f Grease trap present: es or no)� 6a� r- /�-- Industrial Waste Holding Tank present: (yes or no)� Non-sanitary waste discharged to the Ti e 5 system: (yes or no) -A G ,(f - 4141 Water motor readings,If vailable: ,/ .,,+ Last date of occupancy:) s '� 1 ` 9r,�6' d - OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING REC RDS and ;pur�of inform do 6 �(/ j System pumped as part of inspection: (yes or no) If yes, volume pumpad:/J allons Reason for pumping: 0 )-Ira P /'L, u ' TYPE OF SYSTEM ;) Septic tank/distribution box/soil absorption system A[Q_ Single cesspool AM Overflow cesspool 44 Privy Afb Shared system(yes or no) (if yes, attach previous inspection records,if any) AJIT I/A Technology etc.Attach copy of up to date operation and maintenance contract J,,t_ Tight Tank 04 Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed4if known)-and source of4oformation: Sewage odors detected when arriving at the site: (yes or no)4,0 ^J _ revised 9/2/98 Page 6of11 h k Nave: Cape Regency Nursing Home Customer Code: Address: 120 South Main Street Pg 1 crnh Town: Centerville state:Ma 7ip:02632 wiling address: 778-1835 617-356-3000 120 So Main St Centerville MA 02632 see card 1992&before Notes: 10122192 pump rear 840.00 1121193 10123192 pump frontT 840.00 1121193 11113192 pump upper T 210.00 1121193 11123192 pump all pits off gt's 1470.00 1121193 120192 pgt's 630.00 1121193 116193,pump grey water side 1840.00 3116193 C116193 snake 155.00 3116193 218193 pgt 660.00 3119193 2118193 pump LP 690.00 517193 314193 pgt&Ichbck 825.00 5125193 319193 pump 1 53900 3110193 pump 76950 1 61 0.00 5125193 �3)12193 snake 85.00 pgt 460.00 6118193 3120193 pump LP 460.00 6118193 Name: Cape Regency Nursing Home Customer Code: Address: 120 South Main Street Page 2 crnh2 Town: Centerville State:Ma zip:02632 Mailing address: 778-1835 617-356-3000 120 S Main St Centerville MA 02632 Notes: g1.9193_resetcover 79.70 6118193 415193 pgt&FB from LP 675.00 8117193 411 U93 pump sewsys 1150.00 snake 210.00 8117193 4128193 pgt 460.00 8117193 518193 pump LP 690.00 9110193 5N 1193 pgt&LP 690.00 11116193 6111193 pgt 690.00 11116193 7120193 pgt 675.00 1217193 8113193 pgt 690.00 1217193 9115193 pgt 690.00 318194 10115193 pgt 690.00 3115104 11129193 pump comp gw sys 1610.00 3115194 12128193 pgt 690.00 4112194 1128194 pgt 720.00 5117194 " 2125194 pgt 645.00 617194 4113195 pump comp gw sys 1610.00 Name: Cape Regency Nursing Home Customer Code: Address: 120 South Main Street Pg 3 crnh3 Town: Centerville state:Ma zip:02632 Mailing address: 120 S Main St Centerville MA 02632 Notes: 3125194 pgt 690.00 617194 4128194 pgt&LP's 1380.00 7115194 512%4 pgt 520.00 812194 619194 pgt 460.00 812194 6130194 pump sys gwside-&LP's 1380.00 1017194 7128194 pgt 690.00 1017194 8114194 pump gw490.00 snake 125.00 1219194 8130194 pgt 690.00 1219194 10114194 pgt&LP 920.00 1120195 11115194 pgt 690.00 . 1131195 11130194 3 loads gw side 690-00 2110195 1211194 pgt&LP's 1150.00 313195 12128)94 pgt 690.0.0 417195 1130195 pgt 690.00------------ �El Customer Code: H�1e: Cape Regency Nursing Home 2 crnh2 Address: 120 South Main Street page 2 02632 Town: Centerville State:Ma. Mailing address. Centerville MA 02632 120 S Main St 2127195 pump LID's grey wside 920.00 515195 Notes: 2128195 pgt 690 00 5�5195 13128195 S C 65.00 pump 4 loads6grreyy wat 920.00 5119195 19195 3130195 SC snake 135.00 619195 417195 pgt 460.00 4113195 pump comp GW 1610.00 619195 412 519 5 pump 6 loads gray wside 1380.00 6123195 511 1195 pump 4 loads gray wside 920.00 6130195 5112195 pump3 load gray wside 690.00 61301195 612195 pump 4 loads gray wside 920.00 717195 120195 6112195 pgt's 690.00 717195_ 618195".pump T's_2070.00 _ --145.00___8115195 1122195 pow snake interior line to grease trap ._ 6122195 pump 4 load gray wside 920.00 8115195 6130195 pump 6 load gray wside 1380.00 7114195 718195 pump 7 load gray wside 1610.00 8115195 Customer Code: Nai1e: Cape Regency crnh3 Address: 120 South Main Street Page 3 10*�: state-Ma Zip-zip. Centerville "I' g address" Centerville Ma 0263.2 120 South Main Street 7117195 pump gray wside 690.00 1s50 00 8115195 Notes: 7126195 pump 5 loads gray'161de 9113195 815195 pump 5 loads gray wside 1150.00 1014195 oil 0195 pgt 690.00 10125195 8114195 pump gray y,,ide 920.00 10125195 8119195 pump gray yrside 690.00 10125195 812 619 5 pump 3 load gray wside 690.00 1111195 912195 pump grey wside 690.00 1111195 918195 pumped gray wside 690.00 11)1195 91,0195 pump upper gt 230.00 1111195 9111195 pump lower gt 460.00 9115195 pump 4 loads grey wside 230.- 0 1118195 9116195 pump 1 load grey wside wside 920.00 11115195 9122195 pump 4 loads grey 9130195 pump 3 loads grey wside 690.00 11115195 1 J� Macomber Customer History Screen 3119199 Customer number 1611 Company Name I .............................................................................................................................. Customer Name Pxr&.' 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C�-stor _.� rlrr �I';t Billing Address :a. ! .. ?!�f�i.IV1::�1T]..;i.�t. :............................ ............................... Print BiilingCity t'i.: .f'A.IJ.I. ......................................................................... BillingState1':?1.:...................................................................................................................... Billin gZi p Notes ...........1.1.1.))...'�. ............................................................................................................. 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Macomber Customer History Screen 3119199 C u-3t orn er n un. b er 1613 Create New lriyolcp Com pang Name .............................................................................................................................. C u3t om er Nam e C-'*�?.pe..R.,, xta�;d...................................................................................... Firid In'V0j1'.e JobAddress ............................................................... I - Find cu-storner Jo Kity �-are U.I.................................................................................................. Jo b stat e C,,.dA.................................................................................................................... Add Billing Address JobZip ............................................................................................................ I ,I Tel F—Print— H i-s t,,-.,r� Fax ............................................................................................................................. Custorn-:11r List Billing Address .........................................I...................... Print BillingCity fitery'.ifk.................................................................................................. BillingStatet.v.IA........................................................................................................... BillingZipCQ.L.3.2..................................................................I........................................ Notes .................1.21.4196 41.13R,1.9-f.pwrrip...c-,.A,pt i.c..0 ri U..I a4.G.)3.0 1.212181.9f....................................................................... Q 4 L-,'1.9.f)... r..4 fj.Q�0 j) 1. p g, p p e ................................................................................................... nn .........................112.91.9A.......................... .I..................................................................... ........................11291.9-.7................................................................................................ .......................Z.1 Q�.9.7................................................................................................ ..........................242.61.9.7................................................................................................. 21.12.1. U..rK)L4.ftl.a 0 ................- ............................I............I.................................................... .31 J2 .1,9.1'..r.g( t.4.5.0..ja 0.......................41.3.01R.7.................................................................................................... 1.1.9.7..pg L4.U.,.Q 0.........................Q2-41.9.7.................................................................................................. ......................71.11.9.7......................................................................................................... Macomber Customer History Screen 3119199 Customernumber CompanyName ...............................................................................................:.............................. Customer Name !.:?p D".G li;1........................... I Fir1a lrr c�ic JobAddress ............................................................... Fin�.-i c�_ ��.� torr-��r I JobCity ............................................................................................... Add Elillinq .hddmss JobZip ......................................... PM Kstor.� Tel Fax ............................................................................................................................. I Cu torrier Lit Billing Address :I.2)D..5Q.l1 I-I'd a.itl. .�K�r............................................................... i : Print BiilingCity ::rIr i. ................................................................................................ BillingStataf'.,A ..................................................................................................................... BillingZi p U.U.,Z........................................................................................................... Notesx1.;5-1.9 ..r';gt.-1.5D..D.Q.....1.01.1.5117.................................................................................................................. j�l 2PR92. L4.bD..D.Q.......I.W.1..519.7................................................................................................................. 7.�_�.Q......1.011 19.7............................................................................................. 91. ,,.R7 .....1.:11.1.%93........................................................................................... 1.?.h.9.7..����t.�1.r� 11.1.241.92............................................................................................................... ................................................................................................................ .7..pgLA5.0�QD..... ............................................................................................................... :1.2�2 gt.45.0.Ut......al.:11.9.8................................................................................................................. ri!�...9:l�.........Z.M.0.................................................................................................................. 21:1.1.9B.p!jL1.5.!a..!Q.........:�1.1.��.9.�................................................................................................................... l..........5141.9.9..................................................................................................................... 51 2 91.9.8......................................................................................... ?.S..t�z'r.'xrX.. .9.Q...11.9.......51?.91.98......................................................................................... .41.1'.31.98..pg LAFU...Q.Q...........51.20.93................................................................................................................ | � rici r ) ==v' Macomber Customer History Screen Cu3\omernunmUer 49� Company Name --------------------_---------.------� CUstV��erN8��e LJ�[K�' ..................... rid Invc Fit ic ........................................................ 1�~O��m��W�����L'__'_-______- JobCity � JobStm1e JobZip _______________________________. Print Histotv Tel -.-------------_-'--.-_----------------' LiFax ----'---'--.----.------_--------------� BiU{ngAddrenn Uth.I.Y.1a t............................................................... B||DnOCiiy -----------------------------' DiUiogSt01e .............................................. DiUinDZip \l,2f,J.2..... .................................................................................................... NoLe3 �ql11 [A5U.U\L-/Il1.91a........................................................................................................ 1.1 nu �'I.23'O |t ____ -------`-�__-'-----------.................................................................................................................... _ ___ --'----------'---_------------' ---'_-.-"------'----_-_-----'_----------------___------ � I � '----' � � U`-''__---.................................................................................................................................................. ----_-`-_-,------'-'`-'-_'--_----.................................................................................. ` Li ff -----92.'-'-,_'-----'_.-'--''----'------.1.--0---------_----' - -----'- | � � � � � � � ^ � I - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:120 South Main Street Centerville ,Mass . Ownet: Oakwood Living Centers Date of Inspection: 3/19/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade:V a r g a e o n each system. Material of construction: cast iron Y 40 PVC—other(explain) Distance fro Rrivate water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,-etc.) — SEPTIC TANK: (locate on site plan) Depth below grade:Cl ^ �� — —Material of construction: concrete metal Fiberglass Polyethylene—other(explain) If tank is Enetal,list age a 13.age.coonrfumed-by Certificate of Complianc (Yes/No) Dimensions: /7 �46:�g ��10��/U/f % O� /i � � 641 � ► Sludge depth:_ Distance from top of sludge to bottom of outlet tee ortxaffle- Scum tNckness:_Q Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to boqpm of out] t tee or baffle:_ How dimensions were determined: Comments: (recommendation for pumpind;'condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structur&Hntegrity, evidence of leakage,etc.) :Pump septic `tanks twice per year ., Grease trams nmparl monthly , Dishwashers and garhaga rdi 4nca1 anrd 1 ann ry @M i go i n&e GREASE TRAP: (locate on site plan) ' env er5 Depth below grader —metal of construction: concrete metal Fiberglass Polyethylene—other(ex p lain) Dimensions: ��k Scum thickness: Distance from top of scum to top of outlet tee or baffle: j� Distance from bottom o cum to bottom of outlet tee or baffle:V Date of last pumping: Comments: (recommendation for pumping;condition'of inlet and outlet tees or baffles;depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) 'Pump grease traps month1 T annrdr3 ni chwacher anrd al l the grey water amnti ac i-nfn th ie grease t1;'SIPS. revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corronued) Property Address: 120 South Main Street Centerville Mass . Owner: Oakwood Living Centers Dm of inspectt«t:3/19/9 9 TIGHT OR HOLDING TANK: t1C(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade:A)/# Material of construct)onr(1concreteAJ�hnetalAR lbergla&&AjPolyethylene4gother(explaln) Dimensions: 109 Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm In working order:Yes4L,4 No*,4 Date of previous pumping: AM Comments: (condition of Inlet tee, condition of alarm and float switches,etc.) TigHt or noidinR tanks are not nrPsent DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet Inverts_ Comments: (note-it level and distribution Is equal, evldenoe of solid&carryover, "dance of leakage Into or out of box, etc.) —All boxes have equal flow as designP(( No PvidpnrP of gnlirig carry Over Nn Pvi r(Pnre of 1 ankaSo iatQ 9£ out 9—f I (38 baxl4g - All bQx severs are atii-ieee east and covers . PUMP C HAMBER:A�J& (locate on site plan) Pumps In working order:(Yes or No) Alarms In working order(Yes or No)w Comments: (note condition of pump chamber,condition of pump&and appurtenances, etc.) uMD chambers—are not =rPRent - A11 gggtPmg arP ornirity revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropwyAddress: 120 South Main Street Centerville ,Mass . owner: Oakwood Living Centers Date of inspection:3/19/9 9 SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:�b leaching chambers, number: leaching galleries,number:—tj�`) leaching trenches,number, length: 0 leaching fields, number, dime ion overflow cesspool,numb r. Alternative system: k Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to medium coarse sand . No signs of hydraulic fai1tirP or :onding 4ni1 ¢ are not damn Vaoatat-inn is nnrmal CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: AW _ Depth of scum layer: _ Dimensions of cesspool: lfjlq Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) q Cesspools are not present Comments: (note condition of soil, signs of hydraulic failure,level of.ponding,condition of,vegetation, etc.) Cesspools are not present . PRIVY:k4li„ (locate on site plan) ? Materjals of construction: /Ll� Dimensions: W1 Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) Privy is not present revised 9/2/98 Page 9ofII Opp Ir �r eye I 1 k, I 7—j 30 � b ,.o i Y ; ;,_•,�,��¢ n� ,.SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFOR)AATION(coif rx-d) SY r ra °•F KpSlyy��E IS SAL SYSTEM: } Jn 1Vde tJes to�t least two parmanent,rofersnce landmarks or benchmarks �- foat0 al(=wells wlthln 100 (Locate where public water supply comes Into house) _ 1` n / I J� r � y � `C, Past tU of tl r i DIM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFORMATION(continued) PropertyAd&—:120 South Main Street Centerville ,Mass . o`"nef Oakwood Living Centers Date of Inwecoon: 3/19/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes Into house) i - Ty.11� of•LA� —��.�—�- �/t ,/I ��`/t Fri rT iv =v revised 9/2/98 Page 10of11 :Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAd&.: 120 South Main Street Centerville ,Mass . Owner: Oakwood Living Centers Date of Inspection:3/19/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Y Obtained from Design Plans on record __...,/O^bserved.Site(Abutting property, observation hole, basement sump etc.) . Determined from local conditions �`—/ Checked with local Board of health Checked FEMA Maps hacked pumping records —Z/Checked local excavators,installers —Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water Contours Map . Gahrety & Miller Model 12/16/94 r , revised 9/2/98 Page 11of11 1 nrnr+.-n.•rrr-.-rr.rn:am•nmro--rs.•t rennr..r::T-strmrlTrrre+•mn matt*.atrr.sr.rar •� TOWN OF Barnstable BOARD OF HEALTH j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION �_ �'•••-••t•Y••. •••.�T.tIT.�.�T 1tlTI'.i.TSI T'TTr SSlflfl'TtT''T�.:'t"11lTTlR1CrTTTRNR RR0�RO7C�7 lemn'mTrrnses•t7rr+rr+r.•.�rrr•r•-:• •�..� —TYPE OR PRINT CLEARLY— PROPERTY INSPECTED STREET ADDRESS 120 South Main Street Centerville Mass . ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Cape Regenby Nursing Home 0 PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber. & Soir Inc . COMPANY ADDRESS Box 66 Centerville Mass . 02632 Street Town or CSty State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage dispose`], system at this address and that the information reported is true , accurate , and complete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : i System PASSED The inspection trhich I have conducted has not found any information which indicates that the system fails to adequately protect public hea1Lh or the environment as defined in 310 CMR 16 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con ircted has found that the system fails to Protect the public health and the environment in accordance with Title 6 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature t �� Da —te One copy of this rt.ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF ItEALT7i. * If the inspection FAILED, the owner or.".operator shall u d within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 CFJR 16 . 305 . ` partd .doc r ti W (n Zj f'1 THE COMMONWEALTH OF MASSA.CHUS ETTS DEPARTMENT OF ENVIRONMENTAL PROTECTIO N BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is her eby reby authorized to use the title CER'Z IFIED TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A 'of the General Laws. Issued by The Department of Environmental Protection_ h...c X. V,")% Act.,iy n�rcct��r of tlu l) i wit ul, W:114cr 1'ulluliun C u��tri,l � _ l r- ,.1 No�.r-�. ...._.. Fim....30•..•� --...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applirtttiun for Diijpmial Marks Cnumitrnr#tun Famit Application is hereby made for a Permit to Construct ( ) or R_epairX�X) an Individual Sewage Disposal System at: 1,20„South_.Main_-_Street Centerville ,... l �f ocati n-i\ddrcss or Lot ---'......... ...........................Vanguard Healt Services • . . --•-----•--•-----------------------•-----••- -•---- WOwner Address a J-.•P.Macomber Jr.. ---------------------------- -••-------------•-. ---•--••-----••---•-•------- --------•-••-•-------••--•--••---•.....------•------••----••-----•-•--•-------•-•--' "-•._-•-•-- 9Q Installer Address UType of Building Size Lot............................Sq. feet ►-� Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-----.---------. Diameter---............. Depth................ x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter----------------s--- 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_..._._._.______-____._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit_.----------------- Depth to ground water........................ 9 -------------•---------------•--•------..........-----------...-•--------•--•••--.............................. ------------------------ ••------------------ 0 Description of Soil.....L.oamy...aa.nd.._tn...me.dium...sa.n.d....to----finja...s-and-----------------------.............-.................. x U ••••--••••...--•--•----••-•-••••••-•--•--•-•----•-•-••--•-•-•----•-•--•-------•••-•--•-----•-••--•--------•••-------•-••--••-------•...-•----•--•------••......--•-••------•----....................... W --------------------------------------------------------------------- ............................................... 0 Nature of Repairs or Alterations—Answer when applicable.AddiSig._-tI..Q_ 1_e.a chLag-__-pit s....t.Q._.�17......... existing 2500 gallon grease trap and a SOOU gallon grease trap, 1 - Agreement: Distribution box and three leach pits . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has be n • sue by the Aar of health. Signe --__ ----------- - -- J..... - ........./.2.9./.9.5..:...._ Dace Application,Approved B ---- - ----------------------------------- ---------------------------- Dace Application.Disapproved for the following yy reasons: --------------------------------__------------------------------------------------------------------------------------------- .... .......... .. .................... ...... .......... .............. . . . --------------- - Permit No. ---------------------� '�— 1 �GL Issued ................................ g Dace................. ace - ............. ......................................... -------------------------------- Dace l L {Y f t I y Iq —- - irk- ... -----""•"• _ - b.00 FEB...................... THE COMMONWEALTH OF MASSACH"USETTS , BOAR® OF HEALTH r` TOWN OF BARNSTABLE a. �rltrtttilarit"fnr i5 rt1 tt1 Works Towitrnrtinn lirrmi# ' -Application is hereby made for a Permit to Construct ( ) or RepairX(-X) an Individual Sewage Disposal t System at: i- 0••South. Main Street Centerville,Mass ��( �- 6� �e_n� �- 1 ..- . - -- ---•--1 = ............... . Loc t n-Addr•ss Vanguard--Hea,lt i ery ces . or IAt`°rro. W Owner Address ..._P.Macomber Jr.. Installer Address Q Type of Building ' U YP g Size Lot............................Sq. feet Dwelling—No. of Bedrooms.=-:p-'_____________-----------------------Expansion=Attic ( ) Garbage Grinder ( ) a -Other—Type of Building ____________________________ No. of persons------.;----------------.... Showers ( ) — Cafeteria ( ) ` Other fixtures "` Q -------- -------------------------- ----- ------- ., - WDesignf Flow------------------------- -,--.,_.____.!._gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic;Tank—Liquid capacitv___._______gallons Length---------------- Width_______________ Diameter---------.------ Depth---------------: x Disposal Trench—No. .................... Width.: -___---_-.___.___ Total Length-------------------- Total leaching area_______-_._._______-sq. ft. Seepage Pit No--------_------------ Diameter......... .......... Depth'lielow 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-.-__-._-_----________-- f1 Test ,Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water......................... Description of Soil_..._Itn .j.n.v.. _n�1....t __m_�3�1 .t?71i--- . ?_d_..ta-.ffnja•--awn-d.....--••----•---•-•--••-----... V .....--•----•••••-•-••--•--•---•---•---•---••-•-..= N4 W V. Nature of Repairs or Alterations—Answer when applicableAddfnp,--ttoto---� ea ...............ra3�t ,..tca...ax1.....•- ex stingy 2500 .c allonarease..trap and yak 500� a1.Zbn „grease trap, l Agreement: Distribution box and three leach {grits. - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the.provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the ;far fof health. , a Signed ._........... .... ce ..._,�.. Application.Approved B --- -- --- ��------ --- - -- --------------.._.._------ ------------------------------ • i Dare Application,Disapproved for the following reasons: -----------': -- - _....... _.... - - ..... -- - r ... - - -..... ---� �' fcai Dace Permit No. ` -�... ..... � ,, ,,;.a'Issued Dare to�.�jw-�.��-_. ! 5 THE COMMONWEALTH OF MASSACHUSETTS yt , BOARD OF HEALTH . /. TO�WN OF BARNSTABLE ( THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired;(xxx) by ........JOseph...P.....:Macomber....Jr...._-.... - ... ..... - fa South Main Street Centervil be Cape Regency s at -------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------------------- --------_. dated ....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. m DATE-- -- 'r" -- `. '- ............... Inspectors —� .t .r x^�" <. 4V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 30.00 No... �_.. FEE Rapolltt1 nrk dun #r tuan rruti# Permission is hereby granted.... ....Jr.--------------------------------•---- ....................................................... to Construct ( ) or Repair Y(XX) an Individual Sewage Disposal System atNo.2-0...S.c1a.th...Ms_i a--. --------_-------- ..................................... street as shown on the application for Disposal Works Construction Permit 1__ Dated___lb:-:�s.-.---••--••--•• ------------------------•---- -------�-� -------------- 1 / / Board of Health DATE...... T y FORM 36508 HOBBS A WARREN.INC.,PUBLISHERS .. WleitAIC\4 IAQ SP14 t-L it) JTi- &A.)Te4f-W U','C�' r� / `v i • 1 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I,Joseph P. Macomber Jr , hereby certify that the application for disposal works construction permit signed by me dated 11 /29/9 5 , concerning the property located at 120 . South Main Street Centerville meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells.within 150 feet of the proposed septic system • The observed groundwater table is t4 feet or greater below the bottom of the leaching facility 1 I • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED DATE: 1 1 /29/95 LIC D SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]: 1 r 362-4541 .926 main street yarmouth mass. 02675 down cape enfineerifg civil engineers& land surveyors structural design James H.Bowman P.E.,R.L.S. Arne H.Ojala R.L.S. land court John W.Jalicki surveys December. 18, 1981 site planning sewage system Town of Barnstable designs Office of the Board of Health 367 Main Street Hyannis, IVIA 02601 inspections ATTENTION MR. JOIN KELLEY, DIRECTOR OF PUBLIC'HEALTH permits Gentlemen: SUBJECT: CAPE REGENCY NURSING HOT451, CENTERVILLE, MA In compliance with your letter to Mr. Marvin Blank on PIarch. 13, 1981 , I am submitting an "as-built" plan of the sewage system as. some of the components are located dif- ferently than shown on the approved plan. - However, I have located the .three systems in the field and certify that they meet the requirements of Title V as . shown on the enclosed plan. Sincerel , Richard R. Fairbank, P.E. RRF/mkh Enclosure cc: Prudent Acceptance Corp. „�� .. F�."�/f {,. � ,. [�.' ..,1,�-tit _ .���� � .. � ., 1�1• •I•I �� 'i�,`�'i � `i.�(/%�,� ! 01 1 /`.. I:L\''1.�;'• -�- �- rr- r ,�r- (. lI. , )1'IiL C1_ .1- F1.CATE OF, h1r � . .. rn Y i :r �i P-1 C i 'LAME : Cape Regency Nursing Home 11.- .,; 0.3878 - r-�,_G' • pFOJ :C-1- i'ROPnPTNT: Mr. James Plunkett r iOI': August 22, 1980 F1J, Su1li. I'i., ,.1'... Chil1)tc:i' f) ,( .. i_.lnll h ';,, d'id ii1.OLIc.J a Lhe „<i)� Ii'.' ;on Jvc.',`I''In9 the illl)1CIli(.'11La;; : ;1 o f L11 `achuSet,''- oiI _ I l., 1 he r ce�,:�i�l� -� ne v'('.1 C C 'ioeS nor 1"e,q1,1 11"(' 1111 I.r', Although the site includes several acres of wetlands, as defined by Ch. 131 , S. 40, the project does not propose any alteration of those wetlands or of land within 100 feet of them. 11 i r1I rLao F 5;\\ .I- ,` �I THETO TOWN OF BARNSTABLE ON— OFFICE '�Sj OF e B9Ha9TeBLE, :MA68. BOARD OF HEALTH � p� �pA 1639. 367 MAIN STREET TEQ MA`S A" HYANNIS, MASS. 02601 March 13 , 1981 Mr. Marvin Blank 11 Stetson Lane Hyannis, Ma. I I Re: Cape Regency Nursing Home, 120 South Main Street, Centerville Dear Mr. Blank: The construction of the on-site sewage system for the Cape Regency Nursing Home, 120 South Main Street, Centerville, .must be supervised by the designing engineer. Prior to the issuance of a certificate of compliance, or an oc- cupancy permit, the designing engineer must certify, in writing, to the Board .of Health that his design has been strictly ad- hered to. Very truly yours, o'"hn�M. irector of 6ublic Health JMK/mm cc: Down Cape Engineering I i . r J e�i•^ Nov/ Fimx THE COMMONWEALTH OF MASSACHUSETTS R'�# BOARD OF HEALTH L ----------- .r rya:: .. ........................................ ,���rlir��inat..fur ��tn�u��g1 �arkn C�natn�rtt�r�i�an rrtnit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewa Disposal System .......:......a..t� ..._ ..... .. ..... .yr: ! •••-- ----LA. 0. Location- ress V� ....... or N . f , . . ....._. ... wner Ad ress W ............................. . (r. Installer Address d Type of.Building r,- Size Lot............................Sq. feet ., Dwelling—;.lo. of Bedrooms .. ... ..... ..............Expansion Attic ( ) Garbage Grinder ( ) ( Other—Type of Building of persons.s 2�3 C-�J)......... Showers (>c ) — Cafeteria a Other fixtures -- - ------------------------ ---------------------------------•---------------------...--•--- -------- Design Flow.. _ ...1. ?.�� � s er person per day. Total daily flow_..J.Z..! .?`�.................•....._ W g - �-g� P P P Y• Y gallons. WSeptic,_Tank2_Liquid capacity............gallons Length................ Width---------------- Diameter-------------... Depth................ x Disposal Trench—No.............±........ Width.................... Total Length.......... ......_ Total leaching area....................sq. ft. .�-.____ Diameter___-_ _ � Seepage Pit No.___...�_ _ ,�4�_f"_____-Depth below inlet..:................. Total leaching area..................sq. ft. z Other Distribution box (t/) Dosing tank ( ) S'c PL A I aPercolation Test Results Performed by_►.._ -A , .r�, „ -----•-•-••-••-•••••... •-•---••--••• Date-Ji 1 r Test Pit No. I.......7..-._minute s per inch Depth of Test Pit.................... Depth to ground Test Pit No. 2,., ........._...minutes per inch Depth of Test Pit................... Depth to ground water................... ODescription of Soil.., l n �__.- t .............r c, .......................................ta � --, r 1 n, 1 .1 V -••••-•-••••••--••-------•-•-•-------••...-••------••-••••-••--••••--•--••--••••••--•-••--.....•--•-•••••••-------------•-•••-•••-•... -•--•----•-•••-••••••••••-••••-•••-•......•--•-•......•---•••--- ! W UNature 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 : LE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation-%until a Certificate of Compliance has been issued by the board of health. Sign ---- .' - --- Da/t�' Application Approved By....... �. .. � �`( •--•----•-- .� � / f/Application Disapproved for the following reasons-.............................IV............................................................................. �t =, ----------------------------- Date erm>t No............... Issued_----......-•--- .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J% O..!l�`1:..... .....OF............. �.. k �`.................. L (9rdif iratr of TOUtpliFatta THIS IS TO CERTIFY, That the Indiiv�idual Sewage Disposal System constructed (�or Repaired ( ) by... �-_N. = ...................................... -------- R Installerat U44A a has beerf installed id accord like with the provlions UP, 5 of The State Sanitary Code.as described in the application for Disposal Works Construction Permit ...?-,/..................... dated-.. '/"11 R THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4 DATE.................................. ' !L'f1 L. Ins pector..........'_4j5z.Ae.-. ..... ...�p------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p� ..�.Q..ZI.41./...........OF...........Z- ................... No...... -•-•-••--•---•-- FEE. r ............. Dtop a i al lVarkv T-Fnnntrnduatt "pan fit ' Permission is hereby granted----------''=.................. `"= fry' = - `� 4 _. .. - to ConAruct.(Y or Repair ( ) Individual Se ge Disposal System t-Gd'eref' f YZ4414. -�- / 1 / Street as shown orthe application for Disposal `Forks/l Eelmt N ...... .......... Dated,:..1 ............... � Boa d of Health .- DATE............ -- ----_--- ----------- ---•----61..----•-------•---------... FORM 1255 He)BBS & WARREN. INC., PUBLISHERS 1 �. r 01 .. Fps �� No.--•-•-•-.-............. z. .................... THE COMMONWEALTH OF MASSACHUSETTS ` BOAR® OF HEALTH Off.-N. ............OF... ......................................... Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewagp Disposal System at: rV .....�1URS 1_C.........k4�2MIE ..... z�.._.v_4...../ _. -/�!!._...-------•--------------------------- .� -• Location-Address or Lot No. .... ................................ r i �.. . ---- - Owner Address .... .-----••-•-•---------------------•-----._...--•-------•----•----•-----------....-•---------•-••-- Installer Address Type of Building Size Lot_._./I_Sy ....._ t U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) &VQSll"l�__.K AA o. of ersons.:12v__ge.P.S---___ Showers X — Cafeteria St) p,a Other—Type of Building p ( ) a' Other fixtures ..._. ---- W Design Flow...;.,, 34�Q�---- - lh's.per person per day. Total daily flow----1!.j_ZZ `--.-....•...............gallons. WSeptic Tank2—Liquid capacity__i�kgA6 A/Length................ Width................ Diameter--._--__-___-.__ Depth................ x Disposal Trench' No.-------------------- Width-------------------- Total Length.... ... Total leaching area....................sq. ft. Seepage Pit No.......J-3------- Diameter_._.. _5 Depth below inlet____________________ Total leaching area......t.........sq. ft. Z Other Distribution box (lam ,.Dosing tank ( ) S r-- P(.A o..k 'F v PL O-.r^1 t--S ~' Percolation Test Results Performed by..R_._VA_N_V..L5A.L\.V ..........:.......................... Date..a 0 Vmla.n...___.._...... Test Pit No. I.......Z___._minutes per inch Depth of Test Pit____________________ Depth to ground water..E-L t. Q._N1Ax (i Test P_it'No. 2................niinutes per inch Depth of Test Pit.------------------- Depth to ground water........................ P4 ............................. -----•••-•-•-•-••-••-•--•••••••--•--••••••......-•-••-•-----•-----•••.......................................................... 0 Description of Soil----We )..=..C-9. Q.5-e.------..SA11Q..------...A_ -4_.L---1_0C_ATl® `-------------------------------------- W -------------------•----•-------------------------------------------------•-•----------------------------------------------------------------------------------........................................ UNature 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'TTLE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. P-rAde_E Corr Signr %,1 . ----------------•----------- Date Application Approved By--••--4 1 � .. y_ 0-� Dates Application Disapproved for the following reasons:..............................•--•-----•--•-•••-•--••-•-•-•-•••--------••-••-•----------••--••---••.....-•--•- ---------------------•----------------------•---------------------------------------------------------••-•-••••-•••----••--••••••••••---•-•--•--•--•••-••-•••--•••---•--••---•••••-----•--••---........_ Date PermitNo......................................................... Issued....................................................... Date TOWN OF B d ABL C , LOCATION [ �-- /11 SEWAGE # ©o s O VILLAGE `-,g. 7 e/L.!G i�`E� ASSESSOR'S MAP & LOTS� 0 P6�,'oc' i INSTALLER'S NAME&PHONE NO.d� %2 t a `% j�0 t 7 r 3 5'Ll_ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L P•T (size) %0.X f f or NO. OF BEDROOMS "'g i�c^► :r— BUILDER OR OWNER CAIPe:7 12E t .eG PERMIT DATE: r. j/ y S$ /COMPLIANCE DATE: Separation Distance Between the: Maximum"Adjusted Groundwater Table and 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 0 I lz� pro Q3 RN vs It it J ^ LE LOCATION C gr, r- mat s�wA•iE � �' ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE�NO.,Tp' or-nu, -bfC CC�� eas5 SEPTIC TANK CAPACITY 612-60 ±M22 ",TAvt,lL LEACHING FACILITY: (type) 5'— '?1+ 15 (size) 7 000 (5 NO.OF BEDROOMS BUILDER OR OWNER / PERMIT DATE: COMPLIANCE DATE: '` 3 4� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by vQ � `�� ,y0 � � � � � � \ % i ' /.�" _� ��-@c � s�� '�' �. u` y� �. �` � �- "- _ �� �� -� a, �� ,� �'.' _ �� ry _ V y K' F` GENERAL NOTES: S imz„ LL 1. THE AS-BUILT MODIFICATIONS ARE SOLELY INTENDED TO ALLOW TEMPORARY USE MAWOLIM W7k B. 98.65' Z 0 OF THE SYSTEM WHILE IN PROCESS OF CONSTRUCTING A SUBSURFACE DISPOSAL tr nxu MAW(nn) 0 SYSTEM UPGRADE. NOTHING SHOULD BE CONSTRUED AS A GUARANTEE THATob. sever Z THE SYSTEM WILL PERFORM AS INTENDED. (~,I 2. TIGHT JOINT (TJ) PIPING CONSIST OF POLYVINYL CHLORIDE PIPE (PVC) w SCHEDULE 40. _ 3. HEAVY MACHINERY SHALL NOT BE PERMITTED TO PASS OVER THE LEACHING FLOW FROM SEPTC TANK- AREA. o o w o t, 4. NO PROPERTY SURVEY WAS MADE AS A PART OF THIS PLAN. SEPTIC SYSTEM' LO a• Pvc, LEVEL 2 0 0 _ :0 owimcr a o 0 0 0 ' O INFORMATION INDICATED WAS OBTAINED FROM PLAN ENTITLED: SEWAGE SYSTEM DESIGN BY �� O DOWN CAPE ENGINEERING DATED OCT. 30, 1981 AND A TITLE 5 INSPECTION REPORT DATED 10/28/04. o 0 o a o THIS PLAN IS INTENDED FOR THE SOLE PURPOSE OF SUBSURFACE DISPOSAL SYSTEM D-BOX TO B' o o a m o ON MODIFICATION AND SHOULD NOT BE USED FOR ANY OTHER REASON. - BE SET ON A MECHANICALLY a m o 0 o c n Q \ COMPACTED LEVEL AND STABLE PROPOSED 04 5. TOPOGRAPHIC SURVEY CONDUCTED BY: SS DESIGNS BASE KITH Br OF CRUSHED STONE INV ELEV o all o 0 0 o e f— V) ON 6 05 , IS BASED UPON AN ASSUMED BENCH MARK (B.M.)= 100.00' TO MINIMIZE SETTLING p am o 0 o m o ' PR_QPQL€V o m o 0 o a o Q AS-BUILT CONSTRUCTION NOTES (INSTALLATION DATE 1212/05) w✓t t o m e o m c o � w 1. L.P. #5 COVER RAISED TO BE LOCATED 12" BELOW EXISTING GRADE; Q C) 2. RETRENCHED SEWER LINE FOR LEACH PIT #5 (L.P. #5) CONNECTED 82" BELOW COVER. / PROPOSED --� 6'-6• (TYP) �+— 0 = 0 J. T/ES TO LOCATE SEPTIC SYSTEM PRECAST CONCRETE V BLOG CORNER DISTRIBUTION BOX EXISTING LEACH PIT . NOT TO SCALE L.P. k5 Li D—BOX 71 97' a DISPOSAL SYSTEM PROFILE cl) NOT TO SCALE Q ELEVA TIONS• EXISTING ASBUILT M Z W cn INV AT D-BOX INLET 92.79' 92.80 _ INV. AT D-BOX OUTLET L.P. hF1 EXIST 92,67 / ��'' ry of N INV AT D-BOX OUTLET L.P. 12 EXIST 92.66' INV. AT D-BOX OUTLET.L.P. p EXIST 92.65, L.P. #1 CO — Z �U INV. AT D-BOX OUTLET L.P. 4 XI T 92.67' / / f` Q ` — 2 >— cn(n INV. AT D-BOX OUTLET L.P. #5 Ex/sr 92.66' �°� ISTING 8,000 GAL U W V) INV-AT INLET L.P. J5 92.74' 90.91, Y SEPTIC ,TANK ` I � .� Lj W Cn 2 L) 0 52 2 o LLJ N n n o Z IN W TO THE BEST" OF MY KNOWLEDGE AND BELIEF, AND i ' L.P. #2 ti 3 " S TO Y °- U � , WITHIN ACCEPTABLE INDUS.TR Y. TOLERANCES, / HEREBY °•) CERTIFY THAT THE SUBJECT SEPTIC SYSTEM COMPONENAQ WERE INSTALLED IN ACCORDANCE WITH TITLE 5 _�w. \ zs" BRICK AND THE APPROVED PLANS. �• L.P. ,# \ ��. � It OFa B U .1 LD I N G _ d� THOMABA. BM #1 CORNER OF. CONCRETE PAD Z"\ RYDER I & UILDING EL=100.0 (� �Q5 Tie CIVIL L.P. #4 1 . � , No.41578 R S10NAL \ I \ Q GRAPHIC SCALE 20 0 ,o 20 40 80 L-110 L.P. #5 B Nm ( IN FEET ) 1 inch = 20 ft. s GROUNDWATER DISCHARGE , . FOR CAPE REGENCY REHAB AN .D NURSING CENTER 120 SOUTH MAIN STREET CENTERVILLE , MA PREP ARED B Y. S!IE�T L iST., SS DES✓G✓VS z-"v 'ry0%✓ME✓vTAL C0N501-" TAIV/75 DATE: DULY 9 2006 CO VP? S�-✓E-T 24 WOM AND HEIGHTS ORl�E Cl— EX✓ST✓n✓G C0iV0✓T✓C- PL Are✓ WEST 50 Yl STON, IVA C2— GROUND PIA TER Dl'S C,�;4RGE rQL A 508-6I5—7826 C�— P✓AN DATA✓✓S R, AOTE S C4— PRET.REA TMENT 4L DISC✓BARGE P OE✓LES r , C5- SU1 D1AIV, L A YOL✓T T SEA IWAi T DETAI✓S C6— Su/ D✓iVG DET AIL S C7- CONS TRJC//O/V DE!'Al✓S FACILITY FLOW EXIST 5,000 GAt SEPTIC TA,"dK _ r�'3 • ' �' i r J ' f4 — - p CONTROL BUILDING f / CARBON FEED LKALIN/TY FEED FACILITY FLOW EXIST. 8,000 GAL � C.;� - ' SEPTIC TANK C ✓ENT TO SOL, AL:SORPTION SYSTEMS [EXIST. 5,000 GAL 110 GREASE TRAP �, �— ANOXIC 6"GRAl4TY SEKER MAIN I PROPOSED 14,000 GAL � DISCHARGE LAUNDRY FLOW _ EQUAL1ZATi0N TANK CLEAR `PROPOSED .SJS GAl - EQUALIZATION TANK � MBR i47LL FINAL TA, WDER aft tft.'sm 'w KITCHEN FLOW Ea7ST. 2,500 GA! ��� GREASE JRAP - RETURN - - - - - - - PROPOSED SMITH&LOVELESS TITAN MBR TREA TMENT PROCESS DIAGRA��9 1- r - \ r ^ Qo h Cli --- .._..-� , DGE OE WE_�� i \\ - 1h rJ'7 -\ w W Q di) W ."------------------_-_----- -_s{ - \ i\ ry \\ a v ) CH / ------- _ � \ 8S^ IG LF -- \- -�------------ O"ESE lCti 3-DUMPS� S TO TOLD \ FENC -- - \\ S57 �—' -- --=- - ---- \\�:�sarP\\ \ ` \ ,0 'o f'---_�-- - 1 E Nr PATIO0. 8XI4\ SUBSURFAC G-SEP If �• �. J =.z c_\ 0 d AREA �/ //��`�` ----_,�GEASSED ARE&-\ �� \\\ \ u`\ \ \ \ \ \ 0 \ ( 1 1/2 STORY \ \ \ \B \\ \\ \\ \ \ '�\��t�S a /\ / OFF ,`�P� o \ I s l0 a 3 STORY BRICK \ \\`�\\ \ ,�\ \ \ \ \ ' $� / x' / �\� r >.xr BRICK $UBSU f\ E BUILDING BUILDING 1 ° 17' HIGH S PTIC \ 1 32' HIGH ( (EXIST) a. \� 1 (EXIST) I \� ZT "��►►o!!\''\�i � TRANti)uKmr RJO •w \\ �� - - ------ J _ " a l o ._4 _ EF € _� 9 %6: 17813±S.F. \\ I / P �\ \ ,>O, \ GROSS I / \`--- ---- ---j.•� $ \ AREA `-- --- - \ (EXIST) / ------ / i iAPO — _ 10 _ TXOW9A - _..� PAVED FIRELANE \ \ WITH GRASS YT eu STRIP IN THE FF�OC�9O M ��".ox /� -\ ® v 7 �O I \ \ 6�\$O •dWV �� MIDDLE \ op AB \ \ GRASSED AREA � Of 4 ® \ woo0 ® ® \LA 104ft ,, P. $ COURT \ -- SUBSURFACE GAZEBO ���� \\ SHRU \0. QJ BOUND A `\ 5 EPTIC AREA \� ®� �► WA I-P _ w m WITH Disc 8� \ 3 5 0� c3, C) uJ 9R8 \\ 3 z w CD Q > \ 4 \- \� �w \ 2 \ 14 i '\ \ \fin �p 15' FRONT SETBACK AS O_�g = NOTES: _ �Q� \ \ \� 'p z \ PER BOOK 464, PG 410 z V) U N 1. WETLANDS DELINEATED. BY NORMAN HAYES. P.W'.S. NOVEMBER 2005 AND JULY 2006 mow < w o - 2. THE WETLAND AREAS DEPICTED ON THIS PLAN ARE EXISTING WETLAND RESOURCES WITHIN 100 FSIP�C+ 6 LINE �.� Q\ \. zQ -1 � o FEET OF PROPOSED PROJECT. FtiCF'9Q `\ 1,,. THE / i '�� �� '� _ - Q� w z 3. THIS PLAN 4V.4S PREPARED IN SUPPORT OF THE DESIGN AND CONSTRUCTION CF A SEPTIC ' , -. `\a TREATMENT PLANT AND BUILDING ADDITION BY THE CLIENT. \ L�NE / O� //\ S�' �/ vv�\G m� O o G / \ BUILDING SEjB_ACK 1gp5 ( p P wo z O 4. EXISTING UTILITIES SHOWN ARE APPROXIMATE. ` 1�' -. rp� \� ,1 �60w z z �m THE CONTRA.CIOR SHALL BE RESPONSIBLE FOR PROPERLY LOCATING AND �' S DO GJ Vv �-o U Q v) o^ COORDINATING THE PROPOSED CONSTRUCTION ACTIVITY WITH DfG-SAFE 48 6g' \ nn `A1 AND THE .APPLICABLE UTILITY COMPANY AND MAINTAINING THE _ W l $6 1v ONVV zN LW Dt EXISTING UTILITY SYSTEM IN SERVICE- DIG-SAFE SHALL BE NOTIFIED PER S 83`35'14'" S <<-� w THE STATE OF MASSACHUSE1 IS STATUTE CHAPTER 82. SECTION 409 W LAND N AT TEL. 1-888-322-4844. THE ENGINEER DOES NOT GUARANTEE - THEIR ACCURACY OR THAT ALL UTILITIES AND SUBSURFACE STRUCTURES COURT 0_ `� • ARE SHOWN, LOCATIONS ANDELEVATIONS OF UNDERGROUND UTILITIES BOUND `�,P\N EXISTING w TAKEN FROM RECORD PLANS. THE CONTRACTOR SHALL VERIFY SIZE, GjNa WITH DISC `�, �` 5' X IC OVAL SIGN O_ LOCATION AND INVERTS OF UTILITIES AND STRUCTURES AS REQUIRED PRIOR ❑ O\��C, "C BRICK PIER Q tANO COURT BOUND FOUND � EXISTING i1GN7 �j 'CAPE REGENCY" U TO THE START OF CONSTRUCTION. EXISTING TREES GREATER THAN]O"DfANfi£R EXISTING CATCH BASIN a 5. TOPOGRAPHICAL SURVEY CONDUCTED BY SS DESIGNS IN APRIL AND AUGUST OF 20G6 — EXISTING CONTOURS - .BASED ON A VERTICAL DATUM SET BY DOWN CAPE ENGINEERING CIVIL ENGINEERS AND �- --� EXISTING 8UFr W GA v LrNE EXISTING BUFFER ZONE LAND SURVEYORS ON A PLAN ENTITLED, "SEWAGE SYSTEM DESIGN FOR 120 BED NURSING HGME c GAS(rvE - LAND IN B�`.RNS`ABLE, MASS MADE FOR CAPE REGENCY NURSING HOME, OCT. 30. 1981. - ErT ELECTRtcAt tm•E o Ems TING FENCE BM#1 TOP OF _AND COURT BOUND EL. 49.08' - - - - - T � 0 ANK E, xsnvc PIER GRAPHIC SCALE - 6. PLAN REFERENCE: "A.LTA/ACSM LAND TITLE SURVEY O EXISTING EFACNPIT zN 120 SOUTH tv1Al?J ST, BARNSTABLE (VILLAGE OF CENTERVILLE)" DATED JANUARY 18, 1999 ���-�--� --- I I•aN BY HIDELL-EYSTER TECHNICAL SERVICES. ® £X15TNG M.ON TOR/NCLi L I It FEET I t i SHEET 1 OF 7 nch ft.= � �, �y, wE�ANo •./� \\ by tib \ �`� •-_,-� EDGE GF�. % / ,��. � co (CTI J-\ v ZOO I —swnrgc cz,�0 MROSiD r0U Dax TAIIX \ \ - \ v _ � Q5 PA I- - MATBALES / v BAD PLANIg�\' \ `\ \ \\ / O A. /• -_.. s a - ^d•--'_ I ¢..w.m• \l1 yr1 _ \` `gsro rxttrxow O,o ; / 7`- �"� sEvSlc rnMrc i' I \ -� u•ro•\� "'G , \ - ^ �S h ./���\> / NAP ETAS,a06'� v�w 1 a 3 STORY 1 1 112 STORY • \ '' \ �°/ /' 7 I a w BRICK I BRICK \ \ \ \�y( �a \ / F�FL �� UT a BUILDING BUILDINGUT \ w I 17' HIGH z ,1 1 �� y\ a 3(EX(EXIST)GH (EXIST) \` ®: \\�\����� . �° ,�/ 0 i \ \ / O' /��� a A A \\ �• d� / \ / / FF 0 9Q �' 17,813±S.F- \ m N GROSS \ _ �.y / / \ F U AREA '° I _ - _` �_.a�•�""_-" '.�`"i .\_ _ _ta ix . mTMlwc PAYco Nxr Lwr \ (EXIST) - w.as smP N mr uRwE OETUL I rrot Dnv _ a EXIBT a SEPTIC NM( ( ` - LA C/rye / z I � \yI 7 lv-o•axlm 10 \ q J TMOINBA y.. _ RYDER .i TEST PIT DATA rL w.OB' �, J C� ` `\ `` �A p°Sf0 s'"rrrxa �� \ S pau-r �W i3 \ sxoOm SOIL EVALUATOR.- STANLEY SZCZURKO SOIL EVALUATOR: STANLEY SZCZURKO SOIL EVALUATOR: STANLEY SZCZURKO .\ \J \\\ \ \ �\S\ LOCATE MAIrR WITNESSED BY., CHRISTOS D/MISIORIS WITNESSED BY.' CHR/STOS OIMISIOR/S WITNESSED BY CHRISTOS O/MlSf0RIS�/ \ \ ' ws \ DATE,• 1/!7/06 DATE: 1117106 DATE: 1/l7/06 Q \.\ rj TEST PIT p 7FST PIT/2 TEST PIT u 5 �► \o fL£V=4839' £LEV=48.69' Q£V=4764' - Q \-\ O cc< 0-10' Ap SL 10 YR 2/2 0-10' Ap SL 10 YR 2/2 0-12' Ap SL 10 YR 2/2 ' _ lh Lli - 10'-24' B S 7.5 YR 4/6 10'-22' B S 7.5 YR 4/6 12'-36' B S 7.5 YR 4/6 \ 2 tl 4 i \ \� W Im COURSE SAND COURSE SAND COURSE SAND �S( \ ® 1 4 �t \ �n 15(.SY 0 le\ ' FRONT SETBACK AS 24-78' Cl, S IOYR 5/6 22'-60' CI S IOYR 4/6 36'-52' Cl S IOYR 6/6 'Q \\ /+ / \ \1 'O PER BOOK 464, PG 410 01I LLI COURSE SAND SOME PEBBLES COURSE SAND, SOME PEBBLES COURSE SAND, S>' �J\ .� " zW 0 ma 78'-91' C2 S lOYR 5/6 60'-63' C2 S 52'-180' C2 S IOYR 6/6 \ C i Ld w COURSE SAND, SOME PEBBLES MN& FERROUS OXIDE COURSE SAND,FEW GRAVEL \ \ 6 TREE LINE / / O+ � \\ �of < _ �s~ 91'.192' C3 S IOYR 5/6 63'-90' C3 S 10YR 6/6 \ / o LSD �� C_J Z COURSE SAND,SOME PEBBLES COURSE SAND, SOME GRAVEL & \ _ \� 1 •� 011 P,�i" z z Lij V) J NO MOTTLES OBSERVED STONES NO MOTTLES OBSERVED \ TggCK LINE l 5 - O. E� \�\c) J a COURSE SAND, SOME GRAVEL6& \ 1(]' BUILDING SE _ ,\80 �_ `�' Pv8 z� STONES ._. c Q > w NO MOTTLES OBSERVED •J \ r o S 83°35'14" `N 6� ��\`� ,w o z o (n 11 al GROUND WATER£LEV(OBSERVED) N/A GROUND WATER OEV(OSSERVEDI�yI(/e GROUND WATER ELEV(OBSERt'fD)___ly/e •� f ` cn W z a n MDIIDNG ELfV(�SfRVEO)_�'/A MORUNC fLEV(GBSERVFQ), N/A MOTION=nEV(OBSERVED) N/A ARE U REFUSAL£LEV N/A REFUSAL£1£V N/A •REFUSAL ELEV N/A - S. („)N 0_' Z P\N EXISTING z D, PERCOLATION TEST DATA LEGEND N M 5' X 40" OVAL SIGN LIJ C3 SOIL EVALUATOR: STANLEY SZCZURKO ON BRICK PIER Wes' WITNESSED By. rHRSrns D/MLS7001; o 0157RIBUR TANK BOX oQo TA CAPE REGENCY" tr ¢ DATE: I,117Z06 -600- - EXISTING CONTOURS _ \N Lil PERC I PERC 2 —1600W/E--- PROPOSED CONTOURS SEE PLAN BEN"ARK ND ES O� OL DEPTH: 42' �i✓ WATER DNE TEST PUT t THERE ARE NO KNOWN DRINKING WELLS WITHIN 100 FEET OF THE PROPOSED GROUNDWATER DISCHARGE SYSTEM.'IM[SITE DOES NOT LIE WITHIN A ZGNC 1,ZONE 11.CR IVPA OF A PUBLIC WATER SUPPLY.OR MD RATE.' t2 UPI 0 DRAIN UNE PERC 7FST TU AN AREA TRIBUTARY III SURFACE WRIER SUPPLY,OR 111IN 110 YEAR FLOOD PLAIN.—FM— LAIN. U FM FORCE MAIN 2 SOME DF THE WORK SHOWN ON THESE PLANS IS SUBJECT TU THE WETLANDS PROTECTION ACT. THE CONTRACTOR IS RESPONSIBLE FOR READING AND ADHERING TO THE ORDER OF CONDITIONS AND Imo. DESIGN RATE' 2 MPI --DETAIL NUMBER COORDINATING WITH THE CENTERVILLE CONSERVATION COMMISSION PRIOR TD START OF CONSTRUCTION. - SOIL CCASS/FICA IFON.• ® - SFAER MANNOCE - CLASS I I DETAIL 3. AT MINIMUM OF TWO WEEKS PRIOR TO START OF CONSTRUCT ION,THE CONTRACTOR SHALL CONTACT THE ENGINEER TO SCHEDULE A PRE—CONSTRUCTION MEETING. THE CONTRACTOR IS RESPONSIBLE FOR MAKING C-5 ARANGEMENTS F.INSPECTIONS OF THE INSTALLATION WITH THE ENGINEER,THE STATE DER AND THE LOCAL BOARD OF HEALTH AND CONSERVATION COMMISSION. DESIGN CRITERIA REFERENCE SHEET NUMBER A. CONSTRUCTION OF THE SOIL ASSORBTION SYSTEM WILL REDUIRE RELOCATION OF THE GAS AND VpIER SUPPLY SERVICES. UTILITY CONSTRUCTION SHALL BE IN ACCORDANCE WITH THE UTILITY COMPANY AND _ DIP SPECIFICATIONS. COORDINATION WITH THE UTILITY COMPANY,DPW,CAPE REGENCY NURSING 6 REHAB CENTER'S MAINTENANCE DIRECTOR AND OTHER APPLICABLE PARTIES SHALL BE MAINTAINED TO MINIJZE ANY - TYP£OF ESTABLISHMENT.• 120 ROOM NURSING HOME+29 ASSL$TED LIVING - SERVICE DISRUPTIONS. DESIGN FLOW 149•150 GPD/RM=22,350 GPD GRAPHIC SCALE 5. ANY SITE CONDITIONS ENCOUNTERED WHICH ARE DIFFERENT THAN THOSE REPRESENTED ON THE PLANS SHALL BE REPORTED TO THE ENGINEER, 11; pZN LEACHING CAPALYTY REQUIRED(22 i50 GPD)/25 GIu/SF/J10y=694D SF 6, ALL CONSTRUCTION SHALL CONFORM TO THE OFFSET REQUIREMENTS SPECIFIED IN TITLE 5.DCP'S WASTEWATER TRCATMCNT GUIDANCE DOCUMENT.TR 16,AND THE DEP'S FIANL PERMIT CONDITIONS,AND ANY pH ADDITIONAL CONDITIONS AS REOU.RED BY THE LOCAL BOARD OF HEALTH. y HYDRAULIC CAPACITY PROWLED: (3)SAS TRENCH CONRGURAT/ONS-SEVEN 2'WIDE X 2'DEEP X 71 FOOT TRENCHES _ I FINISHED GRADING SHALL BE AS INDICATED ON THE SITE PLAN, _ _ QQ - 3 SAS X 6 SOFT117 X 7 TRENCHES X 71 FEET=8.946 SOFT l IN FEET 1 B. ALL EXISTING STRUCTURES IN THE VICINITY OF THE SYSTEM SHALL BE FIELD VERIFIED BY THE CONTRACTOR PRIOR TO CONSTRUCTION IF THERE ARE ANY CEINFICIS BETVEN EXISTING AND PROPOSED SHEET 2 OF 7 1 i-b- 31 11. UTIL ITES.THE ENGINEER SHALL BE NOTIFIED IMMEDIATELY BEFORE CONSTRUCTION MAY BEGIN. SEXIST — DETAIL 1 \ `I' CHECK THE STRUCTURA_ IN TEGR NOTES ITY OF THE SEPTIC TANK AND J N (REPAIR/REPLACE IF NECESSARY NOTES. v O W / I AFTER CONSULTATION WITH THC --� 1. SYSTEM THREE PRIMARILY EXIST 9,00 GAL/ ENGINEER. ��1 RECEIVES FLOW FROM KITCHEN AND C/� I 2. THE EXISTING ON-SITE SEPTIC —� LAUNDRY WASTEWATER. THE v QLn ��'--- CCP ___ SYSTEM MUST REMAIN IN SERVICE DETAIL —te r vJE-v EXISTIN LaUNOR'f FLOW SHALL BE Q v —SC THROUGHOUT CONSTRUCTION OF THE DISCONNECTED FROM THE GREASE Q i PROPOSED UPGRADE. THE SHEET C-3 VENT TRAPS AND CONNECTED DIRECTLY TO O W m CONTRACTOR SHOULD TAKE NOTE THE PROPOSED 6"PVC GRAVITY Ca THAT TEMPORARY PIPING TO SYSTEM I 9 32 SEWER MAIN AS SHOWN ON PLAN ( :. 0 If) COMPONENTS MAY 2E NEC_ESSARY IN AND DETAIL - ORDER TO PREVENT DISRUPTIONS IN I C-7 2. CHECK THE STRUCTURAL WASTEWATER FLOW. 3, INTEGRITY OF THE GREASE TRAPS v ) I Z 3. ALL GRAVITY PIPE SIHALL BE SCH AND REPAIR/REPLACE IF NECESSARY C_7 4D PVC(MIN). WATER TIGHT AND AFTER CONSULTATION WITH THE �1 LAID ON FIRM BASE. 36 ENGINEER. 7 4. EXISTING SEPTIC TANK OUTLET 3 \ N T -3. THE EXISTING ON-SITE SEPTIC SHALL BE SEALED WATER TIGHT WITH SYSTEM MUST REMAIN IN SERVICE — — _ — 6 _S HYDRAULIC CEMENT OR OTHER C-7 THROUGHOUT CONSTRUCTION OF THE APPROVED EQUAL METHOD. RE-CORE �\ PROPOSED UPGRADE THE �' FOR A 4"(SCH. a0 PVC MIN)PIPE —�! \ CONTRACTOR SHOULD TAKE NOTE C r -AT THE SEPTIC TANK SIDE AS SHOWN' \' �- - \ THAT TEMPORARY PIPING TO SYSTEM I �a I, P yC BP O \�\ COMPONENTS MAY BE NECESSARY IN ON FLAN. V i 5. SEPTIC TANK EFFLUENT WILL C� �' SMH RIM ORDER TO PREVENT OISRUPTICNS IN \ DISCHARGE TO A 5"(SCH 4D PVC S y WASTEWATER FLOW. I o BM Jj N.IN)SEWER MAIN AND WILL DOWN EL. 39.61' ` I 4. ALL GRAVITY PIPE SHALL BE SCH H VI T/ GRADIENT COMBINE FLOW WITH i a0 PVC(MIN), :WATER TIGHT AND I I a SMH I SYSTEMS 2&3. AND EVEN?LIALLY ` AID ON FIRM BASE. DISCHARGE TO THE WWTF \``p 5. Tr.E SECOND GREASE TRAP - HEADWORKS FOR TREATMENT. - ` SHALL BE FITTED WITH A E-(MIN) I lol RELOCATED EL. 49.2 ' 6. SAW CUT EXISTING PAVED WAY SEPTIC TANK \ I EFFLUENT SEDRISER I ER AT THE TP.E ,AND REPAVE AFTER INSTALLATION OF r�iiC `Z�500 GAL ^) (SHEDS FRO II THE GRAVITY MAIN. PROVIDE LYb S SE-T `J 6. LAUNDRY AND KITCHEN EFFLUENT (BUFFER ZO E `, MEASURES TO PREVENT SETTLING OF GR O COMBINE VYITH WASTEWATER FLOW TP.ENCHES IN THE AREA. FROM SYSTEMS i& 2. I� BM #1 W OP OF L.C.B a I io EL. 49.08' o Im IN a . I IoIaI FRONT BUILDING SYSTEM (SYSTEM 1) REAR BUILDING SYSTEM (SYSTEM 3) (z 0"=10') (1"=10) e DETAIL 2 -" `mm ° °q�� HeE NOTES: C per' \ R N V�� 1. THE SOIL ABSORPTION SYSTEM (SAS) \\ SH Ey.T'l.-3 N \ ,4 Op0(� \� �, // -CONSISTS OF THREE EQUALLY SIZED TJ SEPARATELY PRESSURE DOSED SYSTEMS. GNekC \ \ ce 4 —T— — ' EACH SAS GILL RECEIVE WASTEWATER NOT S: Pq "� EACH FROM A SEPARATE 4"FORCE F �Q /. O MAIN. mK 1. CHECK THE STRUCTURAL WTEGRiT'f OF - PA r EROSTDN` _��' 2. FORCE MAINS SHALL BE SOR 26 PVC da THE SEPTIC TANK AND REPAIR/REPLACE IF PROPOSE STOCKPILE (MIN), WATER TIGHT AND LAID ON FIRM a~ NECESSARY AFTER CONSULTATION WITH THE a ' --(CONTROL _� BASE. ALL BENDS GREATER THAN 22' EXIST 8 00 GAL ENGINEER. I SHALL HAVE CONCRETE TRUST BLOCKS. } �h 2. THE EXISTING ON-SITE SEPTIC SYSTEM 3. THE MINIMUM DISTANCE BETWEEN ANY y I MUST REMAIN IN SERVICE THROUGHOUT TWO TRENCHES SHALL BE 2 TIMES THE Z m Cr i l TAN CONSTRUCTION OF THE PROPOSED UPGRADE. i tA EFFECTIVE TRENCH WIDTH (4 FEET). LLJ L THE CONTRACTOR SHOULD TAKE NOTE THAT 4. RESERVE ARE IS PROVIDED BETWEEN 0 LJ (/} 1 TEMPORARY PIPING TO SYSTEM ♦� 0. (f TRENCHES. (� W COMPONENTS MAY BE NECESSARY IN ORDER ''— IA- VENT SIDE OF THE SAS SHALL HAVE U'L�.I Of F— m _ TOM PREVENT DISRUPTIONS IN WASTEWATER VENT LATERALS AND CONNECTED TO ITS w �H FLOW, - - �' OWN SEPARATE VENT. SEE PROFILE SHEET ZC ¢ Q O 3 3. ALL GRAVITY PIPE SHALL BE SCH 40 C_q u)F— _ = C_7 PVC(MIN).WATER TIGHT AND LAID ON FIRM ETAIL 5. THE CONTRACTOR SHOULD TAKE NOTE �(n U BASE, T x pROPOSED THAT TEMPORARY PIPING TO SYSTEM, D w Cn / FL W FROM SYSTEM 1.SEPTIC TANK EFFLUENT WITH H _ AND ST COMPONENTS MAY BE NECESSARY IN ORDER zZ J _ _ _ ?O PREVENT DISRUPTIONS IN WASTEWATER Q J Q B #3 / W A K __ _ W. 7L0 EXISTING WATER AND GAS SERVICE WILL �� I-a (%1 - ( _ _ NEED TO 8E RELOCATED PRIOR TO z > W J SM 'RIM' \ O q C=_ = _ _ — — — _ _ _ CONSTRUCTION OF TRENCHES T15 THROUGH Q= Q Q / ` ( __ — — —_ T27. WATER LINE MUST A A MINIMUM OF {—(yJ L. 7.62' (` TO FEET FROM CLOSEST SAS TRENCH. m�H- W o C _ _ _ 8. EXISTING RHODODENDRUMS AND OTHER Q Q \ 7 SHRUBS IN THE AREA OF THE SAS SHALL =�W z 0 O` C-7 C - — BE REMOVED AND REPLANTED AT THE Ld a _ _ _ _ ——— DIRECTION OF THE FACILITIES DIRECTOR C, 0 Z o DI EXISTING MONITORING WELLS E THE �0 Q C = C_ — -_ _ _ _ AREA OF THE SAS ARE TO REMAIN. WELL r� J Z CAPS AND CASINGS ARE TO BE REPLACED C) IF DAMAGED DURING CONSTRUCTION. E3 'J" T C— — —__ ___C — — —_ = 10. EXISTING GAZEBO TO BE RELOCATED w y AS SHOWN-ON THE PLAN. THE �wy \ �O 1 s� -� '—— CONTRACTOR MUST COORDINATE ACTIVITIES W aH A/ — VriTH a OTHER CONTRACTORS AS TO THE y CONSTRUCTION OF THE NE GAZEBO AND Q' PRO WAY OVER THE SAS. �STURBEDSED KPARKIN' AND DRIVE AREAS bi _ FROM CONSTRUCTION ACTIVITY SHALL BE 0- REPAVED AS DIRECTED: Q '^ \ EXISTING SEPTIC LEACH PIT(TYP) O . i SIDE BUILDING SYSTEM SYSTEM 2 G�� o ( ) SOIL ABSORPTION SYSTEM zcu (1"=20 UN � SHEET 3 OF 7 a iTl d _ WZ AC �- Zi n T -4�-I z b » A s var v r*ixO o nr• ' x � � < �i � z _ _I Z m o i om 12 D °a y 17 m m n x mo U, G7 o I 1 I� :^- (�� nr wuvrtn (p f�il n I Not r- Ao t '1 n \-\ vxEN 1 W2 no Xi ? a o � of I y � `=m � z>•o o:�i g :. - -• o av9i �� �n n y �j I DOc Q yma°0� �= O o oorOjr� ps�nmrn �^ p�l�b A� O O � s � SIN^iNyimr� ✓'✓� ny ,�* `S' zo � �^ U HIM m i l l 2 S m 00�•0� $ ~ I o P rl N n L' 1 yn �• D AGE N o ^i�jH I ^3 V) A ba Nan f a r COME/NED a J J � O � zli �f1 I mti� LI a Iv �ro i ao^DD/ D O y f'J A 1 ar9� o ma 'o' n �--\N, b2 --- o m cry D fU� 0 8 rn a? z n o o I - a � goy D .N (� 0 O A n a O O O O ITI �O o _ - ca ^ mZ Lp O o o DO allAD AP n ti y P €W mim a g a C vol N U n. ti CCM9/ ) xo fL OWNEO � FROM 51WW I m y D L • z U) CAPE REGENCY REHAB AND NURSING CENTER z ^ 120 SOUTH MAIN STREET SS DESIGNS `•� CENTERVILLE, MA a� ° -- _ __ _ ENVIRONMWAL CONSUL TANTS GROUNDWATER DISCHARGES 3�E No. Date Dr-By Ck.B App.By Description 4' �( a r A P y P R o v E D 24 WOODLAND HEIGHTS DR. o cADD No. PRETREATMENT & FINAL DISCHARGE PROFILES d� F'' —" --- W. BOYLSTON, MA 0 SHT2 V FlLE SCAIE. DATE: DR.BY MBY APP.BY 9 j __. 508-615-7826 AS SHOWN 7/9/06 TAR TAR REGISTERED PROFESSIONAL ENGINEER DATE J - Z O - N �= [o•za i N > Z O ® - v oC l7 CT) N 4 _ tz P � m o� zlit m D � Z 3 �. r ' Imo-) , 1,2 Z m D A�fC' G 0, z 1 r 3 C 10 N D x0m mnmwmW-0<0 CA mm Ncr-+NC Ay�A�a ^rr � _ C7Q V O 3 tTi o�nzenb i ANAr'eio� O z��..ANm.^m< oN- E=l rT r = m A z_ e'nAz-'awD'<"mai"��r O n O — - W f.l --i no n m Z M 'O oeb�o D - N o A m ? oV � Fg I A D f D mbm➢ry H n c- m y D Vl � � I'�1 �3 pyAy - ! Zt7 00 Z ;0 \ O Z ru w j \ ,� I _ r:7 z Z O r m rr� ri x m F o Ir-- c N r-' o m — — m.o cvi A ti m z D Z o z_ G \\ D N O y D n n m ~ o z A Z O A S ➢ D G N ➢ A O D -�• D r ram- �^ A D Z m r DF ZI Z Ci �1 N �\ A m N r 'O c A II 1 z NM1 �01 is C I- 0? E I N A l y, C t C L t ' �;1---- �-- 0 0 nm z n _ 7 o x C O ��, I❑� W D Z Z r Rg m� g V1 D ZJ p S O �y 79 0'. �\ - "l n _ > Go � \ D- Wr ro 2 7 a O Am N �r I O A oy a>Zz 0 i AZ �z xo - z D n to D D V � Z VfO SQ y Op � 4 2 Z • 2 < m T O �p ZO ~ ZL Z o ,g o Am ` Nt A O = CAPE REGENCY REHAB AND NURSING CENTER _ n/ ^ 120 SOUTH MAIN STREET + _ __ — �. —__—^__- SS DESIGNS m `, CENTERVILLE, MA ENVIRONMENTAL CONSULTANTS Ul GROUNDWATER DISCHARGE No. Dote .Dr.By Ck.By App.By Description A P P R o v E --- 24 WOODLAND HEIGHTS DR. O Mll ND. -BUILDING LAYOUT AND TREATMENT DETAILS — W. 80YLSTON, MA fy -n SHT2 i'i'v.�.+�� REGISTERED PROFESSIONAL ENGINEER DATE - - J FlLE: SCALE DATE DR.BY CK.BY APP.BY �2�! — _ 508 615 7826 A$ $HOWN 7/09/06 TAR TAR /ad ' p PROPOSED AL)UHHUN . EXISTING BLDG. \ W J (J� V Z O I QO O �\ I; SLAB FOR MBR O I _y SEE SECTION C-C ( � S ----------- MBR. UNIT v ) 25 7' X 7' W17N 7ANKSE 3 I - I L GENERATORI, I ;I RvOr ------------ J f HATCH I I a I I I \�4. 12.5' BLILDING FOOTING I a w I + I r ----------------------------------------- f r I om ns' I I I 44.G' I OI EXHAUST DUCT EXTEND TO 2 FEET I z P.BOVE ROOF TOP LCJ� COVER WITH DUTCH� A SOUTH PLAN ViE�^J ROOF AND FOUNDATION C LAP\QNYL SIDING _ EXISTING BLDG. (SCALE 1'=5) I p ml I N —_— _LIGHT WITH PHOTO SENSOR (TYP)- PROPOSED ADDITION! EXISTING BLDG. INTAKE VENT AUDIO AND VISUAL ALARM EXHAUST DUCT I� Q - EXTEND 2 FEET N ABOVE ROOF TOP COVER WITH DUTCH W r:r r:rrl r rr LAP VINYL SIDING —----—— _ _ -------J------�---- ---_�i - --1L-------- z HEAVY OUT) CORP.ER i �� a°�` � c• / VENEER rlFI,ym 4.. . 'I lhstam EXISTING BLDG. 4/� 1 co �' o \V` \�\� EL 37.6 FL. 37.0' uj D DROP FOOTING TO ALLOW ROOM FOR DRAIN PIPE WEST ELEVATION VIEW I I n \ , o Lij DISCHARGE TO EOUAUZATION TANK O W IU SOUTH ELEVATION VIEW ' EAST ELEVATION VIEW zw 0 METAL SHIELDING �� Q Q V7 ~ GAS HEATER FIRE SUPPRESSION AROUND,HATCH FRAME VENT INTAKE (TYP) INTERICR LIGHTS(TYP) -� \ VENT EXHAUST - - z(n (n Q LOUVER(TYP) 1 \ DUCT(TYP) Q¢ Q LLJ Q H r- LIGHTING PANEL - Ir '1 I t W U' 3 PHASE 460 V PANEL -- b _-J II - m ~ _ RAISED PLATFORM n ~� # b b Q W Q-Z NEMA 4 PLC CONTROL CENTER — 27.0' _ W ~ -J WITH TELEPHONE A ,LADDER W/ ! _ �N W z m w 2' 12.0'-- O z AUTO DIALER F--7T-T7,TT S"AF E7Y GATE [Q Qn MBR UNIT MBR UNIT MBR UNIT Ua O F z N (� 3 TRANSFORMER EFFLUENT DISCHARGE 5' CONCRETE W o TO PUMP CHAMBER / FLOOR SLAB (MIN) C9 / 43\, W WATER TIGHT SEA' AROUND MBR LNIT t� ...., • o AND 1" CONCRETE BERM N — FL. 37.C' — - W �¢ -- SHUT OFF VALVE 48 WITH RISER AND D I D _- COVER TO SURFE C AC - _ t" i i 47 EL U EL 1,83' EYE WASH AND WATER SUPPLY - - 3 I FAUCET WITH BACK FLOW PREVENTION 160' ANCHOR (TYP) - -") ' OL0 EACH REBAR AT 12" O.C. CHEMICAL STORAGE �..� ;SEE G'FTAIL C-7) _ EACH WAY TOP AND BOTTOM WITH CONTNNMENT / 1 s ` 'V4 REBAR AT 12"O.C. FACE C AL 6"SCH. 80 PVC . - �,� >/ .. ,..-..- - -• `_:. ,}. .. _- _ _,.. .. - AND EACFIHOR HORIZONTAL � {//.•� DRAIN S=.01 FT/FT \% - • _ 4" T-WYE CONNECTION TOcu 80 PVC DRAIN J SECTION A-A SECTION ION B-B SECTION C-C c 6' SCH. (EACH MBR COMPARTMENT) - - �((4 SHEET 6 of 7 N D mp ^` — 't ll MRb y o 0 A III R a o MR,th � M� 8El � Dm �a an D o _ @ § a _ N — v w m rri F7� 0r-9 0r 5 0 MIN i,\IT71 o �' ---------- �I MIN. y , 1 G f D 'tni Z A� fi, C E Cl 5:_0' MIN. r' w � � NI ti oc o ^�� R> r„ �m 000n m- O k I i" - ----- — o — h - 4 z TJ n N r ° Z O z Fri A 0) D o m 3 ¢ (n m D v mo m� D m O z A `; 3 z o - z D o Cm z n o m O a Z o b � 0 1 O, } = CAPE REGENCY SOUTH MAIN STREET CENTER — _ �� OC�/�n/� m ^ -- L /V m `•�, CENTERVILLE, MA "� - — — -- ---____-- --i -- ENl/IRONMENTAL CONSUL TANTS y GROUNDWATER DISCHARGE 9 � No. Data_ Dr.ey Ck.By APP.ey — Do"',tion 24. WOODLAND HEIGHTS OR. O CADDNO. - DETAILS ' a I' _ R 0 v-"E-_._D.___ -SHT2 W. BOYLSTOIV, MA v ALE: SCALE: DATE: DR.BY CK.BY APP.BY - 508-615-7826 I AS SHNWN 7/9/06 TAR REGISTERED PROFESSIONAL ENGINEER DATE I L GROUNIDWATER DISCHARGE FOR CAPE R.. ,F-,.: GENCY r-,FtE , ,---,BAND NURSING CENTER I. 1 120 SOUTH MAIN STREET Pfi r_Pi?RFD B y. CENTERVILLE MA ., SHFFT L IST. SS DESIGNS E V KROINENTA Z CONSvL TA I^JTS 24 ✓1/OODLA��ID HFIGh'TS DR!�E DATE: JULY 9, 006 CO!/FR SH_FET WEST Bo y�sToti; MA � cI- C XrS;I1,,6 CONDITIONS PLANWES 508-EI5-782E C2- GROUND PLATER DISCHARGE PL AIV 16,3- PLAN DETAILS AND NOTES 'L C4 PRE i RF A TM EN T & r 11tiAC DISCHARGE PROFILES C5-- BUIL DING L A YOU & TREQ 71 /V T OFT%IL S CE- BUIL DMIC DETAIL S ` C7- COWS TRUCTION DETAIL S FACILITY FLOW EXIST. 9,000 GAL - { SEPTIC TANK "`-- ({ CONTROL BUILDING FACILITY FLOW i CARBON FEEDLKAVNITY FEED - EXIST 8,000 GAL - (� SEPTIC TANK VENT •T� �C TO SOIL A3SORP DON SYSTEMS `) ))) EXIST. 5,000 GAL ! __ 2ND GREASE TRAP - ANOXIC 6"GRAWTY SEK-P MAIN PROPOSED 74,000 GAL .}' I CLEAR DISCHARGE j f0UAC1ZATlON TANK `PROPOSED 7,500 GAL LAUNDRY FLOW £OUALIZATION TANK r MBR WftL FINAC OISCNARC£ �zncv�,,,,�, ANOXIC -Z nroex uwa w m 6 � S en KITCHEN FLOW .. Z,500 CAi \�p ASE TIAPl —1::Ill 11R�l PROPOSED SMITH&LOVELESS TITAN MQR - - TREA Tii�IENT PROCESS 'DIAGRAIV� \\ Q _ Q 90 44 \ K3-DUMPSTEPS TADE\-------------DESELFUEL NN �\ \ ___ _ v \ �\ f cQ Nt PATIO BY14\ \ \ \hoc' 16 SUBSURFACE G \ \\-SEP \ \\\ \Fo o tinT AREA -..\ \ \ "►\ \ \ \\ \tio' \ \ ��G \\P o GRASSED�RE&-\ , ��'� ��\\\ \ \\�-{ \ \ \\ \ \ \ ��0 \ 6ljypy� / � ! >I 1 1/2 STORY \ \ \ \� \\ \\ \\ \ \ . \\ yf� a /\. /JFF� % \\P O 71, CO a 3 STORY BRICK \ \\�\\ \ °�•\ \ \ \ \ ..r BRICK I �UB U F� E BUILDING BUILDING b \\\^ `\ \ SF\ 1 a 17' HIGH \"+ \ \' Fe \ \ \1� // / / n 3 PTIC I . a \ \\ \ \ \ \ �. l \ 1 32' HIGH (EXIST) 1 \ \ l F o\ \ 1� / @� \ �' / F�� ` m b (EXIST) f \ °\ 2T lt�'\ �\\� 1l \\ \\ o \ \\ �' �i /.\ \ lQp SSg \� TRANSFORMER Iy \-----',, GROSS o' AREA \ 3 - (EXIST) �i Afo � '-----------------r'--- \ :\ �Op,-guFFER t0 Y✓'c �. / j / r - xc nERCIAL r , PAVED FIRELANE WITH GRASS F Tp Q M STRIP N THE FIO�90 EL ® 0 \\ 6(k 1 MIDDLE a o � \ GRASSED AREA 3; w WOOD LAND \ - °P_� GAZEBO BOUND 5 S R SHRU \O. Q COURT � \ - _. � SUBSURFACE \� \EPTIC AREA � � \i CS LL1 WITH DISC R�.3 ` 3 / 5 a� s. z 9R \\ 3 \J' ? J (n w < - \ 2 4 \ )[} i' '( \ \9n �� 15' FRONT SETBACK AS 0' _ NOTES: 'R \ ® ' \ \� PER BOOK 464, PG 410 z(n U Z 1. WETLANDS DELINEATED.BY NORMAN HAYES. P.W.S. NOVEMBER 2005 AND JULY 2006 \ wow ' ' N s Q9 \ \ r'`s�. . �� o z- o oF-: 2. THE WETLAND AREAS DEPICTED ON THIS PLAN .ARE EXISTING WETLAND RESOURCES WITHIN 100 - F TOC \ 6 LINE i'' Qj. \• Z Q J of 0 FEET OF PROPOSED PROJECT. FNCTREE �� o �� a ~ 1 w z �Gl m=� a a 3. THIS PLAN WAS PREPARED IN SUPPORT OF THE DESIGN AND CONSTRUCTION OF A SEPTIC `At n TREATMENT PLANT AND BUILDING ADDITION BY THE CLIENT. - LINE ' \v �� \ S� �V�' Q U 4. EXISTING UTILITIES SHOWN ARE APPROXIMATE. \ �Q' BA BUILDING SET 6 '\� - �\. �t\� Of(nv oz Q° THE CONTRACTOR SHALL BE RESPONSIBLE FOR PROPERLY LOCATING AND _ !S COORDINATING THE PROPOSED CONSTRUCTION .ACTIVITY WITH DIG-SAFE, AND THE APPLICABLE UTILITY COMPANY AND MAINTAINING THE 148•69' ' \ J B�O� �+ \�� zo 0 LEI DI EXISTING UTILITY SYSTEM IN SERVICE" DIG-SAFE SHALL BE NOTIFIED PER S BY35'14„ \N S!�'( O Ld oz THE STATE OF MASSACHUSETTS STATUTE CHAP IER 82, SECTION 409 w AT TEL. 1-888-322-4844. THE ENGINEER DOES NOT GUARANTEE LAND - S THEIR ACCURACY OR THAT ALL UTILITIES AND SUBSURFACE STRUCTURES COURT \\ a EXISTING BOUARE SHOWN. LOCATIONS ANDELEVATIONS OF UNDERGROUND UTILITIES \\v: WITH `, �P 5 X 40" OVAL SIGN LEGEND a TAKEN FROM RECORD PLANS, THE CONTRACTOR SHALL VERIFY SIZE, ��`` ON BRICK L PIER Q LOCATION AND INVERTS OF UTILITIES AND STRUCTURES AS REOUIRED PRIOR El LAND CO✓RT BOUND FOUND FkiSF(VG uCHT OjO "CAPE REGENCY CJ TO THE START OF CONSTRUCTION. WO EXISIINc TREES GREATER THAN 10"DIAMETER ,Y;sTfm G CATCH RAsrN' 5. TOPOGRAPHICAL SURVEY CONDUCTED BY SS DESIGNS IN APRIL AND AUGUST OF 2006 _ _gap_ _ CXISTINGCCNTUjRS Off\ --� 1%IST1A'G B'viY BASED ON A VERTICAL DATUM SET BY DOWN CAPE ENGINEERING CIVIL ENGINEERS AND w WATER LINE „ LAND SURVEYORS ON A PLAN ENTITLED, "SEWAGE SYSTEM DESIGN FOR 120 BED NURSING HOME c GAS LINE DUFFER ZONE LAND IN BA.RNSTABLE, MASS MADE FOR CAPE REGENCY NURSING HOME, Oc T. 30. 1981. --FjT EL£CTRICAI LINE e-- a-�•vc FENCE - BM#1 TOP OF LAND COURT BOUND EL. 49.08- TAW casTwG PIER - GRAPHIC SCALE /'. i n1 6. PLAN REFERENCE: "ALTA/ACSM LAND TITLE SURVEY O ENTSTl1JGLEACH PIT v ~ 120 SOUTH MAIN ST, BARNSTABLE (VILLAGE OF CENTERVILLE)" DATED JANUARY 18, 1999 EXISTING MON170RfNC%fL1 cai N ar BY HIDELL-EYSTER TECHNICAL SERVICES. ® - ( IN FEET) I m,h= �° R. SHEET 1 OF 7 �_, •-.. Ep of r anti ��h Q GE fir. Cr3 i/ I \, \ � y{ ,L•y \ _ �. v f . V p h Pawaseo T000ael_' t �\ \ v _ \• HATauBs ./'_ se'sh' _ Ts�.\ \ ry \ � Z-z Q3 �•'/. --�r�7— - _-�,-a \- �'nc uNwe,' �� � kA nn���� \ s I O a 3 STORY I 1 1/2 STORY ♦ \ \ \ \. \ �`' \ 6(. /'• % c w BRICK I BRICK BUILDING BUILDING 17' HIGH i 32' WITH 1 (EXIST) \ �, \. 5� \J z \ ' ) t O\• \ \ \� \ \\ 1 Via`° a� 0 \ /� z C,-I z 17813tS.F. � j � � ��J4�._����—T�-��s'•.��-� / � � . � �Q' \ GROSS \ AREA PAN�TME \ (EXIST) a ' M \ —T ------- - - c\\ \` Cpyf / z TEST PIT DA TA ,rJ SOIL EVALUATOR: STANLEY SZCZURKO SOIL EVALUATOR.• STANLEY SZCZURKO SOIL EVALUATOR• STANLEY SZCZURKO^' \\ ` J \�\\`j \` `\ —•s�RnalNs-A� WITNESSED 8Y CHRISTOS DIM12ORIS WITNESSED BY f.HRISTO.S D/MISIORIS -WITNESSED BY. CHRISTOS OWN0RIS DATE.• 1/77/06 DATE: 1/17106 - DAIF, - 1117106 - Q \ cJ. rEsr wr p TFsi PIT(2 r£sr P r f3 � 9. 3 ? 5 �► �s m EL£V=4d39' ELEV=48.69'. EEEV=4Z64' 0-IO' Ap SL 10 YR 2/2 0-10' AID SL 10 YR 2/2 0-12' AID SL 10 YR 2/2 ' \ -- - - - W 10-24' R. S 75 YR 4/6 101-22, B S 75 YR 4/6 12-36' B S 7.5 YR 4/6 �Y \ 2 COURSE SAND - COURSE SAND COURSE SAND cQ� \\ ® 1 14 - �i \ - \�� (SO 15' FRONT SETBACK AS U 24-78' Cl S IOYR 5/6 22-60' Cl S IOYR 4/6 36-52' Cl -S IOYR 6/6 -- 'S7 \ /0 - i \ \� 'Q .PER BOOK 464, PG`'410 C.9 W COURSE SAND, S13ME PEBBLES COURSE SAND, SOME.PEBBLES COURSE SAND, 9' �\ - ZLE-1 a n 78'-91' C2 S 10YR 5/6 60'-63' C2 S 52'-180' C2 S IOYR 6/6 \\ / \. _ (n W Q Q � COURSE SAND, SOME PEBBLES MN 4 FERROUS OXIDE COURSE SAND,FEW GRAVEL -\ 6 _ TREE UNE ' 91'-192` C3 S "IOYR 5/6 63-90' C3 S lOYR 6/6 - - COURSE SAND, SOME PEBBLES COURSE SAND. SOME GRAVEL 4- \ - - 'p S� P�i G> z W Q STONES NO MOTTLES OBSERVED \ Tp A�`K 'SINE I.i (j D. '\ S�i f1\,\ �z J Q NO MOTTLES OBSERVED 90-192' C4 S IOYR 6/6 - \ 10' BmUNG SE V_ STONES SAND,.SOME GRAVEL 4 _.—.—.—.-'. 61k \. kQ Q� W h W NO MOTTLES OBSERVED - \, 148.69'. - �b �' '� m?r-- � >- o S 83'35'14" W 6t �N� WO z 0 � \ S c cn Li z GROUND WATER ELEV(08S(OBSERVED)-A{/A GROUAV WA TERELEV(LTBSERVE0)_�7A --WWNDMOTTLING WATER£LEV(ODSERVEL?,L_dl/A \ r O U O o MOTTLING£LEY(OBSERVED) /A MOTTLING FLEW(OBSERVED) N%A MOTTLING ECEY(OBSERVED) N/A - � - REFUSAL ELEV N/A REFUSAL ELEY N/A REFUSAL ELEV_ N/A - S (�N Z P\N EXISTING z CD 3 PERCOLATION TEST DATA LEGEND M 5' X 40" OVAL SIGN LLJ SOIL EVALUATOR. STANLEY SZCZURKO 'S� W W11N£SSED BY QHRI'NOS DlYISIM3 ON BRICK PIER ' DATE t,/17/Os o - w5rRi9unoNsox 0 raNx _ CAPE REGENCY" —600—— EX)SANG CavTOURS O\�\� w PROPOSED CONTOURS SEE PERC I PERC 2 - - SEE PLAN DENaWARK a- - 00 - Q DEPTH.- 42' LEST P/T 1. THERE ARE NG'KID"'DRIPKING WILLS W3-I\-IUD FEE' OF THE PROPOSED GROVN'pIAfER DISCHARGE SYSTEM. THE SITE DOES,MET.LIE WITHIN A ZONE 1,ZONE O.OR IWPA GF A PUBLIC WATER SUPPLY.OR WATER LINE i❑hM .RCA TRIBUi HRY 10 A SURFACE—TERF'vL:',GR Y IH!T 'AB YFAP F117-PAIN - 0 FIELD RAT£.• C2 MPI D DRAW LINE PERC TEST - - - 2. SOME OF THE Vpn'K SHOWN ON THESE PLANS SUBJE T ID THE WETLANDS PROTECTION ACT. THE CGNIRACTDR.IS RESPONSIBLE FOR READING AND A➢HERiNG TO THE ORDER OF CONDITIONS AND DESIGN RA7F.- 2 MPI FORCE MAIN DETAIL NUMBER 'COORDINATING WITH THE LENTF RV3LLE CGNSERV COMS UN PRIOR T❑START OF CONSTRUCTION.SOIL CLASSIF/CA DON' GLASS l O SEWER'MAAHaE 1 3. AT MINIMUM BF TWO VEEKS PRIOR TO START OF CONS!PLC ION,THE CONTRACTOR SHALL CONTACT THE ENGINEER TO SCHEDULE A PRE-CONSTRUCTION MEETING. THE CONTRACTOR IS RESPONSIBLE EDP.MAKING DETAIL AR.ANGEMENTS FOR INSPECTIONS of THE INSTALL..IN VI iH THE ENGINEER,THE STATE DER AND THE LOCAL BOARD OF HEALTH AND CONSERVATION COMMISSION. DESIGN CRITERIA REFERENCE SHEET NUMBER q CONSTRUCTION OF THE SOIL ABSURETITION SYS ILL RFRUIRE RELOCA'ION OF THE GAS AND WATER SUPPLY SERVICES.'UTILITY CONSTRUCTION SHALL BE IN ACCORDANCE WITH THE UTILITY COMPANY AND _ DPW SPECIFICATIONS, COORDINATION WH THE L.i41TY-COMPANY.DPW CAPE REGENCY NURSING 6 REHAB CENTER:S MAINTENANCE FIRECTOR AND,OTHER_APPLICABLE PARTIES SHALL BE MAINTAINED TO MINIiZE ANY TYPE OF ESTABLISHMENT.- 120 ROOM NURSING HOME 1 29 ASSISTED LIVING DISRUPTIONS,SERVICE DISRUPONS. - - �- DESIGN FLOW 149•150 GPD/RM=27.350 GPD _ -, GRAPHIC SCALE s. ANY SITE:CONDIT ION .. S ENCOUNTERED WHICH . IFFERFNT THAN THOSE REPRESENTED ON THE PLANS SHALL BE REPORTED TO THE ENGINEER. - V' ZN LEACHING CAPALYTY REQUIRED 22350 GPD 2.5 pV= 8.940 SF 6. ALL CONSTRL[t1O I SHALL CONFORM TO TH CE.SLT PF GU REMENTS SPCCIFIED IN TITLE 5,DEP•S WASTEWATER TREATMENT GUIDANCE DOCUMENT.TR 16,AND THE DEP'S FIANL PERMIT CONDITIONS,AND ANY pH- x ( �/ Ga//SF/� PD➢ITIONAL CONDITIONS AS REQUIRED.By THE LO:A. BOARD O HEALTH pN HYDRAULIC CAPACITY PROVIDED: (3)SAS TRENCH CONFIGURATIONS-SEVEN 2'WIDE X 2'DEEP X 71 FOOT TRENCHES 7. FINISHED GRADING SHALL BE AS INDICATED ON-HE S-lF PLAN. - 3 SAS X 6 SOFT/FT X 7 TRENCHES X 71 FEET-8,946 SOFT p(IN FEET)� B. ALL E%1ST ING STRUCTURES IN THE VICINITY O THE SY EM SHALL BE FIELD VERIFIED BY THE CONTRACTOR PRIOR TO CONSTRUCTION IF THERE ARE ANY CONFICTS EETWEN EXISTING AND PROPOSE❑ SHE ] OF 7 3D ft. UTIL ITES.THE ENGINEER SHALL.BE NOTIFIED IMME^IATPLY BEFORE CONSTRUCTION MAY BEGIN. - - III CE G ------------- EXIST - -------- � � — - z o Q NOTES IN h I e J Q DETAIL 1_ HECK THE STRUCTURA: TEGRITY OF THE SEPTIC TANK AND = V' N REPA.;R/REPLACE IF NECESSARY NOTES' /(1 TAPER CONSULTATION WITH THE 1. SYSTEM THREE PRIMARILY \ 0 Ell Z 1\ EXIST 9 00 GAL/ ENGINEER _ _ f �J� I RECEIVES fLGl4 FROM KITCHEN AND 2. THE LISTING ON-SITE SEPTIC �� --n��ryp.E-p1 1 LAUNDRY WASTEWATER. THE I V SYSTEM h1U5i REMAIN IN SERVICE DETAIL _- �PStJI VJLU �- EXISTING LAUNDRY FLOW SHALL BE �!\f Q E-fT�i THROUGHOUT CONSTRUCTION Of THE CISCONNECTEC FROM THE CREASE PROPOSED UPGRADE. THE SHEET C-3 VENT TRAPS AND CCNNECTED D'.REC7LY 70 O Q Q CONTRACTOR SHOULD TAKE NOTE THE PROPOSED 6" PVC GRAVITY 0 THAT. TEMPORARY PIPING 10 SYSTEM 5 SEWER IN AS SHOWN ON PLAN COMPONENTS MAY BE NECESSARY IN AND DEMTAIL- ORDER TO PREVENT DISRUPTIONS INI C-7 2. CHECK ?HE STRUCTURAL ( � " 1 WASTEWATER FLOW. INTEGRITY OF THE GREASE TRAPS " ) Flo 3. ALL GRAVITY PIPE SHALL BE SCH AND REPAIR/REPLACE IF NECESSARY S V" AFTER CONSULTATION WITH THE �\1 C_7 L PVC(MIN). WATER TIGHT AND _ �f ]c ENGINEER. L 7 LAIU ON FIRM BASE. 3V I 3. THE EXISTING ON-SITE SEPTIC s. EXIS i1WG SEPTIC TANK OUTLET 3 I (y� NT cySTEM MUST REMAIN IN SERVICE 6 c SHALL BE SEALED WATER TIGHT WIT14 — HYDRAULIC CEMENT T OTHER C-7 I THROUGHOUT GRADE.CONSTRUCTION OF THE 3 APPROVED EQUAL METHOU. RE-CORE PROPOSED R SHO'E. THE C FOR TA 4' (SCH T40 PVC MIN)PIPE SHOWN VC -�r�- \\\ CTHAT ONTRACTOR ARYUPID FAKE NOTE V I CS IVI O i COMPONENTS MAY BE NECESSARY ECESSA.RY SYSTEM IN �a ON FLAN. i / �� I 'vRDER TO PREVENT DISRUPTIONS IN 5. SEPTIC TANK EFFLUENT Vr7LL C/' i DISCHARGE TO A 6" (SCH 40 PVC ,7V/� SMH RIM —_ WASTEWATER FLOW. I. MIN SEWER MAIN AND 'lAll DOWN ' I 4. ALL GRAVITY PIPE SHALL BE SCH I BM # ) EL. 39.61' MN ) H GRADIENT COMBINE FLOW W iH 40 PVC MIN WATER TIGHT AND n w SM H I SYSTEMS 2 &3. AND EVENTUALLY �\ \ 5. THE SECOND GREASE TRAP o LAID ON FIRM BASE. � DISCHARGE TO THE WWiF HEADWORKS FOR TREATMENT. SHALL 6E FITTED WITH A 6" (MIN) ( (RELOCATED EL. 49.2 ' 6. SAW CUT EXISTING PAVED WAY SEPTIC TANK �\ VENT IN THE RISER AT THE > AND REPAVE AFTER INSTALLATION OF I ` EFFLUENT SIDE (SHEDS FRO GRAVITYLAUNDR AND KITCHEN OF THE TANKEFFLU- . t� y THE GRAVITY MAIN. PROVIDE S 2,SOO GAL �� O /v\' COMBINE WITH WASTEWATER FLOW-IJT _ Y/' MEASURES TO PREVENT SETTLING OF 'BUFFER ZO E jjs_ GR F( FROM SYSTEMS 1 & 2. TRENCHES IN THE AREA. I BM #1 ,s ` r 1 m W OP OF L.C.B EL. 49.08' \ o I 0 i Ia �o a Im w I I la W FRONT BUILDING SYSTEM (SYSTEM 1) REAR BUILDING SYSTEM (SYSTEM 3) a z • TNONA9A '`F`\ flYUEfl CML _ Ma°ISM . DETAIL 2 AR pqR�� L O�j v, HPrpgE NOTES: L ��q uuu CC C��r, ,��� SOIL ABSORPTION SYSTEM(SAS) I. SHEET -3 CONSISTS SEPARAT OF THREE EQUALLY SIZED STEMS. EAP�RA SL APR SSURE LL RE EIVE DOSED TER / ' 3' - OA.- •('C !' �� ° 4 - ' I EFFLUENT FROM A SEPARATE 4"FORCE NOTES.. 'VV A�'O V— p0 i'� m< �d�W 1. CHECK THE STRUCTURAL INTEGRITY OF ` � �„ p r" — —' MP.IN. pROPOSEO EROSION( _, FORCE MAINS SHALL BE SCR 26 PVC n H THE SEPTIC TANK AND REPAIR/REPLACE IF ' STOCKPILE (MIN), WATER TIGHT AND LAID ON FIRM a i - NECESSARY AFTER CONSULTATION WITH THE 4CONTROL BASE, ALL BENDS GREATER THAN 22' T EXIST 8,0 GAL a ENGINEER. SHALL HAVE CONCRETE TRUST BLOCKS, w �� 2. THE EXISTING CN-SITE SEPTIC SYSTEM 3. THE MINIMUhd DISTANCE BETWEEN ANY F- > i MUST REMAIN IN SERVICE THROUGHOUT TWO TRENCHES SHALL BE 2 TIMES THE Z m I TAN CONSTRUCTION OF THE PROPOSED UPGRADE. I _ EFFECTIVE TRENCH WIDTH(4 FEET). d THE CONTRACTOR SHOULD TAKE NOTE THAT c- 4 RESERVE ARE IS PROVIDED BETWEEN U Lli V) \ i TEMPORARY PIPING TO SYSTEM - /♦� A p• CE TRENCHES (�_.Lil / 1 - COMPONENTS MAY BE NECESSARY IN ORDER T 5. EACH SIDE OF THE SAS SHALL HAVE C7 ELJ 0, F- In Q TO PREVENT DISRUPTIONS IN WASTEWATER VENT LATEEV RALS AND CONNECTED TO ITS z Q Q 0 z1- FLOW. c-T OWN SEPARATE VENT. SEE PROFILE SHEET � ~ 3 3. ALL GRAVITY PIPE SHALL BE SCH 40 C-4. PVC(MIN). WATER TIGHT AND LAID ON FIRM ETAIL 6. T � = z HE CONTRACTOR SHOULD TAKE NOTE (n U Q C-7 �BASE. T 2 - THAT TEMPORARY PIPING TO SYSTEM. D Lil Cn / 4. SEPTIC TANK EFFLUENT COMBINES VWTH f-{ PRAANNDSs� COMPONENTS MAY BE NECESSARY IN ORDER Zz z I`JI�, FLOW FROM SYSTEM 1. _ _ — _ TO PREVENT DISRUPTIONS IN WASTEWATER W. Q— J 0 Q. B�l/I #3 _ W WA y�J — — — _ —_ 7`O EXISTING WATER AND GAS SERVICE WILL Z�~ (n ,rj(j (\ _ _ _ _ _ NEED TO BE RELOCAED PRIOR TO ,> Ev -i } SM RIM \ O Q CONSTRUCTION OF TRENCHES T15 THROUGH _ C _ T21. WATER LINE MUST BE A MINIMUM OF F-Lj Q Q �-• L. 7.62' , = — -- — _ — — _ _ — — = / I 10 FEET FROM CLOSEST SAS TRENCH. mD W o C 8. EXISTING CLOSEST AND OTHER QQ z \ 7 —_ '----— — SHRUBS IN THE AREA OF THE SAS SHALL 2(n W Z 0 0\ C= _ _ _ BE REMOVED AND REPLANTED AT THE Lli a n C-7 t = — _ — — — — — =—— =__= DIRECTION OF THE FACILITIES DIRECTOR. U Z o a — — — — 9. E STING MONITORING WELLS IN THE �� Q _j C� � � C _ PREP.OF THE SAS ARE TO REMAIN. WELL }N � J Z `l�C� —— = CAPS AND CASINGS ARE ONS RJCTIONREPLACED C..) U' C3 IF DAM ACED DURING C E — _ _ _ — _ _ AS EXISTING GAZEBO 7. BE RELOCATED w = �T �- — — = AS SHOWN ON THE PLAN. THE Iy QO CONTRACTOR MUST COORDINATE ACTIVITIES N PATH OTHER CONTRACTORS AS TO THE L'i yVj Q \ / ``A�C — CONSTRUCTION PATH THE NEW GAZEBO AND Of III, PROPOSED WALKWAY OVER THE SAS. 11. DISTURBED PARKING AND DRIVE AREAS L11 ' \ O FROM CONSTRUCTION AC'fI VITY SHALL BE <. . REPAVEO AS DIRECTED. Q U EXISTING SEPTIC LEACH PIT(TYP) A 0 SIDE BUILDING SYSTEM (SYSTEM 2) 501L ABSORPTION SYSTEM ci =� (1"=10') (1"=20) �N G SHEET 3 OF 7 L r / r a a ti r- iti "®2\ oc- alp — Z _ b up cnm a� D �� pD A tiro IN� Off' f \ V> -_a xp Z- 2 D n A �.rv.:. w Z7 Hl �A. �z' 'i D ron vg o UI 3 x o p A l w Z ^ a (ten ? o o � a p,. I 0 Z n U ^o -I -1 O -1 O A 00 z Inz 2 L7 Q A Z 2 - f U I - \�A to G7co r � o 00 1 E O O lZ � a cmi m ❑o Ln FTJ a9 O v C) UI p '� o \z 1• Or n< icDn !: N i D iJ� r� vF (f L mo n�m o8. Ln A C @ -TI a 0 rTl vtivwc fTl .c �= D oocaA e A n �" - az a m m�Nimi A r ....�",9Qmn' o y m <_ -fin No p nati rn� O . V w a DN �.�.. op o O � m mA tiC A J r.l D In < r Z-Ni�O 2n I �o�O9 Z3fern pp pU n Lj wp? v N o �y< o� �ti O � xxgr >�i O O 0ON0 ]1D DNV1 �� Oyr" rn U O o> m 0 w A no z 11 ®® C 0rq O O a•II (n W N Nn II (Z(�� PI m ~ B O�AZI f1 _ y\N � a a(pUN N DNS c� i2 � C) tl ; Nq> p I + L >ov - K Z r1 X g Z na - m m D v 'A$a "ri o ao .p rM1 Ir � s q p n I n ?D' �) na tNi a0 Icn �D r COMB/NEO ) J ( O r L� Z = G FROM SY57EM5 1 R p O 0 ���1 I n^n� C) Rl< Qx cn 11�n�o ti G C / m A o v n Off- m 1.. 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FP- I 4 i0 ICY SPR.COu 1 L� (SEE DETAIL DWG.f-4) FP-4 -OR f'L1, INV. 47. 51 IvlAl�l, . 1ZI5E� A 3"W/aTtR. METER (E)Y CIONTR PL5G . CC)WTR. STARTS AFTER 3" \JALVEI) OUTLET FROM Id' MAI :`,': _ NOT ES I. ALL PI (' ► NG SHC� PJ S� i �•` GI� nMI�iAT i C- ,�� L '�� E �P. 0 I � C��"� ! - T ION TO 13E 0ETERMIKiC0 AFTER COOR1_,1N /-\TIC> LIP TO f' C0 � W i VH ELL CTR.) 14E/-,Ttt G) SPRI " KLER F, GEN'►- . CC)�-41' R. O S H ALL Z. ALL HORIZONTAL RZOC' f D I�AII�AGE AF�UVE FLOG t� N RISE\� A RISER "A' 6E 11.ISULATE D. I n n n 41, B A S E M E N T F L 0O R L f N 3. LOCATE WALL CLE AhAOUT 5 OR CtEAU0UT5 AT CASE OF ALL 5AWITARY) WASTE STACI< 5 AW0 Ro\ ',14 LEADERS • U SCALE I/ " I 0'I - - - - ---- -- -, 4. FCr - )(ACT LOCAT 1 Otl OF ROOF VDIzAIthIS SEE. ARC1-11TECTL.DWCS. < PROVIDE ACCESS TO Vt\LVES AND TRAPS AC30V C CEiLa►,1�, SMOKE PARTITION I HR CONSTRUCTION r BOVINE DRAIN VALVES AT ALL LOW PC)INTS .OF WATER PIPING_ Q � 2 HR FIRE RATED PART I T ION 7 PROvIDE CLEANIOU 'TS, VACUUM I'.5TZG/NKER5 ;-\WD OTHSIT COM- J 4, PONEWT% RCQUIRLO ljY COtDI` WHETHE-M OR NOT INOICATEp, j I NOTE I 8. ALt- ,;\S � ► `� ► IBC. TO HAVE. G" DIRT P0CICET AT T5OTT0tVk ALL PARTITIONS TO RUN FULL HEIGHT Ci j oF- Tz ► SLRci) FROM FIN FLOOR -TO UNDERSIDE OF w 2). ALL EXPOSED WATER PIMMC, SHALL+ 13E CHROMC 1-LATED. DECK ABOVE. CONS T RIJC T IN ACC. CRD - W WITH O.SU: I HR FIRE TEST T - 1 174 ~ 10. LOCATC WALL IiYDRAtvTS (EXTL-R10Q YVALL) 3-0 AT�ov� U ; ANCE Q Flh.i ISI-ICD G1?AI� E, O U x 4' ST"°RM � 'e--I ,_o.—+1I 11. f'L_LtM ►JII�c Corer RAcTorz 51-IALI. s�:T FLOOR DRAINS 'iZ' 1 V ° 1 r3ELCDvN F ►-I�115ML173 FL.OorZ . O U i N . 480 4 l I ) • - - - - z -- � � IZ PIZovIDE SHUT-OFF vALvEs oN A>,L ar�A>Jcl-1 P► `DINc, AlacD ol4 -t- -- -- -- I _ _- - - ---- INV. 4�.1� R► 5ER �' RISER A ALL SLlI�t>L\( I� 1 r' 1 NC, TO Y NpiVlbUl\!_ F lkTURES i�ra� 1 � 4" EQU1PMLNT•. VALV ES SHNL.L BE ACCE551 frLE . �i 13 5t:C '/4' SCALE K ITCHEN PLA 4 DRAW ING NO . P - C FOR PlPi SIC, CLARITY . l ( J 14. SEE S71Z.UGTURAL DGLAWl1►�C�S FAR OPEI�IIr.1C�S I►.J �-ECAS`(' PLAtI 14 VACUUM DREAKL"rZ SOLENOID VANE usE CPEiJi►k1 c;) wNEtzF EVF_R PC�SIP�LE TN►S CO�T(ZACTC�R =� L_L D 2I LL. P L A J K Fc0FZ ALL O j H E-2 Of'E rl i r�lG�S t.E F_D E O To 14 G TALL A i S Z %Z CW --3/4 .C.W. 4 WoRA4 , Q12C1-1ITEC-F toAPPaOVE ALLOPEt�Iir.IC� SIDES AJ-IO MET)-AC D b- C U I t�LA rJ IL U P TO F C O � '� r T'i" �i Lu N 15 C oo rZ D�r�e.1"E ,4 Ll,. v,/bF21� W t j N oT N E 2 TRAv 5-5 Z DISNWA51�E1Z RISER 'A D15POSAL I/z "-SHUT- OFF VALvE rat r �� ' A 16v SEE STtzUcTUI2AL >]�wttJC-,S Foa. L�co.Ttc�►.L or M,&-tO 1rz ' uj (N I PC) C,O _ 5NOCK AP�SORI3ER 4 41 MALLS ACID tWLJT'E ALL. Pi Pi tJCa TO AYc�i� SAM e- cnT e WA5TE 4-VE.14T ---J INV.4G.18 TYPICAL DISPOSAL.. UNIT - -- -WATER PIPING DETA� � DONA��. y� i tU'=0 CALL No. 13d,1 — ql. �-