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Home My WebLink About0220 BAY STREET - Health 220 Bay Street A = 094—005 1 j No. 2o 2 q 3 Fee D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplitation for Disposal *pstrm Construction Fermat A3 Application for a Permit to Construct( ) Repa4( ) Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. ZZo 'Bay S,ire Owner' Name, � Address,aid el.No ��,'an �oG�G2 Assessor's Map/Parcel Installer's Name,A d'ress,ian/d�Tel.N 6 � 7"1 esigner's N e,Address,and Tel.No. �/�- ryryI �G� ►—" Su T.v4h Frf;n�eh'nJ rConi�l E� ��nl. l� S09—Y2 6- 33y-/ Type of Building: v Dwelling No.of Bedrooms 7 Lot Size l&3i 130 sq.ft. Garbage Grinder( ) Other Type of Building R `O�PA+,4( S'� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required yy� d Design flow provided �®s.2 gpd Plan Date II jt6IW2( Number of sheets I Revision Date Title s.-16, ®lph Tr . 4Seot c� 'f1C Doi i = Size of Septic Tank 1 S� +��®x C s Type of S.A.S. � a� VS�/j wi 44 Description of Soil T H-1:6^ 12" h;/l IL'-3 0" 13a, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo f Si Date "1 ,- Z Application Approved by 1 v Date .2 Application Disapproved by Date for the following reasons Permit No. 2—p l d Date Issued _• No. >2' Fee ` Entered in com uteri THE COMMONWEALTH OF MASSACHUSETTS P _,,00' PUBLIC HEALTH DIVISION - TOWN OF:BARNSTABLE, MASSACHUSETTS Yes '01pplication for Misposal 6pstem•Constructio'n,permit .Application for a Permit to Construct( ) Repaj�_* Upgrade( ) Abandon( ) []`Complete System ❑Individual Components r, Location Address or Lot No. ZZO 3 r P. Owner's Name,Address and Teel.No. Assessors Map/Parcel Installer's Name,Address,and Tel.No. Y b 7 11.5. {''t `I Z-Designer's Name,Address,and Tel.No. .( �y ` I S 11,t{47ri " „A rl'n rCanSLf :r n<. Type of Building: Dwelling No.of Bedrooms Lot Size i 1d 0 30 sq.ft. Garbage Grinder( ) Other Type of Building R-,!�5;4474+;C4 1 S'^�f r c No.of Persons Showers( ) Cafeteria( ) Other Fixtures ~ Design Flow(min.required) � gpd Design flow provided S 0 gpd ` Plan Date O 1 n� Number of sheets I Revision Date Title S, �c,M f/ap�5�� << Z>�S i�rt_ .. •. Size of Septic Tank f 5' 6ci11oh C"&rS Type of S.A.S. / bY•� i;e' Description of Soil ..�^ ,,; — (2 c t /1 ` (3�r t7 �k. �� e!' �QG{��p SQnGN C, ri h/6, 3®ftcl — r. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H'lJK_ Signed y # Date h Application Approved by C Date i /�C, Application Disapproved by Date for the.fol'lowing reasons Permit No. 2 0 t ' 't a Date Issued (f J co A., f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at Q �/ S /` �..�' D,rt.�/% ��f has been constructed in accordance with the provisions of Title 5 and the-for-Dispos`^S stem Construction Permit No.. 63 (' ?1 dated . I 1 Installer � *✓' Designer .S„1Ggk1 F �►,nr 16l{5/J.Sof #bedrooms Approved design flow gpd t' The issuance of this permit�shall/n6t be construed as a guarantee that the syste will functi`on�as designed.,, Date }�tom/" Inspector No. ez �' 7 Fee THE COMMONWEALTH OF MASSACHUSETTS \~` PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS t Misposal Opstem Construction pertnit Permission is herebyanted to Construct Repair Upgrade Abandon l�' ( ) P ( ) P� (// ) ( ) System located at C J4/- s .o s4.P1(rc• 1i and as described in the above Application fdr-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 `ust be completed within three years of the date of this permit. Date T �7. Approved by P �. L0CATIO °� EWAGE PE T NID'-. .. VILLAGE A = � 1NSTAI ER'S ME i ADDRESS I \ r S UILDER ' 0 ER c. f� �1 DATE PERMIT ISSUED O A E .' .C�40�Ii� P L I A N E I U E D 9 8 _�� l :220 g*y , �ut�t! .,� C��o� M°'y �otr-ecf. O C I'. \r V v 6 t c9 1^^ �, Q f Town of Barnstable Regulatory Services Richard V. Scali,Interim Director ` & Public Health Division Thomas McKean,Director 200 Mai>!n Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form 12/8/2021 2021-427 094-005 Date: Sewage Permit# Assessor's MaplParcel Designer: Sullivan Engineering&Consulting, Inc. Installer• Address: 711 Main Street/PO Box 659 Address: Osterville, MA 02655 11/19/2021 On was issued a permit to install a (date) (installer) septic system at 220 Bay Street, Osterville Ma based on a design drawn by (address) Sullivan Engineering&Consulting, Inc. dated 11/10/2021 (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i ompliance with the terms of the BA approvapetters (if applicable) ZN OF k4 s HARL T. yG ow (Instal er', Signature) o. L ti FCISTor E SSbNAI ' '(Designer's Signature) (Affix Des tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13:doc Town of Barnstable �; Board of Health MRWsaSM 1 200 Main Street, Hyannis MA 02601 Office: 508-8624644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt. March 8, 2022 Mr. Chuck Rowland Sullivan Engineering 711 Main Street Osterville, MA 02655 RE .220'Bay Street,.Osterville, Dear Mr. Rowland, You are granted variances on behalf of your clients, Brian Koelbel and Tracy Ryan, to construct an onsite sewage disposal system with a NitROE treatment unit incorporating advanced nitrogen reduction technology at 220 Bay Street Osterville, Massachusetts. The variances granted are as follows: Section 360-1 of the Town of Barnstable Code:: To install a soil absorption system 92 feet away from wetlands, in lieu of the 100 feet minimum separation distance required. Section 360-1 of the Town of Barnstable Code: To install a septic tank 61 feet away from wetlands, in lieu of the 100 feet minimum separation distance required. Section 360-1 of the Town of Barnstable Code:: To install a NitROE tank 74 feet away from wetlands, in lieu of the 100 feet minimum separation distance required. 310 CMR 15.211:: To install a soil absorption system four (4) feet above the maximum adjusted groundwater table, in lieu of the five (5) feet minimum separation distance required. The following requirements are provided within the multi-page MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter dated May 12, 2020: (1) Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the ,unit, stating that the property owner: a) has been provided a copy of the Provisional Use Approval Q:\WPFILES\Rowland 220BayStreet0sterville Variances and NiTROE Approval May 2021.docx 1 and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; KleanTu NitROE 2K Provisional Approval, May 2020 Page 11 of 15 Technology: NitROEO 2KS & 2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval; and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). (2) Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000, the approved design plans, and all local requirements, including any local approving authority site-specific requirements' (3) Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i) a certified Registry copy of the Notice bearing the book and page/or document number; and (ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department. (4) Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year. (5) The wastewater effluent shall be sampled and analyzed/tested quarterly if this facility is utilized year-round. Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection. [Note:a)Year-round facilities shall be inspected and effluent sampled quarterly; b)Seasonal properties shall be inspected and effluent sampled a minimum of twice per year,with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample; and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling shall also include Field Testing of System wastewater when determined necessary by the operator,see DEP Field Testing Protocol at http://www.mass.gov/eea/docs/deptwater/laws/i-thru-zltestsamp.pdf] (6) A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator 0&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. Q:\WPFILES\Rowland 220BayStreet0sterviIle Variances and NiTROE Approval May 2021.docx The above list is not all inclusive. All of the other requirements listed in the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter dated May 12, 2020 need to be adhered to. Sincerely, n Orman Chairman E Q:\WPFILES\Rowland 220BayStreetOstervilie Variances and NiTROE Approval May 2021.docx r DATE: � $95.00 FEE*: t KASS. Town of Barnstable I=EEc., 6"�`�, Board of Health sCHED.DATE: aif 200 Main Street,Hyannis MA 02601 Office: 509-962-4644 John T.Norman FAX: 508-790.6304 Donald A.Guadagnoli,M.D. Paul Canniff,D.M.D. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM , LOCATION �y,� �• � DS,��l 1 Property Address: oZ0&0 Assessor's Map and Parcel Number: __Size of Lot: y a Wetlands Within 300 Ft. Business Name: Subdivision Name: APPLICANT'S NAME: Phone f Did the owner of the property authorize you to represent him or her? Yes Vr No PROPERTY OWNER'S NAME CONTACT PERSON Name k0 'N I Name: Address: IV) 6N O� 01k t Address: I I I 1 y lLKq,i Phone: Phone: U —3-54 t EMAIL: on VARIANCE FROM REGULATION(inet.Reg.cove a) REASON FOR VARIANCE(May attach separate sheet i oro spat needed) I - S ' Vlpi NATURE OF WORK: House Addition House Renovation Repair of Failed Septic System Chec lst (to be completed by office staff-person receiving variance request application) ji ease submitflPstfour on list as S collated packets ---/A. Five(5)copies of the completed variance request form _✓ . Five(5)copies of MA DEP approval letters for Innovative/Altemative septic system(when proposing an VA system or secondary treatment unit(S.T.U.). _ Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(I)electronic version submitted to email: health own.bamstable.ma.us *(Pool Plan—5 hard copies) _ D.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. _ A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or R.S. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only} _ Fee Submitted*$25.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1) Septic repair withou an increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. Q:\Application Forms\VARIREQ Rev Jan .1-2020.docx NARRATIVE TO ACCOMPANY HEALTH DEPARTMYET FILING REQUEST FOR VARIANCE& ADDITIONAL BEDROOM INCORPORATING INOVATIVE ALTERNATIVE SYSTEM For Brian C. Koelbel&Tracy A.Ryan 220 Bay Street, Osterville MA Map 094 Parcel 005 The project site is located at 220 Bay Street, Osterville abutting North Bay. The site is developed with a single-family dwelling constructed around 1980, and an existing pier, ramp, and float constructed around 1984. Additions/renovations were approved in 1996 and 97, and a retaining wall to die north of the dwelling in 2002. In 2020, the applicants received approval from Conservation to renovate die existing dwelling under SE3-5807. The approved construction is under way. The applicants are voluntarily asking die Board to approve the use of an I/A system on their property. They are aware of the benefits dais type of system can offer. Since die site is almost entirely in the 100' buffer zone to die wetlands, variances are requested for separation to the wetlands in addition to requesting a variance for separation to ground water of 4'. The design of the septic system incorporates die NitROE innovative alternative septic system by Jolm Smith of K1eanTU to better reduce nitrogen of die effluent. Widi die incorporation of die innovative alternative,we are requesting die additional bedroom allowance to be used for future use for a total of 5 bedrooms. p Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 Charles D.Baker Kathleen A.Theoharides Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner PROVISIONAL USE APPROVAL RENEWAL Pursuant to Title 5,310 CMR 15.000 Name and Address of Applicant: KleanTu LLC. 300 Old Pond Road, Ste#206 Bridgeville,PA 15017 Trade name of technology and models: NitROE® Waste-Water Treatment System (NitROE® WWTS) with unit sizing for design flows up to 2000 gpd (NitROE® 2KS WWTS and NitROE® 2KM WWTS) (hereinafter the `System' or the `Technology'). Owner and Operator manuals, installation manual, schematic drawings illustrating the System models and the technology inspection checklist are part of this Certification. DEP Transmittal No.: X285590 Date of Issuance: May 12,2020, Expiration date: May 12,2025 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000,the Department of Environmental Protection (hereinafter "the Department") hereby issues this Provisional Approval to: K1eanTu LLC, located at 300 Old Pond Rd., Ste 206 in Bridgeville, PA (hereinafter "the Company"), NitROE® 2KS WWTS and NitROE® 2KM WWTS (hereinafter "the Technology" or "System") for use in the Commonwealth of Massachusetts subject to the conditions herein. Sale and use of the Technology is subject to compliance by the Company, the Designer, the System Installer,the Operator, and the System Owner with the terms and conditions herein. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. May 12,2020 Marybeth Chubb, Section Chief Date Wastewater Management Program Bureau of Resource Protection This information is available in alternate format.Contact Michelle Waters-Ekanem,Director of Diversity/Civil Rights at 617.292-5751. TTY#MassRelay Service 1-800-439.2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper KleanTu NitROE 2K Provisional Approval,May 2020 Page 2 of 15 Technology:NitROE®2KS&2KM WWTS I.PURPOSE Subject to the conditions of this Approval and any other local requirements,the purpose of this Approval is to allow installation and operation of at least 50 on-site sewage disposal systems utilizing the technology in Massachusetts in order to conduct a performance evaluation of the capabilities of the Technology during the first 3 years of operation of each system, in accordance with Title 5 — 310 CMR 15.286(7),Provisional Approval of Alternative System. The specific goal of the Performance Evaluation is to determine if the Technology is capable of consistently meeting the concentration limits for total nitrogen (TN) of less than 11 milligrams per liter (mg/L) for installations with design flows less than 2,000 GPD in the effluent discharged to the soil absorption system. In areas subject to nitrogen loading limitations,increases in the discharge rate per acre may be allowed when the nitrogen concentration discharged to the soil is reduced. The Company is responsible for oversight and sampling of the systems during the Performance Evaluation. The System Owner has responsibility for continued oversight and sampling of the system if the property served was allowed to increase the discharge rate per acre above 440 gallons per day per acre (gpda) in an area subject to Nitrogen Loading Limitations. The System Owner will be required to repair, replace,modify or take any other action as required by the Department or the local approving authority, if the Department or the local approving authority determines that the System is not capable of meeting the required reduction in nitrogen in the effluent. With the other applicable permits or approvals that may be required by Title 5, this Approval authorizes the installation and use of the Alternative System in Massachusetts. All the provisions of Title 5, including the General Conditions for all Alternative Systems (310 CMR 15.287), apply to the sale, design, installation, and use of the System, except those provisions that specifically have been varied by this Approval. II.GENERAL DESCRIPTION OF THE TECHNOLOGY The NitROE ®2KS or 2KM WWTS (the `System') is installed in series between a Title-5 system septic tank and a soil absorption system constructed in accordance with 310 CMR 15.100 — 15.279, subject to the provisions of this Approval to accommodate design flows of less than 2,000 GPD. The System is comprised of two-unit processes which are sequentially performed in two different chambers. The first chamber is aerated, via an external air pump and airline header/hose arrangement,to achieve both organic carbon reduction along with the biological conversion of ammonia-N to nitrate-N. From the Aeration Chamber, the wastewater then gravity flows into a Denitrification Chamber where, in the presence of natural organics from wood chips,bacteria mediate the conversion of nitrate-N to inert N gas that exits to the atmosphere via the Title 5 system vent piping. Depending on design flow and availability of local tank structures, the sequential Aeration and Denitrification process steps can be performed in the same single tank, which is NitROE®2KS WWTS, or each process could be performed in its own separate tank with the overall NitROE® WWTS comprised of multiple tank combinations, which is NitROE®2KM WWTS. The use of the Technology under this Approval requires: • Disclosure Notice in the Deed to the property; • Certifications by the Company,the Designer,and the Installer; • System Owner Acknowledgement of Responsibilities; KleanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15 Technology:NitROEO 2KS&2KM WWTS • A certified operator under contract for periodic inspection and maintenance; • Periodic sampling; • Recordkeeping and reporting;and • An external power supply III.CONDITIONS OF APPROVAL A. Basis for Conditions 1. The term "System" refers to the Technology in combination with any other components of an on-site treatment and disposal system that may be required to serve a Facility in accordance with 310 CMR 15.000. 2. The term "Approval"includes the Special Conditions, Standard Conditions, General Conditions of 310 CMR 15.287,and the approved Attachments. 3. Items required by this Approval include: a) Performance Evaluation Plan (PEP) with sampling and analysis requirements and approved by the Department. The PEP must be submitted to the Department for review and approval within 60 days of issuance of this Approval and meet the requirements of the Department's Guidance for the Preparation of Performance Evaluation Plans <2,000 GPD; b) Minimum System installation requirements; c) Company schematic drawings and specifications; d) Owner's Manual, including information on substances that should not be discharged to the System; e) Operation and Maintenance manual, including but not limited to, operator qualification requirements, inspection requirements, sampling and analysis requirements, recordkeeping requirements,and/or reporting requirements;and f) MassDEP Operation and Maintenance (O&M) checklist and I/A technology inspection checklist. B. Special Conditions l 1. Department review and approval of the System design and installation is not-required unless the Department determines on a case-by-case basis pursuant to its authority at 310 CMR 15.003(2)(e)that the proposed System requires Department review and approval. 2. System installations must meet the specific siting conditions for Provisional Use provided in 310 CMR 15.286(4)and the facility must meet the siting requirements of this Approval. 3. Any System for which a complete Disposal System Construction Permit Application is submitted while this Approval is in effect,may be permitted,installed, and used in accordance with this Approval unless the Department,the local approval authority,or a court requires the System to be modified or removed or requires discharges to the System to cease. 4. The System Owner shall provide access to the site for purposes of sampling the System in accordance with the Company's technology Performance Evaluation Plan approved by the KleanTu NitROE 2K Provisional Approval,May 2020 Page 4 of 15 Technology:NitROE®2KS&2KM WWTS Department, in addition to providing access for performing inspections, maintenance,repairs, and responding to alarm events. 5. The System Owner shall ensure that no permanent buildings or structures other than the Y P g System, are constructed in the area for the installation of all the components of a fully conforming Title 5 system with a reserve area. The area for a fully conforming Title 5 system with a reserve area shall not otherwise be disturbed by the System Owner in any manner that will render it unusable for future installation of a fully conforming Title 5 system. 6. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sanitary sewer system. If it is feasible to connect a new or existing facility to the sewer, the Designer shall not propose an Alternative System to serve the facility and the facility Owner shall not install or use an Alternative System. When a sanitary sewer connection becomes feasible after an Alternative System has been installed,the System Owner shall connect the facility served by the System to the sewer within 60 days of such feasibility and the System shall be abandoned in compliance with 310 CMR 15.354, unless a later time is allowed in writing by the Department or the Local Approving Authority. 7. The control panel including alarms shall be mounted in a location accessible to the System Operator. 8. For any System that does not flow by gravity to the SAS, the System shall be equipped with sensors and high-level alarms to protect against high water due to pump failure, pump control failure, loss of power, or system freeze up. The control panel including alarms and controls shall be mounted in a location always accessible to the operator (or service contractor). Emergency storage capacity for wastewater above the high level alarm shall be provided equal to the daily design flow of the System and the storage capacity shall include an additional allowance for the volume of all drainage which may flow back into the System when pumping has ceased. Instead of providing emergency 24-hour storage,an independent standby power source may be provided for operation during an interruption in power. With any interruption of the power supply the source must be capable of automatically activating in addition to manual start up capability.The standby power must be sufficient to handle peak flows for at least 24 hours and sufficient to meet all power needs of the System including, but not limited to, pumping, ventilation, and controls. Standby power installations must be inspected and exercised at least annually and all automatic and manual start up controls must be tested. Standby power installations must comply with all applicable state and local code requirements. Provided that a standby power installation complies with these requirements, no variance is required to the provisions of 310 CMR 15.231(2). 9. System unit malfunction and high water alarms shall be connected to circuits separate from the circuits to the operating equipment and pumps. 10. All System control units,valve boxes,conveyance lines and other System appurtenances shall be designed and installed to prevent freezing per the Company's recommendations. KleanTu NitROE 2K Provisional Approval,May 2020 Page 5 of 15 Technology:NitROE®2KS&2KM WWTS 11. Any System structures with exterior piping connections located within 12 inches or below the Estimated Seasonal High Groundwater elevation shall have the connections made watertight with neoprene seals or equivalent. 12. In compliance with 310 CMR 15.240(13), a minimum of one (1) inspection port shall be provided within the SAS consisting of a perforated four inch pipe placed vertically down into the stone to the naturally occurring soil or sand fill below the stone. The pipe shall be capped with a screw type cap and accessible to within three inches of finish grade. Operation and Maintenance 13. Inspection, operation and maintenance (O & M), sampling, and field testing of the System required by this Approval shall be performed by a System Operator with the following qualifications: a) is an approved System Inspector in accordance with 310 CMR 15.340; b) has been trained by the Company and whose name appears on the Company's current list of qualified operators;and c) has been certified at a minimum of Grade Level IV (four) by the Board of Registration of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. The name of the Operator shall be included in the O&M agreement required by paragraph B(14). 14. Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year and include the following provisions: a) The name of the qualified Operator that appears on the Company's current list of Service Contractors; . b) The System Operator must have the qualifications specified in paragraph B (13); c) The System Operator must inspect the System in accordance with the Approval and. anytime there is an equipment failure, System failure,or other alarm event; d) In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications,or violations of the Approval, procedures and responsibilities of the Operator and System Owner shall be clearly defined for corrective measures to be taken immediately. The System Operator shall agree to provide written notification within five days describing corrective measures taken to the System Owner,the Company,and the local board of health; e) The System Operator shall determine the cause of total nitrogen effluent limit violations if they occur and take corrective actions in accordance with the approved O & M Manual; and f) Procedures and responsibilities for recording quarterly or monthly wastewater flows must be defined,see paragraph B(32)"Flow Metering". 15. At all times, the System' Owner shall maintain an O&M Agreement that meets the requirements of paragraph B(20). 16: The System Owner and the System Operator shall properly operate and maintain the system in accordance with this Approval, the Designer's operation and maintenance requirements, and the requirements of the local approving authority. KleanTu NitROE 2K Provisional Approval,May 2020 Page 6 of 15 Technology:NitROE®2KS&2KM WWTS 17. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Operator shall notify the System Owner immediately. 18. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Owner and the System Operator shall be responsible for the notification of the local approving authority within 24 hours of such determination. 19. In the case of a System failure,an equipment failure, alarm event,components not functioning as designed or in accordance with the Company specifications, or any violations of the Approval, the System Owner and the System Operator shall be responsible for the written notification of the local approving authority and the Company within five days describing corrective measures taken. 20. Within 60 days of any site visit, the System Operator shall submit an O&M report and inspection checklist to the System Owner and the Company. The O&M report and inspection checklist shall include,at a minimum: a) for a System failing,any corrective actions taken; b) wastewater analyses,wastewater flow data,and field testing results; c) any violations of the Approval; d) any determinations that the System or its components are not functioning as designed or in accordance with the Company specifications;and e) any other corrective actions taken or recommended. 21. By September 30th of each year, the System Owner and the Service Contractor shall be responsible for submitting to the local approving authority all monitoring results with all O&M reports and inspection checklists completed by the System Operator during the previous 12 months. 22. By September 30th of each year, the Service Contractor shall be responsible for submitting to the Company copies of all O&M reports including alarm event responses, all monitoring results, violations of the Approval, inspection checklists completed by the Service Contractor, notifications of system failures,and reports of equipment replacements with reasons during the previous 12 months. 23. A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. 24. The System Owner shall notify the Approving Authority in writing within seven days of any cancellation,expiration or other change in the terms and/or conditions of the O&M Agreement required by Paragraph B(14). 25. The System Owner and the Service Contractor shall maintain copies of the Service Contractor's O&M reports, inspection checklists, and all reports and notifications to the LAA for a minimum of five years. 26. The System may only be installed to serve facilities where a fully conforming Title 5 system with a reserve area exists on-site or could be built on-site in compliance with the design standards for new construction of 310 CMR 15.000, and for which a site evaluation in KleanTu NitROE 2K Provisional Approval,May 2020 Page 7 of 15 Technology:NitROE®2KS&2KM WAITS compliance with 310 CMR 15.000 has been approved by the Approving Authority. A fully conforming Title 5 system may include other approved alternative technologies in accordance with the conditions imposed on the alternative technologies. 27. Subject to the provisions of this Approval, the Technology shall be installed in a manner which neither intrudes on, replaces a component of, or adversely affects the operation of all other components of the System designed and constructed in accordance with the standards for new construction of 310 CMR 15.200- 15.279. Effluent Limit and Monitoring Requirements, 28. For the new construction, unless the facility meets a TN effluent limit of 11 mg/1 or less, the system shall not be designed to receive more than 440 gallons of design flow per day per acre (gpda) in an area that is subject to the Nitrogen Loading Limitations of 310 CMR 15.214. If the facility does not meet with the Nitrogen Loading Limitations pursuant to the aggregation provisions of 310 CMR 15.216, the System Owner shall repair, replace, modify or take any other action as required by the Department or the local approving authority to meet the total nitrogen concentration limits in the effluent. Violation of the TN concentration in the System effluent shall not require notifications as required in paragraphs B(18)and(19). 29. Prior to Department approval of the Company's Performance Evaluation Plan, the Company shall be responsible for the following monitoring requirements for all System installations that are subject to a total nitrogen concentration limit in accordance with paragraph B (28). Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection, see"Flow Metering"section below. a) Year-round facilities shall be inspected and effluent sampled quarterly; b) Seasonal properties shall be inspected and effluent sampled a minimum of twice per year, with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample;and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling shall also include Field Testing of System wastewater when determined necessary by the operator,see DEP Field Testing Protocol at http•//Wmv mass.,zov/eealdocsldeplwater/laws/i-thru-zltestsamp.pdf. Properties occupied at least 6 months per year are considered year-round properties. Properties occupied less than 6 months per year are considered seasonal properties. 30. During the Performance Evaluation period, the Company shall follow the monitoring requirements specified in the Performance Evaluation Plan for installed Systems. 31. After the three (3) year Performance Evaluation period by the Company and approval by the Department, and until this Approval is modified, terminated, or superseded by a General Use Certification, the System Owner shall comply with the following monitoring requirements if the System is subject to a total nitrogen concentration limit in accordance with paragraph B? (28). KleanTu NitROE 2K Provisional Approval,May 2020 Page 8 of 15 Technology:NitROEO 2KS&2KM WWTS a) Year-round properties shall be inspected and sampled for at least the TN parameter a minimum of twice/year, at least 5 months apart and with at least one sample taken between December 1 and March 1 of each year. Field testing shall be completed as determined necessary by the System operator,see DEP Field Testing Protocol at h ttp://www.mass.g_ov/eea/docs/dep/water/laws/i-thru-z/testsamp.pdf. Water meter readings shall be recorded at each inspection,see"Flow Metering"below. b) Seasonal properties shall be sampled for at least the TN parameter a minimum of twice/year. At least one annual sample must be taken 30 to 60 days after each seasonal occupancy. A second sample must be taken no less than 2 months after the first sample. Field testing of the System shall be completed as determined necessary by the operator. Water meter readings shall be recorded at each inspection,see"Flow Metering"below. 32. Flow Metering - At a minimum, for all systems installed prior to this Approval, water meter flow data shall be recorded each time the system is inspected and sampled by the System Operator. For systems installed after the effective date of this Approval, wastewater flow data shall be recorded each time the system is inspected and sampled by the System Operator and may be based on: a) actual metering data of wastewater flow to the system;or b) water meter data for the total facility with metered non-wastewater flows, if available, subtracted from the total facility water usage. 33. Field Testing: Turbidity,pH and Apparent Color-Turbidity,pH,DO and apparent color shall be measured and/or recorded in the field when when determined necessary by the operator. See applicable sections of the Department's Field Testing Protocol at http://www.mass.gov/eea/docs/dep/water/1 aws/i-thru-z/testsamp.pdf. 34. At a minimum,the System Operator shall inspect the System: a) two times per year; b) in accordance with the approved O&M manual, the Designer's operation and maintenance requirements,and the requirements of the local approving authority;and c) any time there is an alarm event,equipment failure,or system failure 35. The System Operator shall collect samples and obtain analysis results from an approved lab, perform field testing required by the Approval and submit results within 60 days of the site visit to the System Owner. 36. If the Company successfully demonstrates the effectiveness of the System to reduce nitrogen loadings during the Performance Evaluation period, a minimum of three years, the System Owner shall operate the System subject to the requirements of the General Use Certification,if issued, for this technology. C. Special Conditions Specific to the Company 1. The Approval shall only apply to model units with the same model designations specified in this approval and meet the same specifications, operating requirements, and plans, as provided by the manufacturer at the time of the application. Any proposed modifications of the units shall be subject to the review of the Department for coverage under the Approval. KleanTu NitROE 2K Provisional Approval,May 2020 Page 9 of 15 Technology:NitROEO 2KS&2KM WWTS 2. Prior to submission of an application for a DSCP,the Company shall provide to the Designer and the System Owner: 4 a) All design and installation specifications and requirements; b) An operation and maintenance manual,including: i) an inspection checklist; ii) recommended inspection and maintenance schedule; iii)monitoring(i.e.water use and power consumption)and sampling procedures,if any; iv)alarm response procedures,if any,and troubleshooting procedures; c) An owner's manual,including proper system use and alarm response procedures,if any; d) Estimates of the Owner's costs associated with System operation including, when applicable: power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; e) A copy of the Company's warranty; and f) Lists of Designers,Installers,and Service Contractors. 3. The Company shall implement the Performance Evaluation Plan, as submitted and approved by the Department, and shall be responsible for all data collection and submissions to the Department until a final determination on the Performance Evaluation has been made by the Department. 4. Until a final determination has been made by the Department on a completed Performance Evaluation, the Company shall submit to the Department an annual report by February 15th of each year that includes the following: a) a table of all sample data collected for all systems installed to date and all information required by the Department as part of the approved Performance Evaluation Plan; b) status of preparation of a Performance Evaluation Plan if not yet provided to MassDEP,or any recommended changes to the approved Performance Evaluation Plan; c) a list of pending applications for system installations which have been submitted to local approving authorities; d) identification of any System after start-up in violation of the Approval or not in compliance with any performance criteria at the time of the annual report, the reasons for the noncompliance and the status of any corrective actions that are needed; and e) any recommendations and requests for changes to the system monitoring and reporting plan or the performance criteria of the Approval. The report shall be signed by a corporate officer,general partner or the Company e _ owner. (Service Contractor records submitted to the Company should not be included with the annual report to the Department,but shall be made available to the Department within 30 days of a request by the Department,) , 5. The Company shall institute and maintain a program of Installer training and continuing education that is at least offered annually. The Company shall maintain and annually update, and make available the list of qualified Installers by February 15th of each year. The Company shall certify that the Installers on the list have taken the training and passed the Company's training qualifications. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 10 of 15 Technology:NitROE®2KS&2KM WWTS 6. The Company shall institute and maintain a program of Designer training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Designers by February 15th of each year. The Company shall certify that the Designers on the list have taken the training and passed the Company's training qualifications. 7. The Company shall institute and maintain a program of Operator training and continuing education,as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Operators by February 15th of each year. The Company shall certify that the Operators on the list have taken the training and passed the Company's training qualifications. 8. The Company shall not sell the Technology to an Installer unless the Installer is trained to install the System by the Company. 9. Prior to its sale of any System that may be used in Massachusetts,the Company shall provide the purchaser with a copy of the Approval with the System design, installation, O&M, and Owner's manuals. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of a System for use in Massachusetts with copies of these documents,prior to any sale of the System. 10. Within 60 days of issuance by the Department of a revised Approval, the Company shall provide written notification of changes to the Approval to all Service Contractors servicing existing installations of the Technology and all distributors and resellers of the Technology. 11. The Company shall provide written notification to the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership,responsibility,coverage and liability between them. 12. The Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns, including but not limited to dealers, distributors, and resellers. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities, respectively, shall constitute violation of the Approval by the Company unless the Department determines otherwise. IV. CERTIFICATION AND NOTIFICATION REQUIREMENTS 1. Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit,stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 11 of 15 Technology:NitROE®2KS&2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)and the Approval;and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner,as required by 310 CMR 15.287(5). 2. Upon submission of an application for a DSCP to the Approving Authority, the Company shall submit to the Approving Authority,with a copy to the Designer and the System Owner, a certification by the Company or its authorized agent that the design conforms to this Approval and that the proposed use of the System is consistent with the unit's capabilities and all Company requirements. The review shall include evaluation of the need for installation of water meter(s) at each facility. An authorized agent of the Company responsible for the design review shall have received technical training in the Company's products. 3. The System Designer shall be a Massachusetts Registered Professional Engineer, or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. 4. Thirty (30) days prior to delivery of the treatment unit to the site for installation, the Company shall provide to the Approving Authority a copy of a signed contract for a minimum period of one year with a Company approved Operator and the initial Owner/Occupant of the property. 5. Prior to the commencement of construction,the System Installer must certify in writing to the Designer and the System Owner that (s)he has taken the Company's training, passed the Company's training qualifications,and is listed on the Company's list of Installers. 6. Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000, the approved design plans, and all local requirements, including any local approving authority site-specific requirements; b) In accordance with 310 CMR 15.021(3), the Designer must certify in writing that any changes to the design plans have been reflected on as-built plans which have been submitted to the Approving Authority by the Designer; c) As a condition of this Approval, the System Installer and Designer must certify to the Approving Authority in writing that the System has been constructed in compliance with the terms of this Approval; d) An authorized agent of the Company must certify to the Approving Authority in writing that the installation was done by a qualified Installer approved by the Company and the installation conforms to this Approval.The authorized agent of the Company responsible for the inspection of the installation shall have received technical training in the Company's products;and e) Prior to signing any agreement to transfer any or all interest in the property served by the system, or any portion of the property, including any possessory interest, the System Owner shall provide written notice, as required by 310 CMR 15.287(5) of all conditions contained in the Approval to the transferee(s). Any and all instruments of transfer and any leases or rental agreements shall be included as an exhibit attached thereto and made K1eanTu NitROE 2K Provisional Approval,May 2020 Page 12 of 15 Technology:NitROE®2KS&2KM WWTS a part thereof of a copy of the Approval for the System. The System Owner shall send a copy of such written notification(s) to the Local Approving Authority within 10 days of such notice to the transferee(s). V. STANDARD CONDITIONS 1. The provisions of 310 CMR 15.000 are applicable to the design, installation, use and operation of a System utilizing an approved or certified alternative technology, except those provisions that specifically have been varied by the conditions of this Approval. 2. The design, installation, and use of the System must conform to the terms and conditions of the Approval and the Department approved attachments. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. Standard Conditions Applicable to the System Owner. 4. This Approval shall be binding on the System Owner and on its agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the System Owner unless the Department determines otherwise. 5. The System Owner shall obtain all necessary permits and approvals required by 310 CMR 15.000 prior to the installation and use of the System in Massachusetts. 6. The System is approved for the treatment and disposal of sanitary sewage only. The System Owner shall not introduce any wastes that are not sanitary sewage into the System. The System Owner shall dispose of wastes generated or used at the facility that are not sanitary sewage by other lawful means. 7. Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR 15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i)a certified Registry copy of the Notice bearing the book and page/or document number; and(ii)if the property is unregistered land,a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department. 8. The System Owner shall at all times have the installed System properly operated and maintained in accordance with the most recent O&M provisions of this Approval for the alternative technology and in accordance with any additional requirements of the Approving Authority. The most recent O&M provisions of this Approval for the alternative technology are available from the Department. 9. The System Owner shall furnish the Department any information that the Department requests regarding the System,within 21 days of the date of receipt of that request. Standard Conditions Applicable to the Designer KleanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 15 Technology:NitROE®2KS&2KM WWTS 10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day. 11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy of this Approval. Standard Conditions Applicable to the Company 12. This Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the Company unless the Department determines otherwise. 13. The Company shall include copies of the Approval with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require all vendors, distributors, and resellers to provide each purchaser of the System with copies of the Approval. 14. The Company shall make available, in printed and electronic format, the approved Attachments and any approved updates associated with the Approval, to the System Owners, Operators,Designers,Installers,vendors,resellers,and distributors of the System. 15. The Company shall submit to the Department for approval any proposed updates or changes to the Attachments to the Approval. 16. The Company shall notify all System Owners, resellers, and distributors of changes to the Approval within 60 days of issuance by the Department. 17. The Company shall notify the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership, responsibility, coverage and liability between them. All provisions of the Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 18. The Company shall furnish the Department any information that the Department requests regarding the Technology within 21 days of the date of receipt of that request. 19. If the Company wishes to continue the Approval after its expiration date, the Company shall apply for and obtain a renewal of the Approval. The Company shall submit a renewal application at least 180 days before the expiration date of the Approval, unless written - permission for a later date has been granted in writing by the Department. Upon receipt of a timely and complete renewal application, the Approval shall continue in force until the Department has acted on the renewal application. Reporting KleanTu NitROE 2K Provisional Approval,May 2020 Page 14 of 15 Technology:NitROE®2KS&2KM WWTS 20. All notices and documents required to be submitted to the Department by the Approvalshall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street-5th floor Boston,Massachusetts 02108 Rights of the Department 21. The Department may suspend, modify or revoke the Approval for cause, including, but not limited to, noncompliance with the terms of the Approval, non-payment of any annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare, or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to the Approval and/or a System utilizing the Technology against the Company,the Designer, the System Owner,the Installer,and/or the Operator of the System. VI. GENERAL CONDITIONS Title 5 Regulations 310 CMR 15.287: "General Conditions for Use of Alternative Systems Pursuant to 310 CMR 15.284 through 15.286" "The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284 through 15.286: 1. All plans and specifications shall be designed in accordance with 310 CMR 15.220. 2. Any required operation and maintenance, monitoring and testing plans shall be submitted to the Department and approved prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a Department approved plan. Sample analysis shall be conducted by an independent U.S.EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory, unless otherwise provided in the Department's written approval. It shall be a violation of 310 CMR 15.000 to omit from a report or falsify any data collected pursuant to an approved testing plan. 3. The facility served by the alternative system and the system itself shall be open to inspection and sampling by the Department and the Local Approving Authority at all reasonable times. 4. The Department and/or the Local Approving Authority may require the owner or operator of the system to cease operation of the system and/or to take any other action necessary to protect public health,safety,welfare and the environment. r 5. The owner or operator shall provide written notice to any new ownero operator that the system is an alternative system. Such notice shall include notice of the general conditions and any special conditions applicable to the system and its owner. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 15 of 15 Technology:NitROE®2KS&2KM WWTS 6. The owner or operator, or the proponent of the alternative system, shall obtain and provide the Department with a determination from the board of certification of operators of wastewater treatment facilities established pursuant to M.G.L. c. 21, § 34A as to whether a certified operator is required for operation of the alternative system. The Department shall waive this requirement if it has on file a determination for the alternative system, and shall notify the owner,operator,or proponent of the determination. 7. It is a violation of 310 CMR 15.000 to install, construct, or operate an alternative system except in full compliance with the written approval and 310 CMR 15.287. 8. The Department may require the issuance of a groundwater discharge permit pursuant to 314 CMR 5.00(groundwater discharge program)for any alternative system. 9. The system owner shall maintain an operation and maintenance contract with a Massachusetts certified operator where one is required by 257 CMR 2.00,or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. 10. Prior to obtaining a Certificate of Compliance for installation of a new or upgraded system, the system owner shall record in the chain of title for the property served by the alternative system in the Registry of Deeds or Land Registration Office, as applicable, a Notice disclosing both the existence of the alternative on-site system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the Local Approving Authority. 2. ; t t Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 220 Bay St Property Address ` MOORE, ROBERT B JR&AMANDA K � Owner Owner's Name information is Osterville Ma 02655 3/28/2019 required for every - page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 54 ( 3(, on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane rab Company Address Cotuit Ma 02635 - City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 4/1/19 Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • /` 220 Bay St ,V Property Address MOORE, ROBERT B JR&AMANDA K Owner Owner's Name required for is every Osterville required for eve Ma 02655 3/28/2019 page. Citylfown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ' ® I have not found any information which indicates that 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: System contains a 1500 Gallon septic tank as well as a new distribution box and 3 leaching chambers. System is functioning as designed. 2) System Conditionally Passes: ❑ 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank 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. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osterville Ma 02655 3/28/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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. ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts rp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wu 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information isequired or every very Osteryille Ma 02655 3/28/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ._ ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from 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 fecal coliform bacteria indicates absent 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 must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 220 Bay St v Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is Osterville Ma 02655 3/28/2019 required for every - page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in We last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow.of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of,18' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information equir for is every Osterville required for eve Ma 02655 3/28/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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 depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp,doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osterville Ma 02655 3/28/2019 ` page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 - DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ® .Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 239 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts lF Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osterville Ma 02655 3/28/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts 1. Title 5 Official Inspection Form ;� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 220 Bay St V� Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required,for every Osterville Ma 02655 3/28/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: s ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ -Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: - feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line, t5i9sp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information equir for is every Osterville required for eve Ma 02655 3/28/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): l5insp.doc-rev.7/26/2018 Title 5 Official Ihspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is Osterville Ma 02655 3/28/2019 required for every - page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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 Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osterville Ma 02655 3/28/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert New 4/1/19 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is Osteryille Ma 02655 3/28/2019 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan,,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields, number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form ja Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is Osteryille Ma 02655 3/28/2019 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No sign of falure 12. Cesspools (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 Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osteryille Ma 02655 3/28/2019 . page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18_ Commonwealth of Massachusetts a Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osteryille Ma 02655 3/28/2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osterville Ma 02655 3/28/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface'water ❑ Check cellar ❑ Shallow wells , Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7/7/80 Date ❑ 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 high ground water elevation: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official In Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title,5 Official Inspection Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 220 Bay St Property Address MOORE, ROBERT B JR &AMANDA K Owner Owner's Name information is required for every Osterville Ma 02655 3/28/2019 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 .. �✓�' a +� � 1 �,� ''r .may � y 'DRt � � Ja Bt p,` `yl � d §, , 14 IF d - " X, � t x b 7 { '•. � i xk F'f^- ,` ,,3' f�:' �.„ �' !� ;s ?x_ ygE.,T1 .. 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Tf✓isse..✓`k:S,K.xaY 1s,6;$ !'71Z i.. y axs,►i3 Z.*4&£1!�'-xi �Sn,T s`,:7 fig?=::.• t � r��''=,t'r_ x"'y� ate' w� ¥ "P f�� 4 !°� , tpw 5 t � rwvr+s �tr _y� .,,v �.xdwr t.r4 ` - � yn `"` ✓ a,"'>�_. � ��,'"s�S �'�.� 4 'x`� ,r.i :ems � r � aF i,_ '�'' °"`• �'�"` �� 4 atEn v ,� 14 tr .� 6 f V Y t E x -;r f � e. 10 z w, ;44 *� ! e-t -WbLV . �. � Lt�cxl B'... c v.: a'w':6esl� !u✓ t,� ttA .,ry s c , �, ,K:qp to t; ��sx• � ' ! k e i _ 3,� _-y t+,n r < .rFz 3 +k _ .^ ON i, a/tSTLA3"6 ti?jfsyl: h 8Laj x u. % _ � ..@ w a No. � /� � Fee 0-6 110, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye ftphLation for Mispo8al *pstrm (Construction i3Ermit Application for a Permit to Construct( ) Repair(;Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.•270 - y Owner's Name,Address,and Tel.N i ,0 a feA B&,,e Assessor's Map/Parcel OS f U v e'd e gy_ Installer's Name,Address,and Tel.No. fV� ZO y s' Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size —sq.ft. Garbage Grinder( ) g Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank %�� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 EnvirorimgjUQ Code and not to place the s in in operation until a Certificate of Compliance has been issued by this Board of H i. •gne Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. '— / Date Issued '7g 9 No. Fee / 3L THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: 1 i W PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplitation for MiS 'osal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(0/upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.270 lea Il . S f Owner's Name;Address,and Tel.N 0X o a,h. /�0 lt✓G Assessor's Map/Parcel OS f cI y+ I(C Installer's Name Address and Tel.No. 9` I�� S's�7 Designer's Name,Address,and Tel.No. �J�a�kv►^• �e� et�.� pray Type of Building: DwellingNo.of Bedrooms Lot Size s .ft. Garbage Grinder q g ( ) { Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title { Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /'/4 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 in operation until a Certificate of Compliance has been issued by this Board of Healt . S:i�gned� � � Date Application Approved by ` Date Application Disapproved by~ Date for the following reasons Permit No. � . ^` f� L J Date Issued 411 l )R THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS CPrtifirate of Compfiatue THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded*( ) Abandoned( )by CE , G�.o sti �'� 'r." / O/. ,. at 47 v /o,7 ,S 4 4!4-�-V W/I e has been constructed in accordance with the provisions of Title 5 and they far-Disposal isposal System Construction Permit NqX. - -11 dated Installer Designer . S #bedrooms Approved design flow I IA-- gpd The issuance of this permit shall not be construed as a guarantee that the system will fimcti as designed. �Date 11 � � '�{ Inspector ` M,i. ,� S No. 4 "" f�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *psttm onstrUttion Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 2 26 a �'� mrf'�/ ✓i // i 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 bomplr�eted within three years of the date of this Cby� Date. / ) Approved -- r r 10/21/2019 ShowAsbuilt(1700x2800) - iiv-as �T ?ram— 16 L0CATIO EWACE P T N0. . VILLAGE- INSTAL EI's ME 1 ADDRESS �lUILDEN 0 EA ' c ' DATE PERMIT ISSUED DATE COMPLIANCE ISSUED T a o . 0 https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=094005&sq=1 1/1 '� i Lit el�iT/4 e / 0 � _jECT TO A' STD EE C� - NSEE10 " .�. d� THE COMMON-WEALTH OF MASSACHUSETTS� �1�PnI� ��9� BOARD aF H EA L.T H ., Ir F4 Appliration for Uiipntia1 Warkri Tiam4rurtion Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: 7 :...y. .......................................................... ocatio -A dr s f or L0V Z..�-•aw4.lam. /��------------- - --------- -- d dlz/cr c/r/ ess ............ ............ ........• d r... nstaller (. Address a // � � U Type of Building Size Lot..p . L............ LI'7welling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (vf Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtur W Design Flow................Cr75...._....�....•_.gal lons per person pfr day. Total�claily flow____-___-_-_. __ __. _. ........._.___ Ions. W Septic Tank—Liquid capacityjl.(Ogallons � � g Length__�(,8.-(0r. Width---- Diameter......_y..... Deptl�'�..._. x Disposal Trench—No. ...-1............... Width._f.6_....__.__.. Total Length--- - ....... Total leaching area_An _a....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (L—T, Dosing tank ( ) Percolation Test Results Performed by..b G ----- --.....A...�tq_ ------------ Date...... ......��..... ....._..__.. `4.l Test Pit No. 1-._�Z-._minutes per inch Depth Test Pit____ ___.____._ Depth to ground water.....{............... Test Pit No. 2................minutes per inch Depth of Test Pit__-_ --11- -__- Depth to ground water....-.......... _. a' �r f-------•- r8f 1`..... 0 Description of Soil....v-- 11.2 ---------JIM 5�' � j------------ --X...9... ✓ �'! ...-•----. x V = W -----------------------------------------------------------------------------------------------------------'---•----•--------------•--•------------•••------••....--•-•--•--•-•--••----••..._......-•-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I- p 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 - • ------•---------------------------•-------•-•- ........•-----------•-•-- ate Application Approved By........... ;7. 4a- te Application Disapproved for the following reasons---------------------••-•----• --- ....---•--•. ......................................................... -------------------------------------------------•---------------------------------------•-•----•----•---•••----•-•-•••-•-•------------------•--•--------------------------------------•-•-•........... Date PermitNo....."......................................................... Issued....................................................... .Date �0 _..._No.,c_....L_..s.. F>�s....,r.�.. •. r THE COMMON`WEALT,H OF MASSACHUSETTS " /O HEALTH ---- --OF.........-./��/f:1 cL: -.-..: ,��:� • ,��rli��i�art fug �i��.��1� �ark.� C�.�n��x�r�tnn ernti� w pplication is hereby made"for a Permit to Construct(x) or Repair ( ) an Individual Sewage`Disposal System at: ....... ---------- L. ------C4....... ------------•--••------------ Location-Addrest or Lot No. W v ddress ..........-.------.--••-..--••-----•-•--------••--•--•- -•-•. ....., a--_----- ......................... � „t } installer . . Addres,s_„ \ d Type�of Building Size�"Vot___ ---/Z-____:______ a ., welling—No. _ �No. of. Bedrooms.___._ ___ ----Expansion,,Attic ( ) Garbage Grinder p I Other—Type of Building ............_---------___1__ No. of persons...............;_,.....,... Showers ( ) — Cafeteria ( ) -Other fixtures .--••-•-••----------•---- W Design Flow................. !; ...........:_____gallons per-Re ,rson per day. Total daily flow........ , ........_.........gallons. 9 Septic Tank—Liquid capacityi' gallons Length:_�(j�:�!�.= Width 6 '_. Diameter__._ -.:___ Depth,_—C __`_:-- .X Disposal Trench—No. __._`............... Width_ _.___._.__. Total Len th Z:,; Total leaching area._ `" Seepage Pit No________ ____________ Diameter............. ;:.._.:Depthh below irnlet.................... Total leaching area..................sq. ft. . Ogler Distribution box (L-.), Dosink tank (' �) Percolation Test Results Performed by.-(;),v1_1 •. .___ -�tyi0.Q _.____..-. aTest Pit No. _..minutes per inch Depth„ Test Pit______ Depth to groun water f_' r' (s, Test Pit No. 2____............minutes per inch Depth. f Test Pit_____ _L_________ Depth to group• water____lei-_ _......... a ----------------------------------------------------------- .................................. . O Description of Soil--- ' 1 . - 1-f ---•-----------------------------------t W UNature of Repairs or Alterations—Answer when applicable.____________________'.......................................................................... ..Agreement: t The undersigned agrees to install the faforedescribed Idr ividual Sewage Disposal System in accorda ce'w,ith /!1'.� the provisions of f'1 T ,.;.. 5 of the State Sanitary Code-The undersigned further-_agrees not to place the system in operation until a Certificate of`Compliance has been issuedby the board of health: Sie ---•- - .................... Date Application Approved B ......................... ?��!� .__ • ._. -_ PP, PP Y r Da Application Disapproved for the following reasons-----------------------------•--------------------- ---------_---------------•-------------------••F ✓" Date Permit No' .. - Issued.......... .^ka- t••••-------• -•-••---_. Die THE COMMONWEALTH OF MASSACHUSETTS BOARDJF HEALT M..........OF...... ...:.......:................................................ ............. �,/ irtif rate of Tome ianre t M E xFY* - tl S'e, Disposal System constructed; ( ) epaired ( ) at. . #,, � - --•--•-----•-------•----•••-has beet installed in accordance with the provisions, IrThe-State Sanit de r the applicationfor Disposal Works Construction Permit __ -_____________________ date ----_____ _- .______,�_---__r_.__._.:_______ THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM�'WILL FUNCTION SATISFACTORY. r x� DATE......... ............... ....... . Inspector l /V 7� - � Z9 *s THE COMMONWEALTH OF MASSACHUSETTS BOAROF H'ELi No......................... , " FEE........................ rmi sik"Is hereby ranted--_--- -- -- - •- --------- - - -- --. _.. _ "_.. .. ._ _p: .._ ........... to C S� ( pr �'t an 4ndi ew r ial' t� at .. � ' �' ✓ f ------- ........... as shown on the application for Disposal �t'orks Constructio e it N Ja ,p at ......................��_ ` ." •--•-••• - ..../ ---- ---- ................................. t Board of Heal •••-....... DATE ! ---------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE ti LOCATION 2-2,C a SEWAGE# 2.Q;4 ASSESSOR'S MAP&PARCELp�� INSTALLER'S NAME&PHONE NO. Q V SEPTIC TANK CAPACITY LEACHING FACILITY:(type �� '�� a(size) 4-s r I-L NO.OF BEDROOMS Q OWNER D9y`G4�. �/� PERMIT DATE: 1 �►� _ COMPLIANCE DATE: 1, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY /1gng Q` 9 �'� � Cam' � � • a 47. fj -y-- ri- KOELBEL-RYAN , RESIDENCE •,bR AT...a l ---- --- --- .j ' --- --- --- ----- ---- 1 -------- --L----------- --- 220 BAYST STREET -- --- - ------ ---_----- ----- -- - ------- --- ----- - - --- - - ----------- --- ----------- ------ ---- ——— '--—'—'— -- —'—'—'——'—'—'—— ----- ---_----- OSTER .MA LW d OROA.D OlCa /��••. COLUMN //j` -. Co UMN{� •yLNp j' - , I1I•R .,, I�10�' ,3'-TA ,Y"T� l a,.l•-�. TNKIven•TO� - � ocolo' F� y� ,i� �'1. ` � .. / _ 16'- awan+r•m11nn _..._ /awe x,12 ME j s'-B• '-s�• s'-B1 I I p=,.�7 COV.PORCH ®MARVIN MARVW OMA VIN i /I __•_-I.� 1' I J I:.! t I - �'''`� �9 I - - ® I _— /. j. ; • CN3 RN CN30N LH j ..-.JI _ © n• Vr -•''Tj'°,�' 4.6�.-r-- ooE a•6R.•.6 o�� ,T�.aw.e�e_^..,�� GENERAL NOTES: ' 31. * L" COV PORCH ®� r- _ _ �_ I 1 __,°__, roR car.0 I \ m'/ .n �...v um.w...,,.m.mam'a»�ow• L �I MARVW I j I _PQWOER nw d] i�l' - �1;1. .. �� j.r'•.... (.,1 II I. ,.�,...-.1�o°R.r..L bo li j I �oN// .m� �v°°.:�n•.e..twA...m+..n O Y I�,1 •1ij �; - ,� I I. I:U' I I .I .. ` - m. A - m w a sD. ._( I O,,z° j 0 ---- ----- ----- ---- ----------- FAMILY ��n �.w.�m.v,� •tea.<.•° ,22 .-- rm•w/ mac:=> -1 I -II ,a. 7. i� I ] li- -- L. . . SHOWE ®ln • I® f I L ,J 90. . 191 :# `, ROOM I, O \. < / � >°,o.A..mm.m>,n..wr•m°.K,.m. •r m ,. .' it-E ., ! - - ' g�p��C�p •.m .�.mw II COlIBO 1 d1 - I �� O �` x'-d ,.T.z, -3j. r-w .. aoFR�b o�w•s� R.�. DI NG d. - : "� �� t I o I L tT: 1 4 .. - ----oo UMN T !( V,.•N , I W DECK .OQ - r iv.araai r-Y -- ---- - -- �1.�. IL I I _ u'-p�•kALVED PLAT cEtunG 3 _ - „7 l \ (. H L WAY ..w.�, t - L _ _ _-T J_ 4 I-,.O 1x 1, ., T .+1 I I- I '1 — J LMODFAOOfv1 ,.r.-.I - - ....,, E �-'- .3I STO ' GE - . . O' S'r-,`1 q;.' .,rA„ ..[`.r b ;_. r o t;. INIS z '-32. wcaercN LN .... ----- T ,25 ,OS,= q_ 1T - __ ______ - - -F- - - - EUJ FLNIem___i T ' TRECH I W N33664 M CH �' W , s v3+,- -- - ------ ----------- „� 5 104 #I----r mcu -- ON_ II125 1 1 ' KR HEN 101 �IM,tLOM'MOVE - - -- sum ,26 D. BEDROO F. O LINEN j I $ I t ENTRY FOYER ua �°°+I�e _ I ..0 I �I� ` nu636 t+/.r1•ot NeNrma•n _ K' I ,I � _ n �._..- i�..-..-,.,-...,:.. FlJT IAIR TIJ® pp�R w/ .MHoown 000le.ro .r®ra _ 4 H- ------ -- - - -- - -- - - a. - - m Iuroen• aN - 102 •1. wnnaane�. - a� - nu'amw - HALLWAY 3604® �3 arse®wNoasla wrnN `N - - 'TId¢MLLIr BRpON � ®� •.\ .®c MNLH �� b• � N3658 RH TI.LL6 TA•L<�-+•� ®pp W A.WId / .. .. - m:R4me w..,,• ®_ea ro n xdrfi + •Y��1 1 O MMVIIJ RBCeN9 19 ureNt 4/b TIFe•It• xt 1 CN3660 CN3860'U1. mM CprtHIOVA RYVI - - - � - � cN366o LH MCHOLAEFF All COV. ORCM- NRM ®, PO°R'' - -cN3•..• o- - - ARCHITECTURE+DESIGN Fl 2-1 . . -- - - - n - .2-CAR GARAGE -„ : co -—\I__ _— —__- _ I I I - _ 6•..Z ' 891 Mein S�rAeet J Q' .: MnRVIN 'PALED LONGRETE v _ _ 02655 a r-E HALI�WA OsteMlle, CN36W F •" - ® t �-e , MARNN T 508 420 5296 I - IfmgTH Oe®lAtm `\ i , F SOB 420 2240 LrJ • minas ,3'-T T AT` nicholeefl.Com s= . . . . - _ MARVIN ---_.j._-___ • _ X'i GLA - I CN3660 RH r.. .' •yp L r H.D. 3 61 36,-T. s1D. c N . REVISION#5' r �r l n -- ---- � '. ��, y® CONSTRUCTION SET I. I I l ® ,_ i —Iwo l-♦I T �•. 3•-T1• 04/01/2021 1. � .I _ I. CNN33660 w N. �I 107 f yf .� °® �I I ,O,-s, SLAB WPOINT ,' I i R T ,~,�.J I - j I EIEVI• I ..�� - cN3856 - ; - B DR M 1 all ___� i PROJECT NUMBER:KL801 - CN3660 RH DRAWN BY AH DV r { .I SLABE OMT ` N•w m SCALE:AS NOTED F i _ ®GN'y62p' rr�CN362I DATE:APRIL 1,2021 - _ N'JODft I CN300 �q CN3660 -- i REV#1:FOUNDATION,FRAMING.STAIRS REV#2:FIRST FLOOR FRAMING/FOUNDATIONS REV#3:FNDN/FIRST FLOOR MUDROOM, - REV#4:FOUNDATION.MISC FLOOR PLAN ADJ . - - FIRST FLOOR PLAN SCALEI/4•-1'-0' 1 REV'#5:FOUNDATION REV.FRONT PORCH ,.INTERIOR DOOR DMENSIONS SHOWN ARE NOMINAL DOOR LEAP SIZES IN INCHES.G.C.TO CONFIRM ACTUAL ROUGH OPENING SAES L I - " �Y REQUIRES WITH THE INTURIOR DOOR.I•ABRICATOR.INTERIOR AND FIRST FLOOR A HEATED f 2,620 SQ.FT. TITLE: EXTERIOR DOOR s WINDOW HEAD CASINGS TO ALLIGN UNLESS ONEW WALLS a NOTED OTHERwuE. GARAGE 810 SQ.FT FIRST FLOOR PLAN I DIMENSIONS ARE TAKEN.TO PACE OF ROUGH STUD FRAMING, - CENTER-LINE OF DOOR'OR WINDOW.OR CONTROL POINT LINE. - - i®,�r„�. EXISTING.WALLS UNLESS INDICATED OTHERWISE. - 3.ALL EXTERIOR WALLS SHALL BE 3X6 FRAMING,UNLESS NOTED - wAu TD DeMQLw+ I OTHERWISE AREA CALCULATIONS 2 . l 4.ALL INTERIOR PARTITIONS SHALL'BE FULLY INSULATED W/AV . - - UNPAGED FIBERGLASS SCUM INSULATIONi - - 6.SECOND FLOOR DECK SHALL BE INSULATED WITH V UNPAGED ID- HARD-WIRED PHOTOELECTRIC SMOKE DETECTOR FIBERGLASS SOUND INSULATION S.D._ WITH BATTERY BACKUP B.ROOF FRAMING SHALL BE INSULATED W/R-30 FIBERGLASS INSULATION. - H. HARD-WIRED FIXED TEMPERATURE HEAT DETECTOR ■ H.D. WITH BATTERY BACKUP I 4 ® HARD-WIRED CARBON.MONOXIDE DETECTOR. WTH BATTERY BACKUP. A 1 _ . 1 LEGEND 15:1 GENERAL NOTES 4 !FIRE PROTECTION 1311. KOELBEL-RYAN }RESIDENCE , 220 BAY.STREET. OSTERVILLE,MA -------------- ----;-----•-------------21 6 DEC ®N ,, M�12VMRVIN DECK - •LN Nx4eoeo 2'r ' . N..vc `°n®tra si - 1,�, � 4' ^ 4 &-e, _ $ GENERAL NOTES: 204 TMamn.avde,.�..+e•m•,.m.edo•ww. l-" TOIL.20 - SHO ER _ M 8 RUN BBG HOOD EXH T IN �� RADI9E DECK FRAMING ro H MASTER B DROOM G_ •LEILIN6 VOID SPACE arse _ ______ __ _________�___ __ n ems �.. �wa.o.c.�o,�.dm• i,e ode«.oaron�.. - MODFED EXTERIOR -- > — SAND- 21 O 1v —TRIM TO CLEAR 1w ai ___ ______ Y BLASTED I ' GUTTER PL ° �' ��O o __ ------_ GLASS HALIWAV ® V DOOR c1r' ,i.Y. t. 36 I S I '- INKS ROOK N F + t - 2 9 ea oucnrclrc Fl:.r_+ CLOSETY, .�:IT i - 11 SIT IR GLASS. Nooc T ' 14"2 1 1 _ L...._ .7Za.. .__ 2 M DEN Dow ameneo v�,weawt .- `�,.„tTr:- __}• I +... _— ——————————— —— 1 M INLpLK.�,ypII��rI. UNDER - __________ .ndna m 2 1 S R REP. Q¢�+� ___ BAL ONY '� MA a TE N` BEVERA I 1 Ely - wcT Rarte—� 'O8 1 I MARVI ' .. `:i•' - - OPEN T KRCH N am 1 1 LVJ MARVIN N212-r - 21 3 uTNa�a scowl CN3N3644e CN�is�aery CN93W LN MAaVM N I 1 CN3 _ M H. I _ —_ — -� 1 ®MARVIN ®MAMIN OPCKET I1 11 II II I III _____ _ __ ___ __ � _—__ ------ _ ------ --------- CN �111 IIII II F ` -—-J 1 1 ARCHITECTURE+DESIGN 1— — — 0 GUEST BEDROOM SD. - CLOS I I _ I I I I 691 Mein Street Oster",MA 02655 T 508 420 529e F 508 420 2240 nicndeeff— 3 I II �. it �r ----------J *'-REVISION#5" A3.1 O . � 6, Of 6��, �6,-6, 6•_� I i _ I 1 CONSTRUCTION SET 04/01/2021 .PROJECT NUMBER:KLB01 DaAWN BY:AH,DV - I Ai.l I 1 1 I I I SCALE:AS NOTED IL________________� - 11 DATE:APRIL 1,2021 - , REV It:FOUNDATION,FRAMING,STAIRS REV e2:FIRST FLOOR FRAMING/FOUNDATIONS REV•3:FNDN/RRST FLOOR MUDROOM /� PLAN N4:FOUNDATION,.MISC FLOOR PLAN ADJ r SECOND FLOOR PLAN SCALE I/4'=1'-0' REV IS:FOUNDATION REV.FROM PORCH 1.INTERIOR DOOR DIME119K7nS SHOWN ARE MOMNAL DOOR LEAP SMF3 IN INCHES G.C.TO CONFIRM ACTUAL ROUGH OPEM4G SAES KEY REW62m WITH THE INTERIOR DOOR FABRICATOR IryTPJ210R AND SECOND FLOOR HEATED 1,420 SQ.FT. TITLE: IN - EXTERIOR DOOR"9 WINDOW HEAD CASINGS TO ALLI H UNLESS . NEW WALLS MOTED OTHER , 2.0I4EM31OMS ARE TAKEN TO PACE OF ROUGH STUD PRAMNG, SECOND FLOOR PLAN' CEITTER-LNE OF DOOR OR WINDOW,OR CONTROL POV4T LINE, - �. EXISTNG WALLS U111.-- INDICATED OTHERWISE S.ALL EXTERIOR WALLS SHALL BE 2X6 FRAMING,UNLESS MOTED .. WALLS TO DEMOLSH A.ALL AREA CALCULATIONS 2 A.ALL INTERIMFIBERGLASS PASS SCUS SHALL BE FULLY INSULATED W/61Q . I UI'IFACED FIBERGLA99 SOUND NSULATKJry ' S.SECOND PL.00R DECK SHALL BE INSULATED WITH 9'UryPACED G HARD-WIRED PHOTOELECTRIC SMOKE DETECTOR FIBERGLASS SOUK INSULATION S.D. WITH BATTERY BACKUP 6.ROOF FRAMING SHALL BE INSULATED W/R-30 FIBERGLASS INSULATION H. HARD-WED FIXED TEMPERATURE HEAT DETECTOR Al 0 + H.D. WITH BATTERY BACKUP 1 e HARDWIRED CARBON MONOXIDE DETECTOR I C.O. WITH BATTERY BACKUP LEGEND 151 GENERAL NOTES 141 FIRE PROTECTION 3 KOELBEL-RYAN RESIDENCE- 220 BAY STREET. . . ----------------------------=- --�----- � OSTERVILLE,MA i - .. .. . . .. GENERAL NOTES: Q 6 Fooll .. BASEMENT . . . -UNFINISHED/EXI5TINGCL i I 0061 x BASEMENT �N OEM I "--VESTIBU6E _ - _ IN NICH lL - - - I I .e. . . I• ARCHITECTURE SIGN C O ECT F URE+DE F0081 891 main street SLAB ON GRADE L®___ — _—_ - .T 508 420 5298 - .. .. - .. F 508 420 2240 - _ nlcholaeN.com ' REVISION#5' CONSTRUCTION SET 04/01/2021 �. PROJECT NUMBER;KLBO DRAWN'BY:AH,DV SCALE:AS NOTED , - DATE:APRIL 1.2021 REV#1:FOUNDATION.FRAMING,STAIRS . .. .. - - REV#2:FIRST FLOOR FRAMINOIFOUNDATIONS - REV#3:FNDWFIRST FLOOR MUDROOM - - - BASEMENT I� n AL REV#4:FOUNDATION,MISC FLOOR PLAN ADJ - BAS E I V I ENT PLAN SCE 1/4'=1'-01 1 REV#5:FOUNDATION REV.FRONT PORCH 1.INTERk7R DOOR DIMCH3k748 SHOWH ARE 1NOMINAL DOOR LEAF SAES IN INCHES.G.C.TO CONFIRM ACTUAL ROUGH OPENING SIZES - RCOUIRFm WITH THE INTERIORR IN DOOR FABRICATOR. AND BASEMENT VESTIBULE :- 260 SQ.FT. TITLE' . rXTERIOR'DOOR 6 WINDOW HEAD CASINGS TO ALLIGN UNLESS NOTED OTHERWLSE - 2 DMENSIONS ARE TAKEN TO FACE OF ROUGH STUD FRAMING. BASEMENT PLAN CENTER-LINE OF DOOR OR WINDOW,OR CONTROL POINT LINE.. I - UNLESS INDICATED OTHERWISE .. ALL EXTERIOR WALLS SHALL BE 2X6 FRAMING.UNLESS NOTED - OTHERWISE AREA CALCULATIONS 12 A.ALL INTERIOR PARnTION3 SHALL BE FULLY INSULATEDW/91S• . . UNFACED FIBERGLASS SOUND INSULATION - 5.SECOND FLOOR DECK SHALL BE INSULATED WITH 9'UNFACED G HARD-WIRED PHOTOELECTRIC SMOKE DETECTOR - . FIBERGLASS SOUND INSULATION - S;D. WITH BATTERY BACKUP - 6.ROOF FRAMING SHALL BE INSULATED W/R-30.FIBERGLASS 0 HARD-WIRED FIXED TEMPERATURE HEAT DETECTOR INSULATION WITH BATTERY BACKUP ® HARDWIRED CARBON MONOXIDE DETECTOR - . WITH BATTERY BACKUP A 1 . - . GENERAL NOTES 4 FIRE PROTECTION 3 f .. - W N KOELBEL-RYAN RESIDENCE 220 BAY STREET - OSTERVILLE,MA GENERAL NOTES: r - --� mT - !� an.ewrMmvr��buModns:enN 1. kn varele worst Amlab,d aw l.n Waw apcva • - vJ ��44}��..— �J •w.uv.�c . N i I \I I; ,�w•mam�nlc�ovKb�mvro arerm.va arn.*m uv D - .wn r.ee aw+rmrcae.rov.s vuemnea•dried wd�ra /12 Y/ 11, 5 I 6A3 ve v a w ro nruYPu*ro a vaYa. PLAN .. NICHOLAEFF ARCHITECTURE+DESIGN — W - N I 891 Mail Swcet OsteMUe.MA 02655 T 508 420 5298 351V .. F 508 420 2240 . - - nichclaell._ * *REVISION#5 Ya. CONSTRUCTION SET - a C FIXED 3658 FU(ED 04/01/2021 .. J Nudvea 7 1 PROJECT NUMBER:KLB01 - ' - 1 . - crnnud4 R'/I•J _Ham(. T DRAWN BY:AH.DV . 2-CAR GARAGE`� ✓/ \i SCALE:AS NOTED - 5EALFD CONCRETE ��`/J/ �. . I 2-Vi wius� 0 5 �l /iD DATE:I VI INNS® n �,I AP RIL 1 202/ ,o r �( 5 MAfiVIN I on REV B1:FOUNDATION,FRAMING,STAIRS __ ______- _ 1_ — _-_____ R11 N FIXED I_ - ---- _ I / -_-I_ -_--- II —— •_-- L REV#2:FIRST FLOOR FRAMINGiFOUNDATIONS _ _ I I i i I l �. C 36'-T 2 REV s3:FNDN/FIRST FLOOR MUDROOM REV B4:FOUNDATION,MISC FLOOR PLAN ADJ REV 05:FOUNDATION REV.FROM PORCH v I Y a 14TFRM DOOR DVISM340"SI4OWN ARE NOMINAL DOOR LEAP I I I TITLE: SIZES IN INCHMS.G.C.TO CONFIRM ACTUAL ROUGH OPENING Snco DETACHED GARAGE 825 SQ.FT. s I I I RECUItED WITH THE INTERIOR DOOR PABRIC,ATOR.INTERKM AND I I DETACHED GARAGE- ExTEROR DOOR a WINDOW HEAD CASINGS TO ALLIGH UNLESS NOTED OTHERWISE I I FLOOR PLANS 4 I DI•tEnS1ONS ARE TAKEN TO PACE OF ROUGH STUD FRAMING. - .. CENTERLINE OF DOOR OR WINDOW.OR CONTROL POINT LINE, 6A3• U"LEW INDICATED OTMRR"" AREA CALCULATIONS 5 6.ALL EXTERIOR WALLS SHALL BE 2X6 FRAMING.Unless NOTED onlEawlsE 4.ALL INTERIOR PARTITIONS SHALL BE FULLY INSULATED W/02' bb, >,q 6'-10Z 6'-101 6'-102 6'-1q UKFACED FIBERGLASS SOUND INSULATION O HARDWIRED PHOTOELECTRIC SMOKE DETECTOR 6.SECOND FL L IT FLOOR DECK SHALL BE INSULATED WITH 9'UMPACED S.D. WITH BATTERY BACKUP FIBERGLASS SOUND INSULATION 6'q 73 79 6.ROOF FRAMING SHALL BE INSULATED W/R-60 FIBERGLASS (� HARD-WIRED FIXED TEMPERATURE MEAT DETECTOR 35,-6, INSULATION - H.D. WITH BATTERY BACKUP - I G-A1 . 1 GENERAL NOTES 161 FIRE PROTECTION 14 FIRST FLOOR PLAN ----------- SEPTIC NOTES DIRECTIONS: ASSESSORS REF: 1.Location of Utilities Shown on This Plan Are Approx.At Lout 72 Hours From Hyannis - Follow Main Street to the West End Map 094, Parcel 005 Prior to Any Excavation For This Project the Contractor Shall Make Rotary, Take third exit onto Scudder Ave. Turn right onto the Required Notification to Dig Safe(1-888-344-7233)and contact smith street at the stop sign. Continue on to Cralgville Sullivan Engitiming&Consulting Inc.(508428-3344). Beach Road and left onto South Main Street. Continue over OVERLAY DISTRICT. 2.The Contractor is Required to Secure Appropriate Permits From Town the bridge to Osterville. Turn left onto Parker Road and AP - Aquifer Protection District Agencies For Construction Defined by This Plan. right onto Boy Street. f220 is on the right. 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shan FLOOD ZONE: ------ -- 7- 2 WF 13 r Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to Assure Watertightness. In General,Water Lines Shall be Constructed in Zones AE Elev. 13, AE Elev. 12, Coordination With COMM Water,and Shall be in Accordance ZONE: X (0.27. Annual Chance) With 248 CAR 1.00-7.00&310 CAM 15.00. T. , RF-1 & X (Min Flood Hazard) ./.............. 4.A Minimum of 9"of Cover is Required for All Components. Community Panel No. ...... 5.Ali Structures Buried Three Feet or More or Subject Area (min.) 87,120 Sr (RPOD) Remaining Parts of Frontage (min) 20' #25001 C 0563 J V2:ting SepticItsten' to Vehicular Traffic to be H-20 Loading.It is the Engineer's Comp D ring onents Domage, Width (min) 125' July 16, 2014 d Recommendation that H-20 Always be Used _nstrucqon to be 6.Install Watertight Risers and Covers to Finished Grade 100' Over Septic Tank Inlet and Outlet;and Within 6"of Grade over D-box, Setbacks: New Conc. REFERENCES: Fron t 30' oved Per 310 CMR 1! 04 1* Foundation Existino Sept 50' and One Leaching Chamber. LOCATION MAP Side 15' o Deed Cert. 219229 &-be'Remo tn (1--2000-+') Rear 15' N Pion LCP 26772 p R 1 M co All covers are to be maximum 18 11 for concrete or 24"Cast Iron. Lu LU 7.Septic System to be Installed in Accordance With 310 CMR 15.00& Z W'Q r Garage i o248 CAR 1.00-7.00 Latest Revision and the Town of Barnstable Under Drainag Locate Junction Box WIM U-1 "Constructim Board of Health Regulations. Outside of Tank e Af Wtructure 8.All Piping to be Sch.40 PVC. f 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum n Pump Power & Float Control - ---- -------- 7, Sump of6". Cables Installed In Accordance 245.05' With Federal, State & Local 10.The Separation Distance Between the Septic Tank Inlets and Bldg. & Elec. Codes N86* 54' 02"W X. Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend/* Alarm To Be On Separate Api (p- a Minimum of10"Below the Flow Line.Outlet Tees Shall Extend 14" Service From Pumps If Baffle and Zabel 112"0 Golv. Pipe Below thePlow Line,and Shall be Equipped With a Gas �,�ke For Float Support Effluent Filter or Approved Equivalent. Flogged Wetland 44 4 4" 0 To D-Box I Garage 0 00 C�l roposed Proposed Under I - Vent 0�00 00 -1,X\ 15QO Galion Proposed onstructioni -P 10 H�20 • 0 .1 Gra,�&K 4"0 Sch. 40 PVC 1 0 00 0-1;� <-• SeptiqTank E�r 24"0 Opening Above 08 ki 1 -kn �. - h ive From Septic Tank ct Lo'15 Y.New Conc. TH 2 For Manhole 4-4 Comportm en t Frame & Cover ii % New TH-13 -4- 10' New Conc. Concrete Slab x rn ii 0 0.. Foundation Garage 45 D, #220 ........... 0 Lot 14 V xx 0, C\? I, 103,130sf± to MHW0 tol PUMP CHAMBER PLAN VIEW DETAIL CP /1 0 013 "N' Bench Mark e i... 0 _bO: 0 0 00 ddition r NOT TO SCALE nder of Conc Bound \W1 laL/ _tion - 1 Cj_ 0p Elev. 15.34' --biropqsed -C, 6\ Gravel Conduit Thru Chamber For C, 0-\ \ 1 24"0 Manhole 0 5T49' Proposed Sept U64,. Power & Floot Cables 0 Septic Unsuitable Material Strip Out Frome & Cover Finished 9 Min. .......... See Detail View Strain Filled with Clean Sand Grade Cover Per 310 CMR 15.255(3) 0(10 5 now Diffusers See SAS Detail Pion View V1- eet 1q) N 4"0 Sch. 40 PVC Drill 118"0 Hole \ '� 9 2C a Golv. Cho' For Drain N Inv. 1L5, From Septic Tank X N To D-Box O _0 0 504 Min. 2' Cover X b\o,< 0 Emergency Storage Ln C14 li: .1 . .:�i .1 Volume 673 Gal. Q LV Alarm On El. 8.90 0 X ;) cl Pump Detail Plan View Scale: 1 20 DESIGNDATA Pump On El. 8.60 Cb Single Family 150 Gallon Cycle 2"0 Sch. 40 PVC -.0 Overall Plan View -4Badroomatll0GFD, Pumps Off El. 8.00 Threaded Pipe V7 Scale: 1 50 No Garbage Grinder Check Valve Total Daily Flow=440 GPD 1=e, 04 Q)/N Use 1500 Gal H-20 Septic Tank f (hnmhpr FI_ 7 rin In "no Finish Grade LEACHING AREA Secure Pipe"at Top &: 4.1 r- Filter 440 GPD/0.74(LTAR)=5-94.6 SF Required Bottom of Chamber (1 11 1 - . 11 Stable Compacted Fabric 14,2- Q 1 /1, Sidewall 118.9xO.92=109.4F 4110 H.P. Myers Pump Base 41 Compacted Fill AND/OR Bottom Area-573.3 SF or Approved Equal*-- 1/- 112- Total Provided=109.4+573.3=682.7 SF(505.2 GPD) MI-11M Pea Stone *Prior to Ordering Pumps the Contractor In in r-1 Im A A Must Confirm the Compatibility of the 314" - 1 112 LEACHING CHAMBER DESIGN Existing Electrical Service 4' Double Washed All Pipes to be Schedule 40. Use 12' Stone 5 Flow Diffusers in a Double Washed Z Stone Field as Shown. PUMP CHAMBER SECTION DETAIL Proposed H-20 -VARUNCE REQUEST NOT TO SCALE 1500 Gallon CROSS SECTION OF FLOW DIFFUSOR Counter Variance 4 Septic Tank Proposed Vent Failed Septic System NOT TO SCALE Plastic Infiltrators and Septic Tank Crushed 0 During Construction and Excavation of the New Addition Oo et PERC TEST. 192,727 1 00'Separation From Wetland to Septic Tank Required 1TV >75'Requested PERFORMED BY.JOHN OVEA,PE- SULLIVAN ENGINEERING 10 0 &CONSULTING,INC Thrust SOIL EVALUATOR NO.2911 BlocksWITNESSED BY.73M O'COMMLL,R.S.-TOWN OFBARNSTABLE DECEAIBER 7,2020 Charcoal Filtered Vent 4-tT SITE PASSED Final Location to be Determined ._-fro 10 at time of installation or in D-Rox accordance with Landscape Plan TEST HOLE 1 EL.13.5 TEST HOLE-2 EL.13.2 I . .. ........ Proposed .. .... ............. ... ....... .................... ................... ................. FF Main House 16.......... . ............................. ............. ............. Main House F.G. EL. 15±* ....GRA V .011 (t`) 12- .GR AVEL DRIVE-1 HARDENER. 12.5 Ion,:.... .EL-DRIVE-1HARDENER-.-.-.- 12.4 Court Yard Dev. 14.0±- *Final Foundation Grading To Be -Y BwLAER Existing ......................... ..15 .......... Coordinated With Lon scope Plan F.G. EL. 14'± 0 .......... TCF 15.7 See Note 6 (typ.) F.G. EL. 14.40' Max. L ..................................... Y .......L LOAMY.SAND....... ..... ............. pose 30. .... ......... .0, ............ 11.0 32el 10.2 1 0 oil P Stone Field 5 Flow-Wfusers CLAYERZ5Y616 PERC TEST C-10 P6mp Chom er t1n Stone Fielel OLIVE YELLOW 25 GALLONS GONE IN 4 MIX,30 SEC. �P- MEDIUM SAND PERC RA TE<2 MININ TAR=0.74) EL.12.00 48.0' e a eno 1191, 3.6 South Invert EL. 13.9 1 GROUNDWATER ENCOUNTERED 380 CLAYERZ5Y&6 21.5 North Invert D. 13.2 EL Proposed H-20 1\ 10' Filled with Clean Sand OLIVE YELLOW installer To 1500 Gallon 1 .16 D-Box Too EL. 11.40 R 15-2_W3L_ .......... _Eer 310 CAL_ EL. 11.5 ...... CL 0, 115m MEDIUM SAND 3.6 Confirm Prior H-20 Septic Tank 1000 Gallon C3 C2 ca 17-1 C2 cm '13 Cb GROUNDWATER ENCOUNTERED To Any Work Pump Chamber Bot. EL. 10.90 (See Note 5) EL. 11.75 H-20 Splash ...�:: EL 11.86� H-20 .......... Guard Ll J Flow Diffusor .......... .....................I.. ................................ ........ .......... ... .......... ........................*.................................... .................................. ............. . .......... ....... ....... ..................... ...... ............... ...... .............. ...... . LO TEST HOLE-3 TEST HOLE-4 M.11.3 ... . .. . .. ............... ............. ..............!�P.q� .............. ......................... b 6 s . ........ .... ............. .......... .............. .............. ................... ................. .......... ............ \-EL. 7' AII ......... ... ....... ........... ........ ............ .. . .. ..... Bench Mark ...... ........ ........ .... Effluent Tee Om ................... ....... .......... e Ob t6'r"P T.h S t...... .............. ............. ..... ........ ............ .. . ... ........... .... . ...... ................... ...... ........I......... ........ ............... SAS Detail v011 Cam View ....jc4LL. Zabel Filter or ........ . Top of Conc Bound ............................................................ .......I............................ To Be Installed On ............... ...................................................... EL. 5.9 Scale: 1" 10' Elev. 15.34' -.-.-.-.-.-GRA- VEL-DRIVE 1HARDENER-.-.-.-. 10.3 10.0 approved Equivalent Stable Compacted Base Bedding,"T"s, Adjusted Groundw ............. -Y- R.10YR.51 ............... See Note 10 Elev. J.6+2.3=5.� ...Bw.LA E .6 BRQW '9k YELL6W GONE&.4411K j6�Sgc�' Inspection Port, ...................................... ...............................I.......... & Boffels OF 9.1 .-.PERCP.A7E-,!-q-ZAIIN/IN-(LTAR.-.0.74-) DEVELOPED PROFILE OF SYSTEM CLAYER2.5Y616 Tgw--c LAYER 2.3y 616 &3 as Per Title 5 T. OLIVE YELLOW OLIVE YELLOW W ALE 98"1 MEDIUM SAND AIEDIUMSAND 3.6 NOT TO SC MILD D 13.6 92"1 LEGEND: GROUNDWATER ENCOUNTERED GROUNDWATER ENCOUNTERED 2 SS NA�_ 0 Bush / Shrub OFF0 CDT Cedar Tree RevisionT. Incorporate Health Inspector Comments 11118120211!�::7 JA� / 0- HT Holly Tree NOTES: PREPARED FOR: PREPARED BY.• TI TL E. •Site Plan DT Deciduous Tree CT Coniferous Tree 1) The structures shown were located on the ground Brion C Koelbel & Tracy A. Ryon Engineering & Proposed Septic Design by conventional survey method or RTK GPS on 616 Eost Eight StreetC Naft" c-CL_) Utility Pole 911312019. Li- -E- Electric 2) The property line information shown hereon was Boston MA 02127 u iv- -- onsuitingtac. At -G- Gas compiled from available record information. (508)428-3344•P.O. Box 659 .711 Main Street, Osterville, MA 02655 220 Bay Str eet � Wetland Flog 3) The datum used is NAVD 1988 based on RTK GPS 10 -Detail View 0 5 10 20 40 secl@suilivanengin.com•www.suilivanongin.com g Liht Post Bench Mark supplied by Sullivan Engineering & 20 -Detail View 0 10 20 40 80 El CB/DH Consulting, Inc. 50 -Overall Plano 25 50, 100 200 Draft: C TR Field: WHKIJODICTR Barnstable (osterville) Mass. _OHW Overhead Wires I Review: JOD Comp.: C TR DATE: SCALE. -25- Elevation Contour ===I r I Project: Koelbel Project#: 2002024 November 10, 2021 As Noted _J DIRECTIONS: ASSESSORS REF.: From Hyannis - Follow Main Street to the West End Map 094, Parcel 005 §Fi�4 SEPTIC NOTES NITRIDE NOTES Rotary, Take third exit onto Scudder Ave. Turn right onto ��r 1 r 1.Location of Utilities Shown on This Plan Are Approx.AtLeast72Hours 1. PROVIDE MlNWUM2"DROP WHILE MEETING REGULATORY SLOPE smith street at the stop sign. Continue on to Croigville OVERLAY DISTRICT: 'r / ' Prior to Any Excavation For This Project the Contractor Shall Make REQUIREMENT FROM THE SEPTIC TANK OUTLET PIPE INVERT TO R >x, Beach Road and left onto South Main Street. Continue over AP - Aquifer Protection District i r i i 1 the Required Notification to Dig Safe(1-888-344-7233)and contact THE INVERT OF THE]NFL VENT PIPE INTO THE NITROE TANK . the bridge to Osterville. Turn left onto Parker Road and q i l r i 'I, 1 Sullivan Engineering&Consulting Inc.(508-428-3344). 2. NTTROE TANK TOP TO HAVE TWO-24THREE-12 HOLES AND � I right onto Bay Street. #220 is on the right. _ -r WF 13 t ' 2.The Contractor is Required to Secure Appropriate Permits From Town MULTIPLE 4"DIAMETER ACCESS HOLES WITH RISERS AND COVERS 2 FLOOD ZONE: - --=-=_ �`� >�' _-� - -_ • - o-�> _ , \ i Agencies For Construction Defined by This Plan. FOR MAIlVTENANCE AND SAMPLING. Y Zones AE Elev. 13', AE Elev. 12, -- -" -- 1`` '� _ ' ► 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall 3. FOR THE 24"HOLES,PROVIDE 24"DIA.ADS PIPE WITH COVER TO 12" ' ZONE: X (0.2% Annual Chance) \\ / - - _ Constructed of Class 150 Pressure Pipe and Shall be Water Tested to BELOW GROUND SURFACE. BOLTED 12 TANK TOP. `y et r & X (Min Flood Hazard) ............. . :.._. . .. } i Assure Watertightness. In General,Water Lines Shall be Constructed in 4. FOR THE 12"HOLES;PROVIDE THREE-12"HOLES WITH ADAPTER ` RF-1 f Community ' l Coordination With COMM Water,and Shall be in Accordance RINGS,RISERS AND COVERS TO 12"BELOW GROUND SURFACE. .. ..,.. fi .: . . .>< Area (min.) 87,120 SF (RPOD) Y Panel No. -- f With 248 CAM 1.00-7.00&310 CAM 15.00. INSTALL 4"DIA.MONITORING PIPE(1"BELOW GROUND SURFACE) t * + Frontage (min) 20' #25001 C 0563 J Jul 16, 2014 t i� 4.A Minimum of 9"of Cover is Required for All Components. WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH WITH Y 1 .' , rainage �1 Po Width (min) 125' i • 3. truc tune 3 S.All Structures Buried Three Feet or More or Subject GROUND SURFACE. Setbacks: REFERENCES: New Conc. _ I O z o S. PROVIDE FOUR-6"DIAMETER PLASTIC ROUND BOXES AND COVERS .. a - �� d to Vehicular Traffic to be H 20 Loading.It is the Engineer s Fron t 30' ar . Foundation Existin Sept' J o OE AND SEPTIC TANKS LOCATION MAP Side 15' C N p - 0 _ Recommendation that H-20 Always be Used. (NHR )TO BE INSTALLED AT GROUND LEVEL. o Deed Cert. 219229 / / d-6�Remo ed ,. 50� ,0to 6.Install Watertight Risers and Covers to Within 6"ofFinished Grade 6. PROVIDE INFLUENT SAMPLING PIPE(2"DIA.)6"FROM EDGE OF 1 2000t' Rear 15' W N Plan LCP 26 772 R 1 / ' Over Septic Tank Inlet and Outlet;D Box,and One Leaching Chamber. GROUND SURFACE. ( - ) p ' SEPTIC TANK WALL WITH 6"PLASTIC ROUND BOX AND COVER AT 4JUjQ Gdrage f z All covers are to be maximum 18"for concrete or 24"Cast Iron. M Q J 61, r ' Under ' 7.Septic System to be Installed in Accordance.With 310 CAM 15.00& 7. OPERATION AND MAINTENANCE PLAN TO BE IN EFFECT IN I ` :• ter/ Construction 100' PERPETUITY. 248 CAR 1.00-7.00 Latest Revision and the Town of Barnstable ___ _74'_ Vim / ' �� Board of Health Regulations. __ --- - -- -, 8.All Piping to be Sch.40 PVC. 245.05' --- - J: / Z r �- 9.D-Box Shall Have a Minimum Inside Dimension of 12.and a Minimum - / O N / Sump of 6". N86' S4' 02"W - I �LCA Oetd� 10.The Separation Distance Between the Septic Tank Inlets and P oto •� \ i O i c Outlets Shall be No Less than the Liquid Depth.I>let Tees Shall Extend PERC TEST. 192,727 Pro osed ' 0/ Hp 20 ( '�j J�� a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" PERFORMED BY. O'DEA,PE- SULLIVAN ENGINEERING 0 °'� �\ ,, o p 0 Equippeda Gas Baffle. &CONSULTING,INC. Flagged Wetland. i / �, � � '� / Septic Yank Below the Flow Line and Shall beWith 1 Garage n c, 11.An O and M agreement with a qualified consultant shall be in place during SOIL EVALUATOR NO.2911 46. Under I o4o°oss� �.\, 92' \\ Proposed f/ �' Pr Vented the entire time the NitROE system is in use. WITNESSED BY.DAVID STANTON,R.S.-TOWN OFBARNSTABLE O nstruc to l �o T NITRIDE / ,� / DECEMBER 8,2020 =N -� t n °^ p SITE PASSED a,>s° Pro ose �ystem New Conc. Pro :- • Og o s a• �� Grovel ( rH-2 - , Patio Dri D-Bax > yg 0 t0 / 6' - s \ 7N-4 TH-/3 \ . ' 11 ` k os �` 4s \�. New - 13.5 - 3.2 TEST HOLE 1 \ _ _ - o i o � New Conc. Concrete'Slob .�''� � ..... .... . EL. EL.1 O O. Cr ::. ` .,. / 1 1 �\ Foundation .Garage r :: FILL::::::::....:.::..: FILL:.. y `Q ,•' ti ¢, o • 121 GRAVELDRIVE/HARDENER 12.5 10" GRAVEL DRIVE/HARDENER .... 12.4 O Lot 14 - 6 C` ti \ -S one Field i i O O o y 2 2 Bcv LAYER Lt}YR S/6.......... i( 103,130sft to MHW BROWNISH YELLOW 11 ob �'� a��o , ✓ BROWNISITYELLOiV: . O O O \ , p• ono- - .. ......................... . u O - ,. ? � ,.. ... F� \�, -^ / 1 Cf09 Reserve 30 .. LOAMYSAND:. 11.0 32' . LOA1�fYSANll.... .. O w N e -� ' CO-• Bench Mark C LAYER 2 5Y 616 PERC TEST O O ddition � �� 10.2 rd O �� O O r_ \ A �ndection l i \` / op of Conc Bound OLIVE YELLOW 25 GALLONS GONE IN4MIN.30SEC. l 1I� `�. � stru \ w Elev. 15.34 119' MEDIUM SAND 36 PERORATE<2M1N/IN(LTAR=0.74) z\ O �' __ - C w Bra sed f 5' 89' 4 4 C/ �'Zo ` O O. \\ O._ - ,__- \ �o Gravel GROUNDWATER ENCOUNTERED 38 C LAYER 2.5Y 6/6 21. >> ° / �• Proposed Septic �� \ Drive` / OLIVE YELLOW t7.. , 4 '� ` O i�, _ See Detail View °� 7 100 rain ` - 115' MEDIUM SAND 3.6 �. N \ 7 GROUNDWATER ENCOUNTERED \..:..St ctur ' � 6PFIowsDiffusers - : See SAS Detail Plan View ` TEST HOLE 3 EL. TEST HOLE=4 4(3�ro 0 N ID EL.11.3 N :. 5�t 60 =N v , <z'� FILL:...... .. .... FILL....... \ y 0 S `- ( ,.: ° o Bay 18" .....GRAVELDRIVE/HARDENER 16' GRAVELDRIVE/HARDNER:. A 0 5 �o o ` � 10.3 10.0 \ 1� �s1 / .� O N , °^ De all I eW ...... \ cv G N Bw LAYER I0YR.5/6 : PERC TEST. �,\ �s ��,,• , oy W c ` ` ::BROWNISH YELLOW:::::: ZS GALLONS GONE IN 4:MUV 80 SEE7.: so\ z yti 00 W 'IN x V_ ' Scale: 1„ = 20' 32 : LOAMY SAND:.......:.... 9.1 PERC RATE<2:MIIV/IN(LIAR=:0.74) o• F \ / ul� o X C LAYER 2.5Y 6/6 6 C LAYER 2.5Y 6/6 8.3 �•� �� ate`' OLIVE YELLOW OLIVE YELLOW Xr n 98" MEDIUMSAND 3.6 9211 MEDIUM SAND 3.6 0 OVe1 sII PI s/1 View GROUNDWATER ENCOUNTERED GROUNDWATER ENCOUNTERED \7 5ytk Scale: 1 = 50' '11' c co• Proposed / .. 5yti 1a Nl N, )Proposed \\ I . Vent w j DISTANCE VARIES 154 W , J S;stom / �� / TOTAL TANK LENGTH 14J, W O /�� ! OUTSIDE WALL TO OUTSIDE WALL Q W r Gravel Drive j ooE�et 1 �° TANK WALL d�oL THICKNESSF DESIGNDATA \� �� J %� AT TOP a Single Family ! D-Bo / o c (3"TYP) �► -► " LLO U -4 Bedroom&1 Future Use Finish Grade -► 0 S Bedrooms Total at 110 GPD / , �o rn O No Garbage Grinder Fabric INFLUENT F- \ M / Filter INFLUENT M D ENITRIFlCA Total Daily Flow=550GPD N Compacted Fill AND/OR (SEE NOTE 1) M •. ERA ON DC) ° EFFLUENT Use 1500 Gal H-20 Enhanced Septic Tank r l I 12.0' - - t/8" - 1/2" • Y O ER ' / J rm cm 0 C2 C2 P2 Pea Stone N z O LEACHING AREA _ INFLUENT e,a I- �„ .,.. --- / / -(-� 3/4.. - t 1/2" SAMPLING PIPE Q� �- 1 ( a Double Washed (2 DIA PVC PIPE) I- 3 TO TITLE 5 550 GPD/0.74(LIAR)=743.2 SF Required Stone Field � 4' Sidewall=2(12'+56)x0.92=125.1F Proposed SAS l 12, stone SEENOTE6 �Wo ---r SOIL Bottom Area=12x56=672.0 SF 6 Flow Diffusers 56.0' , �a T ABSORPTION TITLE 5 SEPTIC Total Provided=125.1+672.0=797.1 SF(589.8 GPD) ✓ '' �?o m TANK :1SYSTEM TANK WALL --.► -y► CROSS SECTION OF FLOW DIFFUSOR ° THICKNESS = (SAS) LEACHING CHAMBER DESIGN y 100% Reserve NOT TO SCALE AT BOTTOM f w AD .Pipes to 6e Schedule 40. UseNOT TO SCALE (a 1/2 Tire) I- . :: :., •: , . . . ,... ; 6 Flow Diffusers in a 12'x56'Double Washed J / Stone Field as Shown. / SEE NOTES 2,3 AND 4 I � VARIANCE SAS Detail Plan View Charcoal Filtered Vent DEP State Environmental Code Proposed Final Location to be Determined 6"PLASTIC BOX AND COVER WITH 4" 310 CAM 15.212De Depth to Groundwater FF Main House 15.7' Scale: 1" 10' at time of installation or in MONITORING PIPE;SEE NOTE 5(TYP) PGoroce Slab accordance with Landscape Plan SEE NOTE 5(TYP) Required: Main House F.G. EL. 15f SEE NOTE 3(TYP) b)Five feet in soils with a recorded Garage F.G. Elev. 14.5f SEE NOTE 6 SEE NOTE 5(TYP) 12"ACCESS HOLE WITH COVER percolation rate of two minutes or less per Court Yard Elev. 14.0f- *Final Foundation Grading To Be F.G. EL. 14'f See Note 6 (tYP) F.G. EL 14.23' Max. GROUND SURFACE P - _ - - - - SEE NOTE 3(TYP) SEE NOTE 4(TYP). inch. Coordinated With Landscape an - - - - - Proposed:4'separation EL. 1 f EL. 13.1 f TO TITLE 5 SOIL EL. 13.20 51/2"TANK ABSORPTION SYSTEM Town of Barnstable Installer To Proposed Flow Equalizers TOP(TYP) (SAS) 60-1 Location ofcom components with re to Con firm Prior EL. 1 1500 Gallon PROPOSED As Required INFLUENT ••�.rr,.•, "� ''�t �„: �•ia'�`., r�' :%. :. a'ti •v.•��+� •'.�,•. '., r:•�• .. •S• •*.• •..a. 3 Im respect EL. 11.75 t':, .. . �r.,. ►?. i: 4. :.: :'i.' , : .y..�•,.,. .,. •. . water bodies. To Any Work H-20 Enhanced EFFLUENT EL. 91.80 NITRIDE a (SEE NOTE 1) Separation to SAS 92' 'Septic Tank 2000 Gallon EL. 11.50 RO. 48"STATIC ' Separation to Tank 61' of (See Note 5) Mono Tank H-20 Top EL 11.23 w - - - - - - - - - - - - - _WATER DEPT� 0_..... Separation to NITRO 74' H-20 EL. 11.12 0 o ca w D-Box . Required Separation 100' a a a ® ® _ Bot. EL. 9.90 Ow r• _"' _� u_ EL. 10.82 H-20 I- � a Flow Diffusor TITLE 5 SEPTIC D z SUBMERGED v DENITRIFlC(D j CHAMBER o a a To Be Installed On O AERATION able ompocte ase TANK _° CHAMBER �� ZWH (NOT TO SCALE) o o le (SAC)�-� SAC 1 z W W :10Bedding,,.Ts " z M Inspection Port. o> LO LL O3 LL & Baffels EL. 5.9 w v z_ as Per Title 5 .: ►: ' 1' OF Adjusted Groundwater -_ -� -'' y' ISS"y, Elev. 3.6+2.3'=5.9' r+TANK BOTTOM EGEND.w DEVELOPED PROFILE OF SYSTE�/' THICKNESS4 CRUSHED AGGREGATE OR APPROVED ' de. 2tis9 ` PROFILE �Y� TANK WALL THICKNESS MATERIAL(DEPTH TBD-6"MIN);ON LEVEL, �•AT BOTTOM(41/2") f COMPACTED AND STABLE BASE \\ G/$'(ERA 4� Bush / Shrub TANK WALL THICKNESS 5pt71JB�1��'' O NOT TO SCALE AT TOP(3") CDT Cedar Tree HT Holly Tree NOTES: PREPARED FOR: PREPARED BY. T/TLE: Plan DT Deciduous Tree S'to CT Coniferous Tree 1) The structures shown were located on the ground Brian C Koelbel CX ! roc A. Ryon on • Engineering & Proposedby conventional survey method or RTK GPS on Septic Design Tft C-Q--) Utility Pole 911312019. 616 East Eight Street LL_ -E- Electric n consulting, Inc. At o 2) The property line information shown hereon was Boston MA 02 1 2 7 -G- Gas compiled from available record information. (508)428-3344•P.O. Box 659.711 Main Street, Osterviile, MA 02655 Bayt QQwetland Flog secs sullivanen in.com•www.suilivanen in.com 220 Street Li ht Post � 3) The datum used is NAVD 1988 based on RTK GPS 1p-Detail View o 5 1D 20 40 � 9 9 g Bench Mark supplied by Sullivan Engineering & 20-Detail View 0 10 20 40 80 n Mass. O CB/DH Consulting, Inc. 50-Overall Plano 25 50 100 200 Draft: CTR Field: WHK/JOD/CTR a�e ■Stabl a (OsterVille) LLJ W OHW- Overhead Wires Review: JOD Corn CTR DATE: _ 25 Elevation Contour SCALE: Project: Koelbel Pro ect#: 2002024 May 5, 2020 As Noted - s A C c r /\,� q ion`' -� � \ • �I 1 14 13 wd _ bc'�e'? 6kL 5t�I1(?. TA.�.�Ic_ - - - �C... r 1t�t tom: Z..F.� �,,..,� • r-._ � � j - `I 4 �) �1 -4, x ' 6F- - 1-^ a� r Y t 1 Ulu F�9 SIP x Z. SF = Z2 > Y' Tr�-Z-zi TIC")I(, Q = 6.6 8G, I7. `� - l_ i \d �E = 446 x c-G G P G 0_ R d G 4, -- - L l4t OC>t...t_ ty ►3 .z s — - - ----------- 4q, �� U suQSvic I t✓ :.N G� ►/�t`P :a i�,v __ ►,,v 3cx Jv� -- IUV I S .� tVY v e SC-YTS 0 T-N ry tc_ r u � sc ell r l i 4 WILLIA \�` �vD TtT L� NAB'nr VIA-I 7 �a + �.�!a.1 `-��"t;►T�'J t...�.tlJV SU12NL`{G�2� F=' r