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HomeMy WebLinkAbout0138 BRIDGE STREET - Health (2) 13 8 Bridge Street Osterville i A=093 - 030 1 oa S M E A No.2-153LGN UPC 12134 HASTINGS,MN 1J � 1 DO`'l, 2 0 0� 10 c 1,� � ? I bo h ��� `J'� tad, D 1 a 9 O G r A y i c c-4 No. - � S Ijvl,r� Fee THE COMMONWEALTH OF MASSACHUSETTS j E," j''VFomputer: sPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MA ACHr1STS Yes AppliLation for Misposal *pstrm Construction hermit r Application for a Permit to Construct(Pl' Repair( ) Upgrade(LYbandon(4t—IIT6omplete System ❑Individual Components Location Address or Lot No. / 3/, Owner's Name,Address,and Jel. o. leee Assessor's Map/Parcel O (d Q C. O v l,P Installer's Name,Address,and Te.No. Lft_5V vr_+3S Designer's Name,Address,and Tel.No. �.�o}c'li ,�•S kills InH• OzW6 I4'4'e?.4 04ru���f� C 500-�28—"�'3YY Type of Building: 6 Dwelling No.of Bedrooms G Lot Size 2 2, 300 sq.ft. Garbage Grinder( ) Other Type of Building ges,4A ,R No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 41 va gpd Design flow provided Y 71 gpd Plan Date 5-h0 4 2 Number of sheets ( Revision Date Titled Moot ®/wos-ej Size of Septic Tank 1500 Type of S.A.S. 5= i`KO'11 Z)rL'qCy Se f I Description of Soil O -�d " (�;�� , 3 -'l2�` Qc., l0YR 51 [Do f g y2 12 0 `` G 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 ealth. Date (� i Z) Application Approved by Date e J Application Disapproved by Date for the following reasons Permit No. .l .30 Date Issued ] it ,r' a�• F f, t?wk �•:: `a *a Qt J s 11 No. Fee r Entered in computer: -{ THE COMMO'N�IVE ►ITH.•OF MASSAC¢HU�SETTS ; PUBLIC HEALTH DIVISION 1TOWN^OF BeRNSTABLE, MASSACHUSTTS of tation for Mis�osar*pstryjm ConstrucJ{t�iJ{on 3permit y .'`. 11•jj^.RjjllSS7d ` Application for Permit to Construct(�) Repair( ) Upgrade(L,),-Abandon(L)_-�Complete System -❑Individual Components Location Address or Lot No. Own r s Name 1Address,ah Tel'No Assessor's Map/Parcel � E6 "r fl�r,;kInstaller's Name,Address,and Tef No. VC.�JS Desigrie'sflame,Address,and Tel.No. r , ��ix�tS.' � 7�C✓ Type of Building: o 'd ;.. Dwelling No.of Bedrooms / Lot Size 27, 360 :6q�ft, Garbage Grinder( ) Other T e of Buildin Qo t' o,a err yp g � -•�.n � �No.of Pe Sons, �`,:�" � g V., S owers( Cafeteria( ) Other Fixtures Design Flow(min.required) / IY VO 4 gpd Design flow provided 7 gpd Plan Date Gi��y/Z G 2 Number of sheets Revision Date Title C-( t�P6 17 6"i rx'J es 3 e,/ / T Size of Septic Tank l 500 (6�. Type of S.A.S. "5- Description of Soil P,,., /P kx 51K i a_ a( :, 7 1246 t Nature of Repairs or Alterations,(Answer when applicable) t , Date last inspected: >. Agreement: #' n� The undersigned agrees to ensure the construction,and maintenance of the afore described on-site sewage disposal systetn'in L ,;0 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 o ealth. ) Sighed s-- - Date Application Approved by Date Application Disapproved by Date for the following reasons 1 ,..,,A rt �• Permit No. r• Date Issued.4 �/1 / 1 �...r . a �� t - - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of CompliantP THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( G,,.)-- Repaired( ) Upgraded Abandoned( )by at ; 3 A 'k ,, o has been constructed in accordance a r4 with the provisions of Title c and the for Disposal System Construction Permit N�o .�/--'�� dated sa Installer Designer -5,//" #bedrooms r Approved design flow gpd The issuance of this pve/�it shall not be construed as a guarantee that the system wi�ft nctiinas designed. 4/Date /� 3.1 Inspector V kA - -- ------- -- - - - ---- --- No. / Fee THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS MIsposal *pstem Construction 3permit Permission is hereby granted to Construct O' Repair( ) Upgrade( ) Abandon( ) System located at ? and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special"conditions. Provided:Construction must be completed within three years of the date of this permit. Date �.J 1 '" APProved by� Town of Barnstable Regulatory Services Q; Richard V. Scali, Interim Director '. M saxxsrABM • . MASS. Public Health Division A'fo ° Thomas McKean, DirectorNa 200 Main Street,Hyannis,MA 02601 `. L? Office: 508-862-4644 Fax: 508-790-6304-' tt; Installer& Designer Certification Form 6/28/2021 Date: Sewage Permit# 2,0�l-Z3a Assessor's Map\Parcel 093/030 Designer: Sullivan Engineering&Consulting, Inc. Installer: Address: 711 Main Street/PO Box 659 Address: P6. hm Osterville, MA 02655 M8W0 5 InUS M. On Ls a 2 S�2� Corzr, was issued a permit to install a (date) (installer) 138 Bridge Street,Osterville septic system at' based on a design drawn by (address) Sullivan Engineering&Consulting, Inc. dated 5/10/2021 (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 const iance with the terms of the IAA approval letters (if applicable) o=� CHARLES T. �G ROWLAND o CIVIL ( r s ignature) No. 52699 FSS10NAl ' (Designer's Signature) (Affix Designer's Stamp 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 • &MMSTABUF. • 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 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. John O'Dea Sullivan Engineering 711 Main Street Osterville, MA 02655 0 �O REC.1,38 Bridge Street,:b, steiv 093''Jii6*,'. Dear Mr. O'Dea, You are granted variances on behalf of your client, Mark Curley, to construct an onsite sewage disposal system with a NitROE treatment unit incorporating advanced nitrogen reduction technology at 138 Bridge Street, Osterville, Massachusetts. The variances granted are as follows: 310 CMR 15.211:: To install a soil absorption system five (5) feet away from a property line, in lieu of the 10 feet minimum separation distance required. 310 CMR 15.212:: 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 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: 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 Q:\WPFILES\Odea 138 Bridge5treet0sterville Variances and NitROE Approval May 2021.docx +# 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 0&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-z/testsamp.pdfl (6) 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. 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. Sincerel , y� ohn Norman Chairman Q:\WPFILES\Odea 138 BridgeStreetOsterville Variances and NitROE Approval May 2021.docx S / DATE: $95.00 FEE*: Town of Barnstable >,Er.BY: i679 a1� — "`�` Board of Health SCHED.DATE: 200 Main Street,Hyannis MA 02601 Office: 508-8624644 John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D. F.P.(Thomas)Lcc,Alternate VARIANCE REQUEST FORM LOCATION Property Address: S� OST��V I I�LF Assessor's Map and Parcel Number:bQ3 - Size of Lot: 22��j Dy ��- -2F Wetlands Within 300 Ft. NeS Business Name: Subdivision Name: APPLICANT'S NAME: (y 1` y- CUt?L&q Phone Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: r e-y' G xl f:-j Name: �Ukkw^� ER \vie e Y cm o tu-�h Address: 13���12t�� 6E �� VS�L-�V lU Address:l��4�1►�1i�� �k, �"f- y1Lk(; Phone: Phone: EMAIL: Ghkkc\—7.5(UwV an(V\U t12 (f1Yh VARIANCE FROM REGULATION(tncixq.Code a) REASON FOR VARIANCE(May attach separate sh4t if more space needed) 6'Q r.+)NOWe -Z-(- 3\p r m t 15.Z\1 - S6T-t:b m IL 'Cb Un-` NATURE OF WORK: House Addition U House Renovation U Repair of Failed Septic System Checklist (to be completed by office stag-person receiving variance request application) P�e submit Jlrst four on list as 5 collated packets Five(5)copies of the completed variance request forth ✓B. Five(5)copies of MA DEP approval letters for Innovative/Altemative septic system(when proposing an I/A system or secondary treatment unit(S.T.U.). ✓C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: health( town.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 RS. Signed letter stating that the property or business owner authorized you to represent him/her for this request f 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*S95.00 for the following variances: 1)New construction, 2) Septic repairs wih 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"). F 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& INCORPORATING INOVATIVE ALTERNATIVE SYSTEM For Mark Curley 138 Bridge Street, OstexvMe MA Map 093 Parcel 030 The project site is located at 138 Bridge Street, Osterville abutting West Bay. The site is developed with a single-family dwelling, detached garage, accessory structure and working boat marina. The main house was renovated in 2016 under conservation permit SE3-5340 and the docks for die marina were reconstructed in 2017 under SE3-5443. The applicant is voluntarily asking die Board to approve the use of an I/A system on their property. They are aware of die benefits dais type of system can offer to groundwater protection and die water quality of die three bays. The applicant is requesting variances from; 310 CMR 15.212-Separation to die property line and 310 CMR 15.211 -Separation to ground water of 4'. The applicant is requesting from 310 CMR 15.212 for a proposed 5' setback to die property line. The proposed setback will allow die new I/A system to be placed outside die 100' buffer to die wetland and will yield less disturbance to die site. Also being requested, is a variance from 310 CMR 21J, die applicant is proposing a 4' depdi to groundwater. The applicant will not be adding a pump'cliainber and die approval of this variance will allow such action. The design of die septic system incorporates die NitROE innovative alternative septic system by John Smidi of K1eanTU to better reduce nitrogen of die effluent. KleanTu®LLC John R.Smith KleanTu Wastewater P.O.Box 1154 Treatment Edgartown,MA 02539 Technologies 412-719-5976-Mobile ® 508-627-3072-Office To: Mark Curley June 1,2021 138 Bridge Street Osterville,MA 02655 Chuck Roland Sullivan Engineering&Consulting,Inc. 711 Main Street P.O.Box 659 Osterville,MA 02655 RE: Installer Certification for New NitROE®2KS WWTS Enhanced Title 5 Septic System Installation for 138 Bridge Street,Osterville,MA 02655 To: Mark Curley and Chuck Roland: To comply with Item IV-#5 cited in Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.:X285590;Issued May 12,2020),this letter certifies that the New NitROE®2KS WWTS Enhanced Title 5 Septic System design for 138 Bridge Street will be installed with supervision and direction provided by KleanTu® personnel will be onsite to ensure that the NitROE Enhanced Title 5 Septic System is installed in a manner that conforms with KleanTu®'s design and operating requirements.This also acknowledges that the site owner will be contracting with a a Licensed Installer. Please contact me with any questions or comments regarding this certification. My cell#is 412-719-5976. Regards, John R.Smith President -1- 1 r Excerpt from the Board of Health Meeting Minutes on May 25, 2021 A. John O'Dea, Sullivan Engineering & Consulting, representing Mark Curley, owner— 138 Bridge Street, Osterville, Map/Parcel 093-030, 22,300 square feet parcel, repair of failed septic system, using a NitROE Innovative Alternative septic system requesting two variances. Chuck Rowland, Sullivan Engineering, presented plan with two variances, setback to property and 4 feet separation to ground water instead of five feet. The property owner had option to do a septic permit with a pump chamber but has opted for the the more expensive route to install the NitROE system as he believes it will be better for the water and environment. Property is right on the water. Tom Lee agreed it would be better for the environment. He stated the board has approved similar variances to groundwater for Innovative/Alternative (I/A) systems. Upon a motion duly made by Mr. Lee, seconded by Dr. Luczkow, the Board voted to approve the plan as presented. Roll Call: Tom Lee —Yes, Dr. Luczkow—Yes, Dr. Guadagnoli —Yes. (Unanimously, voted in favor.) KleanTu®LLC John R.Smith KleanTu Wastewater P.O.Box 1154 Treatment Technologies Edgartown,MA 02539 412-719-5976-Mobile ® 508-627-3072—Office ismith@kleantu.com To: Town of Barnstable Board of Health July 2,2021 200 Main Street Hyannis,MA 02601 RE: Certification for New NitROE®2K W WTS Enhanced Title 5 Septic System Installation for 138 Bridge Street,Osterville,MA 02655 Dear Members of the Board: Kindly refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.: X285590;Issued May 12,2020)(the"DEP Permit");and(ii)the Enhanced Title 5 Septic System installed for a private residence(the"New System"),featuring the use of a new NitROE®2KS wastewater treatment system(the "NitROE®2KS Components"). Item IV-#6d of the DEP Permit requires that,to obtain a Certificate of Compliance from the Approving Authority, "an authorized agent of the Company"(i.e.,KleanTu®LLC)"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." To meet this requirement,KleanTu®LLC hereby certifies that trained KleanTu®personnel were onsite and supervised the installation of the NitROEI 2KS Components. Also,KleanTu®personnel performed some of the key installation activities to ensure that the NitROE®2KS Components are now installed in a manner that conforms with KleanTu®LLC's design and operating requirements. Please contact me with any questions or comments regarding this certification. Sincerely yours, 1 John R. Smith President -1- KleanTu® LLC John R.Smith Treatment ter KleanTu t P.O. Box 1154 Trea =P Technologies Edgartown,MA 02539 O 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80030-040-2106 for 138 Bridge Street,pg. 1/5 To:North Bay Realty Trust(Site Owner) June 24,2021 Mark Curley—Trustee 138 Bridge Street Osterville,MA 02655 RE: NitROE®2K WWTS Start-Up and Operation&Maintenance(O&M)for 138 Bridge Street,Osterville,MA; KleanTu Job No.: 80030-040 Dear Mark: KleanTu®LLC is pleased to submit this"Contract"to provide Start-Up and Operation&Maintenance(O&M) services for the first year of your newly installed NitROE®2K Waste-Water Treatment System(WWTS) at 138 Bridge Street, located in the Town of Osterville,MA. The main purpose of the NitROE®2K WWTS is to enhance your Title 5 Septic System for the purpose of significantly reducing total nitrogen(TN)from the sanitary wastewater flow. In addition to significant TN reduction,the NitROE"enhanced Title 5 septic system will also produce a highly treated effluent low in organic carbon constituents (measured as BODs)and low in total suspended solids(TSS)levels. Please note that entering into a yearly O&M contract is a requirement of K1eanTu's Mass DEP Provisional Permit (DEP Transmittal No.: X285590;issued May 12,2020). As this is the first year of operation,start-up services are also provided. As cited in Section IV-4 of the Provisional Permit,yearly O&M contracts must be in place to ensure proper operation and consistent treatment performance. In this regard,this contract also provides budgetary price estimates for subsequent years of 0&M. CONTRACT DETAILS AND PRICE PROJECTIONS Regarding start-up and O&M services,Table 1 provides a yearly breakdown of scheduled deliverables and associated prices. The contract price for 12 months in the 2021/2022-time frame is fixed and reflects requirements cited in the Mass DEP Provisional Permit. All O&M activities,including monitoring and sample collection,will be performed,or directly supervised by a System Operator that has been certified at a minimum Grade Level IV by the Board of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. Specific to this Contract,the System Operator will be John R. Smith, Certificate No.: 1914. Electronic copies of the Provisional Permit and the NitROE®2K WWTS O&M Manual are provided along with this contract proposal. -1- KleanTu® LLC John R.Smith KleanTu P.O. Box 1154 Edgartown, MA 02539 412-719-5976-Mobile " 0 508-627-3072-Office CONTRACT No. 80030-040-2106 for 138 Bridge Street,pg.2/5 The contract prices for subsequent years 2022 and beyond are estimates at present,with the higher amounts reflecting continuation of quarterly inspections and sampling, or being allowed to do less frequent inspections and sampling by the Mass DEP and the Barnstable Board of Health(BoH). Table 1. Scheduled (Routine)Yearly O&M Deliverables and Pricing for New NitROE®2KS WWTS for 138 Bridge Street Time Price per Period Period Deliverables ($) July 2021 thru . Start-Up including bacterial seeding and monitoring at least once every $1,300 June 2022 2 weeks during the I"8-weeks of operation to ensure that NitROEO 2K ($600 for site (12 months) WWTS is properly functioning. inspection/sampling • Provide and Review an O&M Manual to homeowner and address any visits and$700 for and all related questions. Mass DEP certified • Quarterly Sample Collection and Analyses per Mass DEP Provisional lab analyses) Permit. • Respond to Homeowner issues,concerns and questions. • Quarterly Inspection and Monitoring Updates to Homeowner. (NOTE: All NitROE®WWTS Components Covered Under Warranty) July 2022 thru . Quarterly Inspection and Sample Collection per Mass DEP Provisional $600-$1,250 June 2023 Permit Issued or Yearly Inspection per General Permit,once issued. (Projected Range (12 months) • Covers Maximum of 4 site calls per year. with New Contract • Yearly Update to Homeowners. to be Executed) (NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) January 2023 . Quarterly Inspection and Sample Collection per Mass DEP Provisional $600-$1,250 thru Permit Issued or Yearly Inspection per General Permit to be issued. (Projected Range December • Covers Maximum of 4 site calls per year. with New Contract 2023 • Yearly Update to Homeowners. to be Executed) (NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) January 2024 . Yearly Inspection and Sample Collection per Mass DEP General $450-$650 On Permit. (Extended Yearly • Covers Maximum of 3 site calls per year. Contract to be • Yearly Update to Homeowners. Executed) (NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) -2- f KleanTu® LLC John R.Smith KLeanTU P.O. Box 1154 Edgartown,MA 02539 412-719-5976-Mobile 0 508-627-3072-Office CONTRACT No. 80030-040-2106 for 138 Bridte Street,ng.3/5 As the NitROE82K WWTS moves through the Mass DEP permitting process from Provisional Permit Use to General Permit Use,Table 1 reflects that the associated price for yearly O&M significantly decreases. This 0&M price reduction is primarily due to the fact that the Mass DEP requirements for inspections and sampling and analyses move from quarterly(under the Provisional Permit)to yearly under a General Use Permit. At this time, it is not known if a General Use Permit will be issued in year 2022 or 2023 as that decision rests with the Mass DEP. It is also cited in Table 1 that this 1S`year contract, once executed,runs through June of 2022 during the Provisional Permit phase. As the NitROE®2KM WWTS operation then moves into 2022, a new contract will need to be executed with each renewal for a minimum 1-year period. In addition to the pricing of scheduled O&M activities cited in Table 1,Table 2 provides non-scheduled and non-routine O&M activities and associated price estimates,with anticipated timeframes as to when such O&M activity may be needed and thus the cost incurred. While KleanTu has designed and utilized equipment to provide low maintenance operation and treatment,Table 2 is provided so the system owner has some sort of idea what costs may be incurred in future years associated with non-routine O&M activities. The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the continuous operation of one(1) 120-watt air pump required to enhance and maintain the appropriate level of biological processes required. -3- KleanTu® LLC John R.Smith C P.O. Box 1154 Edgartown, MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80030-040-2106 for 138 Bridge Street,pg.4/5 Table 2. Non-Routine O&M Items and Price Estimates for New NitROE®2KS WWTS for 138 Bridge Street Item Description Price Estimate Air Pump . One(1) 120 W air pump. $210 Electrical Usage . Total daily electrical usage measured at—2.9 kWhr/day/pump. per Year • Cost/day at$0.20/kWhr x 2.9 kWhr/day=$0.58/day. Non-routine . After 12-month warranty period,troubleshooting site calls(more than $120 Troubleshooting 4/year)will be charged at$120/hr with 1 hour minimum. per Hour Visits Septic Tank . KleanTu will determine when this is needed based on scheduled site $600 (EST)Pump visits. (for EST Septic Out . Pump out to be done by non-KleanTu contractor with estimated price= Tank Pumped $600/EST tank. Out Every • Exact time period is site-specific with estimate of every 3-5 years. 3-5 Years) (NOTE: This pump out cost would need to be done even if this was a conventional Title 5 septic system) Replace Remote . Replacing remote sensing unit and probes=$360. $360 Sensing Probes . Exact time period is variable with estimate of every 8-10 years. (Every and Unit (NOTE: For remote sensing operation,Wi-Fi connection from homeowner 8-10 Years) is needed) Replace Air . Air pump repair and/or replacement. $500 Pump . Exact time period range is variable with estimate of every 7-8 years. (Every 7-8 Years) Replace . Replace all air tubing=$800. $800 Aeration . Exact time period is variable with estimate of every 10-20 years. (Every Tubing 10-20 Years) Replace Wood . Replace all wood chips=$1,000. $1,000 Chips . Exact time period is variable with estimate of every 20-30 years. (Every 20-30 Years) Replace . Limestone Addition=$1,600. $1,600 Limestone . Exact time period is variable with estimate of every 20-30 years. (Every 20-30 Years) -4- KleanTu® LLC John R.Smith KLeanTu P.O. Box 1154 Edgartown, MA 02539 412-719-5976-Mobile 0 508-627-3072-Office CONTRACT No. 80030-040-2106 for 138 Bridge Street,pg. 5/5 PAYMENT TERMS For the 2021-2022 period price of$1,300,$650 (50%)needs to be paid upon signature execution of this contract. The remaining amount of$650 will be invoiced in January 2022. Contracts executed for subsequent yearly time periods will need to be signed by June 30 of the respective contract time period and will have similar payment terms as cited above. CONTRACT ACCEPTANCE To execute this contract, and comply with Mass DEP Provisional Permit Requirements,please sign below to acknowledge acceptance of this proposal and mail original with your signature, or e-mail pdf copy of this page with your signature,back to me. Please contact me with any questions or comments. My cell#is 412-719-5976. Thank you, 2L IFLWZ�l� John R Smith(Jun 24,202111:46 EDT) John R. Smith President SYSTEM OWNER SIGNATURE Name: Mark Curley Signature: Mark Curley(Jun 24,202 11:45 EDT) -5- NitROE 2KS OM Contract for 133 Bridge St Osterville MA 210624 R2 Final Audit Report 2021-06-24 Created: 2021-06-24 By: Marianne Weber(mweber@kleantu.com) Status: Signed Transaction ID: CBJCHBCAABAA43kdMW8jbMgUR372aH_Iz7rnkpD[Qivm "NitROE 2KS OM Contract for 138 Bridge St Osterville MA 2106 24 R2" History Document created by Marianne Weber(mweber@kleantu.com) 2021-06-24-2:00:20 PM GMT-IP address:73.79.52.31 'tee Document emailed to Mark Curley(markcurley@kmave.com)for signature 2021-06-24-2:01:01 PM GMT 6'® Document e-signed by Mark Curley(markcurley@kmave.com) Signature Date:2021-06-24-3:45:25 PM GMT-Time Source:server-IP address:24.63.246.215 Document emailed to John R Smith Qsmith@kleantu.com)for signature 2021-06-24-3:45:27 PM GMT Email viewed by John R Smith Osmith@kleantu.com) 2021-06-24-3:45:57 PM GMT-IP address:73.100.231.74 &S® Document e-signed by John R Smith Qsmith@kleantu.com) Signature Date:2021-06-24-3:46:29 PM GMT-Time Source:server-IP address:73.100.231.74 (a Agreement completed. 2021-06-24-3:46:29 PM GMT Adobe Sign KleanTu® LLC John R.Smith KleanTu Wastewater P.O.Box 1154 Treatment Technologies Edgartown,MA 02539 412-719-5976-Mobile ® 508-627-3072-Office To: Town of Barnstable Board of Health June 1,2021 200 Main Street Hyannis,MA 02601 RE: Homeowner Certification for New NitROEO 2KS WWTS Enhanced Title 5 Septic System Installation for 138 Bridge Street, Osterville,MA 02655 To Whom 1t May Concern: To comply with Item IV-#1 cited in Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.: X285590;Issued May 12,2020),this letter certifies that the Site Trustee for 138 Bridge Street,Mark Curley, has been made aware and agrees(per his signature'below)with the following: l. Has been provided a copy of the Provisional Use Approv 1 and ag' complyees towith all terms and conditions cited herein. 2. Has been informed of all homeowner's costs associated with operation&maintenance O& activities a ( � and associated costs with the operation of the New NitROVI 2KS WWTS Enhanced Title 5 Septic System to be installed,'including power consumption,maintenance,sampling,recordkeeping,reporting, and equipment replacement. 3. Understands the requirements for a O&M contract to be in place with K1eanTut or with their designated and trained entity,and that the NitROE®2KS WWTS op rator must be licensed by the Mass DEP as stipulated in KleanTu®'s Provisional Permit. 4. To fulfill his responsibilities to provide a Deed Notice as equired by 310 CMR 15.287 10 and the Approval by the Town of Barnstable BoH. 5. To fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5): Please contact me with any questions or comments regarding this certification. My cell#is 412-719-5976. Thank you, John R. Smith President SYSTEM OWNER SIGNATURE 1 Name: Kc r K C 1 Affiliation/Title:-j�.�,�1 ens-l�oPlh AAV A-,Q#.v Tyr-7� Signature: d-- - Date: 1 1 o 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"), NitROEO 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 terns and conditions herein. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. k' 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 1-600-439-2370 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; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15 Technology:NitROE®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 Ih 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 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 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. I 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). It 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 K1eanTu NitROE 2K Provisional Approval,May 2020 Page 7 of 15 Technology:NitROE®2KS&2KM WWTS 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. i 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 h t1,2:11www.mass..eov/eea/docs/dep/water/laws/i-thru-z/testsamp.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 b a General Use p PP P Y 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:NitROE®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 t(p://www.mass.-aov/eea/docs/dep/water/laws/i-thru-z/testsam o.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..eovleealdocsldeplwater/laws/i-thru-z/tesisamp.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:NitROE®2KS&2KM WWTS 2. Prior to submission of an application for a DSCP, the Company shall provide to the Designer and the System Owner: 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 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 u 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. REQUIREMENTS AND NOTIFICATION RE IV. CERTIFICATION Q 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 b the unit,stating that the roe owner: P P Y Y g property 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:NitROEO 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 PP 1� 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. 4 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 Dg artment 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. Vl. 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. 5. The owner or operator shall provide written notice to any new owner or 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 r vide obtain and o 6. The owner or operator, or the proponent of the alternative system, shallo p 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. Bk 34173 Pg106 #37519 06-02-2021 @ 01: 04p Notice of Alternative Sewage Disposal System M.G.L. c. 21A, .§ 13 and 310 CMR 15.0287(10) jThis Notice to be recorded and/or filed for registration in the chain of title of the Property served by an Alternative sewage Disposal System-("Alternative System").] NAME(S) OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: _North Bay Realty Trust II: Mark Curley-Trustee ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: 138 Bridge Street, Osterville, MA 02655 TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and complete each that applies]: Deed recorded with the Ar-4tAg k Registry or Deeds in Book Ry OS� ,Page Certificate of Title No. I issued by the Land Registration Office of the Registry District Source of title other than by deed [If Alternative System Owner(s)is other than Property Owner(s),complete the following:] Alternative System Owner Name: Alternative System Owner Address: WHEREAS, Section 15.280 of Title 5 of the State Environmental Code ("Approval of Alternative Systems"),provides for the Massachusetts Department of Environmental Protection(the "Department")to approve or certify, as appropriate, all proposals to construct, upgrade or replace on-site sewage disposal systems using alternative systems; WHEREAS, owners and/or operators of approved or certified alternative systems are subject to general conditions, as specified in Section 15.287 of Title 5 of the State Environmental Code, 310.CMR 15.287, and may be subject to special conditions, as specified in the Department's approvals or certifications; such general and special conditions potentially including, without limitation,requirements relating to the use of trained operators,periodic inspections,maintenance, sampling, reporting and/or recordkeeping; WHEREAS, Section 15.287(10)of Title 5 of the State Environmental Code, 310 CMR 15.287(10), requires that"prior to obtaining a Certificate of Compliance for installation of anew 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 and/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 [J" and WHEREAS, the Property is served by an alternative sewage disposal system. NOW, THEREFORE, Notice of an alternative sewage disposal system is hereby given for the above-referenced Property, as follows: 1. Existence. An alternative system has been installed as a new or upgraded alternative sewage disposal system, on or adjacent to the Property, and serves the Properly. The trade name and model number(s) of the alternative system are as follows: Trade name of technology: NitROE®Waste-Water Treatment System Manufacturer Name: KleanTu®LLC Model number(s): NitROE®2KS WWTS Page 1 of 2 Bk 34173 Pg107 #37519 2. Approval/Certification. On May 112020 [date], the Department, pursuant to its authority wider the section of Title 5 as specified below, approved or certified the technology used in the above- referenced alternative system, under MassDEP Transmittal Number: X285590 [Transmittal Number of approval or certit cation]. [Check one of the following,as applicable:] Approved for remedial use under 310 CMR 15.284 Approved for piloting wider 310 CMR 15.285 X Provisionally approved under 310 CMR 15.286 Certified for general use under 310 CMR 15.288 A copy of the Department's Approval/Certification is available from the Department in person or on- line at the Department's website: littp://www.mass, og v/dep, . WITNESS the execution hereof under seal this L�" day of ru. u i�- , 20 g.l ,made by the above-named Alternative System Owner(s). VA ---- C [Alternative System Owners Print Name(s):hmK C COMMONWEALTH OF MASSACHUSETTS Barnstable , ss � a On this 2nd day of June , 20_, before me,the undersigned notary public,pa31i' :xp�,.�S+'�+ appeared Mark C. Curley {name of document signer),proved to me through s i .4 ?p �0a� r evidence of identification, which were_no to me , to be the person whistw wn p signed on the preceding or attached document, and n wledged to tha ) N* sinek it ' r ' voluntarily for its stated purpose. s, oo•�bTAAv pVO�\C;.JaIy N, zvz� (official signs. dseal notary) h1he ------------------------------------------------------------------------------------------------------------------------------------ [Complete the following Property Owner(s)Consent if Alternative System Owners)is other than the Property Owner(s):] CONSENTED TO: [Property Owner(s)] Print Name(s): Date: COMMONWEALTH OF MASSACHUSETTS ss On this day of , 20-,before me, the undersigned notary public,personally appeared (name of document signer),proved to me through satisfactory evidence of identification,which were , to be the person whose name is signed on the preceding or attached document, and acknowledged to me that(he) (she) signed it voluntarily for its stated purpose. (official signature and seal of notary) Upon recording, return to: [Name and address of Property Owner(s)] Page 2 of 2 JOHN F. MEADE, REGISTER BARNSTABLE COUNTY REGISTRY OF DEEDS RF.r W..TZrwn L Rfi:r`(pnw.n F.T.F.f!TR0NT(!LT.T.V KleanTu®LLC John R.Smith KleanTu Wastewater P.O.Box 1154 Treatment Edgartown,MA 02539 Technologies 412-719-5976-Mobile ® 508-627-3072-Office To: Town of Barnstable Board of Health June 1,2021 200 Main Street Hyannis,MA 02601 RE: Designer Certification for New NitROE®2KS WWTS Enhanced Title 5 Septic System Installation for 138 Bridge Street,Osterville,MA 02655 To Whom It May Concern: To comply with Item IV-#2 cited in Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.:X285590• Issued May 12 2020),this letter certifies that the New NitROE®2KS WWTS Enhanced Title 5 Septic System design for 138 Bridge Street conforms with the Provisional Approval and that the system is consistent with the NitROE®2KS WWTS capabilities. Furthermore,the system was designed by Chuck Roland of Sullivan Engineering&Consulting,Inc.who is a Massachusetts Registered Professional Engineer,License#52699. Please contact me with any questions or comments regarding this certification. My cell#is 412-719-5976. Thank you, John R.Smith President cc: Chuck Roland,Sullivan Engineering&Consulting,Inc. Mark Curley,Site Trustee -1- TKT Town of Barnstable Inspectional Services Department aAMMAB - �f Public Health Division a Nu► 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7021 0350 0000 1549 3662 May 6, 2021 CURLEY, MARK C TR 138 BRIDGE STREET OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 138 Bridge Street, Osterville,MA was inspected on 04/20/2021 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails"under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER OW, OF THE BOARD OF HEALTH '` J Th�as�cKean, S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\l38 Bridge Street Osterville.doc I i f 111E TQ� Town of Barnstable BL n t �"�A� Inspectional Services Department ►639• V0 639, 6 Public Health Division 200 Main Street, I-lyannis MA 02601 l'humas A McKean,010 ()ttice 508-862-4644 FAX 508-790-6304 Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town(Town Code §360-44 and Title V: 310 C MR An ' x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground i Yum in€ more than 4 times during the last year not due to clogged or obstructed ❑ p pi e. ackup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE I YEAR DEADLINE CRITERIA [I Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cessp e SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of th ❑ A portion of the cesspool is located within a Zone i to a public well portion of the cesspool is located within 50 feet of a private water supply well ❑ A with analysis. (This system passes if the water analysis no acceptable water q indicates the well is free front pollution). TWO f 2 YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation ofa driveway due to II-10 components, etc) ❑ I,eachin facility with standing. liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline:_ -- ---- —_-- 0.\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS doc Commonwealth of Massachusetts p�3— 030 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Bridge St Property Address 3 Curley ;. Owner information is Owners Name required for every Osterville MA 02655 4/20/21 page. Cityrrown 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. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 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 4OIA5�r 4/20/21 Inspe ignature 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 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. •t;, 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. Cityrrown 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: 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 r Commonwealth of Massachusetts �. rp Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owners Name required for every Osterville MA 02655 4/20/21 page. City/Town 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 �. (e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Bridge St 'u 9 Property Address Curley Owner Owner's Name information is required for every Osterville MA 02655 4/20/21 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: Y pP Y 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 ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4. 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. City/Town 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 1/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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 El ® 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 f ❑ ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. City/Town 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts ,? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: No engineered plan on file, 1982 permit but the number of bedrooms not filled out Number of current residents: 5 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 75 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �o ,e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial 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 4/15/21 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Backup into home t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 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: 1982 per BOH record` Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): 2 lines from home to tank i Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts li� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-20 tank appears to be structurally sound, steel cover at the inlet, charged soils at the inlet and outlet covers If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >12" � Scum thickness trace �2 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection 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 .� 138 Bridge St Property Address Curley Owner Owner's Name information is required for every Osteryille MA 02655 4/20/21 page. Citylfown 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 r Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 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 0" 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.): H-10 D-box is in the driveway, it is heavily mucked due to backup at the SAS t5ins .doe-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 0 8 P P 9 P Y 9 f1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. Citylrown 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: 2 ❑ 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 �. Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Bridge'St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 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.): Flo chambers per BOH record, they were video inspected and are backed up at this time 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 138 Bridge St Property Address Curley Owner information is Owner's Name - required for every Osterville MA 02655 4/20/21 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 ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. City(rown 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 i c�-6 3a qa6 C_ C- LA Ll t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 • ,.� Commonwealth of Massachusetts �. (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20121 page. City/Town 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: 8'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: 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: TOPO mapping shows the site at 8'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Bridge St Property Address Curley Owner information is Owner's Name required for every Osterville MA 02655 4/20/21 page. City/Town 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 TOWN OF BARNSTABLE LOCATION / ����( � SEWAGE# 7/1 O> VILLAGE � ra l6 ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. '��� SEPTIC TANK CAPACITY 1- 8 V �0 LEACHING FACILITY.(type) (size) NO.OF BEDROOMS / . iv Q V -�e Z11 /re— V, OWNER �. a c dt c�c fiiln oAn i PERMIT DATE: COMPLIANCE DATE: 11247N 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 r� LC)7- r .,t Z No. lVJ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L.Z Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for MIsposal *p9tem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(/Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i39 i l'. y L_ &,rrVf,-r- Owner's Name,Address,and Tel.No. rver<. D`.> Assessor's Map/Parcel 00 •— p 3 Installer's Name,Address,and Tel.No. e L�t`t�tir�c a Designer's Name,Address,and Tel.No. h%%,r7r C n• 50 V `L Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ,r— Nature of Repairs or Alterations(Answer when applicable) -L/`S��\� NCB S 4k,15 Abe-'^� 1���►�.ci^e l� �e �1�� g,�i�-9 SC-p�� ��n C� Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainten f the afore described on-site sewage disposal system in accordance with the provisions of TjBoa the Environmental and not to place the system in operation until a Certificate of Compliance has been issued by thisf e k Signe Date tp o(p i. Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ( Date Issued /0 leg —_/; No. X(Y/ , -; Fees-� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH. DIVISION -*TOWN OF BARNSTABLE, MASSACHUSETTS44 es applicatlo'n for �DIsposal &pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade(/Abandon( ) ❑Complete System ❑Individual Components t_ ', r* " rS�L} Tel;No f }4 Location omS ot �rLotNo.� Owner's Name,t� y 'Address,and Tel�����5 Assessor's Map/Parcel Installer's Name'Address'and Tel No. r L" `' i��,+ Designeri >s Name, Address,-and Tel.No. a , ' � �fX 0 � � ��fA�+m,,t;••'iy, fi �, "C+� d} "'A 6,ao ' Type of Building: _ / Dwelling No.of Bedrooms Lot Size lie I �,/j sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) *f'F gpd Design flow provided 3 gpd Plan Date Number of sheets Revision Date ` Title 1 Size of Septic Tank '��( r, , Type of S.A.S. ") Z ` $c"tit 1 i�,•`:� F,4/ti l 4.! t Description of Soil ,5 �',; „ "# �.�• i' Nature of Repairs or Alterations Answer when applicable) �-+4� r `C� � NL'�w RI G�S��^ � ���:�� ��""�en► rC A�s Date last inspected: C.Q Agreement: The undersigned agrees to ensure the construction and maintenance-of the afore described on-site sewage disposal system in t accordance with the provisions of Title 5 0 the Environmental Cad and not to place the system in operation until a Certificate of l , Compliance has been issued by this Boa of ea h' � Signe , ' Date 1. Application Approved by Date i Application Disapproved by d Date for the following reasons Permit No. lol 3 Date Issued {/ ` - - - . ------------------ ------------------------------------------------------------------------ ----------------------------- �� I TH E COMMONWEALTH OF MASSACHUSETTS t h ,, I ,,.A e T;) BARNSTABLE,MASSACHUSETTS Certificate of Compliance ' / THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( !� Abandoned( )by t �: � q; + 't�,' t.r r / at F r e- Avle has been cons ucted in accordance with the p isions of Ti, 5 and the for Disposal System Construction Permit No. U (�' ��ddated XInstalle' _ ' Designer ' #bedrolms A ' 4- Approved desiCh'flow N gpd U c , The issuance of thins permit shall not be construed as a guarantee that the system will tfunctio�n/as design,l Date ; I I b InspectorU No. �() l-- 31116 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pste Construction permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 3ee I jr ',� C {-�'��/� t�� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. LG Date t' f Approved by r� L>A_O- � AsBuilt Page 1 of 1 'T&W OFRARNSTARLE . F tacanU>ti j�_I�tlr�f S7'._. slwtcra :. 6 ' c VILLAGE V Q � .. I. „ASSLSSOR'3MN'&PARCEL_ OR:?�U.Z ` I R+S1inLl ER 5N�h5B&PFI0NF N0: y"...:W.��..rv�:ir: 'Y .• SfPITCLtNK GAI'ACRY h00-�p a�, '-' I,riACHllrCi FSCffd9YiRypo) "�' (sit) .. 1 Na.OF 13EDk00MS �' '7. -�1 QW,7�L' oe PERMU DATE .�p.16/�E COIMF LANCt Mrl_j 7 f .•---: Seliarzi,a�Ducancr&etv.een du: . Msslnivai,4dF�:edtaouoifxet lnAe tn./pe;Eltraa o�1lctuf:y2 d�'Y. :.___:__.�..:Fete. PmyleK`scr5;•ryly-Will and t.ezrl�.gFxilny 0:ngvells ixixlpn siiea th..?00 twia( nhog f"Ity) Y , ' L'dge otWela�A wdLaxtinRP I.ly(Ilany welk��ds'i;t e:i0u5. .. - 300 fiat llmrhing f.1',Y) FUPOSHCD13Y_,.,. n I: h•v9 0�r1.,P v�.J a✓i�.�i� r12(VI� ..I: ,S 1sr'J I of) 0.>� 1 http://issgl2/intranet/propdata/prebuilt.aspx?mappar-093030&seq=2 10/23/201.7 Y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION _ . TITLE 5 a r: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FOR1r ' PART A CERTIFICATION Property Address: 138 Bridge Street Osterville, MA 02655 Owner's Name: Patricia McNeil Owner's Address: �7: �,-/G Date of Inspection: October 3, 2005 Name of Inspector: (Please Print) James M.Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 .Telephone Number: ,(508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F her Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: October 5. 2005 The system inspector shall sub 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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 138 Bridge Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3. 2005 Inspection Summary: Check A,B,C,D or E'/ALWAYS complete all of Section D A. 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: B. 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1.38 Bridge Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. 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: Cesspool or privy is within 50 feet of a surface water . Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 r Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 138 Bridge Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3. 2005 D. System Failure Criteria applicable to all systems: You must indicate either"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 ✓ 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 the 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)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. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section.E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 138 Bridge Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: 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: Yes No ✓ _ 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(3)(b)]. 5 l Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 138 Bridge Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3, 2005 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2004-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 1126183-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 138 Bridize Street Osterville, kM Owner: Patricia McNeil Date of Inspection: October 3, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 8" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. (H-20) Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: /" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measurintr stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were,present. The liquid level was even with the outlet invert. There did not appear to be anLsignns_of leakage. A steel cover was to grade. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 138 Bridge Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3. 2005 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches;etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 138 Brid{ze Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 2 flow diffusors w/4'stone (per as built card) leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Inn ovative,'alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): A video cmnera was used to inspect the flow diffusors since they were under an asphalt driveway. There did not appear to be any signs of failure. CESSPOOLS: None (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 or no): Commments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 138&idve Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. A Q . n00� v Srul I a 3 a /( 13 y 0 0 a-7 3a'0 10 ' r Page 11 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 138 Bridge Street Osterville, MA Owner: Patricia McNeil Date of Inspection: October 3, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 10+/- feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours naps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the snaps were showing approximately 10'+/-to ground water at this site. The system was within 300'of a tidal bay and therefore no high groundwater adjustment was taken. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,.relating to the system, the inspection andlor this report. i II NAUTICUS MARINA, INC. 339 WEST BAY ROAD OSTERVE=, MA 02655 (508) 420-1960 4 . .n 4� December 18, 2015 Town of Barnstable Regulatory Services Public Health Division 200 Main Street Hyannis, MA 02601 RE: 138 Bridge Street, Osterville,MA Parcel ID: 093-030 To Whom It May Concern: Please be advised that this property is no longer owned by Nauticus Marina, Inc. Kindly update your records accordingly. Thank you for your assistance with regard to this request. Sincerely, Mark C. Curley MCC:jps BAXTER, & NYE, INC. Registered Land Surveyors 32 Wianno Avenue/ Osterville,Massachusetts 02655/ Tel. (617) 428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President January 26 , 1983 Walter Lewis Parker Road Osterville, MA 02655 RE: MAP 93 PCL 30 Dear Walter: This letter will certify- that on Friday January 14, I met you at the subject parcel to observe a new septic system.. The new system was on the easterly side of an existing dwelling and consisted of a septic tank, distribution box and two flow diffussors with 4 feet .of stone all around. Should you have any questions concerning this do not hes- itate to contact our office at any time. ery truly ours, Richard A. Baxter, R.L.S. R.AR/bC r' MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS (� TOWN OFBARNS TABLE LOCATION 1 3 ac/ f�'�t�e'iC ST SEWAGE # ASSESSOR'S MAP &LOT O93' 03o INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) o;L t-(ow I,\�i Msxy (size) d/ STOeuL NO*OF BEDROOMS BUILDER OR OWNER PERMUDATE: COMPLIANCE DATE: 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 leach facility) Feet Furnished by /1 a ing"2n GA/A c, IC 7A�ron'r n Q 4 0o� t 13 a 3 tG 9c� I� 6 y a3 3� al 30� LOCATION SEWAGE PERMIT NO. VILLAGE A - 093 030 INSTALLER'S / N A4A E i ADDRESS GUILDER OR OWNER DATE PERMIT ISSUED Z_ DAT E COMPIi,-ANCE ISSUED W. foe Ql c5e- 7,—., �a S�P TH B­O ^OONWEALTH�OFUASSA;HTS'—E,TTS 0so /""p IZ 1— i-1 L� , f� ...OF.. . ............................. ................................... ApplirFaiion for Uhip sal Works Tonstrnrtiun famit Application is hereby made for a Permit to Construct ( ) or Repa' ) an Individual Sewage Disposal System at: .�:.......� .... ._.... , _ ... Loc ddres or Lot No. -_-- s .f .... .. .. ..... ........ ........ ...................................................... r CJ `5 A �ssIle Installer Address jQ Type of Building Size Lot............................Sq. feet 1 a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - - ----------------=------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length-----------_--- Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.............._..... Total leaching area....................sq. ft. Seepage Pit No-----_------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil......................................................................................................................................................................... x U --•------------•---•---•--•-----------------------------------•---•-------•--•---•------•----------•-....------•-------•-------------•-----------------••-•------•---•...-••-----...-------•----..... --------------------------------------------------------------------- ------------------------------------------- ----------- _�; --- --- -•••------ U Nature of Repairs or Alterations—Answer when applicable.___L�1_���!'�g____-.-__R.tkC__1�A!. ...��5� :_. • -- . -••-•----- ---- - --- --tf --------------- ------ Agreement:d%!%��J� ? �� 4' The un erslgne agrees t costa 1 the afor es ribed Individual Sewage Disposal System in accordance with the provisions of TITI!Z- 1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee"u �, th oard iealth., f �— igne . --- ... ......... _Y...------.----- -- ...... �--•- A Application Approved B ---------• .... «` ....Z— .......----- PP PP Y----•-`-�--- --- Date Application Disapproved f o th following reasons-----------------------------------•-----•---•---------•-•---•----•-----•---•-----------•-•-•--•-------•-•••---- ....----••---------------------------------------------------------------------------------------------•-•----•--•----•-•-•-----•--------...----••------••------•------------------------------......... Date PermitNo.......................................................... Issue<1•....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M ACL DATA No.&..-L1..... Fm3.................J...... THE COMMONWEALTH OF MASSACHUSETTS BOARD--OF HEALTH - 1 .............OF... 1... f1 .- ............. . , pphra Lion for Dispvii al Works Tonfitrudion rami# Application is hereby made for a Permit to Construct ( ) or Repair/(1 ') an Individual Sewage Disposal System at: ?- ••G�;t Cs . ...�� .............. ......................................................`; ,1 Location 6A'ddress or Lot No. ••••.•• 1�n--. (ilk ._ i / Owner rAddress ....1 f _.. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- --- W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 1:4 Septic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit............:....... Depth to ground water........................ -•-•---•---•-----•••-••----•--._...-•••••-•---•----•-•---..._.....•-•--••..................•--•••-------------••••-•--••••--•----------•.....--•---....---- 0 Description of Soil.......................................................................................................................................................................... x U -•--••••----•-•--•••-•--••-----•-••••-•----••••-•._.......---•••-•----•------------•-•-----•-•--••----•-•----•-•--•----•-----•••----••••-----•-•---••--•••••••--••••---•.........................••---•- W -------------------------- --------------...................................................................................................................................:-•••-•-•••-•.....---...•_•. U Nature of Repairs or Alterations—Answer when applicable_.__! __..`� f !v' r/ `- 1_l ..�...... :!l'_."i._.. N �^ ..............:i.............__._____._..___.__ ___._.__.�_...__ ...........................................•._............................._................................................_......_........._•..............................._.._...._.._......_....._. J AgreThenundersigned agrees to/'/install the aforedesribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. r ....................... f f Date Application Approved By............. �r ' >- !.`_. !!_7//"Z' . . ..............- -------------- - Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------------•--- ---•---------•----••-•••••••.......................•••--•••---------•-•----------•....---••--••----•----............••-••-----•------••••----••-•--••-•-•--•---•-••-•----••-----•------•................ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH .............................................................................. Turrtif iratr of Tantlrlitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by........._........................ --............................................................................................................................................................. f / —Installer ----...--•--•-•.. ............................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..4z........�.`................... dated...._?-_------_ ..................... - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WI FUNCTION SATISFACTORY. DATE..../•--•ke1,,V2.--------••-•----------•----------------•--.....•.. Inspector..•-- ......................................_-.................................. THE COMMONWEALTH OF MASSACHUSETTS �. BOARD OF HEALTH �...... .:1:.'?...............OF....... t.6!:..:,:.t.. r+._j•'.l.'.._......... ............_............ No......................... FEE........................ Disposal Workii Tons#rnr nott "permit Permission is hereby granted...........................................---------•----------------...---•-----•---•----------........--•------............................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo................................................................................................................................. .......................................... ..... Street f as shown on the application for Disposal Works Construction Permit No._------ j/!D jed :._.C...��:..................... I DATE............................................................................... /Ii,a,cl of Health ' FORM 1255 HOBBS & WARREN. INC., PUBLISHERS p4 f f AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION a t�+f �e'iC SEWAGE# VILLAGE OSTaIJLL ASSESSOR'S MAP&LOT 093- 030 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) c1 1 11 ow b-4 ,l (size) y STOP NO.OF BEDROOMS_ BUILDER OR OWNER M C lid PERMITDATE: COMPLIANCE DATE: 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 leachi facility)�-- ) Feet Furnished by /1SAG (?/1 —► �D/` Wit`-'` �4 C Fr0rCr B A Q A poo/ st"I a 3 y a /60 13 O O c y a3` 3- L 30� http://issgl2/intranet/propdata/prebuilt.aspx?mappar=093030&seq=1 10/23/2017 TOWN 1OF BARNSTABLE LOCATION /3� SEWAGE# 2021- 23b VILLAGE ASSESSOR'S MAP&PARCEL Q q.1 G30 INSTALLER'S NAME&PHONE NO. F_0Ll c- S%Vr_rL,& SOS-7; 0-?os'T SEPTIC TANK CAPACITY )560 \ Lo e ST V S 1� LEACHING FACILITY:(type) 1g0 (size) NO.OF BEDROOMS OWNER C PERMIT DATE: 424,21 COMPLIANCE DATE: 2 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 A,: '1Z AZ- 28 IZ Al. 2S �s Zs AO- 3 s g�. 32�2 i s usp Na Z ° m 2 � A W W 1 F' YY lu �- ma am ~off `x. FL OO G � f% - 3 FAMILY ROOM z J p Q ` El O ICE r z. ` z KIGE £ - - ° Oa- z:. ..,. zo'-0•x.u•o•. 1 FOYER •^"X �"/9 �. _ 1 ze i d -emu 21 L ON , j M In 1p s ❑ I t} � � I i Q e G.O. - exrb ossx. - UP LAUNDRY/ O PANTRY GREAT ROOM zB•-o•x te•-0• Lu Ul a$•x B'4 kF 5•-0-x B•4• LtVIN6 ROOMtu . PJN.DR. f n P DN N x x o Tr P N 2'$El1- x.10 /TEMP) R.O. 1L .]' t/B' '-B T/0• - - y 4 si'2etf[Ylt - +tY�cni+ ___ __________y�_ __ �_____________.__-_-_-____w Ill (^ v,c GONTRUGTION SET PROJECT» 1507 DATE: 02/09/16 REVISED: Wa a a C 112. KEY mm Nm 'Dm o u L m O m m O O m x x x E%I5TIN6 NEW 5GALE AS NOTED PROPOSFS7 FIRST � B'- FLOOR PLAN 152 y. •.o' B PROPOSED 15T FLOOR FLAN �� SCALE 1/4" 1'O" NOTE5: 1.ALL DIMEN5ION5 OF EXISTIN6 ELE14ENT5 ARE I/-AND MUST SE VERIFIED IN FIELD. 2.ALL EXISTIN6 5TRUGTURE MUST 5E VERIFIED IN FIELD. i 0 z 4'-b' - •O' '-3 i? m om ui Ym m? m I - •�� z m FL G 0 0 DO <of <K <K _ — o- flillittiminillnnnliiii N,• unnn;nn a lunnui — _ e --ASAR ._ BATH ANDERHEN-(9)A31 T-'X 11'-b' W.I.G. xlu» �wr= EX G R.O.3'-5/8'x 31-1/9• SHWR• .'�:r.w:e:a BEDROOM#1 " - 14'-b X W BUILT-N ° w I 2° ANDERSEN Tri3 2(TEMPI cm. _ R.O.3'-6 1/0'x 4'-4 T/H' 26 2° YIET Ln 3 s 2NO FLOOR A sAR \ Ln ❑ ..) L °M 15'-0'x 30'BUILT-IN BREEZEWAY N <\, / m z F� 2° e 2Q 1 y ❑ BEDROOM a2 W �j I1 4 1n x a MASTER BEDROOM 2° �5•_O•x 9TOSRA6E �.. 12' 19'.b•.. 21 m O _ -'❑ -- In DESK y o _ DUI RTSN NBEMTry DYIRSN r CONTRUG7I014 5ET Im m PRO.JEGT p 15011 . �x �• �, �. DATE: 0209/16 m o m m m . • z A v� ��- z? REVISED: K� Kry K-ry Kh D!I'ry o o ZQ zKEY Q ziQ ZQ Zq I L ea EXISTING NEW b SCALE:AS NOTED I PROPOSED rrI__ 95WNDV FFILOOR PLA �L PROPOSED 2nd FLOOR PLAN A�3 NOTES: 1.ALL DIMEN510N5 OF EXISTING ELEMe4T5 ARE+/-AND MUST BE VERIFIED IN FIELD. 2.ALL EXISTNG STRUCTURE MUST BE VERIF®IN FIELD, E N s .D m ry m. i z O � W } = m `a) C 4' BHC d Lu m W ZLL o C T-T i 7 wirer varr m,..o--------------------------------------- --I I - ' aaxo-isoTc�e - `L�1T 901m1V�W `� SONOlIl�W G 10 9/e•%%' � _ 913POOf pPS M. B;6POOf 6P]B M: ��!''�WINl6RAOE �_ V ---- ----- r __. -_ - - _- __ -- -__ - I I ' S EXTG FDN I I AA . AP roam vr.w_,wulcw®sr oz rtc.le yr xav urea va ow uur- eve�•�eol�n BASEMENT �—w�aw.oe"'µ'� w�semis ae-xq � I I Ytlei®t99k�aNV�x BORE- ____ ____ _ _ I r N ^a�"'wev"�ruL swore 17ul ' I I a ' p m I � J 0 LLI , I I I I I � I I __ _ _ L __ _ — L W W Q ava Bv.—x _m_ _3_ _L IV I ' w%Bv ae•xwxlr I ' EXT'G FDN. auai vlaaa 0 ----; -- --- - - -- - -------- ---- ------------------------ --------- -------- ---------- P -- - - .. I , 4 I ' ` ------------------------ - ----- ---------- ---- - ' - GONT'RUGTION SET . PROJECT u 150'1 9 DATE: 02/09/16 . REVISED: OF LEY .. —.._ - --. - ❑ 4X4 WOOD PMT UP B 4X4 WOOD P05T DN. ® 4X4 WOOD POST UP/DN. O 4XH'W0OD PMT UP 0 4Xb WOOD POST DN. SCALE.AS NOTED T ® 4XH WOOD POST UP/DN. 66'Q• ❑exa HXH WooD POST UP FOUNDATION �axa a XH WOOD P05T DN. F'LAN ®bxe 6XH WOOD POST UP/DN. ❑sT T5 4x4X.250 STEEL POST UP FOUNDATION PLAN 911 T5 4x4X.250 STEEL POST DX 5CALE:1/4" = 1'-O" OsT TS"x ao STD POST UPON. T5 4141?50 STEEL.POST UP BASER 9/4 X H'X 17 W/(2)9/4-CAPSULE ANCHORS EX TINO CMU . BIALK.FDN- NEW— NOTES: 1.ALL DIMEN51ON5 OF EXISTING ELEMENTS ARE*/-AND MUST BE VERIFIED IN FIELD. 2'.ALL EXISTING STRUCTURE MUST BE VERIFIED IN FIELD. E 3 LU b 4• Q T W [0 N v N N I J J F Jy_y1 0 '- �� x w $ - z z z z =X x P lL j °O °O =Q m<N °Q i `�n p <K <K <K <R' JI K y Q i h I O VV z K _ 4 ❑ COVERED PORCH 5'-O^%1 -O^ t� _ OFFICE J 000 O O L FAMILY ROOM :Ell O O 2- KITCHEN ° KITCHEN M 20-0-x 11-0^ ! a, FOYER o e _ 2. 2- j- THERMA-TRU 15 LITE 2e R.O.34 1/2'x 62 1/2^ N 26 Y W/O' - G.O. EXi'B DESK UP ry GREAT ROOM L ANDERSEN-L%15 L Q/ LAUNDRY PANTRY 3'-0-x b'-0• LIVING ROOM 2 y R.O.32'x 60 T/B' 5 G A U NU /W/ W Q � m PWDR. � m � m / 5'-b^x 5'-b'2a m W ANDER5EN-TA2446(TEMP) P V N in 1 1 ry 3a 9Q - CONTRUCTION SET PROJECT 0 1507 O DATE: O2/O9/16 REV15ED: 04/25/16 i f � w O o KEY O N x '^ z'0 F x F N EXISTING z ° z m :m m m -� -•Y NEW oT Kiv K Q <K ILQ K m Km SCALE:AS NOTED < III z ai < i <le <rc PROPOSED FIRST /^ - 1n• - FLOOR PLAN 92 0' PROPOSED 15T FLOOR PLAN �� SCALE:1/4" 1'-0" NOTES: 1.ALL DIMEN510N5 OF EXISTING El EMENT5 ARE./-AND MUST BE VERIFIED IN FIELD. 2.ALL EXISTING 5TRUCTURE MUST BE VERIFIED IN FIELD. E 0 UN O � z 9 T -0• 4' 2n'-0• iu N i W m N ZLU Fu1 � �m m „Ip om o'm\ LL ry i a oI6 i 6 66 66 (OC <K (K <K <K �IIIIII!nnl�Inlllll111111 j�-��- %-Illllllll u❑Illnllllllll — — vuurr — - BATH ANDERSEN-13)A21 BEDROOM 01 R.O.2•-s/B•x r-s/B• SHWR. �-� Y-5• 50' - _ 2Q ANDERSEN-TW 442(TEMP) R.O.2'-b 1/8'x 4'-4 l/B' 2# 2Q WET 2Q Ej 4 N 2ND FLOOR BAR N 1s'-0•x 20•HuiLr-iN BREEZEWAY ,1'W ry 0 Ox - HQ V N EXT'G - 2- 2Q BEDROOM 03 EXT'G 3 W W BEDROOM#2 Q fIC j p 2# 2Q �n In S f W LU Q _ p LU m F MASTER BEDROOM 5 3-0x J I POSSIBLE 12'1•X 14-61 II ❑ - m „{ STORAGE - - ANDERSEN-FW6 5068 Q Q N . R.O.60'z 80 1/4 L IIIIii�llllll . ' Illllllllli �-0x m - - � • I 0 GONTRUGTION 5ET m o m olm o 0 0 PROJECT# 15011 i s F x x ry LL DATE: 02/09/16 REV15EV: 04/25/16 T 0o zo a;o CO.o oz �o <u <rc (Irc rc <oi <It KEY EXISTING 1B NEW 3'-b- 1 4 - 2B'-0• ' 5GALE:A5 NOTED PROPOSED SECOND FLOOR PLAN PROPOSED 2nd FLOOR PLAN 50ALE: 1/4" = 1'-O'• A-3 NOTES: 1.ALL DIMEN51ONS OF EXISTING ELEMENTS ARE./-AND MU5T BE VERIFIED IN FIELD. 2.ALL EXISTING 5TRUGTURE MUST BE VERIFIED IN FIELD. - V N `a+ f�tl m O � Z 3 A � N 664 W (1) N W Z lL � n -------------------------------------------------------- ----------------------------------------------------- v m T-,v2• T-,vY " 4 [ �erwForn BF eP�Trr.. �ei6Fom eFie m. :o I Ao Ao I b - F• �•wes Im �� I ______________________________- rr FauKOwnOK WALL 9HMM150m1E� � O'xD9' %TwJgfi FOOBx6 I6xBi o G¢A�190 BM'G 31/]Dui.LALIr • DUIP PPFOOF�0 A�KCWxaRED 9Y O.G. B FOONu6 TTP. I i I :::' I 9/D•AMCH00.BO CONC¢ElE 51J6 UxDE¢ 1 I I S;'� IT FRp+CORnBib I iNFRS B'xD•xl/A' r_____________________I I ____ I _ _ __ _ _ _ _ __ __ L - - __- O - � r rI—I—I�'1 7- T _ _ r_ I I ,u 9om axxo CRAWL SPACE n" 1rn r¢aoF I I A CONCUR Ca5Tx60 - N 8.0.1e D/D'%�• N �� f0N M¢EIA¢06i � � WNOATgK n p L�tT—� � NM¢HfR OF�6RAOG TxE �< 1 ry FOI.G%CMG SLAB unOER _ a Q t O' I I •: Ao E EO FA - N --------------- tu - i .•:. - _TJ IL II IL__-T_--__ _ N= _____ Lu 1'VU^ Y V I — ' ;•. i 51/]rnA.LH1T EXTG FDN, I I I "' wno%DexSe'x Ir I i I ',.. l-6'CI91 BLOCK _4 I I I SUBFLO¢ NOTE:IN NEW AREA r (p ALL OUCTNIORK TO BE J fA METAL AND w V F a m f+ O WATERPROOFED • ALL INSULATION TO BE I CLOSED CELL IGYNENE • • V I x,* I I I I I I I.•. I ________________i _____________________________________________________I ---------------- Q - - --- ---- - -, - - ------------------------------------------------------- r ---------------------------------------------- -- -------- GONTRUGTION 5E7 PROJECT a 150-7 B DATE: 02/09/16 -3 REVI5ED: 04/26/16 LEY ❑ 4X4 WOOD POST UP 0 4X4 WOOD P05T ON. 0 4X4 WOOD POST UP/DN. O 4Xb WOOD POST UP 0 4X6 WOOD POST ON. 51-A-E:AS NOTED I$ 4X6 WOOD POST UP/DN. bb' 0— bXbW POST UP FOUNDATION Elexe bxb WOOD POST ON. PLAN CRO-61 bxb WOOD POST UP/DN. ❑BT TS 4x4x.250 STEEL POST UP FOUNDATION PLAN EIST TS 4x4x.250 STEEL POST ON. 51—ALE: 1/4" = 1'-O" 05T T5 4x4x.250 STEEL POST UP/DN. TS 4x4x.250 STEEL POST UP ❑ BASER 5/4'X B'X 12' I W/W 5/4'CAPSULE ANCHORS I EXISTING CFN BLOCK FON GJ i_ NEW FDN v NOTES: 1.ALL DIMENSIONS OF EXISTING ELEMENT5 ARE+/-AND MUST BE VERIFIED IN FIELD. 2.ALL EXISTING STRUCTURE MU5T BE VERIFIED IN FIELD. Existing Leach field ZONE: r IN §. r to be Removed or Abandoned MB-A2 x /• as per310 CMR 15 Area (min. 10,000 SF u r j Fronta e (min) 20 Gravel Drive i Width (min) Setbacks: DIRECTIONS: Front_ .�. , o Directions: From Hyannis - Follow Main Rear Street west to the West End Rotary; .' I� Follow ,. � ����n; ` •-. »� >, Scudder Avenue to stop sign and then take a C (0 , �: soh / right onto Smith Street, which turns into FLOOD ZONE: y Craigville Beach Road Take a left at the stop light onto South Main Street which turns into Zones AE ELEV. 12 a �`.o Main Street after the bridge, W F y 7 250001 0757 J w� O J c,/o � , West Bay Road, turn left onto bridge street.ke a left to Community Panel No. W I W I o„ooh� f 5 o The property is on the right # 138. July 16, 2014 11.0' cb ph os. Porch do \ •► f f ASSESSORS REFRENCE: ' o ,__ S49Qyt'40„ cb�d i Map 093 Parcel 030 o Existing D-Box _ to be Removed o _ �Sty--wlf _ LOT REFERENCE: FL NO o _� DE LOY D 50.0' d Book 86 P 3 I Plan Book 103 Page 123 rs ` . . . . . . . . . . . . . . . .. . . Y Existing Deed oo g p s _ �L� 1500 Gallon D 205 a e 13 west pay '� `S one St Septic Tank in 48x111 Stone Fielda i _.._ f y To Remain Garage / � NITROE NOTES 8 1. PROVIDE MIMMUM 2 DROP WHILE MEETING REGULATORY SLOPE 4.., /✓.r ,w, SEPTIC NOTES Stone lj Patio / " 1.Location of Utilities Shown on This Plan Are.Approx.At Least 72 Hours REQUIREMENT FROM THE SEPTIC TANK OUTLET PIPE INVERT TO o ll W Mi .Q) Prior to Any Excavation For This Project the Contractor Shall Make THE INVERT OF THE INFLUENT PIPE INTO THE NITROE TANK. ' ) 50' ^4 the Required Notification to Dig Safe(1-888-344-7233)and contact 2. NITROE TANK TOP TO HAVE TWO-24"THREE-12"HOLES AND Sullivan Engineering&Consulting Inc.(508428-3344). MULTIPLE 4"DIAMETER ACCESS HOLES WITH RISERS AND COVERS m 3 i ,<Z� 100' s roposed 2.The Contractor is Required to Secure Approp ate Permits From Town FOR MAINTENANCE AND SAMPLING. a W / + �o / NITROE Agencies For Construction Defined by This Plan. 3. FOR THE 24"HOLES,PROVIDE 24"DIA.ADS PIPE WITH COVER TO 12'° I CAD o #138 Gravel Drive *- 0� \.\ System o 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall BELOW GROUND SURFACE. BOLTED TO TANK TOP. / CV o O Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to 4. FOR THE 12"HOLES;PROVIDE THREE-12"HOLES WITH ADAPTER Flag P fio ro Assure Watertightness. In General,Water Lines Shall be Constructed in RINGS,RISERS AND COVERS TO 12"BELOW GROUND SURFACE. / Po l / 2 Sty. w/f Op G 'o�r, \ P Dwelling �2� \ '' D-Box r Coordination With COMM Water,and Shall be in Accordance INSTALL 4"DIA.MONITORING PIPE(I"BELOW GROUND SURFACE) I O 6 1 j N 9�0 0�• -l\. With 248 CMR 1.00-7.00&310 CAM 15.0(►. WITH "PLASTIC ROUND BOX AND COVER TO BE FLUSH WITH ' : / (� o J \ \ ^^ 3.5 4.A Minimum of9"of Cover is Required fotArl Components. GROUND SURFACE. Lot Area \ , r yS _� Proposed 5.Aft Structures Buried Three Feet or More or Subject 5. PROVIDE FOUR-6"DIAMETER PLASTIC ROUND BOXES AND COVERS 22,300t S.F. l ; ' i` '' �� \ T• Gravel Vent to Vehicular Traffic to be H-20 Loading.It is the Engineer's (NITROE AND SEPTIC TANKS)TO BE INSTALLED AT GROUND LEVEL. v J (: \ < \ a Drive 4 0, I Recommendation that H-20 Always be Used. 6. PROVIDE INFLUENT SAMPLING PIPE(2"DIA.)6"FROM EDGE OF `, ; FIXED DOCKS O ( Existing _ 6 PLA C X COVER AT _ "` - 6.Install Watertight Risers and Covers to Within 6"of Finished Grade SEPTIC TANK WALL WITH STI ROUND BOX AND 4 bedroom \ \ r 'r __ s• Over Septic Tank Inlet and Outlet;D-Box,and One Leaching Chamber. GROUND SURFACE. l Septic ' '` i L: _ .• 5 All covers are to be maximum 18"for concrete or 24"Cast Iron. 7. APPROVED OPERATION AN MAINTENANCE AGREEMENT TO BE IN "� i _ Permit # 82-791 ,� \• - ' _ 0 7.Septic System to be Installed in Accordance With 310 CAM 15.00& EFFECT FOR PERPETUITY. :•_ `._ _ _ 1 7 O ! \' \�� - - " ¢ - 3 248 CAR 00- 00 Latest Revision and the Town ofBarnstable Board ofHealth Regulations. Gravel Drive 8.All Piping to be Sch.40 PVC. max- � o •� \ i �,��._ o, ghal k \ Bo e a um Inside Dimension of a Minimum Proposed Leach Field and Water \ Water 9 D x Shall Have Minim d D' 12',and o Shed J f / Nitro IA System .Main- '- - Main Sumpof6". I ° o ✓ ✓ See Detail Plan View \• M 10.The Separation Distance Between the Septic Tank Inlets and ______ -� _ _ ____ _}-' / \ Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend ' ` Lawn a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" \ ✓✓ Lawn \ QI/e�'a1' Plan View Deter P'GLn View Below the Flow Line,and Shall be Equipped With a Gas Baffle. FIXED DOCK =� Ql Ali \ w� Y 11.An O and M agreement with a qualified consultant shall be in lace durin ✓ �� Scale: 1" 20' h gre q P g GravelDrive o `fr cb�d the entire time the NRROE system is in use. \ � ......... ......Water_ _ '- �' ` o Main � ` -•-- -� � � -,m ---- Z \ Water _ o� Wale Water o' \ \Main Paved with w PERC TEST': 21-120 ' Gravel Drive M Gravel Drive PERFORMED BY:JOHN ODEA,PE- SULLIVAN ENGINEERING \ &CONSULTING,INC. cbf d • f SOIL EVALUATOR NO 2911 l .d �20��� 29J. WITNESSED BY:DAVID STANTON,P.S. ,•OTi L'©FBA pNSTAl3LE Ele tri(c�Pane Hyd Street t Bench Mark Mag Nail MAY 6,2021 Bridge Elev.,9.57' NA VD DESIGN DATA SITE PASSED to be Confirmed Single Family : Prior to construction -4 Bedroom at ll0 GPD TEST HOLE- 1 EL.9.0 TEST HOLE-2 EL.8.8 No Garbage Grinder ... ..... .... .: . ......... Finish Grade ... 1 F � .. ....... FII L ..FILL ... , ;•�, Total Daily Flow=440 GPD Xic a com ocrod Fro aND/oa Use Existing I500 Gal Enhanced Septic Tank . 30' GRAVELDPJW/HARDENER.'.'.'.'. 6.5 28' GRAVEL DRIVE/HARDENER..... 6.5 e P a Stone BwLAYER IOYR 516 PERC TEST ® � LEACHWG AREA 3/4^- i t/r YELLOWISH BROWN 25 GALLONS GONE IN 4 MIN 30 SEC. 4' Double washed 440 GPD/0.74(LTAR)=594.6 SF Required 4214 LOAMY SAND 5.5 PERC RATE<2 MIN/IN(LIAR=0.74) 12• Stone Sidewall=2(11'+48'1)xO.92=108.6 SF C LAYER 2.5Y 6/4 34" Bw LAYER IOYR 516 6.0 Bottom Area=Ilx48=528.0 SF LIGHT YELLOWISHBROWN YELLOWISHBROWN CROSS SECTION OF FLOW DIFFUSOR Total Provided=528.0+108.6SF=636.6(471.1 GPD) 120' MEDIUM SAND -1.0 40' LOAMY SAND 5.5 GROUNDWATER ENCOUNTERED C LAYER 2.5Y 614 NOT TO SCALE LEACHING CHAMBER DESIGN LIGHT YELLOWISHBROWN Charcoal Filtered Vent All Pipes to be Schedule 40. Use 120'1 MEDIUM SAND -1.2 Final Location to be Determined 5 Flow Diffusers in a I ft48'Double Washed GROUNDWATER ENCOUNTERED at time of installation or in Stone Field as Shown. accordance with Landscape Plan Drivewn-y Elev. 1'f- *Final Foundation Grading To Be F.G. EL. 9.3t F.G. EL. 9.3f See Note 6 (typ.) F.G. EL. 9-9.5' Max. Coordinated With Landscape Plan VARIANCE EL. 8.3f DEP State Environmental Code EL 7.9t 310 CAM 15.212 Depth to Groundwater b)Five feet in soils with a recorded Flow Equ it izers percolation rate of two minutes or less per Existing As Required inch.Required EL. 7.17 1500 Gallon PROPOSED 666 H-20 Enhanced EL. 67 EL. 6.92 NITROE EL. 6.54 Proposed-4'separation Septic Tank 2000 Gallon R0. (See Note 5) Mono Tank H-20 Top EL. 6.50 310 CAR 15.211 Minimum Setbacks H-10 D-Box EL. 6.34 Field Separation to Lot Line ® ® ® ® _ Bo t. EL. 5.00 Proposed 5.0' EL. 6.00 H-20 Required 10' To Be Installed On /� Flow Diffusor Stable Compacted ase Elevation to be confirmed Bedding,"T"s Inspection Port, d prior to construction Ins P & Baffels EL. 1.0 as Per Title 5 Adjusted Groundwater Elev. 7.8' From Grade See TH-1 DEVELOPED PROFILE OF SYSTEM MF • NOT TO SCALE . S810NAL LEGEND: 0 CDT Cedar.Tree HT Holly Tree NOTES: PREPARED FOR: PREPARED BY.• TITLE: Site Plan DT Deciduous Tree CT Coniferous Tree ion shown was compiled from North Bay Realty Trust II Engineering &: Pro osed Se t/C1) The property line informat p y y p p �\ available record information. U jn(1 c Utility Pole 2.) The topographic information was obtained from an on the Mark Curley Trustee 11 ConsultingInc. At ground survey using RTK GPS and Survey Total Staion 138 Bridge StreetIV -E- Electric performed on or between September 18, 2015 and May 5, 2021 Street T_ -G- Gas 3.) The datum used is NAVD '8$ based on on RTK bench mark OSte►-VIII e, MA OZF)5J` (508)428-3344•P.O. Box 659.711 Main Street, OSt@rVlll@, MA 02655 138 BridgeWetland Flag supplied by applied coastal engineering. S@CI@SUllivan@ngin.COm•www.SUIIIVanengin.com Light Post 20-Overall Plan p 10 20 40 80 Draft: CTR Field: WHK JOD CTR Bamstable (ostervlle) Mass. LQ LQ 0 CB/DH 10-Detail Plan p 5 10 20 40 OHW Overhead Wires Review: JOD Comp.: CTR DATE: SCALE: � 25- - Elevation Contour Project: Lloyd , Project#: 380008 May 10, 2021 As Noted