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Home My WebLink About0026 BARBERRY LANE - Health �� ( �� - - - - - _ .-- - � f �a � /��1� - - - - - - �-- �' , - a-_ TOWN OF BARNSTABLE LOCATION 2D' 6R _6tv-V- ',O SEWAGE# 2QL(�3�� VILLAGE MPA5TWS MILUS ASSESSOR'S MAP&PARCEL t0Z INSTALLER'S NAME&PHONE NO. C.52,�UrS cx=g 104 Zhr,, SEPTIC TANK CAPACITY lGoO LEACHING FACILITY-.(type) ChP0 6sZ (size) (3X Z-Sf NO.OF BEDROOMS. , OWNER '��k ILI PERMIT DATE: ® Z tj 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 leaching facility) Feet FURNISHED BY L�¢ � rayt 2- 17 . 6:5, A ? 3 6� 3�3 3(o r ��2�� LN 43 y •S `1 , No. [%�/'�' 381 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppliCatlon for Disposal *pstem Construrtion 3PPrmit Application for a Permit to Construct( ) Repair) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2-4 Owner's Name,Address,and Tel.No. 6 :9q&irthpjt{ I,kXk_ Assessor's Map/Parcel /rYc�/V Y A Qntan s kills,NtA RWLAiV?.S V\115, M A Installer's Name,Address,and Tel.No. &v S'Uxtm Designer's Name,Address,and Tel.No. .j em _44tnC4tY3 . SXV.0)S �strvt�'�,�O 3m7� '11 rs\ey 1�i1}crt Grwu 0�ouLle. b,� 1 Iyrpe of Building: MCW1S rV^S M i1 S S08o'8�f7 m 0 S4 OUl �'�i�3 Dwelling No.of Bedrooms Lot Size L sq.ft. Garbage Grinder( ) 3 0 00 Other Type of Building _Res kowc ht%a-L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Z Design Flow(min.required) �7✓ gpd Design flow provided 3✓� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank t a( $ Type of S.A.S. W 1 �"t@ x1 ' rj fIa Description of Soil 9 CQ ox-- f1 e Nature of Repairs or Alterations(Answer when applicable) i 11 -to s �► � 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 Boa Signed Date v Application Approved by Date !1, Application Disapproved by Date for the following reasons Permit No. �jL�i I ^�0 I Date Issued ZJ 2 -- ---------------------- ----------------------------------------- - - fs' . , No. (/�/ J! ` . Fee THE COMMONWEALTH OF MASSACHUSETTS' Entered in computer: PUBLIC HEALTH DIVISION ='TOWN'.OF BARNSTABLE, MASSACHUSETTS Yes Rpplitation for IDisposaY 6Pstem.Construction Permit Application for a Permit to Construct( ) RepairX) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2 1 h `. Owner's Name,Address,and Tel.No. (, aA :rtn ; Er ct Assessor's Map/Parcel /t� /6� �'j�'S1iSri 5 �i'�Ii I A 4" L. kmooS K:Ifi5. M,A � Installer's Name,Address,and Tel.No. LG j�,�r� ` Designer's Name,Address,and Tel.No.-31*_ '44teloi q.y9nL f'.0 E. SkQ. S csnstruc�cr�,,`1c� u�t '�� nrS�c '1�tt l�"ty 10 Rn LA,k.. (aA rJ)Ad. t Type of Building: Id►W$rV?%5 M11I13 5049-` 1(6-4054 00vinwich MA 508-®b ,,.,, k Dwelling No.of Bedrooms Lot Size 0�21 sq.ft. Garbage Grinder( ) ✓�' Other Type of Building No.of Persons Showers( ) Cafeteria( ) q Other Fixtures tt Design Flow(min.required) . gpd Design flow provided _3 3--� gpd Plan Date Number of sheets Revision Date Title' Size of Septic Tank I t M Ot` QI)COS�4'iG� Type of S.A.S. CW tA Tt t1d - ttW 5 Un Description of � CJ Soil �M ` ° _ YL 'Ile,a „aA q (' ' W 1 wit S Nature of Repairs or Alterations(Answer when app�licable) i "1U t hmv %AA a4w.i tst, . � V Date last inspected: f Agreement: The undersigned agrees to ensure the construction and mail tenance of the afore described on-site sewage disposal system in J C {r pr accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of s J t Compliance has been issued'by this Boardaof Ilealth. r' Si ned 1 S i t Date Application Approved by Date Application Disapproved by Date 1 1 for the following reasons J Q Permit No. 7� t.��-f I.Date Issued Z��Z -- ,;.THE,COMMONWEALTH OF MASSACHUSETTS s•� BARNSTABLE,MASSACHUSETTSt Certificate of Compliance THIS IS TO CERTIFY,-that the On-site Sewage Disposal system Constructed( ) Repaired(—)--'Upgraded( ) Abandoned( )by at L 6 _B f1LXWJ " Vo xj • MAVKe KI S, KA has been constructed in accordance t with the provisions of�Title, 5 and the for Disposal System Construction Permit No. s(-3 f9 dated 7i� Z- Installer ^- Designer #bedrooms -3 Approved design flow gpd The-iss`uance.of this ermix shall not be construed as;a guarantee that the system will fund on as designed. �� , Date + .`.Inspector�t• •�.._,,.M.--..., ; _ � f - - - - ----- No. �3 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS r Bisposal *pstem Construction 3permlt Permission is hereby granted to Construct( ) Repair( v� Upgrade( ) Abandon( ) System located at Io t �U+SUg �+e�t{rs� A ItSC r 5 M M N S M A . 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 .ZS r2 Approved by i Town of Barnstable E" Inspectional Services s Public Health Division • seanrsreeLe, _ � AK Thomas McKean,Director �BD MDR A 200 Main Street,Hyannis,MA 02601 Office: 50M624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 12/16/2021 Sewage Permit# 2-0 2-1— 3$9 Assessor's MaplParcel 102/161 Designer: Joe Henderson, Horsley Witten Group, Inc. Installer• C ?e -TT Address: 90 Route 6A Address: (36x.-] I M 2SSrA3S MILL Sandwich, MA 02563 oL(o q 8 S kevtlV� �fM.�C�I.t`7� On �• was issued a permit to install a (date) (installer) septic system at 26 Barberry Lane based on a design drawn by (address) Joe Henderson, Horsley Witten Group, Inc. dated September.3,2021 revised 10/5/2021 (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, X I certify that the system referenced above was constructed in compliance with the to rms of I1A approval letters(if applicable) \� (Affix D i ,-o �St�iri}� here) e? 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. 1VopWeplsIHEALTRSEWERconneeASEPTIODesignerCertification form Rev 9.14-I3.DOC t Town of Barnstable `"E�t•� Inspectional Services BARMast Public Health Division t163 Thomas McKean,Director, 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 12/16/2021 Sewage Permit# Assessor's Map\Parcel 102/161 Designer: Joe Henderson, Horsley Witten Group,.Inc. Installer: C -TT J�NS Address: 90 Route 6A Address: Q,T=S M 1ca-5 Sandwich,MA 02563. - : o?G.y 8 On was issued a permit to install a (date) (installer) septic system at 26 Barberry Lane based on a design drawn by (address) Joe Henderson, Horsley Witten Group, Inc.: dated September 3, 2021 revised 10/5/2021 (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. X I certify that the system referenced above was constructed in compliance with the to rms of INA approval letters(if applicable) "' °* , JOS \9 HFNDPP (Installer's Sig a rrur 1 � 7 (Designer's Signature) (Affix D i�. e '-s l p 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. %Ga\depts\HEALTMEWER connecASEPTICOesigner Certification Form Rev&14-13.DOC BA4- trleT,+e�a,SM Town of Barnstable MM • 163, 9. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt March 4, 2022 Mr. Joseph Henderson Horsley Witten Group 90 Route 6A, Unit 1 Sandwich, MA 02563 RE: 26 Barber Lane, Marstons Mills , ,Y ._. Dear Mr. Henderson, You are granted variances on behalf of your clients, Mary and Dennis Healey TRS, to construct and utilize a NitROE secondary treatment unit with advanced nitrogen reduction technology at 26 Barberry Lane, Marstons Mills, Massachusetts. The following variances were granted: 310 CMR 15.211:: To install a soil absorption system 7.6 feet away from the water line, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.211:: To install a soil absorption system 22.1 feet away from catch basins and dry wells, in lieu of the twenty-five (25) feet minimum separation distance required. 310 CMR 15.221(7):: To install the soil absorption system 15.9 feet away from the foundation wall, in lieu of the twenty (20) feet minimum separation distance required. These variances are granted with the following condition: • The engineering plan shall be revised to relocate the 40 MIL PVC impervious barrier further away from the soil absorption system so that it will not completely surround the leaching facility as currently designed, and in such a manner to alleviate or prevent contamination to the water supply line and catch basins/drainage system. • The engineering plan shall be revised to show the soil evaluation(s) recently conducted and observed. Q:WP/Henderson 26 Barberry Lane Variances&NITROE Approal Sept 2021.docx -w These variances were granted because the physical constraints at the site severely restrict the location of the septic system components due to the small size of the lot and its close proximity to existing catch basis and dry wells.in the road. You are reminded the following requirements are provided within the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter for this particular technology, 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 notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). (2) Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000, the approved design plans, and all local requirements, including any local approving authority site-specific requirements; (3) Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i) a certified Registry copy of the Notice bearing the book and page/or document number; and (ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department (4) Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year. (5) The wastewater effluent shall be sampled and analyzed/tested quarterly if this facility is utilized year-round. Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection. [Note: a)Year-round facilities shall be inspected and effluent sampled quarterly;b) Seasonal properties shall Q:WP/Henderson 26 Barberry Lane Variances&NITROE Approal Sept 2021.docx il� 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/dep/water/lawsf-thru-z/testsamp.pdf] (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. All of the other conditions listed in the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter to KleanTu LLC dated May 12, 2020 shall be adhered to. This permission is granted because the proposed plan appears to meet the maximum feasible compliance provisions of the State Environmental Code, Title 5, and the Town of Barnstable Board of Health Regulations. The application also appears to meet the nitrogen loading restrictions contained within the State and local regulations, with no increase in sewage flow requested at this property at this time. Sincere y yours, y. John Norman Chairman Q:WP/Henderson 26 Barberry Lane Variances&NITROE Approal Sept 2021.docx DATE: $95.00 FEE*: >�(/ Town of Barnstable l �.BY: s�o� Board of Health SCHED.DATE: JA4/ 200 Main Street,Hyannis MA 02601 Office: 508-8624644 �- John T.Norman FAX: 508-790-6304 � --" Donald A.Guadagnoli,M.D. Paul J.Cannitt;D.M.D. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM LOCATION Property Address: 26 Barberry Lane 21 ac Assessor's Map and Parcel Number: 102/161 Size of Lot: 0. �i I Wetlands Within 300 Ft. No Business Name: Subdivision Name: APPLICANT'S NAME: Joseph Henderson (Horsley Witten) Phone 508-833-6600 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Mary A and Dennis E Healy TRS Name: Joseph Henderson (Horsley Witten Group) Address: 26 Barberry Lane, Marstons Mills Address: 90 Route 6A, Unit 1 Sandwich, MA 02563 Phone: Phone: 508-833-6600 EMAIL: Ihenderson(cb_horsleywitten.com VARIANCE FROM REGULATION(tncl.Reg.code a) REASON FOR VARIANCE(May attach separate sheet if more space needed) _Installation of I/A system with existing septic system —See attached variance list. Wastewater Retrofit- NATURE OF WORK: House Addition U HUM mcnuvation Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit first four on list as 5 collated packets — A. 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.). r, 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 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*$95.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. _Exemptions from Variance Fee: 1) Septic repair withou an Increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. Q:\Application Forms\VARIREQ Rev Jan 1-2020.docx MAIL-IN REQUESTS Please mail the variance fee amount of $95.00 (if applicable), along with the documents listed below, to the following address: Checks payable to: Town of Barnstable. Town of Barnstable 'Public Health Division 200 Main-Street Hyannis, MA 02601 For septic system variance requests, each of five packets must include: 1) Variance Request Form, 2) Letter for the Board with further information on the reason for the septic variance request(Optional), 3) MA DEP Approval letters for proposed Innovative Alternative (I/A) septic system or a proposed secondary treatment unit (S.T.U.) 4) Engineering plans,. 5) Floor plans. In additional to the five septic packets above, include one.copy of the seven (7) page checklist, the authorization letter, copy of abutters notice, and fee, if applicable (see checklist below). Please send one electronic submission using a PDF or .jpg of the engineering plan and floor plans to email: health(cD-town.barnstable.ma.us. (Total email must be less than 10 megabytes.) For grease trap variance requests, each of five packets must also include a full menu. (see checklist below). Checklist - Please sub►nit rrst our on list as 5 collated packets. � f A. Five(5)copies of the completed variance request form B. Five(5)copies of MA DEP approval letters for Innovative Alternative septic system(when proposing an I/A 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@barn stable.ma.us D. Five(5)copies of labeled dimensional floor plans submitted(e.g. house plans or restaurant kitchen plans)and one(1)electronic version submitted to email: health@town.bamstable.ma.us A completed seven (7) page checklist, confirming all required items are on the engineered septic system plan submitted by engineer or registered sanitarian. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify the 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*$95.00 for the following variances: 1)New construction,2)Septic repairs with increase in flows,3) New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: I) Septic repair without an increase in flow and variances granted at the counter. 2) Monitoring Plans, and 3) Temporary Food(this is not a variance). Variance request submitted at least 15 days prior to meeting date. For further assistance on any item above, call (508) 862-4644 Email: health(&-town.barnstable.ma.us Back to Main Public Health Division Page a c^ s TITLE 5 VARIANCES No. REGULATION REQUIRED PROPOSED 1 310 CMR 15.211 Minimum Setback distance to water supply line 10 feet 7.6 feet A variance of 2.4 feet is being requested. 2 310 CMR 15.211 Minimum Setback distance to leaching catch basin & dry wells 25 feet 22.1 feet A variance of 2.9 feet is being requested. 3 310 CMR 15.211 Minimum Setback distance to cellar wall 20 feet 15.9 feet A variance of 5.3 feet is being requested. J cc, I� TITLE 5 VAMANCES No. REGULATION REQUIRED PROPOSED � 1 310 CMR 15.211 Minimum Setback distance to water supply line 10 feet 7.6 feet A variance of 2.4 feet is being requested. � Y� 2 310 CMR 15.211 Minimum Setback distance to leaching catch basin &dry wells 25 feet 22.1 feet A variance of 2.9 feet is being requested. 3 310 CMR 15.211 Minimum Setback distance to cellar wall 20 feet 15.9 feet OT� A variance of 5.3 feet is being requested. I f/31 a L Note: Floor Plan provided by homeowner. • "' ��'� F f r r IEb " . M .. .,, � .•' 4,' �•O„"� �9?rt,�is� (iwi fV.,--•f/..x.� j 'si• , g' .. , •',$ .*.`rA o' ��•�• .i�"'r.'t"!v:�x�'`�•7.:rr�,.i�ir ry.,,` :Ir �\� � _ .. , , `tl •Y•�S •4 .•D. i '•C Y f+- P v>: 1 �S : < 'i 3si•.' .3. y; °a'r k �., > .f ia• p 'l J•. L: J e r' ,i 1-- ,.. ..�..:............ .. ..... .. .�. ,�...:>.,•. g q� C�•¢. :'n ids • ...1 :..:'-..,.y.,: �..�.... ... ... .. .. fr. +w1i. f,`f;?Y:� •4 .��f "e,3i:,.. <c%%=-?i?y <`q..: r S r. 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Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office September 8, 2021 To: Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: Designer Certification for New NitROE02KS WWTS Enhanced Title 5 Septic System Installation for 26 Barberry Lane,Marstons Mills,MA 02648;KleanTu Project#80043-2109 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 design for the 26 Barberry Lane,Marstson Mills,MA private residence(the"New System'),featuring the use of a new NitROE® 2KS wastewater treatment system(the"NitROE®2KS Components'). The New System was designed by Joseph Henderson,a Massachusetts Registered Professional Engineer with Horsley Witten Group,Inc.(HWG). The NitROE®2K Components are depicted in Site Drawing Project No.: 20112,prepared by HWG and dated September 2, 2021. Item IV-#2 of the DEP Permit requires that KleanTu®make certain certifications to the Town of Barnstable Board of Health(the"Board")pertaining to the design of the New System. Accordingly,KleanTu®LLC hereby certifies to the Board that(i)the New System design, solely as it relates to the NitROE®2KS Components and their incorporation into the New System,conforms with the design specifications required by the DEP Permit and(ii)the NitROE®2KS Components are able to perform the proposed wastewater treatment for the New System. Sincerely yours, 7vGr�r��1�1itG� John R.Smith(Sep 10,202114:21 EDT) John R. Smith President cc: Joseph Henderson,Horsley Witten Group Mary Healy,Property and System Owner - 1- COMPLETE THIS SECTION ON DELIVERY I A. Signature - A. Signature ■ Complete ittms 1,2,and 3. ■ Complete items 1,2,and 3. ■ Print our name and address on the reverse ❑Agent Y X ❑Agent a Print your name and address on the reverse X rn �� 11 ❑Address you.Y so that we can return the card to ddressee so that we can return the card to you. ■ Attach this Card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery B. ived by(Printed Name) C. Date of Delive ■ Attach this card to the back of the mailpiece, or on the front if space permits. Gl/lLGry4r'1 A/_51� or on the front if space permits. V , —1 C q ' 1. Article Addressed to: D. Is delivery address different from item if ❑ es 1, Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: [3 No If YES,enter delivery addre s¢ below: [3No WESTON.WILLIAM C&CAROL A �\�/\ r MARTIN.LINDA J 1\ rf �IV1hT'/1� 36 BARBERRY LANE \ 23 BARBERRY LN MARSTONS MILLS.MA 02648 MARSTONS MILLS.MA 02648 II I DIIIOI IDII 18)I III I II II I I I I I I II II III IIIII III Service Type ❑Priority re ds Express® III�IIInn II4III�IIIIIIIIIIIIIIIIIIIIIII)IIIIIII 3. Service Type ❑Priority Mail Expre ss® El Adult Signature ❑Registered MaiIT^ Adult Signature d Mail TM Signature Restricted Delivery ❑Registered Mail Restricted nature Restricted Delivery ❑Registered Mail Restric CertifiedMaile ery ❑ rtfSd Mal® Delivery atu9590 9402 6931 1104 3731 52 ❑Certified Mail Restricted Delivery Dgnre ConfinnationTM ❑Certified Mall Restricted.Delivery ❑Signature Confirmatior ❑Collect on Delivery ❑Signature Confirmation 9590 9402 6931 1104 3731 76 ❑Collect on Delivery ❑Signature Confirmatoor 2. Article Number(Transfer from service label ❑Collect on Delivery Restricted Delivery Restricted Delivery ❑Collect on Delivery Restricted Delivery Restricted Delivery ^ --'red Mail 2. Article Number(Transfer from service label) - -,d Mail 7020 0640 0001 9808 0 810 �e$500ji1 Restricted Delivery 7020 0 6 4 0 0 0 01 9 8 0 8 0 7 9 7 �SMall Restricted Delivery PS Form 3811,July 2020 PSN 7530-02-000-9053 Domestic Return Receipt PS Form 3811,July 2020 PSN 7530-02-000-9053 00) Domestic Return Receil - • vjf mm Kft ■ Complete items 1,2,and 3. A. Signature A. Signature I e Print your name and address on the reverse X ❑Agent ■ Complete items 1,2,and 3. � ❑Agent I so that we can return the card to you. ❑Addresse ■ Print your name and address on the reverse X j O Ii n5 O n ❑Addressee ® Attach this card to the back of the mailpiece, B. R c ived by(Printed ame) C. Date of Deliver so that we can return the card to you. B. R ived by(Printed Name) C. Date of Delivery O or on the front if space permits. t 1 O ■ Attach this card to the back of the mailpiece, CtV��d �l ( 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes or on the front if space permits. 1 Artirda ArlrirPecort},,. D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No If YES,enter delivery address below: [3 No JOHNSON,.Pl1LA J&JON KYLE w\ tW HEALY,MARY A&DENNIS E TRS 26 \ti` 241 LAKESIDE-DRIVE � n �''44YY� BARBERRY LANE REALTY TRUST 26 ��\ MARSTONS MILLS,MA 02648 � \YYl 1 MARSTONS MILLS,MA Q Yp 02648 ,/ V '� C"' r'1�Jet II I�I�I�I I II I�I I IIII II II I I I I I I II II II I I�III III 11 Service Type ❑Priority Mail Express® II IN 11111111 3. Service Type ❑Priority Mail Express® ❑Adult Signature ❑Registered MaiITM ❑Registered MailT"' ❑AcJult Signature Restricted Delivery ❑Registered Mail Restricts II �III�I I II I�I I III I II II I I I I I I II ❑Adult Signature ertified MallS "�ry ❑A t Signature Restricted Delivery ❑Del vetered Mail Restrctc ❑Certified Mall Restricted Delivery t9 S`fgnature ConfirmatlonT^ertifiad Mail@ very 9590 9402 6931 1104 3731 38 ry ❑Collect on Delivery ❑Signature Confirmation 9590 9402 6931 1104 3731 21 ❑Certified Mail Restricted Delivery 0 Signature confirmation ❑Collect on Delivery ❑Signature Confirmation 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery Restricted Delivery ❑Collect on Delivery Restricted Delivery Restricted Delivery 0 2 0 0 6 4 0 0 0 01 9 8 0 8 0 8 3 4 ^ red Mail 2. Article Number(Transfer from service label) n,,,�,, d Mali red Mail Restricted Delivery d Mail Restricted Delivery PS Form 3811,July 2020 PSN 7530-02-000-9053 gsoo 7020 0640 0001 9808 1183 seoo _ PS Form 3811,July 2020 PSN 7530-02-000-9053 Domestic Return Receipt Domestic Return Receipt D . ,O ... f F,._. � r • C3 ` Cc d 3l Ce it Fe e C3 v ro ate) c0 $ $ 0" Extra Services&Fees(check addles as :13 Ex a Services&Fees(check box,ad$d fee as as apt t ardcopY) Postmark ❑Return Recei t appropdate) ❑Return RecelP $�_--- Here P(hardcopy) $ ❑Return Receipt(electronic) r-9 ❑Return Receipt(electronic) —�— 0 ❑Certified Mail Restricted Delivery $-- t t, O El Certified Mail Restricted Delivery $—� Postmark C3 ❑Adult Signature Required ❑Adult Signature Required Here �—� C3Adult Signature Restricted Oelrvery$�--"� a $ ❑Adult Signature Restricted Delivery$-- Postage �--- N, Postage �C) 0 $ f '- $ .n T, Tota C3 C3 Prope�Y ID. 102160 $ C CAROL A _____ Property ID: 102161 0 S &Sent WESTON.WILLIAM C3 SiEALY.MARY A&DENNIS E TRS 36 BARBERRY M1 LANE 02648 rU S6 BARBERRY LANE REALTY TRUST 0 Siret MARSTONS MILLS.MA C1 '6 BARBERRY LANE dIARSTONS MILLS.MA 02648 m .. fill •• • m < ,; . • C3 co CO C3 Ce Fee co Ce ail F $ Os Cr Extra Services&Fees(check box,add fee as ap opnate) �;• 0�-. $ ❑Return Receipt(hardcopy) $ � Extra Services&Fees(chec 1- r-9 ❑Return Receipt r box,add lee. ap ropdate) Q ❑Return Receipt(electronic) $ Postmark r� P(hardcopy) ❑Carted Mail Restricted Delivery $ ❑Return Receipt(electronic) $— Here C3 ❑Certified Mail Restricted Delivery $-- � ❑Adult Signature Required $ �� ety $ Postmark El Adult Signature Restricted Delivery$ 0 ❑Adult Signature Required $—'— Here ❑Adult Signature Restricted Delivery$ �•--- p Postage \' C Postage — — Property ID: 102167 / C3 C3 OHNSON.PAULA J&JON KYLE v Property ID: 102162 �r rU 41 LAKESIDE DRIVE C3 ' FORTESCUE.JOSEPH K&JOANNA T C3 ARSTONS MILLS.MA 02648 nj ; 14 BARBERRY LANE MARSTONS MILLS.MA 02648 ------"-"-- ------------------ 5M") ['- Iti ,• ' 0 rt C3ified Mail f� q l )XL w $ wed yam^ �T rvs ''[/� �•` '� `Ya"f �j �u9 X 3{ ,g;�� f3 I y E,•'S'�i, y.. lm�rl Extra — ices&Fees(checkbox,add tee as appropriate) CCe fie ad Fe _q ' 3"R 3 t �y? C' ; 8:+•"3 ❑Return Receipt(hardcepy) $ e'0 $ r9 ❑Return Receipt(electronic) $ r Postmark Q" EXt a Ices 1 V d3 C3 ❑Certified Mail Restricted Delivery $ HB<e ❑Return Receipt ma d�ocheck bar a lee as appropda e) C3 E]Adult Signature Required $ r•9 ❑Return Receipt(electronic) $ ❑Adult Signature Restricted Delivery$ o ❑ Mail Restricted Delivery $------ Certified Postmark 0 Postage ,J�'7 0 ❑Adult Signature Required $�— Here Postage Signature Restricted Delivery$ I Property ID: 102147 "w ru O MARTIN.LINDA J 23 BARBERRY LN CLARK.HERTHA B&ROONEY.JAMES E `r5 C3 E3 %ROONEY.JAMES E r. MARSTONS MILLS.MA 02648 - --_ ---_- M1 251 LAKESIDE DR 0 MARSTONS MILLS.MA 02648 •---------------- I KleanTu® LLC John R.Smith KleanTu Wastewater P.O. Box 1154 Treatment Technologies Edgartown,MA 02539 ,. 412-719-5976-Mobile 508-627-3072-Office September 8,2021 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: Property and System Owner Certification for New NitROE02KS WWTS Enhanced Title 5 Septic System Installation for 26 Barberry Lane,Marstons Mills,MA 02648;KleanTu Project#80043-2109 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 proposed for 26 Barberry Lane,Marstons Mills, MA,a private residence,(the"New System'),featuring the use of a new NitROE® 2KS wastewater treatment system (the"NitROE®2KS Components'). Item IV- #5 of the DEP Permit requires that KleanTu®LLC provide to the Town of Barnstable Board of Health(the "Board")a certification that the owner of the property of record has agreed to certain specific matters with respect to the New System. I have included with this letter the required certification. Should you have any questions,please do not hesitate to contact me. Sincerely yours, L7ohlf,&M,4h .lohn R Smith(Sep 13,2021.13:02 EDT) John R. Smith President Enclosure cc: Mary Healy, Property and System Owner - 1- .September 8, 2021 KleanTu®LLC John R. Smith P.O.Box 11.54 Edgartown,MA 02539 Dear Sir: I 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(the"New System")proposed for my private residence at 26 Barberry Lane, Marstons Mills, MA 02648, featuring the use of a new NitROE®2KS wastewater treatment system(the"NitROE®2KS Components"). By signing this letter and delivering it to you,as the owner of the property known as 26 Barberry Lane,Marstons Mills, MA 02648, I/we hereby certify to the accuracy of all of the following statements: 1. I have been provided a copy of the DEP Permit and I agree to comply with all terms and conditions cited therein. 2. I rave received estimates of all homeowner's costs associated with the operation of the NitROE®2KS Components including power consumption and equipment replacement,as well as maintenance,sampling, recordkeeping, reporting and related matters for the NitROE®2KS Components(collectively,the"O&M Responsibilities."). 3. I understand that I must enter into a contract by which my O&M Responsibilities will be fulfilled with KleanTu® or a KleanTu®-approved operator licensed by the Mass DEP as required by the DEP Permit. 4. 1 understand that I must provide a Deed Notice to the Town of Barnstable Board of Health as required by 310 CMR 15.287(10)and the DEP Permit. 5. I understand that I must fulfill my responsibilities to provide written notification of the conditions of the DEP Permit to any new owner,as required by 310 CMR 15.287(5). I Sincerely yours, 2 Mary Healy 2 September 8,2021 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Sirs, This letter is to verify that I have authorized Horsley Witten to design plan for an alternative septic sys- tem to be installed at my house. This plan will be submitted to you for approval. Please don't hesitate to contact us with any questions at mahealyl4@comcast.net. Mary Heal 26 Barberry Marstons Mills, MA 02648 I 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 Govemor 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: KleanTu LLC, located at 300 Old Pond Rd., Ste 206 in Bridgeville, PA (hereinafter "the Company"), NitROE® 2KS WWTS and NitROEO 2KM WWTS (hereinafter "the Technology" or "System") for use in the Commonwealth of Massachusetts subject to the conditions herein. Sale and use of the Technology is subject to compliance by the Company, the Designer, the System Installer, the Operator, and the System Owner with the terms and conditions herein. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. _May 12, 2020 Marybeth Chubb, Section Chief Date - Wastewater Management Program Bureau of Resource Protection This information is available in alternate format Contact Michelle Waters-Ekanem,Director of Diversity/Civil Rights at 617-292-5751. TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper KleanTu NitROE 2K Provisional Approval,May 2020 Page 2 of 15 Technology:NitROEO 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. H.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 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 K1eanTu 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 an System that does not flow b gravity to the SAS the System shall be equipped with Y Y Y g Y � Y sensors and high-level alarms to protect against high water due to pump failure, pump control failure, loss of power, or system freeze up. The control panel including alarms and controls shall be mounted in a location always accessible to the operator (or service contractor). Emergency storage capacity for wastewater above the high level alarm shall be provided equal to the daily design flow of the System and the storage capacity shall include an additional allowance for the volume of all drainage which may flow back into the System when pumping has ceased. Instead of providing emergency 24-hour storage,an independent standby power source may be provided for operation during an interruption in power. With any interruption of the power supply the source must be capable of automatically activating in addition to manual start up capability. The standby power must be sufficient to handle peak flows for at least 24 hours and sufficient to meet all power needs of the System including, but not limited to, pumping, ventilation, and controls. Standby power installations must be inspected and exercised at least annually and all automatic and manual start up controls must be tested. Standby power installations must comply with all applicable state and local code requirements. Provided that a standby power installation complies with these requirements, no variance is required to the provisions of 310 CMR 15.231(2). 9. System unit malfunction and high water alarms shall be connected to circuits separate from the circuits to the operating equipment and pumps. 10. All System control units,valve boxes, conveyance lines and other System appurtenances shall be designed and installed to prevent freezing per the Company's recommendations. KleanTu NitROE 2K Provisional Approval,May 2020 Page 5 of 15 Technology:NitROE®2KS&2KM WWTS 11. Any System structures with exterior piping connections located within 12 inches or below the Estimated Seasonal High Groundwater elevation shall have the connections made watertight with neoprene seals or equivalent. 12. In compliance with 310 CMR 15.240(13), a minimum of one (1) inspection port shall be provided within the SAS consisting of a perforated four inch pipe placed vertically down into the stone to the naturally occurring soil or sand fill below the stone. The pipe shall be capped with a screw type cap and accessible to within three inches of finish grade. Operation and Maintenance i 13. Inspection, operation and maintenance (O & M), sampling, and field testing of the System required by this Approval shall be performed by a System Operator with the following qualifications: - a) is an approved System Inspector in accordance with 310 CMR 15.340; b) has been trained by the Company and whose name appears on the Company's current list of qualified operators; and c) has been certified at a minimum of Grade Level IV (four) by the Board of Registration of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. The name of the Operator shall be included in the O&M agreement required by paragraph B (14). 14. Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year and include the following provisions: a) The name of the qualified Operator that appears on the Company's current list of Service Contractors; b) The System Operator must have the qualifications specified in paragraph B (13); c) The System Operator must inspect the System in accordance with the Approval and anytime there is an equipment failure, System failure, or other alarm event; d) In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications,or violations of the Approval, procedures and responsibilities of the Operator and System Owner shall be clearly defined for corrective measures to be taken immediately. The System Operator shall agree to provide written notification within five days describing corrective measures taken to the System Owner,the Company, and the local board of health; e) The System Operator shall determine the cause of total nitrogen effluent limit violations if they occur and take corrective actions in accordance with the approved O & M Manual; and f) Procedures and responsibilities for recording quarterly or monthly wastewater flows must be defined,see paragraph B (32)"Flow Metering". 15. At all times, the System Owner shall maintain an O&M Agreement that meets the requirements of paragraph B (20). lb. 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. K1eanTu 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 in 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:NitROEO 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. Effluent Limit and Monitoring Requirements, 28. For the new construction; unless the facility meets a TN effluent limit of 11 mg/1 or less, the system shall not be designed to receive more than 440 gallons of design flow per day per acre (gpda) in an area that is subject to the Nitrogen Loading Limitations of 310 CMR 15.214. If the facility does not meet with the Nitrogen Loading Limitations pursuant to the aggregation provisions of 310 CMR 15.216, the System Owner shall repair, replace, modify or take any other action as required by the Department or the local approving authority to meet the total nitrogen concentration limits in the effluent. Violation of the TN concentration in the System effluent shall not require notifications as required in paragraphs B(18)and(19). 29. Prior to Department approval of the Company's Performance Evaluation Plan, the Company shall be responsible for the following monitoring requirements for all System installations that are subject to a total nitrogen concentration limit in accordance with paragraph B (28). Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated, Flow shall be recorded at each inspection, see"Flow Metering" section below. a) Year-round facilities shall be inspected and effluent sampled quarterly; b) Seasonal properties shall be inspected and effluent sampled a minimum of twice per year, with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample; and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling shall also include Field Testing of System wastewater when determined necessary by the operator, see DEP Field Testing Protocol at http.•//www.mass.gov/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 by a General Use Certification, the System Owner shall comply with the following monitoring requirements if . the System is subject to a total nitrogen concentration limit in accordance with paragraph B? (28). KleanTu NitROE 2K Provisional Approval,May 2020 Page 8 of 15 Technology:NitROEO 2KS&2KM W,A'TS 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 http://www.mass.govleealdocsldeplwaterllawsli-thru-zltestsami2.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.govleea/docsldep/water/laws/i-thru-zltestsam p.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. jC. Special Conditions Specific to the Company I. 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. K1eanTu 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:NitROEO 2KS&2KM WWTS 6. The Company shall institute and maintain a program'of Designer training and continuing education, as approved by the Department.The Company shall maintain and annually update, and make available the list of qualified Designers by February 15th of each year. The Company shall certify that the Designers on the list have taken the training and passed the Company's training qualifications. 7. The Company shall institute-and maintain a program of Operator training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Operators by February 15th of each year. The Company shall certify that the Operators on the list have taken the training and passed the Company's training qualifications. 8. The Company shall not sell the Technology to an Installer unless the Installer is trained to install the System by the Company. 9. Prior to its sale of any System that may be used in Massachusetts,the Company shall provide the purchaser with a copy of the Approval with the System design, installation, O&M, and Owner's manuals. In any/contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of a System for use in Massachusetts with copies of these documents,prior to any sale of the System. 10. Within.60 days of issuance by the Department of a revised Approval, the Company shall provide written notification of changes to the Approval to all Service Contractors servicing existing installations of the Technology and all distributors and resellers of the Technology. 11. The Company shall provide written notification to the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership,responsibility,coverage and liability between them. 12. The Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns,-including but not limited to dealers, distributors, and resellers. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities, respectively, shall constitute violation of the Approval by the Company unless the Department determines otherwise. IV. CERTIFICATION AND NOTIFICATION REQUIREMENTS 1. Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit,stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment ` replacement; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 11 of 15 Technology:NitROE®2KS&2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)and the Approval;and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). 2. Upon submission of an application for a DSCP to the Approving Authority, the Company shall submit to the Approving Authority, with a copy to the Designer and the System Owner, a certification by the Company or its authorized agent that the design conforms to this Approval and that the proposed use of the System is consistent with the unit's capabilities and all Company requirements. The review shall include evaluation of the need for installation of water meter(s) at each facility. An authorized agent of the Company responsible for the design review shall have received technical training in the Company's products. 3. The System Designer shall( be a Massachusetts Registered Professional Engineer, or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. 4. Thirty (30) days prior-to delivery of the treatment unit to the site for installation, the Company shall provide to the Approving Authority a copy of a signed contract for a minimum period of one year with a Company approved Operator and the initial Owner/Occupant of the property. 5. Prior to the commencement of construction,the System Installer must certify in writing to the Designer and the System Owner that (s)he has taken the Company's training, passed the Company's training qualifications,and is listed on the Company's list of Installers. 6. Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000,the approved design plans, and all local requirements, including any local approving authority site-specific requirements; b) In accordance with 310 CMR 15.021(3), the Designer must certify in writing that any changes to the design plans have been reflected on as-built plans which have been submitted to the Approving Authority by the Designer; c) As a condition of this Approval, the System Installer and Designer must certify to the Approving Authority in writing that the System has been constructed in compliance with the terms of this Approval; d) An authorized agent of the Company must certify to the Approving Authority in writing that the installation was done by a qualified Installer approved by the Company and the installation conforms to this Approval. The authorized agent of the Company responsible for the inspection of the installation shall have received technical training in the Company's products; and e) Prior to signing any agreement to transfer any or all interest in the property served by the system, or any portion of the property, including any possessory interest, the System Owner shall provide written notice, as required by 310 CMR 15.287(5) of all conditions contained in the Approval to the transferee(s). Any and all instruments of transfer and any leases or rental agreements shall be included as an exhibit attached thereto and made K1eanTu NitROE 2K Provisional Approval,May 2020 Page 12 of 15 Technology:NitROE®2KS&2KM WWTS a part thereof of a copy of the Approval for the System. The System Owner shall send a copy of such written notification(s) to the Local Approving Authority within 10 days of such notice to the transferee(s). V. STANDARD CONDITIONS 1. The provisions of 310 CMR 15.000 are applicable to the design, installation, use and operation of a System utilizing an approved or certified alternative technology, except those provisions that specifically have been varied by the conditions of this Approval. 2. The design, installation, and use of the System must conform to theterms 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. c i 7. 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 y- 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 1properly operated and maintained in accordance with the most recent O&M provisions of this Approval for the . alternative technology and in accordance with any additional requirements of the Approving Authority. The most recent O&M provisions of this Approval for the alternative technology are available from the Department. 9. The System Owner shall furnish the Department any information that the Department requests regarding the System,within 21 days of the date of receipt of that request. Standard Conditions Applicable to the Designer KleanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 15 Technology:NitROE®2KS&2KM WWTS 10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day. 11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy of this Approval. Standard Conditions Applicable to the Company 12. This Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the Company unless the Department determines otherwise. 13. The Company shall include copies of the Approval with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require all vendors, distributors, and resellers to provide each purchaser of the System with copies of the Approval. 14. The Company shall make available, in printed and electronic format, the approved Attachments and any approved updates associated with the Approval,to the System Owners, Operators, Designers, Installers,vendors,resellers,and distributors of the System. 15. The Company shall submit to the Department for approval any proposed updates or changes to the Attachments to the Approval. 16. The Company shall notify all System Owners, resellers, and distributors of changes to the Approval within 60 days of issuance by the Department. 17. The Company shall notify the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership, responsibility, coverage and liability between them. All provisions of the Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. r 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:NitROEO 2KS&2KM WWTS 20. All notices and documents required to be submitted to the Department by the Approvalshall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street- 5th floor Boston,Massachusetts 02108 Rights of the Department 21. The Department may suspend, modify or revoke the Approval for cause, including, but not limited to, noncompliance with the terms of the Approval, non-payment of any annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare, or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to the Approval and/or a System utilizing the Technology against the Company,the Designer, the System Owner,the Installer, and/or the Operator of the System. V1. 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 15.600 to omit from a report or falsify any data collected pursuant to an approved testing plan. A 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. M KleanTu NitROE 2K Provisional Approval,May 2020 Page 15 of 15 Technology:NitROEO 2KS&2KM WWTS 6. The owner or operator, or the proponent of the alternative system, shall obtain and provide the Department with a determination from the board of certification of operators of wastewater treatment facilities established pursuant to M.G.L. c. 21, § 34A as to whether a certified operator is required for operation of the alternative system. The Department shall waive this requirement if it has on file a determination for the alternative system, and shall notify the owner, operator,or proponent of the determination. 7. It is a violation of 310 CMR 15.000 to install, construct, or operate an alternative system except in full compliance with the written approval and 310 CMR 15.287. 8, The Department may require the issuance of a groundwater discharge permit pursuant to 314 CMR 5.00 (groundwater discharge program)for any alternative system. 9. The system owner shall maintain an operation and maintenance contract with a Massachusetts certified operator where one is required-by 257 CMR 2.00, or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. 10. Prior to obtaining a Certificate of Compliance for installation of a new or upgraded system, the system owner shall record in the chain of title for the property served by the alternative system in the Registry of Deeds or Land Registration Office, as applicable, a Notice disclosing both the existence of the alternative on-site system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the Local Approving Authority. a l� TOWN OF BARNSTABLE l y LOCATION, /.5`,'�r iL_ SEWAGE 3 6 VILLAGEk4uz;t4- ASSESSOR'S MAP & LOT� ��lU INSTALLER'S NAME & PHONE NO, SEPTIC TANK CAPACITY d 0 0® LEACHING FACILITY:(type)- �" _ (size) /00 O, W= NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER h&+ DATE PERMIT ISSUED: /•-/ e V-b DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No , v� No....�.................. F:cs............................_ THE F BOARD J HEALTH Ts `i9 F" fT - /Qke5,4,_ 4 ................OF............................ ................................... p Appliration for Disposal Works Tonutrur#iun Vrrmit _ Application is hereby made for a Permit to Construct ('(') or Repair ( ) an Individual Sewage Disposal System at:0'2 (o &�.� � /?7 d ' 1 AKP 1-I . .-... ----- --•- ---------- ••••-•-----•------....--•-• .................. ..................--•-- - location-Address or Lot No. H NJ ..........................•--•-fi F c; ... .............. .-••--....'..... ......................... ..:�....t.s-•-.-_..t Owner Address w Installer Address ,� -------------••---------•--g--------------....-------...........------•-•---..._...--------•---- -...---•-•-------.._..----......-._.......----------........----•i:-•:----:-..._...5q. feet . Type of Building Size Lot........ ........ aDwelling!f'No. of Bedrooms..... ..::.:............................Expansion Attic ( ) Garbage Grinder ( A Other—Type of Building No. of persons........._3.............. Showers (X) — Cafeteria ( ) dOther fixtures ------------------------•-----------...........------.-----------•....---••------------ ............................................................. w Design Flow.............._:�>.3...Q...............gallons per person per day. Total daily flow............. ..................gallons. WSeptic Tank—Liquid*capacity-55.0.gallons Length................ Width................ DiameteF................... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I--------- Diameter....../0......... Depth below inlet......._........ Total leaching area..................sq. ft. Z Other Distribution box (JE.),� Dosing tank ( ) 0-4 Percolation Test Results Performed by--------------------•---------------...•-----------.....-----•---•------- Date.....................................:. Test Pit No. I... ._-_minutes per inch Depth of Test Pit...... ...... Depth to ground water......JJ.,:4\......... Test Pit No. 2.....Ld�.._._minutes per inch Depth of Test Pit....... .1..... Depth to ground water------W-,&....... - P.' ........................... Description of Soil.... ----•-..... 4"h=v._.. _u� oI -----•-••-----6.d ...... x w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed dividual Sewage Disposal System in accordance with the provisions of iI'LIE 5 of the State Sanitary C e— h dersi ed further agrees not to place the system in operation un it a ertificate of Compli nce has be ' sue b h o r of h Siged..................... .. . .. •• .............................................. ............--•--_............. Date Application Approved By-- ---------------------- - �1.1t___. ...............----• -- . . ... .....---- ........................I _ Date Application Disapproved for the f ollowi g reasons-------------•------------------------------------------•---...--------------.....-----------••----•-•-----•---- ..---•--•......-----•---•••--•------•----•--•------------------•-•---•---••••----•-•••---....---....--------•-----•----.....-----•-•--------•---•------------------------------------•---------••-•----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF..............-.`..:.'. .'..............:-....................................... Allplirat pn for Dhip al Warkii Tonstrnrtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .................___....-.................................. ......... -----............-- ---.......a y:...r 5..7._.... _. '4_».......... Loc ....... i} ..... cation.Address .............................. . _..... / ►t iC• i�r Lot No A p ... Owner •-•-•-------- ....:�.....Address J�/) 1..._..._».»..-..»...._. W --------Installer Address �� Type of Building Size Lot______-,3..-____0.......Sq. feet Dwelling!!f No. of Bedrooms......Z.................................Expansion Attic ( ) Garbage Grinder ( A6A Other—a Type of ,,., No. of persons..........3............. Showers � — Cafeteria d Other ........ ( ) fixtures --•---=-••-••-• -•::..:...................•••-••--.......•-••••••------•-•---•••----•---•-----......•-----•--....-•-•--••-••--------•-•---------- Design Flow................�.3..:Q..............gallons per person per day. Total daily flow..............Z .................gallons. Septic Tank—Liquid capacity.,S_D_gallons Length................ Width................ Diameter................ Dept h................ x Disposal Trench No. Width.................... Total,Len ........ Total leaching area...................sq. ft. 3 Seepage Pit No-----------I l3 ..-_____ Diameter._-..._ .____-__ Depth below inlet__:..__:{p........ Total leaching arm.................sq: ft. Z Other Distribution box ( fi Dosing tank ( ) aPercolation Test Results Performed by-. ,..__ ...... ....................... Date.................... Test Pit No. 1__._ :.._.minutes per inch Depth of ,Test Pit......1 2.'..... Depth to ground water,.__.._V.A...._.. (s, Test Pit No. 2.........:......minutes per inch Depth of Test Pit........ .1..... Depth to ground water....... l :...... t�. R: --------------••-•------ _... ....•--•-••...... -•--------•••---•................. O Description of Soil -- .'.-•- CQ_+ yV.%_+-• r-�. n .I.L...........::. ....... 5�..�!!�?ll._.V.P-AY 9 L:.-----.. x ..... -------------------............................................... ----------•---------------------------------------------------- . ....... ...... U Nature of Repairs or Alterations—Answer when applicable.:..........................................:.:..........:._:_.._........._.................... ..._.. Agreement: ,: The undersigned agrees to install the aforedescribed dividual;.Sewage Disposal S"ystem in accordance with the provisions of TITLE 5 of the State Sanitary Co a—. h ersig ed:further agrees not to place the system in operation until a Certificate of Compl ce has bee i sue e o of hea Sild....*- ---------*... . . .. .......................................... .......... .....•__........ Date Application Approved By........................... ........ - - - ............_ " -0 _g •------ •Date--•••--••- Application Disapproved for the follows reasons:......................................................................-......-........................... __»_ --...-•................................•---......_...............---•-•--...-•---------......------.......__.....-•------•-------------•-----•--•---...----•--•----........._......•_•.._._..•----....._ Date PermitNo...................................................--... issued...................................._......-__......._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............lf........-......OF.........0 ............................................... Trrtif iratr of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............................................................................................................................. .......•------- --••••--•--•----.... .......................................:.__........... ._.... - ..... �I gt er . ' at......l•0.7---- .. ....._._.... 2.J _7 VkI t W - ... ............................... has been installed in accordance with the rovisions of TITS of The State Sanitary Co eat described in the application for Disposal Works Construction Permit No......_.._ `��..:=:.F,S' lo da - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S TI5 FACTORY. �. 2 / DATE:.... .. = --••........................... Inspector...._.. ------....-•---------------.._...................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p ..............O F..............-.--..................:..-.-_._._.........._...-..._................... c�- No................ 3�, Fa$....�-.. ......... �i��ru�tt.i urk� �nn�trnrtiun ��ermit ` Permission is hereby granted...................�.�.�.(?.f .!? f•+.t_.�� 1 .. ........»»_.. ... •• to Construct ( \4 or Repair ( y, an Individual Sewage Disposal,$yst {/�'� at No........... t3?• �..r.'}. 1 .;1 -i -• 'jj.---- KiL--.---•--�-••••--'-._...!....-•--••. -•-•-----•--•................... - / street ?- i 1 as shown on the application for Disposal Works Construction Permit NogS--... ......... ...� ted:.:.....____.__....._..................... ............................. -- l Crj 6 DATE. ¢ = - oard of ealt6 --......... FORM 1255 A. M. SULKIN, INC., BOSTON DESIGN S INGL._E FAMILY DWELL1N& W l�� Br-_Upzaom.s' YV(2 G A RBA GE D IS PC31-5A L --- ._...._... ..} - DA IL y FLOW -- l l O x = G. P, D. __. 9 �'D - ' SE P7'1 c TANK ( VOL . �E1�7'/> ) _J D. G.P. D GALS S. —z�-'- - 4o a 1,L20YJ GAL . TANK. - O,-K, .FIN!. oQ 0 r .!L000 ci.00 DI<3P05AL PIT o USE _-�_� D/A. X �(�' �❑P. t LSTONE o If E FFECY I VE DF PT N = .- a i \o r,,N �1 rl 1.000 12�. ti_KVE C,AP' TY : Ir x Ln. x +, _ � o , CA�.s.r 7, A X- 2.._ram__. _ �1-=71 � o = `� TDTA L CA PPS C I T `( _ Q. GALS. I 'T 1 . 1 E5AP.P '1 �' LAI�IF Tjo L vYv�Y C T Fi N, FLDDR S l TF__ PL A =2.. �ASSUMEDI _TE ST P( 7s ir RL Rc TEsr SCALE • I rI -* 30' -r0V OF WALL FIN.CR.CL. 95o Ex ,s r ((vim -/ Ex tS7"I NG GK.L L .g4� �#: I C-3 F-A � ,r� of rNgss = ' s XX --- ------- 93 F'vr'; -�3 O�� 9 /. hI�LY 9 z,z5— I — 9 z,z5 Attu � .. hs,UPR.M R As NBCDED �u� c , _ :y :A I i� a KINGS©URT r �•r t u <a 4 P t -- :9 I w , VC 9 ' r IN\j 9ANL;� y i.AY 1 l YTi:Yr' .��#267[Di�O P;i /8TEF6� I NU a�'�'-�J I O0C1 I go— I — q.0 �� ST>tR y� n�►� °� . 1 I INV.r?t.75 GAL. ;� I , �_ L XrzL, x1-o surt1�. t I t — I -'� P.C.COnG i CELLAR l=Lo�2 - IO MIN,— 9 � I o� Fe o I EL.'al STATIC + SEWAGE DISPOSAL SYSTF_ M ❑ESIGN I TANK I 1 � u I ; - s-I — { � � — �:1 - ._r wiz o� ��,� 7� r /z . - — 2 0'M I N. I W A-9"E b S-rcD N E s A Nl_r c.k%' _ 1 M r) L;M rD (1,L)/ F o R_ -A 1 { I ' = LE f,__ ;r t I C L'1 ALL ARnUND w/Z I .2n,,rrrf!Ne<! C �` `' SCALE II 1 EL, _`b�l o of .— -... ( o LAYER PE ASToNt= 1 ( � �L_ i-�-1A1_(l4A, (�)_;'. UENT. I = 4' ON Toy, i' oN ,I PRDFILE of ❑ ISPDSAL _SYSTEM I`IOTE : ❑ ISPDSAL JY"TEM To FCC- G0N3'TRUCTL0 IN STRICT LANTEPY ASSOC. r P- ( , (So CONSULT, E"r,,R. E.8ANL, MA , I AccnRDANCE nF Cnr��--� . �� f`(\AS � . F rlv� pori. Gn>✓'F Tlrl_ t._ It �" TESTED.. 9)�?J ,..._ ��' .. , t I 1 _ I ATL. _ _ kAlG. Y I D GENERAL NOTES: RISER TO WITHIN 3"OF 153" 1. NITROE 2KS TANK TOP TO HAVE THREE-24",TWO-12 HOLES AND FINISHED GRADE TOTAL TANK LENGTH MULTIPLE 4"HOLES WITH RISERS AND COVERS FOR MAINTENANCE \V EL.55.5 ` _ OUTSIDE WALL TO OUTSIDE WALL AND SAMPLING. =� - - - A 1I1=III=- �. .. I- - III-III - . .OUTLET TROUGH(OT) LOAM AND SEED_ �`�• .� , •�,: ar � '",�.. -,� �:� 2. FOR THE 24"HOLES;PROVIDE 24"DIA.ADS PIPE(CORRUGATED) t, WITH POLYLOK(OR EQUIVALENT)COVER(OR EQUIVALENT _EL 64 24 TANK WALL Y w CONCRETE RISER AND COVER)TO 12"BELOW GROUND SURFACE CLEAN _ -_ = - s THICKNESS z T P --BACKFILIL-- TAND SECURE TO TANK O --- - s `. AT TOP .. n „ E ADS PIPE CORRUGATED AND POLYLOK _ --- :.:. W 3. FOR THE 12 HOLES; USE (CORRUGATED) -- - - _-_. k• ': :r' � � (3R:•I•Yp) .-► - 06 OR EQUIVALENT COVERS TO 12"BELOW GROUND SURFACE AND - _ _e_ �_ ---- r;______•� _ - MIDDLE - a 40� SECURE TO TANK TOP. _ FLOW--► _ - ,� , •..'• _ `: ,.., -.. ;� u. _ " :.: � r�' �' •c TROUGH 4. PROVIDE FOUR 4"DIA.SAMPLING PORT 1"BELOW GROUND _ � _- _____ � Lu INLET cn ( __ �__:: �------- k. = o MT ¢ SURFACE WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH 6 OF 3/4 �-- - S RGED ( ) DENIT CATI � ) ----_ / v� EFFLUENT TROUGH � .;EL. 52.65 ,�,^ 4.24' � • _ •- , "„ • � : ,: �. s « ��:� �;;,<. p o� � ...,- ---- - ' COMPACTED TED 4.24 -I- IT N HAMBER WITH GROUND SURFACE. - - __ __ 0 C / 4.90 TYP. \ FROM SEPTIC ( ) A � _ � v ,,, ,. . _ :., ALL, � >= � ,, .+x:; ,_ _ ., �• �:_ , ��;: ';`�," v,�, a. ' � 5. FOR EXISTING SEPTIC TANK PROVIDE 2 DIA,SAMPLING PIPE THAT �,,,.,� ,�4, CRUSHED `C y €€", ,,, ,•, „. ; t, , ,. .,-��.- ,e,4,. .,,. r._-, ,,. y�:.;., ea Y O TANK C Al B (DC) _ IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" STONE BASE s° r. s c _ I • : , ! O O6-12" BELOW THE TANK TOP AND BE POSITIONED FROM THE EDGE �, m J O O xa � � I J EFFLUENT OUT OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK 9.90' 9.90' �" '" `'' „ � R "" C �-- Q CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, I I I ` I :I • " .,* O �, - I 8.50' k;. ry - O w THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE 4 ri .N m F- o TYP. .,: - o - GROUND SURFACE AND HAVE A 6"DIA.PLASTIC ROUND BOX AND NOTES: F- COVER AT GROUND SURFACE. 1: PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL �� • LL' t s � �, -� � N � i o TANK WALL STABLE BASE. 25.00' - THICKNESS 2. BLOCK TWO OUTLETS. , , AT BOTTOM 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. 4 ,;_ '` j CHAMBER DIMENSIONS = � , ., (4 1/2"TYP) < .. . . , . , :- , 4. INSTALL SPEED LEVELERS(OR EQUAL)ON OUTLET PIPES. <,, m a x n R ! �, r5".. sl c,z. / 8 PROPOSED H-110 DISTRIBUTION BOX DETAIL �' _, " � x � � � �.:a. { `° ACME'PRECAST OR EQUIVALENT US 11 NOT TO SCALE . ' 6"PLASTIC BOX AND COVER WITH 4" v H � SEE NOTES 3 AND 4(TYP) SEE NOTES 3 AND 4(TYP) MONITORING PIPE;SEE NOTE 2 AND 4(TYP) LYSIMETER INSTALLED AT INLET 0 m w 3/4"TO 1-1/2"DOUBLE WASHED RISER AND COVER TO SIDE OF GALLEY LOCATION TO WASTEWATER NOTES p` SEE NOTE 2(TYP) 24"ACCESS HOLE WITH COVER SEE NOTE 2(TYP), 4"SCHEDULE 40 PVC STONE TO CROWN OF PIPE GRADE AT LOCATIONS BE FIELD VERIFIED. y GROUND SURFACE TYP EL.55.6-56.2 MIN SLOPE 1% s MIN SHOWN IN PLAN VIEW 1. ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SURVEY CONDUCTED SEE NOTE 2(TYP) T MAX TOP OF SYSTEM o m BY THE HORSLEY WITTEN GROUP,INC.ON NOVEMBER 20,2020. TO SOILc w 5 1/2"TANK TOP(TYP) ABSORPTION SYSTEM BREAKOUT "a' 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE IN v M w FILTER FABRIC (SAS) �' .. ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE LOCAL •�+ p r: v o •;;a,.,. :ti � ,�,: w"t' nt' ti•F:�:J:6R7.: '.•�s��e:�;,;„;:.. x a;vr, BOARD OF HEALTH. � > � N a'• 'e. :�'•S ` .�^.%a%-:` .,y�",k5•. y,R�',•.s?�F �'�, y .,+s „:yF''• + ,7. .b,.` � :t a::1:.gy.• a..S:tia»s'.'i,.;:�v, •,•r;rr..'; a,'F?. ..,f. � > 4. EFFLUENT FROM SEPTIC EFFLUENT B ?, cr'• z� r r,Yt s,<. 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO LAYOUT AND W , O O c� 4V STATIC WATER DEPTH • y w . + t+4 l f.. X'. _ O .w`r'n•�a,...,,. ,.L�.a'--+.,.:a�-:R:^s ^`�«.�'.^ :a ..,..0 4 .°a,',..�_ « Y.. .� :f.�2 O TANK = R��:ur•,s,Rd•. &• ,:��.4y,R<�:�:->-s.�:•:�..r,a:M.,�'.rt:?�:>-;�;.�;1"�,�;r::t;••rwr:.„,a.��,'�`�m.•:.ssa ,•� :.�-."�e•�-`+,, ;�+. _}�:^ >$�.�,r:•.x' p�.'.••,.-.-..,a�'y�„•,>,��.;'..3+w:s•>�r•>�.,v CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON IT AND SHOULD NOT BE USED ►. +. „rp •t., c� o ti .3 FOR ANY OTHER PURPOSES. to W �yG. @ #' m 3� «w xs4 ySa `x�µ?r ... � � ', Y. = Q "IDh• A•..d $ ^t .{ a4 Q. :: 6'}•.Se•.�„i.,S�! yi ::i.�•e+ '•a :tiY'sr..,y@ .F.EyV.. :.L:i'F t,w.:br vrtd+X 9v.i4.i'••- x. # ?'��F •. :'k.t. 7 A•'1'L: »+��':i. .4T.q.«..,.•„y%Ka`k'a.h'� ''t9.o 4'":S'...t• I&.. `?'+. Ta fis t.NY;..,. .�:,»i) � � ell) w 2' gr lax V {a. „o' s' '? ".' ? k +x" P` 4. O T MUST BE APPROV D BY THE ENGI EER AND/dR THE LOCAL BOARD OF HEA TH L w a O oo w LL �.q, y ANY CHANGES T HIS PLAN E N L a r. s. • 0 O �► � • w •S" S'. \r4'.*. P "T Su.+S' Pr ): •A.r;:y`9 ... n'X 'A: I wd9La O U� 1- LL ...w y,.,• "'Y'^'•'-0' a°c 2. ,rfi. .4^ -t....q..ar. °T. ° 'y�' ^: 'T•;r ' ,ah r. w :�` . •. , .e -N '.• s..,; ;w. .. ,�., ... r:a (BOH)STAFF. W Z fix+ Aye ., ;.�Yw � .,ej„ : .'s "S:", sx' 6 rt � i 4'ri: �,f �rac; t p O O cc F- a SUBMERGED DENITRIFICATION CHAMBER o a Q w 1C .: .,,: i y". ^` K _ o> CO) O o 0_ _ - !• v W r,. • �• �••.. • •-�•'�--.• '*-•�_-•• .. •+ '� ' ••�� --'�. 5. PRIOR TO CONSTRUCTION THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY OWNER AND o > � I -.. AERATION O (DC) � w n• F- a •-..��'•. '•,�?......,,�::_.: .,<<.. "" '' '` � �._; ;,,: .: ,... i Q z O CHAMBER O 1 > z w z 4•0 8.5' TYP 4:0' ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE AREAS. _ I 4.0' 4.0' I- p J �-� o N z w w r ( ) O H z y o (SAC) F- O O�O D I- 25.0 i 4.9'(TYP) 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY LOCAL AND/OR STATE ~ LO ~ _J w ~w '' " s'MIN PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE REQUIRED TO TAKE PLACE OUTSIDE OF m `° F-v p I- Nwv? 12.9' L� w o D m NORMAL HOURS OF OPERATION FOR THE FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. r O LEACH CHAMBER-INLET 52.9 ' )^ ® CHAMBER BOTTOM TO INVERT 2.0 GW ELEVATION CHAMBER END VIEW 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN ON v 1 LEACH CHAMBER-BOTTOM 50,9 . . ..' :�,.• ••• . ._„ " •.•` �( „ � THE PLAN TO THE DESIGN ENGINEER. 0 i EL.49.0 BOT.OUTSIDE . : KleanTu L BREAK OUT(TOP'SYSTEM) 54.0 12"CRUSHED AGGREGATE OR APPROVED Q i LOWEST FINISH GRADE 56.0 PROPOSED H-10 500 GALLON CHAMBERS 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OR CHANGES TO TANK BOTTOM MINIMUM COVER 2.0 NOT To SCALE THICKNESS 4" EFFLUENT FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR ADJACENT TO THE SITE,MAY RESULT IN W z MATERIAL;ON LEVEL,COMPACTED AND HIGHEST FINISH GRADE 57.0 WIGGINS PRECAST OR APPROVED EQUAL IMPROPER FUNCTIONING OF THE SEPTIC AND LEACHING SYSTEM(S). TANK WALL THICKNESS AT BOTTOM(4") STABLE BASE MAXIMUM COVER 3.0 CAL "DI S F T E 2 S 1 G - - - UJ '^ D G W.ELEVATION 44 9. L G A E A L AST 7 HOUR PR OR TO COMMENCIN CONSTRUCTION AT 1 888 DIG SAFE AND ANY TANK WALL THICKNESS AT TOP(3 ) v) j WROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM (WWTS) ESHGW BELOW SEPTIC BOTTOM.- 6.9 OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF EXISTING UTILITIES. Z _ _ N-ASST20M-H1O 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. < _J U J NOT TO SCALE Q TREATMENT SYSTEM DESIGN CRITERIA 11. THE OWNER SHALL HAVE THE SYSTEM INSPECTED AND HAVE THE SEPTIC TANK PUMPED EVERY 3-8 YEARS. � ) LLI 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE PIPES ENTER OR LEAVE U) Cl) a RELOCATE EXISTING GAS SERVICE ANY CONCRETE STRUCTURES. z Q d co USE SINGLE FAMILY jI �' NUMBER OF BEDROOMS (DESIGN) 3 13. USE SCH.40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE W O O 'Z7 IN, ° TITLE 5 DESIGN FLOW 110 GPD/BEDROOM PLACED ON A COMPACTED FIRM BASE. m [� � �- . cq TOTAL DAILY DESIGN FLOW 330 GPD 14. 'ALL STONE TO BE�OOUBLE-WASHED AND FREE OF DIRT,DUST,AND FINES. 2--500 GAL. LEACHING � EXISTING WATER SERVICE �/ �, ^ VAR 1 � N78°05 5,E* GARBAGE DISPOSAL: NOQ L� M U J CHAMBERS WITH 4-FT STONE "`w, 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND)I►AINTENANCE INFORMATION FOR THE MM IM INV. IN=52.90 100.00 SEPTIC SYSTEM TO THE ENGINEER,IF NECESSARY. W 11.0 4, SEP77C TANKry rNy 200°/a OF DESIGN FLAW: 660 GALLON 16. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR 18.255(3). ANY 1- 1..1.E W PROVIDE 40 MIL: PVC -I- 68 5r�z4 ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL SHALL BE REPORTED TO THE N Cn W m IMPERVIOUS BARRIER 66 EXISTING OVERHEAD ENGINEER. G '"�•.,, ! USE EXISTING 1,000 GALLON SEPTIC TANK < AROUND ENTIRE SYSTEM ELECTRIC, TELEPHONE � Q m LENGTH=±73' & CABLE SERVICE I 17. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. EL. 50.9- 54.0 G `° SUPPORT EIXTING SEPTIC TANK DURING LEACHING SYSTEM DESIGN CRITERIA 18. ALL SEPTIC TANKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS MATERIAL. � . N OH W LEACHING FIELD CONSTRUCTION AS m W N 1 O.0' CJ i W - - SOIL ABSORPTION SYSTEM 19. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION AFTER L . NECESSARY CONSTRUCTION IS COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL BE LEFT NATURAL.THE I�-)^ +56 O � � � CONTRACTOR SHALL TAKE CARE TO PREVENT DAMAGE TO SHRUBS,TREES,OTHER LANDSCAPING AND/OR i ai v 16.1'' LEACHING SYSTEM USED: CONCRETE CHAMBERS NATURAL FEATURES. WHEREAS THE PLANS DO NOT SHOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONS c % , N c' 15.9' ✓ ; DESIGN PERCOLATION RATE: 2 MIN./IN. MUST BE VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK. U) 6'a EXISTING 1,000 GALLON SEPTIC SOIL CLASS. _-_ ,______. .___.'_ a a RISER AND COVER TO ° VAR 3 ,C GRADE WITH LYSIMTER TP-1 TANK TO REMAIN __ .__.. __ _._. 20. ALL UNPAVED AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF LOAM INSTALLED AND 11 INV. IN = 53.91 LONG TERM ACCEPTANCE RATE(LIAR): 0.74 GPD/S.F. BE SEEDED WITH GRASS SEED AS SHOWN ON THE PLAN AND/OR DIRECTED BY THE ENGINEER. THE; -} 55.82` LU TOTAL AREA REQUIRED-LOCAL CODE:' 446 S.F. CONTRACTOR SHALL BE RESPONSIBLE FOR WATERING ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS L I INV OUT=53.66 - LO ESTABLISHED AND APPROVED BY THE ENGINEER AND/OR OWNER. N f 1 r) TOTAL AREA REQUIRED- TITLE 5: 446 S-F; cu C) I 21. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE SYSTEM MUST BE 4" SCH 40 PVC ✓ co i TOTAL AREA PROPOSED: INSTALLED AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT OF ENVIRONMENTAL PROTECTION(DEP) U I L=28.0', S=1.0% j ,J 6 BARBERRY LANE PROVISIONAL USE APPROVAL. tW _ 00 +55.6� � RAISED RANCH � A (Sldewalf) (25+9 83+4 24+19+4 24+9-83)x2 144 S. � L0 (A z f r ( 'BEDROOM DWELL G A(bottom) = (25x12-83)-(3 3) 312 S.F. _a) �, o N 22.1 O , WASTEWATER INSTALLATION INSPECTION NOTES 5 Q 04 U ` T�cp TC7TAL AREA: 458 S:F; 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE ENGINEER AND LOCAL `o L 00 U_ � p cia .- `Q ' VAR 2 TOTAL ALLOWABLE FLOW: 337 GPD BOARD OF HEALTH FOR ANY INSPECTION. a N _ c N °i U a L m U) 2. ALL WASTEWATER COMPONENTS SHALL BE INSPECTED BY THE ENGINEER AND THE LOCAL BOH c d� I USE z-500 GALLON CHAMBERS SURROUNDED IN 4-FT of STONE REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL BE INSPECTED: a` m U � 0- O 0- V 10.01 4" SCH 40 PVC EXISTING 2A. SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL L=6.5', S=1.0% / DISTRIBUTION BOX 2.2. LEAKAGE TEST ON PRECAST TANKS(MIN.24 HR) V I O f / TO BE REMOVED 2.3. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS DESIGNED 15.6' TITLE 5 VARIANCES 2.4. FINAL INSPECTION OF BACKFILLED SYSTEM 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND NOTES INDICATING THE '- +55. _ 4 NO. REGULATION - i REQUIRED I PRtOPOSED HORIZONTAL AND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM COMPONENTS INSTALLED. THESE AS-BUILT 04 / DRAWINGS AND NOTES WILL BE UTILIZED BY THE ENGINEER FOR THE PREPARATION OF RECORD PLANS. O q 1 =31©CMR 15.211 Mlnimurrl SetbacK distance to Water supply tine 10 feet 6 feet Lu 5 _ _ _ _ _a. _ _ . 0 � 4 r I 0 - Cn r ...,a_ �/ (y iA variance of 2.4 feet is being requested. I "..".... 1.J CV �, � _ �-� -t-55.47 „ AI r. 2 310 CMR 15 211 Mlnimum Setback distance to leaching catch basin & dry Wells :25 feet i22 1 feet ESTIMATED FOOTPRINT rn `n ___-_....__. '_ `_ ~-- r_equ_e_ste_d________,__ _ -•� A"�`� �- I � Q �A variance of 2 9 feet is being requested ; J+ k-� N OF UNDERGROUND Ck 3 I310 CMR 15.211 Minimum Setback distance to cellar WaII W-m _ _;20 feet 95 9 feet SOIL TEST PIT DATA o O DRAINAGE _ gquest.W.-:___ _ _ 115- fe '-' iA variance of 5.3 feet Is been requested. L L 4,l SCH 40 PVC o" s.2 o N L=2.0', S=1.0% EXISTING LEACHING 10YR4/3 PERFORMED BY: MATHEW LEHMAN, HORSLEY WITTEN GROUP, INC N 19 � N Y LOAMY SAND WITNESSED BY: DON DESMARAIS, HEALTH DEPARTMENT o co ccrr, "? PROPOSED PIT TO BE REMOVED 17 4.8 DATE: SEPTEMBER 9 2021 'S ¢ °O M E DISTRIBUTION BOX NEST PIT NUMBER PT 21-224 ¢ IS a3 0 • INV.IN-53:32 w ZONING & RESOURCE PROTECTION NOTES 1oYR5/4 0.. a� � � -- o z � � INV. OUT=53.15 LOAMY SAND I certify that I am currently approved by the Department of Environmental Protection a'i o a EXISTING DRIVEWAY PROPOSED NITRIDE 2KS 1. PARCEL ID: LOT SIZE:0.21 AC O c o s ' a pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has = o co c M co N 2,000 GALLON TANK Lo 2. OWNER OF RECORD:MARY A AND DENNIS E HEALY TRS 30' C1 3.7 been performed by me consistent with the required training,expertise and experience = rn cn °- u o PROPOSED AIR PUMP M INV. IN=53.59 ADDRESS: 26 BARBERRY LANE,MARSTONS MILLS 2.5 Y 7/3 described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as Registration: FINAL LOCATION TO BE INV. OUT=53.34 VERY FINE SAND indicated in the attached Soil Evaluation Form,are accurate and in accordance with 310 r- � " FIELD DETERMINED 3. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON PERC @ 36 CMR 15.100 through 15.107. • F.I.R.M.MAP 25001CO542J DATED JULY 16,2014). 80„ 4 MIN/IN 49.5 � tK OF��0 C2 ' 4, THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. 2.5 Y 713 JOSEI;ty E �' O PROJECT BENCH / MED SAND � 14 so �t, MAG SET EL,= 55.52 I 120' 46.2 HIV{ 'i NO GW OR REDOXYMORPHIC +ua N78°0 25"E FEATURES OBSERVED 100.00' s A r N Project Number: Sheet: O 20112 1 of 1 co t- Sheet Number: O Z WW - 1 GENERAL NOTES: RISER TO WITHIN 3"OF 153" 1. NITROE 2KS TANK TOP TO HAVE THREE-24",TWO-12"HOLES AND FINISHED GRADE Z (OT) AND SAMPLING. TOTAL TANK LENGTH MULTIPLE 4"HOLES WITH RISERS AND COVERS FOR MAINTENANCE w EL.55.5 M OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH „' O 2. FOR THE 24"HOLES;PROVIDE 24"DIA.ADS PIPE(CORRUGATED) W LOAM AND SEED_�j(®I I(� _� - - - - --EL.54.24 WITH POLYLOK(OR EQUIVALENT)COVER(OR EQUIVALENT ___-_ k TANK WALL °'' ` Y w CONCRETE RISER AND COVER)TO 12"BELOW GROUND SURFACE -a CLEAN _ __ _ __ - = _ m THICKNESS ¢a AND SECURE TO TANK TOP. BACKFILL - __- - -- AT TOP I 3. FOR THE 12"HOLES;USE ADS PIPE(CORRUGATED)AND POLYLOK _ �- ®�__ i k a _ , -J (3„TYP) O U (0R EQUIVALENT)COVERS TO 12"BELOW GROUND SURFACE AND ----- - ---- -- c MIDDLE „ w O SEC RE TO TANK TOP. _ I I FLOW-. _- ---- _ I 19.00' w �_ TROUGH _ ' 40 o J 4. PROVIDE FOUR 4"DIA:SAMPLING PORT 1"BELOW GROUND ------} mFLOW I- ----- w IN in ( _ r = o (MT) t<t SURFACE WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH = -_ _ 6' OF 3/4 / \ - FLUENT TROUGH SU RGED DENIT CATI ) EL.52.65 " p m E p WITH GROUND SURFACE. .. ...: ---- - ' COMPACTED /4.24' 4.90'TYP. 4.24'\ FROM SEPTIC (IT) A N HAMB - _ __ __ 5. FOR EXISTING SEPTIC TANK;PROVIDE 2"DIA.SAMPLING PIPE THAT _ CRUSHED C y �' w a Y 0 TANK C A B (DC) r ( ( r'". „ m 81 �" z O IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" I STONE BASE 12 90' Q I- S C) O --I i I I I ( ' BELOW THE TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE " W ~-' EFFLUENT OUT _ O � -� ,� � OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK 9.90' � � 9.90' " d ¢ ! N CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, 0 � I � � I I � I I I� ' � � �¢• °� w THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE 8.50 LO TYP. .� o A GROUND SURFACE AND HAVE A 6"DIA.PLASTIC ROUND BOX AND NOTES: '' o I- �y COVER AT GROUND SURFACE. 1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL TANK WALL STABLE BASE. 25.00' THICKNESS 2. BLOCK TWO OUTLETS. ` AT BOTTOM 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. # 41/2"TYP) .. :_ .•. • 4. INSTALL SPEED LEVELERS OR EQUAL ON OUTLET PIPES. CHAMBER DIMENSIONS <� m i Lu PROPOSED H-10 DISTRIBUTION BOX DETAIL �rif r ACME PRECAST OR EQUIVALENT NOT TO SCALE v SEE NOTES 3 AND 4(TYP) O 3 6"PLASTIC BOX AND COVER WITH 4" v m w SEE NOTES 3 AND 4(TYP) MONITORING PIPE;SEE NOTE 2 AND 4(TYP) LYSIME TER INSTALLED AT INLET m WASTEWATER NOTES 3/4"TO 1-1/2"DOUBLE WASHED j RISER AND COVER TO SIDE OF GALLEY LOCATION TO � SEE NOTE 2(TYP) 24"ACCESS HOLE WITH COVER SEE NOTE 2{TYP). 4"SCHEDULE 40 PVC STONE TO CROWN OF PIPE GRADE AT LOCATIONS BE FIELD VERIFIED. to GROUND SURFACE TYP EL.55.6-56.2 MIN SLOPE 1% s"MIN SHOWN IN PLAN VIEW 1. ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SURVEY CONDUCTED SEE NOTE 2(TYP) s'MAX TOP OF SYSTEM L w m BY THE HORSLEY WITTEN GROUP,INC.ON NOVEMBER 20,2020• 5 1/2"TANK TOP(TYP) TO SOIL BREAKOUT +z 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE IN C v C1w (SAS) SYSTEM FILTER FABRIC C r C1 as o ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE LOCAL '.' `�a's:.;.�`�`�'t,. ;;; ��:�: .f. ;,;cwF =•�•r.> BOARD OF HEALTH. ABSORPTION EL.54.8 p r> i r' r' ' ►y .,v ...:• e'' ;< •. ;® '.•' :a:. � . .' .•'' •'� ' A .. :a. .. *'. �. ... 'd : a'k +.•'. . w,,C. ..,q.;°i4 If, ot q.. •L .:Y" ,a .°RA ' y,.•'.:n: ., �P-,°' `"'E. .�. h� � =' ".,' *' = 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO LAYOUT AND ref W Q o O w EFFLUENT FROM SEPTIC �;.. i, ,. EFFLUENT wy' .,�. •48°STATIC WATER DEPTH .�t�,*�y^,.°i..,F 't$ ._ .. •"!v:•._ .i'�. S•1 .: :! :, s ,. r... Q� o tc� •t,..', •7A .. � ,;"S..'Y...d,- .. ..+:5-'..�• S,,.'.L.,y.. y"°! 4.+ .:w,# 'R .. .,..n:s..k»• .c P,..:.Y• .. d Q� Q TANK _ �;•' .; : ��+ ..f .,.:r.�,,..� ^�t�.�. a• �+r,'x':-' � r...,,,..�:• .,.,;.a..w„w, ,:,. , .,,�,..,;r•°s,.. ,. ..,.,�„r•.�• .,r,�r.=9:> ,�., CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON IT AND SHOULD NOT BE USED .. ..°. �,A � Y' } ,<a. .�t< „.n« ;.i." f,Zle�.,, .t'�.w,#.a �. .Am .t ..F;.t`.,l .i L 'k. f ..s.u. d. a j , .- :t � 3�3 FOR ANY OTHER PURPOSES. i d v M cl w 3' .>� +' , `�' o: i�° µg'i H.. 1 r a..- t. R w p w ., Pj M u��,FC. vt,w;k,4'.n:,;.v. n`t 5:4'W ...'R' 'C:<3,::t`". -:,i !•�....�`i`.. epy^�'•. ,±;j.., A,a st'.gip,� ., :iw.,y...r,.W:.?a..•c.:t,_Ay'k;�i "�1.. p � ,.A; ..r�.. .��•,�;*,�° :w-' `em`..''a�e....�1..•)f'r.:d^Ha,y:R;d s•_.heg. ;x`°';�•, ::�i??�'�3ir• `i11.�..... "� •ara;..-,_ ..�c.. •C'. `� l'y M ry' to - 3 a w 2' , ,• "t' E y;i ,• ,} 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL BOARD OF HEALTH L w 't� Q LL --.' r '�• r 4r , w.; t= "�f V! 00 CO Oi pr " ,. a rr, u >w' ,r », I� , s:,. �r. BOH STAFF. 0 m LL' den ,.iG a'k,t,p. >? ..: .d <::e <' "rtb,tsi `•g,; ".•$�^..' ,1.,rr.+3't x '• ,. "Lx^ .:G.,}iyi. F,p ( ) /+�� Q CS o ,w f'- 'V'r °e.�s .,.�S;s ;i t bl•; s. X :: a s N• e � F- a SUBMERGED DENITRIFICATION CHAMBER "' z¢w ^:` =� "° = i. ' ._7 y ,,:,' <. 2.0' O > AERATION p (DC) � W t- a " +`ter.•, +TLC`°'^'^a,•.['YM'+''" ;'•h.,.'3:"'`y v" _ `��:=.:�,':�-�:ti'�r`�:+ "„�:•.��.:�, � >,.- 5, PRIOR TO CONSTRUCTION,THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY OWNER AND z O CHAMBER O > z w z 4.0' 8.5' TYP I I ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCKPILE AREAS. W K w r (TYP) _� �4.Q 4.0' 4A' .J O z y O (SAC) F' 4.9'(TYP) I- s _ F- 10,309 r- 25.0 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY LOCAL AND/OR STATE co `n ►-~ - �' H iv w M s'MIN 12 9, PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE REQUIRED TO TAKE PLACE OUTSIDE OF w O fn NORMAL HOURS OF OPERATION FOR THE FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. _J O LEACH CHAMBER-INLET 52.9 IMPERMEABLE LINER(SEE SITE PLAN FOR LOCATION) 1 .` 1 ��//1� - ® . LU CHAMBER BOTTOM TO INVERT 2.0 GW ELEVATION CHAMBER END VIEW 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN ON v/ EL.49.0 BOT.OUTSIDE r .. ®.,: K l ea n T u L L C LEACH CHAMBER-BOTTOM 54.0 Q � 1 BREAK OUT(TOP SYSTEM) 54.b THE PLAN TO THE DESIGN.ENGINEER. 1 TANK BOTTOM LOWEST FINISH GRADE 56.0 PROPOSED H-20 500 GALLON CHAMBERS 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OR CHANGES TO L..1 THICKNESS 4" 12"CRUSHED AGGREGATE OR APPROVED MINIMUM COVER ZO NOT TO SCALE EFFLUENT FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR ADJACENT TO THE SITE,MAY RESULT IN W MATERIAL;ON LEVEL,COMPACTED AND HIGHEST FINISH GRADE 5TO WIGGINS PRECAST OR APPROVED EQUAL IMPROPER FUNCTIONING OF THE SEPTIC AND LEACHING SYSTEM(S). v! W TANK WALL THICKNESS AT BOTTOM(4") STABLE BASE MAXIMUM COVER 3.t3 Q TANK WALL THICKNESS AT TOP(3") G.WELEVAT,TON 44.0 9, CALL"DIGSAFE"AT LEAST'72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT 1-888-DIG-SAFE AND ANY WROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM (WWTS) ESHGW BELOW SEPTIC SOTTiOM.' 6.9 OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF EXISTING UTILITIES. Z J _ Z N-ASST20M-1-110 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. J NOT TO SCALE 11. THE OWNER SHALL HAVE THE SYSTEM INSPECTED AND HAVE THE SEPTIC TANK PUMPED EVERY 3-8 YEARS. rQ� v/ TREATMENT SYSTEM DESIGN CRITERIA LU 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE-PIPES ENTER OR LEAVE LL v 1 RELOCATE EXISTING GAS SERVICE &-) ANY CONCRETE STRUCTURES. � ZQ LL �. co USE: SINGLE FAMILY NUMBER OF BEDROOMS (DESIGN) 3 13. USE SCH:40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE W 0 O TITLE 5 DESIGN FLOW 110 GPD/BEDROOM PLACED ON A COMPACTED FIRM BASE. m -- A . L CHING `` EXISTING WATER SERVICE W TOTAL DAILYDESIGNFLOW -3�30 GPDFINES. W .� �. 14. . ALL STONE TO BF DOUBLE-WASHED AND FREE OF DIRT,DUST,AND . v J 2 500 G L EA VAR 1 78°05'25" GARBAGE DISPOSAL: NO Q (� � -1 CHAMBERS WITH 4-FT STONE X W E 100.00' 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE INFORMATION FOR THE MM INV. IN=52.90 SEPTIC SYSTEM TO THE ENGINEER,IF NECESSARY. W 11.0 �, W °�, SEPTIC TANK Q a ,Z5` 200fo OF DESIGN FLOW. 66tI GALLON 16. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR 15.255(3). ANY I- LL W PROVIDE 40 MIL. PVC + 6 G W ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL SHALL BE REPORTED TO THE N m EXISTING OVERHEAD ENGINEER. W IMPERVIOUS BARRIER "''�" „� / USE EXISTING 1,000 GALLON SEPTIC TANK z I'_ Q LENGTH=±49' - ELECTRIC, TELEPHONE 17. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. 'Q m EL. 50.9-54.0 &CABLE SERVICE I LEACHING SYSTEM DESIGN CRITERIA 18, ALL SEPTIC TANKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS MATERIAL. Q N OHW OHW 1 SUPPORT EXISTING SEPTIC TANK m -`01�� DURING LEACHING FIELD 19. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION AFTER e- 10.0 SOIL,ABSORPTION SYSTEM I- 07 + 2 1"" CONSTRUCTION AS NECESSARY CONSTRUCTION IS COMPLETE, AREAS NOT DISTURBED BY CONSTRUCTION SHALL BELEFT NATURAL.THE r� T` y ,� CONTRACTOR SHALL TAKE CARE TO PREVENT DAMAGE TO SHRUBS,TREES,OTHER LANDSCAPING AND/OR v) N 16.1"' - ' '' LEACHING SYSTEM USED. CONCRETE CHAMBERS NATURAL FEATURES. WHEREAS THE PLANS DO NOT SHOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONS c T 2 4 f= DESIGN PERCOL4TION RATE' 2 MIN./IN. MUST BE VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK. p� 'I RISER AND COVER TO ' �'� `- 15,9 EXISTING 1,000 GALLON SEPTIC SOIL CLASS: ta. _ VAR 3 TANK TO REMAIN _ _. __._,__ __ 20. ALL UNPAVED AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF LOAM INSTALLED AND a GRADE WITH LYSIMTER TP-{ INV. IN = 53.91 LONG TERM ACCEPTANCE RATE(LTAR) 0 74 GPD/S.F. BE SEEDED WITH GRASS SEED AS SHOWN ON THE PLAN AND/OR DIRECTED BY THE ENGINEER. THE Z +55.8 0` W TOTAL AREA REQUIRED-LOCAL CODE: 446 S.F. CONTRACTOR SHALL BE RESPONSIBLE FOR WATERING ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS INV OUT=53.66 ESTABLISHED AND APPROVED BY THE ENGINEER AND/OR OWNER. Cn TOTAL AREA REQUIRED-TITLE 5. 446 S.F: 0CU +- d 21. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE SYSTEM MUST BE � 4°SCH 40 PVC � � o / TOTAL AREA PROPOSED: INSTALLED AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT OF ENVIRONMENTAL PROTECTION(DEP) _ U I L=28.0, S=1.0% L `_ /I 6 BARBERRY LANE:o coM ° cts PROVISIONAL USE APPROVAL: O +55.6 --_ RAISED . ( ) =( 5+9.83+4.24+19+4.24+9.83)x2 144 S.F. U , RANCH A srdewall 2.�..,.�,.�...�.,,°,.�-, �.�.�.._�_. CA _ ' �k i `BEDROOM DWELL G A(bottom) = (25x12.83)-(3.3) 312 S.F, q) o N WASTEWATER INSTALLATION INSPECTION NOTES c� 22.1 0 :,� `STEP s ..�........,.�.,.,%..�„ .,�..,, .,.�.... ,,...._ TOTAL AREA: 456 S.F. � s� :0 I VAR 2 S 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE ENGINEER AND LOCAL o Q ` TOTAL ALLOWABLE FLOW: 337 GPD BOARD OF HEALTH FOR ANY INSPECTION. _ c <v ai Ln x_ co - lU i s _ - -❑ m` E co M m z ALL WAEWATERSHALL BE INSPECTED BY THE ENGINEER AND THE LOCALn. a> IS USE 2-500 GALLON CHAMBERS SURROUNDED/N 4-FT OF STONE 2 REPRESEN ATIVE PRIOROTO BACKFILLING AT A MINIMUM THE FOLLOWING ITEMS SHALL BEBIN PECTED: n` m U 000 ate- O d V I r \ ( \ 2.1. SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL ��. 10.0' ` 4" SCH 40 PVC EXISTING \ (� O I I L=6.5', S=1.0% �'✓ DISTRIBUTION BOX \ 2.2. LEAKAGE TEST ON PRECAST TANKS(MIN.24 HR) m Q 6 TO BE REMOVED `` 2.3. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS DESIGNED I 15. TITLE 5 VARIANCES 2.4. FINAL INSPECTION OF BACKFILLED SYSTEM � !' � � ��_.w.,,_c.�„n..-,. 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND NOTES INDICATING THE T - +55. r I REQUIRED PROPO§ED HORIZONTAL AND VERTICALLOCATI LOCATION NO. i REGULATI ON - y Y , Q O H TWO TIES OF ALL SYSTEM COMPONENTS INSTALLED. THESE AS BUILT O +5 68 DRAWINGS AND NOTES WILL BE UTILIZED BY THE ENGINEER FOR THE PREPARATION OF RECORD PLANS. O : 1 1310 CMR 15.211 Minimum Setback distance to water supply line 110 feet 17.6 feet' 1 _ A variance of 2.4 feet is being requested +55.47 . ql 2 310 CMR 15,211 Minimum Setback distance to leaching catch basin &dry wells ;25 feet 122.1 feet .,r - _. ESTIMATED FOOTPRINT ° - ---� D�cCk A variance of 2.9 feet Is being,r _._ _ ___._..-__. _. ___�__ __ - __ _ _. _.-- SOIL TEST PIT DATA a. requested. , , V NDERGR UND _ ' 3 310 CMR 15.211 Minimum Setback distance to Cellar wall 120 feet i 15.9 feet_ � .C? OF UNDERGROUND O �,, O DRAINAGE . °A variance of 5.3 feet is being..requested .r� __ w_- -_. ..w_ _ _._.- PVC ', I PERFORMED BY: MATHEW LEHMAN, HORSLEY WITTEN GROUP, INC L=2.0'H CD CN CD 0 0 S 0o EXISTING LEACHING WITNESSED BY: DON DESMARAIS, HEALTH DEPARTMENT o '0 U) N Y - PROPOSED PIT TO BE REMOVED o ch , 3 DATE: SEPTEMBER 9 2021 m +' N CI) m DISTRIBUTION BOX ¢ c ao ZONING & RESOURCE PROTECTION NOTES TEST PIT NUMBER PT 21-224 0 w _ o co a > INV. IN=53.32 I certify that I am currently approved by the Department of Environmental Protection 20. N �, °Oo z .� 1. PARCEL ID: 102/161 LOT SIZE:b.21 AC pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has m i o 5 z INV. OUT=53.15 •� EXISTING DRIVEWAY PROPOSED NITROE 2KS been performed by me consistent with the required training,expertise and experience p © m 0c 2,000 GALLON TANK •- described in 310 CMR 15.017. I further certify that the results of my soil evaluation,as cn Z N (n a U_ a 2. OWNER OF RECORD:MARY A AND DENNIS E HEALY TRS N - INV. IN=53.59 PROPOSED AIR PUMP ° indicated in the attached Soil Evaluation Form,are accurate and in accordance with 310 ADDRESS: 26 BARBERRY LANE,MARSTONS MILLS Registration: N INV. OUT=53.34 FINAL LOCATION TO BE CMR 15.100 through 15.107. FIELD DETERMINED 3. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON .,t F.I.R.M.MAP 25001 C0542J DATED JULY 16,2014). TP-1 TP-2 r 0„ 6.2 0 6.2 I?A QF Z3 `� 4. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. A A i)► ' ' N PROJECT BENCH s o ,` 17 LOAMY SAND LOAMY SAND 10 YR 4/3 10 YR 4/3 JOSE 4` MAG SET EL.- 55.52 C - i .8 17 4.8 Iw „ y. e B C Q. 1V 7$°05 25E ? 10 YR 5/4 10 YR 514 100.00' ❑r LOAMY SAND LOAMY SAND N 30' 3.7 30' 3.7 GRAPHIC SCALE C1 C1 " t7 2.5 Y 7/3 2.5 Y 7/3 N O 10 0 5 10 20 40 VERY FINE SAND VERY FINE SAND trZl Project Number: Sheet: 0 / PERC @ 36„ r - 80„ 4 MIN/IN 49.5 &0 C2 49.5 201 Of 2.5 Y 7/3 2.5 Y 7/3 4�- (in feet) MED SAND MED SAND Q e- 1 I NCH = 1 0 FEET 120 NO GW OR REDOXYMORPHIC 20 2 1NO GW OR REDOXYMORPHIC 2 Sheet Number: Z FEATURES OBSERVED FEATURES OBSERVED , w ,W _ fn --- --- - -Ran% I0/2.> z r T'