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HomeMy WebLinkAbout0225 LAKESIDE DRIVE - Health 225 Lakeside.Drive I`•Marstons Mills , .�P � A ="902 '159001 - -- J 37 i 3-s Lcjj 1 �1 dk UY-• TOWN OF BARNSTABLE LOCATION 125 1AWL ic�,-_ SEWAGE# 'VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. EQk gaf)e a SEPTIC TANK CAPACITY IT LEACHING FACILITY: (type) (5"- J)(size) NO.OF BEDROOMS 3 OWNER Er-,Afd, PERMIT DATE: Q 7 2 COMPLIANCE DATE: u 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 Q pt3,7-7 z '�,�s�a4 0�'�' � t3�• Iry Is _ A 3y '3®1. Ajo,39 0, f3e® o �z �n � �. 1 '225 Lakeside ®rive I Marstons Mills P A = 102 159001 �,A No. � c Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLation for Disposal *pstem Const urtlon permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2ZS � ,� jar, Owner's Name,Address,and Tel.No. �zv-skti�9 1�o'\IS Assessor's Map/Parcel .0 .,Cc, Installer's Name,Address,and Tel.No. �� 5veas Desi ner's Name,Address,and Tel.No. Q�6, �'►ZrrS�..S Yh+IdS _ Su I I I Jam, e.-t i n etyA►. j �06 yQt"33.1j- Type of Building: Dwelling No.of Bedrooms 3 Lot Size 7 + sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1330 Design Flow(min.required)l gpd Design flow provided 'D1� gpd Plan Date tD/ /Zd Number of sheets Revision Date f t7 - Z Title lab ")'be g Size of Septic Tank_ Type of S.A.S. 2 D �W Description of Soil 11— b Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo e th Signed Date 1L Application Approved by _ Date Application Disapproved by Date for the following reasons Permit No. 0 .1' i3 Date Issued �" No. �+ r� .'. FeeX` � tl� ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes s Nplicatlon for ZjspoBal *Pstein Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon j ) ❑Complete System ❑Individual Components Location Address or Lot No. Z,z�- � ►es��. p�, Owner's Name,Address,and Tel.No. mays,kr�n Assessor's Map/Parcel /p I - /5,9.,Ca Installer's Name,Addres ,and Tel.No. rEgiL 5TE\W_14S Desipner's Name,Address,and Tel.No. li"� �t.g i ncer`v. SOS- yz6-3sultr-_: Type of Building: ` Dwelling- No.of Bedrooms '' Lot Size 6160 sq.ft. Garbage Grinder{ ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min. required) gpd Design flow provided . 017- gpd Plan Date ��3/zG� Number of sheets Revision Date to - Q" 2 Title �j fo Y�caq\ y'be ,_ Size of Septic Tank Type of S.A.S. Z Cr Description of Soil 1r6 ♦ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boaxd of Realth Signed _ Si ed Date r � Application Approved by Date Application Disapproved by Date ti for the following reasons ` ) r ; t ,4 r, i Permit No. tic o;� _13P3 1 . '* Date Tssued,� 1 T THE COMMONWEALTH OFMASSACH)U�SETY. Sj 1 BARNSTABLE,rMASSACHUSETTS Certificate)of Compl aince ' ` �- THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(- ) Upgraded( ) Abandoned( )by l�qz%C STE )e N S f ., _ 1 !, F(_ at 'F' Z.�.S 1il.�S.��, has been constructed,in,aocordance ) jJ dated - /�` (p �-`with the provisions of Title 5 and the for Disposal System Construction Permit Nod�^ Installer 6 C S �y'> Designer t�tJ� #bedrooms Approved de sign flow gpd The issuance of this perrmiit*shall not .e construed as a guarantee that the systef�n function as es gned.Date /V Inspectorr _ �.�" +�.- No. ~C0y�l Fee . THE COMMONWEALTH OF MASSACHUSETTS e ' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstpm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) Systemlocatedat 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:Constructiioon�m Ist,be co eted within three years of the date of is permit. Date Approve by I ,:M a a-C I. Innovative/Alternative Septic System: John O'Dea, Sullivan Engineering, representing Barbara Erickson and Patricia Uhlman, owners — 225 Lakeside Drive, Marstons Mills, Map/Parcel 102-159-001, 0.2 acre parcel, requesting voluntary upgrade incorporating an innovative system, in conjunction with the Barnstable Clean Water Coalition with a NitROE Waste Water Treatment System, no variances. John O'Dea, engineer, presented plan. Zee Crocker, Barnstable Clean Water Coalition, sponsoring the project suggested the Board may like a presentation during the August 25th meeting showing the installation. John Smith, engineer, was also available for questions. The plan does not include any variances. The reason they came before the Board is to meeting the Town code of all alternative septic systems are to come before the Board in case the Board would like to request additional testing. Zee Crocker said they project that they will be able to cover all expenses for the first group of 20 homes using the system. The project is to continue in the Shubael Pond area with the hopes of installing 53 operating systems for a three year period with good testing data and be granted State approval. John Norman expressed that the town is truly blessed to have this opportunity afforded to us and thanked Zee Crocker. Upon a motion duly made by Dr. Guadagnoli, seconded by Mr. Lee, the Board voted to grant the installation of the NitROE Waste Water Innovative Alternative Treatment System with the monitoring presented. Roll-Call: Dr. Guadagnoli-Yes, Mr. Lee—Yes, Mr. Norman —Yes (Unanimously, voted in favor.) II. Nitrogen Aggregation: Glen Harrington representing Aliaksandr Kadolka, owner—457 and 465 Old Stage Road, Centerville, Map/Parcel 190-064 31,392 square feet parcel, and Map/Parcel 190-065 1.64 acre parcel, respectively, within the Salt Water Estuary Zone, nitrogen aggregation credit, increase bedrooms from two to four. There had been an informal review of this property at the April 2020 Board of Health meeting. Glen Harrington presented the full plans and the credit of property from 465 Old Stage Road, Centerville. There are no variances needed. Mr. McKean said the staff had no issues with the plan. Upon a motion duly made and seconded, the Board voted to grant to approval of the nitrogen aggregation plan as proposed. Roll Call: Dr. Guadagnoli- Yes, Tom Lee-Yes, John Norman- Yes. (Unanimously, voted in favor). III. Septic Deadline Extension: David Ellsworth and Lucinda Gottfried, owners—459 Wianno Avenue, Osterville, Map/Parcel 162-027, requesting deadline extension. The owners were not present. The Board noted the applicants were actively in process of selling house and had recently dropped the price. Page 2 of 4 BOH 07/28/2020 I Town of Barnstable �"E Tp,, Inspectional Services • • Public Health Division rwtrrszAX L& MASS �$' Thomas McKean, Director �679. w '00 +° 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: �Dl(�/202 Sewage Permit# 21V-310 Assessor's Map\Parcel -16Z 1 s-Q-Op Designer: S�lr` � &► ;n-ePr;n + Installer: �r:c -4Q k1E-1 1' Address: -7(c / t a;h �4re- Address: 4�0, Zo 0s 1 YV1�1P� S o0A _ IA 1U_ w�*SS, On `l 4112-02-1 vf"c Jie_t,-m S was issued a permit to install a (date) (installer) septic system at �2� � S _A',6-e- based on a design drawn by //�� (address) .��((f'",g Fnp -eef;kt f dated R (0 (designer)raysol 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. V I certify that the system referenced above was constructed i ce with the to rms of the RA approval I etters (if applicable) -NNOF 4Ss o T. yc �.� ROW D / Q CI (Inst s ignature) ss 'PFGIST FSSIONAL esigner's Signature) (Affix Design tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. \\toa\depts\HEALTH\SEWER connect\SEPTIODesigner Certification Form Rev 8.14-13.DOC I KleanTu® LLC John It.Smith KleanTu Wastewater P.O.Box 1154 Treatment Edgartown,MA 02539 Technologies 412-719-5976-Mobile 508-627-3072-Office July 29,2021 Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: Property and System Owner Certification for New N itROE®2KS W WTS Enhanced Title 5 Septic System Installation for 225 Lakeside Drive,Marstons Mills,MA 02648;KleanTu Project 480033. Dear Members of the Board: Kindly refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTug'LLC(DEP Transmittal No.: X285590; Issued May 12,2020)(the"DEP Permit');and(ii)the Enhanced Title 5 Septic System proposed for 225 Lakeside Drive; Marstons Mills,MA,a private residence,(the"New S, stem'), featuring the use of anew NitROEQ 2KS wastewater treatment system(the"NitROEO 2KS Components'). Item IV-#5 of the DEP Permit requires that KleanTuG LLC provide to the Town of Barnstable Board of Health(the oard")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, r 7ohlf AV Skegh John R Smith(Aug 4,202107:46 EDT) John R. Smith President - Enclosure cc: Barbara Erickson, Property and System Owner Patricia Uhlman,Property and System Owner -1- 1 July 29, 2021 KleanTu®LLC John R. Smith P.O. Box 1154 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 225 Lakeside Drive,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 225 Lakeside Drive,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. 1 have 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 Respon- sibilities."). 3. 1 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. I 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. 1 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). Sincerely yours, Barbara Erickson M, (f e a G� M Patricia Uhlman 2 KleanTu® LLC John R.Smith KleanTu Wastewater P.O.Box 1154 Treatment Technologies Edgartown,MA 02539 _ 412-719-5976-Mobile 508-627-3072-Office July 29,2021 To: Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: Designer Certification for New NitROE®2KS WWTS Enhanced Title 5 Septic System Installation for 225 Lakeside Drive,Marstons Mills,MA 02648;KleanTu Project#80033. 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 225 Lakeside Drive 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 John O'Dea„a Massachusetts Registered Professional Engineer with Sullivan Engineering&Consulting,Inc("Sullivan"). The NitROE®2K Components are depicted in Site Drawing Project No.: 1998138,prepared by Sullivan and dated June 30,2020. 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, ,7olhh RE kL JOh,R smith laug 1.2D211—EDT John R. Smith President cc: John O'Dea,P.E., Sullivan Engineering&Consulting,Inc. Barbara Erickson,Property and System Owner Patricia Uhlman,Property and System Owner i - 1- C� 0�i1L11"��✓' � KleanTu® LLC John R.Smith KleanTu Wastewater P.O. Box 1154 Treatment Edgartown,MA 02539 Technologies 412-719-5976-Mobile ® 508-627-3072-Office July 29,2021 Barbara Erickson and Patricia Uhlman 225 Lakeside Dr. Marstons Mills,MA*02648 - -- - John O'Dea Sullivan Engineering and Consulting P.O. Box 659 7 Parker Road Osterville, MA 02655 RE: Installer Certification for New NitROE®2K WWTS Enhanced Title 5 Septic System Installation for 225 Lakeside Dr.,Marstons Mills,MA 02648;KleanTu Project#80033. Dear Barbara, Patricia and John: - - - - - 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 a private residence located at 225 Lakeside Drive(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 the system installer make certain certifications to both of you pertain- ing to the installer's qualifications as to its installation of the NitROE®2KS Components. In lieu of such certifica- tion by the installer,KleanTu®LLC hereby certifies to both of you that KleanTu®personnel will be onsite to super- vise the installation of the NitROE°2KS Components. Such supervision will ensure that the NitROE®2KS Com- ponents are installed in a manner that conforms with KleanTu9LLC's design and operating requirements. Please contact me with any questions or comments regarding this certification. My cell#is 412-719-5976. Sincerely yours, .7ol�h�l fsr�i�ti JohnR Smllh lAug 1.10111WOEDT) ---- - - - - John R. Smith President is I KleanTu® LLC KleanTu Wastewater John R.Smith Treatment P.O.Box 1154 Technologies Edgartowm,MA 02539 ® 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80033-2107 for 225 Lakeside Drive.Marstons Mills,MA 02648 pg. 1/6 July 29, 2021 - - Ms. Barbara Erickson Ms.Patricia Uhlman 225 Lakeside Drive Marstons Mills,MA 02648 RE: NitROE®2K WWTS Installation for 225 Lakeside Drive,Marstons Mills,MA K1eanTu® Job No.: 80032 Dear Barbara and Patricia: KleanTu®LLC is pleased to provide this contract document for a NitROE®2K Waste-Water Treatment System (WWTS)to be installed at 225 Lakeside Drive,Marstons Mills,MA. The main purpose of the NitROE®2K WWTS is to serve as a supplemental upgrading of a new Title 5 septic system. A new.NitROE®2K WWTS tank will be inserted in between the gravity flow path of a new septic tank and anew leaching chamber. The purpose of the NitROE®2K WWTS is to significantly reduce total nitrogen(TN)from the sanitary wastewater flow prior to permitted discharge to the new Title 5 leaching chamber. In addition to significantly reducing TN,the NitROE®2K WWTS enhancement will produce a highly treated wastewater effluent with significantly reduced levels of organics and suspended solids as well. NitROE®ENHANCED TITLE 5 SEPTIC SYSTEM OVERVIEW The NitROE®2K WWTS to be installed is specified in Site Drawing Project No.: 1998138,prepared by Sullivan Engineering& Consulting,Inc. dated June 30, 2020. With reference to this site drawing,wastewater will first be collected into a new 1,500-gallon H-20 septic tank. After solids separation in the septic tank,wastewater will then gravity flow into a NitROE®2K WWTS tank for enhance total nitrogen reduction. From there,the significantly treated wasterwater will gravity flow into a new leaching chamber. 1 CONTRACT No.80033-2107 for 225 Lakeside Drive,Marstons Mills.MA 02648 pg.2/6 REGULATORY REQUIREMENTS The NitROE®2K WWTS will be installed and operated under a Mass DEP Provisional Permit granted to KleanTu® LLC (DEP Transmittal No.: X285590; issued May 12,2020). Specific regulatory items that need to be addressed are summarized below. It is to be noted that various actions among the site owner,the site design engineer,the installer,and KleanTu®LLC must be followed and respectively documented. The majority of the documentation required will be provided by the Barnstable Clean Water Coalition(BCWC)with input from KleanTu®. Furthermore,these Mass DEP regulatory requirements pertain to respective actions from project initiation through to NitROE®2K WWTS start-up and yearly operation. A. Obtaining a Disposal System Construction Permit(DSCP). This is issued by the local Board of Health (BoH)after completion of the following: 1. Submittal of the site engineering design and DSCP application to the local BoH. Normally this is done by the Design Engineer_ 2. Along with the DSCP application,to comply with Section IV 1 of the Provisional Permit,the BCWC,with input from KleanTu®LLC,will provide to the local BoH,a certification letter that the site owner: i. Has been provided a copy of the Provisional Use Approval and agrees to comply with all terms and conditions cited herein. ii. Has been informed of all owners costs associated with operation& maintenance(O&M) activities with the operation of the New NitROE®2K WWTS Enhanced Title 5 Septic System to be installed, including power consumption,maintenance, sampling, recordkeeping,reporting,and equipment replacement. iii.Understands the requirements for a O&M contract to be in place with KleanTu®LLC, or with their designated and trained entity,and that the NitROE®2K WWTS operator must be licensed by the Mass DEP as stipulated in KleanTu®'s Provisional Permit. iv. Agrees to fulfill their responsibilities to provide a Deed Notice,and file with the local Registry of Deeds,as required by 310 CMR 15.287(10)and with the Approval by the local BoH. v. Agrees to fulfill their responsibilities to provide written notification of the Approval conditions to any new owner,as required by 310 CMR 15.287(5). 3. Along with the DSCP application,to comply with Section IV-2 of the Provisional Permit,the BCWC,with input from KleanTu®LLC,will provide to the local BoH,with a copy to the Designer and the Site Owner,that the site-specific design conforms to Provisional Permit requirements and that the proposed use of the NitROE®2KM WWTS is consistent with the unit's capabilities and all KleanTu®LLC requirements. CONTRACT No.80033-2107 for 225 Lakeside Drive,Marstons Mills.MA 02648 pg.3/6 2 f B. Executed Operation & Maintenance Contract In-Place. To comply with Section IV-4 of the Provisional Permit,thirty (30)days prior to installation of the NitROE®WWTS,the BCWC,with input from KleanTu®LLC,will provide to the local BoH,a copy of a signed O&M contract for a minimum period of one year,between the site owner and KleanTu®LLC,or their designated approved operator,who has been properly trained and certified by KleanTu®. In this regard, in addition to signatory execution of this Contract document,the site owner will also be required to sign and thus execute an O&M contract for start-up and the first 12-months of operation and monitoring. C. Obtaining a Certificate of Compliance(COC). This is issued by the local Board of Health(BoH)after installation, local BoH inspection and sign-off,and completion of the following to comply with Sections IV-5 and IV-6 of the Provisional Permit citing the following: 1. A local BoH inspector,the installer and the designer all need to sign the COC and thus certify, in writing,that the NitROE®2K WWTS was constructed in compliance with both the Provisional Permit and Mass DEP 310 CMR 15.000 requirements,and that any changes to the design plans are reflected in as-built drawing and/or notes. The completed COC then needs to be filed with the local BoH. 2. The BCWC,with KleanTu®LLC input,will submit a written certification letter to the local BoH, and copy the site owner,that the: i. NitROE®WWTS has been constructed and installed in compliance with approved site design plans,the Provisional Permit requirements,Mass DEP 310 CMR 15.000 and local BoH requirements. ii. NitROE®WWTS was constructed and installed under direct supervision and oversight by KleanTu®personnel,and that KleanTu®also did the installation of the aeration system, bacterial seeding of the tanks, and installation of other pertinent items such as risers and access ports. D. NitROE®WWTS Site Inspections and Monitoring. To comply with Section III B, items 13-36 of the Provisional Permit related to Operation and Maintenance (O&M),KleanTu®,or a designated representative entity trained by KleanTu,will be responsible for doing the appropriate number of site inspections,along with sampling and analyses for specific wastewater treatment parameters,and for reporting respective results to the Site Owner,the local BoH and the Mass DEP. Initially the required number of site visits and monitoring will be done on a quarterly basis,per the Provisional Permit requirements. Once a General Permit is issued,then the site inspections and monitoring will be reduced to a semi-annual or annual basis. In any event,the site owner will be required to have contracts in place with KleanTu®,or their designated representative, for O&M, including the monitoring and reporting required. CONTRACT No. 80033-2107 for 225 Lakeside Drive.Marstons Mills.MA_02648 pg.4/6 INSTALLATION ACTIVITIES AND PRICE 3 I For installation of the enhanced NitROE®2K WWTS,the task activities to be carried'out,along with their respective prices,are provided in the table below. , IT IS TO BE NOTED THAT ALL OF THE COSTS CITED WILL BE COVERED BY THE BARNSTABLE CLEAN WATER COALITION(BCWCI PER AN AGREEMENT THEY HAVE WITH THE SITE OWNER. An electronic copy of the NitROE®WWTS Installation Manual is provided along with this Contract proposal. This document serves to identify the various activity responsibilities among the site owner or the BCWC,the installer and KleanTu®LLC. Of particular note, it is the responsibility of the site owner to identify and make the installer aware of any buried utility lines such as gas,electrical and cable; here Dig Safe can be contacted to provide this service at no cost(http://www.dip-safe.com),but they only identify public utility lines and not any private lines. As cited in the Table 1 below,the contract price for K1eanTu® to provide the task activities cited is$15,000.This also cites that the site owner is also responsible for the engineering and installation services to be done by others. Additionally, it is to be noted that the BCWC will arrange for,and pay for additional site-specific activities related to: 1. Providing a dedicated electrical service and a two-receptacle GFI outlet box in a location near the NitROE® 2KS tank locations. 2. Filing a notarized deed restriction with Barnstable County and paying the filing fee as well as obtaining a copy of the deed restriction document for the local BoH. A deed restriction to be executed is provided with this contract proposal. 4 I CONTRACT No.80033-2107 for 225 Lakeside Drive,Marstons Mills,MA 02648 pg. 5/6 Table 1.KleanTu®Price of Title 5 Enhancement via NitROE®2KS WWTS Enhancement for 225 Lakeside Drive,Marstons Mills,MA 02648 ONE 1,500 GALLON SEPTIC TANK(ASST152M-H20)AND ONE 2,000 GALLON NitROE TANK(N-ASST20M-H10) (KleanTu°Project No.80032-0821) KleanTu° Task Categories and Description Price (Covered by BCWC) Task 010-Project Management,Engineering and Permitting Includes overall project management coordination including review and input to the site engineering design, local BoH and MassDEP permitting interactions,and ensuring that all work is done in a manner protective of workers and the environment. Note:BCWC is responsible for site design engineering and $0 local BoH interactions including obtaining all permits and final certification. BCWC is also responsible for ` filing"Notice of Alternative Sewage Disposal System"with Registry of Deeds and pay$105 fee,with KleanTu® providing review and coordination. Task 020-Procurement and Field Fabrication of TWO Concrete Tanks Includes providing one 1,500-gallon H-20 septic tank at a price of$2,500 and one 2;000-gallon NitROE® $15,000 2KS H-10 tank at a price of$12,500. These prices include all media,access riser ports and covers near or to surface,aeration assembly w/air pump and installed air tubing,and faux rock for air pump enclosure. Task 030-Tank Delivery and Installation Oversight Installation oversight and air-line hook-up of delivered NitROE®Tank;including remote sensing unit connection to homeowner Wi-Fi network. Note:BCWC is responsible for procurement and sewer piping $0 connections of septic and NitROE®tank,procurement and installation of leach chambers and all piping connections,providing electrical service(120V;20 amp)and outlet boxes to location selected by site owner for running air pump. NOTE:TASK ACTIVITIES PROVIDED BY KLEAN TU AS IN-KIND SERVICE. TASKS 010-030 TOTAL THRU INSTALLATION $15,000 Task 040-Start-Up and Monitoring,Operation&Maintenance(MOM)Per MassDEP Provisional Permit and Barnstable BoH Requirements Includes NitROE®WWTS bacterial seeding,system start-up, bi-monthly visits,quarterly sampling and analyses by MA certified lab, record keeping and reporting required by MassDEP,and operational $0 oversight for 1st year to address issues that may arise. MOM for subsequent years will be$500-$1,300 depending on MassDEP and Barnstable BoH requirements. Note: 1st five years of MOM to be covered by BCWC:subsequent years to be determined to be borne by the homeowner. Note: Final Grading and Some.Landscaping to be Provided by BCWC 5 CONTRACT No.80033-2107 for 2.25 Lakeside Drive Marst-QM Mille MA 02648 pg 6/6 SCHEDULE Barring unforeseen circumstances,K1eanTu®will have the NitROE WWTS tank ready for installation the week of August 9,2021,with the actual date to be finalized with the site owner and their installer. PAYMENT SCHEDULE All KleanTuQ1costs to be paid by the BCWC under separate contract with KleanTu@ LLC. WARRANTY KleanTuIP guarantees NitRO.EM 2K WWTS specific equipment and materials to properly operate fora period of one year. This is contingent that the NitROEO 2K WWTS is.installed per the engineering design and that the NitROE,O 2K WWTS receives typical sanitary wastewater(as defined per Title 5)and is within the design flow and does not exceed 330 gallons per day(gpd). SITE ACCESS By signing this contract,site owner agrees that KleanTuO and BCWC designated personnel will be allowed access to the site for the purpose of performing routine MOM activities associated with the NitROES 2K WWTS. CONTRACT ACCEPTANCE KleanTu®looks forward to working in partnership with the BCWC and for providing direction and oversight for installing and operating a NitROEO 2K WWI:IS to enhance your upgraded Title 5 septic system. By accepting this contract,you also agree to comply with the regulatory requirements cited on pages 2 and 3 of this contract document. Specifically,that you agree to yearly MOM contracts with KleanTus,or their designated representative,to begin when the BCWC no longer covers yearly MOM activities. And that you also will work. with the BCWC to file the appropriate paperwork with the Registrar of Deeds so that it is identified that you have a NitROE@ WWTS enhanced Title 5 septic system operating on your property. To accept this contract so that work may continue as planned,please sign below. Also,please contact Zenas"Zee" . Crocker at zcrockcr bcleanwater.orP- at Barnstable Clean Water Coalition with any questions or comments. Sincerely, 7vl�t��S�ti�Gr John Smith(Aug 4,202107:47 EDT) - John R. Smith President Name:Barbara Erickson Signature: Lit✓ � -d ��Name:Patricia Uhlman Signatur : � c�` r)I.fit:. 6 Notice of Alternative Sewage Disposal System M.G.L. c. 21A, § 13 and 310 CMR 15.0287(10) Rhis Notice to be recorded and/or filed for registration in the chain of title of the Property served by an Alternative Sewage Disposal System ("Alternative System").] NAME(S) OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: Barbara Erickson and Patricia Uhlman ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: 225 Lakeside Drive:Marstons Mills,MA 02648 TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and complete each that applies]: ?C Deed recorded with the Town of Barnstable Registry of Deeds in Book33886 Page Of 3 _Certificate of Title No. issued by the Land Registration Office of the Registry District _Source of title other than by deed [If Alternative System Owner(s)is other than Property Owner(s),complete the following:] Alternative System Owner Name: Alternative System Owner Address: WHEREAS, Section 15.280 of Title 5 of the State Environmental Code ("Approval of Alternative Systems"), provides for the Massachusetts Department of Environmental Protection (the "Department")to approve or certify, as appropriate, all proposals to construct, upgrade or replace on-site sewage disposal systems using alternative systems; WHEREAS, owners and/or operators of approved or certified alternative systems are subject to general con- ditions, as specified in Section 15.287 of Title 5 of the State Environmental Code, 310 CMR 15.287, and may be subject to special conditions, as specified in the Department's approvals or certifications; such general and special conditions potentially including,without limitation, requirements relating to the use of trained operators, periodic inspections, maintenance, sampling, reporting and/or recordkeeping; WHEREAS, Section 15.287(10) of Title 5 of the State Environmental Code.,310 CMR 15.287(10),rre- quires that"prior to obtaining a Certificate of Compliance for installation ofoa n&w7of�upgraded+system, the sys- tem owner shall record in the chain of title for the property served by the altemat v-A system n'the.Registry of Deeds and/or Land Registration Office,as applicable, a Notice disclosing b oth"the existence of thealternative 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 [;]" and WHEREAS, the Property is served by an alternative sewage disposal system. NOW, THEREFORE,Notice of an alternative sewage disposal system is hereby given for the above-ref- erenced Property, as follows: 1.Existence.An alternative system has been installed as a new or upgraded alternative sewage disposal system, on or adjacent to the Property, and serves the Property. The trade name and model number(s) of the alternative system are as follows: Trade name of technology: NitROE®Waste-Water Treatment System Manufacturer Name: KleanTu®LLC 4...4_.,..,., , Model number(s): NitROE®2KS WWTS i+ q ,.� ' y+` f <•� a•p ,fit 14 t rd 4 z• w- n.,d Page 1 of 2 2.Approval/Certification. On May 12, 2020 [date], the Department,pursuant to its authority under the section of Title 5 as specified below, approved or certified the technology used in the above-referenced alternative system, under MassDEP Transmittal Number:X285590 [Transmittal Number of approval or certification]. [Check one of the following,as applicable:] Approved for remedial use under 310 CMR 15.284 Approved for piloting under 310 CMR 15.285 X Provisionally approved under 310 CMR 15.286 Certified for general use under 310 CMR 15.288 A copy of the Department's Approval/Certification is available from the Department in person or on- line at the Department's website: hllp://www.mass. og v/dep . WITNESS the execution hereof under seat this So day of J °t� , 20 Z l , made by the above- named Alternative System Owner(s). f [Alternative System Owner(s)] (�L¢Y� �A[�11 Barbara.Erickson. .. [Alternative System Owner(s) atricia Uhlman COMMONWEALTH OF MASSACHUSETTS ssrbA�'a On this �day of u , 20�lbefore me, the undersigned notary public,pe s all appeare (name of document signer),proved to me through satisfactory evidence of identification, which e ` k IA to be the person whose name is signed on the preceding or attached document,and acknowledged to me that (he) (she si ned it voluntanlfo�its stated purpos '. MELISSA ABRAMS Notary 0661iC % io 4P 2026 ,1 , "s (office 1 signature and s al of notary) t, ;� COMMONWEALTH OF MASSACHUSETTS :w. � h'� My Commission Expires On -Iry u [Complete t e)followin&4broaM.der s nsent if Alternative System Owner(s)is other than the Property Owner(*] CONSENTED TO: [Pro(e Owners t ' Print N me(s): 4'"rl eI QL U l 11 1 /l_ f Date: COMMONWEALTH OF MASSACHUSETTS wo ss On this 2 day of hNiA us - , 20a before me, the undersigned notary public,personally appeared X (name of document signer),proved o me through satisfactory evidence of identification, which were D(iye a Uc"f, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that (he) she signed it vo u s stated purpose. JENNA MORGAN'-KIDD" Notary Public \ N COMMONWEALTH OF OMACHUSE#S ( ; Ulf My Commission Expires'. (official signature and seal of notary) -e 'December 13, 202kr"� .T' 91 d r�3 Upon recording,return to: all. Barbara Erickson and Patricia Uhlman 225 Lakeside Drive Page 2 of #Jir rv ,z�h Marstons Mills,MA 02648 BARNSTABLE REGISTRY Of DEEDS John F Meade. Re-dktar �. I t .� ��� �� -.---.,� KleanTu® LLC John R.Smith KleanTu Wastewater P.O.Box 1154 Treatment Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-,Office CONTRACT No. 80033-004-2107 for 225 Lakeside Drive,Marstons,Mills,MA 02648 pg. 115 July 29,2021 Ms. Barbara Erickson Ms. Patricia Uhlman 225 Lakeside Drive Marstons Mills, MA 02648 RE: NitROE®2K WWTS Start-Up and Monitoring, Operation and Maintenance(MOM)for 225 Lakeside Drive, Marstons Mills,MA 02648;KleanTu®Job No. 80033 Dear Barbara and Patricia: In concert with the Barnstable Clean Water Coalition(BCWC),KleanTu®LLC is pleased to submit this ' "Contract"to provide Start-Up and Monitoring,Operation,and Maintenance(MOM)oversight services for up to five years from the NitROE®2K Waste-Water Treatment System(WWTS) installation date at 225 Lakeside Drive, _Marstons Mills, MA. The main purpose of the NitROE®2K WWTS is to enhance your Title 5 Septic System for the purpose of significantly reducing total nitrogen(TN)from the sanitary wastewater flow. In addition to significant TN reduction,the NitROE®enhanced Title 5 septic system will also produce a highly treated effluent low in organic carbon constituents(measured as BOD5)and low in total suspended solids(TSS) levels. Please note that entering into a yearly MOM contract is a requirement of KleanTu's Massachusetts Department of Environmental Protection (DEP)Provisional Permit(DEP Transmittal No.: X285590; issued May 12,2020). As this is the first year of operation, start-up services are also provided. As cited in Section IV-4 of the Provisional Permit,yearly OM&M contracts must be in place'to ensure proper operation and consistent treatment performance. In this regard,this contract also provides budgetary price estimates for subsequent years of MOM. CONTRACT DETAILS AND PRICE PROJECTIONS As cited in Table 1,regarding start-up and MOM services, it is to be noted that the BCWC will provide for and cover all costs associated with MOM,including_sample collection and analyses for the first five years of ooperation. BCWC intends to work with The Massachusetts Alternative Septic System Test Center(MASSTC)and the U.S. Environmental Protection Agency(US EPA)to cover all MOM costs for a total period of 5 years as part of the t Shubael Pond Innovative and Alternative Septic System Project. After this initial five years,MOM related costs will be the responsibility of the homeowner. CONTRACT No.80033-004-2107 for 225 Lakeside Drive,Marstons,Mills,MA 02648 pg.2/5 - 1- I All MOM activities, including monitoring and sample collection,will be performed,or directly supervised by a System Operator that has been certified at a minimum Grade Level`IV by the Board of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. Specific to any K1eanTu® Contract,the System Operator will be John R. Smith,Certificate No.: 1914. Electronic copies of the Provisional Permit and the NitROE®2K WWTS MOM Manual are provided along with this contract proposal. Table 1. Scheduled (Routine)Yearly MOM Deliverables and Pricing for New NitROE®2KS WWTS for 225 Lakeside Drive,Marstons Mills,MA. Time Price per Period I Period Deliverables M September i • Start-Up including;bacterial seeding and monitoring at least once $0 2021 to every 2 weeks during the 1st 8-weeks of operation to ensure that (All related MOM E August 2022 ; NitROE82K WWTS is properly functioning. costs to be paid (12 months) Provide and Review an OM&M Manual to homeowner and ad- for by the BCWC) dress any and all related questions. • Monthly Sample Collection and Analyses beyond what is required j by the Mass DEP Provisional Permit. • Respond to Homeowner issues,concerns and questions. • Monthly Inspection and Quarterly Monitoring Updates to Homeowner. C (NOTE:All NitROE®WWTS Components Covered Under Warranty) September • Sample Collection and Analyses with minimum per Mass DEP $0_ 2022 to Provisional Permit. (All related MOM August 2025 • Respond to Homeowner issues,concerns and questions. costs to be paid (5 years) • Quarterly Inspection and Monitoring Updates to Homeowner. for by the BCWC) I I 1 September Quarterly Inspection and Sample Collection per Mass DEP Gener- $600- $1,200 2025 and al Permit conditions. (Projected Range beyond Covers Maximum of 4 site calls per year. of Yearly Contract Yearly Update to Homeowners. to be covered by (NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) the Homeowner) t CONTRACT No.80033-004-2107 for 225 Lakeside Drive,Marstons,Mills,MA 02648 pg.315 As the NitROE®2K WWTS moves through the Mass DEP permitting process from Provisional Permit Use to General Permit Use,Table 1 reflects that the associated price for yearly MOM significantly decreases. This 1 These terms are expected to be modified(e.g.,monthly monitoring)as a result of the Shubael Pond Innovative and Alternative Project with all relevant MOM cost covered by BCWC,MASSTC and US EPA. -2- OM&M price reduction is primarily due to the fact that the Mass DEP requirements for inspections and sampling and analyses move from quarterly(under the Provisional Permit)to yearly under a General Use Permit. At this time, it is not known if a General Use Permit will be issued in year 2022 or 2023 as that decision rests with the Mass DEP. It is also cited in Table 1 that this 1 st year contract,once executed,runs from September 2021 -August 2022, anticipating use immediately after installation. As the NitROE®2K W WTS operation then moves into 2022,a new contract will needs to be executed with each renewal for a minimum 1-year period. In addition to the pricing of scheduled MOM activities cited in Table 1,Table 2 provides non-scheduled and non- routine MOM activities and associated price estimates,with anticipated timeframes as to when such MOM activity may be needed and thus the cost incurred. While KleanTu®has designed and utilized equipment to provide low maintenance operation and treatment,Table 2 is provided so the system owner has some sort of idea what costs may be incurred in future years associated with non-routine MOM activities. While the BCWC will cover the first five years of MOM support, it is to be noted that all the items cited in Table 2 will need to be covered by the homeowner as respective issues and situations arise after this initial five- year period. The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the continuous operation of one(1)120-watt air pump required to enhance and maintain the appropriate level of biological processes required. This yearly electrical cost will be borne by the homeowner,along with periodic pumping of their septic tank as required. I -3- r CONTRACT No. 80033-004-2107 for 225 Lakeside Drive,Marstons,Mills.MA 02648 lag.4/5 Table 2. Non-'Routine MOM Items and Projected Price Estimates for New NitROE®2KS WWTS Replacement Items for 225 Lakeside Drive,Marstons Mills,MA Item Description Price Estimate f Air Pump • One(1) 120 W air pump. $210 Electrical ' Total daily electrical usage measured at—2.9 kWhr/day/pump. per Year Usage ' Cost/day at$0.20/kWhr x 2.9 kWhr/da =$0.58/da . Non-routine I • After 12-month warranty period,troubleshooting site calls(more $120 Troubleshooting than 4/year)will be charged at$120/hr with 1 hour minimum. per Hour i Visits • K1eanTu®will determine when this is needed based on scheduled $600 • site visits. (for EST Septic ' Septic Tank- Pump out to be done by non-K1eanTu®contractor with estimated Tank Pumped (EST)Pump Out I price =$600/EST tank. out every • Exact time period is site-specific with estimate of every 3-8 years. 3-8 Years) (NOTE: This pump out cost would need to be done even if this was a conventional Title 5 septic system) j • Replacing remote sensing unit and probes=$360. $360 Replace Remote 1 • Exact time period is variable with estimate of every 8-10 years. (Every Sensing Probes (NOTE: For remote sensing operation, 8-10 Years) and Unit Wi-Fi connection from homeowner is needed) • Air pump repair and/or replacement. $500 Replace Air Exact time period range is variable with estimate of every 5-8 (Every Pump i years. 5-8 Years) • Replace all air tubing= $800. $800 Replace Aeration Exact time period is variable with estimate of every 10-20 years. (Every Tubing j 10-20 Years) Replace Wood Replace all wood chips=$1,000. $1,000 Chips Exact time period is variable with estimate of every 20-30 years. (Every 20-30 Years) i Replace Lime- Limestone Addition=$1,600. $1,600 stone ; • Exact time period is variable with estimate of every 20-30 years. (Every i 20-30 Years) CONTRACT No 80033-004-2107 for 225 Lakeside Drive,Marstons,Mills.MA 02648 pg. 515 PAYMENT TERMS -4- Even though there is no site owner.cost for the ,first five:years oFMOM,_the contract still needs to be signed and executed by the site owner as it is a confirmation that he/she accepts responsibility for associated MOM costs in M4 subsequent years. 1! Contracts executed for subsequent yearly time periods will need to be signed by September of the respective contract time period with the entire contract amount paid at that time. . After the five-year period,all related MOM costs will be borne by the homeowner/system owner cited herein. CONTRACT ACCEPTANCE To execute this contract,and comply with Mass DEP Provisional Permit Requirements,please sign below to acknowledge acceptance of this proposal and mail original.with your signature,or e-mail pdf copy of this page with your signature,back to me. Please contact Zenas"Zee"Crocker,zcroc er a bcleamvatex ore of Barnstable Clean Water Coalition with any questions or comments. Thank you, 6U11 AVIW_z Gh John R Smith(Aug 4,2021 07:46 EDT) - .. John R. Smith President SYSTEM OWNER SIGNATURE Name: Barbara Erickson Signature: Name: Patricia Uhlman Signature:Na�A,/It-al 1 ti 1 _5- v o�IKE Town of Barnstable Board of Health Y Y Y BARNSIABLE, q Imo. 200 Main Street, Hyannis MA 02601 Qj i639. ♦0 Office: 508-862-4644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt. March 11, 2022 Mr. John O'Dea Sullivan Engineering 711 Main Street Osterville, MA 02655 RE _'225. Lakeside Drive , Marstiyns Mils` 102=159-001 Dear Mr. O'Dea, You are granted permission on behalf of your clients, Barbara Erickson and Patricia Uhlman, to install a secondary treatment unit with advanced nitrogen reduction technology, a NitROE wastewater treatment system, at 225 Lakeside Drive , Marstons Mills, Massachusetts. The following requirements are provided within the multi-page MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter dated May 12, 2020: (1) Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit, stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; KleanTu NitROE 2K Provisional Approval, May 2020 Page 11 of 15 Technology: NitROE® 2KS & 2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval; and e) agrees to fulfill his responsibilities to provide written 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' Q:\WPFILES\Odea 225 Lakeside Drive MarstonsMilIs NitROE July 2020.docx (3) Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i) a certified Registry copy of the Notice bearing the book and page/or document number; and (ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department. (4) Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year. (5) The wastewater effluent shall be sampled and analyzed/tested quarterly if this facility is utilized year-round. Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection. [Note: a)Year-round facilities shall be inspected and effluent sampled quarterly;b) Seasonal properties shall be inspected and effluent sampled a minimum of twice per year,with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample; and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling shall also include Field Testing of System wastewater when determined necessary by the operator,see DEP Field Testing Protocol at hftp:/Mww.mass.gov/eea/docs/dep/water/lawsr-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. The above list is not all inclusive. All of the other requirements listed in the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter dated May 12, 2020 need to be adhered to. Sincerely, hn orman hairman Q:\WPFILES\Odea 225LakesideDriveMarstcnsMil1s NitROE July 2020.docx ` 1Na DATE: $95.00 FEE*: N0 Town of Barnstable REC.BY: &0AvL 6Mfda,� � Board of Health sCIED:DATE: 200 Main Street,Hyannis MA 02601 Office: 508-8624644 John T.Norman FAX: 508-790.6304 `; P�KN Donald A.Guadagnoli,M.D. Paul J.Cannilf,D.M.D. F.P.(Thomas)Lac,Alternate VARIANCE REQUEST FORM LOCATION , �� Property Address: l 1 ► 1(l rs i.]..LC l I s Assessor's Map and Parcel Number: UZ �. 6Nze of Lot: fliYeS Wetlands Within 300 Ft. Business Name: Subdivision Name: APPLICANT'S NAME: t i' hone t6t) Did the owner of the property authorize you o represent him or her? Yes No PROPERTY OWNER'S NAME II CONTACT PERSON Name: ►�o ruft A.0_1LV/ L 1 61 t,,1 UA•U1�1'1'l(&Name: n1tk_)'�d1kf1AA6U_[n1an,_ Address: IJ6 l.0 S Or,— An Iddress: d4m Phone: Phone: EMAIL: VARIANCE FROM REGULATION(Incl.Reg.Code a) REASON FOR VARIANCE(May attach sepJae sheet if more space needed) NATURE OF WORK: House Addition C3 House Renovation LJ Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit f irst four on list as S collated packet ✓A. Five(5)copies of the completed variance request form >l. Five(5)copies of MA DEP approval letters for Innovative/Altemative septic system(when proposing an UA system or secondary treatment unit(S.T.U.). _,---C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one;(1)electronic version submitted to email: health town.bamstable.ma.us *(Pool Plan—5 hard copies) �D.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or R.S. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to mecting date at applicant's expense(for Title V and/or local sewage regulation variances only _ Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only] _ Fee Submitted*S95.00 for the following variances: 1)New construction, 2) Septic repairs 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.Cannif,,D.M.D. Q:\Application Forms\VARIREQ Rev Jan 1-2020.doex UIIO Engineering & ivanConsulting, Inc. (508)428-3344• P.O. Box 659 • 711 Main Street, Osterville, MA 02655 seci@sullivanengin.com • www.sullivanengin.com July 5, 2020 Board of Health Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: 225 Lakeside Drive, Marstons Mills Dear Board, This request is for a voluntary upgrade incorporating an innovative system,in conjunction wide the Barnstable Clean Water Coalition. Attached is die application form, DEP approval of die installation, operation and sampling manuals, engineered plan, seven-page checklist, floor plans, and owner authorization letter for die above referenced property. Tlie system will incorporate a NitROE Waste Water Treatment System wNcli recently received die attached provisional use approval from DEP. This is hopefully die first of many of tliese systems tliat will be proposed, installed and extensively monitored in die area dirough die Barnstable Clean Water Coalition,Town of Barnstable, MA DEP, EPA and USGS. There are no variances requiring a Board of Healdi review. Because tlus project is being offered dirough Barnstable Clean Water Coalition on a voluntary basis,we are requesting pennission for die Perc Test to be perfornied at time of'install, to limit die disturbance of die property and disruption to die owners. I trust dus meets your needs. Very truly yours, Jo C. Oda, P.E. Sullivan Engineering& Consulting, Inc. r 5ry. } r. r: July 6,2020 Town of Barnstable 200 Main Street Hyannis,MA 02601 RE: 225 Lakeside Drive,Marstons Mills Dear Ladies and Gentlemen: Please accept this letter as authorization to have a representative from Sullivan Enigineering&Consulting, Inc. represent us Barbara A. Erickson&Patricia A. Uhlmann residing at 225 Lakeside Drive,Marstons Mills,on matters before tine Town of Barnstable related to designing,improving,modifying,upgrading, replacing and or installing betterments to property we own at 225 Lakeside Drive,Marston Mills. If you have any questions about this letter or its intentions,please contact me at Thank you, Barbara A. Erickson Patricia L. Ulilman BA TH KITCHEN BED DINING LIVING BED BED h I 225 LAKESIDE FLOOR PLANS c 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.Thecharides Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner PROVISIONAL USE APPROVAL RENEWAL Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: KleanTu LLC. 300 Old Pond Road, Ste#206 Bridgeville,PA 15017 Trade name of technology and models: NitROE® Waste-Water Treatment System (NitROE® WWTS) with unit sizing for design flows up to 2000 gpd (NitROE® 2KS WWTS and NitROE® 2KM WWTS) (hereinafter the `System' or the `Technology'). Owner and Operator manuals, installation manual, schematic drawings illustrating the System models and the technology inspection checklist are part of this Certification. DEP Transmittal No.: X285590 Date of Issuance: May 12,2020, Expiration date: May 12,2025 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000,the Department of Environmental Protection (hereinafter "the Department") hereby issues this Provisional Approval to: KleanTu LLC, located at 300 Old Pond Rd., Ste 206 in Bridgeville, PA (hereinafter "the Company"), NitROE® 2KS WWTS and NitROE® 2KM WWTS (hereinafter "the Technology" or "System") for use in the Commonwealth of Massachusetts subject to the conditions herein. Sale and use of the Technology is subject to compliance by the Company, the Designer, the System Installer, the Operator, and the System Owner with the terms and conditions herein. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. May 12,2020 Marybeth Chubb, Section Chief Date Wastewater Management Program Bureau of Resource Protection This information is available in alternate format.Contact Michelle Waters-Ekanem,Director of Diversity/Civil Rights at 617-292-5751. TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper K1eanTu 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. II.GENERAL DESCRIPTION OF THE TECHNOLOGY The NitROE ®2KS or 2KM WWTS (the `System') is installed in series between a Title-5 system septic tank and a soil absorption system constructed in accordance with 310 CMR 15.100 — 15.279, subject to the provisions of this Approval to accommodate design flows of less than 2,000 GPD. The System is comprised of two-unit processes which are sequentially performed in two different chambers. The first chamber is aerated, via an external air pump and airline header/hose arrangement,to achieve both organic carbon reduction along with the biological conversion of ammonia-N to nitrate-N. From the Aeration Chamber, the wastewater then gravity flows into a Denitrification Chamber where, in the presence of natural organics from wood chips,bacteria mediate the conversion of nitrate-N to inert N gas that exits to the atmosphere via the Title 5 system vent piping. Depending on design flow and availability of local tank structures, the sequential Aeration and Denitrification process steps can be performed in the same single tank, which is NitROE®2KS WWTS, or each process could be performed in its own separate tank with the overall NitROE® WWTS comprised of multiple tank combinations, which is NitROE®2KM WWTS. The use of the Technology under this Approval requires: • Disclosure Notice in the Deed to the property; • Certifications by the Company,the Designer,and the Installer; • System Owner Acknowledgement of Responsibilities; i f S KleanTu 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 e � 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 any System that does not flow by gravity to the SAS, the System shall be equipped with sensors and high-level alarms to protect against high water due to pump failure, pump control failure, loss of power, or system freeze up. The control panel including alarms and controls shall be mounted in a location always accessible to the operator (or service contractor). Emergency storage capacity for wastewater above the high level alarm shall be provided equal to the daily design flow of the System and the storage capacity shall include an additional allowance for the volume of all drainage which may flow back into the System when pumping has ceased. Instead of providing emergency 24-hour storage,an independent standby power source may be provided for operation during an interruption in power. With any interruption of the power supply the source must be capable of automatically activating in addition to manual start up capability. The standby power must be sufficient to handle peak flows for at least 24 hours and sufficient to meet all power needs of the System including, but not limited to, pumping, ventilation, and controls. Standby power installations must be inspected and exercised at least annually and all automatic and manual start up controls must be tested. Standby power installations must comply with all applicable state and local code requirements. Provided that a standby power installation complies with these requirements, no variance is required to the provisions of 310 CMR 15.231(2). 9. System unit malfunction and high water alarms shall be connected to circuits separate from the circuits to the operating equipment and pumps. 10. All System control units,valve boxes,conveyance lines and other System appurtenances shall be designed and installed to prevent freezing per the Company's recommendations. ' r KleanTu NitROE 2K Provisional Approval,May 2020 Page 5 of 15 Technology:NitROE®2KS&2KM WWTS 11. Any System structures with exterior piping connections located within 12 inches or below the Estimated Seasonal High Groundwater elevation shall have the connections made watertight with neoprene seals or equivalent. 12. In compliance with 310 CMR 15.240(13), a minimum of one (1) inspection port shall be provided within the SAS consisting of a perforated four inch pipe placed vertically down into the stone to the naturally occurring soil or sand fill below the stone. The pipe shall be capped with a screw type cap and accessible to within three inches of finish grade. Operation and Maintenance 13. Inspection, operation and maintenance (O & M), sampling, and field testing of the System required by this Approval shall be performed by a System Operator with the following qualifications: a) is an approved System Inspector in accordance with 310 CMR 15.340; b) has been trained by the Company and whose name appears on the Company's current list of qualified operators; and c) has been certified at a minimum of Grade Level IV (four) by the Board of Registration of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. The name of the Operator shall be included in the O&M agreement required by paragraph B(14). 14. Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year and include the following provisions: a) The name of the qualified Operator that appears on the Company's current list of Service Contractors; b) The System Operator must have the qualifications specified in paragraph B (13); c) The System Operator must inspect the System in accordance with the Approval and anytime there is an equipment failure, System failure,or other alarm event; d) In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications, or violations of the Approval, procedures and responsibilities of the Operator and System Owner shall be clearly defined for corrective measures to be taken immediately. The System Operator shall agree to provide written notification within five days describing corrective measures taken to the System Owner,the Company, and the local board of health; e) The System Operator shall determine the cause of total nitrogen effluent limit violations if they occur and take corrective actions in accordance with the approved O & M Manual; and f) Procedures and responsibilities for recording quarterly or monthly wastewater flows must be defined, see paragraph B(32)"Flow Metering". 15. At all times, the System Owner shall maintain an O&M Agreement that meets the requirements of paragraph B(20). 16. The System Owner and the System Operator shall properly operate and maintain the system in accordance with this Approval, the Designer's operation and maintenance requirements, and the requirements of the local approving authority. f KleanTu NitROE 2K Provisional Approval,May 2020 Page 6 of 15 Technology:NitROE®2KS&2KM WWTS 17. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Operator shall notify the System Owner immediately. 18. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Owner and the System Operator shall be responsible for the notification of the local approving authority within 24 hours of such determination. 19. In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications, or any violations of the Approval, the System Owner and the System Operator shall be responsible for the written notification of the local approving authority and the Company within five days describing corrective measures taken. 20. Within 60 days of any site visit, the System Operator shall submit an O&M report and inspection checklist to the System Owner and the Company. The O&M report and inspection checklist shall include,at a minimum: a) for a System failing,any corrective actions taken; b) wastewater analyses,wastewater flow data,and field testing results; c) any violations of the Approval; d) any determinations that the System or its components are not functioning as designed or in accordance with the Company specifications; and e) any other corrective actions taken or recommended. 21. By September 30th of each year, the System Owner and the Service Contractor shall be responsible for submitting to the local approving authority all monitoring results with all ` O&M reports and inspection checklists completed by the System Operator during the previous 12 months. 22. By September 30th of each year, the Service Contractor shall be responsible for submitting to the Company copies of all O&M reports including alarm event responses, all monitoring results, violations of the Approval, inspection checklists completed by the Service Contractor, notifications of,system failures,and reports of equipment replacements with reasons during the previous 12 months. . 23. A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. 24. The System Owner shall notify the Approving Authority in writing within seven days of any cancellation,expiration or other change in the terms and/or conditions of the O&M Agreement required by Paragraph B(14). 25. The System Owner and the Service Contractor shall maintain copies of the Service Y P Contractor's O&M reports, inspection checklists, and all reports and notifications to the LAA P P 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 h ttp://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). e ' I KleanTu NitROE 2K Provisional Approval,May 2020 Page S of 15 Technology:NitROE®2KS&2KM WWTS a) Year-round properties shall be inspected and sampled for at least the TN parameter a minimum of twice/year, at least 5 months apart and with at least one sample taken between December 1 and March 1 of each year. Field testing shall be completed as determined necessary by the System operator,see DEP Field Testing Protocol at http://www.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamp.pol.' Water meter readings shall be recorded at each inspection, see"Flow Metering"below. b) Seasonal properties shall be sampled for at least the TN parameter a minimum of twice/year. At least one annual sample must be taken 30 to 60 days after each seasonal occupancy. A second sample must be taken no less than 2 months after the first sample. Field testing of the System shall be completed as determined necessary by the operator. Water meter readings shall be recorded at each inspection,see"Flow Metering"below. 32. Flow Metering - At a minimum, for all systems installed prior to this Approval, water meter flow data shall be recorded each time the system is inspected and sampled by the System Operator. For systems installed after the effective date of this Approval, wastewater flow data shall be recorded each time the system is inspected and sampled by the System Operator and may be based on: a) actual metering data of wastewater flow to the system; or b) water meter data for the total facility with metered non-wastewater flows, if available, subtracted from the total facility water usage. 33. Field Testing: Turbidity,pH and Apparent Color-Turbidity,pH,DO and apparent color shall be measured and/or recorded in the field when when determined necessary by the operator. See applicable sections of the Department's Field Testing Protocol at http://www.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamp.pdr 34. At a minimum,the System Operator shall inspect the System: a) two times per year; b) in accordance with the approved O&M manual,the Designer's operation and maintenance requirements, and the requirements of the local approving authority; and c) any time there is an alarm event,equipment failure,or system failure 35. The System Operator shall collect samples and obtain analysis results from an approved lab, perform field testing required by the Approval and submit results within 60 days of the site visit to the System Owner. 36. If the Company successfully demonstrates the effectiveness of the System to reduce nitrogen loadings during the Performance Evaluation period, a minimum of three years, the System Owner shall operate the System subject to the requirements of the General Use Certification,if issued,for this technology. C. Special Conditions Specific to the Company 1. The Approval shall only apply to model units with the same model designations specified in this approval and meet the same specifications, operating requirements, and plans, as provided by the manufacturer at the time of the application. Any proposed modifications of the units shall be subject to the review of the Department for coverage under the Approval. KleanTu NitROE 2K Provisional Approval,May 2020 Page 9 of 15 Technology:NitROE®2KS&2KM WWTS 2. Prior to submission of an application for a DSCP,the Company shall provide to the Designer and the System Owner: a) All design and installation specifications and requirements; b) An operation and maintenance manual,including: i) an inspection checklist; ii) recommended inspection and maintenance schedule; iii)monitoring(i.e.water use and power consumption)and sampling procedures,if any; iv)alarm response procedures,if any,and troubleshooting procedures; c) An owner's manual,including proper system use and alarm response procedures,if any; d) Estimates of the Owner's costs associated with System operation including, when applicable: power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; e) A copy of the Company's warranty; and f) Lists of Designers,Installers,and Service Contractors. 3. The Company shall implement the Performance Evaluation Plan, as submitted and approved by the Department, and shall be responsible for all data collection and submissions to the Department until a final determination on the Performance Evaluation has been made by the Department. 4. Until a final determination has been made by the Department on a completed Performance Evaluation, the Company shall submit to the Department an annual report by February 15th of each year that includes the following: a) a table of all sample data collected for all systems installed to date and all information required by the Department as part of the approved Performance Evaluation Plan; b) status of preparation of a Performance Evaluation Plan if not yet provided to MassDEP, or any recommended changes to the approved Performance Evaluation Plan; c) a list of pending applications for system installations which have been submitted to local approving authorities; d) identification of any System after start-up in violation of the Approval or not in compliance with any performance criteria at the time of the annual report, the reasons for the noncompliance and the status of any corrective actions that are needed; and e) any recommendations and requests for changes to the system monitoring and reporting plan or the performance criteria of the Approval. The report shall be signed by a corporate officer,general partner or the Company owner. (Service Contractor records submitted to the Company should not be included with the annual report to the Department,but shall be made available to the Department within 30 days of a request by the Department.) 5. The Company shall institute and maintain a program of Installer training and continuing education that is at least offered annually. The Company shall maintain and annually update, and make available the list of qualified Installers by February 15th of each year. The Company shall certify that the Installers on the list have taken the training and passed the Company's training qualifications. KleanTu 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 the terms and conditions of the Approval and the Department approved attachments. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. Standard Conditions Applicable to the System Owner. 4. This Approval shall be binding on the System Owner and on its agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the System Owner unless the Department determines otherwise. 5. The System Owner shall obtain all necessary permits and approvals required by 310 CMR 15.000 prior to the installation and use of the System in Massachusetts. 6. The System is approved for the treatment and disposal of sanitary sewage only. The System Owner shall not introduce any wastes that are not sanitary sewage into the System. The System Owner shall dispose of wastes generated or used at the facility that are not sanitary sewage by other lawful means. 7. Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 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. 8. The System Owner shall at all times have the installed System properly operated and maintained in accordance with the most recent O&M provisions of this Approval for the alternative technology and in accordance with any additional requirements of the Approving Authority. The most recent O&M provisions of this Approval for the alternative technology are available from the Department. 9. The System Owner shall furnish the Department any information that the Department requests regarding the System,within 21 days of the date of receipt of that request. Standard Conditions Applicable to the Designer KleanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 15 Technology:NitROE®2KS&2KM WWTS 10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day. 11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy of this Approval. Standard Conditions Applicable to the Company 12. This Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the Company unless the Department determines otherwise. 13. The Company shall include copies of the Approval with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require all vendors, distributors, and resellers to provide each purchaser of the System with copies of the Approval. 14. The Company shall make available, in printed and electronic format, the approved Attachments and any approved updates associated with the Approval, to the System Owners, Operators, Designers,Installers,vendors,resellers,and distributors of the System. 15. The Company shall submit to the Department for approval any proposed updates or changes to the Attachments to the Approval. 16. The Company shall notify all System Owners, resellers, and distributors of changes to the Approval within 60 days of issuance by the Department. 17. The Company shall notify the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership, responsibility, coverage and liability between them. All provisions of the Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 18. The Company shall furnish the Department any information that the Department requests regarding the Technology within 21 days of the date of receipt of that request. 19. If the Company wishes to continue the Approval after its expiration date, the Company shall apply for and obtain a renewal of the Approval. The Company shall submit a renewal application at least 180 days before the expiration date of the Approval, unless written permission for a later date has been granted in writing by the Department. Upon receipt of a timely and complete renewal application, the Approval shall continue in force until the Department has acted on the renewal application. Reporting K1eanTu 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. VI. GENERAL CONDITIONS Title 5 Regulations 310 CMR 15.287: "General Conditions for Use of Alternative Systems Pursuant to 310 CMR 15.284 through 15.286" "The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284 through 15.286: 1. All plans and specifications shall be designed in accordance with 310 CMR 15.220. 2. Any required operation and maintenance, monitoring and testing plans shall be submitted to the Department and approved prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a Department approved plan. Sample analysis shall be conducted by an independent U.S.EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory, unless otherwise provided in the Department's written approval. It shall be a violation of 310 CMR 15.000 to omit from a report or falsify any data collected pursuant to an approved testing plan. 3. The facility served by the alternative system and the system itself shall be open to inspection and sampling by the Department and the Local Approving Authority at all reasonable times. 4. The Department and/or the Local Approving Authority may require the owner or operator of the system to cease operation of the system and/or to take any other action necessary to protect public health, safety,welfare and the environment. 5. The owner or operator shall provide written notice to any new owner or operator that the system is an alternative system. Such notice shall include notice of the general conditions and any special conditions applicable to the system and its owner. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 15 of 15 Technology: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. } KLeanTU Wastewater Treatment Technologies Installation Manual for NitROE® Waste-Water Treatment System (Massachusetts) By KleanTulm LLC P.O. Box 1154 Edgartown, MA 02539 February 1, 2020 NitROE® WWTS Installation Manual NOTE This Installation Manual is designed to give an overall understanding of the NitROE®Waste-Water Treatment System (WWTS). It also provides information related to respective roles and responsibilities of the homeowner, the installer and KleanTusM LLC. IT IS ROCOMMENDED THAT HOMEOWNERS AND INSTALLERS REVIEW THIS MANUAL TO BECOME FAMILIAR WITH THE NitROE® WWTS TECHNOLOGY CONCEPT AND ITS INSTALLATION. THIS MANUAL IS NOT INTENDED AS A STAND-ALONE DOCUMENT FOR THE INSTALLER AS KLEANTUsM PERSONNEL WILL BE ONSITE TO ASSIST WITH AND SUPERVISE EACH INSTALLATION. IN THIS REGARD, PLEASE CONTACT THE LOCAL DESIGNATED KLEANTUsM REPRESENTATIVE (CITED BELOW) WITH ANY QUESTIONS PRIOR TO AND DURING INSTALLATION. KLEANTUSM LLC INSTALLATION REPRESENTATIVE Name: Address: Phone No.: - i- February 1,2020 1 9 1 KLeanTu NitROE® WWTS Installation Manual Table of Contents NOTE......................................................................................................................................i KLEANTUSM LLC INSTALLATION REPRESENTATIVE ....................................................................i NitROE®WWTS AT A GLANCE ................................................................................................1 NOTEWORTHY THINGS TO KNOW ABOUT THE NitROE®WWTS...............................................3 ROLES AND RESPONSIBILITIES................................................................................................4 APPENDIXA....................................................................................................................... A-1 List of Figures Figure 1—Conventional Title 5 Septic System Concept............................................................1 Figure2—NitROE®WWTS Concept ........................................................................................2 Figure 3—NitROE®WWTS Tank Major Installation Stages ......................................................4 Figure A-1-Step 1. Dig Pit and Place Tank......................................................................... A-1 Figure A-2—Step 2.Addition of Treatment Media.............................................................. A-1 Figure A-3—Step 3. Place Tank Top and Add Access Ports Risers......................................... A-2 FigureA-4—Step 4.Sewer Connection Hook-Up................................................................. A-2 Figure A-5-Step S.Add Bacterial Seed Sludge Sourced from Local POTW........................... A-3 Figure A-6—Step 6.Add Clean Backfill on Top of Tank to Grade Level................................. A-3 Figure A-7—Step 7. Hook-Up Aeration System and Final Grading ....................................... A-4 Figure A-8-Step 8.System Start-Up,O&M and Monitoring................................................ A-4 ii February 1,2020 f KieanTu NitROE® WWTS Installation Manual NitROE® WWTS AT A GLANCE Figure 1 illustrates a standard Massachusetts Title 5 septic system for disposition of household sanitary wastewater. This system includes a septic tank and a leach pit or leach field. KtesA4u -77 HitlesseUa Titte S leach Pit or Leach Field tTt�lls� Q U Figure 1. Conventional Title 5 Septic System Concept Figure 2 illustrates the supplemental addition of NitROE® WWTS tank that is placed in the wastewater flow path between the septic tank and the leach pit or leach field. The main purpose and functional design of the NitROE® WWTS tank is to achieve total nitrogen (N) removal significantly beyond what is achieved by a standard Title 5 septic system per Figure 1. Specific to the NitROE®WWTS tank itself, Figure 2 illustrates that it has two primary 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 passively exits to the atmosphere via the Title 5 system vent piping. -1- February 1,2020 KleanTu NitROE® WWTS Installation Manual ,p"�' err • r • rr rr-• -r a - converts Converts Ammonia-N to Nitrate-N to Nitrate-N - Nitrogen Ws A r Pump Title 5 Septic Tank L Aeration _ enitrification Title 5 teach Pit or Leach Field Chamber— Chamber 100 percent gravity flow I Figure 2. NitROE®WWTS Concept Thus it is to be noted that the NitROE® WWTS tank is not a replacement or modification to a compliant Title 5 septic system (i.e., septic tank and leach field or pit), but rather, it is a supplemental tank for the purpose of enhanced total nitrogen reduction beyond that achieved via a standard septic system. Significantly, the NitROE® WWTS also produces an effluent much lower in suspended solids and biodegradable organic compounds than a compliant Title 5 septic system. As such, it is an integrated extension of a standard septic system and can be installed as part of a new septic system, or it can be installed to supplement an existing one. 2- February 1,2020 NitROE® WWTS Installation Manual NOTEWORTHY THINGS TO KNOW ABOUT THE NitROE® WWTS 1. After solids settling and removal in the septic tank, enhanced wastewater treatment is achieved via biological and chemical reactions. These reactions take place in a supplemental NitROE® WWTS tank which is designed to consistently generate a highly treated effluent low in suspended solids, biodegradable organics and total nitrogen. The treated wastewater is then discharged to a compliant Title 5 leach field or leach pit. 2. The NitROE® WWTS tank is designed and configured such that in the unlikely event of the tank encountering operational difficulty, the Title 5 septic system will perform as originally designed and installed,thereby maintaining the overall environmental protection of a standard Title 5 septic system at a minimum. 3. In general,. the NitROE® WWTS tank utilizes the same materials of construction and operational approach as a standard septic system. Thus, personnel servicing a standard septic system can also service a NitROE® WWTS tank with some minor additional training. 4. The NitROE®WWTS tank is a standard concrete septic.tank that is retrofitted with internal recycled plastic wood partitions and aeration piping to provide both the aeration and denitrification chambers per previously shown Figure 2. 5. The interior of the NitROE® WWTS consists of stationary, non-mechanical internal components,with the only piece of mechanical equipment being a small external air pump, with an average motor size of 120 watts. 6. The NitROE® WWTS tank has a permanent top similar to that of a Title 5 septic tank. However, the NitROE®tank top is modified with specifically located access ports. These access ports allow for sampling and periodic maintenance to be performed from the surface without having to dig down or remove the top. Note that for routine sampling and checking the overall operation of the NitROE® WWTS tank, 2-3 access ports are in small round valve boxes with covers at the ground surface. The other ports are for maintenance, if needed,and are located 6-12 inches below the ground surface for convenient access but are not visible at ground level. 7. The external air pump,which supplies oxygen to the aeration chamber,requires a dedicated ,l 15V/20-amp outlet and is installed in compliance with the appropriate local codes. The air pump is placed in a surface housing and connected to the aeration apparatus via a valve arrangement. Typically, the housing is a faux rock, as shown in Figure 2, but can also be a custom-made enclosure. The small size of the air pump and its enclosure results in a relatively quiet operation. -3- February 1,2020 I KleanTu NitROE® WWTS Installation Manual ROLES AND RESPONSIBILITIES Figure 3 pictorially illustrates the five major stages of a NitROE® WWTS tank installation from the initial pit excavation through to operation and final landscaping. c _ i Stags t-Pripar*ttols&00411 arTaA Staaall-Install Tan% i Stag*in-Piping&Hookup IL KleanTu SagoV-Finai SUga,IV-BackfilltoG" Figure 3. NitROE®WWTS Tank Major Installation Stages To achieve a successful and efficient NitROE®WWTS tank installation requires the understanding and cooperation among the homeowner, the installer and K1eanTusM In this regard, below are the respective roles and responsibilities, noting that some of the items may be also done by KleanTusM personnel after discussion and understanding with the homeowner and/or installer. Note: Some of the roles and responsibilities may vary due to addressing site-specific issues and to accommodate any homeowner preferences as applicable. -4- February 1,2020 I "`ea"Tu NitROE® WWTS Installation Manual I. Homeowner(or their contracted engineering designer)to provide: ✓ Site engineering design. ✓ Obtaining ALL permits and approvals. ✓ For a retrofit installation,to have the Title 5 septic system inspected and septic tank pumped out if not done in the last 2 years prior to installation. If any repairs are needed to the septic system, it is assumed that these will be done by the Installer as cited below under their responsibilities. ✓ Contract with Installer. ✓ Location of NitROE® WWTS tank air pump and selection of the air pump enclosure. ✓ Location and installation of a 120-volt/20-amp GFI electrical outlet box and a dedicated circuit line from the house service panel per local code requirements. ✓ Site access. ✓ Obtaining respective sign-off related to ALL permits and approvals once installed. ✓ Final landscaping of the disturbed ground surface and bringing disturbed driveway or parking areas back to pre-installation conditions. ✓ Wi-Fi access for remote monitoring and sensing of airline pressure and wastewater temperature. II. Installer to provide: ✓ The location and marking of all underground utility lines within the area to be excavated. This will be done in consultation with both the homeowner and the engineering designer. ✓ Site prep, including the removal and proper disposal of. • Shrubs,trees,and all surface structures in the vicinity of the excavation area. • All underground structures not in use and not needed such as tanks, pipes, etc. ✓ For a retrofit installation, any repairs identified per a failed Title 5 septic system inspection are to also be done in conjunction with the NitROE®tank installation so that the final NitROE®WWTS installation is Title 5 compliant. This includes the septic tank, D-Boxes, associated piping, and the leach pit or leach field. • It is to be noted that Title 5 non-compliance issues may also arise during a NitROE® WWTS tank retrofit installation, and that these will also need to be addressed by the Installer per direction of both the local BoH and the engineering designer. ✓ Purchase and installation of Title 5 septic system components per the engineering design. To include at a minimum,the following: • Septic tank and risers. • D-boxes. • Leach field. • Sewer connection piping. ✓ Off-site disposal of excavated soil in accordance with applicable laws and regulations. -5- February 1,2020 KleanTu NitROE® WWTS Installation Manual ✓ Assistance with NitROE® WWTS tank installation and hook-up, with fabricated tank,modified top, related materials and media to be provided by KleanTusM • Excavation of pit for NitROE® WWTS tank installation by concrete tank supplier, including leveling and compaction of bottom surface per engineering design. • The addition of limestone and wood chips that will be delivered to the site by KleanTusM • The installation of the 12-inch and 24-inch diameter risers and covers onto the tops of the NitROE® WWTS tank, with KleanTusM providing the respective risers and covers. • Assistance to KleanTusM personnel by raising and supporting the NitROE® WWTS tank top for running the respective air lines through the modified tank top holes and then placing the tank top(with asphalt tape placed)onto the NitROE®WWTS tank. • Surface trenching associated with aeration piping. • Drilling an access hole into the effluent end of the septic tank top and securing a 2-inch diameter PVC pipe for sampling of the untreated wastewater going to the NitROE®WWTS tank. ✓ Purchase and placement of clean soil per site plan. • Backfill, compaction and grading of disturbed areas back to general grade in accordance with the engineering design. III. KleanTusM to provide: ✓ A fabricated NitROE®WWTS tank,with modified top,delivered to site,along with respective media and materials cited below: • Limestone and wood chips. • NitROE®WWTS tank top 12-inch and 24-inch diameter risers and tops, to be placed by the installer. ✓ Purchase and installation of the 4-inch diameter PVC riser pipes and tops,including the round 6-inch diameter valve covers for surface access. ✓ Purchase, installation and testing of the aeration assembly, including air hoses and a valve box with enclosure. This also includes purchase and installation of the air pump and a faux rock enclosure (with blue light power indicator), or if the homeowner prefers, a custom enclosure could also be provided and installed. ✓ Purchase and installation of the bio-seed sludge line and the addition of bio-seed sludge. ✓ Purchase, installation and hook-up of a remote sensing and monitoring unit. ✓ NitROE®WWTS start-up. ✓ Yearly O&M contract with homeowner. Appendix A provides a step-by-step pictorial sequence of a NitROE® WWTS tank installation with associated roles and responsibilities for the installer and KleanTusM repeated. -6- February 1,2020 KleanTu NitROE® WWTS Installation Manual Appendix A Step by Step Sequence for NitROE® WWTS Tank Installation KleanTu to Provide: Installerto Provide: ' \ Scheduled delivery of assembled NitROE' • Hole excavation& WWTS Tank and material disposal . 2; �;.• ** } specialized top • Install or supervise Supervisory personnel installation by onsite others to insure °'�; " �T• i � NOTE: In some cases, that Nit W r! ,[ 'ri WWTS Tk.is S l ^; ® 't =' KleanTu personnel may. +' ,installed per site -t •t assemble tank NUROE• '� " '*�� ` Tank components once Engineering design tank is placed in the ground .T Figure A-1: Step 1. Dig Pit and Place Tank Installer to Provide: • The placement of respective media into designated compartments once the :.x:• f NitROE•WWTS Tank is placed in the ground = `• KleanTu to Provide: Appropriate amounts of media ' Y delivered to site Supervisory personnel providing direction to the installer Figure A-2: Step 2.Addition of Treatment Media -A-1- February 1,2020 5 i KleanTu NitROE® WWTS Installation Manual _F InstaliertoProvide: • Place tank top on with asphalt `s KleanTu to Provide: sealing tape supplied per KleanTu ,.. • Tank top with modified access holes specifications 1 • Concrete or plastic risers and covers Assist KleanTu site personnel to • Material and installation of 4-inch run tubing up through 4-inch diameter PVC risers,tops and diameter access ports p p associated tubing • Install larger(l2-and 24-inch diameter)risers and covers on tank top(like a septic tank) • Backfill around side of tank with clean fill just below influent and >f effluent lines Y " u Z f r Figure A-3: Step 3. Place Tank Top and Add Access Ports Risers Installer to Provide: " f • Supply and connect sewer v- connection piping from septic tank to and from NitROE' VAINTS Tank. And if applicable, ; ,- isolation line and 2 on/off valves per design. - KleanTu to Provide: • Sewer connection to be done Supervisory personnel onsite internal influent and effluent sampling tees are aligned with tank top access holes r ' • Drill access hole in effluent end w of septic tank and install 2-inch diameter pvc sampling pipe. le, k y Figure A-4: Step 4.Sewer Connection Hook-Up -A-2- February 1,2020 KleanTu NitROE® WWTS Installation Manual 4 Installer to Provide: # KleanTu to Provide: • Assist with adding supplied '.+. 1 • Coordinate with local POTW bio-seed sludge to be done for delivery of bio-seed sludge by KleanTu designated • Add bio-seed sludge to personnel respective compartments Supervisory personnel onsite t ,`F Figure A-5: Step S.Add Bacterial Seed Sludge Sourced from Local POTW • y KleanTu to Provide: Installer to Provide: ` ` • Supply and place clean =� st' � . Tie off and securement of fill on top of tank being aeration and bio-seed sludge careful NOT to damage l t`:e addition tubing risers and/or tubing Supervisory personnel onsite Y f Figure A-6: Step 6.Add Clean Backfill on Top of Tank to Grade Level -A-3- February 1,2020 KleanTu NitROEO WWTS Installation Manual KleanTu to Provide: Work with site owner to determine location of electrical outlet it and air pump Aeration system Installerto Provide: components and • 120-V and 20-amp • !I hook-up such as �+ ,_ tubing and electrical line with GFI r connectors outlet and pole support • air pump and Final Grading and stand landscaping specified by faux rock pump site owner enclosure n. w/blue light -,,, — •- •�c+ ; Install 2-3 surface �t "t access ports w/covers 3 at final grade Supervisory personnel onsite Figure A-7: Step 7. Hook-Up Aeration System and Final Grading a,YY. FW * KleanTu to Provide: s� ' '• .. t System initial inspection and Installer to Provide: K r r �' start-up • Final walk through with site O&M Manual owner and KleanTu to review , t 0&M per contract with site installation and address any owner outstanding issues • i To dis se of ALL associated ' Training of other entity to( II.--, debris or materials from assume O&M per choice of site _ owner installation that can be ° _ Installation and web hook-up of discarded remote sensing and alarm for air -� pump pressure and wastewater temperature Figure A-8: Step 8.System Start-Up,O&M and Monitoring -A-4- February 1,2020 KLeanTu Wastewater Treatment Technologies Homeowner Operation and Maintenance Manual for NitROE® Waste-Water Treatment System j (Massachusetts) � I By KleanTusm LLC P.O. Box 1154 Edgartown, MA 02539 February 1, 2020 NitROE® WWTS O&M Manual NOTE This Operation and Maintenance (O&M) Manual is designed to give an overall understanding of the NitROE® Waste-Water Treatment System (WWTS). It also provides information related to normal operation, operating, dos and don'ts, and troubleshooting guidelines, including answers related to frequently asked questions a homeowner may have. It is to be noted that this manual is primarily intended for use by the homeowner regarding general O&M related issues. For issues identified and cited as requiring changes to respective NitROE® WWTS components, such as aeration equipment, the homeowner is directed to contact the local K1eanTusm LLC service representative. IT IS ROCOMMENDED THAT HOMEOWNERS REVIEW THIS MANUAL TO BECOME FAMILIAR WITH THE NitROE®WWTS TECHNOLOGY CONCEPT AND ITS OPERATION. PLEASE CONTACT THE LOCAL DESIGNATED REPRESENTATIVE (CITED BELOW)WITH ANY QUESTIONS AND IF ANY ISSUES ARISE. NitROE® WWTS INFORMATION Model No.: Serial No.: Installation No.: Installation Date: Remote Sensing Unit No.; GPS Coordinates: i KLEANTUSM REPRESENTATIVE (OR LISCENSED DESIGNEE) Name: Address: Phone No.: i- February 1,2020 NitROE® WWTS O&M Manual Table of Contents NOTE.................................................................................:....................................................i NitROE®WWTS INFORMATION...............................................................................................i KLEANTU'm REPRESENTATIVE(OR LISCENSED DESIGNEE)..........................................................i NitROE®WWTS AT A GLANCE ................................................................................................1 THINGS TO KNOW ABOUT YOUR NitROE®WWTS TANK..........................................................4 NORMAL OPERATIONAL OF YOUR NitROE®WWTS TANK........................................................5 THE DOs& DON'Ts OF YOUR NitROE®WWTS TANK................................................................6 THINK THERE's A PROBLEM WITH YOUR NitROE®WWTS?......................................................7 SCHEDULED OPERATION AND MAINTENANCE VISITS..............................................................9 APPENDIXA....................................................................................................................... A-1 List of Figures Figure 1—NitROE®WWTS Concept .....................................................................................1 Figure 2—Installed NitROE®WWTS Tank Showing Orientation and Operational Elements...2 -H- February 1, 2020 KieanTu NRROE® WWTS O&M Manual NitROE® WWTS AT A GLANCE As illustrated in Figure 1, a NitROE®WWTS tank is placed in the wastewater flow path between a Title 5 septic tank and a Title 5 leach pit or field. Here, the NitROE® WWTS tank serves as a supplemental tank component to a compliant Massachusetts Title 5 septic system for the main purpose of enhanced total nitrogen (N) removal, significantly beyond that achieved by a Title 5 septic system alone. Specific to the NitROE®WWTS tank itself, Figure 1 illustrates that it has two primary 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 passively exits to the atmosphere via the Title 5 septic system house vent piping. ' • "' •• • KleanTu + V Converts Converts i Ammonia-N to Nitrate N to Nitrate•N Nitrogen Gas Air Pump �; .• " s Title S Septic Tank Aeration Denitrification Title S Leach Pit or Leach Field Chamber ber TT T CC 100 percent gravity flow. Figure 1. NitROE®WWTS Concept -1- February 1,2020 f KleanTu WROE® WWTS O&M Manual Figure 2 provides photos of an installed NitROE® WWTS tank identifying the major design and operational elements. KleanTu faux Rock witfi Air Pump& c; Power Source � � Air Header ' k • Distribution 'u 1 s Treated YVW Sample Port NitROE®Tank with Modified Installed NitROE•Tank Top for Surface Access Surface Access Elements Figure 2. Installed NitROE® WWTS Tank Showing Orientation and Operational Elements The items listed below are noteworthy: • The NitROE®WWTS tank is a standard concrete septic tank that is retrofitted with internal recycled plastic wood partitions and aeration piping to provide both the aeration and denitrification chambers per previously shown Figure 1. • The interior of the NitROE® WWTS consists of stationary, non-mechanical internal components,with the only piece of mechanical equipment being a small external air pump, with an average motor size of 120 watts. • The NitROE® WWTS tank has a permanent top similar to that of a Title 5 septic tank. However, the NitROE®tank top is modified with specifically located access ports. These access ports allow for sampling and periodic maintenance to be performed from the surface without having to dig down or remove the top. Note that for routine sampling and checking the overall operation of the NitROE® WWTS tank, 2-3 access ports are in small round valve boxes with covers located at the ground surface. The other ports are for maintenance, if needed, and are located 6-12 inches below the ground surface for convenient access but are not visible at ground level. -2- February 1,2020 Kies"Tu NitROE® WWTS O&M Manual • The external air pump,which supplies oxygen to the aeration chamber,requires a dedicated 115V/20-amp outlet and is installed in compliance with the appropriate local codes. The air pump is placed in a surface housing and connected to the aeration apparatus via a valve arrangement. Typically, the housing is a faux rock, as shown in Figure 2, but can also be a custom-made enclosure. The small size of the air pump and its enclosure results in a relatively quiet operation. 1-3- 2020 February , KLeanTu NitROE® WWTS O&M Manual THINGS TO KNOW ABOUT YOUR NitROE° WWTS TANK 1. The NitROE® WWTS tank is not a replacement or modification to a compliant Title 5 septic system (i.e., septic tank and leach field or pit), but rather, it is a supplemental tank for the purpose of enhanced total nitrogen reduction beyond that which is typically achievable via a standard septic system. 2. The NitROE®WWTS tank is an integrated extension of a standard septic system and can be installed as part of a new septic system, or it can be installed to supplement an existing one. 3. After septic tank solids settling and removal,.enhanced wastewater treatment is achieved via biological and chemical reactions. These reactions take place in a supplemental NitROE®WWTS tank which is designed to consistently generate a highly treated effluent low in suspended solids,biodegradable organics and total nitrogen. The treated wastewater is then discharged to a compliant Title 5 leach field or leach pit. 4. The NitROE®WWTS tank is designed and configured that in the unlikely event of the tank encountering operational difficulty, the Title 5 septic system will perform as originally designed and installed, thereby maintaining the overall environmental protection of a standard Title 5 septic system at a minimum. 5. In general, the NitROE® WWTS tank utilizes the same materials of construction and operational approach as a standard septic system. Thus, personnel servicing a standard septic system can also service a NitROE® WWTS tank with some minor additional training. 6. From a longer-term operational perspective,the NitROE®WWTS tank design provides for maintenance-related change-out and replacement of critical components via access ports without having to remove the tank top. 7. With focus on simplicity of design, fabrication and operation, the NitROE® WWTS tank requires relatively little maintenance as there are no recycle pumps or lines, no frequent routine sludge wasting,no continuous chemical addition,and no significant process control requirements. 8. To constantly monitor the NitROE® WWTS equipment operation to attain consistently good wastewater treatment performance over the long-term, the NitROE®WWTS tank is equipped with continuous remote sensing of the air pump pressure and the wastewater temperature,with high and low set point alarms for each. If a respective set point alarm is triggered, an e-mail will be sent to the local KleanTusm representative (or a licensed designee) so that the situation can be addressed in an expeditious manner, with minimal homeowner action. This remote sensing unit is connected to the home wi-fi and only sends an outgoing signal and does not receive any input signals. 9. The NitROE®WWTS tank can be installed in a lawn area or under a driveway or parking area. 10. If operating correctly, the system requires little upkeep or involvement from the homeowner. -4- February 1,2020 NitROE® WWTS O&M Manual NORMAL OPERATIONAL OF YOUR NitROE® WWTS TANK This section discusses the limited number of operational features that the homeowner should be aware of in terms of helping to confirm that the NitROE® WWTS tank is operating and treating household sanitary wastewater as designed. Visual: All NitROE®WWTS tanks are located below the ground surface just as a septic tank is. For the septic tank, there will be one 4-inch diameter observation/sampling port, and for the NitROE® WWTS tank, there will two 4-inch diameter observation/sampling ports, with all three being located in small round valve boxes with green covers at ground level. There should also be no ponding water on the ground surface in and around both the septic tank and the NitROE® WWTS tank. There will also be some combination of a diffuser box (about 1 ft. by 2 ft.) and a pump housing (often a faux rock). The storage of these two components may be combined to take up less space, but wherever the pump is located,it will have an illuminated blue light to signal electricity is being supplied to the pump. Along with the air pump, there will also be a small white box with a black antenna that is the remote sensing unit. Additionally,a blue light indicator(on the faux rock or air pump housing) should always be on, confirming that there is power to the air pump on a 24-7 continuous basis. Sound: There should be a low humming noise coming from the air pump that is audible to a person nearby or with the air pump cover or faux rock lifted off. Depending on the depth of your system, a faint bubbling noise may be observable coming from the observation/sampling ports with the top off. Both of these sounds are completely normal and mean your NitROE®WWTS is operating correctly. Smell: It is unlikely that an odor will be present unless the sampling port covers become dislodged. Note: If you see, smell,or hear anything that is different than described above,please refer to the troubleshooting guide or call the local K1eanTusm representative as soon as possible. -5- February 1,2020 I KleanTu NitROE® WWTS O&M Manual THE DOs & DON'Ts OF YOUR NitROE° WWTS TANK Avoid flushing the following items down your toilet or drain: • Cooking Grease • Food • Strong Acids and Bases • Drain Cleaning Products • Baby Wipes/Cleaning Pads • Dental Floss • Q-Tips/Cotton Balls • Diapers • Pills • Paper Towels • Cigarette Butts • Highly Concentrated Chlorine • Paints and/or Solvents • Personal Hygiene Products * Even with a normal Title 5 septic system, it is recommended that you do not flush these items down the drain to avoid costly clogged pipes or system malfunction. This is more important with the introduction of your NitROE® WWTS, as it could complicate any repairs your system might need as a result, or disrupt the normal biological activities occurring in your system. If you do happen to flush such products down the toilet or drain, please flush with water for dilution. Keep sampling ports and other surface components covered and tightly sealed. It is important for the function of your NitROE®WWTS that all the components remain protected by their covers. The sampling ports and air valve control box are designed and installed so that you can mow your lawn normally. Chemical Septic Treatments Before treating your septic system with any chemical oxidizers, please contact a K1eanTusM representative for advice as these could disrupt the biological activities occurring in your NitROE® WWTS. Septic Pumping Your NitROE® WWTS tank should not have to be pumped out if properly operated and maintained. If it does need to be pumped to address an upset condition; it should only be done so at the recommendation and direction of your K1eanTusM representative. However, it is recommended by most local boards of health that your septic tank should be pumped out every 3-5 years. This is an important aspect of regular maintenance for any septic system, especially when your system includes a NitROE®WWTS tank. If the septic tank fills with solids, including floating scum and oil & grease, due to insufficient periodic pumping,the solids can overflow into the NitROE®WWTS tank and negatively affect its treatment performance. Bringing the NitROE® WWTS tank back to its high level of performance could potentially result in a substantial cost to the homeowner. -6- February 1,2020 Kura"�' NitROE® WWTS O&M Manual THINK THERE's A PROBLEM WITH YOUR NitROEO WWTS? Check Out Our Homeowners Troubleshooting Guide Below SOMETHING LOOKS WRONG Blue.Indicator Light is Off If pump is running and humming,it is likely the indicator light has either been disconnected or has burned out,please call a KleanTusM representative. Depressions in the:Ground If one or more of your sampling ports seems to be popping too far out of the ground, or you can observe surface depressions around your system, it is likely that the soil is settling unevenly. This does not necessarily indicate an issue with.your NitROE® WWTS tank, however, please call a KleanTusM representative. Surface Water Pondinr on the Ground If ponded surface water is observed in and around the septic tank and/or the NitROE® WWTS tank, please call a KleanTusM representative immediately. Damaged Surface Level Components If there is any significant damage to any surface level components (green topped sampling ports, air control box, air pump, etc.)please call a KleanTusM representative. SOMETHING SOUNDS WRONG Pump is Off(Not Humming) If the humming of the air pump is not audible while standing next to it indicating it is not running, and the blue indicator light is off as well, then first check to see if the power source ground fault interceptor (GFI) outlet has tripped and reset it if it has. If this does not work for either the blue indicator light or the pump, then contact a KleanTusM representative immediately. Please note that if the air pump has stopped running, that an alarm signal should have already been sent to a KleanTusM representative, and they are aware of the situation and taking action to address it. Pump is Making a Banging Sound If the air pump is making a loud banging type noise,then first check to see if the air pump is level on the ground.. If not level,then reposition the air pump so it is level,and the banging noise should stop. If this does not work, then please call a KleanTusM representative immediately. Rushing Air or Hissing Noise If you can hear rushing air or hissing from any component of your NitROE® WWTS, including the air pump, the air distribution header box and any buried hoses in the vicinity of the NitROE® WWTS tank, then call a KleanTusM representative immediately. -7- February 1,2020 KleanTu NKROV WWTS O&M Manual SOMETHING SMELLS WRONG If you smell any offensive odor, like a septic smell or rotten eggs, then call a KleanTusM representative immediately. I i -g- February 1,2020 K`eanTu NitROE® WWTS O&M Manual SCHEDULED OPERATION AND MAINTENANCE VISITS While the NitROE® WWTS is designed to be LOW maintenance (i.e.,just slightly more than a standard Title 5 septic system), it is not NO maintenance. Thus, to ensure that the NitROE® WWTS continuously operates as designed and consistently produces a treated wastewater of high quality and low total nitrogen, the following will be performed by a local KleanTusM representative, or a licensed designee, regarding scheduled O&M visits and sampling as appropriate. During these site visits, the "NitROE® WWTS Inspection and Sampling Checklist," provided as Appendix A, will be completed. Once done; a copy will be provided to the homeowner,with any findings and recommendations cited. As appropriate, sample results, as may be required by the Mass DEP and/or the local Board of Health (BoH), will also be shared with the homeowner. As appropriate, copies will also be shared with the Mass DEP,the local BoH and/or other appropriate stakeholders. Year 1 Monthly inspections during the first 6 months of operation. Bi-monthly inspections (1 every 2 months) for the remaining 6 months of operation. Years 2 and 3 Quarterly inspections (1 every 3 months) Year 4 and Beyond Semi-annual inspections (1 every 6 months) All personnel conducting these site visits and inspections will have, or be directly supervised by someone having, a Mass DEP Grade 4 Wastewater Treatment Plant Operators Certification or higher. NOTE: These site visits by local K1eanTusM personnel,or a licensed designee,are contingent on the respective homeowner having a contract in place for these visits and inspections. -9- February 1,2020 fueanru NitROE® WWTS O&M Manual Appendix A NitROE® WWTS Tank Inspection and Sampling Checklist Date: Time: Homeowner Name: Location: By: Signature: Sample ID: Sample Date: I. Field Measurements(in-Situ or From Collected Sample) Item NitROE®Tank NitROE®Tank NitROE®Tank Influent(1) Middle Trough(MT) Final Effluent(E) (Sample"1 ft.below (Sample-2 ft.below (Sample-1 ft.below surface) surface) surface) Water Depth (ft) pH (su) Temperature(°C) Dissolved Oxygen (mg/1) Conductivity(umho/cm) Sludge Depth via sludge judge(ft) Suspended Solids Present(visual) Color Turbidity(NTU) Odor NOTES: -A-1- January 24,2020 NitROE® WWTS O&M Manual II. Aeration System General Checklist ✓ Air Pump Running Hot: Y N ✓ Air Pump Make/Model #: ✓ Air Pump Power indicator Light On: Y N • If light Not on provide details: Air Pump On: Y N • If air pump Not on provide details: ✓ Air Valves Open Pressure: AIT(Black); AC1 (Yellow); AC2 (Red); AC3 (Green); AMT(White); AOT(Blue) ✓ Air Pump Pressure: psig • Air flow per pump curve: LPM III. Operational Sample Collection and Analyses Item NitROE®Tank NitROE®Tank Test Kit Analysis Results Influent(1) Final Effluent(E) Carbonaceous BOD5(mg/1) TSS(mg/1) Alkalinity(mg/I as CaCOA Total Kjeldahl Nitrogen(TKN) (mg/1)=A Nitrite- N (mg/1)= B Nitrate- N(mg/1) C Ammonia-N (mg/L)=D Meas.Total N (mg/1)=A+B+C Computed Organic N =A-D NOTES: -A-2- January 24,2020 KleanTli NitROE® WWTS O&M Manual IV. Findings V. Recommendations -A-3- January 24,2020 r { r KleanTu wastewater Treatment Technologies Sampling Protocol for NitROE® Waste-Water Treatment System (Massachusetts) By KleanTusm LLC P.O. Box 1154 Edgartowm, MA 02539 February 1, 2020 'uea"T" NitROE® WWTS Sampling Protocol NOTE This Sampling Protocol is designed to give an overall understanding of the NitROE®Waste-Water Treatment System (WWTS), along with specific information provided as to where and how samples are to be collected. The main purpose of this Sampling Protocol is to provide guidance on collecting and properly analyzing representative samples so that accurate data and information is collected in a consistent manner. This is critical and necessary for a comparative analysis and tracking of data to be done on the operational performance of a particular NitROE®WWTS over time, as well as comparing the operational performance across multiple NitROE® WWTSs installed. Having representative and accurate data also serves to provide information that can be used to help estimate the average amount of total nitrogen removed collectively from a particular area and/or watershed via multiple NitROE®WWTS installations over time PLEASE CONTACT THE LOCAL DESIGNATED REPRESENTATIVE (CITED BELOW)WITH ANY QUESTIONS REGARDING THIS DOCUMENT. KLEANTUSM LLC REPRESENTATIVE (OR LISCENSED DESIGNEE) Name: Address: Phone No.: -i- February 1,2020 1 I Kies"T" NitROE® WWTS Sampling Protocol Table of Contents NOTE......................................................................................................................................i KLEANTUSM REPRESENTATIVE(OR LISCENSED DESIGNEE).........................................................i NitROE®WWTS AT A GLANCE ................................................................................................1 SAMPLING PROTOCOL SPECIFICS............................................:...............................................4 APPENDIXA...................:................................................................................................... A-1 List of Figures Figure1—NitROE®WWTS Concept .............:..........................................................................1 Figure 2—Installed NitROE®WWTS Tank Showing Orientation and Operational Elements......2 Figure 3-NitROE®WWTS Sampling Location Example............................................................3 -H- February 1,2020 Klea""' NitROE® WWTS Sampling Protocol NitROE® WWTS AT A GLANCE As illustrated in Figure 1, a NitROE®WWTS tank is placed in the wastewater flow path between a Title 5 septic tank and a Title 5 leach pit or field. Here, the NitROE® WWTS tank serves as a supplemental tank component to a compliant Massachusetts Title 5 septic system for the main purpose of enhanced total nitrogen (1) removal, significantly beyond that achieved by a Title 5 septic system alone. Specific to the NitROE®WWTS tank itself, Figure 1 illustrates,that it has two primary 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 passively exits to the atmosphere via the Title 5 septic system house vent piping. Figure 1 also illustrates the concept of small sampling ports accessible from the ground surface. e � '� • • KleanT Converts Converts Ammonia-N to Nitrate N to Nitrate-N Nitrogen l.as Air pump Title 5 Septic Tank Aeration enitrification Titre 5 teach Pit or leach Field Chamber Chamber 100 percent gravity flow Figure 1. NitROE®WW SI Concept -1- February 1,2020 KleanTu NitROE® WWTS Sampling Protocol Figure 2 provides photos of an installed NitROE®WWTS tank identifying the major design and operational elements, as well as the location of the treated wastewater sampling port for the installed NitROE®WWTS tank. KleanT µ � ; faun o ith Air Pump& Power Source 40. 4 T + :1 �t•a tti Air Header - Distribution - Box Treated WW ~ Sample Port NitROE®Tank with Modified Installed NitROE•Tank Top for Surface Access Surface Access Elements Figure 2. Installed NitROE®WWTS Tank Showing Orientation and Operational Elements Figure 3 is another photo showing the locations of both the surface sampling port of the influent to the NitROE®WWTS tank,as well as its effluent sampling port. Here,the untreated wastewater influent to the NitROEO WWTS tank is actually the final effluent of the Title 5 septic tank. -2- February 1,2020 NitROE® WWTS Sampling Protocol a. as, Air Line Header Valve Box f Influent Pipe to NItROE° . WWTS Tank (Septic Tank Effluent Pipe) L Effluent Pipe from ` + WROEO WWTS Tank Figure 3. NitROE®WWTS Sampling Location Example It is to be noted that even though the NitROEO WWTS tank has a permanent top similar to that of a Title 5 septic tank, the top is modified with specifically located access ports. Referring to both Figures 2 and 3, these access ports allow for sampling and periodic maintenance to be performed from the surface without having to dig down or remove the top. Thus, for routine sampling and checking the overall operation of the NitROE®WWTS tank, 2-3 access ports are located in small round valve boxes with covers at the ground surface. The other ports are for maintenance, if needed, and are located 6-12 inches below the ground surface for convenient access but are not visible at ground level. -3- February 1,2020 1 i "`ea"Tu NitROE® WWTS Sampling Protocol SAMPLING PROTOCOL SPECIFICS Appendix A provides an example of a NitROE®WWTS Tank Inspection and Sampling Checklist that will be used for collecting and recording all relevant data and information needed to provide documentation on the operational performance of a specific installation. Based on the data generated, it-will serve to confirm the level of wastewater treatment being achieved, as well as provide information that can be used to improve and optimize wastewater treatment as appropriate. With the previously cited Figures showing the respective sampling ports for sampling both the influent to the NitROE® WWTS Tank (i.e., septic tank effluent) as well as the final treated NitROE®WWTS Tank effluent being discharged to a Title 5 leach field or leach pit,Appendix A provides all relevant information related to respective sampling and analysis, including both field testing procedures, following U.S. EPA protocol as well as the respective analytical procedures that must be followed by the respective Mass DEP certified laboratory contracted to do the sample analyses per both U.S. EPA and Standard Methods procedures, or equivalent. It is also to be noted that all personnel conducting these site visits and inspections must have, or be directly supervised by someone having, at least a Mass DEP Grade 4 Wastewater Treatment Plant Operators Certification or higher. -4- February 1,2020 "`eanh NitROE® WWTS Sampling Protocol Appendix A NitROE® WWTS Tank Inspection and Sampling Checklist Date: Time: Homeowner Name: Location: By: Signature: Sample ID: Sample Date: I. Field Measurements(In-Situ or From Collected Sample) Item NitROE®Tank NitROE®Tank Final Method(see Influent(1) Effluent(E) References) (Sample`0.5 ft.below (Sample-0.5 ft.below surface) surface) Stick or Pipe Water Depth(ft) Indicating Water Level pH (su) EPA[1] Temperature(°C) EPA[2) Dissolved Oxygen(mg/1) EPA[3] Conductivity(umho/cm) EPA[4] Sludge Depth(ft) Sludge Judge Visual Suspended Solids Present Observation Color(visual observation) Visual Observation Turbidity(NTU) EPA(5) Odor Observation NOTES: -A-1- February 1,2020 KleanTu NitROE® WWTS Sampling Protocol 11. Aeration System General Checklist ✓ Air Pump Running Hot: Y N ✓ Air Pump Make/Model#: ✓ Air Pump Power indicator Light On: Y N • If light Not on provide details: ✓ Air Pump On: Y N • If air pump Not on provide details: ✓ Air Valves Open Pressure: AIT(Black); AC1 (Yellow); AC2 (Red); AC3 (Green); AMT(White); AOT(Blue) ✓ Air Pump Pressure: psig • Air flow per pump curve: LPM III. Operational Sample Collection and Analyses Item NitROE®Tank NitROE®Tank Analytical Testing Methodology Influent(1) Final Effluent(E) (see references) Carbonaceous BOD5(mg/1) SM5210B CBOD TSS(mg/1) SM2504D Alkalinity(mg/1 as CaCO3) SM2320B Total Kjeldahl Nitrogen(TKN) =A MCAWW 351.2 (mg/1) Nitrite-N(mg/1)= B MCAWW 354.1 Nitrite-Nitrate- N (mg/1) MCAWW 3S3.2 Nitrate-N(mg/1)=C Computed-Difference Ammonia-N (mg/L)= D MCAWW 350.0 Meas.Total N (mg/1)=A+B+C Computed-Addition Computed Organic N=A- D Computed-Difference NOTES: -A-2- February 1,2020 NitROE®WWTS Sampling Protocol 1V. Findings V. Recommendations VI. References EPA [1]. "Operating Procedure—Field pH Measurement,"U.S. EPA Science and Ecosystem Support Division,Athens, Georgia,Rpt. No. SESDPROC-100-R4, Dec. 16, 2016. EPA [2]. "Operating Procedure—Field Temperature Measurement,"U.S. EPA Science and Ecosystem Support Division, Athens, Georgia, Rpt. No. SESDPROC-102-R4, Oct. 23, 2014. EPA [3]. "Operating Procedure—Field Measurement of Dissolved Oxygen,"U.S. EPA Science and Ecosystem Support Division,Athens, Georgia, Rpt. No. SESDPROC=106-R3, Jan. 8,2014. EPA [4]. "Operating Procedure—Field Specific Conductance Measurement,"U.S. EPA Science and Ecosystem Support Division,Athens, Georgia, Rpt. No. SESDPROC-10 1-R6, July 13,2016. EPA [5]. "Operating Procedure—Field Turbidity Measurement,"U.S. EPA Science and Ecosystem Support Division, Athens, Georgia, Rpt. No. SESDPROC-103-R4, July 27, 2017. SM. Standard Methods for the Examination of Waters and Wastewaters. MCAWW. "Methods for Chemical Analysis of Water and Wastes,"EPA 600/4-79-020; March 1983, and Subsequent Revisions. -A-3- February 1,2020 1 p Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 Charles D.Baker Kathleen A.Theoharides Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner PROVISIONAL USE APPROVAL RENEWAL Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: KleanTu LLC. 300 Old Pond Road, Ste#206 Bridgeville, PA 15017 Trade name of technology and models: NitROE® Waste-Water Treatment System (NitROE® WWTS) with unit sizing for design flows up to 2000 gpd (NitROE® 2KS WWTS and NitROE® 2KM WWTS) (hereinafter the `System' or the `Technology'). Owner and Operator manuals, installation manual, schematic drawings illustrating the System models and the technology inspection checklist are part of this Certification. DEP Transmittal No.: X285590 Date of Issuance: May 12,2020, Expiration date: May 12,2025 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000,the Department of Environmental Protection (hereinafter "the Department") hereby issues this Provisional Approval to: 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. '4 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 ofAlternative System. The specific goal of the Performance Evaluation is to determine if the Technology is capable of consistently meeting the concentration limits for total nitrogen (TN) of less than 11 milligrams per liter (mg/L) for installations with design flows less than 2,000 GPD in the effluent discharged to the soil absorption system. In areas subject to nitrogen loading limitations,increases in the discharge rate per acre may be allowed when the nitrogen concentration discharged to the soil is reduced. The Company is responsible for oversight and sampling of the systems during the Performance Evaluation. The System Owner has responsibility for continued oversight and sampling of the system if the property served was allowed to increase the discharge rate per acre above 440 gallons per day per acre (gpda) in an area subject to Nitrogen Loading Limitations. The System Owner will be required to repair, replace,modify or take any other action as required by the Department or the local approving authority,if the Department or the local approving authority determines that the System is not capable of meeting the required reduction in nitrogen in the effluent. With the other applicable permits or approvals that may be required by Title 5, this Approval authorizes the installation and use of the Alternative System in Massachusetts. All the provisions of Title 5, including the General Conditions for all Alternative Systems (310 CMR 15.287), apply to the sale, design, installation, and use of the System, except those provisions that specifically have been varied by this Approval. II.GENERAL DESCRIPTION OF THE TECHNOLOGY The NitROE ®2KS or 2KM WWTS (the `System') is installed in series between a Title-5 system septic tank and a soil absorption system constructed in accordance with 310 CMR 15.100— 15.279, subject to the provisions of this Approval to accommodate design flows of less than 2,000 GPD. The System is comprised of two-unit processes which are sequentially performed in two different chambers. The first chamber is aerated, via an external air pump and airline header/hose arrangement, to achieve both organic carbon reduction along with the biological conversion of ammonia-N to nitrate-N. From the Aeration Chamber, the wastewater then gravity flows into a Denitrification Chamber where, in the presence of natural organics from wood chips,bacteria mediate the conversion of nitrate-N to inert N gas that exits to the atmosphere via the Title 5 system vent piping. Depending on design flow and availability of local tank structures, the sequential Aeration and Denitrification process steps can be performed in the same single tank, which is NitROE®2KS WWTS, or each process could be performed in its own separate tank with the overall NitROE® WWTS comprised of multiple tank combinations, which is NitROE®2KM WWTS. The use of the Technology under this Approval requires: • Disclosure Notice in the Deed to the property; • Certifications by the Company,the Designer, and the Installer; • System Owner Acknowledgement of Responsibilities; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15 Technology:NitROE®2KS&2KM WWTS • A certified operator under contract for periodic inspection and maintenance; • Periodic sampling; • Recordkeeping and reporting; and • An external power supply III.CONDITIONS OF APPROVAL A. Basis for Conditions 1. The term "System" refers to the Technology in combination with any other components of an on-site treatment and disposal system that may be required to serve,a Facility in accordance with 310 CMR 15.000. 2. The term "Approval"includes the Special Conditions, Standard Conditions, General Conditions of 310 CMR 15.287, and the approved Attachments. 3. Items required by this Approval include: a) Performance Evaluation Plan (PEP) with sampling and analysis requirements and 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 UA technology inspection checklist. B. Special Conditions 1. Department review and approval of the System design and installation is not required unless the Department determines on a case-by-case basis pursuant to its authority at 310 CMR 15.003(2)(e)that the proposed System requires Department review and approval. 2. System installations must meet the specific siting conditions for Provisional Use provided in 310 CMR 15.286(4)and the facility must meet the siting requirements of this Approval. 3. Any System for which a complete Disposal System Construction Permit Application is submitted while this Approval is in effect,may be permitted, installed, and used in accordance with this Approval unless the Department, the local approval authority, or a court requires the System to be modified or removed or requires discharges to the System to cease. 4. The System Owner shall provide access to the site for purposes of sampling the System in accordance with the Company's technology Performance Evaluation Plan approved by the KleanTu NitROE 2K Provisional Approval,May 2020 Page 4 of 15 Technology:NitROE®2KS&2KM WWTS Department, in addition to providing access for performing inspections, maintenance, repairs, and responding to alarm events. 5. The System Owner shall ensure that no permanent buildings or structures, other than the System, are constructed in the area for the installation of all the components of a fully conforming Title 5 system with a reserve area. The area for a fully conforming Title 5 system with a reserve area shall not otherwise be disturbed by the System Owner in any manner that will render it unusable for future installation of a fully conforming Title 5 system. 6. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sanitary sewer system. If it is feasible to connect a new or existing facility to the sewer, the Designer shall not propose an Alternative System to serve the facility and the facility Owner shall not install or use an Alternative System. When a sanitary sewer connection becomes feasible after an Alternative System has been installed,the System Owner shall connect the facility served by the System to the sewer within 60 days of such feasibility and the System shall be abandoned in compliance with 310 CMR 15.354, unless a later time is allowed in writing by the Department or the Local Approving Authority. 7. The control panel including alarms shall be mounted in a location accessible to the System Operator. 8. For any System that does not flow by gravity to the SAS, the System shall be equipped with sensors and high-level alarms to protect against high water due to pump failure, pump control failure, loss of power, or system freeze up. The control panel including alarms and controls shall be mounted in a location always accessible to the operator (or service contractor). Emergency storage capacity for wastewater above the high level alarm shall be provided equal to the daily design flow of the System and the storage capacity shall include an additional allowance for the volume of all drainage which may flow back into the System when pumping has ceased. Instead of providing emergency 24-hour storage,an independent standby power source may be provided for operation during an interruption in power. With any interruption of the power supply the source must be capable of automatically activating in addition to manual start up capability.The standby power must be sufficient to handle peak flows for at least 24 hours and sufficient to meet all power needs of the System including, but not limited to, pumping, ventilation, and controls. Standby power installations must be inspected and exercised at least annually and all automatic and manual start up controls must be tested. Standby power installations must comply with all applicable state and local code requirements. Provided that a standby power installation complies with these requirements, no variance is required to the provisions of 310 CMR 15.231(2). 9. System unit malfunction and high water alarms shall be connected to circuits separate from the circuits to the operating equipment and pumps. 10. All System control units,valve boxes,conveyance lines and other System appurtenances shall be designed and installed to prevent freezing per the Company's recommendations. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 5 of 15 Technology:NitROE®2KS&2KM WWTS 11. Any System structures with exterior piping connections located within 12 inches or below the Estimated Seasonal High Groundwater elevation shall have the connections made watertight with neoprene seals or equivalent. 12. In compliance with 310 CMR 15.240(13), a minimum of one (1) inspection port shall be provided within the SAS consisting of a perforated four inch pipe placed vertically down into the stone to the naturally occurring soil or sand fill below the stone. The pipe shall be capped with a screw type cap and accessible to within three inches of finish grade. Operation and Maintenance 13. Inspection, operation and maintenance (O & M), sampling, and field testing of the System required by this Approval shall be performed by a System Operator with the following qualifications: a) is an approved System Inspector in accordance with 310 CMR 15.340; b) has been trained by the Company and whose name appears on the Company's current list of qualified operators; and c) has been certified at a minimum of Grade Level IV (four) by the Board of Registration of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. The name of the Operator shall be included in the O&M agreement required by paragraph B(14). 14. Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year and include the following provisions: a) The name of the qualified Operator that appears on the Company's current list of Service Contractors; b) The System Operator must have the qualifications specified in paragraph B(13); c) The System Operator must inspect the System in accordance with the Approval and anytime there is an equipment failure, System failure,or other alarm event; d) In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications, or violations of the Approval, procedures and responsibilities of the Operator and System Owner shall be clearly defined for corrective measures to be taken immediately. The System Operator shall agree to provide written notification within five days describing corrective measures taken to the System Owner,the Company, and the local board of health; e) The System Operator shall determine the cause of total nitrogen effluent limit violations if they occur and take corrective actions in accordance with the approved O & M Manual; and f) Procedures and responsibilities for recording quarterly or monthly wastewater flows must be defined, see paragraph B(32)"Flow Metering". 15. At all times, the System Owner shall maintain an O&M Agreement that meets the requirements of paragraph B (20). 16. The System Owner and the System Operator shall properly operate and maintain the system in accordance with this Approval, the Designer's operation and maintenance requirements, and the requirements of the local approving authority. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 6 of 15 Technology:NitROEO 2KS&2KM WWTS 17. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Operator shall notify the System Owner immediately. 18. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Owner and the System Operator,shall be responsible for the notification of the local approving authority within 24 hours of such determination. 19. In the case of a System failure, an equipment failure, alarm event,components not functioning as designed or in accordance with the Company specifications, or any violations of the Approval, the System Owner and the System Operator shall be responsible for the written notification of the local approving authority and the Company within five days describing corrective measures taken. 20. Within 60 days of any site visit, the System Operator shall submit an O&M report and inspection checklist to the System Owner and the Company. The O&M report and inspection checklist shall include,at a minimum: a) for a System failing,any corrective actions taken; b) wastewater analyses,wastewater flow data,and field testing results; c) any violations of the Approval; d) any determinations that the System or its components are not functioning as designed or in accordance with the Company specifications; and e) any other corrective actions taken or recommended. 21. By September 30th of each year, the System Owner and the Service Contractor shall be responsible for submitting to the local approving authority all monitoring results with all O&M reports and inspection checklists completed by the System Operator during the previous 12 months. 22. By September 30th of each year, the Service Contractor shall be responsible for submitting to the Company copies of all O&M reports including alarm event responses, all monitoring results, violations of the Approval, inspection checklists completed by the Service Contractor, notifications of system failures,and reports of equipment replacements with reasons during the previous 12 months. 23. A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. 24. The System Owner shall notify the Approving Authority in writing within seven days of any cancellation,expiration or other change in the terms and/or conditions of the O&M Agreement required by Paragraph B(14). 25. The System Owner and the Service Contractor shall maintain copies of the Service Contractor's O&M reports, inspection checklists, and all reports and notifications to the LAA for a minimum of five years. 26. The System may only be installed to serve facilities where a fully conforming Title 5 system with a reserve area exists on-site or could be built on-site in compliance with the design standards for new construction of 310 CMR 15.000, and for which a site evaluation in K1eanTu NitROE 2K Provisional Approval,May 2020 Page 7 of 15 Technology:NitROE®2KS&2KM WWTS compliance with 310 CMR 15.000 has been approved by the Approving Authority. A fully conforming Title 5 system may include other approved alternative technologies in accordance with the conditions imposed on the alternative technologies. 27. Subject to the provisions of this Approval, the Technology shall be installed in a manner which neither intrudes on, replaces a component of, or adversely affects the operation of all other components of the System designed and constructed in accordance with the standards for new construction of 310 CMR 15.200- 15.279. 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.govleealdocsldep/water/laws/i-thru-zltestsamp.pd( 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:NitROE®2KS&2KM WWTS a) Year-round properties shall be inspected and sampled for at least the TN parameter a minimum of twice/year, at least 5 months apart and with at least one sample taken between December 1 and March 1 of each year. Field testing shall be completed as determined necessary by the System operator,see DEP Field Testing Protocol at http://www.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamn.ndf. Water meter readings shall be recorded at each inspection, see"Flow Metering"below. b) Seasonal properties shall be sampled for at least the TN parameter a minimum of twice/year. At least one annual sample must be taken 30 to 60 days after each seasonal occupancy. A second sample must be taken no less than 2 months after the first sample. Field testing of the System shall be completed as determined necessary by the operator. Water meter readings shall be recorded at each inspection,see"Flow Metering"below. 32. Flow Metering - At a minimum, for all systems installed prior to this Approval, water meter flow data shall be recorded each time the system is inspected and sampled by the System Operator. For systems installed after the effective date of this Approval, wastewater flow data shall be recorded each time the system is inspected and sampled by the System Operator and may be based on: a) actual metering data of wastewater flow to the system; or b) water meter data for the total facility with metered non-wastewater flows, if available, subtracted from the total facility water usage. 33. Field Testing: Turbidity,pH and Apparent Color- Turbidity,pH,DO and apparent color shall be measured and/or recorded in the field when when determined necessary by the operator. See applicable sections of the Department's Field Testing Protocol at http://www.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamn.Pdf. 34. At a minimum,the System Operator shall inspect the System: a) two times per year; b) in accordance with the approved O&M manual,the Designer's operation and maintenance requirements,and the requirements of the local approving authority; and c) any time there is an alarm event,equipment failure,or system failure 35. The System Operator shall collect samples and obtain analysis results from an approved lab, perform field testing required by the Approval and submit results within 60 days of the site visit to the System Owner. 36. If the Company successfully demonstrates the effectiveness of the System to reduce nitrogen loadings during the Performance Evaluation period, a minimum of three years, the System Owner shall operate the System subject to the requirements of the General Use Certification, if issued, for this technology. C. Special Conditions Specific to the Company 1. The Approval shall only apply to model units with the same model designations specified in this approval and meet the same specifications, operating requirements, and plans, as provided by the manufacturer at the time of the application. Any proposed modifications of the units shall be subject to the review of the Department for coverage under the Approval. 1 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:NitROE®2KS&2KM WWTS 6. The Company shall institute and maintain a program of Designer training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Designers by February 15th of each year. The Company shall certify that the Designers on the list have taken the training and passed the Company's training qualifications. 7. The Company shall institute and maintain a program of Operator training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Operators by February 15th of each year. The Company shall certify that the Operators on the list have taken the training and passed the Company's training qualifications. 8. The Company shall not sell the Technology to an Installer unless the Installer is trained to install the System by the Company. 9. Prior to its sale of any System that may be used in Massachusetts,the Company shall provide the purchaser with a copy of the Approval with the System design, installation, O&M, and Owner's manuals. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of a System for use in Massachusetts with copies of these documents,prior to any sale of the System. 10. Within 60 days of issuance by the Department of a revised Approval, the Company shall provide written notification of changes to the Approval to all Service Contractors servicing existing installations of the Technology and all distributors and resellers of the Technology. 11. The Company shall provide written notification to the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership,responsibility,coverage and liability between them. 12. The Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns, including but not limited to dealers, distributors, and resellers. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities, respectively, shall constitute violation of the Approval by the Company unless the Department determines otherwise. IV. CERTIFICATION AND NOTIFICATION REQUIREMENTS 1. Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit, stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; 1 K1eanTu NitROE 2K Provisional Approval,May 2020 Page 11 of 15 Technology:NitROEO 2KS&2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)and the Approval; and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). i 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 KleanTu NitROE 2K Provisional Approval,May 2020 Page 12 of 15 Technology:NitROEO 2KS&2KM WWTS a part thereof of a copy of the Approval for the System. The System Owner shall send a copy of such written notification(s) to the Local Approving Authority within 10 days of such notice to the transferee(s). V. STANDARD CONDITIONS 1. The provisions of 310 CMR 15.000 are applicable to the design, installation, use and operation of a System utilizing an approved or certified alternative technology, except those provisions that specifically have been varied by the conditions of this Approval. 2. The design, installation, and use of the System must conform to the terms and conditions of the Approval and the Department approved attachments. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. Standard Conditions Applicable to the System Owner. 4. This Approval shall be binding on the System Owner and on its agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the System Owner unless the Department determines otherwise. 5. The System Owner shall obtain all necessary permits and approvals required by 310 CMR 15.000 prior to the installation and use of the System in Massachusetts. 6. The System is approved for the treatment and disposal of sanitary sewage only. The System Owner shall not introduce any wastes that are not sanitary sewage into the System. The System Owner shall dispose of wastes generated or used at the facility that are not sanitary sewage by other lawful means. 7. Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR 15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i)a certified Registry copy of the Notice bearing the book and page/or document number; and(ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department. 8. The System Owner shall at all times have the installed System properly operated and maintained in accordance with the most recent O&M provisions of this Approval for the alternative technology and in accordance with any additional requirements of the Approving Authority. The most recent O&M provisions of this Approval for the alternative technology are available from the Department. 9. The System Owner shall furnish the Department any information that the Department requests regarding the System,within 21 days of the date of receipt of that request. Standard Conditions Applicable to the Designer KleanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 15 Technology:NitROE®2KS&2KM WWTS 10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day. 11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy of this Approval. Standard Conditions Applicable to the Company 12. This Approval shall be binding on the Company and its officers, employees, agents, -contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the Company unless the Department determines otherwise. 13. The Company shall include copies of the Approval with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require all vendors, distributors, and resellers to provide each purchaser of the System with copies of the Approval. 14. The Company shall make available, in printed and electronic format, the approved Attachments and any approved updates associated with the Approval,to the System Owners, Operators, Designers,Installers,vendors,resellers,and distributors of the System. 15. The Company shall submit to the Department for approval any proposed updates or changes to the Attachments to the Approval. 16. The Company shall notify all System Owners, resellers, and distributors of changes to the Approval within 60 days of issuance by the Department. 17. The Company shall notify the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership, responsibility, coverage and liability between them. All provisions of the Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 18. The Company shall furnish the Department any information that the Department requests regarding the Technology within 21 days of the date of receipt of that request. 19. If the Company wishes to continue the Approval after its expiration date, the Company shall apply for and obtain a renewal of the Approval. The Company shall submit a renewal application at least 180 days before the expiration date of the Approval, unless written permission for a later date has been granted in writing by the Department. Upon receipt of a timely and complete renewal application, the Approval shall continue in force until the Department has acted on the renewal application. Reporting r ' K1eanTu NitROE 2K Provisional Approval,May 2020 Page 14 of 15 Technology:NitROE®2KS&2KM WWTS 20. All notices and documents required to be submitted to the Department by the Approvalshall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street-5th floor Boston,Massachusetts 02108 Rights of the Department 21. The Department may suspend, modify or revoke the Approval for cause, including, but not limited to, noncompliance with the terms of the Approval, non-payment of any annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare, or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to the Approval and/or a System utilizing the Technology against the Company,the Designer, the System Owner,the Installer,and/or the Operator of the System. VI. GENERAL CONDITIONS Title 5 Regulations 310 CMR 15.287: "General Conditions for Use of Alternative Systems Pursuant to 310 CMR 15.284 through 15.286" "The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284 through 15.286: 1. All plans and specifications shall be designed in accordance with 310 CMR 15.220. 2. Any required operation and maintenance, monitoring and testing plans shall be submitted to the Department and approved prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a Department approved plan. Sample analysis shall be conducted by an independent U.S. EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory, unless otherwise provided in the Department's written approval. It shall be a violation of 310 CMR 15.000 to omit from a report or falsify any data collected pursuant to an approved testing plan. 3. The facility served by the alternative system and the system itself shall be open to inspection and sampling by the Department and the Local Approving Authority at all reasonable times. 4. The Department and/or the Local Approving Authority may require the owner or operator of the system to cease operation of the system and/or to take any other action necessary to protect public health, safety,welfare and the environment. 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. f 1 1 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. I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION p0 Property Address: 225 LAKESIDE DR 4/d 0 MARSTONS MILLS Owners Name: LAURIE Owner's Address: i Date of Inspection: 10/24/06 1 Name of Inspector: (please print) Douglas A.Brown I C) r I Company Name: Douglas A.Brown Septic Inspections ca Mailing Address:P.O Box 145 Centerville,MA 02632 Telephone Number:508-420-4534 CERTIFICATION STATEMENT c� r I certify that I have personally inspected the sewage disposal system at this address and that th inforniWon rep%rted below is true,accurate and complete as of the time of the inspection.The inspection was perf ed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 10/24/06 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving, authority. Notes and Comments SYSTEM MEETS MINIMUM PASSING REQUQZIVIENTS AT THIS TIME. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different Conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: one or more system components as described in the"Conditional Pase'section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 C.Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.3030)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2.System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ the system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 D.System Failure Criteria applicable to all systems: You must indicate"yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure, E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or no to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered yeg"m Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner: LAURIE Date of Inspection: 10/24/06 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks ? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) X — Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding,the SAS,located on site? X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on.- Yes no X _ Existing information. For example, a plan at the Board of Health. _ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3 ))(b)] 5 u Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection. 10/24/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NA Seasonal use: (yes or no): NO V Water meter readings,if available(last 2 years usage(gpd)): n c% _ 5,CC'X5 kof y er, Sump pump(yes or no): NO Last date of occupancy: 0 COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach.a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site (yes or no)? NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_ (locate on site plan) Depth below grade: 24" Material of construction: X concrete_metal_fiberglass _ polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: 1000GAL TANK Sludge depth: 18" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: WOODEN POLE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) TANK LOOKS STRUCTUALLY SOUND AT THIS TIME GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiberglass—polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:f Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I 1 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): LIQUID DEPTH IN PIT IS ABOUT 1/2 NO STAIN LINE AT THIS TIME CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. z-ytc r 42 ov i I out Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 225 LAKESIDE DR MARSTONS MILLS Owner's Name: LAURIE Owner's Address: Date of Inspection: 10/24/06 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) T Accessed USGS database-explain: You must describe how you established the high ground water elevation: COMMONWEALTH OF MASSACHUSETTS ' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF .ENVIRONMENTAL PROTECTION y 1519 ® C 1 5 M4 .-A(1.c—..L. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: V2.S LC,6SkNRr. .JWc�:t�td��5 M�1 L Owner's Name: lic Lc f g rrxJ Owner's Address: Date of Inspection: 10. 7 -0 Name of Inspector: (please printj)6ijalaS A_&=n Company Name: Qnualas 0 an+Wn Septic Inspections Mailing Address: Rel lkx 145 Telephone Number: A 02632 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and mainienanc4 of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section.15.340 of Title 5(310 CMR 15.000). The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fail g Inspector's Signature. C/Z Date: P The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments l a,✓�r✓�r ale . c kS e r�0 «/- o� �a�✓/C 5 r� 00d l,,xt/Ic'NS ion► va P erA'P{Y aluw* AL ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. noon 1 V..° rI/1 L7/Y1 Ic/b/2" Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 21 Owner's Name: !"OrGiS Lc•r5 v�✓ Owner's Address:. Date of Inspection: /O. 7 Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A. Sy�have es: found any information which indicates that any of the failure criteria described in 310 CN R 15.303 or in 310 CMR 15.304,exist.Any faihue criteria not evaluated are indicated below. Co ment : B. Sera Conditio Passes: one or more system co nents as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon com etion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined ,N,ND)in the following statements.If"not determined"please explain. The septic tank is metal and er 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial=�comp n or exffitration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 'ng septic tank as approved by the Board of Health. *A metal septic tank wilt pass ir>specdo if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 old is available. ND explain: Observation of sewage backup or break t or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or un n distribution box System will pass inspection if(with approval of Board of Health): broken pipe(S)are rep obstruction is removed distribution box is leveled or reply The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed I Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: v.0 Owner's Name: Owner's Address: Date of Inspection: C. Further Evaluation is Required by the Board of Health: onditions exi 'ch require further evaluation by the Board of Health in order to determine if the system is failing to protect public he safety or the environment 1. System will pass unless Boa of Health determines in accordance with 310 CMR 15.303(i)(b)that the system is not functioning in a anner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 t of a surface water _ Cesspool or privy is within 50 f a bordering vegetated wetland or a salt marsh 2. Syste 1 unless the Board of Health(and Public Water Supplier,N any)determines that the systems functiom in a manner that protects the public health,safety and environment: _ the system has a eptic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply o tributary to a surface water supply. _ The system has a se 'c tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septi and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.M od used to determine distance **This system passes if the well w analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compoun ' c ates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nits trogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the anal be attached to this form 3. Other: • , 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner's Name:— fro.f !-c�•-s c Owner's Address: Date of Inspection: !D - 7 ` Q D. System Failure Criteria applicable to all systems: You pqg indicate"yes"or"no"to each of the following for AU inspections: Yes No / _ f/Bp of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool �1 Li depth in cesspool is less than 6"below invert or available volume is less than'/:day flow ✓Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number _Atimes pumped ✓Any portion of the SAS,cesspool or privy is below high ground water elevation •portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _Ly portion of a cesspool or privy is within a Zone 1 of a public well. _ ✓Ally portion of a cesspool or privy is within 50 feet of a private water supply well. _ .�portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis most be attached to this form.] (Yes/No)The system fll .I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E � To be considered a system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"y 'or"no"to each of the following: (The following criteria apply to azge systems in addition to the criteria above) yes no the system is within 400 f t of a surface drinking water supply the system is within 200 feet a tributary to a surface drinking water supply the system is located in a nitrogen 'five area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply we If you have answered"yes"to any question in Section E �Oupg ficant threat,or answered "yes"in Section D above the large system has failed.The owne system considered a significant threat under Section E or failed under Section D shaaocordance with 310 CMR .y J Page 5 of I I OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: S Owner: Qi Date of Insp tion: /0 Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health V ere any of the system components pumped out in the previous two weeks? he system received normal flows in the previous two week period? slave large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? /Was the site inspected for signs of break out? �,�►'�vJ/-ems Were all system components,vteiaiiegthe S. AS,located on site? �/Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)j S Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2 Owner's Name: Owner's Address: Date of Inspection: 7-1) G/ FLOW CONDITIONS RESIDENTIAL Number ofbedrooms(design):-a_ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#ofms): _ Number of current residents:_Q Does residence have a garbage grinder(yes or no):4tV Is laundry on a separate sewage system(yes or no):,� Jf yes separate inspection required] Laundry system inspected(yes or no): �A Seasonal use: (yes or no):e:ea Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no);/1/4 Last date of occupancy: OMMERCLr1L/INDUSTRIAL: lishment: Design flow(ba n 310 CMR 15.203): apd Basis of design flow s/persons/sgft,etc.): Grease trap present(yes o _ Industrial waste holding tank nt(yes or no) _ Non-sanitary waste discharged to th tle 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFO ON Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):An If yes,volume pumped:_____—gallons--How was quantity pumped determined? Reason f pumping: TYP�SYSTEM Septic tank, soil absorption system —Single cesspool Overflow cesspool --privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _T Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained froni.system owner) Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site Nes or no):A)0 J Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address:. Owner's Name: Owner's Address: Date of Inspection: B iING SEWER pocate on site plan) Depth below grade: Materials of construction:_ n _40 PVC te., other(explain): Distance from private water supply w suction Comments(on condition of joints,venting, eakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grader Material of construction: oncrete_metal Sberglass,—polyethylene other(explain) If tank is metal list age:_ is age confirmed by—a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: I COO Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:A2__ Scum thickness: _ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on Pan►Ping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to ou et invert,evidence of I kage etc.): GREASE :_(locate on site plan) Depth below grade: Material of oonstructio , concrete metal—fiberglass _polyethylene_other Dimensions: Scum thickness: Distance from top of scum to top of o et tee or baffle: Distance from bottom of scum to bottom outlet tee or baffle: Date of last pumping: . Comments(on pumping recommendations,inlet d outlet tee or baffle condition,structural irate as related to outlet invert,evidence of leakage,etc.): sty.liquid levels Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner's Name: Owner's Address: Date of Inspection: TIG or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below e: Material of oons concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: Design Flow; Alarm present(yes or no): Alarm level: Alarm in working order(yes or Date of last pumping: Comments(condition of alarm and lioat switches,etc.): DISTRIBUTION BOX-&&present must be opened)(locate on site plan) Depth of liq 1 above outlet invert: Comments(note if bo 1 and distribution to outlets equal,any evidence of solids leakage into or out of box,etc.): carryover,_ any evidence of P ER:__(lam on site plan) Pumps in working o s or no): Alarms in working order(yes Comments(note condition of pump c r,condition of pumps and appurtenances,etc.): i d Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C YS. M INFORMATION(continued) Property Address: 214Pc St Owner's Name: C•rn or i rn_n mA 1 Owner's Address: Date of Inspection:AO — OY SOIL ABSORPTION SYSTEM(SAS):_(locate on site plan,excavation not required) If SAS not looted explain why: Type eaching pits,number: (y ' p ►r Lo k v�\ e*I Owp leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typelname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): _C POOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and co lion: Depth—top of liquid to vert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, el of ponding,condition of vegetation,etc.): PRIVY: to on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic level of ponding,condition of vegetation,etc.): T Page 10 of 11 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: tpLO Owner's Name: I,c�rsa Owner's Address: Date of Inspection: l O • 7 - !h SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent ref mce landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 2 o Q�H k.2 - `i& RI _ t8, ,90� 'Veck �floe Page 11 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner's Name: Owner's Address: Date of Inspection: 10 7 —O 61 SITE EXAM Slope%Y PS Surface water:.• O Check cellar:a Shallow wells Estimated depth to ground water IQ feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: /fo,-�J �vf,r•� bPs:�� ,o i4- AP /v',4/o cj.c� ��c�v.✓� ✓ '0 � . LOCATION SEWAGE PERMIT NO. Lo-�- lfo< l�r. U- 1101 Vr-Cl Awr� /off -,6q _ CV/ INSTAL ER'S NAME i ADDRESS 58 _. iA r5+era! �e U I L D E R OR OWNER Oia' Co DATE PERMIT ISSUED ` DAT E COMPLIANCE ISSUED 2- $kl q7 1-6 lad Uv l-3 �/ FE$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... �u1I.)...........OF.............�. -6t.1�;. ro_CZ: ......................... A pliration for Uiopoottl Works Tontrnrtion rrntit Application is hereby made for a Permit to Construct (P�'or Repair ( ) an Individual Sewage Disposal System at: �a�.. .:.....�- .s...�. , ......... .R.L.....-•............................. ............. "----------- t��� ... -----------...--•--•---------------- ocatio ddres or"Yot No. .G. 1......... .. �.� f1Z.dCsaz^...... .... ........................... .._............._._.._.. .................. Own Address er a --••--------•... j...... . ._.. ......... ........•--...... ©. Installer Address Type of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms......_.. .....................:.....Expansion Attic (Ivljj Garbage Grinder 04 Other—Type of Building ._kl.................... No. of persons........' ............... Showers (,;P,) Cafeteria Q, Other fixtures --------------------------•----•----.......-•--•.. • W Design Flow............... ..................gallons per person per day. Total daily flow............3.- .� ..................gallons. WSeptic Tank—Liquid ca citv.LAod.gallons Length.....1.a...... Width......4..... Diameter-_4........ Depth................ Disposal Trench—No. 4=._.. Width.................... Total Length.................... Total leaching area-----AJ<,-.�-...sq. ft. x Seepage Pit No-------------------_ Diameter.........---.--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (jw� Dosing tank ) `~ Percolation Test Results Performed by....... .��2e P. ................................... Date...... ( ._._... .... r a Test Pit No. 1....!;� -.minutes per inch Depth of Test Pit.......'L- ...... Depth to ground water.......... (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ RS ------•-_---------------------------------------r-•---------•-•-•--••-------------------••-•-----•••••---------•--------•-------•--....--•-•••--------•-- O Description of Soil.............0..._...?3......._L c� £ x ......_••..S..c4 ..1�-----......-••..................•.... 3 -•1--:•.......✓-L e. W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ............................••--.......••••----•-•---•.................••.........--••--------•--•...-•••-•-----•-••--•-----•----.........•---•----•------••----••......•••--..._............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance been issued by the board of health. igne .....,rat- �-•-- �............ .... Date ------------- Application Approved .. .............. .................... .................... a-t.e.............. Date Application Disapprov f the following reasons:•----•-......-•-•-•----••.................•-•----•-......----••-••-•-......---•........... ....-•-._....... -.--.----_--•---.--•----------------•---•--•-•-•-•--•---•------•---•-•---------------------• ---•---------- Date PermitNo......................................................... Issued......------..........---•------....................... Date _ ---------- ------------------------ ----� No..,�.,X.6 ".1 :?!i FEs....E�......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7..tT tlhl.tv...........OF.............! ..62...t�l.C ..1-�14?�l...lt---......._.................--- Applirttiion for DiiipwiFal Works Tomtrur#inn �(ami# Application is hereby made for a Permit to Construct ( for Repair ( ) an Individual Sewage Disposal System at: _ ...................:............ .............................................................. ..... ....-•••--................- `.. •-----------............................. Location-Address � ( or Lot No. :• l- c. 1 I i t t� •1 t� Gvv`� .............................. .................. ................ ...................-•_......... -----....._.........------•..........................._. Own; `C `n(; Address a .................��_.� ...... C ..... Instal Ier Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........-.9..............................Expansion Attic (fir.) Garbage Grinder (Nth' '4 Other—Type of Building ��� F. P-I YP g --�'-'�-------------------•-•• No. of persons._.___._.,�?._.____.._.__.. Showers (�„) — Cafeteria (A/C,.) Q' Other fixtures ...................................................... W Design Flow................. ..................gallons per person per day. Total daily flow...............'?.d................._gallons. WSeptic Tank—Liquid capacitv'r.r_oQ.gallons Length.....!a..... Width......Z_....... Diameter...!_........ Depth................ Ili x Disposal Trench—No. _N.............. Width.................... Total Length.................... Total leaching area..... ...sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( V)r Dosing tank ( ) `" Percolation Test Results Performed by........ G .. _.�...................................... Date...... J/�:�.... �` Test Pit No. 1....... ...�.Z._minutes per inch Depth of Test Pit...... ....... Depth to ground water..__.. ?`'! 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... P4 ......................................................-...................................................................................................... 0 Description of Soil-------------f......... • L (:' -!...............a ------. ------------------------•--------•--------------------------------..._.............. U W ------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------....._--•---•--•-------..._. V Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. -------------------------------------------------------------------------------------- •--••------------------------------------------------- •---------------------------•-------------•........----- Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ssbeen issued by the board of health. / ...................................... . ....... ................................ Date li ApplicationApproved ] ±!= - --------------------------•--••-•-•--••----•----•---•--•-----...._...-- ........................................ Date Application Disapprove f or, e following reasons----------------------------•---•------.....-------------------•-------------------------._....---------........_ ................................... ...... ............................................................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s one-�t..........OF........... � IL . . ........................................................ (Irdifirate of Tnntplianrr THIS IS TO CERTIFY, That t e Individual Sewage Disposal System constructed ( A or Repaired ( ) by. =-..-••`......------......7--.- ;-(--"`-�-..----•------------------------------- ------------------•----------•---------•-------------••--------•-----.--------.--.------ _ _ Installer at............... i:- L fl f`_ .. !!..c .l i..= 1 '--------------•--•---------------------...._............•-------...---- ----•---------------- has been insial d it talcs»dance with the provisions of TITLE 5 of The State Sanitary Code S scribed in the application for Disposal Works Construction Permit No... 3 �1Q__'�✓_..._... datedf. ....�. .. .......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE THAT THE SYSTEM 1111 L F GTION SATISFACTORY. rSACHUSETTS DATE..I... T..._... InspectoTHE COMMONWEALTH OF . BOARD OF HEALTH �..c....... -t t..........OF.......t 7 cs-`L- :....................................................... ... N z... f�0.. FE0...0.............. �in�ruuttl Turku C�onu#rn.rtion anti# Permission is hereby granted a-- -------•-------.....=---•------•-•----•---------••...-•-----•...............•••--• to Construct ( vror Repair ( ) an Individual Sewage Disposal System at No. , 4_C..ttr r .y �i'l fI ---....---- •--••-•----------------------••--•--....................-d-----------------------------•-------------------•---------------------....--•--- Street as shown on the appli tion for Disposal Works Construction Per y ...............m Dated.......................................... Board of Health DATE----------------------------------••-------------...-••--------------•----•---- FORM 1255 A. M. SULKIN, INC., BOSTON 1 f 41 o�. 4 1} v f .1 � :a �n`o ►. v�. � t I� � swIf lei �r fi a � j M LV✓AT�s�. 7 j 31 OF 8� •�` r o A. MORSE`• N0.'10951 p — LEGENDo NA EXISTING SPOT ELEVATION OxO CERTIFIE® PLOT PLAN EXISTING CONTOUR --_ ® _ FINISHED SPOT ELEVATION �� �'�' FINISHED CONTOUR 0 ROSERr J 'c�' C�.�i�S ��°i� j a , , epuc, APPROVED , BOARD of HEALTH �LQR.ED DATE AGENT S(`ALE� ..�,i�3or DATE ll,12.7/ . tED—fiE®GE ENGINEERING CO. lN CI�tiE;�dT' t CERTIFY THAT THE PROPOSED-_. # 3% . EGb3TIbRE RE41STEl�Ep , JOIN Bd®. ...-,.,..�,.- ®litL.Dthi9 RHOWdN ON THIS PLAN ,. `; CIVIL, LAND CONFORMS .TO THE ZONING LAWS ENf31NEER StIR E ®R°®Y� OF DAK tST dLE MASS. 712 MAIN STREET CH BY, .9.43 ,.. t.. ` Il Y A N N I S, M A,$S. 1 r .� ... .��.. SHIEET..�, OF A E E.G. 1. ;�140 "Uf.?VEYO�R NJ 04.1 z � a o Q,,•e . � a � � � tE kK �f � \� • • • Vie • • • • Q ® Q ° 14 i. 4t �r o 40 IA Zip it Q p� y • •w • O • _ • • 40 Wmaw ® si Cj lk 0 obl a. IA A Q ®O (. k y �sUTS� Q V � o x AK a, v 14 OR rkN �. x *Q:�\ q .Wi k � W � wW W � � 1 � •fro _~ r y �,� _, ,:�5 -. J j f ,� J •:� .. c I -_i 4 g I a , REFERENCES: ZONE: Deed Bk. 31855 Pg 270 RF k n y, Area (min.) 43,560 SF Plan Bk 138 Pg 25 Lot 165 Frontage (min) 150 �Y Width (min) None •� Setbacks: e ' Fron t 30' I Side 15' i Rear 15' 01 NIF TBM - Top of CB Lakeside Drive Property LLC 1` OVERLAY DISTRICT: El. = 73.1 NA 88 - GP - fip2.81' UP € r *t f * Groundwater Protection 5• 44 / Guy ` I State Zone 11 +�✓ 9 - S8 -- W Estuarine Overlay PROPO ED z NITRO I EXISTING , , i I FLOOD ZONE: SYSTEM 120,KE DISTANCE VARIES 154" Zone - X (Min Flood Hazard) TO LA TO BE t TOTAL TANK LENGTH CommunityPanel No. ABANDONED O Q 100 ! Itt / OUTSIDE WALL TO OUTSIDE WALL #250001 C0542J LOCATION MAP: o I� O 1 -2,000f I � July 16, 2014 - / 10' TANK WALL THICKNESS -a o P I J AT TOP a.to O (3"TYP) -� -� LLO U ASSESSORS REF.: I ' w o Map 102 Pcl. 159-1 INFLUENT o INFLUENT S ENIiRIFlCATJ9N! ER o o I I PROPOSED _ t »� (8EE NOTE 1) 3 o RA � ��(DC) EFFLUENT Existing Septic Location t 10 r YH ER from Town Health Dept. ' D-BOX' I aved Drive 12 ' I iv z O _ I Tie Card 1 t INFLUENT oo¢t- t SAMPLING PIPE Q J .: Carport PROPOSED ROPOSE(h (2"DIA PVC PIPE) 3 S I _ l S.A.S. I _ N" SEE NOTE 6 o EPTIC TO OSOILE 5 S 'TA NK _ II Parking / CD TITLE 5 SEPTIC ABSORPTION SYSTEM I TANK O THICKNESS (4 NOT TO SCALE BOTroM (SAS) NITROE NOTES I I. PROVIDE MINIMUM 2"DROP WHILE MEETING REGULATORY SLOPE I � l CD REQUIREMENT FROM THE SEPTIC TANK OUTLET PIPE INVERT TO 100% PROVIDE , ! ' SEE NOTES 2,3 AND 4 THE INVERT OF THE INFLUENT PIPE INTO THE NITROE TANK. CLEANOU T Res v ` 2. NITROE TANK TOP TO HAVE TWO-24,THREE-12"HOLES AND MULTIPLE 4"DIAMETER ACCESS HOLES WITH RISES AND COVES FOR MAINTENANCE AND SAMPLING. j 3. FOR THE 24"HOLES,PROVIDE 24"DIA.ADS PIPE WITH COVER TO 12" # 225 ( ( t I BELOW GROUND SURFACE. BOLTED TO TANK TOP. Z w 1 Sty n g I '; ( 4 RINGS,RISERSOLES;PR 0AND COVER TOTIREE­12"HOLES WITH BELOW GROUND SURFACE. D� Dwelling J _ GROUND_SU_RFACE� -- - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ O F.F. EL. 73.00 7 - - - INSTALL 4"DIA.MONITORING PIPE(1"BELOW GROUND SURFACE) V=6"PLASTIC ROUND BOX AND COVER TO BE FLUSH WITH / TO TITLE 5 SOIL GROUND SURFACE. 5 1/2"TANK ABSORPTION SYSTEM 5. PROVIDE FOUR-6"DIAMETER PLASTIC ROUND BOXES AND COVES _ TOP(TYP) (SAS) (NITROE AND SEPTIC TANKS)TO BE INSTALLED AT GROUND LEVEL. '- '•� � 6. PROVIDE INFLUENT SAMPLING PIPE(2"DIA.)6"FROM EDGE OF INFLUENT �'t••�;�i'' � .,ri �•i L,•:' • • :�. :•. :..mot•.i.•::i�. ''!=��'.,";...; . :�... ._ •;:•4� J (SEE NOTE 1) EFFLUENT SEPTIC WITH 6"TANK WALL WI 6"PLASTIC ROUND BOX AND COVER AT t a 48"STATIC GROUND SURFACE. ILI LLJ I ' w --- -•-------•--- -•-•- .-._WATER DEPTH Of p S7....... _ _ o r♦ 4'^ I TITLE 5 SEPTIC o >a j �� DENITRIFlCA110N CHAMBER o o a=a '` _- RL �.� (NOT TO SCALE) .:,: o _J CHAMBER '8 W W z " Z ► (SAC) 05 ; - bi 0 w LL J 4 E m i / N78• 5 " �• _ ___4_ -� F4 U.in LL Finish Grade 61' ' 8 �- RN, LIM 11 0 no. -� � � ..- . „ Y. - -. Compacted Fill ,..•• :• .' •.• � :Et....• ...».' t•• • •i• CO Filter Chicken Coop ( ELEV.=0 Fabric 4 TANK BOTTOM And is \ THICKNESS 4" CRUSHED AGGREGATE OR APPROVED Or N/F TANK WALL THICKNESS MATERIAL(DEPTH TBD-6"MIN);ON LEVEL, 1/8' / 21/2' I� David A. Grenier i AT BOTTOM(4 1/2") COMPACTED AND STABLE BASE 3, Pea Stone TANK WALL THICKNESS H-20 3/4" - 1 1/2" t AT TOP(3") KleanTU LLC LEACHING Double Washed PLAN VIEW 1 PLAN AND PROFILE VIEW CHAMBER Stone NITROE WASTE-WATER TREATMENT SYSTEM (WWTS) SCALE: 1" = 10' I 4' - 10'---- 12' - 10" T-AS2000-H10 CROSS SECTION OF CHAMBER SEPTICNOTES DESIGNDATA NOT TO SCALE 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Single Family Prior to Any Excavation For This Project the Contractor Shall Make -3 Bedroom @ 110 GPD the Required Notification to Dig Safe(1-888-344-7233)and contact No Garbage Grinder Sullivan Engineering&('onsulting Inc.(508-428-3344). Total Daily Flow=330 GPD 2.'The Contractor is Required to Secure Appropriate Permits From Town Use Existing 1000 Gal Septic Tank Charcoal Filtered Vent Agencies For Construction Defined by This Plan. Final Location to be Determined 3. Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall LEA CMVG AREA F.F. D. 73.00 a t time of installation or in Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to 330 GPD/0.74(LTAR)=446 SF Required accordance with Landscape Plan Assure Watertightness. In General,Water Lines Shall be Constructed in Sidewall=2(75)-150 F F.G. EL. 70.00 F.G. EL. 69.5 - 68.5 F.G. EL. 70.l0 - 68.0 Coordination With COMM Water,and Shall be in Accordance Bottom Area=320 SF See Note 6 (typ.) F.G. EL. 68.0 - 65.5 j With 248 CAM 1.00-7.06&310 CAM 15.00. Total Provided=470 SF(347 GPD) 4.A Minimum of9"of Cover is Required for All Components. 5.All Structures Buried Thrw Feet or More or Subject LEACHING CHAMBER DESIGN EL. 68.70 to Vehicular Traffic to be H-20 Loading.It is the Engineer's All Pipes to be Schedule 40. Use Installer To PROPOSED Flow E quilizers Recommendation that H-20 Always be Used Confirm Prior EL. 66.75 As Required 6.Install Watertight Risers and Cover,to Within 6"offinished Grade 2-500 Gal.Leaching Chambers in a To An Work 1500 Gallon EL. .7 q Double Washed Stone Field as Shown. Over Septic Tank Inlet and Outlo4 D-Box,and One Leaching Chamber. y Sep ic2Tonk EL. 66.50 P NOPO E D EL. 65.50 RO All covers are to be maximuml8"for concrete or24"Castlron. (See Note 5) 64.75 Top EL. 63.00 7.Septic System to be Installed in Accordance With 310 CAM 15.00& H-20 EL. 64.58 m 248 CAM 1.00-7.00 Latest Revision and the Town ofBastable D-Box Board ofHealth Regulations. VARIANCE ffifflm PROPOSED 310 CAR 15.221 General 7 -3'Depth Allowed / 62.00 H-20 8.All Piping to be Sch.40 PVC. O To Be Installed On / Leaching 9.D Box Shall Have a Minimum Inside Dimension of 12",and a Minimum 5'Depth Proposed e Chamber to e o Sump of 6". (Approvable By a Health Inspector) mpacease _ Bo t. EL. 60.00 10.The Separation Distance Between the Septic Tank Inlets and Bedding,"T"s, PN�kA OF Inspection Port, JfticaUr7a'ered:Rerriawe`&.Replace Outlets Shall 6eNo Less t�ian the Liquid Depth.Inlet Tees Shall Extend & Boffels .............: `StiilS uVithin:; a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" as Per Title 5 The:Ou ter:..Perirri e ter:.:o f;.`The:::.S�stei; o Below the Flow Line,and Shall be Equipped With a Gas Baffle. .... . . . .. .. ....... Uc�< Por DEVELOPED PROFILE OF SYSTEM LEGEND. EL. 44f Lake Elevation Q CDT Cedar Tree NOT TO SCALE Add Proposed Septic Tank (Existing Tank Seam Blown 8 10 2021 HT Holly Tree Reserve: Add Reserve Area 1611012021 DT Deciduous Tree NOTES: i PREPARED FOR: PREPARED BY: TI TLE: AU CT Coniferous Tree Site Plan Utility Pole 1.) The structures shown were located on the ground Barnstable Clean Water Coalition Engineering & Proposed Septic Upgrade by conventional survey methods in June 2020. p p -E- Electric ) property 8 6 4 Main St. consuitinone.-G- Gas 2. Theline information shown hereon was At � O � Wetland Flag compiled from available record information. Stervill e, MA 02655 22.5 �^ Lakeside � � Light Post 508 428-3344•P.O. Box 659.7111 Main Street, Osterville, MA 02655 L . a eside Drive (] CB/OH 3.) The datum is NAVD '88. secs@sullivanengin.com •WWW.suilivanengin.com OHW- Overhead Wires • Barnstable (Marstons Mills) Mass. 25 Elevation Contour 10 0 5 10 20 40 Draft: ASL Field: WHK/CTR LQ ~ W Review: CTR Comp.: ASL DATE: SCALE: I Project: BCWC Project#: 1998138 June 30, 20201 t t=1 Q t S x; REFERENCES: ZONE:RF R Deed Bk. 31855 P 270k ? g Area (min.) 43,560 SF Plan Bk 138 Pg 25 Lot 165 Frontage (min) 150 � ' Width (min) None Setbacks: Front 30' " " • �. Side 15' �• - ` •, �� � � Q rn � Rear .15' aw ON N/F OVERLAY DISTRICT. TBM - Top of CB Lakeside Drive Property LLC El. = 73.1 NA 88 \ - GP - Groundwater Protection W2.81' Gu OP State Zone 44"W � � y S85. 0 I Estuarine Overlay PROPO ED z / r I I NITRO EXISTING PIT J 1 I FLOOD ZONE: TO BE / 120'f DISTANCE VARIES 154" Zone - X (Min Flood Hazard) I ABANDONED ` � TO LAKE TOTAL TANK LENGTH Community Panel No. LOCATION MAP" w / !O O I!v_ #250001 C0542J 1 =2,OOOf O O O OUTSIDE WALL TO OUTSIDE WALL , o - / I N \ July 16, 2014 TANK WALL - ! 10 t THICKNESS .. ,... :. z a I1 O - - - i AT TOP a �- (3 3'_8" i -TYP) i o ASSESSORS REF." _ - / - I V y v o° Map 102 Pcl. 159-1 t OPOSED I ° =o -' P i I` ° ( INFLUENT Q? INFLUENT S M D ENITRIACAPN 1,JAAM ER 0 3 I ' -BOX Q i cl ' '-1 O"II (SEE NOTE 1) Y O HRA OR v ((DC) EFFLUENT Existing Septic Location frojp Town Health Dept. ' aved DrjVe 12 ' I INFLUENT co Q E5 0 Tie Card O I ! ` SAMPLING PIPE J Carport ROPOSED Q Q / o I (2"DIA PVC PIPE) a TO TITLE 5 S. I S. d N" SEE NOTE 6 w �. SOIL � ?� Shell o` 0- TITLE 5 SEPTIC ABSORPTION�- a :� ; Parking ' I I I N TANK o TANK WALL --� y. SYSTEM THICKNESS r (SAS) NOT TO SCALE AT BOTTOM < (a 1/2'TYP) -• ;: :., . . ;, .. NITROE NOTES I 1. PROVIDE MINIMUM 2"DROP WISE MEETING REGULATORY SLOPE I (D REQUII2EMENT FROM THE SEPTIC TANK OUTLET PIPE INVERT TO SEE NOTES 2,3 AND 4 THE INVERT OF THE INFLUENT PIPE INTO THE NITROE TANK. I 2. NITROE TANK TOP TO HAVE TWO-24,THREE-12"HOLES AND 1 I fi MULTIPLE 4"DIAMETER ACCESS HOLES WITH RISERS AND COVERS FOR MAINTENANCE AND SAMPLING. 3. FOR THE 24"HOLES,PROVIDE 24"DIA.ADS PIPE WITH COVER TO 12" # 225 I I BELOW GROUND SURFACE. BOLTED TO TANK TOP. a 4. FOR THE 12"HOLES,PROVIDE THREE-12"HOLES WITH ADAPTER a Z 1 Sty w/f w ( !' GROUND SURFAC�TYP) - - - RINGS,RISERS AND COVERS TO 12"BELOW GROUND SURFACE. Dwelling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INSTALL 4"DIA.MONITORING PIPE(1"BELOW GROUND SURFACE) F.F. EL. 73.00 WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH WITH 11 ( TO TITLE 5 SOIL GROUND SURFACE. o �1 nR V.: / 5 1/2"TANK N -1 FABSORPTION SYSTEM 5. PROVIDE FOUR-6"DIAMETER PLASTIC ROUND BOXES AND COVERS 1 TOP(TYP) (SAS) (NITROE AND SEPTIC TANKS)TO BE INSTALLED AT GROUND LEVEL. " ! - 6. PROVIDE INFLUENT SAMPLING PIPE(2"DIA.)6"FROM EDGE OF f INFLUENT r .y`,:� .•;n..: '1• .y,t_•'.•:•:,.'.'��.••r :: ..: :;y; . J / 1 (SEE NOTE 1) ` ' ' ''' "' "' ``"' " ' EFFLUENT SEPTIC TANK WALL WITH 6"PLASTIC ROUND BOX AND COVER AT = 48"STATIC / ;j GROUND SURFACE. s ❑ W WATER DEPTH LL O w ; LL TITLE 5 SEPTIC W a ;• l y SUBMERGED DENIiRIACATION CHAMBER O a Q w TANK z 3 1 AERATION (DC) W a (L -o CHAMBER f >I.-w z \ bti (NOT TO SCALE) o 1°z ►' (SAC) -� ? W _ �- •_- 54"E ,. y y w z Finish Cade - i N78 eq p6 y - i -� -� Max. �,., 100 9.. Min Filter Chicken Coop ELEV.=0" , '�'• •�• -••• Compacted Fill _.. Y Fabric TANK BOTTOM Andlor THICKNESS4" CRUSHED AGGREGATE OR APPROVED 2" '' 1/8" - 1/2" \ N/F TANK WALL THICKNESS MATERIAL(DEPTH TBD-6"MIN);ON LEVEL, Pea Stone I� David A. Grenier AT BOTTOM(4 1/2') COMPACTED AND STABLE BASE 3' H-20TANK 3/4" - 1 1/2 AT TOP(3'�THICKNESS KleanTu LLC LEACHING Double Washed PLAN VIEW CHAMBER Stone PLAN AND PROFILE VIEW NITROE WASTE-WATER TREATMENT SYSTEM (WWTS) 4, _ 10, E SCALE: 1" = 10' I _ I 12' 10" T-AS2000-H10 CROSS SECTION OF CHAMBER SEPTIC NOTES DESIGN DATA NOT TO SCALE 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Single Family Prior to Any Excavation For This Project the Contractor Shall Make -3 Bedroom @ 110 GPD the Required Notification to Dig Safe(1-888-344-7233)and contact No Garbage Grinder Sullivan Engineering&Consulting Inc.(508-428-3344). Total Daily Flow=330 GPD 2.The Contractor is Required to Secure Appropriate Permits From Town Use Existing 1000 Gal Septic Tank Ch orcool Filtered Vent Final Location to be Determined Agencies For Construction Defined by This Plan. at time of installation 3. Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall LEACHING AREA F.F. El. 73.00 accordance with Landscape Plan Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to 330 GPD/0.74(LIAR)=446 SF Required Assure Watertightness. In General,Water Lines Shall be Constructed in Sidewall=2(75)=150 F F.G. EL. 71.00* - *Final Foundation Grading To Be F.G. EL. 70.0 - 68.0 Coordination With COMM Water,and Shall be in Accordance Bottom Area=320 SF oor rn o e with LandscapeSee Note 6 (t yp.) F.G. EL. 68.0 - 65.5 With 248 CMR 1.00-7.00&310 CAR 15.00. Total Provided=470 SF(347 GPD) 4.A Minimum of9"of Cover is Required for All Components. 5.All Structures Buried Three Feet or More or Subject LEACHING CHAMBER DESIGN EL. 68.70 to Vehicular Traffic to be H-20 Loading.It is the Engineer's Installer To Flow Equilizers All Pipes to be Schedule 40. Use EL. 6 5 Existing Recommendation that H-20 Always be Used. Confirm Prior 9 As Required 2-500 Gal.Leaching Chambers in a 1000 Gallon EL. 65.75 6.Install Watertight Risers and Covers to Within 6"ofFinished Grade To Any Work Double Washed Stone Field as Shown. Septic Tank EL 68.00 PROPOSED Over Septic Tank Inlet and Outlet,D-Box,and One Leaching Chamber. ( )See Note 5 NI TROE EL. 65.00 R0. All covers are to be maximum 18"for concrete or 24"Cast Iron. 7 Tot) EL. 63.00 7.Septic System to be Installed in Accordance With 310 CAM 15.00& D-Box EL. 64.58 248 CAM 1.00-7.00 Latest Revision and the Town ofBamstable PROPOSED Board of Health Regulations. VARIANCE 310 CAM 15.221 General(7)-3'Depth Allowed 62.00 Leaching 8.All Piping to be Sch.40 PVC. To Be Installed On 5'Depth Proposed , Chamber 9.D-Box Shall Have a Minimum Inside Dimension of 12;and a Minimum table omp oc ec ase _ Bo t. EL. 60.00 Sump of 6". (Approvable By a Health Inspector) Bedding, T s, 10. The Separation Distance Between the Septic Tank Inlets and Inspection Port, If Encountered Rerrlbve & Replaee. Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend & Boffel s All tlnsurtable...Sti�7s ..... f r.. a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" as Per Title 5 Tf e Du ter::P&Tiri:eter;:o:f.::Th""Sysf:em.: pF/9 Below the Flow Line,and Shall be Equipped With a Gas Baffle. �ZN "SUS_ o JOHN O'D .; ,IVIL DEVELOPED PROFILE OF SYSTEM EL. 44f 48168 LEGEND. GIST ' NOT TO SCALE �A C�C Lake Elevation or �l�Sr ""� CDT Cedar Tree 1 V 1 HT Holly Tree i DT Deciduous Tree NOTES: PREPARED FOR: PREPARED BY. TI TLE: n CT Coniferous Tree EngineeringS/to P/a/ 1Utility Pole 1.) The structures shown were located on the ground Barnstable Clean Water Coalition & Proposed Septic Upgrade by conventional survey methods in June 2020. 864 Main St. (� lt� Ine, -E- Electric Consulting At -G- Gas 2.) The property line information shown hereon was ivalft � O V> Wetland Flag I compiled from available record information. Osterville, MA 02655 • Light Post (508)428-3344•P.O. Box 659•`711 Main Street, Osterville, MA 02665 225 Lakeside Drive 3.) The datum is NAVD '88. seci@suliivanengin.c�om•wwwsullivanengin.com Barnstable (Marstons El CB/DH Mills) Mass. � OHW- Overhead Wires W 25 Elevation Contour 10 O 5 10 20 40 Draff: ASL Field: WHK/CTR W 614 Review: CTR Comp.: ASL DATE: SCALE: June 30 2020 1 "=10' Project: BCWC Project#: 1998138 l