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HomeMy WebLinkAbout0241 LAKESIDE DRIVE - Health 241 Lakeside Drive Marstons Mills P A = 102 167 i o. 4210 113 YEL q. x pe nd ar, •1r r A CC \J !U% a s, C�v � 3 77 - 79 z S j ` � 11 v�a /63 TOWN OF BARNSTABLE LOCATION ( -�.iC�,�D� SEWAGE# (�®� VILLAGE MAkCJtQJS ph ILLS ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. O. SEPTIC TANK CAPACITY I�D"a LEACHING FACILITY.(type) Ck4eM L'49P-S r (size) I k CI A?,O�r;01 NO.OF BEDROOMS OWNER PERMIT DATE: 12 117 1 0g COMPLIANCE DATE: 1113116 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) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ® Feet FURNISHED BY 50 I 245 Q�,2 2,5� �3 a35 �. �TOWN OF, ARNSTABLE LOCATION �"" SEWAGE # V-1LAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY -LEACHING FACILITY: (type) (size) NO.OF BEDROOMS ;BUII.DER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlan exist-7 within 300 feet of leaching facility) lJ( Feet Furnished_by r y r I F r hi � s a� �� to ��� L0 CAT ION ---:ZLI/ _ S f,AG,�� J ERMIT NO. VILLAGE Z,V1;v13 7'e,eV INST LER'S NAME - & ADDRESS 0 U I L DE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED j. ��,� �� �. � _, y f � �. j t. r , _ r •r '. Town of Barnstable 39. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt March 7, 2022 Mr. Joseph Henderson Horsley Witten Group 90 Route 6A, Unit 1 Sandwich, MA 02563 RE:= �24'1 LakesitlemDnve; Marstons Mills 4 .. g A 1021fi7, Dear Mr. Henderson, You are granted permission on behalf of your clients, Paula and Jon Johnson, to construct and utilize a NitROE secondary treatment unit with advanced nitrogen reduction technology at 241 Lakeside Drive, Marstons Mills, Massachusetts. This permission is granted with the following condition: • The engineering plan shall be revised to correct multiple errors and omissions (i.e. buoyancy calculations, knock out in pump chamber, incorrect outlet notation on NiTROE unit, septic pumping frequency) provided in the email from Chief Health Inspector David Stanton to Joseph Henderson dated August 18, 2021 You are reminded the following requirements are provided within the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter for this particular technology, dated May 12, 2020: (1) Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit, stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; KleanTu NitROE 2K Provisional Approval, May 2020 Page 11 of 15 Technology: NitROE® 2KS & 2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) Q:WP/Henderson 241 Lakeside Drive MarstonsMills NitROEApproval Aug 2021.docx and the Approval; and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). (2) Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000, the approved design plans, and all local requirements, including any local approving authority site-specific requirements; (3) Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i) a certified Registry copy of the Notice bearing the book and page/or document number; and (ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department (4) Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year. (5) The wastewater effluent shall be sampled and analyzed/tested quarterly if this facility is utilized year-round. Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection. [Note:a)Year-round facilities shall be inspected and effluent sampled quarterly; b)Seasonal properties shall be inspected and effluent sampled a minimum of twice per year,with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample; and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling shall also include Field Testing of System wastewater when determined necessary by the operator, see DEP Field Testing Protocol at http://www.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamp.pdfl (6) A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. The above list is not all inclusive; all of the other conditions listed in the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter to KleanTu LLC dated May 12, 2020 will need to be adhered to. This permission is granted because the proposed plan appears to meet the maximum feasible compliance provisions of the State Environmental Code, Title 5, and the Town of Barnstable Board of Health Regulations. It also appears to meet the nitrogen loading restrictions contained within the State and local regulations with no increase in sewage flow requested at this property at this time. Q:WP/Henderson 241 Lakeside Drive MarstonsMills NitROEApproval Aug 2021.docx f�• Sincerely yours, n Norman hairman Q:WP/Henderson 241LakesideDriveMarstcnsMills NitROEApproval Aug 2021.docx DATE: O /D Z t�. Town of Barnstable REC.BY: � %639 e1� Board of Health 3CFtED.DATE ZLtg 200 Main Street,Hyannis MA 02601 Once: 508-9624644 John T.Norman FAX: 508-790-6304jj��' Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM LOCATION 241 Lakeside Drive - Marstons Mills Property Address: 102/167 0.17 acres Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. No Business Name: Subdivision Name: APPLICANT'S NAME: Joseph Henderson(Horsley Witten) Phone 508-833-6600 Did the owner of the property au"gi VOR to represent him or her? Yes X No PROPERTY OWN AM , CONTACT PERSON ' Paula J Jon yl Johmson Joseph Henderson(Horsley Witten Group) Name: Name: l 241 Lakeside Drive ons Mills 90 Route 6A,Unit 1 Sandwich,MA 02563 Address: Address: _ Phone: Phone: 508-833-6600 EMAIL: jhenderson@horsleywitten.com VARIANCE FROM REGULATION(incl.Reg.Code a) REASON FOR VARIANCE(May attach separate sheet if more space needed) Installation o system. NATURE OF WORK: House Addition U House Renovation LJ Repair.of Failed Septic System LJ Checklist (to be completed by o ice sta -person receiving variance request application) Please submit first four on list as 5 collated packets. A. Five(5)copies of the completed variance request form B. Five(5)copies of MA DBP approval letters for Innovative/Alternative 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: healthO.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 PLS. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submined•$95.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1)Septic repair without an increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. Q:\Application Forms\VARIREQ Rev Jan 1-2020.docx ayiT�� (J:ksr tA(satiJ ILI 1� fa � x /01 x � 0 /c-3 r . ,+ KleanTu® LLC KleanTu Wastewater John R.Smith Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80040-040-2108 for 241 Lakeside Drive Marstons Mills MA 02648 pg. 115 August 8, 2021 Ms. Paula Johnson Mr.Jon Kyle Johnson 241 Lakeside Drive Marstons Mills,MA 02648 RE: NitROE02K WWTS Start-Up and Monitoring,Operation and Maintenance(MOM)for 241 Lakeside Drive, Marstons Mills,MA 02648;KleanTu®Job No.80040 Dear Paula and Jon: 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 241 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 signif-_cantly 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 130135)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 operation. 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 Shubael Pond Innovative_and Alternative Septic System Project. After this initial five years,MOM related costs will be the responsibility of the homeowner. - 1- CONTRACT No.80040-0821 for 241Lakeside Drive Marston Mills MA 02648 Be,2/5 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 241 Lakeside Drive,Marstons Mills,MA. I Time Price per Period Period Deliverables ($) September • 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 August 2022 NitROE®2K 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 by the Mass DEP Provisional Permit. • Respond to Homeowner issues,concerns and questions. Monthly Inspection and Quarterly Monitoring Updates to Homeowner. (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 2027 • Respond to Homeowner issues,concerns and questions. costs to be paid (5 years) Quarterly Inspection and Monitoring Updates to Homeowner. for by the BCWC) September Quarterly Inspection and Sample Collection per Mass DEP Gener- $600- $1,200 2027 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) 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- f CONTRACT No.80040-040-2108 for 241 Lakeside Drivej Marstons Mills MA 02648 .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 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 I that this I"year contract,once executed,runs from September 2021 -August 2022, antic-'pating use immediately after installation. As the NitROE82K WWTS 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 K1eanTuo 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. -3- CONTRACT No.80040-040-2108 for 241 Lakeside Drive Marstons Mills MA 02648 pg. 4/5 Table 2. Non-Routine MOM Items and Projected Price Estimates for New NitROE°2KS WWTS Replacement Items for 241 Lakeside Drive,Marstons Mills,MA . Item Description Price Estimate 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/day=$0.58/day. Non-routine . 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 Visits • K1eanTuo 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 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) • Replacing remote sensing unit and probes=$360. $360 Replace Remote . 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 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 10-20 Years) Replace Wood . Replace all wood chips=$1,000. $1,000 Chips . Exact time period is variable with estimate of every 20-30 years. (Every 20-30 Years) Replace Lime- • Limestone Addition=$1,600. $1,600 stone . Exact time period is variable with estimate of every 20-30 years. (Every 20-30 Years) -4- CONTRACT No. 80040-040-2108 for 241 Lakeside Drive,Marstons,Mills,MA 02648 pg. 5/5 PAYMENT TERMS Even though there is no site owner cost for the first five years of MOM,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 subsequent years. 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, zcrocker ,bcleanwater.org,of Barnstable Clean Water Coalition with any questyons or comments. Thank you, Tohn R,5rnifh John R Smith(Aug 9,202107:14 EDT) John R. Smith President SYSTEM OWNER SIGNATURE Name: Paula Johnson 7ohe,f,v Signature: Paula J Johnson(Aug 8,202116:39 EDT) Name: Jon Kyle Johnson ld_>`li�G /O�UZ�tfi%i Signature: jon kjohn on(Aug 8,202118:12 EDT) -5- McKean, Thomas From: Stanton, David Sent: Wednesday, August 18, 2021 11:14 AM To: . Joe Henderson Cc: McKean, Thomas; Crocker, Sharon; Soto, Kathryn Subject: 241 Lakeside Drive Marstons Mills, staff comments for Board of Health hearing Hi Joe, I was given the application for the Board of Health to review for 241 Lakeside Drive, Marston's Mills. Here are the following staff comments/questions I am passing along to the Board of Health, note that some of these may not pertain to you. Also note that an error in the Health Division left very little time for review, so I apologize if I missed anything during this rushed review,which was not a fault on your end: -Application and Agenda have different spelled names (Johmson vs Johnson,Jon vs Joh -Letter to you & Paula Johnson from John Smith dated August 9, 2021 in the second paragraph Item IV-#5 of the DEP permit requires...In lieu of8UFP certification... Tom says this is not allowed as it is a DEP requirement and must comply with DEP requirements -The floor plans submitted are different from the floor plans on record (Building permit 2009-06356, with a new number of 86064 for the open gov software program) 754M1- W Jr '"'6 5- -The outlet of the Nitroe tank says to SAS, should be to Pump Chamber .lP -Note 16 refers to the order of conditions for conservation for dewatering the hole (I assume this if for the Nitroe tank installation) can we get a copy of the order of conditions and can you ensure the installer is given a copy as well. j -No buoyancy calculations provided for the Nitroe tank being installed below high groundwaten� -Plans show a revision date of 6/15/21 per BOH comments. Did this go to the Board of Health already? The plans show a date of 8/2/21 on them �vr;L� � jeaO-' , -How is the invert into the pump chamber being lowered? Le. Is there a lower knock out in the pump chamber existing or are they attempting to drill a new hole in the pump chamber, or removing, excavating and dropping the pumpL chamber lower? (Note,there will be more to follow depending on what the proposal is) WA �'j r` wj't�-- LJ+y - -Note 11 says to pump the septic tank out every 2 years, this is contradictory to the signed contract by the owner from the company that says typically every 3 to 8 years. (note, not in my jurisdiction, but it is recommended that they may want to get rough estimates from a couple local septage haulers on the cost to pump out a tank, $600 seems a little high to me, but I could be wrong, maybe they priced it off of the Vineyard prices as I heard that is where they started these systems, again,just a thought as a homeowner usually likes lower fees, or at lea ts, I do and it may help their cause) - '1AV�� Any questions let me know, again I apologize if I missed anything on the short review notice. J Thanks, Dave 1 n KleanTu® LLC KleanTu Wastewater John R.Smith Treatment P.O. Box 1154 Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office August 9,2021 Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: Property and System Owner Certification for New NitROE®2KS WV S Enhanced Title 5 Septic System Installation for 241 Lakeside Drive, Marstons Mills, MA 02648; KleanTu Project 480040. Dear Members of the Board: Kindly refer to the following:(i)the Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.: X285590; Issued May 12,2020)(the"DEP Permit");and(ii)the Enhanced Title 5 Septic System proposed for 241 Lakeside Drive, Marstons Mills,MA,a private residence,(the"New System'),featuring the use of a new NitROE® 2KS wastewater treatment system(the"NitROElo 2KS Components"). Item IV - #5 of the DEP Permit requires that KleanTu®LLC provide to the Town of Barnstable Board of Health (the "Board")a certification that the owner of the property of record has agreed to certain specific matters with respect to the New System. I have included with this letter the required certification. Should you have any questions,please do not hesitate to contact me. Sincerely yours, To n R Srnrth John R Smith(Au 9,202107:1.5 EDT) - John R. Smith President Enclosure cc: Paula Johnson, Property and System Owner -1- I August 9, 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 241 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 241 Lakeside Drive,Marstons Mills, MA 026L8, 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 1 agree to comply with all terms and conditions cited therein. 2. I 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,record- keeping,reporting and related matters for the NitROE®2KS Components(collectively,the"O&M Responsibili- ties."). 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 1 must fulfill my responsibilities to provide written notification of the conditions of the DEP Per- mit to any new owner,as required by 310 CMR 15.287(5). Sincerely yours, Paula J Johnson(Aug 8,2021 16:57 EDT) Jon k john on(Aug 8,2021 18:10 EDT) Paula Johnson Jon Kyle Johnson 2 August 9,2021 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Sirs, This email is to verify that I have authorized Horsley Witten to design plans for an alternative septic system to be installed at my house. This plan will be submitted to you for approval. Please don't hesitate to contact me with any questions. Paula J Johnson(Aug 8,2021 16:40 EDT) Jon kjohnron(Aug 8,2021 18:09 EDT) Paula Johnson Jon Kyle Johnson 241 Lakeside Drive Marstons Mills, MA02648 t KleanTu® LLC eo. Wastewater John R.Smith Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80040-2108 for 241 Lakeside Drive Marstons Mills MA 02648 p 1/6 August 8,2021 Ms.Paula Johnson Mr.Jan Kyle Johnson 241 Lakeside Drive Marstons Mills,MA 02648 RE: NitROE®2KS WWTS Installation for 241 Lakeside Drive, Marstons Mills,MA KleanTu® Job No.: 80040 Dear Paula and Jon: KleanTu®LLC is pleased to provide this contract document for a NitROE®2KS Waste-Water Treatment System (WWTS)to be installed at 241 Lakeside Drive,Marstons Mills,MA. The main purpose of the NitROE®2KS WWTS is to serve as a supplemental upgrading of a new Title 5 septic system. A new NitROE®2KS WWTS tank will be inserted in between the gravity flow path of a new septic tank and a new leaching chamber. The purpose of the NitROE®2KS 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® 2KS 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 N:tROE®2KS WWTS to be installed is specified in Site Drawing Project No.: 20112,prepared by Horsley Witten Group Inc.(HWG)dated August 2,2021,and modified August 4,2021. With reference to this site drawing,wastewater will first be collected into an existing 1,500-gallon septic tank. After solids separation in the septic tank,wastewater will then gravity flow into a 1,500-gallon H2O NitROE®2KS WWTS tank for enhance total nitrogen reduction. From there,the significantly treated wastewater will gravity flow into an existing pump chamber for pressurized pipe transfer to an existing leach field. 1 K , CONTRACT No. 80040-2108 for 241 Lakeside Drive Marstons Mills,MA 62648 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 owner's costs associated with operation&maintenance(O&M) activities with the operation of the New NitROE02K 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 KleanTuo'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. 2 C CONTRACT No.80040-2108 for 241 Lakeside Drive Marstons Mills MA 02648 DIE.3/6 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 installatior_ 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. 3 CONTRACT No.80040-2108 for 241 Lakeside Drive,Marstons Mills,MA 02648 In. 4/6 INSTALLATION ACTIVITIES AND PRICE 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(BCWC)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 KleanTuo 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.digsafe.com),but they only identify public utility lines and not any private lines. As cited in the Table 1 below,the contract price for KleanTu® to provide the task activities cited is$12,500.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 r CONTRACT No.80040-2108 for 241 Lakeside Drive,Marstons Mills MA 02648 pg.5/6 Table 1. KleanTu°Price of Title 5 Enhancement via NitROE®2KS WWTS Enhancement for 241 Lakeside Drive,Marstons Mills,MA 02648 ONE 1,500 GALLON NitROE TANK(N-ASST152M-H20) (KleanTu°Project No.80040) 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 local $0 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 one 1,500-gallon NitROE®2KS H-20 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 $12,500 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 $12,500 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 oversight $0 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. 80040-2108 for 241 Lakeside Drive,Marstons Mills MA 02648 Pa.6/6 SCHEDULE Barring unforeseen circumstances,KleanTu®will have the NitROE WWTS tank ready for installation in September 2021,with the actual date to be finalized with the site owner and their installer. PAYMENT SCHEDULE All KleanTu®costs to be paid by the BCWC under separate contract with KleanTu®LLC. WARRANTY KleanTu®guarantees NitROE®2KS WWTS specific equipment and materials to properly operate for a period of one year. This is contingent that the NitROE®2KS WWTS is installed per the engineering design and that the NitROE®2KS 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 KleanTu® and BCWC designated personnel will be allowed access to the site for the purpose of performing routine MOM activities associated with the NitROE®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 NitROE®2K WWTS 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 KleanTu®,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 NitRO.E®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 zerocker(a�bcleanwater.org at Barnstable Clean Water Coalition with any questions or comments. Sincerely, Tohn R Smrfh John R Srr ith(Aug 9,202107:13 EDT) John R. Smith President 7,z2y& o Name: Paula Johnson Signature: PAULA J JOHNSON(Aug a,202116:21 EDT) ion� 1a� Name: Jon Kyle Johnson Signature:ion k)ohn on(Auga,202118:13 EDT) 6 i KleanTu® LLC KleanTu Wastewater John R.Smith Treatment P.O. Box 1154 Technologies Edgartown,MA 02539 (R, 412-719-5976-Mobile 508-627-3072-Office August 9,2021 Ms. Paula Johnson 241 Lakeside Drive Marstons Mills,MA 02648 Joseph Henderson Horsley Witten Group 90 Route 6A, Unit 1 Sandwich, MA 02563 RE: Installer Certification for New NitROE02K WWTS Enhanced Title 5 Septic System Installation for 241 Lakeside Drive, Marstons Mills,MA 02648;KleanTu Project#80044. Dear Paula: 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 241 Lakeside Drive,Marstons Mills,MA(the"New S stem'),featuring the use of a new NitROE® a e co n s ----------------- 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 certification b the installer KleanTu®LLC hereby certifies to both of you that KleanTu®personnel will be onsite ervise the installation of the NitROE®2KS Components. Such supervision will ensure that the NitROE®2KS onents are installed in a manner that conforms with KleanTu®LLC's design and operating requirements. Please contact me with any questions or comme ing this certt nation. My cell #is 412-719-5976. Sincerely yours, John R Sm th(Aug 3,202111.:48 EDT) John R. Smith President KleanTu® LLC KleanTu Wastewater John R.Smith Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office Augc.st 9, 2021 To: Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: Designer Certification for New NitROE02KS WWTS Enhanced Title 5 Septic System Installation for 241. Lakeside Drive,Marstons Mills,MA 02648;KleanTu Project#80040. 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 241 Lakeside Drive, Marstson Mills, MA private residence(the"New System"),featuring the use of a new NitROE®2KS wastewater treatment system(the"NitROE®2KS Components"). The New System was designed by Joseph Henderson,a Massachusetts Registered Professional Engineer with Horsley Witten Group, Inc.(HWG). The NitROE®2K Components are depicted in Site Drawing Project No.: 20112,prepared by HWG and dated August 9,2021. Item IV-#2 of the DEP Permit requires that KleanTu®make certain certifications to the Town of Barnstable Board of Health(the"Board")pertaining to the design of the New System. Accordingly, KleanTu®LLC hereby certifies to the Board that(i)the New System design,solely as it relates to the NitROE®2KS Components and their incorporation into the New System,conforms with the design specifications required by the DEP Permit and(ii)the NitROE®2KS Components are able to perform the proposed wastewater treatment for the New System. Sincerely yours, John R Smilh(Aug 3,2021 10:10 EDT) .. .. - John R. Smith President cc: Joseph Henderson, Horsley Witten Group Paula Johnson,Property and System Owner - 1- f McKean, Thomas From: Stanton, David Sent: Tuesday, August 24, 2021 9:18 AM To: McKean, Thomas Subject: FW: 241 Lakeside Dr, MM - file FYI. Here is the e-mail I was referring to for the floor plans as his plans didn't match our plans. I hope this doesn't create a problem at the hearing. I did re-send this e-mail to Sharon, so hopefully it will get resolved before the meeting. From: Stanton, David Sent: Thursday, August 19, 2021 1:13 PM To: Crocker, Sharon Subject: RE: 241 Lakeside Dr, MM - file Hi Sharon, No worries. It is really more for Joe Henderson, I do have pictures of the info, but they are on my work cell phone (which is hopefully at home.) He was surprised when he called me to go over the problems with the plans for the Board and by accident he was told we didn't have a file. It appears that someone may have looked for the wrong address (or village) and that's why he was told we didn't have a folder. Thank you for sending him a copy of the plans. Also when you get a second if you could send him the floor plans from the file, his floor plans that he submitted to the Board are different from our folder, and again he was surprised we had a copy of the floor plans because it was assumed we didn't have a folder. Thanks, ,. Dave AFrom: Crocker, Sharon Sent: Thursday, August 19, 2021 11:09 AM To: Stanton, David Subject: 241 Lakeside Dr, MM - file Dave, I should have left an Out Card—I apologize. The file I brought over was this file—too late to help. I have put the file back on Tom's desk and those files now have Out cards. I understand your frustration. Sharon Sharon Crocker Office Manager Town of Barnstable—Health 508-862-4739 The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a 1 Barnstable .CLEAN WATER Coalition August 9, 2021 Ms. Paula Johnson Mr. Jon Kyle Johnson 241 Lakeside Drive Marstons Mills, MA 02648 RE: Tax Treatment of Klean Tu NitROE Waste Water Treatment System Dear Paula and Kyle: This letter is to memorialize the position of Three Bays Preservation, Inc. d/b/a Barnstable Clean Water Coalition("BCWC") concerning the tax treatment of the installation of a K1eanTu NitROE Waste Water Treatment System (the "System") on your property. Under the terms of the Contract No. 80040-0821 for 241 Lakeside Drive, Marstons Mills, MA, 02648 (the "Contract"), you have agreed to let BCWC modify your home's existing Title V septic tank with a System. The purpose of this modification is to allow BCWC to, among other things, gather data in order to evaluate the effectiveness of the System at reducing total dissolved nitrogen concentrations in the surrounding groundwater. As you are aware,the costs of the System installation including excavating the necessary soil, establishing the electrical connection, and associated equipment to your existing septic system are not insignificant. Pursuant to the Contract's terms, BCWC shall be responsible for all of the costs associated with the System including installation. As part of the process, BCWC requested a legal opinion concerning the federal and Massachusetts income tax consequences to you of the installation of the System. It is the opinion of our tax counsel that the installation of the System on your property will most likely not constitute taxable income to you. Our legal counsel believes this to be the case because: • Your selection as a participant in the program is solely determined because your residence is located within the identified System's test area; • BCWC is receiving certain rights from you to periodically access the System and the soil on your land in order to gather test data; RO.Box 215 Osterville, Mn 02655-0215•(508)420-0780.BCleanwater.org The Contract provides that BCWC is responsible for selecting the contractor and controls the process by which the excavation and installation of the System will be performed on your property; • Aside from the anticipated environmental benefit of reducing water-based nitrogen pollution, the System is not expected to enhance nor improve the performance of your existing septic system in any measurable way; and •None of the funds expended to purchase and install the System on your property will be received or controlled by you at any point. Because the installation of the System on your property does not result in taxable income to you, BCWC's position is that there is no transaction to report on your annual income tax returns, nor is there any requirement that.BCWC furnish you with a payee statement. If you would like to review the opinion provided to us b our tax counsel or have questions concerning these conclu- sions,please reach out to us. Thank you again for your participation in this important to project to help improve and preserve this special place that is Cape Cod. Sincerely, Zenas(Zee) Crocker VII Executive Director cc: Michael P. Duffy,Esq. Fletcher Tilton PC P.O.Box 215•Osterville,MA 02655-0215•(508)420-0780•BCleanWater.org Barnstable CLEAN WATER Coalition August 9, 2021 Ms. Paula Johnson Mr. Jon Kyle Johnson 241 Lakeside Drive Marstons Mills, MA 02648 Dear Paula and Kyle: Thank you for agreeing to partner with us in the Shubael Pond Innovative and Alternative ( I/A ) Septic System Project ('Project"). While there will be no cost to you, your participation is an investment in the future of Shubael Pond and all of Cape Cod. Having experienced the closure of your pond for several years running, you know how important water is to our community and everyone hereon the Cape. In your home, you will see no difference between the new system and the old one. The way you use water; toilet flushing, shower, laundry and, so forth will not change. What will be different is what takes place in the treatment tanks underground. Contaminants will be treated, and nitrogen gas will be released harmlessly into the atmosphere. Your wastewater will be treated to a level leaving it largely harmless to the environment, all using the power equivalent of a single light bulb. Why this project is so important. Shubael Pond is one of many freshwater ponds experiencing an increase in toxic algal blooms that often force beach closures during the spring and summer months. Reductions in recreational opportunities and restrictions on shellfishing are occurring in growing numbers along our coastline in the saltwater as well. In the Shubael Pond neighborhood, almost all of us use what are known as Title 5 systems. These systems do help with bacteria, but they do little to remove other contaminants. Wastewater flowing through these Title 5 systems is the primary culprit for most of our water problems. Generally, our nitrogen-rich wastewater is released into the groundwater, flowing into our fresh and saltwater bodies. This action has been identified as the single largest cause of environmental degradation to our marshes, bays, beaches and drinking water. With your help, we are taking one of the first critical steps to fix this problem so we can save our water and our way of life. We think of these new systems as "Title 6" technology. Ultimately, we believe that most households that do not get connected to municipal treatment (town sewer) will transition to "Title 6" type technology. Time is of the essence. The Town of Barnstable has received approval from the State to implement the town's Comprehensive Wastewater Management Plan ("CWMP"). The CWMP is a 30-year plan and the Sand Shores neighborhood is included in Phase 3. This means that Shubael may see no treatment for 25 years or more. Your pond may be essentially dead by then. We are glad the Town is starting to act, and we support the plan, but we want to find faster, lower-cost solutions. That is what this project is all about. We believe that the wastewater treatment system we are installing will reduce nitrogen and other contaminants to levels equal to or better than municipal sewering at a much lower cost. P.O.Box 215•Osterville,Mn 02655-0215•(508)420-0780.BOcanWater.org Why your property was selected for this project. Over the past year and a half, water samples have been collected and data has been analyzed from the 34 monitoring wells and 4 Multilevel Groundwater Monitoring Systems (MLS) installed around the Sand Shores neighborhood. This work has been conducted by our project partners at the U.S. Environmental Protection Agency and the U.S. Geological Survey. The data has identified where the groundwater flows are occurring and this will allow us to intercept the groundwater near your property and several other properties inclose proximity. With this information we will be able to compare the groundwater that the KleanTu NitROE Wastewater Treatment ("NitROE"), that is being installed at your house, has treated with the untreated groundwater from the neighborhoods existing Title 5 systems. Next Steps. The engineering firm Horsley Witten Group ("HWG") has completed the inspection of your existing septic system, has surveyed your property and has developed a septic system design plan. With this information, HWG and Barnstable Clean Water Coalition will present your property with the system design and any necessary variance request(s) to the town of Barnstable's Board of Health ("BOH") at its August 24, 2021 meeting. Anticipating approval of the NitROE installation from the BOH, our goal is to have the NitROE system installed by September or October. In preparation for the installation, this Homeowner's Manual has important information for you to review and in places provide your signature for approval. In addition to this cover letter in the form of a Project Overview (Section1), the Homeowner's Manual includes the following sections: • Section 2: Support.Letters from Project Partners • Section 3: KleanTu NitROE Wastewater Treatment System • Section 4: Contract and Installation • Section 5: Operation and Maintenance (OM&M) • Section 6: Legal and Tax Implications • Section 7: Questions and Answers • Section 8: Site Documents This manual will be updated accordingly as we obtain more inform the next several months. ation from our project partners over As a lifelong Cape Cod.resident and a recent Sand Shore property owner, I look forward to the days where we can swim, fish and sail in clean waters that.I remember from 50 years ago. With your help and with others who share the same concerns, we can return to those days— but we must act NOW. I look forward to working with you on this project and am available to answer your questions via e-mail (zcrockeKa)bcleanwater.org) or phone 508-420-0780. Sincerely, Zee Crocker GExecutive Director P.O.Box 215.Osterville,MA 02655-0215•(508)420-0780•KleanWater.org 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"), NitROER 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 e K1eanTu NitROE 2K Provisional Approval,May 2020 Page 2 of 15 Technology:NitROE®2KS&2KM WWTS I.PURPOSE Subject to the conditions of this Approval and any other local requirements, the purpose of this Approval is to allow installation and operation of at least 50 on-site sewage disposal systems utilizing the technology in Massachusetts in order to conduct a performance evaluation of the capabilities of the Technology during the first 3 years of operation of each system, in accordance with Title 5 — 310 CMR 15.286 (7),Provisional Approval of Alternative System. The specific goal of the Performance Evaluation is to determine if the Technology is capable of consistently meeting the concentration limits for total nitrogen (TN) of less than 11 milligrams per liter (mg/L) for installations with design flows less than 2,000 GPD in the effluent discharged to the soil absorption system. In areas subject to nitrogen loading limitations, increases in the discharge rate per acre may be allowed when the nitrogen concentration discharged to the soil is reduced. The Company is responsible for oversight and sampling of the systems during the Performance Evaluation. The System Owner has responsibility for continued oversight and sampling of the system if the property served was allowed to increase the discharge rate per acre above 440 gallons per day per acre (gpda) in an area subject to Nitrogen Loading Limitations. The System Owner will be required to repair, replace,modify or take any other action as required by the Department or the local approving authority, if the Department or the local approving authority determines that the System is not capable of meeting the required reduction in nitrogen in the effluent. With the other applicable permits or approvals that may be required by Title 5, this Approval authorizes the installation and use of the Alternative System in Massachusetts. All the provisions of Title 5, including the General Conditions for all Alternative Systems (310 CMR 15.287), apply to the sale, design, installation, and use of the System, except those provisions that specifically have been varied by this Approval. II.GENERAL DESCRIPTION OF THE TECHNOLOGY ' installed in series between a Title-5 system septic The NitROE ® 2KS or 2KM WWTS (the System ) is nsta se s b y p 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 K1eanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15 Technology:NitROEO 2KS&2KM WWTS • A certified operator under contract for periodic inspection and maintenance; • Periodic sampling; • Recordkeeping and reporting; and • An external power supply III. CONDITIONS OF APPROVAL A. Basis for Conditions 1. The term "System" refers to the Technology in combination with any other components of an on-site treatment and disposal system that may be required to serve a Facility in accordance with 310 CMR 15.000. 2. The term "Approval" includes the Special Conditions, Standard Conditions, General Conditions of 310 CMR 15.287, and the approved Attachments. 3. Items required by this Approval include: a) Performance Evaluation Plan (PEP) with sampling and analysis requirements and approved by the Department. The PEP must be submitted to the Department for review and approval within 60 days of issuance of this Approval and meet the requirements of the Department's Guidance for the Preparation of Performance Evaluation Plans <2,000 GPD; b) Minimum System installation requirements; c) Company schematic drawings and specifications; d) Owner's Manual, including information on substances that should not be discharged to the System; e) Operation and Maintenance manual, including but not limited to, operator qualification requirements, inspection requirements, sampling and analysis requirements, recordkeepin.g requirements, and/or reporting requirements; and f) MassDEP Operation and Maintenance (O&M) checklist and I/A technology inspection checklist. B. Special Conditions 1. Department review and approval of the System design and installation is not required unless the Department determines on a case-by-case basis pursuant to its authority at 310 CMR 15.003(2)(e)that the proposed System requires Department review and approval. 2. System installations must meet the specific siting conditions for Provisional Use provided in 310 CMR 15.286(4)and the facility must meet the siting requirements of this Approval. 3. Any System for which a complete Disposal System Construction Permit Application is submitted while this Approval is in effect, may be permitted, installed, and used in accordance with this Approval unless the Department,the local approval authority, or a court requires the System to be modified or removed or requires discharges to the System to cease. 4. The System Owner shall provide access to the site for purposes of sampling the System in accordance with the Company's technology Performance Evaluation Plan approved by the KleanTu NitROE 2K Provisional Approval,May 2020 Page 4 of 15 Technology:NitROE&2KS&2KM WWTS Department, in addition to providing access for performing inspections, maintenance, repairs, and responding to alarm events. ' 5. The System Owner shall ensure that no permanent buildings or structures, other than the System, are constructed in the area for the installation of all the components of a fully conforming Title 5 system with a reserve area. The area for a fully conforming Title 5 system with a reserve area shall not otherwise be disturbed by the System Owner in any manner that will render it unusable for future installation of a fully conforming Title 5 system. 6. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sanitary sewer system. If it is feasible to connect anew 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 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. 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 0&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.govleea ldocsldep/water/l aws/i-thru-zltestsamp.P&.. 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). r K1eanTu 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 htW:Ilwww.mass.gov/eealdocsldeplwaterl7awsli-thru-zltestsamp.pdf. Water meter readings shall be recorded at each inspection, see"Flow Metering" below. b) Seasonal properties shall be sampled for at least the TN parameter a minimum of twice/year. At least one annual sample must be taken 30 to 60 days after each seasonal occupancy. A second sample must be taken no less than 2 months after the first sample. Field testing of the System shall be completed as determined necessary by the operator. Water meter readings shall be recorded at each inspection, see"Flow Metering" below. 32. Flow Metering - At a minimum, for all systems installed prior to this Approval, water meter flow data shall be recorded each time the system is inspected and sampled by the System Operator. For systems installed after the effective date of this Approval, wastewater flow data shall be recorded each time the system is inspected and sampled by the System Operator and may be based on: a) actual metering data of wastewater flow to the system; or b) water meter data for the total facility with metered non-wastewater flows, if available, subtracted from the total facility water usage. 33. Field Testing: Turbidity, pH and Apparent Color - Turbidity, pH, DO and apparent color shall be measured and/or recorded in the field when when determined necessary by the operator. See applicable sections of the Department's Field Testing Protocol at hgp://www.mass.gov/eea%docs/dep/water/laws/i-thru-z/testsamp.pdf. 34. At a minimum,the System Operator shall inspect the System: a) two times per year; b) in accordance with the approved O&M manual, the Designer's operation and maintenance requirements, and the requirements of the local approving authority; and c) any time there is an alarm event, equipment failure, or system failure 35. The System Operator shall collect samples and obtain analysis results from an approved lab, perform field testing required by the Approval and submit results within 60 days of the site visit to the System Owner. 36. If the Company successfully demonstrates the effectiveness of the System to reduce nitrogen loadings during the Performance Evaluation period, a minimum of three years, the System Owner shall operate the System subject to the requirements of the General Use Certification, if issued, for this technology. C. Special Conditions Specific to the Company 1. The Approval shall only apply to model units with the same model designations specified in this approval and meet the same specifications, operating requirements, and plans, as provided by the manufacturer at the time of the application. Any proposed modifications of the units shall be subject to the review of the Department for coverage under the Approval. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 9 of 15 Technology:NitROEO 2KS&2KM WWTS 2. Prior to submission of an application for a DSCP, the Company shall provide to the Designer and the System Owner: 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; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 11 of 15 Technology:NitROEO 2KS&2K1vI WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)and the Approval; and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). 2. Upon submission of an application for a DSCP to the Approving Authority, the Company shall submit to the Approving Authority, with a copy to the Designer and the System Owner, a certification by the Company or its authorized agent that the design conforms to this Approval and that the proposed use of the System is consistent with the unit's capabilities and all Company requirements. The review shall include evaluation of the need for installation of water meter(s) at each facility. An authorized agent of the Company responsible for the design review shall have received technical training in the Company's products. 3. The System Designer shall be a Massachusetts Registered Professional Engineer, or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. 4. Thirty (30) days prior to delivery of the treatment unit to the site for installation, the Company shall provide to the Approving Authority a copy of a signed contract for a minimum period of one year with a Company approved Operator and the initial Owner/Occupant of the property. 5. Prior to the commencement of construction,the System Installer must certify in writing to the Designer and the System Owner that (s)he has taken the Company's training, passed the Company's training qualifications, and is listed on the Company's list of Installers. 6. Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000, the approved design plans, and all local requirements, including any local approving authority site-specific requirements; b) In accordance with 310 CMR 15.021(3), the Designer must certify in writing that any changes to the design plans have been reflected on as-built plans which have been submitted to the Approving Authority by the Designer; c) As a condition of this Approval, the System Installer and Designer must certify to the Approving Authority in writing that the System has been constructed in compliance with the terms of this Approval; d) An authorized agent of the Company must certify to the Approving Authority in writing that the installation was done by a qualified Installer approved by the Company and the installation conforms to this Approval. The authorized agent of the Company responsible for the inspection of the installation shall have received technical training in the Company's products; and e) Prior to signing any agreement to transfer any or all interest in the property served by the system, or any portion of the property, including any possessory interest, the System Owner shall provide.written notice, as required by 310 CMR 15.287(5) of all conditions contained in the Approval to the transferee(s). Any and all instruments of transfer and any leases or rental agreements shall be included as an exhibit attached thereto and made K1eanTu NitROE 2K Provisional Approval,May 2020 Page 12 of 15 Technology:NitROEO 2KS&2KM WWTS a part thereof of a copy of the Approval for the System. The System Owner shall send a copy of such written notification(s) to the Local Approving Authority within 10 days of such notice to the transferee(s). V. STANDARD CONDITIONS 1. The provisions of 310 CMR 15.000 are applicable to the design, installation, use and operation of a System utilizing an approved or certified alternative technology, except those provisions that specifically have been varied by the conditions of this Approval. 2. The design, installation, and use of the System must conform to the terms and conditions of the Approval and the Department approved attachments. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. Standard Conditions Applicable to the System Owner. 4. This Approval shall be binding on the System Owner and on its agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the System Owner unless the Department determines otherwise. 5. The System Owner shall obtain all necessary permits and approvals required by 310 CMR 15.000 prior to the installation and use of the System in Massachusetts. 6. The System is approved for the treatment and disposal of sanitary sewage only. The System Owner shall not introduce any wastes that are not sanitary sewage into the System. The System Owner shall dispose of wastes generated or used at the facility that are not sanitary sewage by other lawful means. 7. Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 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 K1eanTu 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. r • o I K1eanTu NitROE 2K Provisional Approval,May g 2020 Page 15 of 15 Technology:NitROE&2KS&2KM WWTS 6. The owner or operator, or the proponent of the alternative system, shall obtain and provide the Department with a determination from the board of certification of operators of wastewater treatment facilities established pursuant to M.G.L. c. 21, § 34A as to whether a certified operator is required for operation of the alternative system. The Department shall waive this requirement if.it has on file a determination for the alternative system, and shall notify the owner, operator,or proponent of the determination. 7. It is a violation of 310 CMR 15.000 to install, construct, or operate an alternative system except in full compliance with the written approval and 310 CMR 15.287. 8. The Department mGy 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 roped b the alternative property served Y 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. r No.� 915 FEE_/610 V COMMONWEALTH OF MASSACHUSETTS Board of Health, Bac a le- ,MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(�y Upgrade( ) Abandon( ) - 1160mplete System ❑Individual Components Location 2ql Owner's Name J!Lcile Q Map/Parcel# !Q 2 Address Lot# &9Telephone# Installer's Name A0 s-R• CIO DesigPPnCCerr's Nair J B � OMEMG ONO Addres I ✓ !Q gs6 i / ft=Vft MA Telephone# W, tj ©2Z 4,6 Telephone# 10 r� Type of Building -ire-((I A 4 Lot Size 745 y�� sq.ft. Dwelling-No.of Bedrooms Garbage grinder( ) Other-Type of Building No.of persons Showers( ),Cafeteria ( ) Other Fixtures Design Flow (nu .r quired) ��� gpd Calculated design flow Design flow provideId 8 gpd Plan: Date 1Z 1 �1 Number of sheets Revision Date Title Description of Soil(s) C kAJ _ Soil Evaluator Form No. Name of Soil Evaluator 6ADate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS eP P A CK A ., CIVIL t o. . A � I The unde ed es to' ve a ed Individual Sewage Dispo al System in accordance with th visions and further s to t fle p e eration until a Certificate of Co pliaitc has been issued by the Board'of Health. Signed Date 4T 0 Inspections FEE_ COMMO NWEALTH OF MA � ITU TT SS C S� S Board of Health; DG. 1r n S'rA 12 MA. , CERTIFI�-'ATE Of COMPLIANCE Description of Work: U4 idual Component(s) 0 Complete System The undersigned hereby certify that thte Sewage Disposal System;"Constructed( ),Repaired fpgraded O,Abandoned( ) it III by at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5).and the approved design plans/as-built plans relating to application No. 2 na - dated ►Z-17-O, Approved Design Flow ?i �d(gpd) Installer Designer:. Insp on Date: The issuance of this permit shall not be construed as a.guarantee that the system will function as designed._ - Nol I�' FEE j F COMMONWEALTH Of MASSAC USETTS oe Board of Health, r-Af 7 S ,: P- MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby rant d to; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at .(./ CA,kQ 11, as described in the application for Disposal System Construction Permit No.2:00� L ► ,dated_I a--17-6 f) . Provided: Construction shall be completed within three years of the date of this permit. All local co ditto must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.ChadestuR MA Date Q- 17 CA Board of Health r7 V�- Town of Barnstable ,,oFt"E'O�ti Regulatory Services P, o; Thomas F. Geiler, Director +' WtNVABLE, 9 MASS., ]Public Health Division pTFD MAC A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 5087862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 2 I Sewage Permit# 20 d q 4f 5Assessor's Map`Parcel J D2 4 7. Designer: G_ s _ Installer: Address: 1 C J o Address: L i A- J On*d1ate.) ft �kR' was issued a permit to install a (installer) septic system at l ��` cS I based on a design drawn by (address) dated a 0 q (designer) 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. 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. qAA o �1ERACKA JR. �N (Insta e s Signature) civil. No. 25237 • A'Q� RfiGi `� ��4' (Designer's Signa (Affix Designers Stamp Here) PLEASE RET URN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Town of Barnstable P# ? $� 1` ATMs i Department of Regulatory Services B,R,>r AMM; Public Health Division Date l 200 Main Street,Hyannis MA 02601 G� Date Scheduled Time ✓ � T Fee Pd. O v Soil Suitability Assessment fora Sewage •spos l PerformedB:—�a.3C��7 c.1JlK—[�„i7 PL.s Witnessed By: ✓' w. LOCAtrTION&GENERAL INFORMATION Location Address 27 y Owner's Name Av 1 tf�I' t. f I Address 8 Qr Assessor's Map/Paroel: /O Z Ai i 7 ��Engineer's Name �y�iS/GiNCfei NEW CONSTRUCTION REPAIR C Telephone# y�/t � Land Use R�c�jg:�'kiky%.I Slopes(%) t. Surface Stones Distances from: Open Water Body FO d ft Possible Wet Area 'J/�'j V ft Drinking Water Well ft w Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) \ �Pr Parent material(geologic)�W aa Depth to Bedrock cmeDepth to Groundwater: Standing Water in Hole: 1 y�tv Y 6C,� Weeping from Pit Face Estimated Seasonal High Groundwater t DETERMINATION FOR SEASONAL HIGH WATER TABLE` ZZ Method Used: 1 r. ... __ .. Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level t-- ()0 Pil PERCOLATION TEST Date Time Observation Hole# J��J Time at 9" Depth of Perc Time at 6" Start Pre-soak Time Q /� //f1(' Time(9"6") cA s End Presoak l /V a Rate Min./Inch Z 2rn fI GG Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Original:Public Health Division Observation Hole Data To Be Completed on Back--------— ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORMDOC f DEEP OBSERVATION HOLE LOG Hole# ' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel c S L to y R 3 2 3V Q 1 h '9q C C Se�rl D - S — 400,5e /z ' c ti _ DEEP OBSERVATION HOLE LOG` Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten %Gravel �oA 3 A3 2. VA, 811C "t DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in-) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graved Flood Insurance Rate Mai): Above 500 year flood boundary No_ Yes Within 500 year boundary No �l Yes Within 100 year flood boundary No v Yes_ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring ious material? Certification I certify that on Q- (date)I have passed the soil evaluator examination approved by the Departm t of Envi onmental Protection and that the above analysis was performed by me consistent with the req re training pertise and experience cribed in 310 CMR 15.017. G Signature Date ��� Q:SEPnCIPERCFORMDoc no l 00 t (,3ao� plc ► J d�'�s �e� . � 3 �PNM Ur x w� Ind , a D6 3,5� ,�i d q1S ' L. 1.� ► ,ns �c�Of� - ��,,� II c CL- ov) ZaZl ns�� :.x RECEIVED COMMONWEALTH OF MASSACHUSETTS JUL 2 9 2003 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS RNSTABLE DEPARTMENT OF ENVIRONMENTAL PROT + + TOWN OLBADEPT. m v � d h ti Y O� ��M yyev TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS, MA 02648 lb c� Owner's Name: MANNING HAMILTON Owner's Address: 853 PALM CIRCLE LARGO, FL 33778 Date of Inspection: 7/3/03 Name of Inspector: (please print) JOHN GRAC1, INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET, MA. 02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address a:,d that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was perf6med 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). Tile system: X Passes r _ Conditionall asses _ Needs Furt Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 7/3/03 The system inspector shall submit opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti n. If the system is a shared system or has a desigi+ 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 systetV owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY I WO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND NOT DRIVING OVER SEPTIC SYSTEM. ****This report only describes conditions at the time of inspection and under tl,e 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. r Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 Inspection Summary: Check A,B,C,D or E 11 ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.RECOMMEND NOT DRIVING OVER SEPTIC SYSTEM. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. n/a The septic tank is metal and over 20 ears old*or the septic tank(whether metal or not)is structural) unsound, exhibits P Y P Y 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: n/a n/a Observation of sewage backup or break out or high static:water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 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 n/a "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: n/a Pagg 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 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 '/2 day flow X Required pumping more than 4 timers in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. 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 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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 X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. a Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 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. X _ 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 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents:2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): air (L\ U(�� Sump pump(yes or no):NO Last date of occupancy: n/a �� " 'Acts COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a 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): n/a Approximate age of all components,date installed(if known)and source of information: 20 YEARS BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO Pagp 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 BUILDING SEWER(locate on site plan) Depth below grade: 8" Materials of construction:_cast iron _40 PVC Xother(explain):20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 2" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000 GALLONS" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): D-BOX WAS VIDEO INSPECTED AND IS STRUCTURALLY SOUND-SYSTEM IS FUNCTIONING PROPERLY. PUMP CHAMBER:-(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R 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: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 SOIL ABSORPTION SYSTEM(SAS): X locate on site 1( ) ( pan,excavation not required) I If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.): DID NOT EXPOSE LEACH PIT,APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE.RECOMMEND RAISING COVER TO LEACH PIT. BOTTOM IS APPROXIMATED 8 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): n/a I Q Page 10 of I I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS, MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 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. �D T iN �b a in 1 h,tge•I I,of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 LAKESIDE DRIVE MARSTONS MILLS,MA 02648 Owner: MANNING HAMILTON Date of Inspection: 7/3/03 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 10+FT. - tt FORM 30 C&w HOBBs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2t� S-�N e L F_ CITY/TOWN EA L DEPARTMENT ca ® Nam HyAN MiS h'V� ADDRES TELEPHONE Address YL&Zo ti5 hIt i t-L S 1-' Occupant-`(A ^'Z Floor Apartment No. — No.of Occupants U%_V-a No.of Habitable Rooms l�'j No.Sleeping Rooms 1 No.dwelling or rooming units_ No.Stories i k/ 7 Name andaddress of owner F 40g o;c M•4��2�+.s S�L z 2 7 f G—A Z e a- 0 , -(4 ( 4 pL,^t/4 " Remarks Reg. Vio. YARD Out Bld s.: Fences: 2 3 G6 Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: A/ 0 JF4 A"-s .,-i ❑ B ❑ F ❑ M Doors,Windows: 0_<,&,A, + Roof Atoth,U.. l Gutters, Drains: =--Tr••-a ;. 9 Walls: Foundation: bN �.a,p -oct�tlg� Chimney: 5,0 S e el?ice- 1 BASEMENT Gen.Sanitation: 'L DjrA 9VA S Dampness: JUEMUvira — ZN S,40 A-axtw Stairs: t L M Lighting: i 41KT STRUCTURE INT. Hall,Stairway: Obst'n.: 00I'LeG"S Hall, Floor,Wall,Ceiling: A4 if ' 46 ® 391 Hall Lighting: Hall Windows: rLo-okl,-& - b HEATING Chimneys: 13,FLO 1 4 a 4,06 Central ❑ Y ❑ N Equip. Repair --C TYPE: Stacks, Flues,Vents: C- , • , 2 e �. PLUMBING: Supply Line: t�.� is ,2�-1V,., AZ 4- to -90 2 ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom —Pantry Den —Living Room Bedroom(1).. Bedroom 2 12Z A J. Bedroom 3 ! 1 -mod Bedroom 4 �a- Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks n Doors:o s o 0o :s ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECT ON REPORT I SI ED AND CERTIFIED UNDER THE PAINS AND PENALTIES O ERJURY., INSPECTOR 71 `� TITLE t0� A. DATE �a TIME f' d A.M. THE NEXT SCHEDULED REINSPECTION P.M. >. Kr�t.:r..r..,,,..ti,,,,,; .+'�..-.f„t.,�y� �;, _ « KM' .<i-i � . M .;^v; R«iYYca, •.. .. .. .r, .. ., 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation,any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105'CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. t (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the'creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,. so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. j (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. t awl- ++...,r^-.�yl'.a...... "i"°'^"7b""i'^�9"n++t'.c'..T'Yrai�'`n.+?`n�rM'�+�lMtr+�.'+..wn:.�Y�1kY d:<•iAr•.ii'R4•�S.:R Tha�lh�,fiR."4F*'+�""t}Y+.�.,•,�.+• .,.P.n1. e,.., +�*«wi*o`a,..^)-"'""":"^.'.'AtiFY� i FORM 30 c&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS {BOARD OF HEALTH tea S' / CITY/TOWN = W �--1 i;nL-1;q o DEPARTMENT r ADD S b 2 q1 L,1 kc Sr46- TELEPHONE Address t'lA►V.s^70" S 1 4 t v-L . It 4A Occupant\ (,\ ^'- Floor ----~-"' Apartment No. — No.of Occupants & A No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units-1 No.Stories 1 V 'Z- Name and address of owner 17re, IZ�►s L t. S Z 7 ( "I C2. l7 , u c t ./, 1 � rl UV?11 f*_- J'7 Remarks Reg. Vio. YARD Out Bld s.: Fences: r c ..)Z Garba e and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: AJ `' 94,rrf 1 1=°r2 1 ❑ B F ❑ M Doors,Windows.- Roof Gutters, Drains: Walls: Foundation: t` 1Nt�ED Chimney: BASEMENT Gen.Sanitation: 4'41 Dift >WA S Dampness: Stairs: 19W J,+ 4o,* Al a-r Li htin : A4 a# + 'fig k4T tfA r STRUCTURE INT. Hall,Stairway: Obst'n.: 1-?ei4is Hall, Floor,Wall,Ceiling: /4 'C >a 41A 416 V,¢'t< Sy Hall Windows: : HEATING Chimneys: A OE Central ❑ Y ❑ N E ui . Repair t**4rs; v3 r --r, , o u e. A�,n. e..-4,-4a„M,r,�. TYPE: Stacks, Flues,Vents: ,r,r,,. x7* u..,, : ,� , 04. ._, 2 .ur. PLUMBING: Supply Line: 1.-o A6 4- 'A ►-0 R -T ow,rt- to Ho2,� ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) � � ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: t DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 . t Z 7__ f-,A C C i Bedroom 2 2-Z? �11 1 Bedroom 3 („ rT � T c4 are .'.. Bedroom 4 j , /.ST` Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: r Kitchen Facilities Sink =" Stove ' " Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub`. Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH j MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE-- AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF.PERJURY.f`{� J� rf INSPECTOR !^--- �- lr r TITLE DATE 11212 6� ` TIME d (P M. P:M. ` THE NEXT SCHEDULED REINSPECTION 7 R P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24.hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. .-Aassa '6464 Department of Environmental Protection Bureau of Rl source Protection -Wastewater Management Program Form Application for Local Upgrade Approval Required by 310 CMR 15.403(1) Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where full compliance, as defined in 310 CMR 5.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. , NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer,use only the tab key Name to move your P-W kt6Lcursor-do not use the return Stree _ dress r key.. ✓n 51,0a�l City MA2,5-ray M f'(S State Zip Code 2. Owner Name and Addre : FC92i(Gj OGVI �o21p• � � � ILZi(Ghc� 11 Name Street Ad Tess C(/tIl VA 3 City State 22 402- Zip Telephone Number 4 3. Type of acility(check all that apply): Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility:: 5. Type of Exis�tiinnE `+g System: LY / ❑ Privy esspoot(s) Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): t5form9a•rev.5/02 Application for Local Upgrade Approval*Page 1 of 4 ; -Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: gpd Design flow of proposed upgraded system 2YE gpd Design flow of facility 3 � gpd B. Proposed Upgrade of System 1. Propos d upgrade is(check one): Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: i La rs' 3. Local Upgrade Approval is requested for: Reduction in setback(s)—describe reductions: f D' Ao Fes►.0aA,A . w:(t� QGrrl& I ngeX c)� 20 f ❑ Percolation rate for 30 to 60 min./inch: minfnch ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater. Separation reduction ft Percolation rate min.lnch Depth to groundwater ft ❑ Relocation of water supply well (explain): t5form9a•rev.5/02 Application for Local Upgrade Approval*Page 2 of 4 4. It F Massachusetts,Department of Environmental Protection'�t°f`�" T Bureau of Resource Protection=Wastewater Management Program Form:9A Applficatid,6f&Local Upgrade Approval Required by 310 CMR 15.403(1)✓ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: b To cllnw 2,771 a--/ oS a If the P9 upgrade involves a reduction in the required separation between the bottom of the soil proposed absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member or agent of the local approving authority. . High groundwater evaluation determined by: Evaluators Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: X 1 v11'1 e4 VQOW O O Ae- - 2. An alternative system approved pursu t to 310 CMR_15.283 to 15.288 is not feasible: �c aw► � c�l� s��Ce 3. A shared system is not feasible: ,z 4. Connection to a public sewer Pe- t5form9a not feasible: none PA OOt I CA is I •rev.5/02 Application for Local Upgrade Approval•Page 3 of 4 a i.Y s6 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program r Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): Application for Disposal System Construction Permit [Complete plans and specifications Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." �j C( -p 4) F c li Owners Sig a �r Date LI I I Pnnt Name ir kc- Z 1 10,q Name of P //r��e��r Date 150 L.(.71/V4, Preparers address City/Town Wl4 ` 81 �a� State/ZIP Telephone NOTE: 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of Watershed Management, upon issuance by the local approving authority and before commencement of construction. t5form9a•rev.5/02 Application for Local Upgrade Approval, Page 4 of 4 I Nf . rll -_ 11 Fzs.v ............... THE COMMONWEALTH OF MASSACHUSETTS �Y� ���BO�eRD OF HEALTH .........OF.......................................................................................•- , lirtt#ion for 31iipoiial luorks Cfonotrnr#ion Famit A 'cati n is hereby mad a Per to Construct ( ) or Repair ( ) an Individual Sewage Disposal ...... U. ............ ........................ ------ ----------•-----------_... t M Lot No. ^ Owner Address - L ------ .............................. --.... -----------------------------...----------. Installer Address Type of Building Size Lot.....2.1�......Sq. feet U Dwelling—No. of Bedrooms.........�--.........................Expansion Attic (AV) Garbage Grinder (/�--- '4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures .....-•------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY----...................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------•---••-----.....------•-----•--..._..----•--••-•-.................................................I.......-. 0 Description of Soil........................................................................................................................................................................ x x ----•- 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 iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ope on Vuil Certificate f Compliance has been issued by the board of hea h. 'cH... . / f i ned.. .......... ._...----•..........3.45R.............. ....•l . i �� - � ate Applcation Approved -•---••---•-•--- •-•...••-----•......•-•••...._...•-••..............•-•-----•---••-- --_. / �.... ate Application Disapprove he following reasons----------------------------•--•-------------•---•--•--••-----.....----------•-....-•-•••-- •--------........_ .....................................-••• --•--....-----••-••-•-....................._......--•--•....--............................................................................................... Date PermitNo.......................................................- Issued....................................................... Date --------------------------------- �a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................O F..................................... Appliratiun for Uiupu,ittl Workii Tonutrurtiun Prrutit Applicatii n is hereby niade.foraa Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ll ` / _ :. ............... �......... .. 4 1, \1rs.f?' ! �f��5...................... ., .:: _..:get !t'..... ................... .. .... Owne � -•- _Address W .. . . _ .:........ ................•--.. ......---------------------•••------ Installer Address Type of Building Size Lot.....2.S` .R......Sq. feet Dwelling—No. of Bedrooms_.__.__..2 ............................Expansion Attic (.04) Garbage Grinder (Mr— aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow..................... _......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ a1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Do-'ptIr01 '16stitit.................... Depth to ground water........................ a ................................•_-__•__.....---.....y .f 1,fYj•'......_........._......._...._...... ....._............-_•-•--.............---••---• 0 Description of Soil---------- .. j.�' t... . . t_.q 2=4 x .. �' if/ w `` ------------- -- --- -----------------------------------------------------------------------------•------------------------------------------------------------------------------.....--•---...... V 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 TI'1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ope n unkilift Certificate Compliance has been issued by the board of Beal h. Aigned Application Approved y�--•------ .......................•----•--•--------•--•----------•---.... ----.------ ,�/Late `�? Date Application Disapprovel, the following reasons----------------•----....---•--••----•--•---------------•----...-•--•----•-------•---------••---•...._......... .............................................:.........._._..........._................................................................__....._._....._...................•-----......................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH e ..........................................OF..................................................................................... �, (9rrtif iratr of TontlrliattrieHISS TO`'1 TIFY That the I1ItI�i i -1 Sewage Disposal System constructed Repaired ( ) 11 by.....................P...--• - �_, ...........--------.............-----•------------...............----....-------------•-•------- _ Installer J has been installed in accordance with the provisions of T 5 0,£ e State Sanitary Code as described in the application for Disposa Works Construction Permit No....................................... __..._.___._..._.............__.._.....___...... THE ISSU OF THIS CERTIFICATE SHALL NOT BE CONS A:ted A GUARANTEE THAT THE SYSTEM WIL ION SATISFACTORY. DATE..... ` .._...... Inspector...-•------ -------------------------------------•-•-•----.............----..---- THE COMMONWEALTH OF MASSACHUSETTS � BOARD D O F� H LTH � 1- NO. _ ''............... FEE........................ . ' �tl� urk����onutrttrtiun �rrntit Permission i ereby grantedtt�� fi"� ..�` - �' "••----------••------- •---------------•-----------•-------.......................-•-•--... to Constr or •r ( ,a:n divid` I Sew gejOisposal System .-.- _ ._..: ------------------------•-•------ - at N -• - - - •- --- - --- Street `J� as shown on the application for Disposal Works Construction Permit No �^� ..__:. Dated.......................................... .............. p..... -------- fBoard of Health DATE................................................................................ / FORM 1255 A. M. SULKIN, INC., BOSTON /}-ss � sT�a S� l I s� �- S�F�- 3s-3 3 77­ 7- �J, All ..... -01 t S J" 0 N 0 ij, a �5 J �W 7� V,, q 4 't T�s 4 z" 'T, 5 rp e A6_ 'FOUNDATION 9 Z S,tl� 571 m i, j :t Al 7, I N I I 4-1 F_t- 4 COVER S ONE'� N A I I N.t L.­� 3/8 T L A twl �q d, I SUMP fT,7, 7 10 U I D LIVEL: 'D B -A N J L 6j f -1�l/2:-�-,`W A S H IE -'Ar"0 r-a%) -4�1 a 1 3 e [4, 4 -DEPTH t'IF I", J, v C'7� es I Q C; k i L E At I N 6 P I T S iRESULTS -T EST, TRECAST', -PREC R,AT E ­TANK-�,:�,:- IT cp A �sp L L Ly- AST SEPTM�� H ITN ESSED By ,.,,.CAST :.-,IN- ,,PLACE _:J,�"*': -StlF. R' j e -OF- HEALTH � -0 'j. -BOARD -�O ATE _�O U j P T 11 t T L E T,,,,'� S 1 Z EL'� 17 r t C> 1 A _�j ""5' _A- L L,1-1_4 A&3 L 7 v�, r 'J, .1� "A i, 0 m `G _7 A -�­`E "'S E, S T E' POSE-D ,W �`._O F lir RO_,F LE_i, RC Sly I F tl �jo M T 10 N S -'�AN 0 _llisl GNE't 9 Y -10 E�ie ,:, L It> , /4 T I E S C Al E 'I I ��O ISP OS� L �Of cr O'll ' SUBSUR -SEWAGE FACE STA F ��'_S YS T t 1:0 W N' V�` IL IT i�� i �7. f l, S L 0 1 8 U' -PER 2' S 40�P.V'C `�VWER P I P E P I PES� H A lt'L CHE L LY, BE'" lrj04i LY OULE:� A L L P I P E S' S H A t L' PED EXCEPT" F FOOT 0 A CLH 7 T V, P X M S 1 T -�l E S 16 N :FLOW� ' B E 0 R 0 0 a U I f I I "_SHA' LEVEC 8 W L Of J H E­ THE F I R S T EET _Y P E R B R 3 GA tO A GA 'I'D A* ­11 ZE A —S E T C AN K 'k vay po Ji� 4#r V 4- M lb USE S A L' W 0 Is SAL GARBAG US �_l H-1 N 6 Sys Ll A C TE'M E' k 0 F 0 EA IFFECTIVE _Z 4 G 04, ' BOTTOM' IL TOTAL FL OW 4 A, Me 6 A L/.D At` 4 FLO W 0 T A L wh�� D I S P 0 S A L MUGU. RESERVE 7 7--77 -77 7 Ul ' up,:p 7� AA v E EN C E:,-­",".,f LAN I E F ER �k ,A Z jr)' T,0, ........... AV k3 877 T,i�� Y ,A P.P 8 0 VED v J4 8 0 Al 0 0 F` HEALI H 4 L_ V ,.,D AT F A,Nb V'­fP `VA 6AA El p, SE 44 OWN E R 1 P'R 0 P E A T Y"! D YA,p k V I c— _tl'lo t�"r V KF A Lt> Lo I Eg M,Ajq 4 To K 97 D T E L A�N T ADD 3„ A-1801 HIP ZABEL FILTER 24"M.H. COVER TO FINISH GRADE SECURED NOTE: NOTE: TO PREVENT UNAUTHORIZED ACCESS RISERS AND COVERS SHALLL BE MAGNETIC TAPE SHALL BE PLACED ABOVE AND ALONG WATERTIGHT AND WATERPROOF ALL COMPONENTS OF LEACHING SYSTEM NOT EXPOSED c' IN ORDER TO LOCATE THEM ONCE BURIED. ELEV.=99.90 24"M.H. COVER TO FINISH GRADE SECURED TO PREVENT UNAUTHORIZED ACCESS (2) 20-MANHOLE COVERS _ UNION GATE VALVE (2) 20-MANHOLE COVERS ITHIN 6" OF FINISH GRADE DISTRIBUTION BOX 4" CHARCOAL VE"_EQ JUNCTION BOX WITHIN 6" OF FINISH GRADE RISER TO WITHIN FLOW 6" OF FINISH GRADE RISER TO WITHIN 1/2" HANDLE ''�JUA - LEVEL SWITCHES (5 OUTLET BOX) 3" OF FINISH GRADE ~ o i, 4"SCH. 40 PVC o0 108.43 I-F.G'= 01 t - = 01 (min. = Ott (MI _ WAIVER 1 _ Z - �Ti_iTi Ti i1i ii-ifl l i F 1�ii(lil=n) 11=III-III= U) I I INV.=98.82 2" PVC W/ PRESSURE _ ;� I' ;;- FG F.G.-102.89(M N)) W- UNDERGROUND SEPTIC TANKS & PUMP CHAMBERS ,� LL- _ L0 � FITTINGS INV.=O± - - - - _4" SEWER PIPE OO o N n _ 3/8" BLEED HOLE `n 100.92 =f4" DIA. C.I. OR 101.27 - 101.10 TOP OF ChIAMBER 1.)TANKS SHALL BE STRUCTURALLY SOUND AND TO WITHSTAND THE N O O A1801 ZAIBEL FILTER SUPER IMPOSED LOADS. 1/16" FILTER SLOTS E- - - " " I :95.72 ALARM ON SC�4L; ELEV.=101.39 g m 10 -0 L x 5 -' 2 W d 13-3 4 99.60 1 2.)TANKS SHALL BE WATERTIGHT. O 5.5 PUMP ON CK VALVE 98..2- FILTER GASKET �- ,:« .. _ `,:: *. - .... 595.07POFF "11.73" IG 0 GAL. SEPTIC TANK 98.821000 GAL. oN COMPACTEDTBASE 9 CHE 3.)TANKS SHALL BE PRECAST CONCRETE. _ MP CHAMBER ,. fifi- 6" CRUSHED STONE ON COMPACTED BASE ELLV.=94.32 101.00 4.)MANUFACTURERS OF SEPTIC TANKS SHALL IMPLEMENT A QUALITY - (A-1801 HIP) _ PUMP I 6" CRUSHED STO E ON COMPACT BASE 10' 'MIN.) oN CRUSHED aasE s c r 100.06 CONTROL/QUALITY ASSURANCE PROGRAM IN CONFORMITY WITH , , 1O'-6"L X 5'_8"W - ) RUSHED STONE ASTM STANDARD C-1227-93. TANKS SHALL BE EMBOSSED 8'-O"L X 4'-2"W M'Y " ON COMPACTED BASE WITH A SEAL STATING THAT THIS ASTM STANDARD HAS BEEN 3 MET. TANKS NOT EMBOSSED WITH A SEAL SHALL BE REJECTED. ZAB EL FILTER DETAIL 2O'(MIN.) _ 8'-6"L x 4'-8"W 5.)TANKS SHALL BE ACCESSIBLE FOR INSPECTION AND MAINTENANCE. (NOT TO SCALE) NO STRUCTURES SHALL BE LOCATED DIRECTLY UPON,ABOVE,OR EXISTING 1000 GAL. PROPOSED 1000 GAL. ?RO{DOSED SECTION T{ IRU SYSTEM NEAR THE TANKS WHICH MAY INTERFERE WITH PERFORMANCE, - ACCESS,INSPECTION,PUMPING OR REPAIR. PRECAST CONCRETE SEPTIC TANK PRECAST CONCRETE PUMP CHAMBER (NOT TO SCALE) 6.)INLET AND OUTLET TEES SHALL BE OF CAST IRON,SCHEDULE 40 PVC, (NOT TO SCALE) (NOT TO SCALE) ' OR APPROVED EQUAL - PROPOSED FLOW LINE GRADES "AS-BUILT" GRADES 7.)SEPTIC TANKS SHALL BE PROVIDED WITH AT LEAST THREE(3) 20"DIAMETER MANHOLES. MANHOLES SHALL BE AT THE CENTER AND OVER EACH INLET AND OUTLET TEE. FOR COMPARTMENT INV.AT FOUNDATION 99.60# L HALL BE THE ACCESS TO THE 4" CAPPED INSPECTION PORTS TANKS THE CENTER MANHOLE S I nvsrEcnoNroRr WITH 1"W x6"L SLOT (TYP) ESTABLISH VEGETATIVE COVER INV. INTO SEPTIC TANK 99.17 COMPARTMENT CONNECTION. SYSTEM DESIGNS IN EXCESS OF I 1,000 GPD,ALL MANHOLES SHALL BE MADE ACCESSIBLE. FOR l TO WITHIN 3" OF FINISH GRADE IMPERVIOUS BARRIER DETAII, LIC GUS �'I}I, P INV.OUT OF SEPTIC TANK 98.92 SYSTEM DESIGNS OF 1,000 GPD OR LESS AT LEAST ONE(1) BACKFILL WITH FILTER FABRIC SECTION "A A" MANHOLE SHALL BE MADE ACCESSIBLE. IF APPLICABLE,PROVIDE CLEAN SAND CLEAN SAND MEETING (N.T.S.) a"y<ti "'�"'°`� 98.82 WATERTIGHT ACCESS PORT(RISERS),PRECAST CONCRETE OR 16" • >'��' A1 INV. INTO PUMP,CHAMBER 310 CZAR 15.255(3) zr • 141 �, 1 e';;r EQUIVALENT,WITH STEPS WHERE APPROPRIATE. MANHOLE _ „1. eb F.G.=105.10 MAX.) WAIVER REQ. • C� 101.27 = • s ? INV. INTO DISTRIBUTION BOX COVERS SHALL BE REMOVABLE,AND OF IMPERMEABLE AND F.G.= F.G.=102.89 MIN.) DURABLE MATERIAL.COVERS SHALL BE WITHIN SIX(6)INCHES OF I-. I I `' "`'$" • t • I � � _ ' ' � ' . ' w � ' INV.OUT OF DISTRIBUTION BOX 101.10 FINISHED GRADE AND SHALL BE SECURED TO PREVENT �� I II I I I I� •• v f ' f IQ.' UNAUTHORIZED ACCESS. -- 75" I I ;. n TOP OF �, i• P c F'` 101.00 III = 11. CHAMBER INV.INTO CHAMBER 8.INSTALLATION: {1-1 = TOP T.,,.= 101." "> • • * "* ° I I I ELEY.• 101.39 ,° fY r . . ,y 7, i a F^. 100.06 A-TANKS SHALL BE INSTALLED TRUE TO GRADE ON A LEVEL,STABLE IIIIII _ - rr 111 � MIL. k " 'b• �.r-� rr tt BOTTOM OF CHAMBER BED IITIII_ III=�" "'=llf�ll 1 g 45 RUBBER k: k�t �. ;r k ^ I leaching chambersr BASE THAT HAS BEEN MECHANICALLY COMPACTED,AND ON WHICH " 5 YAPO:t BARRIER r�rEx �� • ,b WATER TABLE 94.50 11.3" in field a ' SIX(6")INCHES OF CRUSHED HAS BEEN PLACED TO ENSURE n „4.5 (TYP) 6t Pf �# lv STABILTY AND TO PREVENT SETTLING. THE TANK SHALL HAVE PUMPS & CONTROLS 34 (TYp BOTTC'•Yr Y.B. &-:•39 y R p sty 4 a`.a� • ^ -. A MINIMUM OF NINE(9")INCHES OF COVER. ) B-THE INLET AND OUTLET TEES SHALL BE INSTALLED TO THE GRADES 1. (1)-GOULDS MODEL 3887 #WS0311 BF CHAMBER DETAIL , ` • ° ° "' -t j SHOWN ON THE PLAN. THE TEES SHALL EXTEND A MINIMUM OF 1/3 H.P. 2" DISCHARGE, 115 VOLT PUMP (NOT TO SCALE) • • `' ° %'�h F+tFx f/;' 1 .P• 1 T.P•�i2 r CROSS, SECTION A-A DETAIL . ., , ,� k w r ,r SIX(6')INCHES ABOVE THE FLOW LINE OF THE SEPTIC TANK AND 2. (1)-SIMPLEX PANEL WITH BELL & LIGHT 104.2 105.2 SHALL BE ON THE CENTER-LINE OF THE SEPTIC TANK AND LOCATED INSTALLED IN HOUSE). , (NOT TO SCALE) 1 • i ,�` y r q . �d�Z� y ( ) 1 , � , � r' SANDY LOAM SANDY LOAM DIRECTLY UNDER THE ACCESS MANHOLES. CROSS-SECTIONAL ° � s r: 10YR 3 2 10YR 3 2 FLOW BAFFLES SHALL NOT BE USED AS SUBSTITUTES FOR INLET 3• (1)-WATERPROOF JUNCTION BOX "' �w,xp „�x;, 103.7 A / 104.7 A / oRouTLETTEEs. (INSTALLED IN RISER) K, :. , �; � � C-FOR REPAIRS,CONTRACTOR SHALL,WHEN CONNECTING A NEW 4, 3 -SWITCH LEVEL CONTROLS `� `i(„ r ,+ }^^ �' �i�Kzp, ,, 6 LOAMY 6" LOAMY SEPTIC TANK TO AN EXISTING SEWER LINE, VERIFY SEWER LINE 5. 1 -BRACKET BIODIFFUSER 160OBD HIGH CAPACITY LEACHING CHAMBER DETAILS C� � < ' :��_ SAND SAND r x �y � 7 ' i rp@ °' u R ;_ 101.03 B 10YR 5/6 102.03 B 1OYR 5/6 IS SCH.40 OR C.I.IN GOOD CONDITION OR IT SHALL BE REPLACED. " 6. 1 -2 CHECK VALVE (NOT TO SCALE) / / <<° ��� *. � ` r 38" 38" ALSO THAT:ALL OUT FLOW PIPES FROM BUILDING RUN THRU 7. 1 -2" UNION / / Cu ,� �� E SEPTIC TANK. + .= w M V e1 `t �� � ALL WORK IN CONFORMANCE WITH MASS.STATE PLUMPING CODE. 8. 1 -2" GATE VALVE I DESIGN CRITERIA DOSE CALCS. CLASS I SOIL (3 BEDROOM) / / I r rt �` � ��, {; , , 44' NOTES: 330/3 + (.16 x 57) = 119 GAL./DOSE / 20.79 GAL./IN. = 5.73"(0.48') fps / I a "` i�Y °4 ;„ �k . MED. COARSE MED. COARSE I 1. THE ALARM AND PUMP SHALL BE ON SEPARATE _ / / '� • }' ^"''. fJ = a <2 MIN. SAND SAND 9.)UNLESS OTHERWISE NOTED(LION),THE DESIGN OF THIS SYSTEM 330 20.79 -15.87" 1.32' 24 HR STORAGE 2.5Y 5/4 2.5Y 5/4 DEDICATED ELECTRICAL CIRCUITS. / " ( CONFORMS TO THE REQUIREMENTS OF THE COMMONWEALTH OF 2. ELECTRICAL PERMITS ARE REQUIRED' 6 (0.50) SUMP 97.2o C1 98.20 C1 MASSACHUSETTS ENVIRONMENT CODE"TITLE V",AND THE + + REQUIREMENTS OF THE LOCAL BOARD OF HEALTH. 3. ALL WORK SHALL MEET SKATE ELECTRICAL CODE. 773 GAL. ABOVE ALARM =4.25 > 2.30 / / I 1 4d � ai ? '� V 84" MED. COARSE 84" MED. COARSE : SAND SAND 10.)THE DESIGN OF THIS SYSTEM DID NOT ALLOW FOR THE USE OF MEHM FEET / / I 2.5Y 6/3 2.5Y 6/3 A GARBAGE DISPOSAL. - - - - - - - - - - / SERIES: �� 93.53 C2 94.53 50 SIZE: 2"SOUDS / 194 I 128" 128" 5 (MP RPM: VARIES NO WATER NO MOTTLES NO WA1FJ2 NO MOTTLES 11.)THE SEPTIC TANK SHALL BE INSPECTED AND CLEANED IN ACCORDANCE 15 WITH 310 CMR 15.300 AND APPLICABLE LOf AL REQUIREMENTS. t t f � � fi fi `? _ - - SOIL �;(�G�' 40 - j - -- I 12.)GREASE TRAP,IF APPPIAICABLE,SHALL BE INSPECTED EVERY THREE -I- 4- -I- -1- -I-- -I -I-- 4- -I- -I- - 106_ / (3)MONTHS,AND SHALL BE CLEANED EVERY THREE(3)MONTHS OR to /r ]` S 87;00`00" E / T 1 PEPC RATE OF <Z Ml; 1TES/ INGI-1 BENCHMARK: WHEN THE LEVEL OF GREASE IS 25%OF THE EFFECTIVE DEPTH OF 30 - -1 o I ! ' I UU.00' '�� THE TRAP. - - - - - - - / / PRESENT DURING TESTS JN: 12/08/09 TOP OF FOUNDATION / �I , AGENT: DAVID STANTON j ' ELEV. = 108.43 (ASSUMED) 13.)THE DESIGN OF THIS SYSTEM CONFORMS WITH THE FOLLOWING T'- 20 - _ / I \ / _106 ^I SOIL EVALUATOR: JOSEPH E WEBBY JR. MINIMUM DISTBANCES FROM THE PROPOSED SANITARY SYSTEM: 10 A-SURFACE WATER SUPPLY OR GRAVEL PACKED WELLS.......400 FT. 5 1 1 1 fi fi f t I_ - �� 10A' \ ^I ui B-TUBULAR PUBLIC WELLS............................................................250 FT. -I- -I- -I- -�- 4- -I- 1 / 1C C-PRIVATE POTABLE WELLS..........................................................200 FT. 10 I / I PROPOSED / D-NON POTABLE/IRRIGATION WELLS..........................................200 FT. GATE VALVE - I 15 5' 1000'GAL. / DESIGN CALCULATIONS E-OTHER SANITARY SOIL ABSORBTION SYSTEMS.......................10 FT. - - - - - - - - __ - I 10.4' t�j`�- - -- - -`-I PUMP CHAMBER I 1. - - / NU.`ABER OF BEDROOMS = 3 EACH F-WETLANDS...................................................................................100 FT. o 0 20 40 50 so too 120 tao tso U.S. ,MP I / -� _ _ J GALLONS/BEDROOM = 110 @ 110 G.P.D. 14.)NO STRUCTURES SHALL BE LOCATED UPON,ABOVE,OR WITHIN 20'OF o to 20 3o ao �Xn I ¢ / 0 REQUIRED GPD = 330 GAL. THE LEACHING FIELD AREA. THE RESERVE AREA(100%EXPANSION)IS CONSIDERED TO BE THE SAME AS THE LEACHING AREA. 101.27 STATIC HEAD �0W �� I a o REQUIRED LEACHING AREA = 330 / 0.74 (@ <2 MIN./ INCH) _ _446 S.F. 95.07 PUMP OFF I w 77 0 / LEACHING AREA PROVIDED = 470 S.F. > 446 S.F. 6.20 PROPOSED SOIL ABSORBTION SYSTEM ,�N / 15.4' E, / _ 15.)THE TOP OF ALL SYTEM COMPONENTS,INCLUDING THE SEPTIC TANK, I p ( ) LEACHING CAPACITY - 348 GPD. > 330 GPD. DISTRIBUTION BOX OR DOSING CHAMBER AND SOIL ABSORPTION 8.82 FRICTION LOSSES 16 ADS BIODIFFUSER FIELD 160OBD CHAMBERS L / A SYSTEM,SHALL BE INSTALLED NO MORE THAN 36"BELOW FINISH 8.82 T.D.H. ® 40 G.P.M. IN A FIELD 50'L X 6'%"W I o Q / / 2 x 330=660 GAL. USE 1500 GAL. S.A.S. FIELD SIZE: GRADE. P# o 0 MINIMUM SEPTIC TANK 16 x 6.25 x 4.70=470 S.F. LEACHING CHAMBER AREAS \j J 04X8 1 6/ 16.)LEACHING CHAMBER SHALL BE ADS BIODIFFUSER 160OBD I `u 0 / ISSUE DATE DESCRIPTION DRAWN DESIGN CHECK ENGP OR ENGINEER APPROVED EQUAL. i o _ \ I o \ EXISTING EXISTING #1 12/11/09 REPAIR OF SANITARY SYSTEM J.E.W. II 17.)ALL INSTALLATIONS SHALL BE TRUE TO LINE AND GRADE. NOTE: o \ SEPTIC GAL. PAVED WAIVER REQUESTED UNDER I o \ 3 BEDROOM/ DECK SEPTIC TANK I DRIVEWAY 18.)ALL PIPING SHALL BE SCH.40 PVC. a,I \ DWELLING / o MAXIMUM FEASABLE COMPLIANCE 15.405 1 (b) "?I Z \ p#1 #241 / / o I 19.)DISTRIBUTION PIPES SHALL HAVE A MINIMUM DIAMETER OF 4- TO / / / / o AND A MINIMUM SLOPE OF 0.01%. TO ALLOW SOIL ABSORBTION SYSTEM r I - - - - 10 FEET RATHER THAN 20' FEET FROM AN W► \ � 20.)ALL UNSUITABLE MATERIAL,INCLUDING TOP SOIL AND SUB SOIL, I W SHALL BE REMOVED AS FOLLOWS: EXISTING FOUNDATION WITH THE USE OF AN REMOVE SOILS TO ELEVATION 100.5 t,AND A DISTANCE OF 5 FT. IMPERVIOUS BARRIER, AS SHOWN Y I 1 �0 W IN ALL DIRECTIONS OF THE DESIGNATED LEACHING AREA. us INSPECTION \ / i REPAIR OF: SANITARY SYSTEM 21.)REMOVED SOILS SHALL BE REPLACED WITH CLEAN SAND,MEETING WAIVER REQUESTED UNDER ml PORT (TYP.) C 104' 0 1 MAP 102 LOT 167 THE REQUIREMENTS OF 310 CMR 15.255(3). MAXIMUM FEASABLE COMPLIANCE 15.405 1 b 10.0' ix INSPECTION SCHEDULE . O I - - - - � z l 7,825 S.F. ui TOWN : MARSTONS MILLS, MA MAP 102 LOT 167 TO ALLOW S.A.S. 3.71 FEET BELOW FINISH � � o m Q , 23.)TO OBTAIN THE BOARD OF HEALTH CERTIFICATE,CONFIRMATION OF GRADE INSTEAD OF 3' (MAX.) I 2 0 LOCATION : 241 LAKESIDE DRIVE THE PROPER INSTALLATION IS REQUIRED. A-EXCAVATION OF UNSUITABLE MATERIAL \ CHARCOAL I BENCH MARK: \ \ VENT TOP N FOUNDATION PREPARED FOR : FEDERAL HOME LOAN MORTGAGE B-PLACEMENT OF THE CLEAN BACK FILL MEETING 310 CMR 15.255(3) � \ 1103X4 OF FO ND .43 C-INSATLLATION OF THE SYSTEM WITH ALL COMPONENTS 06 SCALE : 1" - 10' DATE : DECEMBER 11, 2009 EXPOSED FOR INSPECTION AND PREPARATION OF"AS-BUILT" \ .-I GAS GAS GAS�--GAS GAS GAS GAS I GAS GAS GAS GAS -GAS D-WHEN EXISTING GROUND ELEVATIONS ARE CHANGED,A FINISHED I GROUND ELEVATION"AS-BUILT"SHALL BE REQUIRED PRIOR TO 1 2 J '1.Bl>BY HEll"WN VJ� - zzv ASSOCIATES, LNG. �e CERTIFICATE OF COMPLIANCE BEING ISSUED. ( I UTILITY NOTES NOTES: \\ 100.00, I CIVIL ENGINEERS & LAND SURVEYORS N 8700'00" W ®--� 180 COUNTY ROAD - PLYMPTON, MA. 24.)THE LOCATION OF UTILITIES IS APPROXIMATE ONLY. DIG-SAFE AND \ OTHER APPROPRIATE AUTHORITIES SHALL BE NOTIFIED TO VERIFY 1.) LOCUS DOES LIE IN A ZONE II AQUIFER PROTECTION \ I I (781 ) 585-1164 ACTUAL RELOCATE ICATIONS,PRIOR E/AS REQUIRED. ANY EXCAVATING. ZONE \\ I I � ��1N 0f,yq 's t �e� k 1' 2.) LOCUS DOES NOT LIE IN A FLOOD HAZARD \ I I © t% JOSEPN ZONE AS DETERMINED BY THE FIRM MAP. � WEBBY, � � h 10 1 2 1 0 � E. " c VERACKA JR, - No, 28717 CIVIL y \ I I = r, E ``' No. 25237 3.) THERE ARE NO WETLANDS WITHIN 1 00'OF THE \ PROPOSED LEACHING FACILITY. \ I ,�/ I�� `� \�c, �s•;..FQ� ? 4.) THERE ARE NO KNOWN WELLS WITHIN I 1 �L 200' OF THE PROPOSED LEACHING FACILITY. �I I "M PRO ONAL LAND OVEYOR R FESSI NAL E INEER _ W-3696 ------------ j' �' ,j' � WASTEWATER NOTES � , n t s J e N M Cl THE CONTRACTOR SHALL PROVIDE A DEIINATERING PROTOCOL PRIOR TO CONSTRUCTION ,' " _ ` a IN ACCORDANCE WITH CONSERVATION COMMISSION ORDER OF CONDITIONS. ro', j/ 1. ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A '= C� E 6 / Of j w r SURVEY CONDUCTED BY THE HORSLEY WITTEN GROUP, INC.ON NOVEMBER 20,2020. c o j` 17. UNSUITABLE SOIL MUST BE REPLACED VWITH TITLE 5 SA SP IN 310 CMR 15.255(3). ANY ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL -� ry _ O ' 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS -° w SHALL BE REPORTED TO THE ENGINEER. tw m ° SHALL BE IN ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND t •* '' u`, '° ---❑ U/ REGULATIONS OF THE LOCAL BOARD OF HEALTH. O� 18. ALL SEPTIC COMPONENTS SHALL BE INSTTALLED WITH MAGNETIC WARNING TAPE. t �' o co c n � 0/y 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO � <: a 19. ALL SEPTIC TANKS SHALL BE APPLIED WIITH 2 COATS OF DAMP PROOFING OR BITUMINOUS ''" ' U.,-� LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON MATERIAL. � - o ~- £ � \_- } IT AND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. a <; �,_• l 5z .n 4 -..,' .. ZR ' 4. ANY CHANGES TO THIS PLAN MUST BE AP 20. THE CONTRACTOR SHALL RESTORE ALL.SURFACES EQUAL TO THEIR ORIGINAL CONDITION .„" % � 3 W n G _E S IN OVERHEAD PROVED BY THE ENGINEER AND/OR THE LOCAL AFTER CONSTRUCTION IS COMPLETE. AREAS NOT '' ' ' ^ Q EXISTING P I BOARD OF HEALTH BOH)STAFF. DISTURBED BY CONSTRUCTION SHALL j. _ BE LEFT NATURAL.THE CONTRACTOR SHIALL TAKE CARE t` _ �� � M CHAMBER TO AIN ° 0/y EEC 'HONE ( To PREVENT DAMAGE To „ v,, �F, �, .�; � v� m PROPOSED AIR PUMP --❑ SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE - #' = 1 � w EXIST INV IN =56.99 `------_ $�CA L SERVI E 5. PRIOR TO CONSTRUCTION,THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY � ' ° / PLANS DO NOT SHOW ALL LANDSCAPE FEATURES, EXISTING CONDITIONS MUST BE ' �r O `� FINAL LOCATION TO BE OWNER AND ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE 1 "'x 4 CDCD LOWER INV 1 =56.11 °- EXISTING LEACHING FIELD DETERMINED N78°05'25„ AREAS. WORK. .N _ 21. ALL UNPAVED .., �. ' •� ca ` �. AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF -� � ,; - . '� N FACILITY TO REMAIN r�`� 100.00!�= 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY '- � .4.,�'" " .,_ _-- 18 BIOD FF O ! LOAM INSTALLED AND BE SEEDED WITH GRASS SEED AS SHOWN ON THE PLAN AND/OR =" + * _ _ �, -LOCAL AND/OR STATE PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE DIRECTED BY THE ENGINE xxx.. a a a ( I USERS) j ER. THE CONTRACTOR SHALL BE RESPONSIBLE FOR WATERING _ M -`OHjW REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL HOURS OF OPERATION FOR THE -�� � ,w � �;�� �; ""� FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. ANY LOAM AND SEEDED AREAS UNTIL LAIWN GROWTH IS ESTABLISHED AND APPROVED BY - �_ 4 n THE ENGINEER AND/OR OWNER. (; " • �,�„,a 4 '� e§* a ,s m p ws n a 2 }' ' 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM w r` 22. AN INNOVATIVE&ALTERNATIVE TREATME = n' - a ✓' °�ENT SYSTEM IS PROPOSED FOR THIS SITE. THE ro0 THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. jp r SYSTEM MUST BE INSTALLED AND MAINTJAINED IN ACCORDANCE �' *�� fiF•� f j _ OF ENVIRONMENTALWITH THE DEPARTMENT r. L , Ifii AIR / - - 8. FAILING TO PROPERLY INSP PROTECTION(DEP)(PROVISIONAL USE APPROVAL. / ECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM ' ✓ '' �- "" OR CHANGES TO EFFLUENT FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR �LU �j' EXISTING SEPTIC TANK ; I .. ..,_,' t •' � ---:. ,_..� _._ _ �--- ' ADJACENT TO THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE SEPTIC AND TO REMAIN � 6 -" 4 SCH 40 PVC E M ' ,! I LEACHING SYSTEM(S). a Y INV OUT=56.86 / L=8', S=1.0% , PROJECT BENCH WASTEWATER INSTALLATION INSPECTION NOTES C m W C 3 d o ` v� 0 y' MAG FND EL.= 57.31 9• CALL"DIGSAFE"AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF ENGINEER AND LOCAL BOARD OF HEALTfH FOR ANY INSPECTION. � C4 I" 0 EXISTING UTILITIES, I 2. ALL WASTEWATER COMPONENTS SHALL BE INSPECTED BY THE ENGINEER AND THE LOCAL LO a m t' �` i` 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT MINIMUM THE FOLLOWING ITEMS SHALL = Y BAGE_GftINDEEt. BE INSPECTED: C' G> E c Lu 0 1 - W j� DECK2.1. SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL C = epi ey 1. THE OWNER SHALL INSPE�AND�PUMPHE SEPTIC TANK ONCE EVERY 2 YEARS. 2.2. LEAKAGE TEST ON SEPTIC TANK(MIN.24 HR) O m o 2.3. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS ,;��' � ZE ) N �! j p I ? O O 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE DESIGNED = j ,;4 24 LAKESIDE DRIVE/ / �� 0 { PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. 2.4. FINAL INSPECTION OF BACKFILLED SYSTEM _y Q p a N 1 3 BEDROOM HOUSE] „ 24 NITRIDE 2KS 1,500 ? 13. USE SCH.40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. 3. THE CONTRACTOR SHALL BERESPONS C� � a> 'O cO M Cl 4 SCH 40 PVC I IBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND p ,,, M M �i i _ _ o i GALLON H-20 TANK ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE. NOTES INDICATING THE HORIZONTAL AND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM tq t p $ M R C7 / L=7,S 6.O/o INV. I N=56.44 COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND NOTES WILL BE UTILIZED BY THE L w a op aD Q �+ z INV. OUT=56.19 14. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT, DUST,AND FINES. ENGINEER FOR THE PREPARATION OF RECORD PLANS. = ti h 1p o '�V ' 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE STAI RSA INFORMATION FOR THE SEPTIC SYSTEM TO THE ENGINEER, IF NECESSARY. j F PAVED J DRIVE Q 26 W ZONING & RESOURCE PROTECTION NOTES ` W in ✓ z M 1.. PARCEL ID: 102/167 LOT SIZE:0.17 AC �,j j ✓ Z. OWNER OF RECORD:PAULA J&JON KYLE JOHNSON a e°' / I �-- p �,•' w (� W z 3. ADDRESS: 241 LAKESIDE DRIVE,MARSTONS MILLS DECK O 4•. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON F.I.R.M.MAP 25001 CO542J DATED JULY 16,2014). W Q EXISTING 0 � > U� = z 5'. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. J WATER Cif J i G SER Q W �. G LU - Z Q LL N780 05,25"E W 02 O 100.00, EXISTING GAS SERVICE (TY .) CO (n J W " W o J cn _ Q Q W Q GRAPHIC SCALE r I- N _ 10 0 5 10 20 40 W N 1 j 1 0-FT ' w Q ;!' UFFER Q � (in feet) O POND I W 0 1 INCH = 10 FEET I- Cn �;; C) c c C GENERAL NOTES: m M � 139" 1. NITROE 2KS TANK TOP TO HAVE THREE-24",TWO-12"HOLES AND a a TOTAL TANK LENGTH MULTIPLE 4"HOLES WITH RISERS AND COVERS FOR MAINTENANCE i OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH(OT) AND SAMPLING. 2. FOR THE 24"HOLES;PROVIDE 24"DIA.ADS PIPE(CORRUGATED) L N WITH POLYLOK(OR EQUIVALENT)COVER(OR EQUIVALENT TANK WALL . •.: . .. :..` ,. ,. N a' a - . ' z w CONCRETE RISER AND COVER)TO 12"BELOW GROUND SURFACE U THICKNESS a..' •.Q`'... a; < a AND SECURE TO TANK TOP. AT TOP ..y LL ` 3. FOR THE 12"HOLES;USE ADS PIPE(CORRUGATED)AND POLYLOK .� Q (6"TYP) n O U (OR EQUIVALENT)COVERS TO 12"BELOW GROUND SURFACE AND (n .4 �_ M16BLE 0 ,�:- 36" o - SECURE TO TANK TOP. CU M TROUGH 00 U = o INLET J 4. PROVIDE FOUR 4"DIA.SAMPLING PORT(1"BELOW GROUND V Lo CL o w EFFLUENT .,' TROUGH SU D (MT) DE ATION a SURFACE)WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH CD c d N = FROM SEPTIC IT) ERATION CHAMB O WITH GROUND SURFACE. _w Q a� (n Y o TANK CHAMBER (DC) 5. FOR EXISTING SEPTIC TANK;PROVIDE 2"DIA.SAMPLING PIPE THAT 0 � Lo 2 00 73" Q (SAC) 0 IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" coLL ��- c c aj LO �- _J BELOW THE TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE n L (73 m ai = EFFLUENT OUT OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK � � � � O N .c(� ~O w CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, a m U 00 a O a m F- p ` _� THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE N GROUND SURFACE AND HAVE A 6"DIA-PLASTIC ROUND BOX AND �" _ COVER AT GROUND SURFACE. 0 000 0 Oyu a' CD g N - O N i N U 6"PLASTIC BOX AND COVER WITH 4" N MONITORING PIPE;SEE NOTE 3 AND 4(TYP) �i 24"ACCESS HOLE WITH FRAME LO Y AND COVER TO GRADE (TYP). Ur SEE NOTE 2(TYP) o 0 GROUND SURFACE TYP EL.58.44 MIN SEE NOTE 2(TYP) / coo 0 0 Jl 19 _LO N >+ 5 1/2"TANK TOP(TYP) v ` a> �. c� n 'o cQo200 - aa)) G� a` N a� . v o°O Z N EL.57.69` a,•.. , t : ';. OL c o X � EFFLUENT FROM SEPTIC ..'• i n a ; / �O TANK _ EFFLUENT / m 2 rn cn CL U_ 0 48"STATIC WATER DEPTH 00 a TO SOIL o m co co O wo ABSORPTION SYSTEM Registration: w (SAS) -� ;91 QF W F w F_ w q w a SUBMERGED DENITRIFICATION CHAMBER = o a¢w .� o CHAMAERABER DC o wEp . LCL Al Z O = _ON ( ) ~ H 0_ 0z o (SAC) �o ZW � j f �' cV `j �� W Wv OLLO� � J -► J LL. - rA. .. Awcz C) CD EL.51.69 KleanTu LL co C TANK BOTTOM N THICKNESS 6" 12"CRUSHED AGGREGATE OR APPROVED Project Number: Sheet: 4 MATERIAL;ON LEVEL,COMPACTED AND i O TANK WALL THICKNESS(6") STABLE BASE 20112 1 of 1 E NItROE 2KS 1,500 GALLON WASTEWATER TREATMENT SYSTEM (WWTS) sheet Number: Cl) N-ASST152M-H20 CU NOT TO SCALE _ _ WW - 1