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Home My WebLink About0285 LAKESIDE DRIVE - Health 285 La essi de Drive-, a�stons Mills P 102164 ZLLL.Q�s 4 No. ZaZ ^,�� (j Fee ! /7-15-1 Entered in computer: THE CO IN�WEALTH OF MASSA HUSETTS p Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpftration for Misposal 6pstrm Construction Jermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. y¢,s LWl-o wAs- xvrp- Owner's Name,Address,and Tel.No. 2 95� L_m"i w 4 Assessor'sMap/Parcel 102 :5., N1i A.: Installer's Name,Address,and Tel.No. _5�40 Fy 77 Fa-ga,5,f Designer's Name,Address,and Tel.No. cl® (0 A, Type of Building: S®S- 8 3 3 a " 'Dwelling No.of Bedrooms IL Lot Size ®" sq.ft. Garbage Grinder( ) Other Type of Building `Rest OLtA h BX No.of Persons Showers( ) Cafeteria( ) Other Fixtures In Design Flow(min.required) 2-2--O gpd Design flow provided gpd Plan Date 5 2 b21 Number of sheets Revision Date 9 Z Title Wd_5+W k ,`Re im ?kXA..vYA �@��,s Size of Septic Tank 9 0 �� Type of S.A.S. FXM Kq CkamY y-e* . Description of Soil N . Nature of Repairs or Alterations(Answer when applicable) likTnKlt15-f ;V J 0q, Vj Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Feat, SigarA Date -1 7, hL - Application Approved by Date J,d - Application Disapproved by Date ` for the following reasons Permit No. 2p 2-I r 36-6 Date Issued aaw s No. (1�� V Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes " ^ ro PUBLIC HEALTH,DIVISION - TOWN`OF BARNSTABLE, MASSACHUSETTS LO 01pplitatt in,for_toppsat 6pstem Construction Permit Application for a Permit to Construct(`) Repair Upgrade( ) Abandon(;� ) El Complete System 91lndividual Components Location Address or Lot No. L1*.ejtCk6 'DAL"* Owner's Name,Address,and Tel.No. ' _ �^ 'fit oltt rN afsti is Nti s A. Assessor's Map/Parcel l Q, 1 " fJy 10'" ,i �/��,ayy� JAh( irQ Instiller Name,Address;and Tel.No.��3 g� 77(v• � Designer's Name,Address,and Tel.No. o 9 Y 9 :„dc,. 121 ` Te,� �tl P�/e N(,JG{t /S,MA Ho.s1e, Zi0� fo�v�• Sa00W ak, M A Type of Building: ,ry 508- 833 Dwelling No.of Bedrooms '" Lot Size Q"1 sq.ft. Garbage Grinder( ) Other Type of Buildinge3tllCfti OLI No.of Persons Showers( ) Cafeteria( ) Other Fixtures ` terry, Design Flow(min.required) gpd Design flow provided �1 ( gpd / 'N Plan Dater �j �» J Z3•� � �* r'u�mber of sheets Revision Date 9841 } Title W d,3'�'Z.4�►&kV-. 01lti r t r s•CJI,i",..C LI d 1/Ct'&id$ }_ —Size Size of Septic Tank 1 S tb I/ Type of S.A.S. 7�tS'klaq 1 4 Description of Soil l At . '.�.- Nature of Repairs or Alterations(Answer when applicable) QjXt 5-hllC4 X%4 V IAf ' Date last inspected: Agreement: f} The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in - accordance with the provisions of Title 5 of the Environmental Code and Atoo place the system in operation until a Certificate of Compliance has been issued by this Board q-We q / S ed ,.+�,: Date i J I r I � " ' r.r. (� Application Approved by (tit�� ,. 1/�- Date Application G ` - A Disapproved Date pP roved b Y 0 for the following reasons Permit No. 20 2-1 35$ Date Issued /()I tj -~ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitatr Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at I® � L\ S I- S�� I �A . `�u k pxs� constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No I- 338 dated/o/q/1,oZ•1 Installer C-P l t- .5T'p E,2 Al Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system wI ctio as designed. t ( r Date 1 o f./1.t/-tl Inspector R -- -'----- ------- ---- ---- D Z �No. 1 r �D Fee THE COMMONWEALTH OF MASSACHUSETTS r� PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction 3permit ` Permission is hereby granted to Construct( ) Re air(X) `` Upgrade( ): Abandon( ) System located at 2- % 5 %�,•Q1cC s1 ttL lAttrt , M mrs tests Milk. M k- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her.duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be competed within three years of the date of this permit. - Date [lei Approved by tA'�-,-}- Town of Barnstable WE Inspectional Services Public Health Division BAMSTABI.B. MAM Thomas McKean,Director o na't s 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 10/21/2021 Sewage Permit#&,el— 3 S6 Assessor's Map\Parcel 102/164 Designer: Joe Henderson, Horsley Witten Group, Inc. Installer: E-9,16- 5.7W.CA S Address: 90 Route 6A Address: P-0, 1&k -11 Sandwich, MA 02563 M 1J725To u5 m i g_S MA-- 0 210 Y8 On D 21 _ Ei21 c ST& CJ 15 was issued a permit to instaf t a da e) (installer) septic system at 285 Lakeside Drive based on a design drawn by (address) Joe Henderson, Horsley Witten Group, Inc. dated May, 7 2021 revised 9/8/2021 (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. Strip out (if required) was inspected and the soils were found satisfactory. X I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were finrnd gAtigfqctorv. Revised water line location and existing leaching chamber elevations, revised plan submitted. X I certify that the system referenced above was constructed 'with the terms of the M approval letters(if applicable) � ZµOFMfii!aty4 o a e s Si ature) — (Desi er's ignature) (Affix D� PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. f THANK YOU. WoMdeptAHEALTIMEWER connecASEPTICkDesigner Certification Form Rev 8.14-13.DOC 0 TOWN OF BARNSTABLE LOCATION Z8157 /nK 5,12f n g _ SEWAGE# 20 Z.1 — 3 S$ VILLAGE Ih6R5U,11, MIUS ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. U21C STCiYy�S SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDRO S OWNER ;� ' PERMIT DATE: I S 2 COMPLIANCE DATE: c Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY At:/o J 'fvnh't Q % n G3: 4 � 13 ,0 CSC Z3 �Ca `22 C� 22 0 9 r cl: 39 L2S�� Or. C6_ Z� I Town of Barnstable > 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 3, 2022 Mr. Joseph Henderson Horsley Witten Group 90 Route 6A, Unit 1 Sandwich, MA 02563 ....w ,c...� .... .-,,.-�, ,y.. :tr rz. ..- , .. ..x :2i "a,°:• Ak.`,a• -.',,. z.; !:,m � - '"i�''� 'irfg�Y.".,.; ,ra`-.•.�,+E' �. Dear Mr. Henderson, During the public meeting of the Board of Health held on August 24, 2021, the Board voted to agree to withdraw your original request to increase the wastewater discharge flow to three (3) bedrooms at 285 Lakeside Drive Marstons Mills. Thus, a request for an innovative system designed for two (2) bedrooms (220 gpd) flow was reviewed. You are granted permission on behalf of your clients, William HC and Sandrea Bolton TRS, to construct and utilize a NitROE secondary treatment unit with advanced nitrogen reduction technology designed for two (2) bedrooms at 285 Lakeside Drive, Marstons Mills, Massachusetts. 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 WVVrS 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). Q:WP/Henderson 285 Lakeside Drive NitROE Approval August 2021.docx (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.pdf) (6) A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. The above list is not all inclusive; all of the other 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. Since ely ours, hn Norman Chairman Q:W P/Henderson 285 Lakeside Drive NitROE Approval August 2021.docx DATE: • • O $95.00 FEE*:—�� • BARM MASS Town of Barnstable REC.BY: � Board of Health SC13ED.DATE: 200 Main Street, Hyannis MA 02601 Office: 508-8624644 John T.Norman FAX: 508-790.6304 Donald A.Guadagnoti,M.D. Paul J.Canniff,D.M.D. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM LOCATION Property Address: 285 Lakeside Drive Assessor's Map and Parcel Number: 102/164 Size of Lot: 0.21 ac Wetlands Within 300 Ft. No Business Name: Subdivision Name: � APPLICANT'S NAME:. Joseph Henderson (Horsley Witten) Phone 508-833-6600 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: William HC &Sandrea L Bolton TRS Name: Joseph Henderson (Horsley Witten Group) Address: 285 Lakeside Drive, Marstons Mills Address: 90 Route 6A, Unit 1 Sandwich, MA 02563 Phone: Phone: 508-833-6600 EMAIL: ienderson(cD_horsleywitten.com VARIANCE FROM REGULATION pnci.Reg code a) REASON FOR VARIANCE(May attach separate sheet if more space needed) , —irfstallation of new I/A system with existing septic system. - —Increase in flow from 2 bedroom to 3 bedroom design. — Wastewater Retrofit_ NATURE OF WORK: House Additiori C3 House Renovation Repair of Failed Septic System LJ Checklist (to be completed by office staff-person receiving variance request application) Please submit first four on list as 5 collated packets. _ A. Five(5)copies of the completed variance request form B. Five(5)copies of MA DEP approval letters(or Innovative/Altemative septic system(when proposing an UA system or secondary treatment unit(S.T.U'.). _ C. Five(5)hard copies of engineered plan submitted(e.g.septic syster'plans)and one(1)electronic version submitted to email: heafth(@town.bamstable.ma.us *(Pool Plan-5 hard copies) D..Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or R.S. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted*$95.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1)Septic repair 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.Guadagnoti,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. Q:\Application Forms\VARIREQ Rev Jan 1-2020.docx MAIL-IN REQUESTS Please mail the variance fee amount of $95 .00 (if applicable), along with the documents listed below, to the following address: Checks payable to: Town of Barnstable. Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 For septic system Variance requests, each of five packets must include: 1) Variance Request Form, 2) Letter for the Board with further information on the reason for the septic variance request (Optional), 3) MA DEP Approval letters for proposed Innovative Alternative (I/A) septic system or a proposed secondary treatment unit (S.T.U.) 4) Engineering plans, _ 5) Floor plans. In additional to the five septic packets above, include one copy of the seven (7) page checklist, the authorization letter, copy of abutters notice, and fee, if applicable (see checklist below). Please send one electronic submission using a PDF or .jpg of the engineering plan and floor plans to email: health town.barnstable.ma.us. (Total email must.be less than 10 megabytes.) For grease trap variance requests, each of five packets must also include a full menu. (see checklist below). Checklist - Please 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 DCP approval letters for Innovative Alternative septic system(when proposing an I/A or secondary treatment unit(S.T.U.). C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: health@barnstable.ma.us D. Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version submitted to email: health@town.barnstable.ma.us A completed seven (7) page checklist, confirming all required items are on the engineered septic system plan submitted by.engineer or registered sanitarian. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify the abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only) Fee Submitted*S95.00 for the following variances: 1)New construction,2)Septic repairs with increase in flows,3) New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1) Septic repair without an increase in flow and variances granted at the counter. 2) Monitoring Plans, and 3) Temporary Food(this is not a variance). Variance request submitted at least 15 days prior to-.meeting date. For further assistance on any item above, call (508) 862-4644 Email: health(@-town.barnstable.ma.us Back to Main Public Health Division Page I C'�'�-� i s . A TRANS. NO.: CITY/TOWN: Marstons Mills APPLICANT: Horsley Witten Group ADDRESS: 285 Lakeside Drive DESIGN FLOW: 220 current, 330 proposed gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] V Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for y upgrades]- if not, a variance is required [310 CMR 15.412(4)] V Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR _ 1 15.220(4)(c)] �! Location and dimensions of system components and reserve _ areas. [310 CMR 15.220(4)(e)] V System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity (required andprovided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and ro osed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] - Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] V Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address 285 Lakeside Drive Sheet 1 of 7 L` p N/A OK NO Location of every water supply,public and private, 1[3 10 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR 15.220(4)(o)] V Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and_eserve unless trenches as permitted in 310 CMR. 15.102(2) or as d approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR _ 15.000] System components not> 36" deep (unless Local Upgrade ,Approval or LUA requested) [310 CMR. 15.405(1(b)] Address 285 Lakeside Drive Sheet 2 of 7 Reuse Existing Septic Tank N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 d CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - r middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access-to within 6 " of grade - one port for systems<I 000gpd, r two for systems>1000 g d [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Multi=Compartment Tanks Required when other than single-family dwelling or flow>1000 g d [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address 285 Lakeside Drive Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water lin e? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/(leachfield below pump chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) V DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Nf Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15,232(3)(d)] PUMP CHAMBERS Capacity (emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE r TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag r mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address 285 Lakeside Drive Sheet 4 of 7 Reuse Existing SAS N/A OK NO SOIL ABSORPTION SYSTEMS-(SAS) GENERAL - Calculations correct? 285 Lakeside Drive 4 feet of naturally occurring material demonstratcU: L-)I v Alvin 15.240(1)] AF Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR _ 15.240(13)] V Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 _ Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate 1' minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] TRENCHES_310_CMR f5.251_ _ __ Width 2' minimum 3' maximum [310 CMR 15.251(1)(b)] Nf 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] AV Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BED,SAS (Maximum size of bed or Feld 500.0--gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address 285 Lakeside Drive Sheet 5 of 7 R N/A OK NO DID THE PLAN INVOLVE - Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] V If used in gravelless system- make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000g d) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System.[UA Approval Letters]_ _ Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative_Septic System,[1/A Approval Letters) _ Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance 'Variances Are the variances listed on the plan ? [310 CMR 15.220 (4)( )] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.414] Address 285 Lakeside Drive Sheet 6 of 7 n N/A OK NO Nitrogen Sensitive Areas _ Is the system in a Designated Nitrogen Sensitive Area (Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Miscellaneous Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address 285 Lakeside Drive Sheet 7 of 7 o © e � as i 52'.;6" P 4' VANITY/SINK Aal BATH �-!.-. ROOM � tis 94, SEWING , iw 4;... ,,f __.__.... _._.. ` n b BED ROOM R 1 � r 1 s BATH ROO ryr— BED ROOM t� 1 1` vt'Itw? W r SUN ROOM OFFICE t + ir.WWII IC. i cri ' ISf;`davll.11'I • � � � T } OOM w ' STAIRS TO NON-LIVING SPACE —M�-,- Ai p ht; t LIVIN KITCHEN , LIVING r� + ROOM— ROOM 17'-6" ._^# HALF WALL Al 17'-11" -.. c Barnstable CLEANWATER Coalition August 9, 2021 Mr. and Mrs. William Bolton 285 Lakeside Drive Marstons Mills, MA 02648 Dear Bill and Sandra: Thank you for agreeing to partner with us in the Shubael Pond Innovative and Alternative (" 1K) 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 here on 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 treatrrient 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•BC1eanWatenorg __ _ C 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 in close 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 information from our project partners over the next several months. 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 workingwith you on this project and y p � am available to answer questions uestions via e-mail Y (zcrocker _bcleanwater.org) or phone 508-420-0780. Sincere , r Zee Crocker Executive Director P.O.Box 215•Osterville,MA 02655-0215•(508)420-0780•BC1eanWater.org I Barnstable &EANWATER Coalition August 9, 2021 Mr. and Mrs. William Bolton 285 Lakeside Drive Marstons Mills,MA 02648 RE: Tax Treatment of Klean Tu NitROE Waste Water Treatment System Dear Bill and Sandra: This letter is to memorialize the position of Three Bays Preservation, Inc. d/b/a Barnstable Clean P Y Water Coalition("BCWC") concerning the tax treatment of the installation of a Klean Tu NitROE Waste Water Treatment System (the "System") on your property. Under the terms of the Contract No. 80038-0821 for 285 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; - 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; P.O.Box 215.Osterville,M 02655-0215-(508)420-0780 BOeanWater.org • 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 re- ceived 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 by 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, fZenas (Zee) Crocker VII Executive Director cc: Michael P. Duffy, Esq. Fletcher Tilton PC P.O.Box 215.Osterville,MA 02655-0215•(508)420-0780•BC1eanWater.org KleanTu® LLC John R.Smith Meaffu Wastewater P.O. Box 1154 Treatment Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office August 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 285 Lakeside Drive,Marstons Mills,MA 02648;K1eanTu Project#80038. Dear Members of the Board: Kindly refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTuo LLC(DEP Transmittal No.: X285590; Issued May 12,2020)(the"DEP Permit");and(ii)the Enhanced Title 5 Septic System design.for the 285 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 I\'-#2 of the DEP Permit requires that KleanTuo make certain certifications to the Town of Barnstable Board of Health(the"Board")pertaining to the design of the New System. Accordingly, KleanTuo 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, �7phIf ��IitGc John R Smith(Aug 3,202110:09 EDT) John R. Smith President cc: Joseph Henderson, Horsley Witten Group William and Sandra Bolton, Property and System Owner - 1- stir KleanTu® LLC John R.Smith KleanTu Wastewater P.O. Box 1154 Treatment 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 WWTS Enhanced Title 5 Septic System Installation for 285 Lakeside Drive, Marstons Mills,MA 02648;KleanTu Project#80038. 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 285 Lakeside Drive,Marstons Mills;MA,a private residence,(the"New System'),featuring the use of a new NitROE® 2KS wastewater treatment system(the"NitROE®2KS Components'). Item IV-45 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, 7M&,Fc D/ff lh John R Smith;Aug9,202107:12 EDT) John R. Smith President Enclosure cc: William and Sandra Bolton,Property and System Owner - 1- 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 285 Lakeside Drive,Marstons Mills,MA 02648,featuring the use of a new NitROE®2KS I� wastewater treatment system(the"NitROE®2KS Components"). By signing this letter and delivering it to you,as the owner of the property known as 285 Lakeside Drive,Marstons Mills, MA 02648, I/we hereby certify to the accuracy of all of the following statements: 1. I have been provided a copy of the DEP Permit and I agree to comply with all terms and conditions cited therein. 2. 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. I understand that I must enter into a contract by which my O&M Responsibilities will be fulfilled with KleanTu® or a KleanTu®-approved operator licensed by the Mass DEP as required by the DEP Permit. 4. 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. I understand that I must fulfill my responsibilities to provide written notification of the conditions of the DEP Per- m:t to any new owner,as required by 310 CMR 15.287(5). Sincerely yours, Ot Sa :34 EDT) William Bolton and Sandra Bolton 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. 5� �17 EDT) William Bolton and Sandra Bolton 285 Lakeside Drive Marstons Mills, MA 02648 KleanTu® LLC John R.Smith KleanTu Wastewater P.O. Box 1154 Treatment Edgartown,MA 02539 Technologies 412-719-5976-Mobile 508-627-3072-Office August 9,2021 Mr. and Mrs. William Balton 285 Lakeside Drive Marstons Mills,MA 02648 Joseph Henderson Horsley Witten Group 90 Route 6A, Unit 1 Sandwich,MA 02563 RE: Installer Certification for New NitROe 2K WWTS Enhanced Title 5 Septic System Installation for 285 Lakeside Drive, Marstons Mills,MA 02648;KleanTu Project#80044. Dear William and Sandra: 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 285 Lakeside Drive,Marstons Mills,MA(the"New System'),featuring the use of a new NitROE®2KS wastewater treatment system(the"NitROE®2KS Components'). Item IV-#5 of the DEP Permit requires that the system installer make certain certifications to both of you pertain- ing to the installer's qualifications as to its installation of the NitROE®2KS Components. In lieu of such certification by the installer, KleanTu®LLC hereby certifies to both of you that KleanTu®personnel will be onsite to supervise the installation of the NitROE®2KS Components. Such supervision will ensure that the NitROE®2KS Components are installed in a manner that conforms with KleanTu®LLC's design and operating.requirements. Please contact me with any questions or comments regarding this certification. My cell#is 412-719-5976. Sincerely yours, �ZOh&AVS�zi h John R Smith(Aug 3,202111:51 EDT) John R. Smith President Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs LlDepartment 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: K1eanTu LLC. 300 Old Pond Road, Ste#206 Bridgeville,PA 15017 Trade name of technology and models: NitROE® Waste-Water Treatment System (NitROE® WWTS) with unit sizing for design flows up to 2000 gpd (NitROE® 2KS WWTS and NitROE® 2KM WWTS) (hereinafter the System or the `Technology'). Owner and Operator, manuals, installation manual, schematic drawings illustrating the System models and the technology inspection checklist are part of this Certification. DEP Transmittal No.: X285590 Date of Issuance: May 12,2020, Expiration date: May 12,2025 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection (hereinafter "the Department") hereby issues this Provisional Approval to: KleanTu LLC, located at 300 Old Pond Rd., Ste 206 in Bridgeville, PA (hereinafter "the Company"), NitROE® 2KS WWTS and NitROE® 2KM WWTS (hereinafter "the Technology" or "System") for use in the Commonwealth of Massachusetts subject to the conditions herein. Sale and use of the Technology is subject to compliance by the Company, the Designer, the System Installer, the Operator, and the System Owner with the terms and conditions herein. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. May 12, 2020 Marybeth Chubb, Section Chief Date Wastewater Management Program Bureau of Resource Protection This information is available in alternate format.Contact Michelle Waters-Ekanem,Director of Diversity/Civil Rights at 617-292-5751. TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper K1eanTu NitROE 2K Provisional Approval,May 2020 Page 2 of 15 Technology:NitROE®2KS&2KM WWTS 1.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. f 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. 11. GENERAL DESCRIPTION OF THE TECHNOLOGY The NitROE ® 2KS or 2KM WWTS (the `System') is installed in series between a Title-5 system septic tank and a soil absorption system constructed in accordance with 310 CMR 15.100 — 15.279, subject to the provisions of this Approval to accommodate design flows of less than 2,000 GPD. The System is comprised of two-unit processes which are sequentially performed in two different chambers. The first chamber is aerated, via an external air pump and airline header/hose arrangement, to achieve both organic carbon reduction along with the biological conversion of ammonia-N to nitrate-N. From the Aeration Chamber, the wastewater then gravity flows into a Denitrification Chamber where, in the presence of natural organics from wood chips, bacteria mediate the conversion of nitrate-N to inert N gas that exits to the atmosphere via the Title 5 system vent piping. Depending on design flow and availability of local tank structures, the sequential Aeration and Denitrification process steps can be performed in the same single tank, which is NitROE®2KS WWTS, or each process could be performed in its own separate tank with the overall NitROE® WWTS comprised of multiple tank combinations, which is NitROE®2KM WWTS. The use of the Technology under this Approval requires: • Disclosure Notice in the Deed to the property; • Certifications by the Company,the Designer, and the Installer; • System Owner Acknowledgement of Responsibilities; I K1eanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15 Technology:NitROE&2KS&2KM WWTS • A certified operator under contract for periodic inspection and maintenance; • Periodic sampling; • Recordkeeping and reporting; and • An external power supply 111.CONDITIONS OF APPROVAL A. Basis for Conditions 1. The term "System" refers to the Technology in combination with any other components of an on-site treatment and disposal system that may be required to serve a Facility in accordance with 310 CMR 15.000. 2. The term "Approval" includes the Special Conditions, Standard Conditions, General Conditions of 310 CMR 15.287, and the approved Attachments. 3. Items required by this Approval include: a) Performance Evaluation Plan (PEP) with sampling and analysis requirements and approved by the Department. The PEP must be submitted to the Department for review and approval within 60 days of issuance of this Approval and meet the requirements of the Department's Guidance for the Preparation of Performance Evaluation Plans <2,000 GPD; b) Minimum System installation requirements; c) Company schematic drawings and specifications; d) Owner's Manual, including information on substances that should not be discharged to the System; e) Operation and Maintenance manual, including but not limited to, operator qualification requirements, inspection requirements, sampling and analysis requirements, recordkeeping requirements, and/or reporting requirements; and f) MassDEP Operation and Maintenance (O&M) checklist and I/A technology inspection checklist. B. Special Conditions 1. Department review and approval of the System design and installation is not required unless the Department determines on a case-by-case basis pursuant to its authority at 310 CMR 15.003(2)(e)that the proposed System requires Department review and approval. 2. System installations must meet the specific siting conditions for Provisional Use provided in 310 CMR 15.286(4) and the facility must meet the siting requirements of this Approval. 3. Any System for which a complete Disposal System Construction Permit Application is submitted while this Approval is in effect,may be.permitted, installed, and used in accordance with this Approval unless the Department,the local approval authority, or a court requires the System to be modified or removed or requires discharges to the System to cease. 4. The System Owner shall provide access to the site for purposes of sampling the System in accordance with the Company's technology Performance Evaluation Plan approved by the K1eanTu NitROE 2K Provisional Approval,May 2020 Page 4 of 1.5 Technology:NitROE®2KS&2KM WWTS Department, in addition to providing access for performing inspections, maintenance, repairs, and responding to alarm events. 5. The System Owner shall ensure that no permanent buildings or structures, other than the System, are constructed in the area for the installation of all the components of a fully conforming Title 5 system with a reserve area. The area for a fully conforming Title 5 system with a reserve area shall not otherwise be disturbed by the System Owner in any manner that will render it unusable for future installation of a fully conforming Title 5 system. 6. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sanitary sewer system. If it is feasible to connect a new or existing facility to the sewer, the Designer shall not propose an Alternative System to serve the facility and the facility Owner shall not install or use an Alternative System. When a sanitary sewer connection becomes feasible after an Alternative System has been installed,the System Owner shall connect the facility served by the System to the sewer within 60 days of such feasibility and the System shall be abandoned in compliance with 310 CNM 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 CNM 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. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 6 of 15 ' Technology:NitROE®2KS&2KM WWTS 17. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Operator shall notify the System Owner immediately. 18. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Owner and the System Operator shall be responsible for the notification of the local approving authority within 24 hours of such determination. 19. In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications, or any violations of the Approval, the System Owner and the System Operator shall be responsible for the written notification of the local approving authority and the Company within five days describing corrective measures taken. 20. Within 60 days of any site visit, the System Operator shall submit an O&M report and inspection checklist to the System Owner and the Company. The O&M report and inspection checklist shall include, at a minimum: a) for a System failing, any corrective actions taken; b) wastewater analyses,wastewater flow data, and field testing results; c) any violations of the Approval; d) any determinations that the System or its components are not functioning as designed or in accordance with the Company specifications; and e) any other corrective actions taken or recommended. 21. By September 30th of each year, the System Owner and the Service Contractor shall be responsible for submitting to the local approving authority all monitoring results with all O&M reports and inspection checklists completed by the System Operator during the previous 12 months. 22. By September 30th of each year, the Service Contractor shall be responsible for submitting to the Company copies of all O&M reports including alarm event responses, all monitoring results, violations of the Approval, inspection checklists completed by the Service Contractor, notifications of system failures, and reports of equipment replacements with reasons during the previous 12 months. 23. A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. 24. The System Owner shall notify the Approving Authority in writing within seven days of any cancellation, expiration or other change in the terms and/or conditions of the O&M Agreement required by Paragraph B(14). 25. The System Owner and the Service Contractor shall maintain copies of the Service Contractor's O&M reports, inspection checklists, and all reports and notifications to the LAA for a minimum of five years. 26. The System may only be installed to serve facilities where a fully conforming Title 5 system with a reserve area exists'on-site or could be built on-site in compliance with the design standards for new, construction of 310 CMR 15.000, and for which a site evaluation in K1eanTu NitROE 2K Provisional Approval,May g 2020 Page 7 of 15 PP Technology:NitROEV 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/l 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 htW:!/www.mass.govleea/docsldeplwater/lawsli-thru-zltestsamp.pd.. Properties occupied at least 6 months per year are considered year-round properties. Properties occupied less than 6 months per year are considered seasonal properties. 30. During the Performance Evaluation period, the Company shall follow the monitoring requirements specified in the Performance Evaluation Plan for installed Systems. 31. After the three (3) year Performance Evaluation period by the Company and approval by the Department, and until this Approval is modified, terminated, or superseded by a General Use Certification, the System Owner shall comply with the following monitoring requirements if the System is subject to a total nitrogen concentration limit in accordance with paragraph B? (28)• 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 http://www.mass.gov/eea/dots/dep/water/laws/i-thru-z/testsamn.pdf. Water meter readings shall be recorded at each inspection, see"Flow Metering"below. b) Seasonal properties shall be sampled for at least the TN parameter a minimum of twice/year. At least one annual sample must be taken 30 to 60 days after each seasonal occupancy. A second sample must be taken no less than 2 months after the first sample. Field testing of the System shall be completed as determined necessary by the operator. Water meter readings shall be recorded at each inspection, see "Flow Metering" below. 32. Flow Metering - At a minimum, for all systems installed prior to this Approval, water meter flow data shall be recorded each time the system is inspected and sampled by the System Operator. For systems installed after the effective date of this Approval, wastewater flow data shall be recorded each time the system is inspected and sampled by the System Operator and may be based on: a) actual metering data of wastewater flow to the system; or b) water meter data for the total facility with metered non-wastewater flows, if available, subtracted from the total facility water usage. 33. Field Testing: Turbidity, pH and Apparent Color - Turbidity, pH, DO and apparent color shall be measured and/or recorded in the field when when determined necessary by the operator. See applicable sections of the Department's Field Testing Protocol at http://www.mass.gov/eea/docs/dep/water/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:NitROEO 2KS&2KM WWTS 6. The Company shall institute and maintain a program of Designer training and continuing education, as approved by the Department.The Company shall maintain and annually update, and make available the list of qualified Designers by February 15th of each year. The Company shall certify that the Designers on the list have taken the training and passed the Company's training qualifications. 7. The Company shall institute and maintain a program of Operator training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Operators by February 15th of each year. The Company shall certify that the Operators on the list have taken the training and passed the Company's training qualifications. 8. The Company shall not sell the Technology to an Installer unless the Installer is trained to install the System by the Company. 9. Prior to its sale of any System that may be used in Massachusetts, the Company shall provide the purchaser with a copy of the Approval with the System design, installation, O&M, and Owner's manuals. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of a System for use in Massachusetts with copies of these documents,prior to any sale of the System. 10. Within 60 days of issuance by the Department of a revised Approval, the Company shall provide written.notification of changes to the Approval to all Service Contractors servicing existing installations of the Technology and all distributors and resellers of the Technology. 11. The Company shall provide written notification to the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership,responsibility, coverage and liability between them. 12. The Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns, including but not limited to dealers, distributors, and resellers. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities, respectively, shall constitute violation of the Approval by the Company unless the Department determines otherwise. IV. CERTIFICATION AND NOTIFICATION REQUIREMENTS 1. Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit, stating that the property owner: a) has been provided a copy of the Provisional Use.Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 11 of 15 Technology:NitROE®2KS&2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)and the Approval; and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). 2. Upon submission of an application for a DSCP to the Approving Authority, the Company shall submit to the Approving Authority, with a copy to the Designer and the System Owner, a certification by the Company or its authorized agent that the design conforms to this Approval and that the proposed use of the System is consistent with the unit's capabilities and all Company requirements. The review shall include evaluation of the need for installation of water meter(s) at each facility. An authorized agent of the Company responsible for the design review shall have received technical training in the Company's products. 3. The System Designer shall be a Massachusetts Registered Professional Engineer, or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. 4. Thirty (30) days prior to delivery of the treatment unit to the site for installation, the Company shall provide to the Approving Authority a copy of a signed contract for a minimum period of one year with a Company approved Operator and the initial Owner/Occupant of the property. 5. Prior to the commencement of construction,the System Installer must certify in writing to the Designer and the System Owner that (s)he has taken the Company's training, passed the Company's training qualifications, and is listed on the Company's list of Installers. 6. Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000, the approved design plans, and all local requirements, including any local approving authority site-specific requirements; b) In accordance with 310 CMR 15.021(3), the Designer must certify in writing that any changes to the design plans have been reflected on as-built plans which have been submitted to the Approving Authority by the Designer; c) As a condition of this Approval, the System Installer and Designer must certify to the Approving Authority in writing that the System has been constructed in compliance with the terms of this Approval; d) An authorized agent of the Company must certify to the Approving Authority in writing that the installation was done by a qualified Installer approved by the Company and the installation conforms to this Approval. The authorized agent of the Company responsible for the inspection of the installation shall have received technical training in the Company's products; and e) Prior to signing any agreement to transfer any or all interest in the property served by the system, or any portion of the property, including any possessory interest, the System Owner shall provide written notice, as required by 310 CMR 15.287(5) of all conditions contained in the Approval to the transferee(s). Any and all instruments of transfer and any leases or rental agreements shall be included as an exhibit attached thereto and made KleanTu NitROE 2K Provisional Approval,May 2020 Page 12 of 15 Technology:NitROE®2KS&2KM WWTS a part thereof of a copy of the Approval for the System. The System Owner shall send a copy of such written notification(s) to the Local Approving Authority within 10 days of such notice to the transferee(s). V. STANDARD CONDITIONS 1. The provisions of 310 CMR 15.000 are applicable to the design, installation, use and operation of a System utilizing an. approved or certified alternative technology, except those provisions that specifically have been varied by the conditions of this Approval. 2. The design, installation, and use of the System must conform to the terms and conditions of the Approval and the Department approved attachments. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. Standard Conditions Applicable to the System Owner. 4. This Approval shall be binding on the System Owner and on its agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the System Owner unless the Department determines otherwise. 5. The System Owner shall obtain all necessary permits and approvals required by 310 CMR 15.000 prior to the installation and use of the System in Massachusetts. 6. The System is approved for the treatment and disposal of sanitary sewage only. The System Owner shall not introduce any wastes that are not sanitary sewage into the System. The System Owner shall dispose of wastes generated or used at the facility that are not sanitary sewage by other lawful means. 7. Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 C1VIR15.287(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 Desigrer i K1eanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 15 Technology:NitROE®2KS&2KM W WTS 10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day. 11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy of this Approval. Standard Conditions Applicable to the Company 12. This Approval shall be binding on the Company and its officers, employees, agents, 'contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the Company unless the Department determines otherwise. 13. The Company shall include copies of the Approval with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require all vendors, distributors, and resellers to provide each purchaser of the System with copies of the Approval. 14. The Company shall make available, in printed and electronic format, the approved Attachments and any approved updates associated with the Approval, to the System Owners, Operators, Designers,Installers,vendors, resellers, and distributors of the System. 15. The Company shall submit to the Department for approval any proposed updates or changes to the Attachments to the Approval. 16. The Company shall notify all System Owners, resellers, and distributors of changes to the Approval within 60 days of issuance by the Department. 17. The Company shall notify the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership, responsibility, coverage and liability between them. All provisions of the Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 18. The Company shall furnish the Department any information that the Department requests regarding the Technology within 21 days of the date of receipt of that request. 19. If the Company wishes to continue the Approval after its expiration date, the Company shall apply for and obtain a renewal of the Approval. The Company shall submit a renewal application at least 180 days before the expiration date of the Approval, unless written permission for a later date has been granted in writing by the Department. Upon receipt of a timely and complete renewal application, the Approval shall continue in force until the Department has acted on the renewal application. Reporting K1eanTu NitROE 2K Provisional Approval,May 2020 Page 14 of 15 Technology: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. K1eanTu NitROE 2K?rovisional Approval,May 2020 Page 15 of 15 Technology:NitROE®2KS&2KM WWTS 6. The owner or operator, or the proponent of the alternative system, shall obtain and provide the Department with a determination from the board of certification of operators of wastewEter 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 ir_full compliance with the written approval and 310 CMR 15.287. 8. The Department may require the issuance of a groundwater discharge permit pursuant to 314 CMR 5.00 (groundwater discharge program)for any alternative system. 9. The system owner shall maintain an operation and maintenance contract with a Massachusetts certified operator where one is required by 257 CMR 2.00, or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. 10. Prior to obtaining a Certificate of Compliance for installation of a new or upgraded system, the system owner shall record in the chain of title for the property served by the alternative system in the Registry of Deeds or Land Registration Office, as applicable, a Notice disclosing both the existence of the alternative on-site system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the Local Approving Authority. i KleanTu® LLC KLeanTu Wastewater John R.Smith P.O.Box 1154 Treatment Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80038-2108 for 285 Lakeside Drive,Marstons Mills,MA 02648 pg. 1/6 August 8,2021 Mr.and Mrs. William Bolton 285 Lakeside Drive Marstons Mills,MA 02648 RE: NitROE®2KS WWTS Installation for 285 Lakeside Drive,Marstons Mills,MA KleanTu® Job No.: 80038 Dear William and Joadn KleanTu®LLC is pleased to provide this contract document for a NitROE®2KS Waste-Water Treatment System (WWTS)to be installed at 285 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 Ni=ROE®2K WWTS to be installed is specified in Site Drawing Project No.:20112,prepared by Horsley Witten Group Inc.(HWG)dated May 7,2021 and modified August,3,2021. 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 2,000-gallon H 10 NitROE®2KS WWTS tank for enhance total nitrogen reduction. From there,the significantly treated wastewater will gravity flow into a new D-Box and then to existing leaching chambers. 1 CONTRACT No.80038-2108 for 285 Lakeside Drive,Marstons Mills,MA 02648 gg 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 IVA 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 NitROE®2K WWTS Enhanced Title 5 Septic System to be installed, including power consumption,maintenance,sampling, recordkeeping,reporting,and equipment replacement. iii.Understands the requirements for a O&M con.ract to be in place with KleanTu®LLC, or with their designated and trained entity,and tht the NitROE®2K WWTS operator must be licensed by the Mass DEP as stipulated in KleanTe's Provisional Permit. iv. Agrees to fulfill their responsibilities to provice 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 provice 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=o 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 NitROEO 2KM WWTS is consistent with the unit's capabilities and all KleanTu®LLC requirements. 2 CONTRACT No.80038-2108 for 285 Lakeside Drive,Marstons Mills MA 02648 pg.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 installation of other pertinent items such as risers and access ports. D. NitROE®WWTS Site Inspections and Monitoring. To comply with Section III B,items 13-36 of the Provisional Permit related to Operation and Maintenance(O&M),KleanTu®, or a designated representative entity trained by KleanTu,will be responsible for doing the appropriate number of site inspections,along with sampling and analyses for specific wastewater treatment parameters,and for reporting respective results to the Site Owner,the local BoH and the Mass DEP. Initially the required number of site visits and monitoring will be done on a quarterly basis,per the Provisional Permit requirements. Once a General Permit is issued,then the site inspections and monitoring will be reduced to a semi-annual or annual basis. In any event,the site owner will be required to have contracts in place with KleanTu®,or their designated representative,for O&M,including the monitoring and reporting required. 3 r CONTRACT No. 80038-2108 for 285 Lakeside Drive,Marstons Mills,MA 02648 pg.4/6 INSTALLATION ACTIVITIES AND PRICE For installation of the enhanced NitROE®2K W WTS,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 BA_RNSTABLE 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(ht_p:/,'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 into 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 , CONTRACT No.80038-2108 for 285 Lakeside Drive,Marstons Mills MA 02648 pg.5/6 Table 1.KleanTu°Price of Title 5 Enhancement via NitROE®2KS WWTS Enhancement for 285 Lakeside Drive,Marstons Mills,MA 02648 ONE 2,000 GALLON NitROE TANK(N-ASST20M-H10) (KleanTu°Project No.80038-0821) KleanTu° Task Categories and Description Price (Covered by BCWC) Task 010-Project Management,Engineering and Permitting Includes overall project management coordination including review and input to the site engineering design,local BoH and MassDEP permitting interactions,and ensuring that all work is done in a manner protective of workers and the environment. Note:BCWC is responsible for site design engineering and 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 providing one 2,000-gallon NitROE®2KS H-10 tank at a price of$12,500. These prices include all media,access riser ports and covers near or to surface,aeration assembly w/air pump and installed air $12,500 tubing,and faux rock for air pump enclosure. Task 030-Tank Delivery and Installation Oversight Installation oversight and air-line hook-up of delivered NitROE®Tank,including remote sensing unit connection to homeowner Wi-Fi network. Note:BCWC is responsible for procurement and sewer piping $0 connections of septic and NitROE®tank,procurement and installation of leach chambers and all piping -connections,providing electrical service(120V;20 amp)and outlet boxes to location selected by site owner for running air pump. NOTE:TASK ACTIVITIES PROVIDED BY KLEAN TL 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 I CONTRACT No.80038-2108 for 285 Lakeside Drive,Marstons Mills,MA 02648 pg.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®2K WWTS specific equipment and materials to properly operate for a period of one year. This is contingent that the NitROE®2K WWTS is installed per the engineering design and that the NitROE® 2K WWTS receives typical sanitary wastewater(as defined per Title 5)and is within the design flow and does not exceed 330 gallons per day(gpd). SITE ACCESS By signing this contract,site owner agrees that 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 NitROE®WWTS enhanced Title 5 septic system operating on your property. To accept this contract so that work may continue as planned,please sign below. Also,please contact Zenas"Zee" Crocker at zerocker@bcieanwater.org at Barnstable Clean Water Coalition with any questions or comments. Sincerely, Jahn R Smith(Aug 9,202107:11 EDT) - John R. Smith President Name: William Bolton and Sandra Bolton Signature: Sa �39 EDT) 6 ,f KleanTu® LLC KleanTu wastewater John R.Smith Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 p 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80038-040-2108 for 285 Lakeside Drive,Marstons,Mills,MA 02648 pg. 1/5 August 8,2021 Mr.and Mrs. William Bolton 285 Lakeside Drive Marstons Mills, MA 02648 RE: NitROEO2K WWTS Start-Up and Monitoring,Operation and Maintenance(MOM)for 285 Lakeside Drive, Marstons Mills,MA 02648;KleanTu®Job No. 80038 Dear William and Sandra: 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 NitROE02K Waste-Water Treatment System (WWTS)installation date at 285 Lakeside Drive,Marstons Mills,MA. The main purpose of the NitROE®2K WWTS is to enhance your Title 5 Septic System for the purpose of significantly reducing total nitrogen(TN)from the sanitary wastewater flow. In addition to significant TN reduction,the NitROE®enhanced Title 5 septic system will also produce a highly treated effluent low in organic carbon constituents(measured as BOD5)and low in total suspended solids(TSS)levels. Please note that entering into a yearly MOM contract is a requirement of KleanTu's Massachusetts Department of Environmental Protection(DEP)Provisional Permit(DEP Transmittal No.:X285590;issued May 12, 2020). As this is the first year of operation, start-up services are also provided. As cited in Section IV-4 of the Provisional Permit,yearly OM&M contracts must be in place to ensure proper operation and consistent treatment performance. In this regard,this contract also provides budgetary price estimates for subsequent years of MOM. CONTRACT DETAILS AND PRICE PROJECTIONS As cited in Table 1,regarding start-up and MOM services,it is to be noted that the BCWC will provide for and cover all costs associated with MOM,including sample collection and analyses for the first five years of 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. 80038-0821 for 285 Lakeside Drive,Marstons,Mills.MA 02648 pg.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?rovisional 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 NitROE02KS WWTS for 285 Lakeside Drive,Marstons Mills,MA. 1 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 l st 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 re- quired 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 Gen- $600 - $1,200 2027 and eral 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 l y' CONTRACT No. 80038-040-2108 for 285 Lakeside Drive,Marstons,Mills, MA 02648 pg.315 As the NitROE®2K W WTS 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 1 that this I"year contract,once executed,runs from September 2021 -August 2022, anticipating use immediately after installation. As the NitROE02K 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 KleanTu®has designed and utilized equipment to provide low maintenance operation and treatment,Table 2 is provided so the system owner has some sort of idea what costs may be incurred in future years associated with non-routine MOM activities. While the BCWC will cover the first five years of MOM support,it is to be noted that all the items cited in Table 2 will need to be covered by the homeowner as respective issues and situations arise after this initial five- year period. The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the continuous operation of one(1)120-watt air pump required to enhance and maintain the appropriate level of biological processes required. This yearly electrical cost will be borne by the homeowner,along with periodic pumping of their septic wank as required. -3- CONTRACT No.80038-040-2108 for 285 Lakeside Drive,Marstons,Mills, MA 02648 viz.4/5 Table 2. Non-Routine MOM Items and Projected Price Estimates for New NitROE®2KS WWTS Replacement Items for 285 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 • KleanTu®will determine when this is needed based on scheduled $600 site visits. (for EST Septic Septic Tank • Pump out to be done by non-KleanTu®contractor with estimated Tank Pumped rice=$600/EST tank. (EST)Pump Out p out every 3-8 Years) • Exact time period is site-specific with estimate of every 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.80038-040-2108 for 285 Lakeside Drive,Marstons,Mills, MA 02648 pg. 5/5 PAYMENT TERMS Even:hough there is no Eite 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 o,bcleanwater.org,of Barnstable Clean Water Coalition with any questions or comments. Thank you, c.7oh#Ay,Lh %�Ll John R Smith(Aug 9,202107:12 EDT) John R. Smith President SYSTEM OWNER SIGNATURE Name: William Bolton and Sandra Bolton Signature: Sa_ _};n , 38 EDT) -5- 00.00, EX. DWELLING r { b x. cD Q oy h# co u1 0 16.51' r- ,a ' Q 0 PROPO (n SLAB 0 GR. DECK Ex. T K PERGOLA J co �(� LF 6� �i v - 78.36' LAKESIDE DRIVE SEP77C FROM ASBUILT ON FILE AT THE TOWN HEALTH DEPARTMENT BUILDER TO CONFIRM CERTIFIED PLO T PLAN MBLU 102-164 I CERTIFY THAT THE IMPROVEMENTS SHOWN OF Al 285 LAKESIDE DRIVE HAVE BEEN LOCATED BY A FIELD SURVEY. ,��` �ss�cy MARSTONS MILLS, MA o DA TE: 1-17-19 DRAWN: RBS ROBB JOB #. S538 c SYKES SCALE. 1"=20 DWG. CPP No. 35418 Hnw EASTBOUND 1-17-19 �F�isTE�``o LAND SURVEYING, INC. ioN 5 P.O. BOX 442 ROBB SYKES, RLS. DATE FORESTDALE, MA 02644 508-477-4511 ,r si23g 9 COMMONWEALTH OF MASSACHUSETTS w W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED `O,7- 9 SEP 0 12004 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 285 Lakeside Drive Marstons Mills MA 02648 Owner's Name: Christopher Birdsey Owner's Address: 23 Hilliard's Hayway West Barnstable MA 02668 I Date of Inspection: July 19,2004 Name of Inspector: PATRICK M. O'CONNELL �iU13 4 7 2004 Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 1.89 CAMMETT ROAD BARNSTABLE MARSTONS MILLS MA 02648 i7ALTH DEPT. Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a` lillllpj approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: , ` •HOF�� _XX_Passes Conditionally Passes ; m Needs Further Evaluation by the Local Approving Authority —+= Fails yk: Inspector's Signature: - c� Date: 7/19/2004 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: System in good condition. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 K Page 2 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 285 Lakeside Drive, Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX ]have not found any mfonnahon which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or mores stem components as described in e" "y p the"Conditional Pass section need to be replaced or i repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or"not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: __ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: �J Page 3 of 1 i OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 285 Lakeside Drive, Marstons Mills Owner: Christopher Birdsey Date of Inspection: 3ulyl9,2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: i Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 285 Lakeside Drive, Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 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 %Z day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped__. _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma _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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "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 i 1 ' r� Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 285 Lakeside Drive, Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 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)] Page 6 of 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 285 Lakeside Drive,Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2002—38,000 gal.2003—33,000 gal.=97 gpd. Sump pump(yes or no): No Last date of occupancy: Two Months Ago. COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Never been pumped. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed{if known)and source of information: System is two years old. Were sewage odors detected when arriving at the site(yes or no): No f 1 �r Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 285 Lakeside Drive,Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 BUILDING SEWER: XX (locate on site plan) Depth below grade: V Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: 25 ' Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: I Material of construction:_X_conerete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5' long x 5.8'wide-1500 gal. Sludge depth: 2" Distance fl-om top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: - Trace Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tees intact and clear,tank not in need of pumping.Recommend pumping every 3-5 years. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): i ' 1 Page 8 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 285 Lakeside Drive,Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: _gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No high stains or solids present. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i f 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: 285 Lakeside Drive,Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _X_leaching chambers,number: 2—500 gal drywells. leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): No excessive vegetation or breakout. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): �1 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 285 Lakeside Drive, Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 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. Lakeside Drive 285 ZZ� Zi 1500 gal tank 2—500 gal chambers Page 1 I of 11 OFFICIAL .INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 285 Lakeside Drive, Marstons Mills Owner: Christopher Birdsey Date of Inspection: July 19,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Property 20-25' higher than pond on opposite side of road. „ t No. :�� - a L $50. 00 �;.^ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for �Digpogar *pgtem Congtruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( )X T]Complete System El Individual Components Location Address or Lot No. 285 Lakeside Drive Owner's Name,Address and Tel.No. Marstons Mills ,Mass . 02648 G; Mystrom Assessor's Map/Parcel I01- 16r 285 Lakeside DRive M&M 02648 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 3. / � C-©,ne e4 9OZ/ J.C. Engineering 5 Roundhill BLVD Type of Building: East are a m, ass . 02538 Dwelling X X$lo.of Bedrooms 2 Lot Size sq.ft. Garbage Grinde* ) Other Type of Building No.of Persons 1 Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 5 2 G P D gallons per day. Calculated daily flow 2 X 1 10=2 2 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 gallons Type of S.A.S. 2-500 galln chambers Description of Soil Loamy sand to medium sand to 20% g_ra321X10 ' 9"X2 ' Nature of Repairs or Alterations(Answer when applicable) Omitting leaching pits . I n s t a l l i n g C =70)1-1500 gallon septic tank. l-Distribution box . 2-500 gallon 'leac i am ers packed 3 of 12 stone on sides and 4 ' on ends and between'. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by thi d Healt Signed r Date 6/7/0 2 Application Approved b C Date Application Disapproved for the following reasons Permit No. Date Issued j. b f x i .� Fee 5 0.0 0 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:, V 1 _ Kes tY PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS r ZIppfication for,]Dig ogal *pgtem Construction Pe ' 4 it r Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( )X:E Complete System ❑Individual Components Location Address or Lot No. 285 Lakeside Drive Owner's Name,Address and Tel.No. — U b ,r , Marstons Mills,Mass.02648 G./Mystrom ; Assessor's Map/Parcel / f 8 5 Lakeside D R i v e M&M 02648 } Installer's Name,Address,and Tel.No.5 0 8—7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 co nR e* & ScvU J.C. Engineering 5 Round4ll BLVD East Ware• am,eass. 53 Type of Building: Dwelling X X No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder"(0 ) Other Type of Building No.of Persons 1 Showers( ) Cafeteria( ) Other Fixtures Design Flow 352 GPD gallons per day. Calculated daily flow 2 X 110 2 2 0 gallons. � Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 gallons Type of S.A.S. 2-500 galln chambers Description of Soil Loamy sand to medium sand to 20% Qra;21X10'911X2 ' d Nature of Repairs or Alterations(Answer when applicable) Omit tin g leaching pits.I n s t a l l i n g fi 77O -1500 gallon septic tank. 1-Distribution box. 2-500 gallon -leaching clambers packed 3 of 1 " stone on sides and 4 on ends and between'. Date last inspected. r i Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i2AA. =rj'1WA&&AA edrd Healt Signed _ Date g6/7/02 , Application Approved ed b � Date /� U 2 Application Disapproved for thefoll following reasons Permit No. c��t��- ��H Date Issued p U --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Z�Xx) Abandoned( )by J.P.Macomber & Son Inc. at 285 Lakeside Drive Marstons Mills,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �- )�� dated J!O!UZ Installer J.P.Macomber & Son Inc. Designer J.C. Engineering The issuance of is permit shall not be construed as a guarantee that the systo will nction as a 'gned. Date In n V. s ector ' --------------------------------------- v No. S 1-5 ' 'Dy'A' Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS niopoal *p5tem Con.5truction Permit Permission is hereby granted to Construct(, )Repair( )Upgrade(XX)Abandon( ) Systemlocatedat 285 Lakeside Drive Marstons Mills,Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this per�ml it. Date: �-e' C� �� Approved by • TOWN OF BARNSTABLE i LOCATION :Z g S' L Ak eSiI?P Dg SEWAGE # 200:2- ,2W VILLAGE- 44 A aC S!Q-NS W/LL 9 ASSESSOR'S MAP & LOT 0 - �6t INSTALLER'S NAME&PHONE NO.T r, IN A C O 14 d e f r S o A/ j SEPTIC TANK CAPACITY A d-6 e LEACHING FACILITY: (type) W 2LC's' (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: U 6' COMPLIANCE DATE: d Separation� Distance Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility_) Feet Furnished by � T h TOWN OF BARNSTABLE S L A� e,�i�1 C D/� SEWAGE # 2oa2- W irILLAvE /YI A X 51 0 N S A4 f LL S ASSESSOR'S MAP & LOT 0 — /6 V INSTALLER'S NAME&PHONE NOI /-' Al A G O M 21 r S O Al SEPTIC TANK CAPACITY A d--0 a - Nan LEACHING FACILITY: (type) OR W eLCS' (size) r�' � " q NO.OF BEDROOMS A Suo b-11" BUILDER OR OWNER r PERMITDATE: U 11' , COMPLIANCE DATE: O Separation Distance Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by' T act: r II _ TOWN OF BARNSTABLE LOCf�T10N b! S kc SEWAGE #�HS�. VILLAGE' ,4:1, Al., S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY d, — C 5,✓, LEACHING FACILITY: (type) (size) NO.OF BEDROOMS n2 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished b . �� ` , . . . yy, . . .. _ , ... , -� _ _� .. ,,. _ w, v TOWN OF BARNSTABLE' LO:'A`�"I0'r �� r � SEWAGE # ,VILLAGE .?� �> / '� ASSESSOR'S MAP & LOT' INSTALLER'S NAME&PHONE NO. FAILED INSPECTION SEPTIC TANK CAPACITY 16k, e- LEACHING FACILITY: (type y%�� % �X�d (size) ��'� _ NO. OF BEDROOMS - BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: ` Separation Distance BeEween 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 Wetlan�- d Leaching Facility( any wetlands exist within 300 f�ro Ic ' . facility) Feet Furni he ti r — ------ - a�� t�e.s tide. d�- . �'1. �'(, ��, .1- C �� 3 � � w\ M\ � poi I �-� ,/� i -- _ _ \ _ �. TROY WILLIAMS ' °"`' " SEPTIC INSPECTIONS f' Certified by MA Department of Environmental Protection T 1 Q,op (508) 385-1300 19 Hummel Drive South Dennis,MA-02660 COMMONWEALTH OF MASSACHU fiS. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS O DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE "'INTER STREET. BOSTON, MA 02108 617-292.5500 WILLIAM F.WELD /� TRUDY CORE Govemor Sccrctan• ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Property Address: a85 Lcxk,- -S;Jc Or• B%3/0 .tilursh�s �1 XId!d�re s of Owner: /Lyu•"t c SC. }f4� Csfa-fc Date of Inspection: (If different) Name of Inspector: Troy Will 1 i amSr �c� Jam• Exc �, I am a DEP approved system inspector pursuant to Section 15.340 of Title S(310 CMR 1S.000) o% /J Company Name: Troy Williams Septic Inspections 'trz-I . Mailing Address: 19 Hummel DriVP , SOutl1 DPnnis , MA 02660 Telephone Number: 508T385-1300 C"5 /3r `I S 1`� �`✓ .? 3 3 3 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection: Tlie inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the local Approving Authority _ Fails nn Inspector's Signature:: S.r.as, L,C e�.u,.� Date: �3 /; The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report,to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, or D: AI SYSTEM PASSES: _ I have not found any information which indicates that the system violates any of the failure akeria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: ///7 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. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances, If'not determined',explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial Infiltration or ex(iltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. tz�vl��d o4/2s/97) .. Pay• 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ERTIFICATION (continued) 285 Lakeside Drive,Marston Mills,MA Property Address: Francis Foster Owner: August 31, 1998 Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N//)- Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to,protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption.system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO N FO RM PART A CERTIFICATION (continued) Property Address: 285 Lakeside Drive,Marston Mills,MA Owner: Francis Foster Date of Inspection: August 31, 1998 D) SYSTEM FAILS: /V /I You must indicate ei;,,er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: N 11 ` You must indicate either "Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 285 Lakeside Drive,Marstons Mills,MA Property Address: Francis Foster Owner: August 31, 1998 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes, No � Pumping information was provided by the owner, occupant, or Board of Health. .Y _ None of the system components have been um p ped for at least two weeks and the system has been receiving ndrmal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note,if they are not available with N/A. .JL _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow, JL _ The site was inspected for signs of breakout. JL _ All system components, excluding the Soil Absorption System, have been located on the site. /j The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material-of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. i9 Existing information. Ex. Plan at B.O.H. JL _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) l r.vl•.A nI/�a io„ t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 285 Lakeside Drive,Marstons Mills,MA Owner: Francis Foster Date of Inspection: August 31, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow: ad .p.d./bedroom for S.A.S. Number of bedrooms:07 Number of current residents: �► Garbage grinder (yes or no): 1V6 Laundry connected to system (yes or no):-S Seasonal use (yes or no):_Ao Water meter readings, if available (last two (2)year usage (gpd): opC y �/� r �( = / 'Woo Sump Pump (yes or no): 6L Last date of occupancy: 14'C CA COMMERCIAUINDUSTRIAL• Type of establishment: Design flow:_ aallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: J J vti i H c, i✓ Ty Ci,d I sa� ✓'� ✓� �� N v w.ti ca e..+ti c✓ Q Syster� pumped as pan of inspection: (yes or no)�q If yes, volume pumped: 0 6 allon Reason for pumping: Co✓ TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool L Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contractt Chher A�'PPROX, IM��ATE AGE of all components, date installed (if known) and source of information: G rjo rJ r 3 brrS 4'� o , Sewage odors detected when arriving at the site: (yes or no)_.,6/6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 285 Lakeside Drive,Marston Mills, MA Owner: Francis Foster Date of Inspection: August 31, 1998 BUILDING SEWER: Al (locate on site plan) Depth below grade: Material of construction: _cast iron_ 40 PVC _ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: /' (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: (recommendation fot pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:�/I (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level In relation to outlet invert, structural integrity, evidence of leakage, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 285 Lakeside Drive,Marston Mills,MA Owner: Francis Foster Date of Inspection: August 31, 1998 TIGHT OR HOLDING TANK:^//'/(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes;_ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:,LI///9 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:�� (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) 1 Fz SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORh1 PART C SYSTEM INFORMATION (continued) Property Address: 285 Lakeside Drive,Marstons Mills,MA Owner: Francis Foster Date of Inspection: August 31, 1998/ SOIL ABSORPTION SYSTEM (SAS): s/ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: L S ti J X 6 <<••. t, �� r . leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, s' ns of hydraulic failure, level of ponding, condition of vegetation, etc.) ✓{� 4-u t 4 ` C J .� -� - aX, d YZ < <' H� .L G 'u • I O S �. CESSPOOLS: (locate on site plan) Number and configuration: 0 ti � (,, ` X G � �c 5}�� •> � . Depth-top of liquid to inlet invert:_ Depth of solids layer: /' Depth of scum layer: / ,, 1 tom, Dimensions of cesspool: / 4 ck ' a N, Materials of construction: Pi--e �.} ��,,� t� ,4 Indication of groundwater: A/oti L inflow(cesspool must be pumped as part of inspection) 4 r. c, cue v"n J / 1-16 i✓ h Ok Comments: (not condition of soil, igns of hydraulic failure, level of ponding, condition of vegetation, etc.) ac✓ / t . u < 4- j GGSS�a<. PRIVY: Al 1,9 (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 285 Lakeside Drive, Marston Mills,MA Owner: Francis Foster Date of Inspection: August 31, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into h use) I i a3 ' S3 ptic/f '� c f,S Sr„d ► yy,�.,h L c s s�o�o (r.vl..a 04/25/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 285 Lakeside Drive,Marstons Mills,MA Owner: Francis Foster Date of Inspection: August 31, 1998 Depth to Groundwater _Feet adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record V/ Observation of Site (Abutting property, observation hole, basement sump etc.) ,Z Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describein ..your own words how you established the High Groundwater Elevation. Must be completed) �/r )U u.. � � ✓d �,o . L, S r«�f .t '7'v 1�!�:. f c✓ � � �u 1..� � b t I,I /og �1J G to! �`�.-./� 5' C T�V r S l.�In l &1 All 4 c G.i✓ATL L�i /�✓�`e � uti c� T 4 S vs-" ILI p 1 /ram L � ate av w 'rC L G r 1 7 ✓i/C 4t G� 1 5 rya s s• &. / • o h "Tv `�r.c r .a c.� r d 7< <• S t 0 0 0 1 L /o(,.y.p� �''^ �^''' • vM J � Ir t� v, r,e Yrr t h �"} .S e, �" b� '� L �t �F.�.. - ti t r 2T-5" POPOFF Ns:/ 4' VANITY/SINK 9 5 i I • BATH - - 1 SEWING I o ROOM I i . o B D M ROOM y � b 0 BATH O _ ROO ED O M ArnC N I CHI CL05ET _ 2'-9' LINEN W/D W/D OFFICE L-J SUN ROOM CV co co - GL ET CD M I I DO I I AS M I STAIRS TO - - - - - - 5Aak OOM CO A4 6 6'-6° NON-LIVING SPACE Az 0 A4 4 o LIVING, Az ROOM- KIT HEN LIVING b I 3' I ROOM 0 I _CX eT 1 T-6" SHELF -T — — — — 9 HALF WALL 17-11" _ 17-11" LEGEND- RO P®S ® ?ANEW WALLS, WINDOWS, AND DOORS Care CAD P RO P05 E D ADDITION FOR• GENERAL NOTES: NOTE SCALE: 1,ALL DIMENSIONS SHOWN ARE FOR REFERENCE ONLY THE PLANS SHOWN ARE THE SOLE PROPERTY OF DRAWING NUMBER: _ - - Y T CONTRACTOR IS TO VERIFY EX1FIELD PRIOR G CONDITIONS THE DESIGNER AND CANNOT D,COPIED, - AND DIMENSIONS IN THE FlELD PRIOR TO START OF REPRODUCED AND/OR ALTERED,USED FOR PERMIT B O LT O N RE 5 I D E N C E WORK AND/OR F LING WITHOUT THE EXPRESS WRITTEN 1/8 1 .2.THE GENERAL CONTRACTOR SHALL BEAR SOLE CONSENT OF THE DESIGNER,PATRICK RIMINGTON. V (/�K F�`^� \/F RESPON5IBIUTY FOR MEANS AND MEM005 OF 2 L/ \1 \L V I D E D R I V L CONS RUCTION AND SAFETY ON THE JOB SITE. 3. ALL WORK SHALL CONFORM TO THE ////////��w�� MA55ACHU5ETT5 STATE BUILDING CODE(LATEST _5 I-ca_n _- _-_._ EDITION)AND ALL OTHER APPLICABLE CODES.-D-e for filing -— -- - ��V/// EXI"N PUCABL ERRING ELEM R SHALL IDENTIFY ALL-� -Approved g DATE• M A R5T O N 5 MILLS M A COMM G LOAD BEARING ELEMENTS PRIOR TO COMMENCING WORK AND SHALL DESIGN AND PROVIDE P.O. BOX 80G SHORING A5 REQUIRED TO SUPPORT LOADS DURING CONSTRUCTION. 1/17/2 019 2 MARSTONS MILLS, MA IN 11E NO E5,5MNGES,EROUGHTT AND/OR THE A SSIONS Patrick Rimington L IN THE NOTES,SHALL BE BROUGHT TO THE ATTENTION THE OF51GNE508-280-7074 COO STRUCTION PRIORRPROCEEDING WITH CO STRUCTION "- CONSTITUTES ACCEPTANCE OF THESE DOCUMENTS AND ANY 015CREPANCIE5,ERRORS AND/OR OMI55;ON5 BECOME THE RE5PON515IUTY OF THE BUILDING CONTRACTOR. " a GENERAL NOTES: ,W rn 2'4- Ah� y 153" 1. NITROE 2KS TANK TOP TO tHAVE THREE-24",TWO-1 2"HOLES AND r TOTAL TANK LENGTH MULTIPLE 4"HOLES WITH RISERS AND COVERS FOR MAINTENANCE K . 4, ` a) v lI E - 1 OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH(OT) AND SAMPLING. k. 4.e. ,- E LL 1 2. FOR THE 24"HOLES; PROVI'IDE 24"DIA.ADS PIPE(CORRUGATED) U N7 °05' ,,> WITH POLYLOK(OR EQUIVALENT)COVER(OR EQUIVALENT ".Y : = 2 25 E � :..... �., TANK WALL �. .• , - �� .•. .• d•�. ,•� .. . ®. .,��. ' •• ' • • :. •�� ,:� '. , .=�� O .� Y w CONCRETE RISER AND COVER)TO 12 BELOW GROUND SURFACE ,# 100.00' z a ( m 2 I ¢a AND SECURE TO TANK TOP. AT CK THITOP CKNESS T _• ~ � 3. FOR THE 12"HOLES'USE ADDS PIPE CORRUGATED AND POLYLOK k o- o (3P) --" O U OR EQUIVALENT COVERS;TO 12"BELOW GROUND SURFACE AND {}. " c V ( ) r o r. MIDDLE a 40 4" o O SECURE TO TANK TOP. a a INLET TROUGH4. PROVIDE FOUR 4"DIA.SAMPLING PORT(1"BELOW GROUND f- - TROUGH S AGED ( ) DENIT l CAT; ¢ SURFACE)WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH e'' `;"""'-•-,_. p cn EFFLUENT F- FROM SEPTIC :Y (IT) A N HAMB O WITH GROUND SURFACE. ° r' Y 0 TANK C BE DC 5. FOR EXISTING SEPTIC TANIK;PROVIDE 2"DIA.SAMPLING PIPE THAT ¢ tLi / f/ 81 1i z O ( ) IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" o BELOW THE TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE w in Ci _J EFFLUENT OUT S ` OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK „�"..� � � S ,z � � � C C) � ! "'-+.'^. I - . ' ;;g .�.; � N ""� CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, ✓ //f w THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE .U) N15 00 • / � � GROUND SURFACE AND H/�4VE A 6"DIA.PLASTIC ROUND BOX AND n� ,",, a ,'# �`�� "" '> APPROXIMATE �-- COVER AT GROUND SURFACE. � TANK WALL 100-FT POND o _"` i BUFFER THICKNESS AT BOTTOM 1 (4 1/2"TYP) • u PROPOSED AIR PUMP z 285 LAKESIDE DRIVE FINAL LOCATION TO BE ONE STORY WOOD FRAME ,° FIELD DETERMINED a, 2 BEDROOM A d' ®OM DWELLING co 6"PLASTIC BOX AND COVER WITH,4" m `1 to SEE NOTES 3 AND 4(TYP) MONITORING PIPE;SEE NOTE 2 AMID 4(TYP) � w SEE NOTE,.;3 AND 4(TYP) EXISTING DISTRIBUTION BOX SEE NOTE 2(TYP) a r° 1 24"ACCESS HOLE WITH COVER SEE NOTE 2(TYP). TO BE REMOVED I GROUND SURFACE(TYP) EL.68.0 51 INV. IN = 63.95ln� SEE NOTE 2(TYP) LO C Ix INV.OUT= 63.78 TO SOIL 0 5 = w 5 1/2"TANK TOP(TYP) o .y EXISTING SEPTIC ! ABSORPTION SYSTEM C TANK TO REMAIN 67.80 SrFAs �' ! - EL.65.80 (SAS) o 10 o INV. IN = 65.04 -} W , •' :}.; ° • �3- 0 INV OUT=64.79 �/ EFFLUENT FROM SEPTIC EFFLUENT W 5, Q O O VV TANK = 48°STATIC WATER OEM 'GI G> 'Qf�o O � ,, o. >; y to to v- N O ®FC `�6 4°SCH 40 PVC '' o v , " ._ o M } a 13.3' fC L=2', S=1.0% £f t o U_ __ i I° _ a o",o I o I y co Ow ~ u' Z O O BOO 1 1 F- � °- .A SUBMERGED g DENITRIFICATION CHAMBER o"� w 1° 0 S PROPOSED 3-OUTLET ' o > I AERATION (DC) _ a i=a = v� v� v� o O DISTRIBUTION BOX CHAMBER =o >Z w z UJ _.. INV. IN =63.61 EXISTI G WATER o z o_ (SAC) a o o .� s . AIR P\FZ INV OUT=63.44 i SERVICE 4 ~ - o N W M z ^J to 4"SCH 40 PVC > _.r.,M _--.. ,. . _.. ,. w ° ,. NITROE 2KS 2,000 s 4" SCH 40 PVC EL.so.o5 " . ®.. . .,: ... - e•. ..; Kl@an 1 u LLV GALLON TANK I '' CONNECT TO EXISTING I TANK BOTTOM ~ 0 INV. IN=64.64 - DISTRIBUTION PIPING r A� ' THICKNESS�" 12"CRUSHED AGGREGATE ORAPPROVED W Q INV. OUT=64.39 i ..? I EXISTING LEACHING FACILITY TO REMAIN MATERIAL;ON LEVEL,COMPACTED AND STABLE BASE U) z 2-500 GAL. LEACHING CHAMBERS WITH 4-FT TANK WALL THICKNESS AT BOTTOM(4") W Z) `�. TANK WALL THICKNESS AT TOP(3")C I o� STONE AT ENDS AND 3-FT ALONG SIDES NifROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM (WWTS) > J = z m �V N-ASST20h1'-H10 J C) <7[ - NOT TO SCALE Ca - <[ .J RISER TO WITHIN 3"OF Q 1..- �- FINISHED GRADE ^�I/^ �/ EL.68.10 \\I/ LL _ I I_-I 11=1 I I- _ Z Q 0 5 ._ a 0 - LOAM AND SEED _ -_ EL.64.68 1 ----� _ CLEAN - - - _ _ - - LLJ - CLEAN - -_- J CO Q _ FLOW-- FLOW = (/� F f _ - _ _ 6"OF 3/4" W W . . EL.63.09':•.:.•:•: ...•°. - -- - - ' COMPACTED CV - G G G EXISTING OVERHEAD -- - - CRUSHED ELECTRIC, TELEPHONE - _ i V , sTONE BASE z � EXISTING GAS SERVICE (TYP.) & CABLE SERVICE m r� N LAKESIDE DRIVE NOTES: PROJECT BENCH 1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL MAG SET EL.=66.90 O� STABLE BASE. a�Q 2. BLOCK ONE OUTLET. rn H 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. @ W W i 4. INSTALL SPEED LEVELERS(OR EQUAL)ON OUTLET PIPES. n • PROPOSED H-10 DISTRIBUTION BOX DETAIL ca ACME PRECAST OR EQUIVALENT 0 -- OH W OH W NOT 70 SCALECU to -- N U CU GRAPHIC SCALE WASTEWATER NOTES U 00 N 16. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR U N q 10 0 5 10 20 40 15.255(3). ANY ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL N w o N (� 1. ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SHALL BE REPORTED TO THE ENGINEER. c M a 2 ¢ `t *=' SURVEY CONDUCTED BY THE HORSLEY WITTEN GROUP,INC.ON NOVEMBER 20,2020. LL � O o CL wupm� -1 N 17. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. ffic N °' "�to 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS m i C3 m (in feet) SHALL BE IN ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND 18. ALL SEPTIC TANKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS � CU O i O n V REGULATIONS OF THE LOCAL BOARD OF HEALTH. MATERIAL. a m U oo a O 1 INCH = 10 FEET V 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO 19. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION m LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON AFTER CONSTRUICTION IS COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL N ZONING St RESOURCE PROTECTION NOTES IT AND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. BE LEFT NATURAL,THE CONTRACTOR SHALL'TAKE CARE TO PREVENT DAMAGE TO SHRUBS,TREES, OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE r- 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL PLANS DO NOT SHOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONS MUST BE p BOARD OF HEALTH(BOH)STAFF. VERIFIED BY THE CONTRACTOR IN ADVANCE,OF THE WORK. N 1. PARCEL ID: 102/164 LOT SIZE:0.21 AC O BOLT ON TRS 5. PRIOR TO CONSTRUCTION,THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY 20; ALL UNPAVED AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF N 2. OWNER OF RECORD:WILLIAM HC&SANDRA L BOL O OWNER AND ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE LOAM INSTALLED AND BE SEEDED WITH GRASS SEED AS SHOWN ON THE PLAN AND/OR N� 3. ADDRESS: 285 LAKESIDE DRIVE,MARSTONS MILLS AREAS. DIRECTED BY THE ENGINEER. THE CONTRACTOR SHALL BE RESPONSIBLE FOR WATERING ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS ESTABLISHED AND APPROVED BY j +0) 4. THE LOCUSTS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON F.I.R.M.MAP 25001 C0542J DATED JULY 16,2014). 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY THE ENGINEER AND/OR OWNER. C) LOCAL AND/OR STATE PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE CL REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL HOURS OF OPERATION FOR THE 21. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE N 5. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. O O FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. . SYSTEM MUST BE INSTALLED AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT � IL OF ENVIRONMENTAL PROTECTION(DEP)PROVISIONAL USE APPROVAL. o 0 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM a ce) IS:: 0 0 Y WASTEWATER INSTALLATION INSPECTION NOTES THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. m N M 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE o M ' 2 ENGINEER AND LOCAL BOARD OF HEALTH FOR ANY INSPECTION. 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM a Q oo M E .0 OR CHANGES TO EFFLUENT FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR >„ coo o 00 o 2. ALL WASTEWATER COMPONENTS SHALL BE INSPECTED BY THE ENGINEER AND THE LOCAL ADJACENT TO THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE SEPTIC AND LEACHING SYSTEMS , � � � � � p Z .t� BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL O �- co BE INSPECTED: rn (0 AT = av_ a S HOURS PRIOR TO COMMENCIN G CONSTRUCTION F "AT LEAST 72 URS O CALL"D GSA E 9 I N 2.1. SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL A 2.2. LEAKAGE TEST ON PRECAST TANKS(MIN.24 HR) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF r 2.3. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS EXISTING UTILITIES. Registration: 0 DESIGNED rCJ 2.4. FINAL INSPECTION OF BACKFILLED SYSTEM 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND OF NOTES INDICATING THE HORIZONTAL AND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM 11. THE OWNER SHALL HAVE THE SYSTEM INSPECTED AND HAVE THE SEPTIC TANK PUMPED SE'PN COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND NOTES WILL BE UTILIZED BY THE EVERY 3-8 YEARS. FNDERS N � ENGINEER FOR THE PREPARATION OF RECORD PLANS. Owl r� 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE I PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. r- CALCULATION 13. USE SCH.40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. cv EXISTING LEACHING CHAMBER SIZING ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE. LO SIDEWALL CAPACITY 14. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT,DUST,AND FINES. 0 (L+W)(2 SIDES)(1.79'HIGH)(0.74 GPD/SF) (29410.9')(2)(1.79')(0.74)=105.70 GPD 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE Project Number: Sheet INFORMATION FOR THE SEPTIC SYSTEM TO THE ENGINEER,IF NECESSARY. N BOTTOM AREA 20112 1 of 1 - (L x W)(0.74 GPD/SF) (29'x10.9')(0.74)=233.90 GPD O Sheet Number: TOTAL AREA WW N 339 GPD f6 PROVIDE PRECAST CONCRETE EXTENSION 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 50.0' - 50.7' GENERAL NOTES TOF EL.= 50.98' RISER WITH CONCRETE COVER TO WITHIN REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM 6" OF FINISH GRADE OVER OUTLET COVER FINISH GRADE OVER D-BOX= 50.69' 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE @ FND. EL.= 50.00' FINISH GRADE OVER TANK EL.= 50.45' 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE METHODS'SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 20" MIN.ACCESS COVER 46.90' TOP OF SAS - 47.73' PLACE RISERS ON ALL CHAMBERS PROPOSED (TYPICAL FOR 3) 36"MAX. - TO 6" OF FINISHED GRADE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 4" SCH. 40 PVC 9 MIN. , OF HEALTH AND THE DESIGN ENGINEER. ANY CONDITIONS ENCOUNTERED DURING R PROVIDE EXTENTION 36" MAX. BREAKOUT EL 47.40 HANDLE I TO THE DESIGN ENGINEER BEFORE CONSTRU CONSTRUCTION DIFFERING FROM THOSE CTION CONTINUES. BE REPORTED 6" 3" - PROVIDE WATERTIGHT o 3" DROP MIN. 3" 9" � JOINTS (TYP.) i o 0rF-= 0 0 0 0 0 00 � 3. 4" SCHEDULE40 PVC PIPE WITH WATER TIGHT JOINTS SHALL EXISTING 10" 4 PVC IN FROM O �woo = = O o I BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 4"PVC PIPE 14 \_ 47.65' SEPTIC TANK 4 PVC OUT TO o00�LEACHING FACILITY �� oo 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS - - Tao 00 00o a . o _ ,48• 9 47.90' 12" THAN ELEVATION =47.40 FOR A DISTANCE OF 15AROUND THE PERIMETER OF THE SAS. .OUTLET TEE 47.30' MIN. 47.13' 2 0 0 � � � � oo oo � � o48" c� o 0 05, SLOPE ALL SOLID PIPE AT 1A/o MINIMUM. NE 2"ZABEL FILTER OVER M CHANI6" CRUSHED �ALLY o17.3' MODEL#A1801 HIP(GAS COMPACTED BASE 4 . g. 'typ. for 1 unit -4_ 4' 3 3' 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 3AFFLE ON BOTTOM) 4.90' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 29 0 (TYP.) PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND OVER TO BE INSTALLED ON A LEVEL STABLE t 44.90 10.9' READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED L COMPACTED ABASE LLY BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV= >14' BGS WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH PIPES TO BE LAID LEVEL. I AND DESIGN ENGINEER. PROPOSED 1500 GALLON CONCRETE SEPTIC ANK CROSS SECTION VIEW ! 2 - 500 GAL. CHAMBERS 5 MIN. „ , „ , „ CHAMBER ENE'�IEW 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.00 MSL LENGTH 10'-6' WIDTH 5 -8 DEPTH 5 .7 � TYPICAL. CHAMBER. PROFILE FROM TOP OF CONCRETE BOUND AS SHOWN ON PLAN. SEPTIC TAN PROFILEDISTRIBUTION AFL � DETAILS 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION NOT TO SCALE NOT TO SCALE NOT TO SCALE THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO THE DESIGN ENGINEER. •, ' ' ,, � ` : T EST -IT DATA 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. t -- t� -INSPECTOR: �,. � 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN •.�, �� ,.,�-,�. � � a�w � SOIL EVALUATOE John L. Churchill Jr. " = SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. N. w9 DATE: May 25, 2002 '<L tJ 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS TEST PIT#: 1 ' � t I LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH - E~ ELEV. TOP = 50.45' i CASE THEY SHALL BE WITHSTAND H-20 LOADING. LOT 161 LOT 158 9� fi Ya ; ` ELEV.WATER 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND � 'F ( FPERC RATE = <2 MIN/IN FINES. tf , . '. , � [DEPTH OF PERC= 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND vp UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES S87�O0'00"E � � f r, -TEXTURAL CLASS: 1 OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN � "" 10 � COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN 0.00' r�� $ ' 0" 50.45' ACCORDANCE WITH 310 CMR 15.255(3). LOT 16Q - p 1st� � Loamy Said I G � � 10YR 3l? 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES °` ± S.f. �•, ti� ,+ 49.79 . � � 97300 FOUND SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. _ �.. ..,.W._.._. 8B Loamy Sk UN WO EXISTING PITS TO - 16. PLAN I REFERENCES _...__. r� r �' ,. 10YR 6r BE PUMPED AND 'd w� � 47.95' i3 30 Medium Sid BARNSTABLE COUNTY REGISTRY OF DEEDS .«4 _,,,.. _,. ,a, k "� ' >. :� t ��, C1 0 PLAN BOOK 138, PAGE 25 LOT 160 FILLED WITH CLEAN 7 `" 3 a ¢ . ' 2oro Gravf - , , »bz _• , , SAND . 45.45 17. RECORD. - _..,. 6 2 5 Y 6/4 CHRISTINE F NYSTR - .. . _ ...., m. ADDRESS: 5 „ OWNER OF OM ,: -------.- ------• ,� ' #�, h, � ADD 28 LAKESIDE DRIVE n�ealum sar -- - - .. j 30' . 3 . EXISTING 2 ; � � � ��•' . \ � I t �� ° �• �� No Groundwiaisr r BEDROOM N 120" 40.45' DWELLING � C' LOCUS PLAN # 285 `�•' ' 0 SCALE: 1" = 1000' 500 GALLON rOF = 50.98' �, CD $ 11 t , I O SEPTIC TANK 11,6----� 10 U) ,11 IDESIGN .TLEGEND Ul o CD o i 11.0 6.3' EXISTING CONTOURS i 'n� CD CD O92 ;., __ 100 PROPOSED CONTOURS LOT 159 z 30"TW ; I PROPOSED LEA(CF-IING NUMBER OF BEDROOMS 2 1O0 PROPOSED SPOT GRADES , ,: TRE._ ! „D-BOX" AREA W 2~ 500 GALLON NUMBER OF PERSONS 4 _ . _- k -•-.- ': ;� --• EXISTING WATERLINE J�. --- CHIMNEY h� 'CHAMBERS DESIGN FLOW 110 GAUDA\Y/BEDROOM rn `10 / TOTAL DESIGN FLOW 330 GAUDAY ' � � ,✓ I, � (TITLE V MINIMUM IS 330 GPD) �, TEST PIT LOCATION TP#1 SEPTIC TANK: Q PROPOSED 1500 GALLON SEPTIC TANK 41,,. 4„®AK fir} DESIGN FLOW X 200 % = 660 GAL/DAY 50x45 r ;;.off � �� PROPOSED: USE 1500 GALLON SEPTIC TANK 4" SOLID SCHEDULE 40 PVC PIPE G 0 DISTRIBUTION BOX TWIN j10` ' - INSTALL 2- 500 GAL. CHAMBERS 500 GAL. CHAMBER P: o O •. .' O 10"TREE '• _ SIDEWALL CAPACITY xs3 .. . .. . . .. . . .. r 18.OA . . 12'r K.'. .':'.'.'.'.. .'. . .. .. .. ... . . .. . . �0/ O i (L+W) (2 SIDES) (2' HIGH) (.74 GPDlS.F.) = GAUDAY 29.0 i (0, • Q (29' + 10.9') ( 2 ) (2' ) ( .74 GPD/S.F.) = 118.1 GAUDAY v: O 0 �� I� BOTTOM CAPACITY G ;{r a _ a (LENGTH x WIDTH) (.74 GPD/S.F.)I = GAL/DAY (29 x 10.9) (.74 GPD/S.F.) 233.9 GAUDAY REV. DATE BY APP'D. DESCRIPTION 7,40„W s86 2 PROPOSED SEPTIC UPGRADE TOTALS: PREPARED FOR: rti 78.36' t TOTAL NUMBER OF CHAMBERS 2 M CH RI STI E NYSTRO f� TOTAL LEACHING AREA 475.7 SQ. FT. BENCHMARK - TAP OF TOTAL LEACHING CAPACITY 352 GAL/DAY LOCATED AT t F / SENT CONCRETE BOUND .0 EDGE. OF PAVEMENT ELEV. 50.00' ± �� - 285 LAKESIDE DRIVE ASSUMED RESERVED FOR BOARD OF HEALTH USE MARSTONS MILLS, MA SCALE: 1 INCH = 10 FT. DATE: MAY 28,2002 0 5 10 20 40 F n+OF o' JOHN PREPARED BY: � HILL JC ENGINEERING �'� 5 ROUNDHILL BLVD. SITE PLAN EAST WARE HAM, MA 02538 SCALE: 1"= 10' 508.273.0377 Drawn By: JLC Designed By: JLC Checked By: PTM Job No.230 III i j GENERAL NOTES: 153" 1. NITRIDE 2KS TANK TOP TFO HAVE THREE-24",TWO-12"HOLES AND TOTAL TANK LENGTH MULTIPLE 4"HOLES WITIH RISERS AND COVE � '«' ". A •RS FOR MAINTENANCE k �� --� AND SAMPLING. ... .,. OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH(OT) � � � � � � "` � �� `� � •{"� N78 05 2. FOR THE 24"HOLES;PROVIDE Q 25 E IDE 24"DIA.ADS PIPE(CORRUGATED) .. WITH POLYLOK OR EQUIIVALEN COVER TANK WALL ': .� a•�. .•• •,d. ' • •i. ( T) R(OR EQUIVALENT � .,� � � �p t G A� , a �•.:,, � � ;< � �� ; I THICKNESS Y W ) CONCRETE RISER AND COVER TO 12"BELOW GROUND SURFACE k z a AT TOP ¢ - AND SECURE TO TANK TFOP. ,.� - (3" gyp) LL ` 3. FOR THE 12"HOLES;USE ADS PIPE(CORRUGATED)AND POLYLOK � Q 00 (OR EQUIVALENT)COVERS TO 12"BELOW GROUND SURFACE AND MIDDLE e 3„ W O SECURE TO TANK TOP. q� o INLETTRO � 4. PROVIDE FOUR 4 DIA.SAMPLING PORT 1 BELOW GROUND - M n o ❑ TROUGH SU RGED ( T) DENIT CA ¢ 03. -ram b ., . .' w: �: p cn EFFLUENT TI SURFACE)WITH 6 PLASTIC ROUND BOX AND COVER TO BE FLUSH ,_ : t f IT A N O WITH ❑ _I.. '^ � FROM SEPTIC ( ) HAMB W H GROUND SURFACE. J.. �� r 5. FOR EXISTING SEPTIC THANK;PROVIDE 2"DIA.SAMPLING PIPE THAT �� "�.'� `>'� f �a�. � � , ;� o. r•> .- /� Y O TANK C BE DC � " P a IF ¢ F- O S C) IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" j � g. Q O /J/ p J o � � BELOW THE TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE�- O -� EFFLUENT OUT OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK � �� - ,� '':��, ,• r,�'� �� ' ' N 0° CONCRETE O OUTLET COWER.ON THE TOP SIDE OF THE SEPTIC TANK, O ! THE 2"DIA.SAMPLING r L NG RIPE SHOULD EXTEND TO 2"BELOW THE '� „`��' � � s �� +.; °-' APPROXIMATE GROUND SURFACE ANDI HAVE A 6"DIA.PLASTIC ROUND BOX AND Y - ❑ 100-FT POND O TANK WALL COVER AT GROUND SURFACE. � � ;� � �� .� `� � '. � �� BUFFER THICKNESS •" a� � � � �� _:: � a s V a a AT BOTTOM (4 112"TYP) a, . p PROPOSED AIR P a.., .x �" �. , ' � ••��. , �,�� ,�: �; '_� � "�� ' 20 x t fi m :::h -..ii` i Z 5 LAKESIDE DRIVE FINAL LOCATION TO BE � ' " '� � ' �� ✓/ " "�` v ONE E S -W7 ,f STORY WOOD FRAME FIELD DETERMINED O. 2 BEDROOM DWELLING " f $ H t o � � PROPOSED 3 BEDROOM F ti f x a DESIGN cow SEE NOTES 3 AND 4(TYP) 6"PLASTIC BOX AND COVER WITH 4 MONITORING PIPE;SEE NOTE 2;AND 4(TYP) O 3 f SEE NOTES 3 AND 4(TYP) � . t` m dt // GROUND SURFACE TYP SEE NOTE 2(TYP) p EL.68.0 24"ACCESS HOLE WITH COVER SEE NOTE 2(TYP). SEE NOTE 2(TYP) / EXISTING DISTRIBUTION BOX i Y EXISTING SEPTIC / 5 1/2"TANK TOP(TYP) TO SOIL 0 aD o TANK TO REMAIN 67.80 S / TO BE REMOVED E = W ABSORPTION SYSTEM O rn �^� �,�' INV. IN = 63.95 EL.s5ao (SAS) c U r a .4r � k INV. IN = 65.04 -.F S' �' INV. OUT- 63.78 s �,• G� o s; c c ❑ U �. INV OUT=64.79 �`�' ► C� EFFLUENT FROM SEPTIC q8"STATIC WATER EFFLUENT N .. TANK _ W Q 4 SCH 40 PVC I �_ `& w :�s y co M N � cc ti M M 0 Go to 0 S ~ w a I SUBMERGED DENITRIFICATION CHAMBER _ O a Q w^ o ct o o o z � 1 =. AERATION x (DC) } - a a _ y v) to to 10 ❑ �2 0 uJ 0 0 �` CHAMBER Iaf _s �a o (SAC) 0 �' z w W w } AIR PROPOSED 3-OUTLET ~ z 11 w o n o J 7.5' s o> m F- F- W -J 4" SCH 40 PVC ._ -._ m�68 .,-, P� DISTRIBUTION BOX `° -,c w Cl j W vz L=14.6, S=2.0% INV. IN = 63.61 z o 4"SCH 40 PVC INV OUT=63.44 NITRIDE 2KS 2,000 GALLON TANK 4"SCH 40 PVC L-14.0 . .• 4 . :. .. �.. ... ,.::. : _ _ = :: KleanTu LLC �- o-. ', S=0.5% EL.60.05 . - - - TANK BOTTOM 9 INV. IN=64.64 L=7.8', S=1.0% - _� - n j ' THICKNESS 4" 12"CRUSHED AGGREGATE OR APPROVED ❑ INV. OUT=64.39 EXISTING LEACHING FACILITY TO REMAIN MATERIAL;ON LEVEL,COMPACTED AND LLB z 2-500 GAL. LEACHING CHAMBERS WITH 4-FT TANK WALL THICKNESS AT BOTTOM(4") STABLE BASE D O STONE AT END D S AND 3-FT ALONG SIDES TANK WALL THICKNESS AT TOP(T) LLJ Q ti C EXISTING LEACHING CAPACITY=352 GPD WROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM WWTS) > _ z � � � - - - - PROPOSED LEACHING CAPACITY=339 GPD N-ASST20M-HID J V Q ® PR. INV. EL.=63.52 - - - - - _ ? NOT TO SCALE _I EX. INV. EL.=63.73 '- ❑ c- G G X} �;�.� RISER TO WITHIN 3"OF � W (^ FINISHED GRADE ! �� f.. �/ � � EL.68.10 ❑ v^J m ��!_ p2 - - :LOAM AND SEED=I I IIII= I I I=1 I I_-- z Q LL ❑--- ° nrro L% p = - - - - - - - - - - EL.64.68 - - 78.36' r' ° _ CLEAN =� _ . -- _- I- - - BACKFILL - - - - ---_ - -❑ FLOW ` FLOW N < - 6"OF3/4"G G EL.63.09 G G EXISTING OVERHEAD COMPACTED ELECTRIC, TELEPHONE CRUSHED v^ LN�L/STONE BASE z EXISTING GAS SERVICE (TYP.) & CABLE SERVICE LO 00 EXISTING WATER SERVICE N PROJECT BENCH NOTES:IDRIVEm W 1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL O MAG SET EL.=66.90 E. N � 2. BLOCK ONE OUTLET, a;U) � � tM VV 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. Q C W 4. INSTALL SPEED LEVELERS(OR EQUAL)ON OUTLET PIPES, m m c� PROPOSED H-10 DISTRIBUTION BOX DETAIL ACME PRECAST OR EQUIVALENT 0 OH W OH W - NOT TO SCALE .,-- GRAPHIC SCALE WASTEWATER NOTES N 16. THE CONTRACTOR SHALL PROVIDE A DEWATERING PROTOCOL PRIOR TO CONSTRUCTION co co rn 10 0 5 10 20 40 IN ACCORDANCE WITH CONSERVATION COMMISSION ORDER OF CONDITIONS. CO LID U V 1. ELEVATION, PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A (1) � o N SURVEY CONDUCTED BY THE HORSLEY WITTEN GROUP, INC.ON NOVEMBER 20,2020. 17. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR Q d N 15.255(3).ANY'ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL u0 O Lo 2 o 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE REPORTED TO THE ENGINEER. - °S cn (in feet) SHALL BE IN ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND = x - j `m i Co REGULATIONS OF THE LOCAL BOARD OF HEALTH. 18. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. i 1 INCH = 10 FEET 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO a Im U aoa (� 19. ALL SEPTIC THINKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS I; 00 IT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON MATERIAL. IT AND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. N / ZONING Sc RESOURCE PROTECTION NOTES 20. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL AFTER CONSTRUCTION IS COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL 0O BOARD OF HEALTH(BOH)STAFF.1. PARCEL ID:102/164 LOT SIZE:0.21 AC BE LEFT NATURAL.THE CONTRACTOR SHALL TAKE CARE TO PREVENT DAMAGE TO N SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE 5. PRIOR TO CONSTRUCTION,THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY 2. OWNER OF RECORD:WILLIAM HC&SANDRA L BOLTON TRS PLANS DO NOT SHOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONS MUST BE N OWNER AND ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE VERIFIED BY T-HE CONTRACTOR IN ADVANCE OF THE WORK. t O 3. ADDRESS: 285 LAKESIDE DRIVE,MARSTONS MILLS AREAS. N 21. ALL UNPAVED AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF fA V 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY 4. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON F.LR.M.MAP 25001 C0542J DATED JULY 16,2014). 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 ENGINEER. THE CONTRACTOR SHALL BE RESPONSIBLE FOR WATERING N REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL HOURS OF OPERATION FOR THE ANY LOAM ANID SEEDED AREAS UNTIL LAWN GROWTH IS ESTABLISHED AND APPROVED BY Q L 5. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. THE ENGINEEIR AND/OR OWNER: p FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM 22. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE (!� THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. o o� WASTEWATER INSTALLATION INSPECTION.NOTES SYSTEM MUST BE INSTALLED AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE ENGINEER AND LOCAL BOARD OF g FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OF ENVIRONMENTAL PROTECTION(DEP)PROVISIONAL USE APPROVAL. T � %� N HEALTH FOR ANY INSPECTION. a �-, o Cl) C? OR CHANGES TO EFFLUENT FLOW,GRADING,OR LANDSCAPING, EITHER ON-SITE OR ao �, ADJACENT TO THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE SEPTIC AND v 10 2. ALL WASTEWATER COMPONENTS SHALL BE INSPECTED BY THE ENGINEER AND THE LOCAL BOH REPRESENTATIVE PRIOR Q � m ,Q TO BACKFILLING. AT MINIMUM THE FOLLOWING ITEMS SHALL BE INSPECTED: LEACHING SYSTEM(&). a`. (D � �_ '� o O 2.1. SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL i o v N 2:2. LEAKAGE TEST ON SEPTIC TANK(MIN.24 HR) 9. CALL"DIGSAFE"AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT '� 2.3. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS DESIGNED 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF O CD co s coa CD 2.4. FINAL INSPECTION OF BACKFILLED SYSTEM EXISTING UTILITIES. V) = rn U) a U- 0 Registration: 0 3 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A . THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND NOTES INDICATING THE GARBAGE GRINDER. HORIZONTAL AND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND OF NOTES WILL BE UTILIZED BY THE ENGINEER FOR THE PREPARATION OF RECORD PLANS. 11. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 YEARS. EXISTING LEACHING CHAMBER SIZING CALCULATION 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE EI^S >� PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. SIDEWALL CAPACITY 13. USE SCH.40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN: 7. r- (L+W)(2 SIDES)(1.79'HIGH)(0.74 GPD/SF) ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE. N (29'+10.91)(2)(1.79')(0.74)=105.70 GPD 14. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT, DUST,AND FINES. 3 O BOTTOM AREA 00 (L x W)(0.74 GPD/SF) 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE S, O (29'x10.9')(0.74)=233.90 GPD INFORMATION FOR THE SEPTIC SYSTEM TO THE ENGINEER, IF NECESSARY, TOTAL AREA Project Number: Sheet: 339 GPD 20112 1 Of 1 O Sheet Number: WW - 1 --- ------- --