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HomeMy WebLinkAbout0295 LAKESIDE DRIVE - Health 3 11" -k A:KESIDE DR{{ VF ✓•" ����tt}Y. tit,,4 Y f .}µ 4 F �s `� � �f 1� 1 �I l TOWN OF BARNSTABLE J1G / - , LOCATION< ` /S;2v ,i?& ��`��P SEWAGE # f VILLAGE/�a Z� -r /Z111j' ASSESSOR'S MAP LOT,&2 ,1�3 INSTALLER'S NAME & PHONE NO.5Z46)�pllj�p SEPTIC TANK CAPACITY. V LEACHING FACILITY:(type) 0`l' (5 (size) ,I� NO. OF BEDROOMS PRIVATE WELL PUBLIC WATE BUILDER OWN R �¢QD�i(> DATE PERMIT ISSUED: z2S DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes �No 5f CG r �G 23 .216� 50 No. V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components es Location Address or Lot No. Z a5 1..ak2stGl� ^ `Owner's Name,Address,and Tel.No. 2_1s t , � M VOL S-Wk KAS, KAA R® 4A- oto� Celcske. 0L�r0%'&1 Assessor's Map/Parcel i < ...I Installer's Name,Addrel,and Tel.No. t.r, S,)Ct.4't11d Designer's Name,Address,and Tel.No. R o R%%d . 6A,Uh t F_ S k f,^5:P?0 ©x '1 i , Mars i"ms rA 11 Is tt0YSI Wan Gmu 5 QA'10.W tth. N A Type of Building: 5061-'776- 508_b33—Iola 60 . Dwelling No.of Bedrooms Lot Size 0.2 3 sq.ft. Garbage Grinder( ) Other Type of Building 5 kdCA h�- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _ �'4"0 gpd Design flow provided VIA gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank i �5 oy Type of S.A.S. E-w 5.In rig L-o O A -geld . Description of Soil Nature of Repairs orAlterations(Answer when applicable) U U "t d �& Septic, 9'451y)y 'V 5 i I/L Natge(, W+l Dom c� , A 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 Ae .B -Signed Date O z J Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. •a•o °'' 6 1/! c*s +, k .i..'`" '.i ,,y Fee A t Ate/ V THE COMMONWEALTH OF MASSACHUSETTS 'Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes - 4plitation for Bisposal 6pstetn Construction 30Ertttit 0 r� Application for a Permit to Construct( ) Repair( a Upgrade( ) Abandon( ) ❑Complete System El individual Component Location Address or Lot No. 2,4 S d.ak ts�E- P A� " '1' 24. � Owner s Name,Address,and Tel.No. S ntyQ. Assessor'sMap/Parcel I(` .''"j , ttS1t �las {j►. aunt #ttSk �4e.r�srek KaystM5 M; N A Installer's,Name,Address,and Tel.No G l�, A avw Designer's Name,Address,and Tel.No. R o {RbW-, bA, U 5kevensr'PtJ 'Box "11 � Mtt��ns M*%113 `t rst, WA G�.W? ttw�ch, "A Type of Building: 5d8-'a!76- Qa54 5L3a_�33-»t�;t�tip Dwelling No.of Bedrooms Lot Size 0 2-3 sq.ft. Garbage Grinder( ) - Other Type of Building Ize 5 t dCA r&L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) +4-o gpd Design flow provided A gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 5 0-0 {S}116 Type of S.A.S. E-w 5 ii n q aC�' ?A cl rt 6i f� . Description of Soil " Nature ,,,of Repairs or Alterations (Answer when applicable) �, �C�Q(�C► w h QM ke � }r 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 Boowd-of l al Signed Date Application Approved by j �j Date 4 j r Application Disapproved by Date for the following reasons 4 -- Permit No._ Date Issued ' . THE COMMONWEALTH OF MASSACHUSETTS ` ,BARNSTABLE,MASSACHUSETTS r Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) t w Abandoned( )by °1 at ZG ,.Q*.tS+(�. —i) ' Vt .,�&W,4 �S>!� ����s.� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Q 1.•'�f%dated ( f�j a . l r Installer Designer #bedrooms Approved design-flower gpd S The issuance of this permit shall not be construed as a guarantee that the system will function a d signed. Date / / /eJ` Inspector ` `�.. •.. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -kBARNSTABLE,MASSACHUSETTS ' Disposal 6pstrmi Constrnttion 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) 09.ystem located at 24 5 tA t1n Ath M{115. NA tr, ~ ' and'as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. ¢. '{// Date (/ ( �,� Approved by 1 `U fVA "11 ' � t N rt'rD wcf - TOWN OF BARNSTABLE LOCATION 2C(S ,ceS,IL Dr. SEWAGE# 702-1 — 37(0 VILLAGE (h r1R5 a N S Vh h-1 g ASSESSOR'S MAP&PARCEL (D Z INSTALLER'S NAME&PHONE NO. a2 L l\ - SEPTIC TANK CAPACITY a LEACHING FACILITY:(type) �n 1�rz�v�S s� .(size) NO.OF BEDROOMS OWNER 0 ,. ;4 PERMIT DATE: � 2 COMPLIANCE DATE: Y Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY "r / I t 02 •��j , 8Z' � �� RZ2 - zz -tz '�d p �T ?JOE , It McKenzie, Marybeth From: Jennifer Loughran <jloughran@bcleanwater.org> Sent: Monday, October 25, 2021 9:29 AM To: McKenzie, Marybeth; Soto, Kathryn Cc: Joe Henderson; Crocker, Sharon Subject: Re: 26 Barberry Lane and 295 Lakeside Drive Good morning. Marybeth—I just received an e-mail from the homeowner of 295 Lakeside Drive (Derosier) and the basement is unheated. I believe with this response and confirmation you are now able to finalize the permit and put in the box for me to pick up. Please confirm. Kathyrn—I just spoke to Joe Henderson the engineer and he is sending you the revised plan for 26 Barberry (Healy) so you can finalize and issue the permit. Please let me know when I can pick up. Thanks! Jennifer Loughran Project Manager- Innovative Solutions Barnstable Clean Water Coalition 864 Main Street Osterville MA 02655 (c)860-680-2275 LEAN WAl`PR On Oct 19, 2021, at 3:15 PM, Jennifer Loughran <jloughranka,bcleanwater.org> wrote: Marybeth—sorry to be silent at this end, I'm waiting to hear from the owner of 295 Lakeside to understand the heating and room situation over there. Kathryn—I understand from staff that you were assigned 26 Barberrry Lane. Is the permit ready for pick up? Or do you have any questions? Thank you! Jennifer Loughran Project Manager- Innovative Solutions Barnstable Clean Water Coalition 864 Main Street Osterville MA 02655 (c)860-680-2275 <image001.jpg> On Oct 15, 2021, at 11:50 AM, McKenzie, Marybeth<Marybeth.McKenzie(aMcKenzie town.barnstable.ma.us>wrote: i � � -� ��1���� �f��e �C�iGQ�.wJ � hL ��� r"�'1"'��"� �� �— � � � ���Z l'� Town of Barnstable • t A►" MASS �, Board of Health " 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt March 4, 2022 Mr. Joseph Henderson Horsley Witten Group 90 Route 6A, Unit 1 Sandwich, MA 02563 RE Wr ,kn 295Lakeslde Dnve,;Mars#onsIls . z A WWI Dear Mr. Henderson, You are granted permission on behalf of your clients, Roger and Celeste Derosier, to construct and utilize a NitROE secondary treatment unit with advanced nitrogen reduction technology at 295 Lakeside Drive, Marstons Mills, Massachusetts. This permission is granted with the following condition: • The applicant or engineer shall provide verification to the Board of Health that the 'storage room' is unfinished. You are reminded the following requirements are provided within the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter for this particular technology, dated May 12, 2020: (1) Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit, stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; KleanTu NitROE 2K Provisional Approval, May 2020 Page 11 of 15 Technology: NitROE® 2KS & 2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval; and e) agrees to fulfill his responsibilities to provide written Q:WP/Henderson NITroe Approval 295 lakeside Drive Sept 2021.docx a �a notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). (2) Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000, the approved design plans, and all local requirements, including any local approving authority site-specific requirements; (3) Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i) a certified Registry copy of the Notice bearing the book and page/or document number; and (ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department (4) Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year. (5) The wastewater effluent shall be sampled and analyzed/tested quarterly if this facility is utilized year-round. Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection. [Note: a)Year-round facilities shall be inspected and effluent sampled quarterly; b)Seasonal properties shall be inspected and effluent sampled a minimum of twice per year,with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample; and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling shall also include Field Testing of System wastewater when determined necessary by the operator,see DEP Field Testing Protocol at http://www.mass.gov/eea/does/dep/water/lawsfii-thru-z/testsamp.pdf] (6) A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. All of the other conditions listed in the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter to KleanTu LLC dated May 12, 2020 shall be adhered to. There were no variances requested. This application 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. V yours _ P*,11� John Norman, Chairman Q:WP/Henderson NlTroe Approval 295 lakeside Drive Sept 2021.docx DATE: Q" $95.00 FEE*: • t �M�'1A • Town of Barnstable JApz I2EC.BY - Board of Health SCHED.DATE: Z� 200 Main Street,Hyannis MA 02601 Office: 508-862A644. .�j c�JtuZ �IPt'1 John T.Norman FAX: 508-790.6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM LOCATION Property Address: 295 Lakeside Drive Assessor's Map and Parcel Number: 102/163 Size of Lot: 0.23 ac Wetlands Within 300 Ft. No Business Name: Subdivision Name: Joseph Henderson (Horsley Witten) Phone 508-833-6600 APPLICANT'S NAME: - Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Roger&Celeste M Derosier Name: Joseph Henderson (Horsley Witten Group) Address: 295 Lakeside Drive, Marstons Mills Address: 90 Route 6A, Unit 1 Sandwich, MA 02563 Phone: Phone: 508-833-6600 EMAIL: Ienderson@horsleywitten.com VARIANCE FROM REGULATION(Incl.Res.Code a) REASON FOR VARIANCE(May attach separate sheet if more space needed) —Installation of new I/A system with existing septic system. - Wastewater Retrofit_ NATURE OF WORK: House Addition U Nuase Renuvatiun Repair of Failed Septic System Checklist (to be completed by office staff person receiving variance request application) Please submit first four on list as S collated packets _ A. Five(5)copies of the completed variance request form B. Five(5)copies of MA DEP approval letters for Innovative/Altemative septic system(when proposing an 11A system or secondary treatment unit(S.T.U.). C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: healtht7atown.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 himther for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu-Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted+$95.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1)Septic repair withou an increase in flow and,variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. Q:\Application Forms\VARIREQ Rev Jan 1-2020.docx MAIL-IN REQUESTS Please mail the variance fee amount of $95.00 (if applicable), along with the documents listed below, to the following address: Checks payable to: Town of Barnstable. Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 For septic system variance requests, each of five packets must include: 1) Variance Request Form, 2) Letter for the Board with further information on the reason for the septic variance request (Optional), 3) MA DEP Approval letters for proposed Innovative Alternative (I/A) septic system or a proposed secondary treatment unit (S.T.U.) 4) Engineering plans, 5) Floor plans. In additional to the five septic packets above, include one copy of the seven (7) page checklist, the authorization letter, copy of abutters notice, and fee, if applicable (see checklist below). Please send one electronic submission using a PDF or .jpg of the engineering plan and floor plans to email: health .town.barnstab'le.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 rirst 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 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.bamstable.ma.us A completed seven (7) page checklist, confirming all required items are. on the engineered septic system plan submitted by engineer or registered sanitarian. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify the abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only) Fee Submitted*$95.00 for the following variances: 1)New construction,2)Septic repairs with increase inflows,3) New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: I) Septic repair without an increase in flow and variances granted at the counter. 2) Monitoring Plans, and 3) Temporary Food(this is not a variance). Variance request submitted at least 15 days prior to meeting date. For further assistance on any item above, call (508) 862-4644 Email: health(a-town.barnstable.ma.us Back to Main Public Health Division Page KleanTu® LLC John R.Smith KleanTu Wastewater P.O. Box 1154 Treatment Edgartown,MA 02539 Technologies 412-719-5976-Mobile 508-627-3072-Office September 2,2021 To: Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: Designer Certification for New NitROE®2KS WWTS Enhanced Title 5 Septic System Installation for 295 Lakeside Drive, Marstons Mills,MA 02648; KleanTu Project#80037-2109 Dear Members of the Board: Kindly refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No. X285590; Issued May 12, 2020)(the"DEP Permit");and(ii)the Enhanced Title 5 Septic System design for the 295 Lakeside Drive,Marstoon Mills,MA private residence(the"New System"),featuring the use of a new NitROE®2KS wastewater treatment system(the"NitROE®2KS Components'). The New System was designed by Joseph Henderson,a Massachusetts Registered Professional Engineer with Horsley Witten Group, Inc. (HWG). The NitROE®2K Components are depicted in Site Drawing Project No.: 20112,prepared by HWG and dated September 2,2021. Item IV-#2 of the DEP Permit requires that KleanTu®make certain certifications to the Town of Barnstable Board of Health(the"Board")pertaining to the design of the New System. Accordingly,KleanTu®LLC hereby certifies to the Board that(i)the New System design,solely as it relates to the NitROE®2KS Components and their incorporation into the New System, conforms with the design specifications required by the DEP Permit and(ii)the NitROE®2KS Components are able to perform the proposed wastewater treatment for the New System. Sincerely yours, John R Smith(Sop 2,2021 13.11 EDT) - John R. Smith President cc: Joseph Henderson,Horsley Witten Group Roger and Celeste Derosier, Property and System Owner - 1- September 2,2021 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Sirs, This letter is to verify that I have authorized Horsley Witten to design plan for an alternative septic system to be installed at my house. This plan will be submitted to you for approval. Please don't hesitate to contact us with any questions at roger@expertclosets.com. Rcg r Derosier(Sep 2,2021 15:53 EDT) Celeste Derosier(Sep 2,2021 15:55 EDT) Roger Derosier Celeste Derosier 261 Lakeside Drive Marstons Mills, MA 02648 KleanTu® LLC John R.Smith KleanTu Wastewater P.O. Box 1154 Treatment Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office September 2,2021 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: Property and System Owner Certification for New NitROE®2KS W WTS Enhanced Title 5 Septic System Installation for 295 Lakeside Drive,Marstons Mills,MA 02648;KleanTu Project#80037-2109 Dear Members of the Board: Kindly refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTu®LLC (DEP Transmittal No.X285590;Issued May 12,2020)(the"DEP Permit');and(ii)the Enhanced Title 5 Septic System proposed for 295 Lakeside Drive, Marstons Mills,MA,a private residence,(the"New System'),featuring the use of anew 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, _Zahn R Smir h John R Smith(Sep 13,2021.10:2.8 EDT) - John R. Smith President Enclosure cc: Roger and Celeste Derosier, Property and System Owner - 1- September 2, 2021 K1eanTuo LLC John R. Smith P.O. Box 1]54 Edgartown,MA 02539 Dear Sir: I refer to the following: (i)the MasE 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 295 Lakesido Drive,Marstons Mills,MA 02648, featuring the use of a new NitROE®2KS wastewater treatment system(the"NitROE®2KS Components"). By signing this letter and delivering it to you,as the owner of the property known as 295 Lakeside,Marstons Mills,MA 02648, I/we hereby certify to the accuracy of all of the following statements: 1. I "lave been provided a copy of the DEP Permit and I agree to comply with all terms and conditions cited therein. 2. 1 have received estimates of all homeowner's costs associated with the operation of the NitROE®2KS Components including power consumption and equipment replacement,as well as maintenance, sampling,record- keeping,reporting and related matters for the NitROE®2KS Components(collectively,the"O&M Responsibili- ties."). 3. 1 understand that I must enter into a contract by which my O&M Responsibilities will be fulfilled with KleanTu® or a KleanTu®-approved operator licensed by the Mass DEP as required by the DEP Permit. 4. 1 understand that I must provide a Deed Notice to the Town of Barnstable Board of Health as required by 310 CMR 15.287(10)and the DEP Permit. 5. 1 understand that I must fulfill my responsibilities to provide written notification of the conditions of the DEP Per- mit to any new owner,as required by 310 CMR 15.287(5). Sincerely yours, Ro r Derosier(Sep 2,2021 15:50 EDT) Roger Derosier -15e�d�re� Celeste Derosier(Sep 13,202109:44 EDT) Celeste Derosier 2 McKean Thomas From: McKenzie, Marybeth Sent: Friday, September 17, 2021 9:29 AM To: McKean, Thomas Cc: Stanton, David Subject: BOH notes for 295 Lakeside Drive MM Hi Tom, BOH notes for 295 Lakeside Drive MM. I have not forwarded these to the engineer because I think they are just discussion points, if you want me too please let me know by the end of the day because I will be off for the next two weeks.Thanks Mb There is a 4 bedroom system on file and the floor plans submitted may show up to 9 or 10 rooms. If Total Room Count is used then the gym in the basement would be ok, but the storage isn't defined as "unheated" .Also they do not show egress, so it may not be an issue, so you may want to clarify it. The new tank is 1.5'from the existing SAS and piping needs to go in this space too. Is being so close to the existing a concern? The permit on file did not show the invert to the SAS, so they may want to verify the inlet elevation. Town of Barnstable Health Inspector 508-862-4644 1 i Expert Closets 11 Atlantic Ave, South Yarmouth, MA 02664 Roger Derosier 5087268223 Roger@expertclosets.com g.\My Drive\Current KGDW jobs Roger1R�gers floor plan.job 9/13/2021 1st Floor Not To Scale #s 334 rn� CP Exterior Deck #1 524 \ N Bath —o Kitchen Room #Q Office/Bedroom #36 mm �ro 334 �u N #N Living Room N N 3 � Guest Dining Room Bedroom • i #5 � 190 #3 Small Deck 334 Front Door A 'l Expert Closets 11 Atlantic Ave, South Yarmouth, MA 02664 Roger Derosier 5087268223 Roger@expertclosets.com g:kMy Drive\Current KCDW jobs Roger\Rogers floor plan.job 9/13/2021 2nd Floor f Not To Scale #12 334 Bath Room N# m M ' #17 63'1/4 S N Bedroom ID Bedroom N W w� N #14 334 l l Expert Closets 11 Atlantic Ave, South Yarmouth, MA 02664 Roger Derosier 5087268223 Roger@expertclosets.com g:1My Drive\Current KCDW jobs RogertRogers floor plan:job 9/13/2021 Basement Not To Scale #23 524 Storage � it N N Gara e N Laundry&Storage g r N N A �N #201 a 139 V Gym V v �N #27 N 190 #25 334 , Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 , Charles D.Baker Kathleen A.Theoharides Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner PROVISIONAL USE APPROVAL RENEWAL Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: 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 v = ' J K1eanTu NitROE 2K Provisional Approval,May 2020 Page 2 of 15 Technology:NitROEO 2KS&2KM WWTS I.PURPOSE Subject to the conditions of this.Approval and any other local requirements, the purpose of this Approval is to allow installation and operation of at least 50 on-site sewage disposal systems utilizing the technology in Massachusetts in order to conduct a performance evaluation of the capabilities of the Technology during the first 3 years of operation of each system, in accordance with Title 5 — 310 CMR 15.286(7),Provisional Approval of Alternative System. The specific goal of the Performance Evaluation is to determine if the Technology is capable of consistently meeting the concentration limits for total nitrogen (TN) of less than 11 milligrams per liter (mg/L) for installations with design flows less than 2,000 GPD in the effluent discharged to the soil absorption system. In areas subject to nitrogen loading limitations, increases in the discharge rate per acre may be allowed when the nitrogen concentration discharged to the soil is reduced. The Company is responsible for oversight and sampling of the systems during the Performance Evaluation. The System Owner has responsibility for continued oversight and sampling of the system if the property served was allowed to increase the discharge rate per acre above 440 gallons per day per acre (gpda) in an area subject to Nitrogen Loading Limitations. The System Owner will be required to repair, replace,modify or take any other action as required by the Department or the local approving authority, if the Department or the local approving authority determines that the System is,not capable of meeting the required reduction in nitrogen in the effluent. With the other applicable permits or approvals that may be required by Title 5, this Approval authorizes the installation and use of the Alternative System in Massachusetts. All the provisions of Title 5, including the General Conditions for all Alternative Systems (310 CMR 15.287), apply to the sale, design, installation, and use of the System, except those provisions that specifically have been varied by this Approval. II.GENERAL DESCRIPTION OF THE TECHNOLOGY The NitROE ® 2KS or 2KM WWTS (the `System') is installed in series between a Title-5 system septic tank and a soil absorption system constructed in accordance with 310 CMR 15.100 - 15.279, subject to the provisions of this Approval to accommodate design flows of less than 2,000 GPD. The System is comprised of two-unit processes which are sequentially performed in two different chambers. The first chamber is aerated, via an external air pump and airline header/hose arrangement, to achieve both organic carbon reduction along with the biological conversion of ammonia-N to nitrate-N. From the Aeration Chamber, the wastewater then gravity flows into a Denitrification Chamber where, in the presence of natural organics from wood chips, bacteria mediate the conversion of nitrate-N to inert N gas that exits to the atmosphere via the Title 5 system vent piping. Depending on design flow and availability of local tank structures, the sequential Aeration and Denitrification process steps can be performed in the same single tank, which is NitROE®2KS WWTS, or each process could be performed in its own separate tank with the overall NitROE® WWTS comprised of multiple tank combinations, which is NitROE®2KM WWTS. The use of the Technology under this Approval requires: • Disclosure Notice in the Deed to the property; • Certifications by the Company,the Designer, and the Installer; • System Owner Acknowledgement of Responsibilities; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15 Technology:NitROEO 2KS&2KM WWTS A certified operator under contract for periodic inspection and maintenance; • Periodic sampling; • Recordkeeping and reporting; and • An external power supply III.CONDITIONS OF APPROVAL A. Basis for Conditions 1. The term "System" refers to the Technology in combination with any other components of an on-site treatment and disposal system that may be required to serve a Facility in accordance with 310 CMR 15.000. 2. The term "Approval"includes the Special Conditions, Standard Conditions, General Conditions of 310 CMR 15.287, and the approved Attachments. 3. Items required by this Approval include: a) Performance Evaluation Plan (PEP) with sampling and analysis requirements and approved by the Department. The PEP must be submitted to the Department for review and approval within 60 days of issuance of this Approval and meet the requirements of the Department's Guidance for the Preparation of Performance Evaluation Plans <2,000 GPD; b) Minimum System installation requirements; c) Company schematic drawings and specifications; d) Owner's Manual, including information on substances that should not be discharged to the System; e) Operation and Maintenance manual, including but not limited to, operator qualification requirements, inspection requirements, sampling and analysis requirements, 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 r K1eanTu NitROE 2K Provisional Approval,May 2020 Page 4 of 15 Technology:NitROEO 2KS&2KM WWTS Department, in addition to providing access for performing inspections, maintenance, repairs, and responding to alarm events. 5. The System Owner shall ensure that no permanent buildings or structures, other than the System, are constructed in the area for the installation of all the components of a fully conforming Title 5 system with a reserve area. The area for a fully conforming Title 5 system with a reserve area shall not otherwise be disturbed by the System Owner in any manner that will render it unusable for future installation of a fully conforming Title 5 system. 6. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sanitary sewer system. If it is feasible to connect a new or existing facility to the sewer, the Designer shall not propose an Alternative System to serve the facility and the facility Owner shall not install or use an Alternative System. When a sanitary sewer connection becomes feasible after an Alternative System has been installed,the System Owner shall connect the facility served by the System to the sewer within 60 days of such feasibility and the System shall be abandoned in compliance with 310 CMR 15.354, unless a later time is allowed in writing by the Department or the Local Approving Authority. 7. The control panel including alarms shall be mounted in a location accessible to the System Operator. 8. For any System that does not flow by gravity to the SAS, the System shall be equipped with sensors and high-level alarms to protect against high water due to pump failure, pump control failure, loss of power, or system freeze up. The control panel including alarms and controls shall be mounted in a location always accessible to the operator (or service contractor). Emergency storage capacity for wastewater above the high level alarm shall be provided equal to the daily design flow of the System and the storage capacity shall include an additional allowance for the volume of all drainage which may flow back into the System when pumping has ceased. Instead of providing emergency 24-hour storage, an independent standby power source may be provided for operation during an interruption in power. With any interruption of the power supply the source must be capable of automatically activating in addition to manual start up capability. The standby power must be sufficient to handle peak flows for at least 24 hours and sufficient to meet all power needs of the System including, but not limited to, pumping, ventilation, and controls. Standby power installations must be inspected and exercised at least annually and all automatic and manual start up controls must be tested. Standby power installations must comply with all applicable state and local code requirements. Provided that a standby power installation complies with these requirements, no variance is required to the provisions of 310 CMR 15.231(2). 9. System unit malfunction and high water alarms shall be connected to circuits separate from the circuits to the operating equipment and pumps. 10. All System control units,valve boxes, conveyance lines and other System appurtenances shall be designed and installed to prevent freezing per the Company's recommendations. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 5 of 15 Technology:NitROE®2KS&2KM WWTS 11. Any System structures with exterior piping connections located within 12 inches or below the Estimated Seasonal High Groundwater elevation shall have the connections made watertight with neoprene seals or equivalent. 12. In compliance with 310 CMR 15.240(13), a minimum of one (1) inspection port shall be provided within the SAS consisting of a perforated four inch pipe placed vertically down into the stone to the naturally occurring soil or sand fill below the stone. The pipe shall be capped with a screw type cap and accessible to within three inches of finish grade. Operation and Maintenance 13. Inspection, operation and maintenance (O & M), sampling, and field testing of the System required by this Approval shall be performed by a System Operator with the following qualifications: a) is an approved System Inspector in accordance with 310 CMR 15.340; b) has been trained by the Company and whose name appears on the Company's current list of qualified operators; and c) has been certified at a minimum of Grade Level IV (four) by the Board of Registration of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. The name of the Operator shall be included in the O&M agreement required by paragraph B (14). 14. Prior to the use of the System, the System Owner shall enter into an O&M Agreement with a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year and include the following provisions: a) The name of the qualified Operator that appears on the Company's current list of Service Contractors; b) The System Operator must have the qualifications specified in paragraph B (13); c) The System Operator must inspect the System in accordance with the Approval and anytime there is an equipment failure, System failure, or other alarm event; d) In the case of a System failure, an equipment failure, alarm event,,components not functioning as designed or in accordance with the Company specifications, or violations of the Approval, procedures and responsibilities of the Operator and System Owner shall be clearly defined for corrective measures to be taken immediately. The System Operator shall agree to provide written notification within five days describing corrective measures taken to the System Owner,the Company, and the local board of health; e) The System Operator shall determine the cause of total nitrogen effluent limit violations if they occur and take corrective actions in accordance with the approved O & M Manual; and f) Procedures and responsibilities for recording quarterly or monthly wastewater flows_ must be defined, see paragraph B (32)"Flow Metering". 15. At all times, the System Owner shall maintain an O&M Agreement that meets the requirements of paragraph B (20). 16. The System Owner and the System Operator shall properly operate and maintain the system in accordance with this Approval, the Designer's operation and maintenance requirements, and the requirements of the local approving authority. r 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 l K1eanTu NitROE 2K Provisional Approval,May 2020 Page 7 of 15 Technology:NitROE®2KS&2KM WWTS compliance with 310 CMR 15.000 has been approved by the Approving Authority. A fully conforming Title 5 system may include other approved alternative technologies in accordance with the conditions imposed on the alternative technologies. 27. Subject to the provisions of this Approval, the Technology shall be installed in a manner which neither intrudes on, replaces a component of, or adversely affects the operation of all other components of the System designed and constructed in accordance with the standards for new construction of 310 CMR 15.200- 15.279. Effluent Limit and Monitoring Requirements, 28. For the new construction, unless the facility meets a TN effluent limit of 11 mg/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 http://www.mass.govleeald6esIdep/water/laws/i-thru-zltestsami2.pdf. Properties occupied at least 6 months per year are considered year-round properties. Properties occupied less than 6 months per year are considered seasonal,properties. 30. During the Performance Evaluation period, the Company shall follow the monitoring requirements specified in the Performance Evaluation Plan for installed Systems. 31. After the three (3) year Performance Evaluation period by the Company and approval by the Department, and until this Approval is modified, terminated, or superseded by a General Use Certification, the System Owner shall comply with the following monitoring requirements if the System is subject to a total nitrogen concentration limit in accordance with paragraph B? (28)• 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 p p P p minimum of twice/year, at least 5 months apart and with at least one sample taken between December 1 and March 1 of each year. Field testing shall be completed as determined necessary by the System operator, see DEP Field Testing Protocol at http.•//www.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamp.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 meteringdata of wastewater flow to the system; or Y , 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.govleealdocsldep water/laws/i-thru-zltestsami2.pdf. 34. At a minimum,the System Operator shall inspect the System: a two times year; per p Y , b) in accordance with the approved O&M manual, the Designer's operation and maintenance requirements, and the requirements of the local approving authority; and c) any time there is an alarm event,equipment failure, or system failure 35. . The System Operator shall collect samples and obtain analysis results from an approved lab, perform field testing required by the Approval and submit results within 60 days of the site visit to the System Owner. 36. If the Company successfully demonstrates the effectiveness of the System to reduce nitrogen loadings during the Performance Evaluation period, a minimum of three years, the System / Owner shall operate the System subject to the requirements of the General Use Certification, if issued, for this technology. C. Special Conditions Specific to the Company 1. The Approval shall only apply to model units,with the same model designations specified in this approval and meet the same specifications, operating requirements, and plans, as .provided by the manufacturer at the time of the application. Any proposed modifications of the units shall be subject to the review of the Department for coverage under the Approval. KleanTu NitROE 2K Provisional Approval,May 2020 Page 9 of 15 Technology: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. J 1 n K ea Tu N'itROE 2K Provisional Approval,May 2..020 Page 10 of 15 Technology:NitROE®2KS&2KM WWTS 6. The Company shall institute and maintain a program of Designer training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Designers by February 15th of each year. The Company shall certify that the Designers on the list have taken the training and passed the Company's training qualifications. 7. The Company shall institute and maintain a program of Operator training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Operators by February 15th of each year. The Company shall certify that the Operators on the list have taken the training and passed the Company's training qualifications. 8. The Company shall not sell the Technology to an Installer unless the Installer is trained to install the System by the Company. 9. Prior to its sale of any System that may be used in Massachusetts, the Company shall provide the purchaser with a copy of the Approval with the System design, installation, O&M, and Owner's manuals. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of a System for use in Massachusetts with copies of these documents,prior to any sale of the System. 10. Within 60 days of issuance by the Department of a revised Approval, the Company shall provide written notification of changes to the Approval to all Service Contractors servicing existing installations of the Technology and all distributors and resellers of the Technology. 11. The Company shall provide written notification to the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership,responsibility, coverage and liability between them. 12. The Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns, including but not limited to dealers, distributors, and resellers. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities, respectively, shall constitute violation of the Approval by the Company unless the Department determines otherwise. IV. CERTIFICATION AND NOTIFICATION REQUIREMENTS 1. Thirty.(30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit, stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; . t KleanTu NitROE 2K Provisional Approval,May 2020 Pagel I 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 tr e 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 1.5.000 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 ar_d 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. t � 5. The System Owner shall obtain all necessary permits and approvals required by 310 CMR 15.000 prior to the installation anc use of the System in Massachusetts. 6. The System is approved for the treatment and disposal of sanitary sewage only. The System Owner shall not introduce any wastes that are not sanitary sewage into the System. The System Owner shall dispose of wastes generated or used at the facility that are not sanitary sewage by other lawful means. 7. Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i) a certified Registry copy of the Notice bearing the book and page/or document number; and(ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice/to be recorded shall be in the form of the Notice provided by,the Department. 8. The System Owner shall at all times have the installed System properly operated and maintained in accordance with the most recent O&M provisions of this Approval for the alternative technology and in accordance with any additional requirements of the Approving Authority. The most recent O&M provisions of this Approval for the alternative technology are available from the Department. 9. The System Owner shall furnish the Department any information that the Department requests regarding the System, within 21 days of the date of receipt of that request. Standard Conditions Applicable to the Desi ner r 1 K1eanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 1.5 Technology:NitROE®2KS&2KM WWTS 10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day. 11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy of this Approval. Standard Conditions Applicable to the Company 12. This Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the Company unless the Department determines otherwise. 13. The Company shall include copies of the Approval with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require all vendors, distributors, and resellers to provide each purchaser of the System with copies of the Approval. 14. The Company shall make available, in printed and electronic format, the approved Attachments and any approved updates associated with the Approval,to the System Owners, Operators,Designers, Installers,vendors,resellers,and distributors of the System. 15. The Company shall submit to the Department for approval any proposed updates or changes to the Attachments to the Approval. 16. The Company shall notify all System Owners, resellers, and distributors of changes to the Approval within 60 days of issuance by the Department. 17. The Company shall notify the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership, responsibility, coverage and liability between them. All provisions of the Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 18. The Company shall furnish the Department any information that the Department requests regarding the Technology within 21 days of the date of receipt of that request. 19. If the Company wishes to continue the Approval after its expiration date, the Company shall apply for and obtain a renewal of the Approval. The Company shall submit a renewal application at least 180 days before the expiration date of the Approval, unless written permission for a later date has been granted in writing by the Department. Upon receipt of a timely and complete renewal application, the Approval shall continue in force until the Department has acted on the renewal application. Reporting ti 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 De artment g p 21. The Department may suspend, modify or revoke the Approval for cause, including, but not limited to, noncompliance with the terms of the Approval, non-payment of any annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare, or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to the Approval and/or a System utilizing the Technology against the Company,the Designer, the System Owner,the Installer, and/or the Operator of the System. VI. GENERAL CONDITIONS Title 5 Regulations 310 CMR 15.287: "General Conditions for Use of Alternative Systems Pursuant to 310 CMR 15.284 through 15.286" The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284 through 15.286: 1. All plans and specifications shall be designed in accordance with 310 CMR 15.220. 2. Any required operation and maintenance, monitoring and testing plans shall be submitted to the Department and approved prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a Department approved plan. Sample analysis shall be conducted by an independent U.S. EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory, unless otherwise provided in the Department's written approval. It shall be a violation of'310 CMR 15.000 to omit from a report or falsify any data collected pursuant to an approved testing plan. 3. The facility served by the alternative system and the system itself shall be open to inspection and sampling by the Department and the Local Approving Authority at all reasonable times. 4. The Department and/or the Local Approving Authority may require the owner or operator of the system to cease operation of the system and/or to take any other action necessary to protect public health, safety,welfare and the environment. 5. The owner or operator shall provide written notice to any new owner or operator that the system is an alternative system. Such notice shall include notice of the general conditions and any special conditions applicable to the system and its owner. f ' KleanTu NitROE 2K Provisional 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 wastewater treatment facilities established pursuant to M.G.-L. c. 21, § 34A as to whether a certified operator is required for operation of the alternative'system. The Department shall waive this requirement if it has on file a determination for the alternative system, and shall notify the owner,operator,or proponent of the determination. 7. It is a violation of 310 CMR 15.000 to install, construct, or operate an alternative system except in full compliance with the written approval and 310 CMR 15.287. 8. The Department may require the issuance of a groundwater discharge permit pursuant to 314 CMR 5.00(groundwater discharge program)for any alternative system. 9. The system owner shall maintain an operation and maintenance contract with a Massachusetts certified operator where one is required by 257 CMR 2.00, or otherwise with a person qualified to operate and maintain the system in accordance with the Department's written approval. 10. Prior to obtaining a Certificate of Compliance for installation of a new or upgraded system, the system owner shall record in the chain of title for the property served by the alternative system in the Registry of Deeds or Land Registration Office, as applicable, a Notice disclosing both-he 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 Autrority. Maur 478 2017 21:51 Jim The Inspector Man 5085349919 page 18 1oa -/i�3 Commonwealth of Massachusetts v Title 3 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 295 Lakeside Drive 1e; Property Address. -•] James Fadden Owner Owner's Name information is arstons Mills MA 02648 3-24-17 required for every M � page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out forms n A. General Informationfilling out forms ��,ptuuuugp�� on lhe computer, use onlythe tab ,```����_ OFAggZ,ip Vim'' key to move your 1. Inspector: 02.�;. •. cursor-do not =�: JAMES 'yN' use the return James D.Sears ;m key. Name of Inspector — :y �� Capewide Enterprises ,; a/fl� I I Company Name �.� -- _ � 153 Commercial Street i��"';v 5 IN Sp�G Company Address Mashpee MA 02649 CityfTown State Zp Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 16.340 of Title 5(310 CMR 16.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-25-17 spector•s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""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. tbins.doo•rev.6/16 Title 50Mcial hispe-lion Form:$LLsurfaoe Sewage Disposal System•Pape 1 of 17 Mar 28 2017 21:52 Jim The Inspector Man 5085349919 page 19 t r Commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owners Name information is required for every Marstons Mills MA 02648 3-24-17 page. CityfTown Stale Zip Code Dale of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CM 15,304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and five chambers. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septio tank is metal and over 20 years old"or the septic tank(whether metal or not) Is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I51ne,doe-rev.61W Us 5 Official NspWion Form:Subsurface Sewage Disposal System-Pape 2 of 17 Mar a8 2017 21:52 Jim The Inspector Man 5085349919 page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments c 295 Lakeside Drive Property Address James Fadden Owner Owner's Name informationis requiredairedfor every Marstons Mills MA 02648 3-24-17 for page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 15ins.0oo•rev.aiis Tdle 5 Dfridal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Mar 28 2017 21:53 Jim The Inspector Man 5085349919 page 21 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name nformation isrequlred for every Marstons Mills MA 02648 3-24-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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". Metfiod used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes" or"No"to each of the following for pj inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in, is less than 6" below invert or available volume is less than '/,day flow t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Mar 28 2017 21:53 Jim The Inspector Man 5085349919 page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information is required for every Marstons Mills MA 02648 3-24-17 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is aicesspool serving a facility with a design flow of 2000gpd- 10,000gpd, ❑ ® The system falls. 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Seclion D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t6ins.doc•rev-6116 Title 5 Official hspecilon Form:Subsurface Sewage lisp eal System•Page 5 of 17 t Mar 28 2017 21:54 Jim The Inspector Man 5085349919 page 23 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information is Marstons Mills required for every MA 02648 3-24-17 page. Cityrrown State Zip Code Date of Inspectlen C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6/16 Title 5 Of el Inspection Form:Subsurface Sewage DiWeal System-Page 6 of 17 Mar 28 2017 21:54 Jim The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name Information is required for every Marstons Mills MA 02648 3-24-17 page. Cttyrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and five chambers. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2015-60,000Gals Detail: 2016-65,000Gal's Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5lns.ddc rev,6116 rtie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 0117 Mar 28 2017 21:55 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information is required for every Marstons Mills MA 02648 3-24-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No r If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Ofridel Inspection Form:Subsuface Sewage Disposal System•Page 9 of 17 Mar 28 2017 21:55 Jim The Inspector Man 5085349919 page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information is required for every Marstons Mills MA 02648 3-24-17 page. Cityl7own State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1995 Permit # 95-176. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal Precast H-10 - Sludge depth: 3" t5irts.tloc•rev.6/16 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 Mar 28 2017 21:55 Jim The Inspector Man 5085349919 page 27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 296 Lakeside Drive Property Address James Fadden Owner Owner's Name rtbn is equired for every Marstons Mills MA 02648 3-24-17 require page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness V Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 1" below grade wlin and outlet tees. No sign of leakage or over loading. Note: Sprinkler line over outlet cover, Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 This 5Official Inspe:llon Form:Subsurface Sewage Disposal Syslern•Page 10 of 17 Mar 28 2017 21:56 Jim The Inspector Man 5085349919 page 28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information required for every Marstons Mills MA 02648 3-24-17 page. Cityfrown State Zip Code Dale of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in wonting order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): •Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No lbire.doc•rev.6/16 Title 5 Official Inspedim Form:Subsurface Sewage Oisposai System-page 11 of 17 Mar 28 2017 21:57 Jim The Inspector Man 5085349919 page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner owner's Name information required for every Marstons Mills MA 02648 3-24-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-32 below grade. Box is clean and solid wltwo lines out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber,condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5lns.doc•rev.6/16 Tdle 5 official Inspection Form:Subsurface Sewage Diaposel System•Page 12 of 17 Mar 28 2017 21:57 Jim The Inspector Man 5085349919 page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name Information n Marstons Mills required for eve MA 02648 3-24-17 page. Cltyrrown State Zip Code Dale of Inspection D. System Information (cons.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ teaching 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.): Leaching is five infiltrators w/2'stone. Leaching is clean and dry. No sign of over loading or solid carry over. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5lns.doc-rev.V 6 Titie 50Ricial Inspection Forth:Subsurface Sewage Disposal System-Pepe 13 of 17 Mar 28 2017 21:57 Jim The Inspector Man 5085349919 page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner' Name information is required for every Marstons Mills MA 02648 3-24-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins.doc-rev.6116 Title 5 Official Insoecton Form:Subsurface Sewe"Disposal System-Pape 14 of 17 Mar 28 2017 21:57 Jim The Inspector Man 5085349919 page 32 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information is every Marstons Mills squired for eve MA 02648 3-24-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks, Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �} of 3 _n •, o o t 41 o n r I� tSins.doc•rev,6/16 Title 5 Dffidal Inspection Form Subsurface Sewage Disposal System•Pegs 15 of 17 Mar 28 2017 21:58 Jim The Inspector Man 5085349919 page 33 Commonwealth of Massachusetts WER l? Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information is Marstons Mills required for every MA 02648 3-24-17 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+ feet Please indicate all methods used to determine the high ground water elevation: Cl Obtained from system design plans on record If checked, date of design plan reviewed Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Area and lot high. 20'+. NO sign of G.W. problem. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc rev.6/16 Title 5 Dftal Inspection Form:Subsurtaoe Sewage Disposal System-Page 16 of 17 Mar 28 2017 21:58 Jim The Inspector Man 5085349919 page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 295 Lakeside Drive Property Address James Fadden Owner Owner's Name information is every Marstons Mills required for eve MA 02648 3-24-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary;A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.eoc•rev.e/16 Title 5 Official inspect=Form:Subsurface Sewage Disposal System•Pape 17 of 17 4 3 No...,? F�$.... a.-........ . ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativit for Di-nVi 3al Workii Tontitrurtturt rumit Application is hereby made for a Permit to Construct ( ) or Repair (b4_an Individual Sewage Disposal System at: ............... ........ ..--------- ;4;ation-Address or Lot No. Owner Address Installer Address UType of Building y Size Lot............................Sq. feet Dwelling— No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow................. .................gallons per person per day. Total daily flow................�. YC1................gallons. WSeptic Tank—Liquid capacity_- __.gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No. --------/.......... Width.....'7_________ Total Length.......-3�otal leaching area....................sq. ft. 3 Seepage Pit No_____________________ Diameter-------------------- Depth below inlet... .... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. ]................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ PG ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ x U ---•------------------------------------------------------------------------------------------------------------------------------------•----------....--------........................................ W x --- U Nature of Repairs or Alterations—Answer when ap�Plicable._._1- 'T- -i -_�-__ "1_ .,' h1.iL� 1%h 'J�'i�'- 1 (r�l --. f-..-......?fix ------------------------•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance s b n issued y board of health. Signed ---------- ------- -------------- Application Approved B -..:�� ......s4.Q PP PP Y ... *�.. - ... ........................... Dare Application Disapproved for the following reasons: ........ .. ... ................. ..... ... . -- . ................................. ------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ........................................ Dace Permit No. ....... cam'' 7�................ ........ Issued ........................................................ Dare _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diti-VagMl Works Tongtrurtion remit Application is hereby made for a Permit to Construct ( ) or Repair (,+>4_ an Individual Sewage Disposal System at: ... V �/1/1 --••------------•........--•--------------------•-------....---------•-............•. --•-•-----....----------•-----.......----.............-•--•------•••--....-------- --Lo ation Address or Lot No. ......................t h/1 !—� 401`a..1 c��_ L,4,Z-2�S1,0 QtC!YJ /Yl1 !tom IIl IS---•-••----•-••-•----..•..................•---••-•••..........---•-•-•------ .....----•-•-----------..............•----......_ 1._... .....• .... Owner Address , 1(0 l C /� vV1 l�_.� -----------------------------------------••------•-•-------•------- ----•--•-----------•-•------- ...................................................-.......------ ........... Installer Address UType of BuildingM Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (r /1J aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- ---------------------------------------•------------------•-- w Design Flow............... ..................gallons per person per day. Total daily flow................9"Yo ................gallons. WSeptic Tank—Liquid cap:acity_l_,ZZ...gallons Length---------------- Width---------------- Diameter_.------------ Depth................ x Disposal Trench—No. ........ .......... Width......`7.._...... Total Length.......:�otal leaching area....................sq. ft. Seepage Pit No_____________________ Diameter-------------------- Depth below inlet___ .... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date..............----------------•--•---- 4 Test Pit No. I................minutes per inch Depth of Test' Pit...........:.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------•-•••--...............-•---•-•-•--••---•-•--•-•---••-•-•--•-•---....•-•......................................................... 0 Description of Soil........................................................................................................................................................................ x u .............................................. ---••-•---•-•-•--•--•-•-••-••--•-•-•-----•---••-•------•--•-••-•-•---•--•--•-•--•-•----------•-...-••-----•---------•-•--...------•--•••-----------••..... w UNature of Repairs or Alterations—Answer when applicable.___I_N.S_;-4-s L .4 -.-/- 1 --C 4_ .c:_a:2!61.I4_/ ....... ------....�,! 'L�'`� =S-'Za,`1 .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha-s Ibben issued y the boardof health. gSi ned ........... !`: ✓ ......... Gs `.................. Dare Application Approved BY ------- Date Application Disapproved for the following reasons: ...................... .................... .. ........ . ................... .............. . . ........ C Date PermitNo. ..------7_�- --------)-7-�--------------------------- Issued .......................---....................... . . .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF�.1- BARNSTABLE P1t�tfi ate of U����T-IIxItpliart.rie THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b G - �.c�cx�T,�7 .w-5.%G w�./.��----------------------------------------------------------- Y ------------------------------_...._----------------------------------- InstaOct at e G-�1. ---. � ......�o�e ------- --- f'YJ--------./J..L.(...U........... . has been installed in accordance with the provisions of TITLE 5�of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....1 1...... .. ....... dated -----------------------.------------------.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r DATE - 1 -----_.......... Inspector L%� � Lc� l.,. THE COMMONWEALTH OF MASSACHUSETTS !�Z- ( � BOARD OF HEALTH Q TOWN OF BARNSTABLE No....&_ f 71- FEE.FO........... Ropmal Workp Tonotrudian "ermit Permission is hereby granted------------------_----- ��Z? -! ...................................................."� to Construct ( ) or Repair (. an Individual Sewage Disposal System at No............................ --• ��--- �L!,�. Sir�/`�-r /G?., /(=<5........... Street 77 as shown on the application for Disposal Works Construction Permit No. = 1. ..... Dated------ ................ ----------•-••--•---.......................; ................................................ Board of Health DATE............ ..-_. �.- ��'--•------------------ FORM 38808 HOBBS&WARREN.INC..PUBLISHERS 069340 10--21-2021 Q 03 2 37P Notice of Alternative Sewage Disposal System M.G.L. c.21A, § 13 and 310 CMR 15.0287(10) [This Notice to be recorded and/or filed for registration in the chain of title of the Property served by an Alternative Sewage Dis- posal System("Alternative System").] r •. iAME(S)OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM:Roger and Celeste Derosier ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM:295 Lakeside Drive Marston s Mills A 02648 TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM[check and complete each that applies]: 7�Deed recorded with the Town of Barn table Registry of Deeds in.Book34188 ,Page 080 _Certificate of Title No. issued by the Land Registration Office of the Registry District _Source of title other than by deed [If Alternative System Owner(s)is other than Property Owner(s),complete the following:[ Alternative System Owner Name: Alternative System Owner Address: WHEREAS, Section 1.5.280 of Title 5 of the State Environmental Code("Approval of Alternative Systems"), provides for the Massachusetts Department of Environmental Protection(the"Department")to approve or certify, as appropriate, all proposals to construct, upgrade or replace on-site sewage disposal systems using alternative systems; WHEREAS, owners and/or operators of approved or certified alternative systems are subject to general con- ditions, as specified in Section 15.287 of Title 5 of the State Environmental Code, 310 CMR 15.287, and may be subject to special conditions, as specified in the Department's approvals or certifications; such general and special conditions potentially including,without limitation,requirements relating to the use of trained operators,periodic inspections, maintenance, sampling,reporting and/or recordkeeping; WHEREAS, Section 1.5.287(10) of Title 5 of the.State Environmental Code,_310 CMR 15.287(10),re- quires that"prior to obtaining a Certificate of Compliance for installation of a new or upgraded system,the sys- tem owner shall record in the chain of title for the property served by the alternative system'in the`Registry of Deeds and/or Land Registration Office,as applicable,a Notice disclosing both the ekistence of the alternative on-site system and the Department's approval of the system. The system owner!shall also provide evidence off such recording to the local Approving Authority [J"and WHEREAS,the Property is served by an alternative sewage disposal system. NOW,THEREFORE,Notice of an alternative sewage disposal system is hereby given for the above-ref- erenced Property, as follows: 1.Existence.An alternative system has been installed as a new or upgraded alternative sewage disposal system, on or adjacent to the Property, and serves the Property.The trade name and model number(s) of the alternative system are as follows: Trade name of technology: NitROE®Waste-Water Treatment System Manufacturer Name: KleanTu'e LLC Model number(s): NitROE®2I4S WWTS s ,' Page,1.of 2 y, 2.Approval/Certification. On Max 12 2020 [date],the Department,pursuant to its authority under the section of Title 5 as specified below,approved or certified the technology used in the above-referenced alternative system,under MassDEP Transmittal Number:X28559O.[Transmittal Number of approval or certification]. [Check one of the following,as applicable:] Approved for remedial use under 310 CMR 15.284 Approved for piloting under 310 CMR 15.285 X Provisionally approved under 310 CMR 15.286 Certified for general use under.310 CMR 15.288 A copy of the Department's Approval/Certification is available from the Department in person or on- line at the Department's website: http://www.mass.2ov/dM. WITNESS the execution hereof under seal this_day of ire 6 6 v- ,20 ,made by the above-named A r ative System Owner(s). Print Name: ro in.J� s Signature: � Signature: Cy �e �C ��� Print Name: COMMONWEALTH OF MASSACHUSETTS Barnstable , ss On this J day of 0cWbei- , 20_,before me,the undersigned notary public,personally appeared c e Qer� (name of document signer),proved to me through satisfactory evidence.of identification,which were`,1!]►� d��;u�•u S Oicc��c cat to bet e person whose name is signed on the preceding or attached document,and acknowledg`e�c e th`at'- (he) W sign it v4oluntari� lets stated purpos . EPleAWW6&AQWtW4bp 8Z isn6ny issiwwoo AVy (official r ture and ea]of no ary) �O H11113MNOWWIOJ d AjeION +r l Consent if Alternative System Owner(s)is other than the Property Owner(s):I CONSENTED TO: [Property Owner(s)] Print Naine(s): Date: COMMONWEALTH OF MASSACHUSETTS Barnstable ss On this SL'`` day of_fl �u y- , 20Ajbefore me,the undersigned notary public,personally appeared j/0 (name of document signer),proved tome through satisfactory evidence of identification,which were Ma. d.yrLvel`5 IrLe H to be the person whose name is signed on the preceding or attached document, and acknowledged to me that e) (she) signed it voluntarily for its stated pure (official sign and seal o to Upon recording,return to: Roger Derosier lit Jennifer E.CareyCeleste Derosier Notary PublicOMMONWEALTH OF MASSACHMEt7S My Commission Expires BARNSTABLE REGISTRY OF DEEDS August zs.2024 John Fa Meade, Register a KleanTu® LLC John R.Smith KleanTu wastevrater Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 O 412-719-5976 Mobile 508-627-3072-Office CONTRACT No.80037-2109 for 295 Lakeside Drive,Marstons Mills,MA 02648 p1j 1/5 September 2,2021 Mr. and Mrs.Roger Derosier 295 Lakeside Drive Marstons Mills, MA 02648 _:. RE: NitROEO2K WWTS Start-Up and Monitoring,Operation and Maintenance(MOM)for 295 Lakeside Drive, Marstons Mills, MA 02648 K1eanTue Job No. 80037 Dear Roger and Celeste: In concert with the Barnstable Clean Water Coalition(BCWC),K1eanTuo LLC.is pleased to submit this "Contract"to provide Start-Up and Monitoring, Operation,and Maintenance(MOM)oversight services for up.o five years from the NitROE12K Waste-Water Treatment System (WWTS)installation date at 295 Lakeside Drive,Marstons Mills,NIA. The main purpose of the NitROEO 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 MONK. 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. i CON-TRACT No.80037-2109 for 295 Lakeside Drive Marstons,Mills.MA 02648 Piz.2/5 All MOM.activities,including monitoring and sample collection,will be performed,or directly supervised by a System Operator that has been certified at a minimum Grade Level IV by the Board of Operators of Wastewater Treatment Facilities,in accordance with Massachusetts regulations 257 CMR 2.00. Specific to any K1eanTu® Contract,the System Operator will be John R. Smith,Certificate No.: 1914. Electronic copies of the Provisional Permit and the NitROE02K WWTS MOM Manual are provided along with this contract proposal. Table 1. Scheduled(Routine)Yearly MOM Deliverables and Pricing for New NitROE®2KS WWTS for 295 Lakeside Drive,Marstons Mills,MA. Time Price per Period Period Deliverables ($) October 2021 Start-Up including bacterial seeding and monitoring at least once every 2 $0 to weeks during the I`8-weeks of operation to ensure that NitROE®2K (All related MOM September WWTS is properly functioning. costs to be paid for 2022 Provide ar_d Review an OM&M Manual to homeowner and address any and by the BCWC) (12 months) all related questions. Monthly Sample Collection and Analyses beyond what is required by the Mass DEP Provisional Permit. Respond to Homeowner issues, concerns and questions. Monthly Inspection and Quarterly Monitoring Updates to Homeowner. (NOTE: All NitROE®WWTS Components Covered Under Warranty) October 2022 Sample Collection and Analyses with minimum per Mass DEP Provisional $0 to Permit. (All related MOM September Respond to Homeowner issues, concerns and questions. costs to be paid for 2027 by the BCWC) (�years) Quarterly Inspection and Monitoring Updates to Homeowner. October 2027 Quarterly Inspection and Sample Collection per Mass.DEP General.Permit $600- $1,200 and conditions. (Projected Range of beyond Covers Maximum of 4 site calls per year. Yearly Contract to Yearly Update to Homeowners. be covered by the (NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) 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 n CONTRACT No.80037-2109 for 295 Lakeside Drive,Marstons,Mills,MA 02648 pg.3/5 As tre NitROE®2K WWTS moves through the Mass DEP permitting process from Provisional Permit Use to General Permit Use,Table 1 reflects that the associated price for yearly MOM significantly decreases. This O.M&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 October 2021 - September 2022, anticipating use immediately after installation. As the NitROE02K WWTS operation then moves into 2022,a new contract will need to be executed with each renewal for a minimum 1-year period. In addition to the pricing of Scheduled 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 op.-ration 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(I)120-watt air pump required to enhance and maintain the appropriate level of biological processes required. This yearly electrical cost will be borne by the homeowner,along with periodic pumping of their septic tank as required. r -3- :r A CONTRACT No.80037-2109 for 295 Lakeside Drive,Marstons,Mills,MA 02648 a 4/5 Table 2. Non-Routine MOM Items and Projected Price Estimates for New NitROE®2KS WWTS Replacement Items for 295 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 0 KleanTu®will determine when this is needed based on scheduled $200-$300 site visits. (for EST Septic Septic Tank • Pump out to be done by non-KleanTu®contractor with estimated Tank Pumped (EST)Pump Out price=$200- $300/EST tank. out every • Exact time period is site-specific with estimate of every 3-8 years. 3-8 Years) (NOTE: This pump out cost would need to be done even if this was a conventional Title 5 septic system) • Replacing remote sensing unit and probes=$360. $360 Replace Remote . Exact time period is variable with estimate of every 8-10 years. (Every Sensing Probes (NOTE: For remote sensing operation, 8-10 Years) and Unit Wi-Fi connection from homeowner is needed) • Air pump repair and/or replacement. $500 Replace Air . Exact time period range is variable with estimate of every 5-8 (Every Pump years. 5-8 Yeas) • 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 • Limestone Addition=$1,600. $1,600 Limestone . Exact time period is variable with estimate of every 20-30 years. (Every 20-30 Years) -4- n CONTRACT No. 80037-2109 for 295 Lakeside Drive,Marstons,Mills,MA 02648 pe.515 PAYMENT TERMS Even though there is no site owner cost for the first five years of MOM,the contract still needs to be signed and executed by the site owner as it is a confirmation that he/she accepts responsibility for associated MOM costs in subsequent years. Contracts executed for subsequent yearly time periods will need to be signed by October 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 ne. Please contact Zenas"Zee"Crocker, zcrocker a bcleanwateL.grg,of Barnstable Clean Water Coalition with any questions or comments. Thank you, ,Tohr, R Smith John R srIith(sep 13,2.021.10:28 FDT) - John R.Smith Presicent SYSTEM OWNER SIGNATURE Name: Roger Derosier Signature: Ro, Derosier(Sep 2.,20J.1.5:51 EDT) - Name: Celeste!)crosier SlgnaturC: Celeste Dero ier(Sep 13,262.1..09:43 EDT) : -5- _ I KleanTu® LLC KleanTu Wastewater P.O. Box John R.Smith math Treatment 1154 Technologies Edg artown,MA 02539 • 412-719-5976-Mobile CR) 508-627-3072-Office September 2,2021 Mr.arA Mrs.Roger Derosier 295 Lakeside Drive Marstons Mills,MA 02648 Joseph Henderson Horsley Witten Group 90 Route 6A,Unit l Sandwich,MA 02563 RE: Installer Certification for New NitROE*2K WWTS Enhanced Title 5 Septic System installation for 261 Lakeside Drive, Marstons Mills,.MA 02648;KleanTu Project#80037-2109 Dear Roger and Celeste: Kindly refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal (�n'1 No.X285590; Issued May 12,2020)(the"DEP Permit");and(ii)the Enhanced Title 5 Septic System proposed for a private residence located at 295 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 makes certain certifications to both of you pertaining to the installer's qualifications as to its installation of the NitROE®2KS Components. KleanTu®LLC acknowledges that the installer will be trained and certified prior to installation. in addition,KleanTu®LLC hereby certifies that KleanTuO personnel will be onsite to supervise the installation of the NitROEO 2KS Components. Such supervision will ensure that the NitROE®2KS Components are installed in a manner that conforms with K1eanTuo LLC's design and oaerating requirements. Please contact me with any questions or comments regarding this certification. My cell#is 412-719-5976. Sincerely yours, 74 h John It (Bep T.,202 :r1:1,1.CUT) John R- Smith President f f ^ KleanTuO LLC John R.Smith 1 wastewater Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 412-719-5976-Mobile KLeanTu 508-627-3072-Office CONTRACT No.80037-2109 for 295 Lakeside Drive Marstons Mills,MA 02648 pg. 1/6 September 2,2021 Mr.and Mrs. Roger Derosier . 295 Lakeside Drive Marstons Mills,MA 02648 RE: NitROEO 2K WWTS Installation for 295 Lakeside Drive, Marstons Mills,MA KleanTue Job No.: 80037 Dear Roger and Celeste: K1eanTO LLC is pleased to provide this contract document for a NitR0E82K Waste-Water Treatment System (WWTS)to be installed at 295 Lakeside Drive,Marstons Mills,MA. The main purpose of the NitROE®2K WWTS is to serve as a supplemental upgrading of a new Title 5 septic system. A new NitROO 2.K 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 NitROEO 2K WWTS is to significantly reduce total nitrogen(TN)from the sanitary wastewater flow prior to permitted discharge to the new Title 5 leaching chamber. In addition to significantly reducing TN,the NitROEO 2K WWTS enhancement will produce a highly treated wastewater effluent with significantly reduced levels of organics and suspended solids as well. NitROE"ENHANCED TITLE 5 SEPTIC SYSTEM OVERVIEW The NitRO.E"2K WWTS to be installed is specified in Site Drawing Project No.:20112,prepared by Horsley Witten Group Inc.01WG)datad September 2,2021. With reference to this site drawing,wastewater will first be collected into an existing septic tank. After solids separation in the septic tank,wastewater will then gravity flow into a NitROEO 2K WWTS tank for enhance total nitrogen reduction. From there,the significantly treated wastewater will gravity flow into a new leaching chamber. 1 ( 1 CONTRACT No. 80037-2109 for 295 Lakeside Drive,Marstons Mills MA 02648 pg 2/6 REGULATORY REQUIREMENTS The NitROE®2K WWTS will be installed and operated under a Mass DEP Provisional Permit granted to KleanTu® LLC(DEP Transmittal No.: X285590; issued May 12,2020). Specific regulatory items that need to be addressed are summarized below. It is to be noted that various actions among the site owner,the site design engineer,the installer,and KleanTu®LLC must be followed and respectively documented. The majority of the documentation required will be provided by the Barnstable Clean Water Coalition(BCWC)with input from KleanTu®. Furthermore,these Mass DEP regulatory requirements pertain to respective actions from project initiation through to NitROO 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: l. Submittal of the site engineering design and DSCP application to the local BoH. Normally this is done by the Design Engineer. 2. Along with tie DSCP application,to comply with Section IV-1 of the Provisional Permit,the BCWC,with input from KleanTu®LLC,will provide to the local BoH,a certification letter that the site owner: i. Has-peen provided a copy of the Provisional Use Approval and agrees to comply with all term3 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 contract to be in place with.KleanTu®LLC, or with their designated and trained entity,and that the NitROE®2K WWTS operator must be licensed by the Mass DEP as stipulated in KleanTu®'s Provisional Permit. iv. Agrees to fulfill their responsibilities to provide a Deed Notice,and file with the local Registry of Deeds,as required by 310 CMR I S 287(10)and with the Approval by the local BoH. v. Agrees to fulfill their responsibilities to provide written notification of the Approval conditions to any new owner,as required by 310 CMR 15.287(5). 3. Along with the DSCP application,to comply with Section IV-2 of the Provisional Permit,the BCWC,with input from KleanTu®LLC,will provide to the local BoH,with a copy to the Designer and the Site Owner,than the site-specific design conforms to Provisional Permit requirements and that the proposed use of the NitROE®2KM WWTS is consistent with the unit's capabilities aad all KleanTu®LLC requirements. t } 2 a CONTRACT No.80037-2109 for 295 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: l. 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 Gs-built drawing and/or notes. The completed COC then needs to be fled 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 ' CONTRACT No.80037-2109 for 295 Lakeside Drive Marstons Mills MA 02648 pg.4/G INSTALLATION ACTIVITIES AND PRICE For installation of the enhanced NitROC®2K WWTS,the task activities to be carried out,along with their respective prices,are provided in the table below. IT IS TO BE NOTED THAT ALL OF THE COSTS CITED WILL BE COVERED BY THE BARNSTABLE CLEAN WATER COALITION(BCWC)PER AN AGREEMENT THEY HAVE WITH THE SITE OWNER. An electronic copy of the NitROO 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 K1eanTuo LLC. Of particular note, it is the responsibility of the site owner to.identify and make the installer aware of any buried utility lines such as gas,electrical and cable;here Dig Safe can be contacted to provide this service at no cost(http://www.di�;safe,coml;but they only identify public utility lines and not any private lines. As cited in the Table 1 below,the contract price for KleanTuo to provide the task activities cited is$12,500.This also cites that the site owner is also responsible for the engineering and installation services to be done by others. Additionally,it is to be noted that the BC WC 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 NitROO 1 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 A �^^*� CONTRACT No. 80037-2109 for 295 Lakeside Drive,Marstons Mills,MA 02648 viz.5/6 k Table 1.KleanTu°Price of Title 5 Enhancement via NitROE®2KS WWTS Enhancement for 2951akeside Drive,Marstons Mills,MA 02648 ONE 2,000 GALLON NitROE TANK(WASST20M-1­110) (KleanTu°Project No.80037-0821) 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 prlges 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 TU AS IN-KIND SERVICE. TASKS 010-030 TOTAL THRU INSTALLATION $12,500 Task 040-Start-Up and Monitoring,Operation&Maintenance(MOM)Per MassDEP Provisional Permit and Barnstable BoH Requirements Includes NitROE®WWTS jacterial 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 t 5 �-- CONTRACT No.80037-2109 for 295 Lakeside Drive,Marstons Mills MA 02648 pg.6/6 SCHEDULE Barring unforeseen circumstances, KleanTu. will have:the NitROE WWTS tank ready.for installation in October 2021,with the actual date to be finalized with the site owner and their installer. PAYMENT SCHEDULE All KleanTe costs to be paid by the BCWC under separate contract with K1eanTue LLC. WARRANTY KleanTuo guarantees NitROEA 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 440 gallons per day(god). SITE ACCESS By signing this contract,site cwner agrees that K1eanTuo and BCWC designated personnel will be allowed access to the site for the purpose of performing routine MOM activities associated with the NitROO 2K WWTS. CONTRACT ACCEPTANCE K1eanTuQ°looks forward to working in partnership with the BCWC and for providing direction and oversight for installing and operating a NitROEO 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 NitROEO 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 acrc»kerbcleanwater.or�; at Barnstable Clean Water Coalition with any questions or comments. Sincerely, .IphaliamtII(S(?j)3,2.027.04:00W) - - - John R. Smith President Roger Derosier GAD, ` Signature: un,.rorr(omoi(Sol)2.202.115t52 FIR, ' Celeste Derosier Signature: 6 Town of Barnstable Inspectional Services ae�s Public Health Division MAS& Thomas McKean,Director 200 Main Street,IHysibnis,MA 02601 Office: 508-862-4644 Fax: 508-190-6304 Installer& Designer Certification Form Date: 12/16/2021 Sewage Permit#Lo 11- 3 S 9 Assessor's Map\Parcel 102/163 Designer: Joe Henderson, Horsley Witten Group, Inc. Installer: 4\C 5T£V T, Address: 90 Route 6A Address: 0 13a,Y 1 Sandwich, MA 025631Pr(?�'\�itJS. Wl1LL$ i'►'1} OZ&&q On S i s �'`St^ was issued a permit to install,a (date) (installer) septic system at 295 Lakeside Drive based on a design drawn by (address) ,Joe Henderson, Horsley Witten Group, Inc. dated September 3, 2021 (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. X I certify that the system referenced above was constructed in compliance with the to rms of the RA approval letters(if applicable) (Affix4"if c t<mp Here) f : PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoWepIAHEALTMSEWER connecllSEPTIODwigner CCAiflcation Form Rev&14-13.DOC i i Town of Barnstable •°`` ' i.� Inspectional Services Public Health Division snnxsraBts. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 12/16/2021 Sewage Permit# Assessor's Map\Parcel 102/163 Designer: Joe Henderson, Horsley Witten Group, Inc. Installer: CdL\c- sTcQ gym, , Address: 90 Route 6A Address: F0a,k---) Sandwich, MA02563 1N\ILLS 1411fi oz:&q On was issued a permit to install a (date) (installer) septic system at 295 .Lakeside Drive based on a design drawn by (address) Joe Henderson, Horsley Witten Group, Inc. dated September 3, 2021 (designer) i i X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the p Strip (i required) P i distribution-box and/or septic tank. Stn out if re u><red was inspected and the sods were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory._ X I certify that the system referenced above was constructed in compliance with the to rms of the 1\A approval letters (if applicable) �_J ii OP 'Tf nstat er s Si (Designer's Signature). (Affix DLki4, e_ SS� np Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WGa\depts\HEALTH\SEWER connecASEPTIODaigner Certification Form Rev 8.14-13.DOC i 'I o`�`✓' ZONING & RESOURCE PROTECTION NOTES G 1. PARCEL ID:102/163 LOT SIZE:0.23 AC ; PROPOSED DISTRIBUTION BOX w INV. IN = 60.05 2. OWNER OF RECORD:ROGER&CELESTE M DEROSIER INV. OUT=59.88 PROPOSED 2" PVC , , ` I 100.00' 1, 3. ADDRESS: 295 LAKESIDE DRIVE _ ADJUST EXISTING PIPES TO FORCEMAIN ( O S780 05 25 W 77 4. THE LOCUS IS IN LOCATED IN F u �'- .'£ INFILTRATORS AS NEEDED FLOOD ZONE X(AS SHOWN ON F.LR.M.MAP 25001C0542J DATED DULY 16,2014), '` o 5, THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. � / PROPOSED 650 EXISTING GALLON PUMP WASTEWATER INSTALLATION INSPECTION NOTES /' 1. THE CONTRACTOR SHALL a EXISTING LEACH FIELD DISTRIBUTION BOX D CHAMBER S L PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE TO BE _ ENGINEER AND LOCAL BOARD OF HEALTH FOR ANY INSPECTION. (5 INFILTRATORS) INV. IN= 59.64 0 / INV. OUT= 59.39 2. ALL WASTEWATER COMPONENTS SHALL BE INSPECTED BY THE ENGINEER AND THE LOCAL _ �. 0 - '� BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL BE INSPECTED: O BENCHMARK ,� / _ _ to EXISTING sl / M r 2.1. SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL .� MAG SET / 0 2.2. LEAKAGE TEST ON PRECAST TANKS(MIN.24 HR) EL. 59.87 ,n C) 2.3. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS DRIVE / o ° T- DESIGNED EXISTING 1,500 / _ O r 2.4. FINAL INSPECTION OF BACKFILLED SYSTEM. GALLON SEPTIC / I z . TANK TO REMAIN 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND X K _k•. w mac: ,n 't � � .. / NOTES INDICATING THE HORIZONTAL AND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM s ,;- a INV OUT-60.13 ' If COMPONENTS INSTALLED. THESE - r .� 10.68' S ESE AS BUILT DRAWINGS AND NOTES WILL BE UTILIZED BY THE O O ENGINEER FOR THE PREPARATION OF RECORD PLANS. ..-- --62-- WASTEWATER NOTES c m W f 4"SCH 40 PVC 16. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND A\S SPECIFIED IIN 310 CMR 3 L=2', S=2.O% 15.255(3), ANY ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL - - 1. ELEVATION;PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SHALL BE REPORTED TO THE ENGINEER. CO) SURVEY CONDUCTED BY THE HORSLEY WITTEN GROUP, INC:ON NOVEMBER 20,2020. _ DECK 15.36' IZ � 17. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNIETIC WARNING TAPE. m G9 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS fi N 4" SCH 40 PVC J NITROE 2KS 2,000 SHALL BE IN ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND E w REGULATIONS OF THE LOCAL BOARD OF HEALTH. 18. ALL SEPTIC TANKS SHALL BE APPLIED WITH 2 COATS OF DAMAP PROOFING OR BITUMINOUS O �' L=10', S=2.0% GALLON TANK MATERIAL. d o c d o INV. IN= 59.93 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO '� 13 N INV. OUT- 59.68 19. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL Tf0 THEIR ORIGINAL CONDITION _ O 0 M = LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON AFTER CONSTRUCTION IS COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL � W �[ _ + I IT AND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. BE LEFT NATURAL.THE CONTRACTOR SHALL TAKE CARE TO I PREVENT DAMAGE TO d d 777SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE UNDERGROUND ELECTRIC 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL (D d v M M 67 PLANS DO NOT SHOW ALL LANDSCAPE FEATURES,EXISTING'I CONDITIONS(MUST BE = O M 'S BOARD OF HEALTH(BOH)STAFF. N -C •y TO PUMP CHAMBER + VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK. w O a o0 00 co O o isco M 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 = to d PROPOSED AIR PUMP 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 � co °_ 00 / FINAL LOCATION TO BE AREAS. DIRECTED BY THE ENGINEER. THE CONTRACTOR SHALL BE FRESPONSIBLE FOR WATERING 295 LAKESIDE DRIVE FIELD DETERMINED ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS ESTTABLISHED AND APPROVED BY J z ^ A 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY THE ENGINEER AND/OR OWNER. 4 BEDROOMS LOCAL AND/OR STATE PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAYBE REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL HOURS OF OPERATION FOR THE 21. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PRO)POSED FOR THIS SITE. THE I••� FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. SYSTEM MUST BE INSTALLED AND MAINTAINED IN ACCORDAPNCE WITH THE DEPARTMENT r^ M OF ENVIRONMENTAL PROTECTION(DEP)PROVISIONAL USE APPROVAL. vJ l y J 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM Q y THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OR CHANGES TO EFFLUENT FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR RISER TO WITHIN 3"OF rUJ Z ADJACENT TO THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE SEPTIC AND FINISHED GRADE \W vJ LEACHING SYSTEM(S). �V �I/ �i/ �/ \i/_ � EL.63.0t / vJ Z LOAM AND!SEED�T! 19 i I III ! _ _ 9. CALL"DIGSAIFE"AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT _ _ _ -' `- 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF -CLEAN - EL.60.97� _ .J r , EXISTING UTILITIES. - -- - - - - - - I. - -BACKFILL- - - - - - - - - 10. THIS ON-SITIE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A _ - _ - - - - _-_- - - - - 'U)GARBAGE GIRINDER. -I FLOW - _ ^ �y _ w vJ vJ s 11. THE OWNER;SHALL HAVE THE SYSTEM INSPECTED AND HAVE THE SEPTIC TANK PUMPED - ____s 0 FLOW-- - �r Or EVERY 3-8`YEARS. EL.59.38 6"OF 3/4" V! Z ... - - - - COMPACTED O O�/ _ _ W LL 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE i CRUSHED �� • / ��/ PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. I I I I I I STONE BASE a 3r /� LLI o� BENCHMARK s�" _ I Q U) J I- W CB/DH FND / 13. USE SCH.40 PVC.PIPING WITH WATEPrIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. J LJ- W •p � �/^ EXISTING WATER SERVICE ,. � i p EL, 67.16 `j ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE. Q Ly Uw w O 14. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT,DUST,AND FINES. NOTES: LLI d Q �/� 72 62' 1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL �• a ,(� STABLE BASE. C�1 `` S71° 33' 05��W 15. THE CONTRAACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE v J W INFORMATION FOR THE SEPTIC SYSTEM TO THE ENGINEER,iF NECESSARY. 2. BLOCK ONE OUTLET. 7 t_ J 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. z I- • 1E », , 4. INSTALL SPEED LEVELERS(OR EQUAL)ON OUTLET PIPES. N zSIDE �RAKE PROPOSED H-10 DISTRIBUTION BOX DETAIL Q EXISTING GA SERVICE G ACME PRECAST OR EQUIVALENT m LLI 90.59 C S71° 30' 19"W EXISTING OVERHEAD)WIRE G NorroscA,LE Cn G _�C G GENERAL NOTES: o C •� 153" 1. NITROE 2KS TANK TOP TO HAVE THREE-24",TWO-12"HOLES AND TOTAL TANK LENGTH MULTIPLE 4"HOLES WITH'IRISERS AND COVERSFOR MAINTENANCE OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH(OT) AND SAMPLING. - L 2. FOR THE 24"HOLES;PROVIDE 24"DIA.ADS PIPE(CORRUGATED) � TANK WALL. '' - � - -• ••� •' d'�• �•• * • • • ' `• � ' - " .•�. ` � - ' < :. •�• •" - WITH POLYLOK(OR EQUIVALENT COVER OR ERUIVALENT ( j N Y w CONCRETE RISER AND COVER}TO 12"BELOW GROUND SURFACE _• (� THICKNESS z a AT TOP a AND SECURE TO TANK TOP. O � 3. FOR THE 12"HOLES;USE ADS PIPE(CORRUGATED)AND POLYLOK CU (3"TYP) 06 (OR EQUIVALENT)COVERS TO 12 BELOW GROUND SURFACE AND N a' < MIDDLE 3„ w O TROUGH 40 4 p I- SECURE TO TANK TOP. (� LO v (� w :` INLET cn 4. PROVIDE FOUR 4"DIA.SAMPLING PORT(1"BELOW GROUND o 0 ,f,, '.',;r CONDUIT THRU WALL WITH CONDUIT I- EFFLUENT TROUGH SU RGED (MT) DENIT CATI Q SURFACE)WITH 6"PLASTIC ROUNDBOX AND COVER TO BE FLUSH Q Q SEAL AND NON SHRINK GROUT TO PUMP _ • ::..• N + . CONTROL PANEL >y p FROM SEPTIC (IT) A N HAMB O WITH GROUND SURFACE. ii O r o Y 0 TANK C A B DC 5. FOR EXISTINIG SEPTIC TANK;PROVIDE 2"DIA,SNMPLING PIPE THAT % = 6 X _ n 'a *•. FLOAT HANGER 8T ¢O O SAC) 0 ) IS CEMENTED OR ANCHORED TO THE TANK TOPAND EXTEND 2 E (B ME m 2"SCH 4o PVC BALL VALVE -� BELOW THE'TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE aai CU O v o Q¢ EFFLUENT TO OF THE OUTILET'END OF THE SEPTIC TANK OR IN THE SEPTIC TANK a m U ono d O Cn a U ~O DBOX CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, m p THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE N .::,' in GROUND SURFACE AND HAVE A 6"DIA.PLASTIC ROUND BOX AND c 2"SCH 40 PVC TO DISTRIBUTION Box TANK WALL COVER AT GROUND SURFACE. T ...' :'u THICKNESS AT BOTTOM .a i� PROVIDE 30"DIA.RISER,WATER 4 1/2"TYP - � - ,• . . PUMP CHAMBER ELEVATIONS. ( O TIGHT FRAME AND COVER TO GRADE I N MIN.30"CLEAR OPENING TOP VIEW CONDUIT THRU WALL WITH CONDUIT 0 SEAL AND NON SHRINK GROUT TO PUMP STORAGE(GAL.) FLOAT SEPARATION,(FT) DESCRIPTION ELEVATION(FT) J CONTROLPANEL 440 3.00 EMERGENCY STORAGE INVERT 59.56 L) 37 0.25 HIGH LEVEL ALARM 56.56 .O - - - - - - 50 0.34 PUMP ON 56.31 O s' II m Im_ - n-n, I i"I W-I 0II 6"PLASTIC BOX AND COVER WITH 4" O �-• 2 HOLES FOR 3/8"BOLTS FOR EACH 37 0.25 PUMP OFF 55.97 SEE NOTES 3 AND 4(TYP) i- .� 440 GALLON EMERGENCY STORAGE ABOVE SEE NOTES 3 AND 4 TYP MONITORING PIPE;SEE NOTE 2 AND 4(TYP) WORKING LEVEL SUPPORT BRACKET (TYP) 2 COATS BITUMINOUS 73 0.50 LOW LEVEL 55:72 SEE NOTE 2(TYP) C N 4"SCH 40 PVC FROM NITRO WATERPROOFING 637 4.34 (BELOW INVERT) GROUND SURFACE TYP EL.64.01 24"ACCESS HOLE WITH COVER SEE NOTE 2(TYP). m N c i �C SEE NOTE 2(TYP) Q Co M 1/4"WEEP HOLE IN v y, DISCHARGE PIPE 5. 2"SCH 40 PVC TO DISTRIBUTION BOX 5 1/2"TANK TOP("TYP) TO SOIL L �' a N 4? c> o z .Q ."•' ABSORPTION SYSTEM s :�?. o0 0 SLIDE RAIL Z �Q C O X EXTEND TEE BELOW PUMP .. _ O Co 0 c0 co OFF EL.PROVIDE BRACING +.` EL.61.10F (SAS) a c 1� - L. ' N CHECK VALVE HIGH LEVEL ALARM $ . + M ---------------- y - - EFFLUENT FROM SEPTIC FLOATS FROM HANGER a'• _ O- O 17 MYERS SRM4(PUMP,0.4 HP,SINGLE TANK ae•srAric WATER DEPTH EFFLUENT Re91Str8tlOr1: PUMP ON PHASE,115V CONTRACTOR TO VERIFY 0 O ---------------- - - --- - VOLTAGE REQUIREMENTS PRIOR TO w p o , s PUMP OFF °4 ORDERING) w LL ., ^ �A �� C ------LOWLEVELALARM- --- - _ a SUBMERGED DENITRIFICATION CHAMBER = o a a w ��1 "V N k JOSEPHE,��G O w _ ` +. _ = a .Lr #4ENOERSO `n ,L : J z 1 = AERATION c� (DC) I o I- a r ,'"..:•t':.:•. A:`.: «.•.: 4 HOLES FOR 1/2"BOLTS FOR PUMP o �� CHAMBER =o w ., Z w w z oo At 6 U BREAKAWAY BASE O F- SAC F- I- W 12 3/4 COMPACTED CRUSHED co _ tL = �A S F (�J STONE BASE F- p !- N W CZ Ca NOTE:ALARM ON CIRCUIT SEPARATE FROM PUMP w p � 4 M O GRAPHIC SCALE ®I -24 EL.55.35 ®. .�. KleanTU LLC 5' ID DIA. 650 GALLON H2O PUMP CHAMBER DETAIL TANK BOTTOM `►/� Project Number: Sheet 0 ACME PRECAST OR APPROVED EQUAL 10 0 5 10 20 40 THICKNESS 4" 12"CRUSHED AGGREGATE A E OR APPROVED 9 20112 � Of N MATERIAL;ON LEVEL,COMPACTED AND TANK WALL THICKNESS AT BOTTOM(4") STABLE BASE V�v hoa O TANK WALL THICKNESS AT TOP(3") (� (in feet) WROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM (WWTS) sheet Number: cu 1 INCH = 10 FEET N-ASNOT TO CALF ( �" `�G' WW - - - - - - - - __---- I I � � I o ZONING& RESOURCE PROTECTION NOTES G G 1. PARCEL ID:102/163 LOT SIZE:0.23 AC PROPOSED DISTRIBUTION BOX , 2. OWNER OF RECORD.ROGER&CELESTE M DEROSIER INV. IN = 60.05 / INV. OUT- 59.88 100.00, PROPOSED 2 PVC 3. ADDRESS: 295 LAKESIDE DRIVE FORCEMAIN �: )e _ N PIPES TO ADJUST EXISTING o o O S78 05 25 W 'l 4. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON F.LR.M.MAP 25001 C0542J DATED JULY 16,2014). f INFILTRATORS AS NEEDED - 5. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. :'" f / PROPOSED 650 Of EXISTING ° GALLON PUMP WASTEWATER INSTALLATION INSPECTION NOTES � 'r x��x Q . :. EXISTING LEACH FIELD DISTRIBUTION BOX ° SHED CHAMBER 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE ` :.y` ENGINEER AND LOCAL BOARD OF HEALTH FOR ANY INSPECTION. ` .;(5 INFILTRATORS) TO BE REMOVED INV. IN= 59.64 �s O R 0 r° INV. OUT= 59.39 2. ALL WASTEWATER COMPONENTS SHALL BE INSPECTED BY THE ENGINEER AND THE LOCAL <'�`. � «� . •' BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL ,. K'r -, � ' « .N m o f O ,,,.�' t � BE INSPECTED: � � � '> O - n N HMARK a)BE C s I_ 2.1. SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKF LL icy S C EXISTING f ,- M tMAG SET 2.2. LEAKAGE TEST ON PRECAST TANKS(MIN.24 HR) � EL. 59.87 p f ° f LO 02.3. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS S X DRIVE f / o DESIGNED _ EXISTING 1,500 r 2.4. FINAL INSPECTION OF BACKFILLED SYSTEM m GALLON SEPTIC / z W w 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND TANK TO REMAIN / NOTES INDICATING THE HORIZONTAL AND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM , INV OUT=60.13 COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND NOTES WILL BE UTILIZED BY THE.., . .µ,,. .��.�•. ;,,N_ .. O O 10.68 ENGINEER FOR THE PREPARATION OF RECORD PLANS. �1 \ .62-� f v m W .1 WASTEWATER NOTES 16. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR $a 4 SCH 4O PVC 15.255(3). ANY ADDITIONAL AREAS THAT ARE FOUIND TO HAVE UNSUITABLE MATERIAL t1 L=2', S=2.0% 1, ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SHALL BE REPORTED TO THE ENGINEER. SURVEY CONDUCTED BY THE HORSLEY WITTEN GROUP, INC.ON NOVEMBER 20,2020. Q ro m 17. ALL SEPTIC COMPONENTS SHALL BE INSTALLED V\VITH MAGNETIC WARNING TAPE. 15.36 � tv 0 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS d E w DECK 4" SCH 40 PVC \ Q J NITRIDE 2KS 2,000 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 = U M L-10', 5=2.0% GALLON TANK REGULATIONS OF THE LOCAL BOARD OF HEALTH. MATERIAL. D O C, to O INV. IN=59.93 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO > C k 19. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION fi > M INV. OUT= 59.68 LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON AFTER CONSTRUCTION IS COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL U Q IT AND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. BE LEFT NATURAL.THE CONTRACTOR SHALL TAKE CARE TO PREVENT DAMAGE TO M �o f� SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE = Ord; Cs M C; cn UNDERGROUND ELECTRIC 67 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 i s C a 0) r -Lo TO PUMP CHAMBER + BOARD OF HEALTH(BOH)STAFF. VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK. 0 a C C C co 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 vb 0 Lo PROPOSED AIR PUMP OWNER AND ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK.PILE STR LOAM INSTALLED AND BE SEEDED WITH GRASS SEED AS SHOWN ON THE PLAN AND/OR 00 FINAL LOCATION TO BE AREAS, DIRECTED BY THE ENGINEER, THE CONTRACTOR'SHALL BE RESPONSIBLE FOR WATERING _- 295 LAKESIDE DRIVE FIELD DETERMINED ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS ESTABLISHED AND APPROVED BY Z 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING PINY THE ENGINEER AND/OR OWNER. 4 BEDROOMS LOCAL AND/OR STATE PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE G� REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL HOURS OF OPERATION FOR THE 21. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. SYSTEM MUST BE INSTALLED AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT '^ W OF ENVIRONMENTAL PROTECTION(DEP)PROVISIONAL USE APPROVAL. vJ M 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM 0 THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. Q \ 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM W Z 6- OR CHANGES TO EFFLUENT FLOW,GRADING,OR LANDSCAPING, EITHER ON-SITE OR RISER TO WITHIN 3"OF '^ ADJACENT TO THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE SEPTIC AND FINISHED GRADE vJ EL.63.0t �/ \�\ 7 LEACHING SYSTEM(S). --._ - .._III=1 I I=��"__ / U) Z W LOAM AND SEED 9. CALL"DIGSAFE"AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT - - - - - - _ EL.60.97 1-1888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF _ CLEAN - - - - - - _ 0 V -J EXISTING UTILITIES. - - - ---- e - -BACKFILL-_- �/'� 1' - - - - - --s W vJ 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH =I I_- _ __ -- .=_ a s I r^ rr�� L GARBAGE GRINDER. - C) vJ vJ r FLOW--- FLOW - 11. THE OWNER SHALL HAVE THE SYSTEM INSPECTED AND HAVE THE SEPTIC TANK PUMPED 6' OF 3/4` O EVERY 3-8 YEARS. I EL.59.38".: ••. ..,.' - - - - - O _. - COMPACTED W - CRUSHED ��L L 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE `' �\ PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. I I STONE BASE J r sr BENCHMARK CS' LLI cs CB/DH FND ��/� 13. USE SCH.40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. I I I I I I I I I J W n/ - II ry p EL. 67.16 C EXISTING WATER SERVICE 1 + Ln O O ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE. NOTES. O7 L 14. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT,DUST,AND FINES. 11J 1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL (� Y a �,[� 72.62' STABLE BASE. vJ LU 3' 05"W 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE S3 2. BLOCK ONE OUTLET.,Q INFORMATION IOPJ FOR THE SEPTIC SYSTEM TO THE ENGINEER IF NECESSARY. 71 1 ORM T , J �--- 3: INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. �/ Q LO 4. INSTALL SPEED LEVELERS(OR EQUAL)ON OUTLET PIPES. Q N PROPOSED H-10 DISTRIBUTION BOX DETAIL 00 LAKEXISTING GA SERVICE G ACME PRECAST OR EQUIVALENT �. 90.59; NOT TO SCALE �}1 S71' 30' 191'W EXISTING OVERHEACd>WIRE G Q r rn G 0) 0 GENERAL NOTES: a a G 153" 1. NITROE 2KS TANK TOP TO HAVE THREE-24",TWO-12"HOLES AND TOTAL TANK LENGTH MULTIPLE 4"HOLES WITH RISERS AND COVERS FOR MAINTENANCE •CU OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH(OT) AND SAMPLING. i 2. FOR THE 24"HOLES; PROVIDE 24"DIA.ADS PIPE(CORRUGATED) CD TANK WALL .: . . .. ,': .• .a... :.. . :' . . •• :. ..d• ` •'• .. WITH POLYLOK(OR EQUIVALENT)COVER(OREQUIVALENT CU w Y CONCRETE RISER AND COVER)TO 12"BELOW GROUND SURFACE N THICKNESS Z d (> ¢ FL AND SECURE TO TANK TOP. AT TOPCD LL 3. FOR THE 12"HOLES; USE ADS PIPE(CORRUGATED)AND POLYLOK C6 •� (3"TYP) 06 (OR EQUIVALENT)COVERS TO 12"BELOW GROUND SURFACE AND CD w NLo �r i wO MIDDLE 40 4„ o SECURE O TA OP. U N o V w INLET ROUGH 4. PROVIDE FOUR 4"DIA.SAMPLING PORT(1"BELOW GROUND (D m o N CONDUIT THRU WALL WITH CONDUIT TROUGH SU RGED (MT) DENIT CATI Q SURFACE)WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH .Q `C `r p p EFFLUENT O u`__ O O to o SEAL AND NON SHRINK GROUT TO PUMP IT WITH GROUND SURFACE. .�., FROM SEPTIC ( ) A N HAMB CONTROL PANEL a ,_, �n N p 5. FOR EXISTING SEPTIC TANK;PROVIDE 2"DIA.SAMPLING PIPE THAT °, _ 0 Y TANK C A B DC I� *•. FLOAT HANGER 81 SAC) I � )J ( } IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" a. E (u m c BELOW THE TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE O O N �c V 2"SCH ao PVC BALL VALVE Q¢ . EFFLUENT TO OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK °- m U °° ° O I DBOX CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, :. C) O w Ti HE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE m `:. GRROUND SURFACE AND HAVE A 6"DIA.PLASTIC ROUND BOX AND N a; :;: SCH 40 PVC TO 2" � •' C,OVER AT GROUND SURFACE. r DISTRIBUTION BOX TANK WALL _,► _ . THICKNESS •' ` AT BOTTOM ty PROVIDE 30"DIA.RISER,WATER (4 1/2"TYP) " • 0 TIGHT FRAME AND COVER TO GRADE. PUMP CHAMBER ELEVATIONS N MIN.30"CLEAR OPENING TOP VIEW CONDUIT THRU WALL WITH CONDUIT ELEVATION(FT) NSEAL AND NON SHRINK GROUT TO PUMP STORAGE(GAL.) FLOAT SEPARATION,(FT) DESCRIPTION C*, CONTROL PANEL (1) 440 3.00 EMERGENCY STORAGE INVERT 59.56 U a) ,,,,,;,,,,,,,,, 37 0.25 HIGH LEVEL ALARM 56.56 Q, _ - _ - 50 0.34 PUMP ON 56.31 O 0 _�I -SIT-I-I I - ��O _ _ a 37 0.25 PUMP OFF 55.s7 SEE NOTES 3 AND 4(TYP) 6"PLASTIC BOX AND COVER WITH 4" / 440 GALLON EMERGENCY STORAGE ABOVE •c. 2 HOLES FOR 3/8"BOLTS FOR EACH WORKING LEVEL SUPPORT BRACKET SEE NOTES 3 AND 4(TYP) MONITORING PIPE;SEE NOTE 2 AND 4(TYP) D M CD o 0 Z; iii ;'; 2 COATS BITUMINOUS 73 0.50 LOWLEVEL 55.72 Cl) '6 � ` SEE NOTE 2(TYP) a"SCH ao PVC FROM NIrROE WATERPROOFING 637 4.3a (BELOWINVERT) GROUND SURFACE TYP EL.64.0t 24' ACCFESS HOLE WITH COVER SEE NOTE 2(TYP). o M TANK lhdw SEE NOTE 2(TYP) > 1/4"WEEP HOLE IN O t� ao O v Q co °D m DISCHARGE PIPE,,. 5, 2"SCH 40 PVC TO DISTRIBUTION BOX 5 1/2"TANK TOP(TYP) TO SOIL z ABSORPTION SYSTfEM' i o a .Q EXTEND TEE BELOW PUMP SLIDE RAIL OFF EL.PROVIDE BRACING EL.61.10 (SAS) p CHECK VALVE '� O � r O iX N in Z rn cn ate- ti C° HIGH LEVEL ALARM t EFFLUENT FROM SEPTIC a 00 ------------ --- `� _ - FLOATS FROM HANGER _ ae"STATICWATERDerrn EFFLUENT Registration: MYERS SRM4 PUMP,0.4 HP,SINGLE TANK 0 PUMP ON • ly 4 PHASE,115V(CONTRACTOR TO VERIFY IL Sz I 0 --------------- ----- VOLTAGE REQUIREMENTS PRIOR TO '6N OJ'�S LLJ LL -- C?�� � ..� •:: ORDERING) � ' _y � _� LL •LOSE PUMP OFF ---- - -- - O �� a SUBMERGED DENITRIFICATION CHAMBER = O a a w '14ENC)ERSO' v' C ------ - -- --- - O AERATION (DC) 1 a F- a c OIVi LOW LEVEL ALARM w I _ ® {- -=0- .L :. O- p:'.:'.., 4 HOLES FOR 1/2"BOLTS FOR PUMP H O O_ U� CHAMBER 0 -- W p Z W w Z .. . BREAKAWAY BASE O Z y O (SAC) W W ~O O LL 0O j � _ LL 12"3/4 COMPACTED CRUSHED 0) � . F- p _J (V W v? (N NOTE:ALARM ON CIRCUIT SEPARATE FROM PUMP STONE BASE _ -y ._ w p Ln pq �t✓/'1+/� KleanTu LLC � GRAPHIC SCALE EL•55.35 " . ®••, • .. _ «. a< ..• � �,..:. . ' Project Number: Sheet: • • 5' ID DIA. 650 GALLON H2O PUMP CHAMBER DETAIL 10 0 5 10 20 40 TANK BOTTOM CRUSHED AGGREGATE OR APPROVED ACME PRECAST OR APPROVED EQUAL 'O THICKNESS 4" I N MATERIAL;ON LEVEL,COMPACTED AND 20112 1 of 1 TANK WALL THICKNESS AT BOTTOM(4") STABLE BASE TANK WALL THICKNESS AT TOP(3") Sheet Number: ('n feet) WROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM (VW►WTS) '. c}n 1 INCH = 10 FEET N-ASST20M-Hio V V V V - CU NOT TO SCALE __,._.-. - -