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Home My WebLink About0306 LAKESIDE DRIVE - Health 306 LAKESIDE DRIVE MARSTONS MILLS / A= 102-028 TOWN OF BARNSTABLE LOCATION ;306 LA P'SI'QLO _PF SEWAGE# (906 f -aL/'k VILLAGE A&mi ,,)s na )S ASSESSOR'S MAP&PARCEL P 0 a/0 INSTALLER'S NAME&PHONE NO SEPTIC TANK CAPACITY f$Qo LEACHING FACILITY:(type) '9. Y) J �(S (size) ©_5'X )?i NO.OF BEDROOMS 3 OWNER v C PERMIT DATE: COMPLIANCE DATE: a a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY�T), v��- r _ , ,qq f vI:f'SKI�' �cic a s 2 2_3Zi�ii -13,611 G�/9 G-H �-3f No. I Fee THE COMM614EALTH DF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair kl) Upgrade(6/) Abandon( ) [k Complete System ❑Individual Components Location Address or Lot No. 341P LJ-4 'e'5 L ^fed' Owners Name,Address,and Tel.N . "-t) C-f-.ex..er Assessor's Map/Parcel 142 J .4 � g.IAZ, Otl5i< A °5 061-011k M-A Z . .M t�i'7 "Ili 1v Installer's Name,Address,and del.No.W`� Fob/1i signer's Nam Addr and T No. a4 9-2110 95 311 blo 'aWG3 f 5-4873 11 1M Type of Building: P,000 Dwelling No.of Bedrooms J 1 Lot Size Go2Z AC sq.ft. Garbage Grinder( ) Other Type of Building 51'n.4 e4-Yh No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 -0 gpd Design flow provided ISO gpd Plan Date'' It s!57 2,1 n Number of sheets Revision Date � 15 zi Title�iwA 4w4 Size of Septic Tank ISy� q Type of S.A.S. �® Description of Soil ,rc1 ;�«�� v �. @ J fi��e. � ��a�i YIA61 ut1 J, Nature of Repairs or Alterations Answer whe applicable) B b '1 !i jLd V �� .,�61C1L�.9 I ��c'�Q 1 '�� .,�� BA� 1� �`�� •�19� �t,,��ea4'�'�� l.®'P�1� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date L� Application Approved by 1 Date Application Disapproved b Date A4 for the following reasons Permit No. Q 3 ( � �' Date Issued r ip, Y{ • by ».•C :r a .. (/ �� ^� a 2 } ' / 1 No t (N !' { 1� f" • Feee / •S snr - kR h THE' aVIMON EALTH OF°;IVFkSSACI#USETTS Entered in computer: k' ° w a a ,, • >��,a� y•.i °g'' 7.. .....yA. YCS PUBLIC HEALTH DIVISION$- TOWN OF BARNSTABLE, MASSACHUSETTS 4pliLation for Mispo8al O.P!trut tonBtrU_Ltion Permit Application for a Permit to Construct( ) Repair k) Upgrade( 4Abandori'('' )` [�Complete System ❑Individual Components Location Address or.Lot No. ' � �•L ftY Owner's Name,Address,and Tel.N lV1di'-S C,M ex-C4, 11-4 MA Assessor's Map/Parcel (a-;1 • 611 1141. 41 4M Installer's Name,Address,and del.No. �� tiw� M Designer's Name Addr s,and T No. a Type of Building: dd r'{ p� S Dwelling No.of Bedrooms J Lot Size Or 4L sq.ft. Garbage Grinder( ) r Other , Type of Building No.No.of Persons Showers( ) Cafeteria( ) Other Fixtures `'Design low(min.required)', f gpd' Design flow provided 11�0 gpd' Plan Dates te�1 S zi Number of sheets Revision Date' � ' �..... Size of SeVc Tank Type of S.A.S. 4( 9 tri1✓r/� 4 Description of Sol ( fY1 e�m A a Q t7�l�+ j+ Q 2tl�t~ Utrx41,a11+ ; hk. �'•t*e� t�on r'on`t>L�lt .f Nature of Repairs or Alterations Answer wheryapplicable) �L�t 15�r�q 1 N1'� ��,1� Q 1' mow 4.1 .441ttu �p &"tor+r I VIA eel 01 11 k -ky2�-,sQo 1, LAI Date last inspected: �p �` s'I'S�`'►K - l J K--- Agreement The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of } Compliance has been issued by this Board of Health. _I_ned}"� j > Date Application Approved by / t/Iw �G C Date Application Disapproved b ( Date for the following reasons Permit No. w" 6 1 1 1 Date Issued 6/.z V 'a. I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _�- ', Certificate of Compliance THIS IS.TOOC CERTIFY, ,tthat the On-site Sewage Disposal system Constructed( ) Repaired(&-I� Upgraded( ) Abandoned( )by A (�IG 1�JP ! t . ti,. ,An.r� at 3.(. r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Q�(—e)gydated L�J Y/) Installer Designer #bedrooms Approved design flow 330 gpd f The issuance of this permitrslhall not be construed as a guarantee that the system will f(unc 'onn as designed. Date /f tl Inspector ( ( ,/� �✓� 1 Y GZ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal *pstem Construction Vermit Permission is hereby granted to Construct(. ) Repair(—f Upgrade( ) Abandon( ) System located at a6 LFG fi�P �� M. a and as descrribed in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the followjng`local provisions or special conditions Provided:Constructionpust/be completed within three years of the date of this permit. ' Date 6(1 v � f Approved by � _ Town of Barnstable Inspectional Services Public Health Division '+ snantsrnatt:. MAM Thomas McKean, Director q ibg . p�FD is 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 8/12/2021 Sewage Permit## 2021-242 Assessor's Map\Parcel 102/028 Designer: Zenus Crocker Installer: D.A. Brown Inc. Address: 306 Lakeside Drive Address: P.O. Box 145 Marstons Mills, MA 02648 Centerville, MA 02632 On D.A. Brown Inc. was issued a permit to install a (date) (installer) septic system at 306 Lakeside Drive based on a design drawn by (address) Joe Henderson, Horsley Witten Group, Inc. dated (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 c lianee with the to rms of the IAA approval letters (if applicable) OF go`' J6SEM E. yG I►lEiIDEF# ' ► (Installe 's Signature) o 1 s� (De i 's Signature) (Affix Des tamp Here) PL ASE 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. WoMdeptMEALTMEWER connect\SEPTIODesigner Certification Form Rev&14-13.DOC Al Town of Barnstable tag Inspectional Services rinmcm�nvts. II Public Health Division MAM Thomas McKean,Director r� A 200 Main.Street,Hyannis,NA 02601 Office: 508-9024644 Fax: 508-790-6304 Installer& Designer Ccrtificat on Form Date. 8/121202.1 Sewage Permit# 7021-242 Assessor's MapkParcel 107J028 Designer: Zenus Crocker _ Installer' D.A.Brown Inc. Address: 306 Lakeside Chive Address: P.O.Box 145 Marstons Mills,MA 02648 Centecvillo,.MA 02632 Or. D.A Brawn Inc. � � was issued a permit to install a (date) (instanter) Septic system at 000 Lakeside Drive based on a design drawn by (yid ress).�......��. Ioe Henderson,Horsley Witten Group. Inc. dated (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. Strap out (if required) was inspected and the soils were found satisfactory. 1 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. flan revision or certified as-built by designer to follow. Strip out(if rewired)was inspected and the soils were found satisfactory. X l certify that the system referenced above wa.5 constructed inkpliance with the to rms of die I1A.approval Betters(if applicable) YP ` (Insta a 's" ignaturc} �' 4 CIVIL {I7c i o's Signature} (Affix tamp Here ,� STAl3Lp- rxrI3, C I r'�ALTII. I) VIS: N. C 12T11 CATC PI,,VAsE ItE ruRN TO BARN OF C O MPL1 MCC WILL Nq'I' B ISSWEV UN!'1f L BOTI� Irk-AD r gIMM AT(D AS- JJU_fI�i��t 'E + 'fir l)BY'I'EiE BARN'SIABLC l'Ul3LIt;HLrAI,I"rlC I)IVISI()Iy. THANK YgIJ. Hrenk(cpisl if nl:rtns�wr it ennneceseP nCUsigrmr Cenlriiention romi Rev 814-13.00C Notice of Alternative Sewage Disposal System M.G.L. c. 21A,§ 13 and 310 CMR 1.5.0287(10) klhis Notice to be recorded and/or filed for re ' tration in the chain of title of the Property served by an Alternative ewage Disposal System("Alternative System�l NAME(S) OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: Zenas Crocker ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: 306 Lakeside Drive; Marstons Mills,.MA 02648 TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and complete each that applies ' - 9 Deed recorded with th �f.Sf n'i t0, Registry of Deeds in BooQ3412 page 7 1 -_--Certificate of Title No. issued by the Land Registration Office of the Registry District —_Source of title other than by deed [If Alternative System Owner(s)is other than Property Owner(s),complete the following:] Alternative System Owner Name: Alternative System Owner Address: WHEREAS, Section 15.280 of Title 5 of the State Environmental Code(':'Approval of Alternative Systems"),provides for the Massachusetts Department of Environmental Protection(the "Department")to approve or certify, as appropriate, all proposals to construct,upgrade or replace on-site sewage disposal systems using alternative systems; WHEREAS, owners and/or operators of approved or certified alternative systems are subject to general conditions, 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,maiptenance, sampling,reporting and/or recordlceeping; WHEREAS, Section 15287(10)of Title 5 of the State Environmental Code, 31.0 CMR 15.287(10);requires that"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 and/or Land Registration Office,as applicable, a Notice disclosing both the existence of the alternative.on-site.system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the local Approving Authority [;]" and WHEREAS,the Property is served by an alternative sewage disposal system. NOW, THE.REFO.RE,Notice of an alternative sewage disposal system is hereby given for the above-referenced 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 l the alternative system are as follows: Trade name of technology:NitROE8 Waste-Water Treatment System -^ . :•d`,.:. r.- Manufacturer Name: KleanTu0 LLC �,A ]Model number(s): NitROE®2KS WWTSilj k .•t.i. Pagel of 2 2. Approval/Certification. On May 12,2020 [datej,the Department, pursuant to its authority under the section of Title 5 as specified below,approved or certified the technology used in the above- referenced alternative system, under MassDEP Transmittal Number:X285590 [Transmittal Number of approval or certification]. [Check one of the following,as applicable:] Approved for remedial use under 310 CMR 15.284 Approved for piloting under 310 CMR 15.285 X Provisi.onally 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://wwwima§s. ovg /den . da of J� 20 made by WITNESS t. this he execution hereof under seat. � �`'� the above-named Alternative System Owner(s). [Alterna ve Syson Owner(s)j Print ame(s): ;F A t -0 lJ COMMONWEALTH OF MASSACHUSETTS ss On this day of ,20-,before me,the undersigned notary public,personally appeared (name of document signer),proved to me through satisfactory evidence of identification,which were ,to be the person whose name is signed on the preceding or attached document;and acknowledged to me that(he) (she) signed it voluntarily for its stated purpose. (official signature and seal of notary) ------------------------------------------------------- ---------------------------------------------------------------------------- [Complete the following Property Owner(s)Consent if Alternative System Owner(s).is other than the Property Owner(s):] CONSENTED:TO: [Property Owner(s)] Print Name(s): Date: COMMONWEALTH OF MASSACHUSETTS Pil rM)r AL ss On this ,_day of ffie_ ,20.Ubefore me,the undersigned notary public,personally appeared Z-e►n(k S G+'Cc_uI r (name of document signer),proved to me through satisfactory evidence of identification,which we to be the person whose name is signed on the preceding or attached document, and ackn ledged tom that(he) (she) signed it voluntarily for its stated purpose. Ftaty 1511A rLlrvt .., - ... .. offs lal ' nature nd eal of notary) c'oii xturn n e to: Nam an(l?a l i afPropertyOwner(s)] JENNA pAORGAN K1DD * Notary Public Page 2 of 2 COMMONWEALTH OF MASSACHUSMS My Commission Expires '- IARNS'TABLE REGISTRY OF DEEDS December ts, 2020 John F. Meade, Register KleanTu®LLC John R.Smith KleanTu Wastewater P.O.Box 1154 (' Treatment Edgartown,MA 02539 Technologies . F 412-719-5976-Mobile 508-627-3072-Office To: Town of Barnstable Board of Health May 21,2021 200 Main.Street Hyannis,MA 02601 RE: Designer Certification for New NitROE'2KS WWTS Enhanced Title 5 Septic System Installation for 306 Lakeside.Drive,Marstons Mills,MA 02648: Dear Members of the Board: To comply with Item IV-#2 cited in Mass DEP Provisional Permit issued to KleanTuO LLC(DEP Transmittal No.:X285590;Issued May 12,2020),this letter certifies that the New NitRW2KS WWTS Enhanced Title 5 Septic System design for the 306 Lakeside Dr.private residence conforms with the cited Provisional Permit Approval and that the proposed use of the system is consistent with the NitROEI 2KS WWTS capabilities. The system was designed by Joseph Henderson;a Massachusetts Registered Professional Engineer. with Horsley Witten Group, Inc. Thank you for your consideration. .... Best Regards, John R. Smith President cc: Joseph Henderson,P.E., Horsley Witten Group,Inc. Zee Crocker,Property and.System-Owner �I I KleanTu®LLC John R.Smith KleanTu Wastewater P.O.Box 1154 v"1 Treatment T9chnotogies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office To; Town of Barnstable Board of Health June 10,2021 200 Main Street Hyannis,MA 02601 RE: Property and System Owner Certification for NewNitROE12.KS WWTS Enhanced Title 5 Septic System Installation for 306 Lakeside Drive, Marston Mills,MA 02648 Dear Members of the Board: To comply with Item IV-#1 cited in Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.: X285590;Issued May 12,2020),this letter certifies that the Property and System owner for 306Lakeside Drive,Zee Crocker,has been made aware and agrees,(per his signature below)with the following: 1. Has been provided a copy of the Provisional Use Approval.and agrees to comply with all terms and conditions cited therein. 2. Has been informed of all homeowner's costs associated with operation&maintenance(O&M)activities and associated costs with the operation of the New NitROE®2KS WWTS Enhanced Title 5 Septic System to be installed, including power consumption,maintenance,sampling,recordkeeping,reporting,and equipment replacement. 3. Understands the requirements for an O&M contract to be in place with KleanTu°,or with their designated and trained entity,and that the NitROE®2KS WWTS operator must be licensed by the Mass DEP as stipulated in KleanTul's.Provisional Permit. 4. To fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)and the Approval by the Town of Barnstable BoH. 5. To fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR.15.287(5). Thank you for your consideration. Best Regards 3Wm N^xnkh 411w 10,2o)1 MI MI - -- - John R. Smith President PROPERTY AND SYSTEM OWNER SIGNATURE Name: Zenas Crocker - �G!?�'t GROG 2� zenas crocker(Jun 10,202109:57 EDT) Signatt.re: - -1- KleanTu® LLC John R.Smith KleanTu wastewater Treatment P.O. Box 1154 Technologies Edgartown, MA 02539 � p 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80032-040-2106 for 306 Lakeside Drive,pg. 1/5 To: Zenas Crocker June 24,2021 306 Lakeside Drive Marston Mills,MA 02648 RE: NitROE®2K WWTS Start-Up and Monitoring, Operation and Maintenance for 306 Lakeside Drive,Marston Mills,MA;KleanTu Job No.: 80032-040 Dear Zenas: KleanTu®LLC is pleased to submit this"Contract"to provide Start-Up and Monitoring,Operation and Maintenance (MOM)oversight services for the first year of your newly installed NitROE'2K Waste-Water Treatment System(WWTS) at 306 Lakeside Drive, located in Marston Mills,MA. The main purpose of the NitROE8 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,MOM contracts must be in place to ensure proper operation and consistent treatment performance. In this regard,this contract also provides budgetary price estimates for subsequent years of MOM services. CONTRACT DETAILS AND PRICE PROJECTIONS As cited in Table 1,regarding start-up and MOM services, it is to be noted that the Barnstable Clean Water Coalition(BCWC)will provide for and cover all costs associated with MOM,including sample collection and analyses for the 1"year of operation; that is July 2021 thru June 2022. For subsequent years,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 five initial years, MOM related costs will be the responsibility of the homeowner. 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 KleanTu Contract,the System Operator will be John R. Smith,Certificate No.: 1914. - 1- KleanTu® LLC John R.Smith KLeanTu P.O. Box 1154 Edgartown, MA 02539 412-719-5976-Mobile 3. � 508-627-3072-Office CONTRACT No. 80032-040-2106 for 306 Lakeside Drive,pg.2/5 Electronic copies of the Provisional Permit and the NitROE®2K WWTS MOM Manual are provided along with this contract proposal. Table 1. Scheduled(Routine)Yearly MOM Deliverables and Pricing for New NitROE82KS WWTS for 306 Lakeside Drive' Time Price per Period Period Deliverables ($) July 2021 thru . Start-Up including bacterial seeding and monitoring at least once every $0 June 2022 2 weeks during the 1"8-weeks of operation to ensure that NitROE'2K (All related MOM (12 months) WWTS is properly functioning. costs to be paid for • Provide and Review a MOM Manual to homeowner and address any and by the BCWC) 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) July 2022 thru . Sample Collection and Analyses with minimum per Mass DEP $0 June 2026 Provisional Permit. (Plan for BCWC to (5 years) • Respond to Homeowner issues,concerns and questions. cover MOM for 5- 0 Quarterly Inspection and Monitoring Updates to Homeowner. year period) July 2026 and o Quarterly Inspection and Sample Collection/Analyses per Mass DEP $600-$1,200 beyond and/or Barnstable BoH requirements. The cost range reflects one (Projected Range of sample collected and analyzed per year at$600 to four samples collected Yearly Contract to and analyzed per year at$1,200. be Covered by • Covers Maximum of 4 site calls per year. Homeowner) • Yearly Update to Homeowners. (NOTE: MOM Calls(>4)and Issues Addressed per Table 2 Items) 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- 1 KleanTu® LLC John R.Smith KleanTu P.O. Box 1154 a Edgartown,MA 02539 412-719-5976-Mobile 0 508-627-3072-Office CONTRACT No. 80032-040-2106 for 306 Lakeside Drive,pg.3/5 As the NitROE®2K WWTS moves through the Mass DEP permitting process from Provisional Permit Use to General Permit Use,Table 1 reflects that the associated price for yearly MOM significantly decreases. This MOM 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. In addition to the pricing of scheduled MOM activities cited in Table 1,Table 2 provides non-scheduled and non- routine MOM activities and associated price estimates,with anticipated timeframes as to when such MOM activity may be needed and thus the cost incurred. While KleanTu®has designed and utilized equipment to provide low maintenance operation and treatment,Table 2 is provided so the system owner has some sort of idea what costs may be incurred in future years associated with non-routine MOM activities. While the BCWC will cover the first five years of MOM support, it is to be noted that all the items cited in Table 2 will need to be covered by the homeowner as respective issues and situations arise after this initial five-year period. The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the continuous operation of one(1) 120-watt air pump required to enhance and maintain the appropriate level of biological processes required. This yearly electrical cost will be borne by the homeowner,along with periodic pumping of their septic tank as required. -3 - KleanTu® LLC John R.Smith P P.O. Box 1154 Edgartown, MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80032-040-2106 for 306 Lakeside Drive,pg.4/5 Table 2. Non-Routine MOM Items and Projected Price Estimates for New NitROE®2KS WWTS Replacement Items for 306 Lakeside Drive Item Description Price Estimate Air Pump . One(1) 120 W air pump. $210 Electrical Usage . Total daily electrical usage measured at—2.9 kWhr/day/pump. per Year • Cost/day at$0.20/kWhr x 2.9 kWhr/day=$0.58/day. Non-routine . After 12month warranty period,troubleshooting site calls(more than $120 Troubleshooting 4/year)will be charged at$120/hr with 1 hour minimum. per Hour Visits Septic Tank . KleanTu will determine when this is needed based on scheduled site $600 (EST)Pump Out visits. (for EST Septic • Pump out to be done by non-KleanTu contractor with estimated price= Tank Pumped $600/EST tank. out Every • Exact time period is site-specific with estimate of every 3-5 years. 3-5 Years) (NOTE: This pump out cost would need to be done even if this was a conventional Title 5 septic system) Replace Remote . Replacing remote sensing unit and probes=$360. $360 Sensing Probes . Exact time period is variable with estimate of every 8-10 years. (Every and Unit (NOTE: For remote sensing operation,Wi-Fi connection from homeowner 8-10 Years) is needed) Replace Air . Air pump repair and/or replacement. $500 Pump . Exact time period range is variable with estimate of every 7-8 years. (Every 7-8 Years) Replace . Replace all air tubing=$800. $800 Aeration Tubing . Exact time period is variable with estimate of every 10-20 years. (Every 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- KleanTu® LLC John R.Smith KleanTu P.O. Box 1154 Edgartown, MA 02539 ,x 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80032-040-2106 for 306 Lakeside Drive,pg. 5/5 PAYMENT TERMS Even though there is no site owner cost for the first year of MOM,the contract still needs to be signed and executed by the site owner as it is a confirmation that he accepts responsibility for associated O&M costs in subsequent years. CONTRACT ACCEPTANCE To execute this contract, and comply with Mass DEP Provisional Permit Requirements,please sign below to acknowledge acceptance of this proposal and mail original with your signature,or e-mail pdf copy of this page with your signature,back to me. Please contact Jennifer Loughran of the BCWC with any questions or comments. Thank you, 90/uz R sma/z John R Smith(Jun 24,202109:57 EDT) John R. Smith President SYSTEM OWNER SIGNATURE Name: Zenas Crocker LG�IG�I G�OG�f�� Signature: zenas crocker(Jun 24,202109:53 EDT) -5- NitROE 2KS OMM Contract - 306 Lakeside Dr. MA 210624 Rev 2 Final Audit Report 2021-06-24 Created: 2021-06-24 By: Marianne Weber(mweber@kleantu.com) Status: Signed Transaction ID: CBJCHBCAABAA.I_8AQWIIOo66s7_zlUx5sOYO-_F-aG1 "NitROE 2KS OMM Contract - 306 Lakeside Dr. MA 210624 Rev 2" History Document created by Marianne Weber(mweber@kleantu.com) 2021-06-24-1:17:40 PM GMT-IP address:73.79.52.31 41 Document emailed to zenas crocker(zcrocker@bcleanwater.org)for signature 2021-06-24-1:18:22 PM GMT Email viewed by zenas crocker(zcrocker@bcleanwater.org) 2021-06-24-1:52:59 PM GMT-IP address:74.92.56.50 (S® Document e-signed by zenas crocker(zcrocker@bcleanwater.org) Signature Date:2021-06-24-1:53:31 PM GMT-Time Source:server-IP address:74.92.56.50 Document emailed to John R Smith Qsmith@kleantu.com)for signature 2021-06-24-1:53:33 PM GMT Email viewed by John R Smith asmith@kleantu.com) 2021-06-24-1:53:58 PM GMT-IP address:73.100.231.74 do Document e-signed by John R Smith Qsmith@kleantu.com) Signature Date:2021-06-24-1:57:28 PM GMT-Time Source:server-IP address:73.100.231.74 ® Agreement completed. 2021-06-24-1:57:28 PM GMT Adobe Sign Klea nTu®.LLC John R.Smith KteanTu wastewater Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 U. 412-719-5976-Mobile - - - 508-627-3072-Office CONTRACT No.80032-040-2106 for 306 Lakeside Drive,pg. 1/5 To: Zenas Crocker June 24,2021 306 Lakeside Drive Marston Mills, MA 02648 RE: NitROE02K WWTS Start-Up and Monitoring,Operation and Maintenance for 306 Lakeside Drive,Marston Mills,MA;KteanTu Job No.: 80032-040 Dear Zenas: KteanTu®LLC is pleased to submit this"Contract"to provide Start-Up and Monitoring;Operation and Maintenance(MOM)oversight services for the first year of your newly installed NitROE®2K Waste-Water Treatment System(WWTS)at 306 Lakeside Drive,located in Marston Mills, MA.. The main purpose of the NitROE®2K WWTS is to enhance your Title 5 Septic System for the purpose of significantly reducing total nitrogen(TN)from the sanitary wastewater flow. In addition to significant TN reduction,the NitROE®enhanced Title 5 septic system will also produce a highly treated effluent low in organic carbon constituents(measured as BOD5)and low in total suspended solids(TSS)levels. Please note that entering into a yearly MOM contract is a requirement of KleanTu's Massachusetts Department of Environmental Protection(DEP)Provisional Permit(DEP Transmittal No.: X285590;issued May 12,2020). As this is the first year of operation,start-up services are also provided. As cited in Section IV-4 of.the Provisional Permit, MOM contracts must be in place to ensure proper operation and consistent treatment performance. In this regard,this contract also provides budgetary price estimates for subsequent years of MOM services. CONTRACT DETAILS AND PRICE PROJECTIONS As cited in Table 1,regarding start-up and MOM services,it is to be noted that the Barnstable Clean Water Coalition(BCWC)will provide for and coverall costs associated with MOM;including sample collection and analyses for the 111 year of operation• that is July 2021 thru June 2022. For subsequent years,.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 five initial years, MOM related costs will be the responsibility of the homeowner. 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 KteanTu Contract,the.System Operator will be John R. Smith,Certificate No.: 1914. -1- KleanTu® LLC John R.Smith KleanTU P.O. Box 1154 Edgartown, MA 02539 412-719-5976-Mobile w? 508-627-3072-Office CONTRACT No.80032-040-2106 for 306 Lakeside Drive,pg.2/5 Electronic copies of the Provisional Permit and the NitROE®2K W WTS MOM Manual are provided along with this contract proposal. Table 1. Scheduled(Routine)Yearly MOM Deliverables and Pricing for New NitROE02KS WWTS for 306 Lakeside Drive' Time Price per Period Period Deliverables - ($) July 2021 thru • Start-Up including bacterial seeding and monitoring at least once every $0 June 2022 2 weeks during the V 8-weeks of operation to ensure that NitROE®2K (All related MOM. 12 months W WTS is properly.functioning. ( ) costs to be paid for • Provide and Review a MOM_Manual to homeowner and address any and by the BCWC) 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®W WTS Components Covered:Under Warranty) July 2022 thru • Sample Collection and Analyses with minimum per Mass DEP $0 June 2026 Provisional Permit. (Plan for BCWC to (5 years) • Respond to Homeowner issues,concerns and questions. cover MOM for 5- 0 Quarterly Inspection and Monitoring Updates to Homeowner. year period) July 2026 and • Quarterly Inspection and Sample Collection/Analyses per Mass DEP $600- $1,200 beyond and/or Barnstable BoH requirements. The cost range reflects one (Projected Range of sample collected and analyzed per year at$600 to four samples collected Yearly Contract to and analyzed per year at$1,200. be Covered by • Covers Maximum of 4 site calls per year. Homeowner) • Yearly Update to Homeowners. (NOTE: MOM Calls(>4)and Issues Addressed per Table 2 Items) 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- KleanTu® LLC John R.Smith LeanTu P.O.Box 1154 Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office /Rl CONTRACT No. 80032-040-2106 for 306 Lakeside Drive,pg.3/5 As the NitROE02K 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 MOM 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 issuedin year 2022 or 2023 as that decision rests with the Mass DEP. 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 K1eanTu®has designed and utilized equipment to provide low maintenance operation and treatment,Table 2 is provided so the system owner has some sort of idea what costs may be incurred in future years associated with non-routine MOM activities. While the BCWC will cover the first five years of MOM support, it is to be noted that all the items cited in Table 2 will need to be covered by the homeowner as respective issues and situations arise after this initial five-year period. The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the continuous operation of one(1) 120-watt air pump required to enhance and maintain the appropriate level of biological processes required. This yearly electrical cost will be borne by the homeowner,along with periodic pumping of their septic tank as required. -3 KleanTu° LLC John R.Smith KLeanTU E garto n1 4 02539 `m 412-719-5976-Mobile 508-627-30.72-Office CONTRACT No.80032-040-2106 for 306.Lakeside Drive, as.4/5 Table 2. Non-Routine MOM Items and Projected Price Estimates for New NitROE02KS WWTS Replacement Items for 306 Lakeside Drive Item Description Price Estimate Air Pump • One(1) 120 W air pump. $210 Electrical Usage .,. Total daily electrical usage measured at—2.9 kWhr/day/pump. per Year • Cost/day at$0.20/kWhr x 2.9 kWhr/day $0.58/day. Non-routine • After 12month warranty period,troubleshooting site calls(more than $120 Troubleshooting 4/year)will be charged at$120/hr with 1 hour minimum. per Hour Visits Septic Tank • K1eanTu will determine when this is needed based on scheduled site _ $600 (EST)Pump Out ::_ visits. - - (for EST Septic • Pump out to be done by non-K1eanTu contractor with estimated price= Tank Pumped $600/EST tank. out Every • Exact time period is site-specific with estimate of every 3-5 years. 3-5 Years) (NOTE: This pump out cost would need to be done even if this was a conventional Title 5 septic system) Replace Remote • Replacing remote sensing unit and probes=$360. $360 Sensing Probes . Exact time period is variable with.estimate of every 8-10 years. (Every and Unit (NOTE: For remote sensing operation, Wi-Fi connection from homeowner 8-10 Years) is needed) Replace Air • Air pump repair and/or replacement. $500 Pump • Exact time period range is variable with estimate of every 7-8 years. (Every 7-8 Years) Replace • Replace all air tubing=.$800. $800 Aeration Tubing . Exact time period is variable with estimate of every 10-20 years. (Every 10-20 Years) Replace Wood • Replace all wood chips=$1MO. $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- KleanTu®LLC -- John R.Smith �. K1ednTu P.O.Box 1154 Edgartown,MA 02539 - - - 412-719-5976-Mobile iRl - 508-627-3072-Office CONTRACT No. 80032-040-2106 for 306 Lakeside Drive,pz. 5/5 i PAYMENT TERMS Even though there is no site owner cost for the first year of MOM,the contract still needs to be signed and . executed by the site owner as it is a confirmation that he accepts responsibility for associated O&M costs in subsequent years. CONTRACT ACCEPTANCE To execute this contract,and comply with Mass DEP Provisional Permit Requirements,please sign below to acknowledge acceptance of this proposal and mail original with your signature,or e-mail pdf copy of this page With your signature,back to me.. Please contact Jennifer Loughran of the BCWC with any questions or comments: Thank you, 9d�uc R stycrf� John R Smith(Jun 24,20210957 EDT) - - - John R. Smith President SYSTEM OWNER SIGNATURE Name: Zenas Crocker - L�`1G�I Signature: zenascrocker(Jun 241 202109:53 EDT) -5- NitROE 2KS OMM Contract - 306 Lakeside Dr. MA 210624 Rev 2 Final Audit Report 2021-06-24 ..Created: 2021-06-24 By: Marianne Weber(mweber@kleantu.com) Status: Signed Transaction ID: CBJCHBCAABAAII 8AQWIIOo66s7 zlUx5sOYO- F-aG1 "NitROE 2KS OMM Contract - 306 Lakeside Dr. MA 210624 Rev . 2" .History - t Document created by Marianne Weber(mweber@kleantu:com) i 2021-06-24-1:1740 PM GMT-IP address:73.79.52.31 12-4 Document emailed:to zenas crocker(zcrocker@bcleanwater.org)for signature :2021-06-24:•:1:18:22 PM GMT Email viewed by zenas crocker(zcrocker@bcleanwater.org) 2021-06-24-1:52:59 PM GMT-IP address:74.92.56.50 &0 Document e-signed by zenas crocker(zcrocker@bcleanwater.org) Signature Date:2021-06-24-1:53:31 PM GMT-Time Source:server-IP address:74.92.56.50 C?, Document emailed to John R Smith as-mith@kleantu.com)for signature 2021-06-24-1:53:33 PM GMT Email viewed by John R Smith asmith@kleantu.com) 2021-06-24-1.53:58 PM GMT-IP address:73.100.231.74 &0 Document e-signedby John R Smith Qsmith@kleantu.com) Signature Date:2021-06-24-1:57:28 PM GMT-Time Source:server IP address:73.100.231.74 ® Agreement completed. 2021-06-24-1:57:28 PM GMT Adobe Sign KleanTu® LLC Jahn R.Smith KleanTu Wastewater Treatment P.O.Box 1154 Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80032-2106 for 306 Lakeside Drive.mz. 1/7 . To: Zenas Crocker June 10,2021 306 Lakeside Drive Marston Mills, MA 02648 RE: NitROE®2K WWTS Installation for 306 Lakeside Drive,MA 02648 KleanTu Job No.: 80032 Dear Zenas: KleanTu®LLC is pleased to provide this contract document for a NitROE®2K Waste-Water Treatment System (WWTS)to be installed at the 306 Lakeside Drive residence. The main purpose of the NitROE®2K WWTS is to serve as a supplemental upgrading of a new Title 5 Septic System. A new NitROE 2K WWTS tank will be inserted in between the gravity flow path of a new septic tank and a new leaching chamber system. The purpose of the NitROE 2K WWTS tank is to significantly reduce total nitrogen(TN)from the sanitary wastewater flow prior to permitted discharge to the new Title 5 leaching chamber. In addition to significantly reducing TN,the NitROE®2K WWTS enhancement will produce a highly treated wastewater effluent with significantly reduced levels of organics and suspended solids as well. NitROE®ENHANCED TITLE 5 SEPTIC SYSTEM OVERVIEW The NitROE®2K WWTS to be installed is specified in Site Drawing Project No.:20112(sheet#WW-1),prepared by the Horsley Witten Group, Inc.,dated May 7,2021. With reference to this site drawing,wastewater will first be collected into a new 1,500-gallon septic tank. After solids separation in the septic tank,wastewater will then gravity flow into a 2,000-gallon NitROE.2K WWTS tank for enhanced total nitrogen reduction. From there,the significantly treated wastewater will gravity flow into a new leaching chamber system. �1 1.:. KleanTu LLC John R.Smith KLeanTU P.O. Box 1154 Edgartown, MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80032-2106 for 306 Lakeside Drive.pg.2/7 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 KleanTu. Furthermore,these Mass DEP regulatory requirements pertain to respective actions.from project initiation through to NitROE®2K WWTS start-up and yearly operation. A. Obtaining a Disposal System Construction Permit(DSCP). This is issued by the local Board of Health (BoH)after completion of the following: 1. Submittal of the site engineering design and DSCP application to the local BoH: Normally this is done by the Design Engineer. 2. Along with the DSCP application,to comply with:Section!IV-.1 of the:Provisional Permit; KleanTue LLC will provide to the local BoH, a certification letter that the site owner: i. Has been provided a copy of the Provisional Use Approval and agrees to comply with all terms and conditions cited herein: ii. Has been informed of all owner's costs associated with operation& maintenance(O&M) activities with the operation of the New NitROE®2K WWTS Enhanced Title 5 Septic System to be installed, including power consumption,maintenance, sampling, _. recordkeeping,reporting, and equipment re iii. Understands the requirements for a O&M contract to be in place with KleanTu®LLC, or. withaheir designated and.trained entity, and that the NitROE®2K WWTS operator must be licensed by the Mass DEP as stipulated in KleanTu's Provisional visional Permit. iv. Agrees to fulfill their responsibilities to provide a Deed Notice, and file with the local Registry of Deeds, as required by 310 CMR 15.287(10)and with the Approval by the local BoH. v. Agrees to fulfill their responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). 3 Along with the DSCP application,to comply with Section IV-2 of the Provisional Permit, KleanTu®LLC will provide to the local BoH, with a copy to the Designer and the Site Owner,that the site-specific design conforms to Provisional Permit requirements:and that the proposed use of the NitROE®2KM WWTS is consistent with the unit's capabilities and all KleanTu®LLC requirements. 2 KleanTu LLC ' John R.Smith KleanTu P.O.Box 1154 Edgartown, MA 02539 412-719-5976-Mobile 508-62773072-Office CONTRACT No. 80032-2106 for 306 Lakeside Drive,pa.3/7 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,KleanTu®LLC will provide to the local BoH,a copy of a signed O&M contract for a minimum period of one year,between the site owner and KleanTu®LLC,or their designated approved operator,who has been properly trained and certified by KleanTu. In this regard,in addition to signatory execution of this Contract document,the site owner will also be required to sign and thus execute an O&M contract for start-up and the first 12-months of operation and monitoring. - - - - -- C. Obtaining a Certificate of Compliance(COC). This is issued by the local Board of Health(BoH)after installation,local BoH inspection and sign-off,and completion of the following to comply with Sections IV-5 and IV-6 of the Provisional Permit citing the following: 1. A local BoH inspector,the installer and the designer all need to sign the COC and thus certify,in writing,that the NitROE®2K WWTS was constructed in compliance with both the Provisional Permit and Mass DEP 310 CMR 15.000 requirements,and that any changes to the design plans are reflected in as-built drawing and/or notes. The completed COC then needs to be filed with the local BoH. 2. KleanTu®LLC 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:Ill B,items 13-36.of the Provisional Permit related to Operation and Maintenance(O&M),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 KleanTu LLC John R.Smith KleanTu P.O. Box 1154 - Edgartown, MA 02539 412-719-5976-Mobile 508-627-3072-Office- CONTRACT No. 80032-2106 for 306 Lakeside Drive pg.4/7 INSTALLATION ACTIVITIES AND PRICE - - For installation of the enhanced NitROE®2K W WTS,the task activities to be carried out,along with their respective prices,are provided in the table below: IT IS TO BE NOTED THAT ALL OF THE:COSTS CITED WILL BE COVERED BY THE BA_RNSTABLE CLEAN WATER COALITION(BCWC)PER THE AGREEMENT THEY HAVE WITH THE SITE OWNER. An electronic copy of the NitROE®WWTS Installation Manual is provided along with this Contract proposal. This document serves to identify the various activity responsibilities among the site owner or the BCWC,the installer and KleanTu®LLC. Of particular note, it is the responsibility of the.site owner to identify and make the installer aware of any buried utility lines such as gas;electrical and cable;:here Dig:Safe can be contacted to provide this service at no cost(h-q://www.digsafe.com),but they only identify public utility lines and not any private lines. As cited in the Table 1 below; the contract price for KleanTu to provide the task activities cited is$14,500. This also cites that the site owner is also responsible for the engineering and installation services to be done by others. Additionally, it is to be noted that the BCWC will arrange for, and pay for additional site-specific activities related to: 1. Providing a dedicated electrical service and a two-receptacle.GFI outlet box in a location near the NitROE® 2KS tank locations: - - -- - - 2. Filing a notarized deed restriction.with Barnstable County and paying the filing fee as well as obtaining a copy of the deed restriction document for the local.BoH. A deed restriction to be executed is provided with this contract proposal. 4 - KleanTu LLC eMeanTu John R.Smith P.O.Box 1154 Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80032-2106 for 306 Lakeside Drive,ae.5/7 Table 1.KleanTu Price of Title 5 Enhancement via NitROE®2KS WWTS Enhancement. for 306 Lakeside Drive;Marston Mills,MA 02648 ONE 1,500 GALLON SEPTIC TANK(ASST152M-H2O)AND ONE 2,000 GALLON NitROE TANK(N-ASST20M-H20) (KleanTu Project No.80032) KleanTu Price Task Categories and Description (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 $0 the environment. Note:BCWC is responsible for site design engineering and local BoH interactions including obtaining all permits and final certification. BCWC is also responsible for filing"Notice of Alternative Sewage Disposal System"with Registry of Deeds and pay$105 fee,with KleanTu providing review and coordination. Task 020-Procurement and Field Fabrication Includes providing 1 septic tank and 1 NitROE®2KS tank,all media,access riser ports and covers near or to surface, $12,500 aeration assembly w/air pump and installed air tubing,and faux rock for air pump enclosure. Task 030-Tank Delivery and Installation Oversight Installation oversight and air-line hook-up of delivered NitROE®Tank,including remote sensing unit connection to homeowner Wi-Fi network. Note:BCWC is responsible for procurement and sewer piping connections of septic and $2,000 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. TASKS 010-030 TOTAL THRU INSTALLATION $14,500 Task 040-Start-Up and 1st year:Operation&Maintenance(O&M)Per MassDEP Provisional Permit and Barnstable BoH Requirements Includes NitROE®WWTS bacterial seeding,system start-up,bi-monthly visits,quarterly sampling and analyses by MA $0 certified lab, record keeping and reporting required by MassDEP,and operational oversight for 1st year to address issues that may arise. 0&M for subsequent years will be$500-$1,300 depending on MassDEP and Barnstable BoH requirements. Note 1st Year O&M to be covered by BCWC;subsequent years to.be determined. Note:.Final Grading and Some Landscaping to be Provided by BCWC 5 KleanTu LLC _. John R.Smith _. KleanTu _ P.O. Box 1154 :. .' Edgartown, MA 02539 \ .� 412-719-5976-Mobile 508-627-3072-Office CONTRACT No. 80032-2106 for 306 Lakeside Drive.u2 6/7 SCHEDULE Barring unforeseen circumstances, KleanTu.will have the NitROE WWTS.tank ready for installation the week of June 21 with the actual date to be finalized with the site owner and their installer. PAYMENT SCHEDULE All KleanTu costs to be paid by the BCWC.under separate contract with KleanTu® LLC. WARRANTY KleanTu guarantees equipment and materials to properly operate for a period of 1 year. This is contingent that the NitR0E®.2K WWTS is installed per the engineering design and that the NitROE®2K WWTS receives typical - sanitary wastewater(as defined.per Title_5)and:is within the design flow and does not exceed 330 gallons per day U (gpd) SITE ACCESS By signing this contract,site owner agrees that KleanTu designated personnel will be allowed access to the site for the purpose of performing routine O&M activities associated with the NitROE®.2K WWTS. III 6 KleanTu LLC 1 John R.Smith KleanTu P.O.Box 1154 Edgartown, MA 02539 412-719-5976-Mobile R= 508-627-3072-Office CONTRACT No. 80032-2106 for 306 Lakeside Drive,pg..7/7 CONTRACT ACCEPTANCE ..... . ..... . ..... KleanTu looks forward to workir_g in partnership with the BCWC and for providing direction and oversight for installing and operating a NitROE®2K WWTS to enhance your upgraded Title 5 septic system. By accepting this contract,you also agree to complying with the regulatory requirements cited on pages 2 and of this contract document. Specifically,that you agree to yearly operation&maintenance(O&M):contracts with KleanTu,or their designated representative,to begin after the first year or longer when the BCWC no longer covers yearly O&M. And that you also will work with the BCWC to file the appropriate paperwork with the Registrar of Deeds so that it is identified that you have a NitROE®WWTS enhanced Title 5 septic system operating on your property. To accept this contract so that work may continue as planned,please sign below. Also,please contact Jennifer Loughran,of the BCWC,with any questions or comments. Thank you, 9rtLis R Scr'i1�i. John RSmith(J�in10,202109:52 EDT- - - --- - ---- ----- -- - - John R. Smith: .....: President To initiate this work,please sign below to acknowledge acceptance of this contract and mail original,or a-mail pdf copy,back to me. Name:Zenas Crocker �1/9L 6tO-M(z� Zenas Crocker(Jun 10,202109:51 EDT)= Signature. - KleanTu NitROE Install Contract #80032-2106 for 306 Lakeside Dr Final Audit Report 2021-06-10 Created: 2021-06-10 By: Marianne Weber(mweber@kleantu.com) Status: Signed Transaction ID: CBJCHBCAABAAG1rrogUbpeQXIU2n4kLGRSufN4e_xd3t "KleanTu NitROE Install Contract #80032-2106 for 306 Lakeside Dr F" History Document created by Marianne Weber(mweber@kleantu.com) 2021-06-10-12:30:44 PM GMT-IP address:73.79.52.31 �'y Document emailed to Zenas Crocker(zcrocker@bcleanwater,org)for signature 2021-06-10-12:31:56 PM GMT Email viewed by Zenas Crocker(zcrocker@bcleanwater.org) 2021-06-10-12:52:18 PM GMT-IP address:74.92.56.50 LS® Document e-signed by Zenas Crocker(zcrocker@bcleanwater.org) Signature Date:2021-06.10-1:51:19 PM GMT-Time Source:server-IP address:74.92.56.50 0.4 Document emailed to John_R Smith osmith@kleantu.com)for signature 2021-06-10-1:51:21 PM GMT Email viewed by John R Smith asmith@kleantu.com) 2021-06-10-1:51:39 PM GMT-IP address:73.100.231.74 d® Document e-signed by John R Smith osmith@kleantu.com) Signature Date:2021-06-10-1:52:20 PM GMT-Time Source:server-IP address:73.100.231.74 Q Agreement completed. 2021-06-10-1:52:20 PM GMT Adobe Sign KleanTu® LLC John R.Smith KleanTu Wastewater Treatment P:O.Box 1154 Technologies Edgartown,MA 02539 r� 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80032-040-2106 for 306 Lakeside Drive,pa.415 To: Zenas Crocker June 24,2021 306 Lakeside Drive Marston Mills,MA 02648 RE: NitROE®2K WWTS Start-Up and Monitoring,Operation and Maintenance for 306 Lakeside Drive,Marston Mills,MA; KleanTu Job No.: 80032-040 - - - Dear Zenas: KleanTu®LLC is pleased to submit this"Contract"to provide Start-Up and Monitoring,Operation and Maintenance(MOM)oversight services for the first year of your newly installed NitROE®2K Waste-Water Treatment System(WWTS)at 306 Lakeside Drive,located in Marston Mills,MA. The main purpose of the NitROE02K 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,MOM contracts must be in place to ensure proper operation and consistent treatment performance. In this regard,this contract also provides budgetary price estimates for subsequent years of MOM services. CONTRACT DETAILS AND PRICE.PROJECTIONS As cited in Table 1,regarding start-up and MOM services,it is to be noted that the Barnstable Clean Water Coalition(BCWC)will provide for and cover all costs associated with MOM,including sample collection and analyses for the 1st year of operation; that is July 2021 thrn June 2022. For subsequent years,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 five initial years,MOM related costs will be the responsibility of the homeowner. 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 KleanTu Contract,the System Operator will be John R. Smith,Certificate No.: 1914. - 1- KleanTu® LLC - John R.Smith MeanTu P.O.Box 1154 Edgartown, MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80032-040-2106 for 306 Lakeside Drive,pg.2/5 Electronic copies of the Provisional Permit and the NitROE02K WWTS MOM Manual are provided along with this contract proposal. I Table 1 Scheduled(Routine)Yearly MOM Deliverables and Pricing for New NitROE82KS WWTS for 306 Lakeside Drive' Time Price per Period Period Deliverables ($) July 2021 thru . Start-Up including bacterial seeding and monitoring at least once every $0 June 2022 2 weeks during the 1 sc 8-weeks of operation to ensure that NitROE®2K (All related MOM i (12 months) WWTS is properly functioning. costs to be paid for • Provide and Review a MOM Manual to homeowner and address any and by the BCWC)..... 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) July 2022 thru a Sample Collection and Analyses with minimum per Mass DEP $0 June 2026 Provisional Permit. (Plan for BCWC to (5 years) . Respond to Homeowner issues, concerns and questions. _ .. cover MOM for 5- 0 Quarterly Inspection and Monitoring Updates to Homeowner. year period) July 2026 and • Quarterly_Inspection and Sample Collection/Analyses per Mass DEP $600 $1,200 beyond and/or Barnstable BoH requirements. The.cost range reflects one (Projected Range of sample collected and analyzed per.year at$600.to four samples collected Yearly Contract to and analyzed per year at$1,200. be Covered by • Covers Maximum of 4 site calls per year. Homeowner) • Yearly Update to Homeowners. (NOTE: MOM Calls(>4)and Issues Addressed per Table 2 Items) 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- KleanTu® LLC - John R.Smith Man Tu P.O. Box 1154 Edgartown,MA 02539 412-719-5976-Mobile a, 508-627-3072-Office I CONTRACT No.80032-040-2106 for 306 Lakeside Drive,p2.3/5 As the NitROE®2K WWTS moves through the Mass:DEP permitting process from Provisional Permit Use to General Permit Use,Table 1 reflects that the associated price for yearly MOM significantly decreases. This MOM 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 Genera_ Use Permit will be issued in year 2022 or 202.3 as that decision rests with the Mass DEP. 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 K1eanTu®has designed and utilized equipment to provide low maintenance operation and treatment,Table 2 is provided so the system owner has some sort of idea what costs may be incurred in future years associated with non-routine MOM activities. While the BCWC will cover the first five years of MOM support, it is.to be noted that all the items cited in Table 2 will need to be covered by the homeowner as respective issues and situations arise after this initial five-year 1 period. The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the continuous operation of one(1) 120-watt air pump required to enhance and maintain the appropriate level of biological processes required. This yearly electrical cost will be borne by the homeowner,along with periodic pumping of their septic tank as required. -3- - KleanTum LLC John R.Smith KLeanTu P.O. Box 1154 Edgartown, MA 02539 ^" 412-719-5976-Mobile K, 508-627-3072-Office CONTRACT No. 80032-040-2106 for 306 Lakeside Drive,pg.4/5 Table 2. Non-Routine MOM Items and Projected Price.Estimates for New NitROV2KS WWTS Replacement Items for 306 Lakeside Drive Item Description P Price Estimate Air Pump . One(1) 120 W air pump. $210 Electrical,Usage :. . Total daily electrical usage measured at—2.9 kW.hr/day/pump. per Year Cost/dayat$0.20/kWhr x 2.9 kWhr/day $0.58/day. Non-routine • After, 12month warranty period,troubleshooting site calls(more than. . $120 Troubleshooting 4/year)will be charged at.$120/hr with 1 hour minimum. per Hour Visits Septic Tank . KleanTu will determine when this is needed based on scheduled site $600 (EST)Pump Out visits. (for EST Septic • Pump out to be done by non-K1eanTu contractor with estimated price= Tank Pumped $600/EST tank. out Every Exact time period is site-specific with estimate of every 3-5 years. 3-5 Years) (NOTE: This pump out cost would need to be done even if this was a conventional Title 5 septic system) Replace Remote . :: Replacing remote sensing unit-and probes=$360: $360 Sensing Probes . Exact time period is variable with estimate of every 8-10 years. (Every And Unit (NOTE: -For remote sensing operation, Wi-Fi connection from homeowner 8-10 Years) is needed) Replace Air • . Air pump repair and/or replacement. $500 Pump .... Exact time period range is variable with estimate_of every 7-8 years. (Every 7-8 Years) Replace • Replace all air tubing=$800. $800 Aeration Tubing . Exact time period is variable with.estimate of every 10-20 years. (Every 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 20-3.0.years. (Every 20-30 Years) -4- KleanTu® LLC - - -- - John R.Smith Mean Tu P.O.Box 1154 Edgartown,MA 02539 412-719=5976-Mobile 508-627-3072-Office CONTRACT No.80032-040-2106 for 306 Lakeside Drive,pp-.5/5 PAYMENT TERMS Even though there is no site owner cost for the first year of MOM,the contract still needs to be signed and executed by the site owner as it is a confirmation that he accepts responsibility for associated O&M costs in subsequent years. CONTRACT ACCEPTANCE To execute this contract,and comply with Mass DEP Provisional Permit Requirements,please sign below to acknowledge acceptance of this proposal and mail original with your signature,or e-mail pdf copy of this page with your signature,back to me. Please contact Jennifer Loughran of the BC WC with any questions or comments. Thank you, John R Snith(Jun 24,20210957 EDT) John R. Smith President SYSTEM OWNER SIGNATURE Name: Zenas Crocker LMaL Signature:. zenasdocker(Jun 24,202109:53EDT) .f l� -5- . FNitROE 2KS OMM Contract - 306 Lakeside Dr. MA 210624 Rev 2 r Final Audit Report . . . 2021-06-24 Created: 2021-06-24 By: Marianne Weber(mweber@kleantu.com) Status: Signed Transaction ID: CBJCHBCAABAAII 8AQWIIOo66s7-zlUx5s0Y0- F-aG1 "NitROE 2KS OMM-Contract - 306 Lakeside Dr. MA 21062.4 Rev 2" History Document created by Marianne Weber(mweber@kleantu.com) 2021-06-24-1:17:40 PM GMT-IP address:73.79.52.31 04' Document emailed to zenas crocker(zcrocker@bcleanwater.org)for signature .2021-06-24-1:18:22 PM GMT Email viewed by zenas crocker(zcrocker@bcleanwater.org) 2021-06-24-1:52:59 PM GMT-IP address:74.92.56.50 &0 Document e-signed by zenas crocker(zcrocker@bcleanwater.org) Signature Date:2021-06-24-1:53:31 PM GMT-Time Source:server-IP address:74.92.56.50 Ell Document emailed to John R Smith asmith@kleantu.com)for signature 2021-06-24-1:53:33 PM GMT Email viewed by John R Smith Osmith@kleantu.com) 2021-06-24=1:53:58 PM GMT-IP address:73.100.231.74 LSo Document e-signed by John R Smith Osmith@kleantu.com) Signature Date:2021-06-24-1:57:28 PM GMT-Time Source:server-IP address:73.100.231.74 0 Agreement completed. 2021-06-24-1:57:28 PM GMT Adobe Sign Town of Barnstable • wuvezts>�, • &639. �, Board of Health , 200 Main Street, Hyannis MA 02601 Office: 508-8624644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt March 8, 2022 Mr. Joseph Henderson Horsley Witten Group 90 Route 6A, Unit 1 Sandwich, MA 02563 RE: 306 Lakeside Drive, 'Marstons-Mills . x M ,r ,g. A 1 Q2' 28 •: Dear Mr. Henderson, You are granted permission on behalf of your client, Zenas Crocker. , to construct and utilize a NitROE secondary treatment unit with advanced nitrogen reduction technology at 306 Lakeside Drive, Marstons Mills, Massachusetts. You are reminded the following requirements are provided within the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter for this particular technology, dated May 12, 2020: (1) Thirty (30) days prior to submitting an application for a DSCP, the Company or its representative shall provide to the Approving Authority a certification, signed by the owner of record for the property to be served by the unit, stating that the property owner: a) has been provided a copy of the Provisional Use Approval and all attachments and agrees to comply with all terms and conditions; b) has been informed of all the owner's costs associated with the operation including power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; KleanTu NitROE 2K Provisional Approval, May 2020 Page 11 of 15 Technology: NitROE® 2KS & 2KM WWTS c) understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval; and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). (2) Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 Q:WP/Henderson 306LakesideDrive M Mills NitROEApproval May2021.docx 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:/twww.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamp.pdf] (6) A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. The above list is not all inclusive; all of the other conditions listed in the MA Department of Environmental Protection (DEP) Provisional Use Approval Renewal letter to KleanTu LLC dated May 12, 2020 will need to be adhered to. This permission is granted because the proposed plan appears to meet the maximum feasible compliance provisions of the State Environmental Code, Title 5, and the Town of Barnstable Board of Health Regulations. It also appears to meet the nitrogen loading restrictions contained within the State and local regulations with no increase in sewage flow requested at this property at this time. Si re yours, ohn Norman Chairman Q:WP/Henderson 306LakesideDrive M Mills WROEApproval May2021.docx tl DATE: Z OA, $95.00 FEE*: t �tom. Town of Barnstable � REC.BY ,FD Board of Health SCHED.DATE: 200 Main Street, Hyannis MA 02601 Office: 508-862A644 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 306 Lakeside Drive - Marstons Mills Property Address: 102/028 0.23 acres Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. No Business Name: Subdivision Name: APPLICANT'S NAME: Joseph Henderson (Horsley Witten) Phone 508-833-6600 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Zenas Crocker Name: Joseph Henderson (Horsley Witten Group) Address: 2102 Oyster Harbors, Osterville MA 02655 Address: 90 Route 6A,Unit 1 Sandwich,MA 02563 Phone: 617-947-9898 Phone: 508-833-6600 EMAIL: ) en erson@ ors eywitten.com VARIANCE FROM REGULATION pncl.Reg.code a) REASON FOR VARIANCE(May attach separate sheet if more space needed) Installation o system NATURE OF WORK: House Addition U House Renovation LJ Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit first four on list as 5 collated packets _ A. Five(5)copies of the completed variance request fore B. Five(5)copies of MA DEP approval letters for Innovative/Aitcmative septic system(when proposing an UA system or secondary treatment unit(S.T.U.). _ C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: health(@town.bamstable.ma.us *(Pool Plan—5 hard copies) D.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or PLS. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only). Full menu—Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted*$95.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1) Septic repair without an increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.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: healthCaD-town.barnstable.ma.us. (Total email must be less than 10 megabytes.) For grease trap variance requests, each of five packets must also include a full menu. (see checklist below). Checklist - Please submit first four on list as 5 collated packets. A. Five(5)copies of the completed variance request form B. Five(5)copies of MA 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: 1) Septic repair without an increase in flow and variances granted at the counter. 2) Monitoring Plans, and 3) Temporary Food(this is not a variance).. Variance request submitted at least 15 days prior to meeting date. For further assistance on any item above, call (508) 862-4644 Email: health(cD-town.barnstable.ma.us Back to Main Public Health Division Page Horsley Witten Group Sustainable Environmental Solutions ., 90 Route 6A•Unh 1•Sandwich,MA 02563 508-333-6600•horstey:ihten.com May 11, 2021 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Re: Septic System Repair— 306 Lakeside Drive, Marstons Mills, MA Dear Members of the Board: Please find enclosed the septic repair plan at the location referenced above. The existing failing septic system will be replaced with a Title 5 compliant system. No increase in design flow is proposed. Assessor's data indicates the residence is a three- bedroom home. The septic system repair includes a 1,500-gallon enhanced settling septic tank (EST), a NitROE 2KS 2,000-gallon wastewater treatment system (WWTS), a 3-outlet distribution box and two 500-gallon leaching chambers.. The existing septic system for the residence will be abandoned in accordance with Title 5. The NitROE system has MassDEP Provisional Use approval in Massachusetts. Thank you very much for your consideration. Sincerely, HORSLEY WITTEN GROUP, INC. r j Joseph Henderson, P.E. Senior Engineer HorsleyWitten.com M d @HorsleyWittenGroup ®Horsley Witten Group, Inc. 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 NitROER 2KM WWTS) (hereinafter the `System' or the `Technology'). Owner and Operator manuals, installation manual, schematic drawings illustrating the System models and the technology inspection checklist are part of this Certification. DEP Transmittal No.: X285590 Date of Issuance: May 12,2020, Expiration date: May 12,2025 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection (hereinafter "the Department") hereby issues this Provisional Approval to: KleanTu LLC, located at 300 Old Pond Rd., Ste 206 in Bridgeville, PA (hereinafter "the Company"), NitROER 2KS WWTS and NitROE® 2KM WWTS (hereinafter "the Technology" or "System") for use in the Commonwealth of Massachusetts subject to the conditions herein. Sale and use of the Technology is subject to compliance by the Company, the Designer, the System Installer, the Operator, and the System_ Owner with,the terms and conditions herein. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. May 12, 2020 Marybeth Chubb, Section Chief Date Wastewater Management Program Bureau of Resource Protection This information is available In alternate format.Contact Michelle Waters-Ekanem,Director of Diversity/Civil Rights at 617-292-5751. TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper K1eanTu NitROE 2K Provisional Approval,May 2020 Page 2 of 15 Technology:NitROE&2KS&2KM WWTS I.PURPOSE Subject to the conditions of this Approval and any other local requirements, the purpose of this Approval is to allow installation and operation of at least 50 on-site sewage disposal systems utilizing the technology in Massachusetts in order to conduct a performance evaluation of the capabilities of the Technology during the first 3 years of operation of each system, in accordance with Title 5 — 310 CMR 15.286 (7),Provisional Approval of Alternative System. The specific goal of the Performance Evaluation is to determine if the Technology is capable of consistently meeting the concentration limits for total nitrogen (TN) of less than 11 milligrams per liter (mg/L) for installations with design flows less than 2,000 GPD in the effluent discharged to the soil absorption system. In areas subject to nitrogen loading limitations, increases in the discharge rate per acre may be allowed when the nitrogen concentration discharged to the soil is reduced. The Company is responsible for oversight and sampling of the systems during the Performance Evaluation. The System Owner has responsibility for continued oversight and sampling of the system if the property served was allowed to increase the discharge rate per acre above 440 gallons per day per acre (gpda) in an area subject to Nitrogen Loading Limitations. The System Owner will be required to repair, replace, modify or take any other action as required by the Department or the local approving authority, if the Department or the local approving authority determines that the System is not capable of meeting the required reduction in nitrogen in the effluent. With the other applicable permits or approvals that may be required by Title 5, this Approval authorizes the installation and use of the Alternative System in Massachusetts. All the provisions of Title 5, including the General Conditions for all Alternative Systems (310 CMR 15.287), apply to the sale, design, installation, and use of the System, except those provisions that specifically have been varied by this Approval. II. GENERAL DESCRIPTION OF THE TECHNOLOGY The NitROE ® 2KS or 2KM WWTS (the `System') is installed in series between a Title-5 system septic tank and a soil absorption system constructed in accordance with 310 CMR 15.100 — 15.279, subject to the provisions of this Approval to accommodate design flows of less than 2,000 GPD. The System is comprised of two-unit processes which are sequentially performed in two different chambers. The first chamber is aerated, via an external air pump and airline header/hose arrangement, to achieve both organic carbon reduction along with the biological conversion of ammonia-N to nitrate-N. From the Aeration Chamber, the wastewater then gravity flows into a Denitrification Chamber where, in the presence of natural organics from wood chips, bacteria mediate the conversion of nitrate-N to inert N gas that exits to the atmosphere via the Title 5 system vent piping. Depending on design flow and availability of local tank structures, the sequential Aeration and Denitrification process steps can be performed in the same single tank, which is NitROE®2KS WWTS, or each process could be performed in its own separate tank with the overall NitROE® WWTS comprised of multiple tank combinations, which is NitROE®2KM WWTS. The use of the Technology under this Approval requires: • Disclosure Notice in the Deed to the property; • Certifications by the Company,the Designer, and the Installer; ! System Owner Acknowledgement of Responsibilities; K1eanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15 Technology:NitROE®2KS&2KM WWTS • A certified operator under contract for periodic inspection and maintenance; • Periodic sampling; • Recordkeeping and reporting; and • An external power supply III.CONDITIONS OF APPROVAL A. Basis for Conditions 1. The term "System" refers to the Technology in combination with any other components of an on-site treatment and disposal system that may be required to serve a Facility in accordance with 310 CMR 15.000. 2. The term "Approval" includes the Special Conditions, Standard Conditions, General Conditions of 310 CMR 15.287, and the approved Attachments. 3. Items required by this Approval include: a) Performance Evaluation Plan (PEP) with sampling and analysis requirements and approved by the Department. The PEP must be submitted to the Department for review and approval within 60 days of issuance of this Approval and meet the requirements of the Department's Guidance for the Preparation of Performance Evaluation Plans <2,000 GPD; b) Minimum System installation requirements; c) Company schematic drawings and specifications; d) Owner's Manual, including information on substances that should not be discharged to the System; e) Operation and Maintenance manual, including but not limited to, operator qualification requirements, inspection requirements, sampling and analysis requirements, recordkeeping requirements, and/or reporting requirements; and f) MassDEP Operation and Maintenance (O&M) checklist and I/A technology inspection checklist. B. Special Conditions 1. Department review and approval of the System design and installation is not required unless the Department determines on a case-by-case basis pursuant to its authority at 310 CMR 15.003(2)(e)that the proposed System requires Department review and approval. 2. System installations must meet the specific siting conditions for Provisional Use provided in 310 CMR 15.286(4)and the facility must meet the siting requirements of this Approval. 3. Any System for which a complete Disposal System Construction Permit Application is submitted while this Approval is in effect, may be permitted, installed, and used in accordance with this Approval unless the Department,the local approval authority, or,a court requires the System to be modified or removed or requires discharges to the System to cease. 4. The System Owner shall provide access to the site for purposes of sampling the System in accordance with the Company's technology Performance Evaluation Plan approved by the K1eanTu NitROE 2K Provisional Approval,May 2020 Page 4 of 15 Technology:NitROE®2KS&2KM WWTS Department, in addition to providing access for performing inspections, maintenance, repairs, and responding to alarm events. 5. The System Owner shall ensure that no permanent buildings or structures, other than the System, are constructed in the area for the installation of all the components of a fully conforming Title 5 system with a reserve area. The area for a fully conforming Title 5 system with a reserve area shall not otherwise be disturbed by the System Owner in any manner that will render it unusable for future installation of a fully conforming Title 5 system. 6. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sanitary sewer system. If it is feasible to connect a new or existing facility to the sewer, the Designer shall not propose an Alternative System to serve the facility and the facility Owner shall not install or use an Alternative System. When a sanitary sewer connection becomes feasible after an Alternative System has been installed,the System Owner shall connect the facility served by the System to the sewer within 60 days of such feasibility and the System shall be abandoned in compliance with 310 CMR 15.354, unless a later time is allowed in writing by the Department or the Local Approving Authority. 7. The control panel including alarms shall be mounted in a location accessible to the System Operator. 8. For 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-h6ur storage, an independent standby power source may be provided for operation during an interruption in power. With any interruption of the power supply the source must be capable of automatically activating in addition to manual start up capability. The standby power must be sufficient to handle peak flows for at least 24 hours and sufficient to meet all power needs of the System including, but not limited to, pumping, ventilation, and controls. Standby power installations must be inspected and exercised at least annually and all automatic and manual start up controls must be tested. Standby power installations must comply with all applicable state and local code requirements. Provided that a standby power installation complies with these requirements, no variance is required to the provisions of 310 CMR 15.231(2). 9. System unit malfunction and high water alarms shall be connected to circuits separate from the circuits to the operating equipment and pumps. 10. All System control units, valve boxes, conveyance lines and other System appurtenances shall be designed and installed to prevent freezing per the Company's recommendations. KleanTu NitROE 2K Provisional Approval,May 2020 Page 5 of 15 Technology:NitROE®2KS&2KM WWTS 11. Any System structures with exterior piping connections located within 12 inches or below the Estimated Seasonal High Groundwater elevation shall have the connections made watertight with neoprene seals or equivalent. 12. In compliance with 310 CMR 15.240(13), a minimum of one (1) inspection port shall be provided within the SAS consisting of a perforated four inch pipe placed vertically down into the stone to the naturally occurring soil or sand fill below the stone. The pipe shall be capped with a screw type cap and accessible to within three inches of finish grade. Operation and Maintenance 13. Inspection, operation and maintenance (O & M), sampling, and field testing of the System required by this Approval shall be performed by a System Operator with the following qualifications: a) is an approved System Inspector in accordance with 310 CMR 15.340; b) has been trained by the Company and whose name appears on the Company's current list of qualified operators; and c) has been certified at a minimum of Grade Level IV (four) by the Board of Registration of Operators of Wastewater Treatment Facilities, in accordance with Massachusetts regulations 257 CMR 2.00. The name of the Operator shall be included in the O&M agreement required by paragraph B (14). 14. Prior to the use of the System, the System Owner shall enter into an O&M Agreement with.a qualified contractor and submit the Agreement to the Approving Authority and the Company. The Agreement shall be at least for one year and include the following provisions: a) The name of the qualified Operator that appears on the Company's current list of Service Contractors; b) The System Operator must have the qualifications specified in paragraph B (13); c) The System Operator must inspect the System in accordance with the Approval and anytime there is an equipment failure, System failure,or other alarm event; d) In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications, or violations of the Approval, procedures and responsibilities of the Operator and System Owner shall be clearly defined for corrective measures to be taken immediately. The System Operator shall agree to provide written notification within five days describing corrective measures taken to the System Owner,the Company, and the local board of health; e) The System Operator shall determine the cause of total nitrogen effluent limit violations if they occur and take corrective actions in accordance with the approved O & M Manual; and f) Procedures and responsibilities for recording quarterly or monthly wastewater flows must be defined, see paragraph B(32)"Flow Metering". 15. At all times, the System Owner shall maintain an O&M Agreement that meets the requirements of paragraph B (20). 16. The System Owner and the System Operator shall properly operate and maintain the system in accordance with this Approval, the Designer's operation and maintenance requirements, and the requirements of the local approving authority. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 6 of 15 Technology:NitROE®2KS&2KM WWTS 17. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Operator shall notify the System Owner immediately. 18. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System Owner and the System Operator shall be responsible for the notification of the local approving authority within 24 hours of such determination. 19. In the case of a System failure, an equipment failure, alarm event, components not functioning as designed or in accordance with the Company specifications, or any violations of the Approval, the System Owner and the System Operator shall be responsible for the written notification of the local approving authority and the Company within five days describing corrective measures taken. 20. Within 60 days of any site visit, the System Operator shall submit an O&M report and inspection checklist to the System Owner,and the Company. The 0&M report and inspection checklist shall include, at a minimum: a) for a System failing, any corrective actions taken; b) wastewater analyses,wastewater flow data, and field testing results; c) any violations of the Approval; d) any determinations that the System or its components are not functioning as designed or in accordance with the Company specifications; and e) any other corrective actions taken or recommended. 21. By September 30th of each year, the System Owner and the Service Contractor shall be responsible for submitting to the local approving authority all monitoring results with all O&M reports and inspection checklists completed by the System Operator during the previous 12 months. 22. By September 30th of each year, the Service Contractor shall be responsible for submitting to the Company copies of all O&M reports including alarm event responses, all monitoring results, violations of the Approval, inspection checklists completed by the Service Contractor, notifications of system failures, and reports of equipment replacements with reasons during the previous 12 months. 23. A copy of the wastewater analyses, wastewater flow data, field testing results, and System Operator O&M reports and inspection checklists shall be maintained by the Company. It is recommended the System Owner also maintain copies of these items. 24. The System Owner shall notify the Approving Authority in writing within seven days of any cancellation, expiration or other change in the terms and/or conditions of the O&M Agreement required by Paragraph B(14). 25. The System Owner and the Service Contractor shall maintain copies of the Service Contractor's O&M reports, inspection checklists, and all reports and notifications to the LAA for a minimum of five years. 26. The System may only be installed to serve facilities where a fully conforming Title 5 system with a reserve area exists on-site or could be built on-site in compliance with the design standards for new construction of 310 CMR 15.000, and for which a site evaluation in K1eanTu NitROE 2K Provisional Approval,May 2020 Page 7 of 15 Technology:NitROEO 2KS&2KM WWTS compliance with 310 CMR 15.000 has been approved by the Approving Authority. A fully conforming Title 5 system may include other approved alternative technologies in accordance with the conditions imposed on the alternative technologies. 27. Subject to the provisions of this Approval, the Technology shall be installed in a manner which neither intrudes on, replaces a component of, or adversely affects the operation of all other components of the System designed and constructed in accordance with the standards for new construction of 310 CMR 15.200 - 15.279. Effluent Limit and Monitoring Requirements, 28. For the new construction, unless the facility meets a TN effluent limit of 11 mg/1 or less, the system shall not be designed to receive more than 440 gallons of design flow per day per acre (gpda) in an area that is subject to the Nitrogen Loading Limitations of 310 CMR 15.214. If the facility does not meet with the Nitrogen Loading Limitations pursuant to the aggregation provisions of 310 CMR 15.216, the System Owner shall repair, replace, modify or take any other action as required by the Department or the local approving authority to meet the total nitrogen concentration limits in the effluent. Violation of the TN concentration in the System effluent shall not require notifications as required in paragraphs B (18)and(19). 29. Prior to Department approval of the Company's Performance Evaluation Plan, the Company shall be responsible for the following monitoring requirements for all System installations that are subject to a total nitrogen concentration limit in accordance with paragraph B (28). Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection, see"Flow Metering" section below. a) Year-round facilities shall be inspected and effluent sampled quarterly; b) Seasonal properties shall be inspected and effluent sampled a minimum of twice per year, with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample; and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling shall also include Field Testing of System wastewater when determined necessary by the operator, see DEP Field Testing Protocol at htW://www.mass.eov/eea/docs/deolwater/laws/i-thru-z/testsamp.pdf. Properties occupied at least 6 months per year are considered year-round properties. Properties occupied less than 6 months per year are considered seasonal properties. 30. During the Performance Evaluation period, the Company shall follow the monitoring requirements specified in the Performance Evaluation Plan for installed Systems. 31. After the three (3) year Performance Evaluation period by the Company and approval by the Department, and until this Approval is modified, terminated, or superseded by a General Use Certification, the System Owner shall comply with the following monitoring requirements if the System is subject to a total nitrogen concentration limit in accordance with paragraph B? (28). KleanTu NitROE 2K Provisional Approval,May 2020 Page 8 of 15 Technology:NitROE®2KS&2KM WWTS a) Year-round properties shall be inspected and sampled for at least the TN parameter a minimum of twice/year, at least 5 months apart and with at least one sample taken between December 1 and March 1 of each year. Field testing shall be completed as determined necessary by the System operator, see DEP Field Testing Protocol at hgp://www.mass.govleealdocsldeplwaterllawsli-thru-zltestsamp.pdf. Water meter readings shall be recorded at each inspection, see"Flow Metering"below. b) Seasonal properties shall be sampled for at least the TN parameter a minimum of twice/year. At least one annual sample must be taken 30 to 60 days after each seasonal occupancy. A second sample must be taken no less than 2 months after the first sample. Field testing of the System shall be completed as determined necessary by the operator. Water meter readings shall be recorded at each inspection, see "Flow Metering"below. 32. Flow Metering - At a minimum, for all systems installed prior to this Approval, water meter flow data shall be recorded each time the system is inspected and sampled by the System Operator. For systems installed after the effective date of this Approval, wastewater flow data shall be recorded each time the system is inspected and sampled by the System Operator and may be based on: a) actual metering data of wastewater flow to the system; or b) water meter data for the total facility with metered non-wastewater flows, if available, subtracted from the total facility water usage. 33. Field Testing: Turbidity, pH and Apparent Color - Turbidity, pH, DO and apparent color shall be measured and/or recorded in the field when when determined necessary by the operator. See applicable sections of the Department's Field Testing Protocol at hyp://www.mass.Qov/eea/docs/dep.lwater/laws/i-thru-z/testsamp.pdf. 34. At a minimum,the System Operator shall inspect the System: a) two times per year; b) in accordance with the approved O&M manual, the Designer's operation and maintenance requirements, and the requirements of the local approving authority; and c) any time there is an alarm event, equipment failure, or system failure 35. The System Operator shall collect samples and obtain analysis results from an approved lab, perform field testing required by the Approval and submit results within 60 days of the site visit to the System Owner. 36. If the Company successfully demonstrates the effectiveness of the System to reduce nitrogen loadings during the Performance Evaluation period, a minimum of three years, the System Owner shall operate the System subject to the requirements of the General Use Certification, if issued, for this technology. C. Special Conditions Specific to the Company I. The Approval shall only apply to model units with the same model designations specified in this approval and meet the same specifications, operating requirements, and plans, as provided by the manufacturer at the time of the application. Any proposed modifications of the units shall be subject to the review of the Department for coverage under the Approval. r K1eanTu NitROE 2K Provisional Approval,May 2020 Page 9 of 15 Technology:NitROE®2KS&2KM WWTS 2. Prior to submission of an application for a DSCP, the Company shall provide to the Designer and the System Owner: a) All design and installation specifications and requirements; b) An operation and maintenance manual, including: i) an inspection checklist; ii) recommended inspection and maintenance schedule; iii)monitoring(i.e. water use and power consumption)and sampling procedures, if any; iv)alarm response procedures, if any, and troubleshooting procedures; c) An owner's manual, including proper system use and alarm response procedures, if any; d) Estimates of the Owner's costs associated with System operation including, when applicable: power consumption, maintenance, sampling, recordkeeping, reporting, and equipment replacement; e) A copy of the Company's warranty; and f) Lists of Designers,Installers, and Service Contractors. 3. The Company shall implement the Performance Evaluation Plan, as submitted and approved by the Department, and shall be responsible for all data collection and submissions to the Department until a final determination on the Performance Evaluation has been made by the Department. 4. Until a final determination has been made by the Department on a completed Performance Evaluation, the Company shall submit to the Department an annual report by February 15th of each year that includes the following: a) a table of all sample data collected for all systems installed to date and all information required by the Department as part of the approved Performance Evaluation Plan; b) status of preparation of a Performance Evaluation Plan if not yet provided to MassDEP, or any recommended changes to the approved Performance Evaluation Plan; c) a list of pending applications for system installations which have been submitted to local approving authorities; d) identification of any System after start-up in violation of the Approval or not in compliance with any performance criteria at the time of the annual report, the reasons for the noncompliance and the status of any corrective actions that are needed; and e) any recommendations and requests for changes to the system monitoring and reporting plan or the performance criteria of the Approval. The report shall be signed by a corporate officer,general partner or the Company owner. (Service Contractor records submitted to the Company should not be included with the annual report to the.Department, but shall be made available to the Department within 30 days of a request by the Department.) 5. The Company shall institute and maintain a program of Installer training and continuing education that is at least offered annually. The Company shall maintain and annually update, and make available the list of qualified Installers by February 15th of each year. The Company shall certify that the Installers on the list have taken the training and passed the Company's training qualifications. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 10 of 15 Technology:NitROE®2KS&2KM WWTS 6. The Company shall institute and maintain a program of Designer training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Designers by February 15th of each year. The Company shall certify that the Designers on the list have taken the training and passed the Company's training qualifications. 7. The Company shall institute and maintain a program of Operator training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make available the list of qualified Operators by February 15th of each year. The Company shall certify that the Operators on the list have taken the training and passed the Company's training qualifications. 8. The Company shall not sell the Technology to an Installer unless the Installer is trained to install the System by the Company. 9. Prior to its sale of any System that may be used in Massachusetts,the Company shall provide the purchaser with a copy of the Approval with the System design, installation, O&M, and Owner's manuals. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of a System for use in Massachusetts with copies of these documents, prior to any sale of the System. 10. Within 60 days of issuance by the Department of a revised Approval, the Company shall provide written notification of changes to the Approval to all Service Contractors servicing existing installations of the Technology and all distributors and resellers of the Technology. 11. The Company shall provide written notification to the Department's Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the Technology for which the Approval is issued. Said notification shall include the name and address of the proposed owner containing a specific date of transfer of ownership,responsibility, coverage and liability between them. 12. The Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns, including but not limited to dealers, distributors, and resellers. Violation of the terms and conditions of the Approval by any of the foregoing persons or entities, respectively, shall constitute violation of the Approval by the Company unless the Department determines otherwise. IV. CERTIFICATION AND NOTIFICATION REQUIREMENTS 1. Thirty (30) days prior to submitting an application for a DSCP, the Company or its a certification signed b the owner representative shall provide to the Approving Authority g y p 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; f K1eanTu NitROE 2K Provisional Approval,May 2020 Page 11 of 15 Technology:NitROEO 2KS&2KM WWTS c). understands the requirement for a contract with a company approved operator and has been provided a current list of all approved operators; d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)and the Approval; and e) agrees to fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). 2. Upon submission of an application for a DSCP to the Approving Authority, the Company shall submit to the Approving Authority, with a copy to the Designer and the System Owner, a certification by the Company or its authorized agent that the design conforms to this Approval and that the proposed use of the System is consistent with the unit's capabilities and all Company requirements. The review shall include evaluation of the need for installation of water meter(s) at each facility. An authorized agent of the Company responsible for the design review shall have received technical training in the Company's products. 3. The System Designer shall be a Massachusetts Registered Professional Engineer, or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. 4. Thirty (30) days prior to delivery of the treatment unit to the site for installation, the Company shall provide to the Approving Authority a copy of a signed contract for a minimum period of one year with a Company approved Operator and the initial Owner/Occupant of the property. 5. Prior to the commencement of construction,the System Installer must certify in writing to the Designer and the System Owner that (s)he has taken the Company's training, passed the Company's training qualifications,and is listed on the Company's list of Installers. 6. Prior to the issuance of a Certificate of Compliance by the Approving Authority: a) In accordance with 310 CMR 15.021(3), the System Installer and Designer must certify in writing that the System has been constructed in compliance with 310 CMR 15.000,the approved design plans, and all local requirements, including any local approving authority site-specific requirements; b) In accordance with 310 CMR 15.021(3), the Designer must certify in writing that any changes to the design plans have been reflected on as-built plans which have been submitted to the Approving Authority by the Designer; c) As a condition of this Approval, the System Installer and Designer must certify to the Approving Authority in writing that the System has been constructed in compliance with the terms of this Approval; d) An authorized agent of the Company must certify to the Approving Authority in writing that the installation was done by a qualified Installer approved by the Company and the installation conforms to this Approval. The authorized agent of the Company responsible for the inspection of the installation shall have received technical training in the Company's products; and e) Prior to signing any agreement to transfer any or all interest in the property served by the system, or any portion of the property, including any possessory interest, the System Owner shall provide written notice, as required by 310 CMR 15.287(5) of all conditions contained in the Approval to the transferee(s). Any and all instruments of transfer and any leases or rental agreements shall be included as an exhibit attached thereto and made K1eanTu NitROE 2K Provisional Approval,May 2020 Page 12 of 15 Technology:NitROE®2KS&2KM WWTS a part thereof of a copy of the Approval for the System. The System Owner shall send a copy of such written notification(s) to the Local Approving Authority within 10 days of such notice to the transferee(s). V. STANDARD CONDITIONS 1. The provisions of 310 CMR 15.000 are applicable to the design, installation, use and operation of a System utilizing an approved or certified alternative technology, except those provisions that specifically have been varied by'the conditions of this Approval. 2. The design, installation, and use of the System must conform to the terms and conditions of the Approval and the Department approved attachments. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. Standard Conditions Applicable to the System Owner. 4. This Approval shall be binding on the System Owner and on its agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute,violation of this Approval by the System Owner unless the Department determines otherwise. 5. The System Owner shall obtain all necessary permits and approvals required by 310 CMR 15.000 prior to the installation and use of the System in Massachusetts. 6. The System is approved for the treatment and disposal of sanitary sewage only. The System Owner shall not introduce any wastes that are not sanitary sewage into the System. The System Owner shall dispose of wastes generated or used at the facility that are not sanitary sewage by other lawful means. 7. Prior to issuance of the Certificate of Compliance and after recording and/or registering the Deed Notice required by 310 CMR15.287(10), the System Owner shall submit the following to the Local Approving Authority: (i) a certified Registry copy of the Notice bearing the book and page/or document number; and(ii) if the property is unregistered land, a Registry copy of the System Owner's deed to the property, bearing a marginal reference on the System Owner's deed to the property. The Notice to be recorded shall be in the form of the Notice provided by the Department. 8. The System Owner shall at all times have the installed System properly operated and maintained in accordance with the most recent O&M provisions of this Approval for the alternative technology and in accordance with any additional requirements of the Approving Authority. The most recent O&M provisions of this Approval for the alternative technology are available from the Department. 9. The System Owner shall furnish the Department any information that the Department requests regarding the System, within 21 days of the date of receipt of that request. Standard Conditions Applicable to the Designer I •KleanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 15 Technology:NitROE&2KS&2KM WWTS 10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair, provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day. 11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy of this Approval. Standard Conditions Applicable to the Company 12. This Approval shall be binding on the Company and its officers, employees, agents, contractors, successors, and assigns. Violation of the terms and conditions of this Approval by any of the foregoing persons or entities, respectively, shall constitute violation of this Approval by the Company unless the Department determines otherwise. 13. The Company shall include copies of the Approval with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require all vendors, distributors, and resellers to provide each purchaser of the System with copies of the Approval. 14. The Company shall make available, in printed and electronic format, the approved Attachments and any approved updates associated with the Approval, to the System Owners, Operators, Designers, Installers,vendors,resellers,and distributors of the System. I 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 t K1eanTu NitROE 2K Provisional Approval,May 2020 Page 14 of 15 Technology:NitROEO 2KS&2KM WWTS 20. All notices and documents required to be submitted to the Department by the Approvalshall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street- 5th floor Boston,Massachusetts 02108 Rights of the Department 21. The Department may suspend, modify or revoke the Approval for cause, including, but not limited to, noncompliance with the terms of the Approval, non-payment of any annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare, or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to the Approval and/or a System utilizing the Technology against the Company,the Designer, the System Owner,the Installer, and/or the Operator of the System. VI. GENERAL CONDITIONS Title 5 Regulations 310 CMR 15.287: "General Conditions for Use of Alternative Systems Pursuant to 310 CMR 15.284 through 15.286" "The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284 through 15.286: 1. All plans and specifications shall be designed in accordance with 310 CMR 15.220. 2. Any required operation and maintenance, monitoring and testing plans shall be submitted to the Department and approved prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a Department approved plan. Sample analysis shall be conducted by an independent U.S.EPA or Commonwealth of Massachusetts approved testing laboratory, or an approved independent university laboratory, unless otherwise provided in the Department's written approval. It shall be a violation of 310 CMR 15.000 to omit from a report or falsify any data collected pursuant to an approved testing plan. 3. The facility served by the alternative system and the system itself shall be open to inspection and sampling by the Department and the Local Approving Authority at all reasonable times. 4. The Department and/or the Local Approving Authority may require the owner or operator of the system to cease operation of the system and/or to take any other action necessary to protect public health, safety, welfare and the environment. 5. The owner or operator shall provide written notice to any new owner or operator that the system is an alternative system. Such notice shall include notice of the general conditions and any special conditions applicable to the system and its owner. K1eanTu NitROE 2K Provisional Approval,May 2020 Page 15 of 15 Technology: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 the existence of the alternative on-site system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the Local Approving Authority. last modified:05/10/21printed:05/10/21 by'h K:\Pro'ects\2020\20112 BCWC Septic Services\Drawin s\306 LAKESIDE ST.dw �— ±15.7' ±12.4' BEDROOM 1 ±20.2' ±9.6' BEDROOM 2 LIVING ROOM ±11.8' ±6.2' KITCHEN DINING ±12.5 BEDROOM 3 ROOM k 12.4' BATH +6.0' ±15.7' �� ±7.8' ±5.7' -- ±9.6' Project Number: Prepared Fa, Plan Set: Barnstable Clean Water Coalition SHUBAEL POND DEVELOPMENT Horsley Witten Group,Inc. 20112 664 Main Street Sustainable Environments]Solutions Osterville MA 02655 BCWC SEPTIC DESIGNS 90R Route 6A dten.com Fa:cPho — MARSTONS MILLS, MA Sandwich,Mieoice "Q Sheet Number: Fax— 508-833-6600 voice 508-833-3150 fax 1 Plan Title: 306 LAKESIDE DRIVE FLOOR PLAN SKETCH Dale: Des fined By: Dawn By: Checked By MAY 2021 JEH JEH MN Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 306 Lakeside Drive Property Address ; Anthony Kraunelis r ' Owner Owner's Name / information is required for every Marstons Mills V MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection r , 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:When filling out forms A. Inspector Information .616-e Lf 3y on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road VQ Company Address Teaticket Ma. 02536 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 05-10-2020 Inspector'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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 3 bedroom home has a main cesspool feeding an overflow cesspool. At the time of the inspection the cesspools were dry and no visible failure criteria was found. 2) 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 septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) "- determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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 water supply 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 a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) 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 Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive V Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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 N/A) ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): N/A Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A Description: I did a walk through of this home and I found 3 bedrooms. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: In 2019-2000 gallons were used and in 2018-3000 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2019 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is Marstons Mills MA 02648 05-08-2020 required for every ' page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal El fiberglass El polyethylene El 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form y< Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A 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.): I ran a camera from the main cesspool into the overflow cesspool and I did not see a D-Box. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ <lo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: one ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the overflow cesspool was dry and no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration one round Depth—top of liquid to inlet invert dry Depth of solids layer dry Depth of scum layer dry Dimensions of cesspool 6 x 6 Materials of construction block Indication of groundwater inflow ❑ Yes ® No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): The main cesspool was dry at the time of the inspection and no visible failure criteria was found. The cesspool is under the shed and there is a very large trap door for good access. The cover is at grade under the trap door and the shed is not impacting the structural integrity of the cesspool. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts F. Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 r A z = 3F Z y6 she. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 14 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ 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: I augered a hole at a lower elevation and I shot it with a transit to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 Lakeside Drive Property Address Anthony Kraunelis Owner Owner's Name information is required for every Marstons Mills MA 02648 05-08-2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included � 1u� y t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 GENERAL NOTES: GENERAL NOTES: 'rr * ONE-4"HOLE WITH 153" 1. NITROE 2KS TANK TOP'TO HAVE THREE-24",TWO-12"HOLES AND ^":� �° ' ' )'t it 1. NitROE SEPTIC TANK TOP TO HAVE THREE 24"AND NE E � '��a•rls��'� c RISERS AND COVERS FOR MAINTENANCE AND SAMPLING. TOTAL TANK LENGTH MULTIPLE 4"HOLES WITTH RISERS AND COVERS FOR MAINTENANCE a� TOTAL TANK LENGTH= 122" 2. INSTALL 4"DIAMETER SAMPLING PORT(1"BELOW GROUND SURFACE) OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH OT AND SAMPLING. x a E DISTANCE VARIES ( ) - "` E OUTSIDE WALL TO OUTSIDE WALL WITH 4"SCH 40 PVC COUPLING INSERT AND 6"PLASTIC ROUND BOX 2. FOR THE 24"HOLES;PROVIDE 24"DIA.ADS PIPE(CORRUGATED) a TANK WALL AT TOP AND COVER TO BE FLUSH WITH GROUNDSURFACE. P d WITH POLYLOK(OR EQIUIVALENT)COVER(OR EQUIVALENT s TANK WALL a '� ` le w CONCRETE RISER AND COVER)TO 12"BELOW GROUND SURFACE T± O (3"TYP) THICKNESS Q F- AND SECURE TO TANK'TOP. %§ m AT TOP LL �, 3. FOR THE 12"HOLES;USE ADS PIPE(CORRUGATED)AND POLYLOK .a, Q_ J (311 TYP) 00 (OR EQUIVALENT)COVERS TO 12"BELOW GROUND SURFACE AND -{ Q MIDDLE W O SECURE TO TANK TOP. e,Y o a > O TROUGH 40 4. PROVIDE FOUR 4"DIA.;SAMPLING PORT 1"BELOW GROUND k" * ` U -� n z C w INLET cn ( , `t rn TROUGH S URGED (MT) DENIT CATI ¢ SURFACE)WITH 6"PLA:STIC ROUND BOX AND COVER TO BE FLUSH * ^` „� p cn 2 EFFLUENT O WITH GROUND SURFACE. r W -0 M FROM SEPTIC (IT) A N HAMB' 5. FOR EXISTING SEPTIC(TANK;PROVIDE 2 DIA.SAMPLING PIPE THAT w n Mr- 0 81 z p TANK C i B (DC) IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" ' ¢ I- ~ O -n ~ 0 SIC) 0 BELOW THE TANK TOP jAND BE POSITIONED 6-12"FROM THE EDGE W m p p EFFLUENT w INFLUENT 0 EFFLUENT TO OF THE OUTLET END OIF THE SEPTIC TANK OR IN THE SEPTIC TANK f✓ O PU CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, O o °, ZO TO NitROE w CH THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE Q J �� Q WASTE-WATER m C GROUND SURFACE AND HAVE A 6"DIA.PLASTIC ROUND BOX AND � I, ::"�1� � ¢ w TREATMENT SYSTEM 0 TANK WALL J p1 i ~ I COVER AT GROUND SURFACE. `° y N M V CD N O p THICKNESS ��> SITE H to AT BOTTOM 7 I t T (4 11/2"TYP) O -{ w TANK WALL AT TOP 149 T (3„TYP) WOW � SEE NOTE 3 2 M _ m W 122 6"PLASTIC BOX AND COVER WIITH 4" SEE NOTES 1 AND 2 116° SEE NOTES 3 AND 4(TYP) MONITORING PIPE,SEE NOTE,2 AND 4(TYP) @ SEE NOTES 3 AND 4(TYP) SEE NOTE 2 GROUND LEVEL = o SEE NOTE 2(TYP) 24"ACCESS HOLE WITH COVER SEE NOTE 2(TYP): RISER TO WITHIN 3"OF CO) GROUND SURFACE TYP SEE PJOTE 2(TYP) FINISHED GRADE O � m _ _ •v y 0 C 4_7 � m � TO SOIL TO NitROE 5 1!2"TANK TOP(TYP) ABSORPTION SYSTEM "�01^i - ®LOAM AND SEED _ _ M of W q 3 3:1 WASTE-WATER (SAS) _- - - - - _e® d i �..: •6 TREATMENT SYSTEM _ CLEAN- ® :3• ... � �-_®BACKFILL- � �� y � o O t4 INFFLUENT " EFFLUENT EFFLUENT`FROM SEPTIC ° a EFFLUENT - - - - - - _ _ - - _ _ _ I W Q O O -�� T TANK 48"STATIC WATER DEPTH -� ••--•- � _ - _. 04 - 6 0 ® FLOW-- FLOW L w ,.0 M � A A W 1411 Y __- - -_- - _- __ __ (/� 4 o M M >_ s Z Q p 27n Q � O - _ 6"OF 3/4" L. a oo ao a ° t~i Q a SUBMERGED DENITRIFICATION CHAMBER o w ¢ w - - - COMPACTED o o o m O t- D uu a I _ (D .4 F- ° = a _ CRUSHED _ M 0 O o p 59" W WO > i = AERATION = (DC) i w f- � �- �- ! I 6 I STONE BASE 0 51 GAS BAFFLE 48,. p d O - O O CHAMBER O > z w z _ Q 3411 � OOU O � z (SAC) I~- � O �LIJ O � D � � F W W I.-u- _J �d O , 24 00 `° we o F- Nwvz LO NOTES: ih a ® Z--" O 1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL f° STABLE BASE U) U) W.' .• ° '. 4 e. ;d. n L 2. BLOCK ONE OUTLET. KleanTu LLC Klea Tu L C �- '` •` 'd•r` '3 `'•' '� 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. 4"TANK BOTTOM (TYP ° d TANK BOTTOM 4. INSTALL SPEED LEVELERS(OR EQUAL)ON OUTLET PIPES. 12"CRUSHED AGGREGATE OR APPROVED THICKNESS 4" �-1T CRUSHED AGGREGATE OR APPRtOVED W 3"TANK WALL AT 114" MATERIAL;ON LEVEL,COMPACTED AND MATERIAL;ON LEVEL,COMPACTED AND PROPOSED H-10 DISTRIBUTION BOX DETAIL BOTTOM(TYP) STABLE BASE STABLE BASE ACME PRECAST OR EQUIVALENT Z 120 TANK WALL THICKNESS AT BOTTOM(4") LLB TANK WALL THICKNESS AT TOP(3") NOT TO SCALE NRROE 2KM SEPTIC TANK NKROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM (WWTS) J _ Z EST-ASST15M H 0 NOT TO SCALE N-ASST20M-H10 NOT TO SCALE ❑ J Q J W � U) Z ' 4"SCHEDULE 40 PVC 3/4"TO 1-1/2"DOUBLE WASHED GRISER RADE AND COVER TO OS WASTEWATER NOTES Q W U) dC E STONE TO CROWN OF PIPE Z k MINI SLOPE 1% SHOWN IN PLAN VIEW 1. ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SURVEY CONDUCTED BY THE O C �ci '- TOP OF SYSTEM HORSLEY WITTEN GROUP,INC.ON NOVEMBER 20,2020. W G 9"MIN 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE IN ACCORDANCE L1. - 36"MAX. BREAKOUT FILTER FABRIC WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE LOCAL BOARD OF HEALTH. W MW O O .; .a •^r:.> #xsa ,.,"ss•.7•Air^;a�::/°p rT. ..r....Y..4 al+,g,'.:G'y': hg' 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO •,z. e ,.:;'�.. :ate• +a•:.." a fim*.�.,a:a. �..;.,.y...r LAYOfJTANDCONSTRUCTTHE �� ..a�. .p , 3•. :"Xa,y`'.''•a._ '.$,. .«7'z.. ' 3r :+:,.,. >ffe s:�•;'. .� :�°;',. .•�.'.�'L•:fl �-,.i.a..`pS „M. gd..s' ,k. °•''ti,,?r•.M •r.3. PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON IT AND SHOULD NOT BE USED FOR `Y OTHER PURPOSES. -- $ ""°a ,,„,. _ .,. _:. �. :fir' "$' .,;,: ,. -'fro C•,u .. ..« .., to .. a ..- ... I f '--, ^� 3 �� .._.. . .. .•� ... x:r ;v.e°.. -..F' «•., � •a. fix-. .,.4 s. ,.x,. 1 ` ---�- : -.,� .��. _ e, �1 .F. ;,, •. x �.v .,� a %. ,. � � 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOC{�L BOARD OF HEALTH BOH 72.62 I ....•,x ( 00 L a y�� STAF . E s` ;r. 4 r. 1� 5 S. �• Y � r t'°� R4-n••a }.s•' ,4 a.,•4`.1:i'i% O 1 " - 7F2n"-. .Kn�^.�r`�`>` �H'c r,e"C. .. .. .. :•.E'eQ.... •''#, ai( ..�#'(.>:��m• adF.r y• Y. y LU S71 33 05 W - � _ � 2' ,,fir;' •�� *,� a;,,r ;r� ;� � � ..��_ 78.36 ,, ,; . �.. to 8N a,. - ° >. 5. PRIOR TO CONSTRUCTION THE CONTRACTOR SHALL COORDINATE �r 0 S71 30 19 � > t< :< r DINATE WITH THE PROPERTY OWNER AND ENGINEER ON Z •:'C .o-°'.•:•-,+..�'� o.,..�.a , ^"k:x ,>y.. ,.t,.,: ,i^ � ''',�'.r._� a �• �.•»a'a. •.a- e••a. .."" .- W "" x.aga<. !rd.y."sr • fsrw; .k3eF� �e....a.. :!a&'`;"� ,.# L.N� ar` {N _$`. {• #a4: �,I " A,. �b ya: 4,� I .• `` � ` �"�'"�Y `� CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE AREAS. I THE CONSTR .a' T 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY LOCAL AND/OR STATE W -" 4.0' 4r-- 8.5'(TYP) -( �-4.0' 4.0' 4.0' PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL Im Q J ELECTRIC,WATER AND • I 25.0 4'8 (TYP) --� HOURS OF OPERATION FOR THE FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. GAS SERVICE ,, U) 0 5'MIN. 12'9 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN ON THE m °' PLAN TO THE DESIGN ENGINEER. P to CHAMBER END VIEWV ° N, == 8. FAILING TO PROPERLY INSPECTOR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OR CHANGES TO EFFLUEINT a a .:._., ;. ,. ,� �M••i�� ,, - FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR ADJACENT TO THE SITE,MAY RESULT IN IMPROPER j DISTRIBUTION PROPOSED H-10 500 GALLON CHAMBERS FUNCTIONING OF THE SEPTIC AND LEACHING SYSTEM S _•.. o ( ). N71 33 05"E �. 0.00' 7D -� h BOX tL5 10 ,.. w a „..<,, `N71 33 ..�° `..,.. NOT TO SCALE 11 ° L 0.00 1 S71° 33' 05"W LANDSC �' WIGGINS PRECAST OR APPROVED EQUAL 9. CALL DIGSAFE AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT 1-888-DIG-SAFE AND ANY OTHER 0 10 ,•00 APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF EXISTING UTILITIES. (I� g MAP 102 BLOCK 028 '� L` . AREA:0.23,AC u * PROPOSED 4 DIA V 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. j SCH 40 PVC PIPES � " ~ LENGTH VARIES 11. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 YEARS. #n uO '' PROPOSED 4" DIA "' SLOPE = 1% � W 1 SCH 40 PVC PIPE GRAVEL ,� x TREATMENT SYSTEM DESIGN CIF IT�E IA 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE PIPES ENTER OR LEAVE ANY V cu C) V P LENGTH = 7A' ''.. DRIVEVI�AY SCHEDULE OF ELEVA TIONS CONCRETE STRUCTURES. � 2 � < ° USE. SINGLE FAMILY a cn j CL SLOPE =2.00/o y EL. 13. USE SCH.4CPVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE PLACED ( ) N dick I e k �t BUILDING FOUNDATION 111.00 NUMBER OF BEDROOMS DESIGN 3 ON A COMP„CTED FIRM BASE. m Z m. M STAI S ;a BUILDING INVERT OUT EXISTING 1i?8.00 ° (EXISTING) TITLE 5 DESIGN FLOW 710 GPL?/BEDROOM C N o V DECK � c co '.,` A w SEPTIC TANK-INLET 107.3C1 TOTAL DAILY DESIGN FLOW 330 GPL3 14. ALL STONE j"0 BE DOUBLE-WASHED AND FREE OF DIRT, DUST,AND FINES. a N cv O EL LL. GARBAGE DISPOSAL NVO (, o LO SEPTIC TANK OUTLET 107.05 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE INFORMATION FOR THE SEPTIC 3y �_,,• TP-1 SYSTEM TOfHE ENGINEER, IF NECESSARY. m N 21.6 s IV dE a- ( NITROE TANK INLET 103.74 SEPTIC TANK dRII/E #306 LAKESIDE DF`"' TP 200% OF DESIGN FLOW: BBO GALLON 16. THE CONTRACTOR SHALL PROVIDE A DEWATERING PROTOCOL PRIOR TO CONSTRUCTION IN ACCORDANCE WITH (q 1 O.8 10.6' NITROE TANK-OUTLET 103.49 CONSERVATION COMMISSION ORDER OF CONDITIONS. NESTOR Y.WOOD FFKA - r O 1T UNSUITABL5SOIL MUST BE REPLACED WITH TITLE FFE=111.85' N ' "D"BOX-INLET 103.35 USE NEW 7,500 GALLON SEPTIC TANK T 5 SAND AS SPECIFIED IN 310 CMR 15.255(3). ANY ADDITIONAL dEC 10.3 ,w T F-111.00' Q O AREAS THAIARE FOUND TO HAVE UNSUITABLE MATERIAL SHALL BE REPORTED TO THE ENGINEER. �( . - i a � "D"BOX-OUTLET 103.18 o W w _ r '`` t I o PROPOSED SOIL LEACHING SYSTEM DESIGN' CRITERIA 18. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. (n o � S L' I I N TAIRS ABSORPTION SYSTEM LEACH CHAMBER-INLET 1(J3.06 19. ALL SEPTIC"ANKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS MATERIAL -_ o - I NFd I -- BULKHEAD S F, 1 .2'` CHAMBER BOTTOM TO INVERT 2.00 � 2-500 GAL, PRECAST SOIL ABSORPTION SYSTEM! CL DECK 3 h 20. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION AFTER CONSTRUCTION IS O N ..,_ 0 .� ° � � p � � '= CONCRETE CHAMBERS LEACH CHAMBER-BOTTOM 1t31.06 0 r w (� COMPLETE.AREAS NOT DISTURBED BY CONSTRUCTION SHALL BE LEFT NATURAL.THE CONTRACTOR SHALL TAKE a ; 25'X13 BREAK OUT(TOP SYSTEM) 104.14 LEACHING SYSTEM USED: CONCRETE CHAMBERS I I PATIO ( CARE TO PF VENT DAMAGE TO SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE o 0 PROPOSED 4° DIA I o BENCHMARK LOWEST FINISH GRADE 105.80 DESIGN PERCOLATION RATE: 2 M1N.JW. PLANS DO N)T SHOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONS MUST BE VERIFIED BY THE CONTRACTOR IN Cl) m o 0 ❑ E I SHED MAG SET MINIMUM COVER 1.66 ADVANCE O THE WORK, > 0 co N SCH 40 PVC PIPE 1 ._. W._•._ SOIL CLASS: t LENGTH = 10.0' 7 EL. 106.19 HIGHESTFINISHGRADE 107.00 LONG TERM ACCEPTANCE RATE LTAR: � 74 GPD/S.F, � � � o M - 0 14.5, ( ) 21. ALL UNPAVE)AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF LOAM INSTALLED AND BE v Q E SLOPE - 7.00/o MAXIMUM COVER 2.86 TOTAL AREA REQUIRED-LOCAL CODE. 446 S.F- SEEDED Wlli GRASS SEED AS SHOWN ON THE PLAN AND/OR DIRECTED BY THE ENGINEER. THE CONTRACTOR SHALL L >, (0 o co > NITROE TREATMENT G.W.ELEVA TION 64.15 BE RESPONIBLE FOR WATERING ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS ESTABLISHED AND o °� w o o APPROVED BY THE ENGINEER AND/OR OWNER. 1 .O S711 3300f PUMP AND 1 ° �-- SYSTEM ESHGW BELOW SEPTIC BOTTOM' 36.91 z O TOTAL AREA REQUIRED- TITLE 5: 446 S.F. � o z co ca co o ai '� o -- ABANDON/ REMOVE PROPOSED 4" DIA t TOTAL AREA PROPOSED: 22. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE SYSTEM MUST BE INSTALLED 0 = M o) a LL- a CV EXISTING DISPOSAL ��1,500 GALLON SCH 40 PVC PIPE AIR PUMP& REMOTE AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT OF ENVIRONMENTAL PROTECTION(DEP)PROVISIONAL USE LO Registration: SYSTEM ❑ ° EST TANK -LENGTH 51.0' = SENSING UNIT A(sidemll):(2 x 25.0'+ 2 x_12.9)x 2'x 2: 151 S.F. APPROVAL SLOPE 7.00% __. ._.. _ A(bottom):25.0'x 12.9: 323 S.F. o m SOIL TEST PIT DATA TP_1 " TP-2 TOTAL AREA: 4 74350 S.F, WASTEWATER INSTALLATION INSPECTION NOTES c"OF s TOTAL ALLOWABLE FLOW: 350 GPD •�?SPI�t ti N 0" 06.0 0 06.5 O � A A 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE ENGINEER AND LOCAL BOARD OF I - G 10 YR 4/3 10 YR 4/3 HEALTH FOR ANY INSPECTION. O #4EEINDERSON .L 12' LOAMY SAND o5.0 12' LOAMY SAND o5.5 USE 2-500 GALLON CHAMBERS SURROUNDED IN 4-FT OF STONE - 0 civit CL 2. ALL WASTEWATER SYSTEMS, INCLUDING THE LEACHING SYSTEM,SHALL BE INSPECTED BY THE ENGINEER OR THE LOCAL No. ZONING & RESOURCE PROTECTION NOTES B B BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL BE INSPECTED: 10 YR 514 10 YR 5/4 2.1. EXCAVATION OF LEACHING FIELD PRIOR TO PLACING SYSTEM STONE/COMPONETS CV 1. PARCEL ID:102/028 LOAMY SAND LOAMY SAND 2.2. LEACHING FIELD COMPLETE INSTALLATION PRIOR TO BACKFILL 0 ?6L 2.3. ALL SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL LO 2. OWNER OF RECORD:ZENAS CROCKER 26' 03.8 24' 04.5 PERFORMED BY: JOSEPH HENDERSON, HORSLEY WITTEN GROUP, INC 2.4. LEAKAGE TEST ON SEPTIC TANK(MIN.24 HR) Ij 21 WITNESSED BY: DON DESMARAIS, HEALTH DEPARTMENT 2.6. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS DESIGNED GRAPHIC SCALE C C 2.6. FINAL INSPECTION OF BACKFILLED SYSTEM Project Number: Sheet: 0 3. ADDRESS: 306 LAKESIDE DRIVE,MARSTONS MILLS 80 2.5 Y 7/3 2.5 Y 7/3 DATE: MAY 24, 2021 � 4. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON F.LR:M.MAP 25001C0542J DATED JULY 16,2014). 20 0 10 20 40 MED SAND MED SAND 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND NOTES INDICATING THE 20112 1 Of Q) PERC @ 36" 1 certify that I am currently approved by the Department of Environmental Protection pursuant to 310 HORIZONTALAND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND 1 i}. <2 MIN/IN CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me NOTES WILLBE UTILIZED BY THE ENGINEER FOR THE PREPARATION OF RECORD PLANS. -p 5. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. consistent with the required training,expertise and experience described in 310 CMR 15.017. 1 further Sheet Number: O 120 6 5 certify that the results of my soil evaluation,as indicated in the attached Soil Evaluation Form,are (in feet) 120' 6.0 NO G'V OBSERVED NO GW OBSERVED accurate and in accordance with 310 CMR 15.100 through 15.107. 1 INCH - 20 FEET WW c� G GENERAL NOTES: GENERAL NOTES: 1. NitROE EST TANK TOP TO HAVE THREE-24"AND ONE 4"HOLE WITH 153" 1. NITROE 2KS TANK TOP TO HAVE THREE-24",TWO-12"HOLES AND d l.} A x •- Lf RISERS AND COVERS FOR MAINTENANCE AND SAMPLING. TOTAL TANK LENGTH MULTIPLE 4"HOLES WITH RISERS SAND COVERS FOR MAINTENANCE Tr, 2. INSTALL 4"DIAMETER SAMPLING PORT 1 BELOW GROUND SURFACE) OUTSIDE WALL TO OUTSIDE WALL OUTLET TROUGH OT AND SAMPLING. TOTAL TANK LENGTH = 132.5" ( ' ( ) " DISTANCE VARIES WITH 4"SCH 40 PVC COUPLING INSERT AND 6"PLASTIC ROUND BOX 2. FOR THE 24"HOLES;PROVIDE 24" DIA.ADS PIPE(CORRUGATED) OUTSIDE WALL TO OUTSIDE WALL WITH POLYLOK OR EQUIVALENT (COVER OR EQUIVALENT r€. TANK WALL AT TOP AND COVER TO BE FLUSH WITH GROUND SURFACE. ( ) TANK WALL •: •. . - , •,:..•. •. $.;, a•• a . : .,. •• ., a. „�, . : e . .*: ... Y ., 1� w CONCRETE RISER AND COVER)TO 12 BELOW GROUND SURFACE (6' TYP) THICKNESS z a AT TOP Q� a AND SECURE TO TANK TOP. r - LL 3. FOR THE 12"HOLES;USE ADS PIPE(CORRUGATED)AND POLYLOK + ' (3"TYP) -"- O U (OR EQUIVALENT)COVERS TO 12"(BELOW GROUND SURFACE ANDar o ¢ - MIDDLE d' 40 �O SECURE TO TANK TOP. T ROUG 4. PROVIDE FOUR 4"DIA.SAMPLING(PORT 1"BELOW GROUND " -i FLOW DISTRIBUTION WALL W INLET �� ( ¢ = o (MT) H ¢ SURFACE WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH „, p cn EFFLUENT TROUGH S RGED DEN( IF�1C,�AT( ) �, o N - �- I (IT) A N HAMBE O WITH GROUND SURFACE. a W Z) FROM SEPTIC n Y O TANK Ck BE (DC) 5. FOR EXISTING SEPTIC TANK;PROVIDE 2"DIA.SAMPLING PIPE THAT = cn $1 z O IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" INFLUENT EFFLUENT OS C) BELOW THE TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE „> m p Q Q EFFLUENT TO OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK C p H PUMP CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK, " O w CHAMBER THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE >fi7 z TO NitROE WASTE-WATER GROUND SURFACE AND HAVE A 6"'DIA.PLASTIC ROUND BOX AND , > -� S TREATMENT SYSTEM �- COVER AT GROUND SURFACE. N ¢ TANK WALL N M v WOn O a 0 THICKNESS a aaaa� 0 _> 0 SITE:. F- AT BOTTOM x1 Vie:. (4 1/2"TYP) p �4X'k z Y a ' N T TANK WALL U AT TOP ,1 24"DIA.H2O RISER AND COVER TO GRADE TYP.2 SEE NOTE 2 (6 TYP) 6"PLASTIC BOX AND COVER WITH 4" v m w SEE NOTES 3 AND 4(TYP) PL40NITORING PIPE;SEE NOTE 2 AND 4(TYP), ;." SEE NOTES 3 AND 4(TYP) ,., 2 GROUND LEVEL SEE NOTE 2(TYP) p GROUND SURFACE TYP 24 ACCESS HOLE WITH COVER SEE NOTE 2(TYP). RISER TO WITHIN 3"OF 0 � SEE NOTE 2(TYP) FINISHED GRADE O m C TO SOIL _ N 5 1/2"TANK TOP(TYP) LOAM AND SEED = �=4 0 m w TO NitROE ABSORPTION SYSTEM _ r _ _ _ _ _ _ _ _ _ WASTE-WATER 4 •.. ,�. .. ... (SAS) I -BACKFILL-- o q ❑ TREATMENT SYSTEM INFFLUENT42 EFFLUENT FROM SEPTIC _ d EFFLUENT _ s W Q o 0 oil EFFLUENT _ aa•srancwnrea"earr} -_ 10 O � N d W - ® FLOW- r FLOW--- _ - I- N 3 rMi M r Y W W - - -- - - - - - 6,OF 3/4" L yam„ 0 Ls 00 0p ® D 0 - _ _ _ y � C00 ui H I - - - - COMPACTED O � w � SUBMERGED = DENITRIFICATION CHAMBER': . � � o a =a .._ - - - CRUSHED _ y a y to h p O z i _ AERATION O (DC) w ~ a I STONE BASE FLOW DISTRIBUTION WALL -I I I 1 O 51 �. 48 - of O CHAMBER > z W z 36" o �Z (SAC) Wp oLLo � _ w III_ J p - LL : Z -�.- N M F- 24" � ' F- F- LLI '• w o � � �--- NOTES: iv , z-'- O 1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL �/� ti STABLE BASE. vJ n a. . BLOCK ONE OUTLET. W ,' : a.. Q•:' •. : . .•"„ • . . .•.s . ° :•,' ''4' KleanTU LLC ELEV.=1. 4 ! , ... . • : . 4 . ..: Klea� LC 3. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. ELEV.= 1.7 ' � 1'1Tle.� L 6"TANK BOTTOM(TYP TANK BOTTOM 4. INSTALL LEVELERS(OR EQUAL)ON OUTLET PIPES. 12"CRUSHED AGGREGATE OR APPROVED THICKNESS 4" 12"CRUSHED AGGREGATE OR APPROVED w Q 6"TANK WALL AT BOTTOM(TYP) 114" MATERIAL;ON LEVEL,COMPACTED AND MATERIAL;ON LEVEL,COMPACTED AND PROPOSED H-10 DISTRIBUTION BOX DETAIL 120 STABLE BASE STABLE BASE z \ TANK ATHICKNESST BOTTO M 4 A KW WALLA W ( ACME PRECAST OR EQUIVALENT MROE 2KM EST 1,500 GALLON ENHANCED SETTLING TANK (EST) TANK WALL THICKNESS AT TOP(3°) NitROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM WWTS NOT To SCALE (n = <C ACME-SHOREY ST152M OR APPROVED EQUAL N-ASST20M-H10 J („� Z NOT TO SCALE NOT TO SCALE C] - C( Q J W !^ r^ 3!4"TO 1-1/2"DOUBLE WASHED RISER COVERTO WASTEWATER NOTES ® vJ vJ CY) Z f .• D T NS 4"SCHEDULE 40 PVC GRA EAT COCA 10 z Q O STONE TO CROWN OF PIPE !� - - " N 1. ELEVATION PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SURVEY CONDUCTED BY THE - tP MIN SLOPE 1/o SHOWN IN PLAN VIEW VJ o TOP OF SYSTEM HORSLEY Wn TEN GROUP,INC.ON NOVEMBER 20,2020. W O Q �- Z 9"MIN. ; 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE IN ACCORDANCE BREAKOUT ,, z' FABRIC WITH THE ENVIRONMENTAL E D THE RULES AN REGULATIONS E LOCAL BOARD HEALTH. v J 36"MAX. FILTER ABR STATE E VIR MENTAL COD AN RU D REGU OF THE OAR OF H Jfy J -'�." 3. THIS PLAN I INTENDED TO ADEQUATELY ROVIDE H INFORMATION NECESSARY TO LAYOUT AND CONSTRUCT HE W �� ., . :.�, .:,ai7,;,.°° ::;.,.� ,••;,•::-a;:-•�•i':s �•"°� �:�.: s arr. :.^�•} ;�.r,°rc,aa•a, •��;.��' �;:�:. ....., .:yr:•�+,. ,�k,+..�,e_..,.�,..a;. ,,r, .z. SP THE A Y O A N T .> Spy �„. v &a" ��t ��' $n., , .Ad.•.x, ..x• x,. % cr A. k� yr �. '• �;„ ,• ,;�,. Y;_ °' >.<, ;. ;: ;;� �,• ��„� PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON IT l�ND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. ' �.,...,.y„e, q •,4, .srn... Aw. -,•,a.,„ •,mf:.F,«'{.,. r.^Z„� 3..-g ..y.. .:...... ;; .'�F'-,"�•�s. ;:gym.,•r:+t,.,.,-'M1C�'a;i" ,,w#.w:i r+4'e°"�J�'f:. :1.i8`,nt: � '.. a{t pua' 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL BOARD OF HEALTH BOH We: # �.. x> STAFF. V J3' 05 E •. «tea SS pp'+ Lwti d ,.9 �:`�tiaw � •�Pa"+1 d8 :.e,�'. 1d' e A 2 .4•'...'w?,4v�- .V,.3QP''o ..s" .�•-,±€• #' : � ��.. ..=:t�'Y"'' • ' a-" '-•wten � ' 190.59 . ,� , .;.. ;:per '+.8• � ,x �� . ...�,•,.f,... S71 33 05 - • • -+s-- 78.36 o e ee l * ,a3. 8"' :,.,. RM' ;' a' s�` S. ?G LD � � � - �� '�• �� ,�k ' K,;, �� r. �• 5. PRIOR TO CONSTRUCTION THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY OWNER AND ENGINEER ON 30 19 W a '•' '.:n Ye•rfic.. $.;�,�Ssi•:';, ^t"' > '?!°y .7. �in. � 'r+'}•.•u,• .Z:� .,^:. :(... �+W ni�.a.. ,S..arucd .+, s., .; e { ''k. ""`.^ :4. v -':^r:z..; °;s .m.•,�R,jMaf ,.,&:•;N,.rna`'r'ta .e P.r:,.,-'.''.aT.�°.rr4" _rb,`w� .. 4;'"' ..Rk°.uk°.:!14 .tn.a•i"•T�a.J'..4 { -®- M.�'-`'`"''� ^Y �•' '>Y'"'""�'""�w °`''> }�. �t THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE AREAS. LL , j 4 t LLI a 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY LOCAL AND/OR STATE 4 4.0' 8.5'(TYP) -I I 4:0' 4.0' >4.0' PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL W J ELECTRIC,WATER AND 25.0 4 9 (�'P) HOURS OF OPERATION FOR THE FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. GAS SERVICE r p ', 5'MIN. 12'� 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN ON THE m °' CO ' PLAN TO THE DESIGN ENGINEER. E } m CHAMBER END VIEW a a � °"=• "� -.-� "`"`° °s "•.,„ `" 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OR CHANGES TO EFFLUENT DJSTRIBUTION '' 1 - FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR ADJACENT TO THE SITE,MAY RESULT IN IMPROPER N71° 33' 05"E _: 0:00' 1�, 16r� � ��, PROPOSED H-10 500 GALLON CHAMBERS FUNCTIONING OF THE SEPTIC AND LEACHING SYSTEM(S). 4 BOX S)q7 NOT TO SCALE 100.00` o n , .�,..., N71° 33' •,, Q S71 33 05 W LAND SC-A "-y , I" WIGGINS PRECAST OR APPROVED EQUAL 9. CALL"DIGSAFE"AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT 1-888-DIG SAFE AND ANY OTHER i - ( MAP 102 BLOCK 028 "' �` h ) 10 d 0 APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF EXISTING UTILITIES. N �$ L6t AREA:0.23 AC "' PROPOSED 4" DIA U / T 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. SCH 40 PVC PIPES LENGTH VARIES 11. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 YEARS. N ` � PROPOSED 4 DIA ~» `' LO GRAVE SLOPE = 1% v -e N SCH 40 PVC PIPE o 'DRIVEWAY "° 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE PIPES ENTER OR LEAVE ANY O � o U ( - `� CONCRETE STRUCTURES. t s LENGTH - 7.0 j � o 2. s ( SLOPE = 2.00% 't., �` � a Cl) T AEG` •.. 13. USE SCH.40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE PLACED �, k (!3 O U) :_ STAI S ' , ON A COMPACTED FIRM BASE. o o _. __. r P DECK a N N O a U_ ,•� 1 W •,,� y � 14. ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT,DUST,AND FINES. OFEL.EVATIONS TREATMENT SYSTEM DESIGN CRITERIA - SCHEDULE I ' , 15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE INFORMATION FOR THE SEPTIC m 3/a<qk d N 21.6' EL. USE: SINGLE FAMILY SYSTEM TO THE ENGINEER,IF NECESSARY. i F N s sepE -; t BUILDING FOUNDATION 111.00 v NUMBER OF BEDROOMS (DESIGN) 16. THE CONTRACTOR SHALL PROVIDE A DEWATERING PROTOCOL PRIOR TO CONSTRUCTION IN ACCORDANCE WITH F #306 LAKESIDE DRIV BUILDING INVERT OUT(EXISTING) 108.00 NE STORYTITLE 5 DESIGN FLOW 110 GPD//BEDROOM CONSERVATION COMMISSION ORDER OF CONDITIONS. I WOOD 10.6 SEPTIC INLET 107.30 f e , Q a I, FFE 11 L85 10.8 �,ry, k s _ TOTAL DAILY DESIGN FLOW 330 GPD 17. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR 15.255(3): ANY ADDITIONAL r O SEPTIC TANK OUTLET 107,05 AREAS T R FOUND T T F=111.00' "'°<.. O EA THAT ARE O HAVE UNSUITABLE MATERIAL SHALL BE REPORTED TO THE ENGINEER. N fi, ck � GARBAGE DISPOSAL: NO T • I O NITROE TANK-INLET 103.74 18. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. j N -� r- ; R SEPTIC TANK PROPOSED SOIL o [(s ^ ! I NITROE TANK-OUTLET 103.49 {-' o # I_..I Q BULKHEAD DECK STAIRS ABSORPTION SYSTEM 200% OF DESIGN FLOW: 660 GALLON 19. ALL SEPTIC TANKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS MATERIAL. U o N i 13.2 x 2-500 GAL, PRECASTCL N _ ,� " o f `D"BOX-INLET 903.35 20. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION AFTER CONSTRUCTION I T S CONCRETE CHAMBERS O .O O # € °O "D"BOX-CQUTLET 103.18 USE NEW 1,500 GALLON SEPTIC TANK COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL BE LEFT NATURAL.THE CONTRACTOR SHALL TAKE L s-- (25 X13) CARE TO PREVENT DAMAGE TO SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE (D co i PATIO i o 0 PROPOSED 4" DIA Q I I I BENCHMARK PLANS DO NOT SHOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONS MUST BE VERIFIED BY THE CONTRACTOR IN m +o 0 N ocfl � cv ® SCH 40 PVC PIPE �' SHED MAG SET LEACH CHAMBER-INLET 103.06 LEACHING SYSTEM DESIGN CRITERIA ADVANCE OF THE WORK. m N O = t _. __ _ .. _.w M LENGTH 10,0 x ¢ u . ..,•,._...„ .,, - „n •- EL. 106.19 CHAMBER BOTTOM TO INVERT 2.00 � CO6 o _ 0 14.5' LEACH CHAMBER-$OTT(JM 101.06 21. ALL UNPAVED AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF LOAM INSTALLED AND BE g ¢ � SLOPE - 7.00/o SOIL ABSORPTION SYSTEM SEEDED WITH GRASS SEED AS SHOWN ON THE PLAN AND/OR DIRECTED BY THE ENGINEER. THE CONTRACTOR SHALL o >-. o o ^ 0 100.00° NITROE TREATMENT BREAK OUT(TOP SYSTEM) 104.14 BE RESPONSIBLE FOR WATERING ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS ESTABLISHED AND a v � z APPROVED BY THE ENGINEER AND/OR OWNER. aTi i Q °' a a e ❑ o fl ❑_ SYSTEM LOWEST FINISH GRADE 105:80 LEACHING SYSTEM USED: CONCRETE CHAMBERS Of °7 S71 33 OL PUMP AND O c o x -*- _ MINIMUM COVER 1.66 DESIGN PERCOLAITIONRATE tl� _�,._ ... 2 MINJ�W: u) = M U)Cc a U_ o � ABANDON / REMOVE ' PROPOSED 4" DIA 22. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE SYSTEM MUST BE INSTALLED N EXISTING DISPOSAL �'�__)_1,500 GALLON SCH 40 PVC PIPE HIGHEST FINISH GRADE 107.00 SOIL CLASS' I AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT OF ENVIRONMENTAL PROTECTION(DEP)PROVISIONAL USE Registration:_ r- SYSTEM ° EST TANK -- LENGTH = 51.0' fo_ MAXIMUM COVER 2.86 LONG TERM ACCEPTANCE RATE(LIAR): � 0.74 GPDNS.F. APPROVAL. L� // SLOPE = 7.00% G.W.ELEVATION 64.15 TOTAL AREA REQUIRED-LOCAL CODE: 446 S.F. e "OF HGW BELOW SEPTIC BOTTOM' 36.91 ES TOTAL AREA REQUIRED- TITLE 5: 446 S-F. �4 s -a WASTEWATER INSTALLATION INSPE CTION ECTION NOTES o .NO3EF ti N H E. G ++ ! TOTAL AREA PROPOSEL?, 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE ENGINEER AND LOCAL BOARD OF ,� HENOEFdSQld C HEALTH FOR NY INSPECTION. 0 -4 EAL FORA NY CIVDC cca I^r-� r r r ri. A(sdclevual!) (2 X 25P 0 + 2 x 12.9)x 2 x 2. 151 S.F. 2. ALL WASTEWATERSYSTEMS,INCLUDING THE LEACHING SYSTEM,SHALL BE INSPECTED BY THE ENGINEER OR THE LOCAL .g ZONING & RESOURCE PROTECTION NOTES _. - -_w ._„_ _ ..,__._. _. �_..... . A(botfom):25.0`x 12.9: 323 S.F. BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL BE INSPECTED: 2.1. EXCAVATION OF LEACHING FIELD PRIOR TO PLACING SYSTEM STONE/COMPONETS F G� TOTAL AREA: 474 S.F. ONA N 1. PARCEL ID; 102/028 TOTAL ALLOWABLE FLOW: 350 GPDi 2.2• LEACHING FIELD COMPLETE INSTALLATION PRIOR TO BACKFILL 2.3. ALL SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL 2.4. LEAKAGE TEST ON SEPTIC TANK(MIN.24 HR) 2. OWNER OF RECORD:ZENAS CROCKER Ln GRAPHIC u /� C USE 2-500 GALLON CHAMBERS SURROUNDED IN 4-FT OF STONE 2.5. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS DESIGNED O 3. ADDRESS: 306 LAKESIDE DRIVE,MARSTONS MILLS G�r n I SCALE 2.6. FINAL INSPECTION OF BACKFILLED SYSTEM Project Number: Sheet 20 0 10 20 40 80 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND NOTES INDICATING THE 20112 1 Of N 4. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON F.LR.M.MAP 25001 C0542J DATED JULY 16,2014). HORIZONTALAND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND 5. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. NOTES WILL BE UTILIZED BY THE ENGINEER FOR THE PREPARATION OF RECORD PLANS. O Sheet Number: (in feet) c}n 1 INCH = 20 FEET V �► V V c� r - _