HomeMy WebLinkAbout0317 LAKESIDE DRIVE - Health 317i Lakeside`Drive
Marstons mills
A 102 145'- 002 ;
I
'4
-3'i-1 L34t,-7 d R J:D-A. ��
TOWN OF BARNSTABLE
LOCATION �'c SEWAGE#
VILLAGE MuC5LV�v%& ASSESSOR'SMAP&PARCEL
INSTALLER'S NAME&PHONE NO. 11�i}� (.'c .ZJ1y�tC�itM gib-dye �i'0
SEPTIC TANK CAPACITY 1000
LEACHING FACILITY. (type) �t,-5001 S (size)
NO.OF BEDROOMS
OWNER4el'AliflA
PERMIT DATE: COMPLIANCE DATE: ZG
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 Le (I y wetland exist within
300 feet o aching Feet
FURNIS BY
1�317 .
A 1p�Jrl�
y13� a-s-6 3z -i�
TOWN OF BARNSTABLE
LOCATION 3 7 L G26(d,Tl jr° og SEWAGE # f J 7 r cbZ
VILLAGE �/M/hl ASSESSOR'S MAP & LOT fQ:L-
INSTALLER'S NAME PHONE N OJ-P-m2r L� so® g
C
SEPTIC TANK CAPACITY 006 L,
LEACHING FACILITY:(type) (size) Woo ok
NO. OF BEDROOMS - PRIVATE WELL OR
BUILDER OR OWNER ,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
�O ' \hF
<No. O'O Fee I V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye
f3 apolitation for Disposal *pstem Construction Permit `.
r
Application for a Permit to Construct( ) Repair( ) Upgrade X
Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 3 s" Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 0 / M .t
Installer's N e,Address,and Tel.No. Des ner's Name dre s,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms �' Lot Size /0 sq.ft. Garbage Grinder( )
Other Type of Building b p / 1 t11— No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) :2 c;i gpd Design flow provided �� '� gpd
Plan Date 1 a J Lt jig Number of sheets ` Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Re s or Alterations(Answ r w�he applicable) ^,��® Qev
S
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and mai nance of a afore described on-site sewage disposal system in
accordance with the provisions o Envi lace the system in operation until a Certificate of
Compliance has been issued by. t
ig ed _ Date
Application Approved by Date
v i
Application Disapproved by Date
for the following reasons
44
Permit No. U 161 Date Issued
» Io- �G'o 1.. Fee
ti THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:=; /
K Y
PUBLICHEALTH DIVISION -,TOWN OF BARNSTABLE, MASSACHUSETTS
3 ftpYication for Disposal *pstrm Construction 3permit
Application for a Permit#to Construct Repair Upgrade, Abandon( ) ❑Complete System El Individual Components
Location Address or Lot No. f 3.S— Owner's Name,Address,and Tel.No. t"Y
Assessor's Map/Parcel O / JY� g- d_ L uj j3 kA A i-f/ y
Installer's Name,Address,and Tel.No. 5 3 Designer's Name Address and Tel.No.
mf
Type of Building:
Dwelling No.of Bedrooms Lot Size IC sq.fr. Garbage Grinder( )
Other Type of Building'k s 11� rlj n wL.— No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) V gpd Design fl_ow;piovided ' 7� gpd
Plan Date /'4 ?11 Number of sheets Revision Date
Title
Size of Septic Tank 2 Type of S.A.S.
Description of Soil
Nature of Re airs or Alterations(Answer when applicable) L 00
t r �
.fi 0_4�4 VF �.ra l sfy1X V .
" 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 -itle S,Tofthe pv ronmental Cod and=not-, place the system in operation until a Certificate of
+ Compliance has been issued by lii d-of Health
Signed . ' Date .`-
Application Approved by Date
v r � /� ,/�,• yr � v-
Application Disapproved by Date
'for the following reasons
Permit No. /` ✓ �� Date Issued J iv
-------------. --------------- - -'---------•- - - -- -- ------ --- - --------------------v----------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS , r
(eertificate of Compliance
THIS IS TO,C TIFY)mt the O ='te Sewage Disposal system Constructed( ) Repaired( ) Upgraded AJ )
Abandoned( )by / bA)
at s ,,yen constru t d in�ca co/r'dJance /l
with thne pro ' ions of Title 5 and the or Disposal System Construction Permit No. ( dated
Installer fq--A.42A)0& Designer
#bedrooms " Approved de-ssi, �'o
w' �� d
gP
The issuance of this permits all not be construed as a guarantee that the system will�fud n as designe .
q
Date 1 J j' 'Inspector
- --- --- - --------------------- i----------------- -- - -- - -
No. Fee
v " V t- THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
° Misposal *pstetn Construction permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade(X) Abandon( )
System located at 3 1 r] L (—Y tl.� a 1t-) �AQ 1•✓el
r
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions ors§pecial conditions.
Provided:Construction mu t b c�mph ted within three ye of the date of this permit.
Date
' /� Approved by.::
Town of Barnstable
`"E' ti° Inspectional Services
Public Health Division
• BARNSTABLE, r
v MASS. 0$ Thomas McKean, Director
i639•
'°jfcmA�a 200 Main Street,Hyannis,MA 02601
Office: 508-862A644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 1 2 ��� Sewage Permit# o2Qad~0) Assessor's Ma \Parcel l�ZZ-
Designer: DA V,IA D, 6 uf74r/'►}JWr Installer: o�s
Address: 15 S 6(V I:Aco �� SO Address:
C
On was issued a permit to install a
(date) (installer)
septic system at_3 17 U(k5'/Je r based on a design drawn by
(address)
u v Co�e� 6 iis kyl— dated
(designer)'-
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
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.
I certify that th ystem eferenced above was constructed i li ce with the to rms of
ap a le er (if applicable — Mq
DAVID cGs
D.
COUGHANOWIR N
sta e s 1gn ture No. 1093
_ STE��O
(Designers Signature) (Affix Desig"fi amp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
WoaldeptA\HEALTHISEWER connecASEPTICOesigner Certification Form Rev&I4-13.DOC
Town of Barnstable
BAILWABUE, ;
Board of Health
200 Main Street, Hyannis MA 02601
Office: 508-8624644 John Norman,Chairrman
FAX: 508-790-6304 Donald A.Guadagnoli,M.D.
F.P.(Thomas)Lee,P.E.
Daniel Luczkow,M.D.Alt
March 3, 2022
Mr. Joseph Henderson
Horsley Witten Group
90 Route 6A, Unit 1
Sandwich, MA 02563
RE 317LLakeside Drive, Marstons Mills �—
Dear Mr. Henderson,
You are granted permission on behalf of your client, Jessalyn Blondin, to construct and
utilize a NitROE secondary treatment unit with advanced nitrogen reduction technology
at 317 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
Q:WP/H Henderson IA approval 317 Lakeside Drive Nov 2021.docx
certify in writing that the System has been constructed in compliance with 310
CMR 15.000, the approved design plans, and all local requirements, including
any local approving authority site-specific requirements;
(3) Prior to issuance of the Certificate of Compliance and after recording and/or
registering the Deed Notice required by 310 CMR15.287(10), the System Owner
shall submit the following to the Local Approving Authority: (i) a certified Registry
copy of the Notice bearing the book and page/or document number; and (ii) if the
property is unregistered land, a Registry copy of the System Owner's deed to the
property, bearing a marginal reference on the System Owner's deed to the
property. The Notice to be recorded shall be in the form of the Notice provided by
the Department
(4) Prior to the use of the System, the System Owner shall enter into an O&M
Agreement with a qualified contractor and submit the Agreement to the
Approving Authority and the Company. The Agreement shall be at least for one
year.
(5) The wastewater effluent shall be sampled and analyzed/tested quarterly if this
facility is utilized year-round. Sampling shall include pH, BOD5, TSS and Total
Nitrogen, unless otherwise stated. Flow shall be recorded at each inspection.
[Note: a)Year-round facilities shall be inspected and effluent sampled quarterly; b) Seasonal properties shall
be inspected and effluent sampled a minimum of twice per year,with at least one annual sample taken 30 to
60 days after seasonal occupancy and a second sample taken no less than 2 months after the first sample;
and c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced sampling
shall also include Field Testing of System wastewater when determined necessary by the operator, see DEP
Field Testing Protocol at http:/Avww.mass.gov/eea/docs/dep/water/laws/i-thru-z/testsamp.pdfl
(6) A copy of the wastewater analyses, wastewater flow data, field testing results,
and System Operator O&M reports and inspection checklists shall be maintained
by the Company. It is recommended the System Owner also maintain copies of
these items.
All of the other conditions listed in the MA Department of Environmental Protection
(DEP) Provisional Use Approval Renewal letter to KleanTu LLC dated May 12, 2020
shall be adhered to.
This permission is granted because the proposed plan appears to meet all of the
provisions of the State Environmental Code, Title 5, Town of Barnstable Board of Health
Regulations It also meets the nitrogen loading restrictions contained within the State
and local regulations with no increase in sewage flow requested at this property at this
time.
Sincerely ours,
J n Norman, Chairman
Q:WP/H Henderson IA approval 317 Lakeside Drive Nov 2021.docx
r
DATE:
Q` $95.00 FEE.*:
Mtn.
S = REC.BY
Town of Barnstable
:
i679. a1
Board of Health SCHED.DATE:
Office: 508-8624644
200 Main Street,Hyannis MA 02601 d
el/r r �CJ John T.Norman
FAX: 508-790-6304 Donald A.Guadagnoli,M.D:
Paul J.Cannitl;D.M.D.
F.P.(Thomas)Lee,Alternate
VARIANCE REQUEST FORM
LOCATION 317 Lakeside Drive,Marstons Mills
Property Address:
Assessor's Map and Parcel Number: 102/145 Size of Lot: 0.24 ac
Wetlands Within 300 Ft. 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: Jessalyn P.Blondin Name: Joseph Henderson (Horsley Witten Group)
Address:
317 Lakeside Dr. Marstons Mills,MA 0264�ddress: 90 Route 6A Unit 1, Sandwich,MA 02563
Phone: Phone: (508) 833-6600
EMAIL: Henderson@horsleywitten.com
VARIANCE FROM REGULATION(InclAcS.code#) REASON FOR VARIANCE(May attach separate sheet if more space needed)
Installation of IA system with existing septic system
NATURE OF WORK: House Addition House Renovation U Repair of Failed Septic System LJ
Checklist (to be completed by office staff-person receiving variance request application)
Please submit first four on list as S collated packets
_ A. Five(5)copies of the completed variance request form
B. Five(5)copies of MA DEP approval letters for Innovative/Altemative septic system(when proposing an 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 RS.
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: health(aD-town.barnstable.ma.us. (Total email must be less than 10 megabytes.)
variance requests, each of five packets must also include a full menu. see
For grease trap. va q
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 1/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@bamstable.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.barn stable.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 *595.00 for the following variances: 1)New construction,2)Septic repairs with increase in flows,3)
New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1) Septic
repair without an increase in flow and variances granted at the counter. 2) Monitoring Plans, and 3) Temporary
Food(this is not a variance).
Variance request submitted at least 15 days prior to meeting date.
For further assistance on any item above, call (508) 862-4644
Email: health(a-town.barnstable.ma.us
Back to Main Public Health Division Page
_ _ J
r ,
y `e Commonwealth of Massachusetts
Executive Office of Energy &Environmental Affairs
Department of Environmental Protection
One Winter Street Boston, MA 02108.617-292-5500
Charles D.Baker Kathleen A.Theoharides
Governor Secretary
Karyn E.Polito Martin Suuberg
Lieutenant Governor Commissioner
PROVISIONAL USE APPROVAL RENEWAL
Pursuant to Title 5, 310 CMR 15.000
Name and Address of Applicant:
K1eanTu LLC.
300 Old Pond Road, Ste#206
Bridgeville,PA 15017
Trade name of technology and models:
NitROE® Waste-Water Treatment System (NitROE® WWTS) with unit sizing for design flows up to
2000 gpd (NitROE® 2KS WWTS and NitROE® 2KM WWTS) (hereinafter the `System' or the
`Technology'). Owner and Operator manuals, installation manual, schematic drawings illustrating the
System models and the technology inspection checklist are part of this Certification.
DEP Transmittal No.: X285590
Date of Issuance: May 12,2020,
Expiration date: May 12,2025
Authority for Issuance
Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000,the Department of Environmental
Protection (hereinafter "the Department") hereby issues this Provisional Approval to: KleanTu LLC,
located at 300 Old Pond Rd., Ste 206 in Bridgeville, PA (hereinafter "the Company"), NitROE® 2KS
WWTS and NitROE® 2KM WWTS (hereinafter "the Technology" or "System") for use in the
Commonwealth of Massachusetts subject to the conditions herein. Sale and use of the Technology is
subject to compliance by the Company, the Designer, the System Installer, the Operator, and the System
Owner with the terms and conditions herein. Any noncompliance with the terms or conditions of this
Certification constitutes a violation of 310 CMR 15.000.
May 12,2020
Marybeth Chubb, Section Chief Date
Wastewater Management Program
Bureau of Resource Protection
This information is available in alternate format.Contact Michelle Waters-Ekanem,Director of Diversity/Civil Rights at 617-292-5751.
TTY#MassRelay Service 1-800-439-2370
MassDEP Website:www.mass.gov/dep
Printed on Recycled Paper
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;
I "
KleanTu NitROE 2K Provisional Approval,May 2020 Page 3 of 15
Technology:NitROE®2KS&2KM WWTS
• A certified operator under contract for periodic inspection and maintenance;
• Periodic sampling;
• Recordkeeping and reporting; and
• An external power supply
III.CONDITIONS OF APPROVAL
A. Basis for Conditions
1. The term "System" refers to the Technology in combination with any other components of an
on-site treatment and disposal system that may be required to serve a Facility in accordance
with 310 CMR 15.000.
2. The term "Approval" includes the Special Conditions, Standard Conditions, General Conditions
of 310 CMR 15.287, and the approved Attachments.
3.Items required by this Approval include:
a) Performance Evaluation Plan (PEP) with sampling and analysis requirements and
approved by the Department. The PEP must be submitted to the Department for review
and approval within 60 days of issuance of this Approval and meet the requirements of
the Department's Guidance for the Preparation of Performance Evaluation Plans
<2,000 GPD;
b) Minimum System installation requirements;
c) Company schematic drawings and specifications;
d) Owner's Manual, including information on substances that should not be discharged to
the System;
e) Operation and Maintenance manual, including but not limited to, operator qualification
requirements, inspection requirements, sampling and analysis requirements,
recordkeeping requirements, and/or reporting requirements; and
f) MassDEP Operation and Maintenance (O&M) checklist and I/A technology inspection
checklist.
B. Special Conditions
1. Department review and approval of the System design and installation is not required unless
the Department determines on a case-by-case basis pursuant to its authority at 310 CMR
15.003(2)(e)that the proposed System requires Department review and approval.
2. System installations must meet the specific siting conditions for Provisional Use provided in
310 CMR 15.286(4) and the facility must meet the siting requirements of this Approval.
3. Any System for which a complete Disposal System Construction Permit Application is
submitted while this Approval is in effect,may be permitted, installed, and used in accordance
with this Approval unless the Department,the local approval authority, or a court requires the
System to be modified or removed or requires discharges to the System to cease.
4. The System Owner shall provide access to the site for purposes of sampling the System in
accordance with the Company's technology Performance Evaluation Plan approved by the
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
Y h' Y p
15.354, unless a later time is allowed in writing by the Department or the Local Approving
Authority.
7. The control panel including alarms shall be mounted in a location accessible to the System
Operator.
8. For any System that does not flow by gravity to the SAS, the System shall be equipped with
sensors and high-level alarms to protect against high water due to pump failure, pump control
failure, loss of power, or system freeze up. The control panel including alarms and controls
shall be mounted in a location always accessible to the operator (or service contractor).
Emergency storage capacity for wastewater above the high level alarm shall be provided equal
to the daily design flow of the System and the storage capacity shall include an additional
allowance for the volume of all drainage which may flow back into the System when pumping
has ceased.
Instead of providing emergency 24-hour storage, an independent standby power source may be
provided for operation during an interruption in power. With any interruption of the power
supply the source must be capable of automatically activating in addition to manual start up
capability. The standby power must be sufficient to handle peak flows for at least 24 hours and
sufficient to meet all power needs of the System including, but not limited to, pumping,
ventilation, and controls. Standby power installations must be inspected and exercised at least
annually and all automatic and manual start up controls must be tested. Standby power
installations must comply with all applicable state and local code requirements. Provided that a
standby power installation complies with these requirements, no variance is required to the
provisions of 310 CMR 15.231(2).
9. System unit malfunction and high water alarms shall be connected to circuits separate from the
circuits to the operating equipment and pumps.
10. All System control units,valve boxes, conveyance lines and other System appurtenances shall
be designed and installed to prevent freezing per the Company's recommendations.
K1eanTu NitROE 2K Provisional Approval,May 2020 Page 5 of 15
Technology:NitROE®2KS&2KM WWTS
11. Any System.structures with exterior piping connections located within 12 inches or below the
Estimated Seasonal High Groundwater elevation shall have the connections made watertight
with neoprene seals or equivalent.
12. In compliance with 310 CMR 15.240(13), a minimum of one (1) inspection port shall be
provided within the SAS consisting of a perforated four inch pipe placed vertically down into
the stone to the naturally occurring soil or sand fill below the stone. The pipe shall be capped
with a screw type cap and accessible to within three inches of finish grade.
Operation and Maintenance
13. Inspection, operation and maintenance (0 & 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 0 & 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.
iR
K1eanTu NitROE 2K Provisional Approval,May 2020 Page 6 of 15
Technology:NitROE®2KS&2KM WWTS
17. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System
Operator shall notify the System Owner immediately.
18. Upon determining that the System has failed, as defined in 310 CMR 15.303, the System
Owner and the System Operator shall be responsible for the notification.of the local approving
authority within 24 hours of such determination.
19. In the case of a System failure, an equipment failure, alarm event, components not functioning
as designed or in accordance with the Company specifications, or any violations of the
Approval, the System Owner and the System Operator shall be responsible for the written
notification of the local approving authority and the Company within five days describing
corrective measures taken.
20. Within 60 days of any site visit, the System Operator shall submit an O&M report and
inspection checklist to the System Owner and the Company. The O&M report and inspection
checklist shall include, at a minimum:.
a) for a System failing,any corrective actions taken;
b) wastewater analyses, wastewater flow data, and field testing results;
c) any violations of the Approval;
d) any determinations that the'System or its components are not functioning as designed or
in accordance with the Company specifications; and
e) any other corrective actions taken or recommended.
21. By September 30th of each year, the System Owner and the Service Contractor shall be
responsible for submitting to the local approving authority all monitoring results with all
O&M reports and inspection checklists completed by the System Operator during the previous
12 months.
22. By September 30th of each year, the Service Contractor shall be responsible for submitting to
the Company copies of all O&M reports including alarm event responses, all monitoring
results, violations of the Approval, inspection checklists completed by the Service Contractor,
notifications of system failures, and reports of equipment replacements with reasons during the
previous 12 months.
23. A copy of the wastewater analyses, wastewater flow data, field testing results, and System
Operator O&M reports and inspection checklists shall be maintained by the Company. It is
recommended the System Owner also maintain copies of these items.
24. The System Owner shall notify the Approving Authority in writing within seven days of any
cancellation, expiration or other change in the terms and/or conditions of the O&M Agreement
required by Paragraph B(14).
25. The System Owner and the Service Contractor shall maintain copies of the Service
Contractor's O&M reports, inspection checklists, and all reports and notifications to the LAA
for a minimum of five years.
26. The System may only be installed to serve facilities where a fully conforming Title 5 system
with a reserve area exists on-site or could be built on-site in compliance with the design
standards for new construction of 310 CMR 15.000, and for which a site evaluation in
r,
K1eanTu NitROE 2K Provisional Approval,May 2020 Page 7 of 15
Technology:NitROE®2KS&2KM WWTS
compliance with 310 CMR 15.000 has been approved by the Approving Authority. A fully
conforming Title 5 system may include other approved alternative technologies in accordance
with the conditions imposed on the alternative technologies.
27. Subject to the provisions of this Approval, the Technology shall be installed in a manner
which neither intrudes on, replaces a component of, or adversely affects the operation of all
other components of the System designed and constructed in accordance with the standards for
new construction of 310 CMR 15.200- 15.279.
Effluent Limit and Monitoring_Requirements,
28. For the new construction, unless the facility meets a TN effluent limit of 11 mg/1 or less, the
system shall not be designed to receive more than 440 gallons of design flow per day per acre
(gpda) in an area that is subject to the Nitrogen Loading Limitations of 310 CMR 15.214. If
the facility does not meet with the Nitrogen Loading Limitations pursuant to the aggregation
provisions of 310 CMR 15.2-1-6, the System Owner shall repair, replace, modify or take any
other action as required by the Department or the local approving authority to meet the total
nitrogen concentration limits in the effluent..
Violation of the TN concentration in the System effluent shall not require notifications as
required in paragraphs B (18)and(19).
29. Prior to Department approval of the Company's Performance Evaluation Plan, the Company
shall be responsible for the following monitoring requirements for all System installations that
are subject to a total nitrogen concentration limit in accordance with paragraph B (28).
Sampling shall include pH, BOD5, TSS and Total Nitrogen, unless otherwise stated. Flow
shall be recorded at each inspection, see"Flow Metering" section below.
a) Year-round facilities shall be inspected and effluent sampled quarterly;
b) Seasonal properties shall be inspected and effluent sampled a minimum of twice per year,
with at least one annual sample taken 30 to 60 days after seasonal occupancy and a second
sample taken no less than 2 months after the first sample; and
c) After 12 rounds of monitoring, sampling may be reduced to TN only quarterly. Reduced
sampling shall also include Field Testing of System wastewater when determined
necessary by the operator, see DEP Field Testing Protocol at
http://www.mass.gov/eealdocs/dep/water/laws/i-thru-z/testsamp.pdf
Properties occupied at least 6 months per year are considered year-round properties.
Properties occupied less than 6 months per year are considered seasonal properties.
30. During the Performance Evaluation period, the Company shall follow the monitoring
requirements specified in the Performance Evaluation Plan for installed Systems.
31. After the three (3) year Performance Evaluation period by the Company and approval by the
Department, and until this Approval is modified, terminated, or superseded by a General Use
Certification, the System Owner shall comply with the following monitoring requirements if
the System is subject to a total nitrogen concentration limit in accordance with paragraph B?
(28)
K1eanTu NitROE 2K Provisional Approval,May 2020 Page 8 of 15
Technology:NitROE®2KS&2KM WWTS
a) Year-round properties shall be inspected and sampled for at least the TN parameter a
minimum of twice/year, at least 5 months apart and with at least one sample taken
between December 1 and March l of each year. Field testing shall be completed as
determined necessary by the System operator, see DEP Field Testing Protocol at
http://Www.mass.govleealdocsldep water/laws/i-thru-z/testsamp.pdf.
Water meter readings shall be recorded at each inspection, see"Flow Metering"below.
b) Seasonal properties shall be sampled for at least the TN parameter a minimum of
twice/year. At least one annual sample must be taken 30 to 60 days after each seasonal
occupancy. A second sample must be taken no less than 2 months after the first sample.
Field testing of the System shall be completed as determined necessary by the operator.
Water meter readings shall be recorded at each inspection, see"Flow Metering"below.
32. Flow Metering - At a minimum, for all systems installed prior to this Approval, water meter
flow data shall be recorded each time the system is inspected and sampled by the System
Operator. For systems installed after the effective date of this Approval, wastewater flow data
shall be recorded each time the system is inspected and sampled by the System Operator and
may be based on:
a) actual metering data of wastewater flow to the system;or
i b) water meter data for the total facility with metered non-wastewater flows, if available,
subtracted from the total facility water usage.
33. Field Testing: Turbidity, pH and Apparent Color - Turbidity, pH, DO and apparent color shall
be measured and/or recorded in the field when when determined necessary by the operator.
See applicable sections of the Department's Field Testing Protocol at
http://www.mass.gov/eealdocs/dep/water/laws/i-thru-z/testsamp.pdf.
34. At a minimum,the System Operator shall inspect the System:
a) two times per year;
b) in accordance with the approved O&M manual, the Designer's operation and maintenance
requirements, and the requirements of the local approving authority; and
c) any time there is an alarm event, equipment failure,or system failure
35. The System Operator shall collect samples and obtain analysis results from an approved lab,
perform field testing required by the Approval and submit results within 60 days of the site
visit to the System Owner.
36. If the Company successfully demonstrates the effectiveness of the System to reduce nitrogen
loadings during the Performance Evaluation period, a minimum of three years, the System
Owner shall operate the System subject to the requirements of the General Use Certification, if
issued, for this technology.
C. Special Conditions Specific to the Company
1. The Approval shall only apply to model units with the same model designations specified in
this approval and meet the same specifications, operating requirements, and plans, as
provided by the manufacturer at the time of the application. Any proposed modifications of
the units shall be subject to the.review of the Department for coverage under the Approval.
t II
I ,
'J
K1eanTu NitROE 2K Provisional Approval,May 2020 Page 9 of 15
Technology:NitROEO 2KS&2KM WWTS
2. Prior to submission of an application for a DSCP,the Company shall provide to the Designer
and the System Owner:
a) All design and installation specifications and requirements;
b) An operation and maintenance manual, including:
i) an inspection checklist;
ii) recommended inspection and maintenance schedule;
iii)monitoring(i.e.water use and power consumption)and sampling procedures, if any;
iv)alarm response procedures, if any, and troubleshooting procedures;
c) An owner's manual, including proper system use and alarm response procedures, if any;
d) Estimates of the Owner's costs associated with System operation including, when
applicable: power consumption, maintenance, sampling, recordkeeping, reporting, and
equipment replacement;
e) A copy of the Company's warranty; and
f) Lists of Designers,Installers,and Service Contractors.
3. The Company shall implement the Performance Evaluation Plan, as submitted and approved
by the Department, and shall be responsible for all data collection and submissions to the
Department until a final determination on the Performance Evaluation has been made by the
Department.
4. Until a final determination has been made by the Department on a completed Performance
Evaluation, the Company shall submit to the Department an annual report by February 15th
of each year that includes the following:
a) a table of all sample data collected for all systems installed to date and all information
required by the Department as part of the approved Performance Evaluation Plan;
b) status of preparation of a Performance Evaluation Plan if not yet provided to MassDEP, or
any recommended changes to the approved Performance Evaluation Plan;
c) a list of pending applications for system installations which have been submitted to local
approving authorities;
d) identification of any System after start-up in violation of the Approval or not in
compliance with any performance criteria at the time of the annual report, the reasons for
the noncompliance and the status of any corrective actions that are needed; and
e) any recommendations and requests for changes to the system monitoring and reporting
plan or the performance criteria of the Approval.
The report shall be signed by a corporate officer,general partner or the Company
owner.
(Service Contractor records submitted to the Company should not be included with the
annual report to the Department,but shall be made available to the Department within
30 days of a request by the Department.)
5. The Company shall institute and maintain a program of Installer training and continuing
education that is at least offered annually. The Company shall maintain and annually update,
and make available the list of qualified Installers by February 15th of each year. The
Company shall certify that the Installers on the list have taken the training and passed the
Company's training qualifications.
KleanTu 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 fo- 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, shE.11 constitute violation of the Approval by the Company
unless the Department determines ofinerwise.
IV. CERTIFICATION AND NOTIFICATION REQUIREMENTS
1. Thirty (30) days prior to submitting an application for a DSCP, the Company or its
representative shall provide to the Approving Authority a certification, signed by the owner
of record for the property to be served by the unit, stating that the property owner:
a) has been provided a copy of the Provisional Use Approval and all attachments and
agrees to comply with all terms and conditions;
b) has been informed of all the owner's costs associated with the operation including power
consumption, maintenance, sampling, recordkeeping, reporting, and equipment
replacement;
K1eanTu NitROE 2K Provisional Approval,May 2020 Page 11 of 15
Technology:NitROE®2KS&2KM WWTS
c) understands the requirement for a contract with a company approved operator and has
been provided a current list of all approved operators;
d) agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR
15.287(10)and the Approval;and
e) agrees to fulfill his responsibilities to provide written notification of the Approval
conditions to any new owner, as required by 310 CMR 15.287(5).
2. Upon submission of an application for a DSCP to the Approving Authority, the Company
shall submit to the Approving Authority, with a copy to the Designer and the System Owner,
a certification by the Company or its authorized agent that the design conforms to this
Approval and that the proposed use of the System is consistent with the unit's capabilities and
all Company requirements. The review shall include evaluation of the need for installation of
water meter(s) at each facility. An authorized agent of the Company responsible for the
design review shall have received technical training in the Company's products.
3. The. System Designer shall be a Massachusetts Registered Professional Engineer, or a
Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system
with a discharge greater than 2,000 gallons per day.
4. Thirty (30) days prior to delivery of the treatment unit to the site for installation, the
Company shall provide to the Approving Authority a copy of a signed contract for a
minimum period of one year with a Company approved Operator and the initial
Owner/Occupani 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 us.- 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
K1eanTu NitROE 2K Provisional Approval,May 2020 Page 13 of 15
Technology:NitROE®2KS&2KM WWTS
10. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts
Registered Sanitarian, including when designing systems for repair, provided that such
Sanitarian shall not design a system to discharge more than 2,000 gallons per day.
11. Prior to the application for a DSCP,the Designer shall provide the System Owner with a copy
of this Approval.
Standard Conditions Applicable to the Company
12. This Approval shall be binding on the Company and its officers, employees, agents,
contractors, successors, and assigns. Violation of the terms and conditions of this Approval
by any of the foregoing persons or entities, respectively, shall constitute violation of this
Approval by the Company unless the Department determines otherwise.
13. The Company shall include copies of the Approval with each System that is sold. In any
contract executed by the Company for distribution or re-sale of the System, the Company
shall require all vendors, distributors, and resellers to provide each purchaser of the System
with copies of the Approval.
14. The Company shall make available, in printed and electronic format, the approved
Attachments and any approved updates associated with the Approval, to the System Owners,
Operators,Designers,Installers,vendors,resellers, and distributors of the System.
15. The Company shall submit to the Department for approval any proposed updates or changes
to the Attachments to the Approval.
16. The Company shall notify all System Owners, resellers, and distributors of changes to the
Approval within 60 days of issuance by the Department.
17. The Company shall notify the Department's Director of the Wastewater Management
Program at least 30 days in advance of the proposed transfer of ownership'of the Technology
for which the Approval is issued. Said notification shall include the name and address of the
proposed owner containing a specific date of transfer of ownership, responsibility, coverage
and liability between them. All provisions of the Approval applicable to the Company shall
be applicable to successors and assigns of the Company, unless the Department determines
otherwise.
18. The Company shall furnish the Department any information that the Department requests
regarding the Technology within 21 days of the date of receipt of that request.
19. If the Company wishes to continue the Approval after its expiration date, the Company shall
apply for and obtain a renewal of the Approval. The Company shall submit a renewal
application at least 180 days before the expiration date of the Approval, unless written
permission for a later date has been granted in writing by the Department. Upon receipt of a
timely and complete renewal application, the Approval shall continue in force until the
Department has acted on the renewal application.
Reporting
�4
KleanTu NitROE 2K Provisional Approval,May 2020 Page 14 of 15
Technology:NitROE®2KS&2KM WWTS
20. All notices and documents required to be submitted to the Department by the Approvalshall
be submitted to:
Director
Wastewater Management Program
Department of Environmental Protection
One Winter Street- 5th floor
Boston,Massachusetts 02108
Rights of the Department
21. The Department may suspend, modify or revoke the Approval for cause, including, but not
limited to, noncompliance with the terms of the Approval, non-payment of any annual
compliance assurance fee, for obtaining the Approval by misrepresentation or failure to
disclose fully all relevant facts or any change in or discovery of conditions that would
constitute grounds for discontinuance of the Approval, or as necessary for the protection of
public health, safety, welfare, or the environment, and as authorized by applicable law. The
Department reserves its rights to take any enforcement action authorized by law with respect
to the Approval and/or a System utilizing the Technology against the Company,the Designer,
the System Owner,the Installer,and/or the Operator of the System.
VI. GENERAL CONDITIONS
Title 5 Regulations 310 CMR 15.287: "General Conditions for.Use of Alternative Systems Pursuant to
310 CMR 15.284 through 15.286"
"The following conditions shall apply to all uses of alternative systems pursuant to 310 CMR 15.284
through 15.286:
1. All plans and specifications shall be designed in accordance with 310 CMR 15.220.
2. Any required operation and maintenance, monitoring and testing plans shall be submitted to
the Department and approved prior to initiation of the use. Monitoring and sampling shall be
performed in accordance with a Department approved plan. Sample analysis shall be
conducted by an independent U.S.EPA or Commonwealth of Massachusetts approved testing
laboratory, or an approved independent university laboratory, unless otherwise provided in
the Department's written approval. It shall be a violation of 310 CMR 15.000 to omit from a
report or falsify any data collected pursuant to an approved testing plan.
3. The facility served by the alternative system and the system itself shall be open to inspection
and sampling by the Department and the Local Approving Authority at all reasonable times.
4. The Department and/or the Local Approving Authority may require the owner or operator of
the system to cease operation of the system and/or to take any other action necessary to
protect public health, safety,welfare and the environment.
5. The owner or operator shall provide written notice to any new owner or operator that the
system is an alternative system. Such notice shall include notice of the general conditions and
any special conditions applicable to the system and its owner.
I
u
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
P S
Approving Authority.
I
317 Lakeside Drive - Provided by Homeowner
shed
Back Yard
bathroom closet with stackahle
bedroom 1
Kitchen washer/dryer
.driveway
deck
Fbedroom 2 Living Room
Dining room
Front Yard
v
i
September 9, 2021
Barnstable Board of Health
200 Main Street
Hyannis, MA 02601
Sirs,
This email is to verify that I have authorized Horsley Witten to design plans for an alternative septic
system to be installed at my house. This plan will be submitted to you for approval.
Please don't hesitate to contact me with any questions.
L11
Jessalyn BloXdin(Oct 6,2021 15:05 EDT)
Jessalyn Blondin
317 Lakeside Drive
Marstons Mills, MA 02648
KleanTu® LLC
KleanTu Wastewater P.O. Box John R.Smith
math
Treatment
1154
Technologies Edgartown,MA 02539
v 412-719-5976-Mobile
508-627-3072-Office
September 8,2021
To: Town of Barnstable Board of Health
200 Main Street
Ayannis,MA 02601
RE: Designer Certification for New NitROE®2KS WWTS Enhanced Title 5 Septic System Installation
r=or 317 Lakeside Drive, Marstons Mills,MA 02648; KleanTu Project#80035-2109
Dear Members of the Board:
Kindle refer to the following: (i)the Mass DEP Provisional Permit issued to K1eanTuo LLC(DEP Transmittal
No.X285590; Issued May 12, 2020)(the"DEP Permit");and(ii)the Enhanced Title 5 Septic System design for the
317 Lakeside Drive,Marstson Mills,MA private residence(the"New System"),featuring the use of a new
NitRGE0 2KS wastewater treatment system(the"NitROE8 2KS Components'). The New System was designed by
Joseph Henderson, a Massachusetts Registered Professional Engineer with Horsley Witten Group, Inc.(HWG).
The NtROEO 2K Components are depicted in Site Drawing Project No.: 20112,prepared by HWG and dated
September 2,2021.
Item 1V-#2 of the DEP Permit requires that Klean7u®make certain certifications to the Town of Barnstable Board
of Health(the"Board")pertaining to the design of the New System.
Accordingly,KleanTu LLC hereby certifies to the Board that(i)the New System design,solely as it relates to the
NitRC-E®2KS Components and their incorporation into the New System,conforms with the design specifications
required by the DEP Permit and(ii)the NitROEO 2KS Components are able to perform the proposed wastewater
treatment for the New System.
Sincerely yours,
.loborssmFL(sop n,2fYLttn:nt-DT)
John R. Smith
Presid:nt
cc: Joseph Henderson,Horsley Witten Group .
Jessalyn Blondin, Property and System Owner
- 1-
KleanTu® LLC
John R.Smith
KLeanTu Wastewater P.O. Box 1154
Treatment
Technologies Edgartown,MA 02539
k, 412-719-5976-Mobile
508-627-3072-Office
September 8,2021 -
Town of Barnstable Board of Health
200 Main Street
Hyannis, MA 02601
RE: Property and System Owner Certification for New NitROE02KS WWTS Enhanced Title 5 Septic System
Installation for 317 Lakeside Drive, Marstons Mills, MA 02648;KleanTu Project#80035-2109
Dear Members of the Board:
Kindly re'er to the following: (i)the Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal
No.X285590;issued May 12,2020)(the"DEP Permit");and(ii)the Enhanced Title 5 Septic System proposed for
317 Lakeside Drive,Marstons Malls,MA,a private residence,(the"New System'), featuring the use of a new NitROE®
2KS wastewater treatment system_•(the"NitROE®2KS Components").
Item IV-45 of the DEP Permit requires that KleanTu®LLC provide to the Town of Barnstable Board of Health(the
"Board")a certification that the owner of the property of record has agreed to certain specific matters with respect to the
New System.
I have incuded with this letter the required certification.
Should you have any questions, please do not hesitate to contact me.
Sincerely yours,
1,1in B,mith fort i L021.34:24 n r) - -
John R. Smith
President
Enclosure
cc: Jessalyn Blondin, Property and System Owner
- 1-
-P'. . ;
September 8, 2021
K1eanTuo LLC
John R. Smith
P.O. Box 1154
Edgartown,MA 02539 -
Dear Sir:
I refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.X285590;
Issued May 12,2020)(the"DEP Permit');and(ii)the Enhanced Title 5 Septic System(the"New System')proposed for
my private residence at 317 Lakeside Drive,M.arstons Mills,MA 02648, featuring the use of a new NitROE®2KS
wastewater treatment system(the"NitROE®2KS Components").
By signing this letter and deliver_ng it to you,as the owner of the property known as 317 Lakeside, Marstons Mills,MA
02648, I/we hereby certify to the accuracy of all of the following statements:
1. I have been provided a copy ofthe.DEP Permit and I agree to comply with all terms and conditions cited therein.
2. 1 have received estimates of all homeowner's costs associated with the operation of the NitR6E8 2KS
Components including power consumption and equipment replacement,as well as maintenance,sampling,
recordkeeping, reporting and related matters for the NitROE®2KS Components(collectively,the"O&M
Responsibilities.").
3. I understand that I must enter into a contract by which my O&M Responsibilities will be fulfilled with KleanTu®
or a KleanTu®-approved operator licensed by the Mass DEP as required by the DEP Permit.
4. I understand that I must provide a Deed Notice to the Town of Barnstable Board of Health as required by 310
CM 15.287(10)and the DEP Permit.
5. 1 understand that I must fulfill my responsibilities to provide written notification of the conditions of the DEP
Permit to any new owner,as required by 310 CMR 15.287(5).
Sincerely yours,
Jessalyn BIo din(Nov4,202117:33 EDT)
Jessalyn Blondin
2
KleanTu° LLC
John R.Smith
KleanTu Wastewrater P.O. Box 1154
Treatment
Technologies Edgartown,MA 02539
412-719-5976-Mobile
508-627-3072-Office
September 9,2021
Ms. Jessalyn Blondin
317 Lakeside.Drive
Marston Mills,MA 02648
Joseph Henderson
Horsley Witten Group
90 Route 6A,Unit 1
Sandw=.ch,MA 02563
RE: ILnstaller Certification for New NitROE02K WWTS Enhanced Title 5 Septic System Installation
for 317 Lakeside Drive,Marstons Mills,MA 02648;KleanTu Project#80035-2109
Dear Jessalyn:
Kindly refer to the following: (i)the Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal
No.X285590;Issued May 12,2020)(the"DEP Permit');and(ii)the Enhanced Title 5 Septic System proposed for
a private residence located at 317 Lakeside Drive, Marstons Mills,MA(the"New System"), featuring the use of a
new Ni:ROE®2KS wastewater treatment system(the"NitROE®2KS Components").
Item IV-#5 of the DEP Permh requires that the system installer makes certain certifications to both of you
pertaining to the installer's qualifications as to its ins-allation of the NitROEO 2KS Components. K1eanTOLLC
acknowledges that the installer will be trained and certified prior to installation. In addition,KleanTu®LLC hereby
certifies that KleanTu®personr_el will be onsite to supervise the installation of the NitRO.E®2KS Components.
Such supervision will ensure that the.NitROE®2KS Components are installed in a manner that conforms with
LLC's design and operating requirements.
Please contact me with any questions or comments regarding this certification. My cell#is 412-719-5976.
Sincerely yours,
Jaw KFu(Oct 6:39 F.DTI :. ..
Jaw K.Ii u
Vice-President
KleanTu® LLC
KleanTu wastewater John R.Smith
Treatment P.O.Box 1154
Technologies Edgartown,MA 02539
r
412-719-5976-Mobile
508-627-3072-Office
CONTRACT No. 80035-2109 for 317 Lakeside Drive,Marstons Mills,MA 02648; pg. 1/5
September 9,2021
Ms.Jessalyn Blondin -
317 Lakeside Drive
Marstons Mills,MA 02648
RE: NitROE®2K WWTS Start-Up and Monitoring,Operation and Maintenance(MOM)for 317 Lakeside
Drive, Marstons Mills,MA 02648;KleanTu®Job No. 80035-2109
Dear Jessalyn:
In concert with the Barnstable Clean Water Coalition(BCWC),KleanTu®LLC is pleased to submit this
"Contract"to provide Start-Up and Monitoring,Operation,and Maintenance(MOM)oversight services for up to
five years from the NitROE®2K Waste-Water Treatment System(WWTS)installation date at 31.7 Lakeside
Drive,Marstons Mills, MA.
The main purpose of the NitROE®2K WWTS is to enhance your Title 5 Septic System for the purpose of
significantly reducing total nitrogen(TN)from the sanitary wastewater flow. In addition to significant TN
reduction, the NitROE®enhanced Title 5 septic system will also produce a highly treated effluent low in organic
carbo-L constituents(measured as 130135)and low in total suspended solids(TSS)levels.
Please note that entering into a yearly MOM.contract is a requirement of KleanTu's Massachusetts Department of
Environmental Protection(DEP)Provisional Permit(DEP Transmittal No.X285590;.issued May 12,2020). As
this is the first year of operation, start-up services are also provided. As cited in Section IV-4 of the Provisional
Perm:.t,yearly OM&M contracts must be in place to ensure proper operation and consistent treatment
performance. In this regard,this contract also provides budgetary price estimates for subsequent years of MOM.
CONTRACT DETAILS AND PRICE PROJECTIONS
As cired in Table 1,regarding start-up and MOM services,it is to be noted that the BCWC will provide for and
cover all costs associated with MOM including sample collection and analyses for the first five Years of
operation.
BCW- intends to work with The Massachusetts Alternative Septic System Test Center(MASSTC)and the U.S.
Environmental Protection Agency(US EPA)to cover all MOM costs for a total period of 5 years as part of the
Shubael Pond Innovative and Alternative Septic System Project. After this initial five years, MOM related costs
will ba the responsibility of the homeowner.
- 1-
I
r ,
CONTRACT No.80035-2109 for 317 Lakeside Drive,Marstons Mills,MA 02648; Im.2/5
All MOM activities,including monitoring and sample collection,will be performed,or directly supervised by a
System Operator that has been certified at a minimum Grade.Level IV by the Board of Operators of Wastewater
Treatment Facilities,in accordance with Massazhusetts regulations 257 CMR 2.00. Specific to any KleanTu®
Contract,the System Operator will be John R. Smith,Certificate No.: 1914.
Electronic copies of the Provisional Permit and the NitROE®2K WWTS MOM Manual are provided along with
this contract proposal.
Table 1. Scheduled(Routine)Yearly MOM Deliverables and Pricing for New NitROV 2KS WWTS for
317 Lakeside Drive,Marstons Mills,MA.
Time Price per Period
Period Deliverables ($)
Oc--)ber 2021 . Start-Up including bacterial seeding and monitoring at least once every $0
to 2 weeks during the I"8-weeks of operation to ensure that NitROE®2K (All related MOM
September WWTS is properly functioning. costs to be paid for
2022 . Provide and Review an O.M&M Manual to homeowner and address any by the BCWC)
(12 months) and all related questions.
• Monthly Sample Collection and Analyses beyond what is required by
the Mass DEP Provisioral Permit.
0 Respond to Homeowner issues,concerns and questions.
• Monthly Inspection and Quarterly Monitoring Updates to
Homeowner.
(NOTE:All NitROE®WWTS Components Covered Under Warranty)
October 2022 . Sample Collection and Analyses with minimum per Mass DEP $0
to Provisional Permit. (All related MOM
September . Respond to Homeowner issues,concerns and questions. costs to be paid for
2027 by the BCWC)
(5 years) ' Quarterly Inspection and Monitoring Updates to Homeowner.
October 2027 . Quarterly Inspection and Sample Collection per Mass DEP General $600- $1,200
and Permit conditions. (Projected Range of
beyond . Covers Maximum of 4 site calls per year. Yearly Contract to
• Yearly Update to Homeowners. be covered by the
(NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) Homeowner)
These terms are expected to be modified(e.g.,monthly monitoring)as a result of the Shubael Pond Innovative and Alternative
Project with all relevant MOM cost covered by BCWC,MASSTC and US EPA.
-2-
CONTRACT No.80035-2109 for 317 Lakeside Drive,Marstons Mills.MA 02648, De: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
OM&M price reduction is primarily due to the fact that the Mass DEP requirements for inspections and sampling
and analyses move from quarterly(under the Provisional.Permit)to yearly under a General Use Permit. At this
time, -t is not known if a General Use Permit will be issued in year 2022 or 2023 as that decision rests with the
Mass DEP.
It is also cited in Table 1 that this I"year contract,once executed,runs from October 2021 - September 2022,
anticipating use immediately after installation. As the NitROE02K WWTS operation then moves into 2022,a
new contract will need to be executed with each renewal for a minimum 1-year period.
In adcition 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 KleanTue 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 cove-the first five years of MOM support,it is to be noted that all the items cited in
Table 2 will need to be covered by the homeowner as respective issues and situations arise after this initial five-
year period.
The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the
continuous operation of one(1)120-watt air pump required to enhance and maintain the appropriate level of
biological processes required. This yearly electrical cost will be borne by the homeowner,along with periodic
pumping of their septic tank as required.
-3-
CONTRACT No. 80035-2109 for 317 Lakeside Drive,Marstons Mills,MA 02648; ve.4/5
Table 2. Non-Routine MOM Items and Projected Price Estimates for New NitROE®2KS WWTS
Replacement Items for 317 Lakeside Drive,Marstons Mills,MA
Item Description Price Estimate
Air Pump • One(1) 120 W air pump. $210
Electrical . Total daily electrical usage measured at—2.9 kWhr/day/pump. per Year
Usage . Cost/day at$0.20/kWhr x 2.9 kWhr/day=$0.58/day.
Nan-routine . After 12-month warranty period,troubleshooting site calls(more $120
Troubleshooting than 4/year)will be charged at$120/hr with 1 hour minimum. per Hour
Visits
• KleanTu®will determine when this is needed based on scheduled $200- $300
site visits. (for EST Septic
Septic Tank • Pump out to be done by non-KleanTu®contractor with estimated Tank Pumped
(EST)Pump Out price=$200-$300/EST tank.
out every
• Exact time period is site-specific with estimate of every 3-8 years.
2-3 Years)
(NOTE: This pump out cost would need to be done even if this was a
conventional Title 5 septic system)
• Replacing remote sensing unit and probes=$360. $360
Replace Remote . Exact time period is variable with estimate of every 8-10 years. (Every
Sensing Probes (NOTE: For remote sensing operation, 8-10 Years)
and Unit Wi-Fi connection from homeowner is needed)
• Air pump repair and/or replacement. $500
Replace Air . Exact time period range is variable with estimate of every 5-8 (Every
Pump years.
5-8 Years)
• Replace all air tubing=$800. $800
Replace Aeration . Exact time period is variable with estimate of every 10-20 years. (Every
Tubing 10-20 Years)
Replace Wood . Replace all wood chips=$1,000. $1,000
Chips . Exact time period is variable with estimate of every 20-30 years. (Every
20-30 Years)
Replace . Limestone Addition=$1,600. $1,600
Limestone . Exact time period is variable with estimate of every 20-30 years. (Every
20-30 Years)
-4-
4
CONTRACT No.80035-2109 for 317 Lakeside Drive Marstons Mills MA 02648., pg 5/5
PAYMENT TERMS
Even though there is no site owner cost for the first five years of MOM,the contract still needs to be signed and
executed by the site owner as it is a confirmation that he/she accepts responsibility for associated MOM costs in
subsequent years.
Contacts executed for subsequent yearly time periods will need to be signed by October of the respective
contract time period with the entire contract amount paid at that time.
After the five-year period,all related MOM costs will be borne by the homeowner/system owner cited herein.
CONTRACT ACCEPTANCE
To execute this contract,and comply with Mass DEP Provisional Permit Requirements,please sign below to
acknowledge acceptance of this proposal and mail original with your signature,or e-mail pdf copy of this page
with your signature,back to me.
Please contact Zenas"Zee"Crocker,7-crockernbcleanwateL=,of Barnstable Clean Water Coalition.with any .
questions or comments.
Than{you,
John R Sirith(Oct 1,202114:21 EDT)
John R. Smith
President
SYSTEM OWNER SIGNATURE
Name: Jessalyn Blondin
Signature: Jessalyn Dlo din(Nov 4,202117:33 EDT)
� -5-
KleanTuO LLC
John R.Smith
Mean Wastewater P.O.Box 1154
Treatment
Technologies Edgartown,MA 02539
412-719-5976-Mobile
508-627-3072-Office
CONTRACT No.80035-2109 for 317 Lakeside Drive,Marstons Mills,MA 02648;Pg. 1/6
September 9,2021
Ms.Jessalyn Blondin
317 Lakeside Drive
Marstons Mills,MA 02648
RE: NitROE02K WWTS Installation for 317 Lakeside Drive, Marstons Mills, MA K1eanTu®Job No. 80035-2109
Dear J--ssalyn:
K1eanTO LLC is pleased to provide this contract document for a NitROE®2K Waste-Water Treatment System
(WWTS)to be installed at 317 Lakeside Drive,Marstons Mills,MA. The main purpose of the NitROE®2K
WWTS is to serve as a supplemental upgrading of a new Title 5 septic system. A new NitROE®2K WWTS tank
will be inserted in between the gravity flow path of a new septic tank and a new leaching chamber. The purpose of
the NitROE"2K WWTS is to significantly reduce total nitrogen(TN)from the sanitary wastewater flow prior to
permi4ed 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:
NitROEO ENHANCED TITLE 5 SEPTIC SYSTEM OVERVIEW
The N:tR0E82K WWTS to be installed is specified in Site Drawing Project No.20112,prepared by Horsley
Witten Group Inc.(HWG)dated September 2,2021.
With reference to this site drawing,wastewater will first be collected into an existing 1,500-gallon septic tank.
After solids separation in the septic tank,wastewater will then gravity flow into a new 2,000 gallon H10 NitROE®
2KS WWTS tank for enhance total nitrogen reduction. From there,the significantly treated wastewater will gravity
flow into a new leaching chamber.
1 ',
CONTRACT No.80035-2109 for 317 Lakeske Drive,Marstons Mills,MA 02648,Pa.2/6
REGULATORY REQUIREMENTS
The NitROE®2K WWTS will be installed and operated under a Mass DEP Provisional Permit granted to KleanTu®
LLC(DEP Transmittal No.:.X285590; issued May 12, 2020). Specific regulatory items that need to be addressed
are summarized below. It is to be noted that various actions among the site owner,the site design engineer,the
installer,and KleanTu®LLC must be followed and respectively documented. The majority of the documentation
required will be provided by the Barnstable Clean Water Coalition(BCWC)with input from KleanTu®.
Furthermore,these Mass DEP regulatory requirements pertain to respective actions from project initiation through
to NitROE®2.K WWTS start-up and yearly operation.
A. Obtaining a Disposal System Construction Permit(DSCP). This is issued by the local Board of Health
(BoH)after completion of the following:
1. Submittal of the site engineering design and DSCP application to the local BoH. Normally this is
done by the Design Engineer.
2. Along with the DSCP application,to comply with Section IV-1 of the Provisional Permit,the
BCWC,with input from KleanTu®LLC,will provide to the local BoH,a certification letter that
the site owner:
i. Has been provided a copy of the Provisional Use Approval and agrees to comply with all
terms and conditions cited herein.
ii. Has been informed of Gll owner's costs associated with operation&maintenance(O&M)
activities with the operation of the New NitROE®2K WWTS Enhanced Title 5 Septic
System to be installed, including power consumption,maintenance, sampling,
recordkeeping,reporting,and equipment replacement.
iii.Understands the requirements for a O&M contract to be in place with KleanTu®LLC, or
with their designated and trained entity,and that the NitROE®2K WWTS operator must
be licensed by the Mass DEP as stipulated in KleanTu®'s Provisional Permit.
iv. Agrees to fulfill their responsibilities to provide a Deed Notice,and file with the local
Registry of Deeds,as required by 310 CMR 15.287(10)and with the Approval by the
local BoH.
v. Agrees to fulfill their responsibilities to provide written notification of the Approval
conditions to any new owner,as required by 310 CMR 15.287(5).
3. Along with the DSCP application,to comply with Section IV-2 of the Provisional Permit,the
BCWC,with input from KleanTu®LLC,will provide to the local BoH,with a copy to the
Designer and the Site Owner,that the site-specific design conforms to Provisional Permit
requirements and that the proposed use of the NitROE®2KM WWTS is consistent with the unit's
capabilities and all KleanTu®LLC requirements.
2
i
CONTRACT No.80035-2109 for 317 Lakeside Drive Marstons Mills MA 02648• pg 3/6
B. Executed Operation&Maintenance Contract In-Place. To comply with Section IV4 of the
Provisional Permit,thirty(30)days prior to installation of the;NitROE®WWTS,the BCWC,with input
from KleanTu®LLC,will provide to the local BoH,a copy of a signed O&M contract for a minimum
period of one year,between the site owner and.KleanTu®LLC,or their designated approved operator,who
has been properly trained and certified by KleanTu®. .In this regard,in addition to signatory execution of
this Contract document,the site owner will also be required to sign and thus execute an O&M contract for
start-up and the first 12-months of operation and monitoring.
C. Obtaining a Certificate of Compliance(COC). This is issued by the local Board of Health(BoH)after
installation, local BoH inspection and sign-off,and completion of the following to comply with Sections
IV-5 and IV-6 of the Provisional Permit citing the following:;
l. A local BoH inspector,the installer and the designer all need to sign the COC and thus certify,in
writing,that the NitROE®2K WWTS was constructed in compliance with both the Provisional
Permit and Mass DEP 310 CMR 15.000 requirements,and that any changes to the design plans are
reflected in as-built drawing and/o:notes. The completed COC then needs to be filed with the
local BoH.
2. The BCWC,with KleanTu®LLC input,will submit awritten certification letter to the local BoH,
and copy the site owner,that the:
i. NitROE®WWTS has been constructed and installed in compliance with approved site
design plans,the Provisional Permit requirements,Mass DEP 310 CMR 15.000 and local
BoH requirements.
ii. NitROE®WWTS was constructed and installed under direct supervision and oversight by
KleanTu®personnel,and that KleanTu®also did the installation of the aeration system,
bacterial seeding of the tanks, and installation of other pertinent items such as risers and
access ports.
D NitROE®WWTS Site Inspections and Monitoring. To comply with Section III B,items 13-36 of the
Provisional Permit related to Operation and.Maintenance(O&M),KleanTu®, or a designated
representative entity trained by KleanTu,will be responsible for doing the appropriate number of site
inspections,along with sampling and analyses for specific wastewater treatment parameters,and for
reporting respective results to the Site Owner,the local BoH and the Mass DEP. Initially the required
number of site visits and monitoring wi J 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
i
CONTRACT No. 80035-2109 for 317 Lakeside Drive Marstons Mills MA 02648• PLY.4/6
INSTALLATION ACTIVITIES AND PRICE
For installation of the enhanced NitROE®2K WWTS,the task activities to be carried out,along with their
respective prices,are provided in the table below.
IT IS TO BE NOTED THAT ALL OF THE COSTS CITED WILL BE COVERED BY THE
BARNSTABLE CLEAN WATER COALITION(BCWC) PER AN AGREEMENT THEY HAVE WITH
THE SITE OWNER
An electronic copy of the NitROEO WWTS Installation Manual is provided along with this Contract proposal. This
document serves to identify t:1e various activity responsibilities among the site owner or the BCWC,the installer
and KieanTuo LLC. Of particular note, it is the responsibility of the site owner to identify and make the installer
aware of any buried utility lir.es such as gas,electrical and cable; here Dig Safe can be contacted to provide this
service at no cost(htt ://wwvLeiigsafc.cc�rn),but they only identify public utility lines and not any private lines.
As cited in the Table 1 below,the contract price for KleanTue to provide the task activities cited is$12,500.This
also cues that the site owner is also responsible for the engineering and installation services to be done by others.
Additionally,it is to be noted that the BCWC will arrange for,and pay for additional site-specific activities related
to:
1. Providing a dedicated electrical service and a two-receptacle GFi outlet box in a location near the NitROE®
2KS tank locations.
2. Filing a notarized deed restriction with Barnstable County and paying the filing fee as well as obtaining a
copy of the deed restriction document for the local BoH. A deed restriction to be executed is provided with
this contract proposal.
4
i
CONTRACT No.80035-2109 for 317 Lakeside Drive,Marstons Mills.MA 02648,pg.5/6
Table 1. KleanTu"Price of Title 5 Enhancement via NitROE®2KS WWTS Enhancement
for 317 Lakeside Drive,Marstons Mills,MA 02648
ONE 2,000 GALLON NitROE TANK(N-ASST20M-H10)
(KleanTu°Project No.80035-2109)
KleanTu°
Task Categories and Description Price
(Covered
by BCWC)
Task 010-Project Management,Engineering and Permitting
Includes overall project management coordination including review and input to the site engineering
design,local BoH and MassDEP permitting interactions,and ensuring that all work is done in a manner
protective of workers and the environment. Note:BCWC is responsible for site design engineering and local $0
BoH interactions including obtaining all permits and final certification. BCWC is also responsible for filing
"Notice of Alternative Sewage Disposal System"with Registry of Deeds and pay$105 fee,with KleanTu°
providing review and coordination.
Task 020-Procurement and Field Fabrication of TWO Concrete Tanks
Includes providing one 2,000-gallon NitROE®2KS H-10 tank at a price of$12,500. These prices include all $12,500
media,access riser ports and covers near or to surface,aeration assembly w/air pump and installed air
tubing,and faux rock for air pump enclosure.
Task 030-Tank Delivery and Installation Oversight
Installation oversight and air-line hook-up of delivered NitROE®Tank,including remote sensing unit
connection to homeowner Wi-Fi network. Note:BCWC is responsible for procurement and sewer piping $0
connections of septic and NitROE®tank,procurement and installation of leach chambers and all piping
connections,providing electrical service(120V;20 amp)and outlet boxes to location selected by site owner
for running air pump. NOTE:TASK ACTIVITIES PROVIDED BY KLEAN TU AS IN-KIND SERVICE.
TASKS 010-030 TOTAL THRU INSTALLATION $12,500
Task 040-Start-Up and Monitoring,Operation&Maintenance(MOM)Per MassDEP Provisional Permit
and Barnstable BoH Requirements
Includes NitROE®WWTS bacterial seeding,system start-up,bi-monthly visits,quarterly sampling and
analyses by MA certified lab,record keeping and reporting required by MassDEP,and operational oversight $0
for 1st year to address issues that may arise. MOM for subsequent years will be$500-$1,300 depending
on MassDEP and Barnstable BoH requirements. Note: 1st five years of MOM to be covered by BCWC;
subsequent years to be determined to be borne by the homeowner.
Note: Final Grading and Some Landscaping to be Provided by BCWC
5
f
CONTRACT No. 80035-2109 for 317 Lakeside Drive Marstons Mills MA 02648• Re 6/6
SCHEDULE
Barring unforeseen circumstances,KleanTuo will have the NitROE WWTS tank ready for installation in
October 2021,with the actual date to be finalized with the site owner and their installer.
PAYMENT SCHEDULE
All K1.eanTOcosts to be paid by the BCWC under separate contract with K1eanTO LLC.
WARRANTY
KleanTuo guarantees NitROE®2K WWTS specific equipment and materials to properly operate for a period of one
year. This is contingent that the NitROEO 2K WWTS is installed per the engineering design and that the NitROE0
2K WWTS receives typical sanitary wastewater(as defined per Title 5)and is within the design flow and does not
exceed 330 gallons per day(gpd).
SITE ACCESS
By signing this contract,site owner agrees that KleanTuo and BCWC designated personnel will be allowed access
to the site for the purpose of performing routine MOM activities associated with the NitROE®2K WWTS.
CONTRACT ACCEPTANCE
K1eanTO looks forward to working in partnership with the BCWC and for providing direction and oversight for
install:ng and operating a NitROE®2K WWTS to enhance your upgraded Title 5 septic system.
By accepting this contract,you also agree to comply with the regulatory requirements cited on pages 2 and 3 of this
contract document. Specifically,that you agree to yearly MOM contracts with KleanTuo,or their designated
representative,to begin when the BCWC no longer covers yearly MOM activities. And that you also will work
k with the Registrar of Deeds so that it is identified that you have a
with the BCWC to file the appropriate paperwor
NitROEO WWTS enhanced Title 5 septic system_operating on your property.
To accept this contract so that work may continue as planned,please sign below. Also,please contact Zenas"Zee'
Crocker at zcrocl(er@.beleanwate.r.org at Barnstable Clean Water Coalition with any questions or comments.
Sincerely,
�7ol�h��T litti
John R SmIth(Oct 1,202113:11 HO'h - - --
John R.Smith
President
Name: Jessalyn Blondin Signature: J.IsalynBlo din(Nov 4,zo2i1.7:a2eDrT
6
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
MAP PAt2C,QZ
`o 14 S CSO'Z-
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
CE
Property Address: 317 Lake-,ide Orj
a tows iT--M R
Owner's Name: Steve* 00y LR
1 b 'Cunt
Owner's Address: kB
Mar O / A OF BARMOTIABLE
Date of Inspection: DBG tO. 2001 . ALTH DEPT.
Name of Inspector: (please tint) D&V1 D D. C• oyQ h a h D w'r ii2S
Company Name: E C O - e C h LE h V l P D k *t3N tl I
Mailing Address:4el Trial%oier
Telephone Number: 4- O R4
CERTIFICATION STATEMENT
1 certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
_ Fails
Inspector's Signature: 26 G . S Date: D,_
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should_be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 3 17 Lit Ke 5 i'A a O r
Mo rs t:&hS M I S
Owner: S D
Date of Inspection: O ec. 6 D . ZOO t
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
v I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
_ distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
i
Page 3 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 3 1 7 La k e S i d e, Dir.1�1 Qmt"DWS Milk,
Owner:
Date of Inspection: c 6
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310.CMR 15.303(l)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
••This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 117 lake I of Or
A4 VS tom S IM 1115
Owner: $
Date of Inspection: P G 10, Od 1
D. ,System Failure Criteria applicable to all systems:
You most 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
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'/2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
7 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.[This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than S ppsa,provided that w other failure criteria
are triggered.A copy of the analysis must be attached to this form.[
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system most serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drbddng water supply
the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
i
Page 5 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: '3(7 LA1Ct5 id.P Or
IM a P4 tb N-S I/U;Ll g
Owner: S 00 y
Date of Inspection: [)ec lD, 200 t
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Ye; 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?
vwcA Val;hq
_ Were all system components,eaeludingthe 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:
Yes no
_ Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)(310 CMR 15.=.02(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT&
SUBSURFACE SEWAGE DISPOSAL SV9rEM INSPECTION FORM.:
-PART C
SYSTEM INFORMATION
Property Address: '3(7 t-Or-eslo e Qr
oKS
Owner. S t H OO)e
Date of Inspection: Dee- LO, 2001
FLOW CONDITIONS
RESIDENTIAL or
Number of bedrooms(design):VLA Number of bedrooms(actual): 2-
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1J 4
Number of current residents: 57
Does residence have a garbage grinder(yes or no): Va
Is laundry on a separate sewage system(yes or no):%J0 (if yes separate inspection required]
Laundry system inspected(yes or no):W14
Seasonal use:(yes or no): llk�jo
Water meter readings,if available(last 2 years usage(gpd)): 0Cj(G
Sump pump(yes or no):*J 0
Last date of occupancy:LktCjLWt W o Peas, q.va;l ab le ot t 6014 . Of
COMMERCIAL/INDUSTRIAL �D�POOwtS LABt listed oN �Phw►�+
Type of establishment: °( P P C q
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etcJ:
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: D w h e f— p o r e curt pump—
Was system pumped as part of the inspection(yes or no): V�O
If yes,volume pumped:_gallons--How-was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the cn mt operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
�3+ wars - S yti'f ew1 vi-;f t 1 r4 4--t s-S q - c e rt i�jcqhe o f coyq 1i a k z-e
ut G d N
Were sewage odors detected when arriving at the site(yes or no): V D
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:117 l-g kesid- Df
GFS*&M5 IM,�Is
Owner: 5 $.N SooX_
Date of Inspection: l7 PL L(2, 2001
BUILDING SEWER(locate on site plan)
Depth below grade: C9 l A
Materials of construction: cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line: 69 I +
Comments(on condition of joints,venting,evi¢ence of leakage,etc.):
Sewtlr a1�5 5-hrue-f dra 6L" auma with wo eyidekcp o4 leQk`+�
or baclWe i lkf-0 dwe Eli Air'
SEPTIC TANK:Z(locate on site plan)
Depth below grade: V, V%
Material of construction: concrete_metal_fiberglass polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: $ a� X ri X S, (t 000
Sludge depth: U ,h
Distance from top of sludge to bottom of outlet tee or baffle: 2G 1 h
Scum thickness: 1 �i h
Distance from top of scum to top of outlet tee or baffle: (O i h
Distance from bottom of scum to bottom of outlet tee or baffle: t�i I h
How were dimensions determined: P Po10 a -t-o to P 0; f a NEC
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
py�R V�ot rema, rAol 41 ttiiS title but r'ec0*01eHded
Q��luPKf le vel at ov+lef, luvert j'o1yK and tees an p gr StrVe ov-44?
500Lol f Vr%cfi0A!14-- WO ev►c etice 'leq koc ivl,
o� o U+•.
GREASE TRAP:l.10(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of l l
t
OFFICIAL INSPECTION FORMM4 NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: ID Dr`
�S
Owner: S S.N S 60�
,
Date of Inspection: eG U2 i 2-n I
TIGHT or HOLDING TANK:jftQ (tank must be pumped at time of inspectionXiscoe an site plan)
Depth below grade:
Material of construction: concrete_metal fiberglass_polyethylene_other(explain):
Dimensions:
Capacity: gallons
Design Flow: Qallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):_
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Gff otrttef I hv0-"
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leaks a into or out of box,etc.):
VI l u e it t I u+ ov i Let i e . Few r'f-t at;cf
Q Q-Vt eACe o1 g t<4g-e IK o r ou.+
PUMP CHAMBER: V)6 (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):_
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
4 "
Page 9 of l I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3l7 LakCSiele_ Dr
uy► rr 5+ 0 A5 IM LLS
Owner: S $H 5 0 0 V
Date of Inspection: 0're
SOIL ABSORPTION SYSTEM(SAS): V/ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number: 1
_leaching chambers,number:
_leaching galleries,number:_
_leaching trenches,number,length:
_leaching fields,number,dimensions:
_overflow cesspool,number:
_innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
eLeach Pit Covltkl pied iN D e4p Itre f• Vo damp SDi(S LVSh
ved•e±o-fiaa o,r other ayoAemce of 1AVdP4u1,'c it vre tAt-as
ob SerV�d
CESSPOOLS:_W_a(cesspool must be pumped as pan of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: Q 0(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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM=440T FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 17 Dr
MiU S
Owner: <
Date of Inspection: OD I
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
LAKG- sI DL= DRWE
2 4ed room
OweW%AJ
� 17
f �
3q'\ i
37
007,
10
r ^
S'
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: '5 17 Lq ke e. e D r
to v 5 �a S
Owner: s ey k
Date of Inspection: e C [D{ Z.OU 1
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth toground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
_Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
_Checked with local Board of Health-explain:
_Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You roust describe how you established the high ground water elevation:
u+ r VWve ve f P r Iskows Megof l cy A4,
to 16'a over E 'v% Vv l c h ho SIQ i 14,t
wa+-eV' wq S o served . I h;r IM ea s v re iftem f I k C-tv P+er
4A*y5+W%#A+ - Well ; SDI,! - 253 ZvKe 1,9dv ZoOt LeVP-1 = 53-V
A,&4 jV5 t Inn a h't
tt
I
•` - =- COMMONWEALTH OF.ir1ASSACHi.;SETTS
EXECUTIVE OFFICE'OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617)292-5500
TRUDY CORE
8 Secretary
ARGEO PAUL CELLUCCI / DAVID HS
Co i er
Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A 9,0
? -7 CERTIFICATION
Property Address: 3 / �-�'K�Sept` pR, Name of Owner �y �A�Q/U �. O INN
L J.
nil?2SW 3 5w
RP-/N toT/y5' Address of Owner: 5�+ 1999
Date of Inspection: �,,
Name of Inspector:(Please Print) EDL41490 ���2 0 FIG LP > d
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: QwI?RAO C-, &esAfe Z ��
Mailing Address: GA W 00 A AVE, �14 c o 63
Telephone Number:
CERTIFICATION STATEMENT
1 certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
$ Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signatur Date'
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection. If the system is a shared system.or has a design flow of 10.,000 gpd.:or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable,.and the approving authority.
NOTES AND COMMENTS 1060 C_&601V SEPrIC 7-1910K , 6000 GOA)1)�77vN.
/000 64ao-v C.6,71tCH PIT.
revised 9/2/95 Page Iorit
Printed on Recycled Paper `•
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
p CERTIRCA71ON(continued)
Property Address: 3�� �AKFS�r7� Dhr
Owner: 6o RARE/
Date of Inspection:
INSPECTION SUMMARY: Check 8, C, or A
A. SYSTEM PASSES:
1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
a. 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.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.
_ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health). .
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more thah four times a year due to',broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
a,+
revised 9/2/98 P8Se2or.11.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: ,317 6,1 £ oc OFr
Owner: E r Ptv&
Date of Inspection:�_3_l gc4c4
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WALL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
s
revised 9/2/98 Pages of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:3)7 606slo(F Of
Owner: E,P/?ROIU
Date of Inspection:&I-J 2/p y9
DD., SYSTEM FAILS: 1
You must indicate either"Yes"or"No" to each of the following:
1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
_ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less•than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes" or"No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000'gpd or greater(Large System)and the system is a significant threat to put
health and safety and the environment because one or more of the following conditions exist:
Yes. No
the system is within 400 feet:of_a surface.drinking watei 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)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regions
office of the Department for further information.
revised 9/2/98 . Page 4ofII
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:3r 7 LAK SIOC Oki
Owner: E,Pr9Rf��1
Date of Inspection:t,_3__'(qq
Check if the following have been done:You must indicate either"Yes"or"No" as to each of the following'.
Yes No
Pumping information was provided by the owner,occupant,or Board of Health.
tit least two weeks and
as been receiving
rNone of the system ates during that period.components volumes of water haveed not been ntrodu ed into system system frec ntly or as part of th sl flow
inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components,a have been located on the site.
The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on.the site has been determined based on:
— Existing information. For example,Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
115.302(3)(b)]
_ The facility owner land occupants,UIliffbfent from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Pap 5of11
11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner: 6 ,Pow
Date of Inspection:t _?_Iggq
I J 1 FLOW CONDITIONS
RESIDENTIAL:
Design flow:P4A0 g•p•d./bedroom.
Number of bedrooms(design): Number of bedrooms(actual):
Total DESIGN flow
Number of current residents._a
Garbage grinder(yes or&:M
Laundry(separate system) (yes or&): tW; If yes,separate inspection required
Laundry system inspected (yes or no)
Seasonal use(yes or 11910-
Water meter readings,if available(last two year's usage(gpd):
Sump Pump(yes or®!:N
Last date of occupancy: S%��- 66J-01E0
COMMERCIALIIN DUSTRIAL:
Type of establishment:
Design flow: 9Pd (Based on 15.203)
Basis of design flow
Grease trap present:(yes or no)_
Industrial Waste Holding Tank present:(yes or no)_
Non-sanitary waste discharged to the Title 5 system:(yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS Id source of intgUEaon: 6I7p, p Ile NEQ
System pumped as part of inspection:(yes or)1tly
If yes,volume pumped:_.gallons
Reason for pumping:
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or not (if yes,attach previous inspection records,if any)
1/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(it known)and source of information:
,qS-Bu�c T
Sewage odors detected when arriving at the site:(yes oe NO
revised 9/2/98 Page 6of11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
7 d SYSTEM INFORMATION(continued)
PropertyAddress:.`/1 `fT�51� OR,
Owner: C�Pr P#R01V
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade:_
Material of construction:_cast iron_40 PVC_other(explain)
Distance from private water supply well or suction line
Diameter
Comments:(condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK:
(locate on site plan)
Depth below grade:A7'SUaF#6c
Material of construction: Lconcrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: ?"Owl to w 'C'11
Sludge depth: CN
Distance from top of sludge to bottom of outlet tee or baffle: X D/NCI-(S
Scum thickness:(I/XIJ
Distance from top of scum to top of outlet tee or baffle: illK F/S
Distance from bottom of scum to bottom of outlet tee or baffle: >'SlNLf�S
How dimensions were determinedpPi�iyl�A��E
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) COe1,y-2ETt� Bf1FFLFS; C0 CONDITlan1
GREASE TRAP:
(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_Fiberglass' explain)
>' polyethylene_other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:-
Date of last pumping:
Comments:
(recommendation for pumping,condition of inlet and outletf.tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
revised 9/2/98 Page 7o(I1
. 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM,INFORMATION(continued)
Property Ao P9R:317(A96 10E X,
Owner: ) Ill
Date of Inspection: q-3-iM
TIGHT OR HOLDING TANK: -1 (Tank must be pumped prior to, or at time of,inspection)
(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes_ No_
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)Depth of liquid level above outlet invert:�16 /r1
Comments: e u evidence of solids carryover,evidence of leakage
into or out of box, etc.)
(note if level
and distribution i s q ,
on)F ME ZAJIZ ORt 8166- 0
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
Inote condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 Page 8of11
a ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:$17 Lf�I�C�Si[ per
Owner: e you
Date of Inspection: t,(3-•(9'
SOIL ABSORPTION SYSTEM -intrusive methods)
ISAS).
(locate on site plan,if possible;excava ion not required,location may be approximated by non
If not located,explain:
Type: 066 S'X Ff b7" C acl9CN to'leaching pits,number:
leaching chambers,number:_
leaching galleries,number:_
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments: _
(note condition of soil, signs of hyyd�raulic failure,level of po ding, damp soil,condition of vegetation, etc.) r r INLET /�/l�C
NO Sif.Ns of HYDRAULIC FRIG�i��, LIQ0110 t6UR 161WCA S L6cLdtti
CESSPOOLS:_
)locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)- -
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
PRIVY:_
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
revised 9/2/98 Page9ofll
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:3l7 6AKCSID67 DRY
Owner: E,PHRDIV
Date of Inspection:, /_?_'qqq
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
REf p,
1
-3b 3�
y�
3
revised 9W98 Page100..r11..
1.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
2 p SYSTEM INFORMATION(continued)
Property.Address:3I� 041CCS106" Del
owner:�,P/3RbN
Date of Inspection: �j_'JAMM/
NRCS Report name JJ
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate. Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater i6o Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
6Rbu/UD ivd9'76-- X 4 -9.
revised 9/2/98 Page11ofA
No _. ._ 173 FxB. .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...............Tow-n..............O F........B,a-r nsta-b l-e------------------------..-._..-----•-------------
App iration for Diapaii al Workii Towitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: XX
• 317 Lakes].d�...Dr.]Lam' mar-s-ta4&...gi 311s - ----------------------•-.---------------•---
Location-Address or Lot No.
............... ............
�-r-a-st------ --- Owner Address
Wa - •.-l�lae� lie .......................................... --•----------------...--••----•--.........-•
...-•......................................
..------Ks;a-ler Address
dType of Building Size Lot............................Sq. feet
V 1Dwelling—No. of Bedrooms.............................. .. .Expansion Attic ( ) Garbage Grinder ( )
Other—%e of Building ---------------------------- No. of persons............................ Showers ( ) Cafeteria ( )
a
a+ Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity.....__._.__gallons Length................ Width---------------- Diameter---------------- Depth.................
x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No: 2................minutes per inch Depth of Test Pit.................... Depth to ground water............._..........
R+' ------------------------------------------------•--•--------------••----............•-------•-_..............................................................
0 Description of Soil........................................................................................................................................................................
-.
V ..................S ad &_--Grave-1----------•-------•--••-----------------------•-------------------------------- -•----.........-----------------------
------------------------------------- ------------------------------------------------------------•-----------------------.._...--------------------------------------------••-----------------....••---
UNature of Repairs or Alterations—Answer when applicable............1_-1.p.pp---ga-3:1oI2---tam-k----•--------------------•----•--
..-•----•-••-•••---------•-•----....---•••----•------------••----••••--•--•--------•---•................•-•----------1--10-0-0----ga-1-1-on---pz-t-------------------.-------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi TIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n issued the/Qo r�Iheallt.hh..Signed ..�= '---- -----3/ -/- --------
Date
Application Approved BY.... . ----•-••�-•----------•-.------•---------
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------•-----..•----
....--•..............•--•-•--•-•------•---•---••--•------•--•--•-•-----------------......--••---•--••-•---•-•-•---•-----•--•-------------••-----•-----•---•••---------------••-----•--••----••-••--_..._
p Date
PermitNo.........Q.. �-��---••--•----•--••--- Issued.......................................................
Date
No...Ig ...J...y1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..........................._............-----------------------------..._............._...
Applir #iOn ar t n a� x Cann #rnr#iun Crruti#
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at:
XX
................_............................--•----•----•---......•••........................... •••-•-••••--..........................••••-•••••-•................................................
317 Lakeside W ,VeddKhrstons Mills. or rat No.
......................_.......................................................................... ..........--......................................................................................
y Owner Address
Fro,
............................ ..........
14 ...._ Installer Address..........-----------••-•---.........-•--•
Toe of•A AR ber -
Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other— e of Building No. -of persons............................ Showers — Cafeteria
der fixtures -----•--•--------•------------------------------------.------------••--------••----•-•-- -----•--------•------
W Design Flow............................................gallons per person per day. Total daily flow.._......................_...._.............gallons.
04 W Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter_---_--_--____ Depth................
x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
t� -•-•-•••••-•-•---------------•-•••••--•-----•-••--•----------------------•-----••-•--••-•-•••.•-----.........................................................
ODescription of Soil........................................................................................................................................................................
x
U ---••-----•---•----•----------------------•--•------------•----•-•-•--•----•----------•--•-----•--._.......•--••----•----••-•------•--------••-•----•---•••._.....------------------•-------....---•--•.
W •-------•------ ------------------------------S.an-d---.&---Gra 1....--------------...-----------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable._........:.....................................................................................
•---------------------------•---•---•---....----•-•--------•-•-•--.......----------.................---•----••-•------1:1_0.0Q--_.ga1.1can•--tiaxnk.----•--•------..............--
Agreement: 1-1000-- gallon pit
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT?.;. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b ;the board of health.
v�(
Signed...... -� L. 4 /_
------
Application3_ ...P..5.........
A roved B L``` -- ----------�� -- �--
PP Y------------ - ---•- ----
Date
Application Disapproved for the following reasons:................................................................................................................
....---•---•-------------•....---••••-•----------••••--•••••----•---•-•-•-•--••-----•-•-•-------......-••-•---•••...__...-•-••------•-•-•--------•••------••--•-•••--•-•--•--•---••-----•------------•--
GG Date
PermitNo..........Q_.a..-...Z23�................... Issued---•---•---------------------------------------•••-••-•
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF......................................................................................
Town Trr#ifira#r # itanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY..............................................................................................................................................................................................X K-
at.t7.P aCOlCtlti3er ---••-•I-nstalle
--e r
---•..I�---••-•-------------- ----- -----------------------------------------•--•--._.......--------------------•-•-------------...
has beealirr7st k6S&-d,&ddiXeiVidi Hajp 9s ? r c -The State Sanitary Code as described in the
application for Disposal Works Construction Permit Noj---- F :.- ...... dated..................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................. 1._�.' 3�..........-•-•-•-••••........•••••• Inspector.................. ................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�d. - .......... ..... .OF......................................-..---------•--............_..._...............
No.... .. .^... . T64 ...... Barnstable FEE...... ...
Disposal Works %Tlano#rur#ion ami#
Permission is hereby granted---------------------- - . --•------------•---•-----------------------•---•---------------....-------••.._._..
to Construct ( ) or Repair ( an Individual Sewage Isposal System
at No.......31-7...,ak-ea.de...DC-1-VIa---Mar.rtarr,.44i4._-a--------------------------------
Street
as shown on the application for Disposal Works Construction Permit No..u(�__�7 Dated..........................................
Board of Health
DATE............... ' ..... ------------•---••---••-----••
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
MARSTONS MILLS. MA -
PROPOSED SOIL
--ABSORPTION Z NOT
ON BACK
SYSTEM -SEE DETAIL SCALE
1 TO
>
LEGEND � � 0
SEPTIC COMPONENTS -TOP OF SYSTEM IS BELOW W 4
M .
CELLAR FLOOR ELEVATION c -+
EXISTING 70 v J
1000 GAL 100.00 ft -TREE REMOVAL AT _
SEPTIC TANK 72
INSTALLERS DISCRETION. - Locus
EXISTING O / ? LAKESIDE DRIVE
LEACH PIT/ OWN 15 12 in
i OAK
�� 12 in. _
• CESSPOOL p QQp . OAK y'
a
�xwT 1 ;. V47 d b I o ..w®��rna,�%u.,`y Oi',,,.a\m•"'t .°.mw, .,maM.am.
DISTRIBUTION BOX®
OAr 20 in
TEST PIT —_L J OAK
® 2 18 in
,.,.nv
10 ft
EXISTING LEACH PIT 74 UT§L§ Il§EFS
TO BE PUMPED AND Q 70 FILLED OR REMOVED / ®� WATER LINE -• / � � � WATER GATE 0
II Cj ^ \ GAS LINE —G—
l� 72
�. �� ® . OVERHEAD WIRE
UTILITY
76 POLE off
�NIMAL
" GRADING
®/ PROPOSED
74 O� °
AREA - 10380 sf+- 0 o0
Plary aoox 138 PAGE 25
THIS IS A �? ASSR MAP 102 PCL 146-2 �I�.. G w " V MCOLOR
' *
PLAN \ �
M q��., � z
.� .�t.4 'rYy',?a`;E'uww+. ��
USE COLOR PLAN ONLY 4 STO DRIVEWAY 1
FOR INSTALLATION �" 76 .d
� a a�Ns�a`aLe o s oqr��1j
FULL DETAIL IS BEST
,+ _ ��� ( ��^�P s � " t "Ah ,w EL E�A T ION
VIEWED IN `
FULL COLOR �_ ��j ° �"• o �� 80 �O 7�. 9
� xr yM P OF FOUNDP� o�c DAVID �yGJ O� DAVID ryG�
72.62 f t 4 � 80 D.
. COUGCOGHANOWR HANO WRNo1093 No. N
461
EDGE OF-PAVEMENT
T �PPR0v1 O
cwe, a L� j Q !E:% 11� � AN / VAL
j GARB PL A N
G R SCALE: I in = 20 ft o�TF�� SE AGE DISPOSAL
OT
A OWED O 20 40 ( A -TO SERVE EXISTING DWELLING
- - PETER S.
o l0 20 HERMAN
�� • • OWNERISI OF RECORD
, PRINT- ON Il x 17 . in � �
PAPER FOR PROPER SCALE p; ESQoo 317 LAKESIDE DRIVE
155 Geo R der Rd s MARSTONS MILLS, MA
THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM y PROPERTY ADDRESS
DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING Chatham, MA O2GS3 ---
PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER - DOVIQdfo�]U®LH�1otmoQll.C((o�l�itl DATE. DECEMBER 11, 2019
SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. - 50S 364-0874 PG. 1I [DB# ETE-1607 ne oe
DESIGN DES �� o ��OO � 0 � � YT B111011 ' A �000 GALLON EP #CNK CLC � A� N 08-3 20 .
SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE #461 DESIGN FLOW: 2 BEDROOMS X 110 GPU = 22U GPD AND DETAIL FOR 2 FEET BEFORE PITCHING DOWN
EXISTINC7 UNIT - DIMENSIONS .& DETAIL DIMENSIONS PIPES EXITING D-BOX TO RUN..LEVEL
WITNESSED BY: DAVID STANTON. HEALTH DEPT. TANK TO BE PUMPED DRY AT TIME OF INSTALLATION
SEPTIC TANK_ 220 GPD X 2 DAYS = 440 GALLONS -
TEST PIT NO GROUNDWATER ENCOUNTERED AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL
PERC AT 60 in - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE.
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT, INSTALL REPLACE WITH A NEW _ 12 1n
INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK.
I In
70.85 Q 1500 GALLON TANK c MIN
0-10 Ap SANDY LOAM 10 YR 3/3 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. IF CRACKED, ROTTED —►
10
68.35 10-30 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: TAPER OR OTHERWISE FROM = = =
30-128 C MEDIUM SAND 10 YR 514 NONE LOOSE COMPROMISED. N TANK TO
60.18 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE �� ,•, o ^ t SAS
SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES .
NO GROUNDWATER ENCOUNTERED
PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. o
TEST PIT 2 2 MIN/INCH IN C SOILS THE 25 ft x 12.83 ft x 2 ft LEACHING GALLERY 6 in STONE BASE
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER WITH 2 CUT CORNERS DEPICTED BELOW CAN LEACH: '""�' "v. z, 'Oulffoi _ " NOT 21 ;� 'L� \� CROSS SECTION VIEW
INCHES HORIZON TEXTURE (MUNSELL) MOTTLES , TO
71.10 BOTTOM AREA = (25x12.83) - (3X3) = 311.75 sq. ft. : U)
0-12 Ap SANDY LOAM 10 YR 3/3 NONE FRIABLEr SCALE'
SIDEWALL AREA=(25+9.83+4.24+19+4.24+9.83)x2=144.25 s f '
68.26 12-34 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE e \�
34-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE TOTAL AREA = 456.0 sq. ft
60.10 FLOW CAPACITY = 0.74 x 456.0 337.4 cal/da 8
9 y ft-6 ;n ` A E '� ORp �
- - ALL THE PROPOSED LEACHING GALLERY AS CONFIGUREDTEM : CONSTRUGTION, DETAIL
BELOW. FLOW CAPACITY = 337.4 gal/dog WHICH EXCEEDS INLET OUTLET
THE 220 gol/dog REQUIRED FOR A TWO BEDROOM DESIGN. COVER COVER O.SE SHOREY,PRECAST,;560 GALLON LEACHING.DRYWELL,,
FLOOR PLAN 3 IN DROP
3 ft 3 ft
-► �! FLOW LINE 19 0 f t
-INSTALLER TO OBTAIN DISPOSAL WORKS _ --►
PERMIT BEFORE STARTING WORK. FROM lO in 14 TO w �` ^ v"
-ALL COMPONENTS INSTALLED SHALL MEET BUILDING 1� D-BOX a S T"O N E'
THE MINIMUM REQUIREMENTS OF 48 in �,, I*pRYWEtL DNYW@LL s M (7
BED BATH KITCHEN MASSACHUSETTS TITLE 5 SEPTIC -
GAS � � �f 00
OO CODE (310 CMR 1s). LIQUID
ROOM -INSTALLER TO VERIFY LOCATIONS OF ALL LEVEL BAFFLE w � uNtT' :� .fUN1T�. JIB"" •CO c� (V
UNDERGROUND UTILITIES BEFORE 00
y-
LIVING EXCAVATING FOR SYSTEM. o
BED ROOM -ECO-TECH RAPID RESPONSE RECOMMENDSp.II
ROOM b in STONE BASE IF NEW
THE INSTALLATION OF LOW FLOW 4 ft 8.5 ft 8.5 ft 4 ft
FIXTURES & APPLIANCES, AND PERIODIC SEPARATION BETWEEN INLET & OUTLET
E PUMPING OF THE SEPTIC TANK. TEES NO LESS THAN LIQUID DEPTH` 25.0 ft
CRAWL SPACE BELOW -SYSTEM IS NOT DESIGNED TO WITHSTAND CROSS SECTION VIEW
VEHICULAR LOADING. DO NOT PARK OR 500 GALLON DRYWELL
DRIVE VEHICLES OVER SEPTIC SYSTEM. DIMENSIONS & DETAIL
INSTALL ONE INSPECTION
RISER TO WITHIN THREE
USE INCHES OF FINAL GRADE
H-l0 & INDICATE LOCATION
UNIT ON
AS-BUILT
L . - O O
33
s�
in
: R
TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO. BE 4 in SCH. 40 PVC
EL = 77.95 + 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN /02 ;n
71.95
CROSS SECTION VIEW
D o 0 INSTALL AN APPROVED GEOTEXTILE
3' FABRIC OVER STONE
M A Y
M USE H-20
E!/ MT� N0 68. 95 314 In TO - 24 in q. 3/4 In TO
TEE 28 GRAVEL • DEFFEC
EPTH IVEe 1-112 In GRAVEL
EXISTING 1000 %GALLON o0000000 in DEPTH e
0000000000 oa ^«
ono 100000o PRECAST 000�oocQa000 -
o°o°000°00000 0000 00000
�LS���� U �IIV� 72.85 poop 00000a ao0o�� 0000 48 in 58 in
000 0000 00 D R Y W E L L o000000a000 48 in
68.33 00 000000 000000 00
EXISTING REFER TO DETAIL BOX STONE 6 in S0�� ARBSOIFRPT�Of� + 154 in
68.50 BASE 68.20
���'��� —REFER TO
EXISTING 6 in STONE BASE IF NEW L1 C� ft 5—12 ft DETAIL BOX
Ln BELOW
66.20 NO GROUNDWATER _
MOTTLING OBSERVED _ 60.10 =-
SEWAGE DISPOSAL SYSTEM PLAN 11317 LAKESIDE DRIVE MARSTONS MILLS, MA DECEMBER ll, 2019 ETE-1607 PG 2/2
FENCE SECTION TO BE TEMPORARILY
:., .
DISTRIBUTION BOX REMOVED DURING CONSTRUCTION.
EXISTING LEACHING FACILITY TO REMAIN - 5 ,
2-500 GAL. LEACHING CHAMBERS WITH INV. IN=66.17 SECTION TORE STORED ONSITE,AND
NOT TO qrAl F
4-FT STONE INV. OUT=66.00 REINSTALLED AS NEEDED. ,
EXISTING LEACHING CAPACITY=337.4 GPD ❑-._ - NITROE 2KS 2,000 GALLON TANK
(PER DESIGN AS-BUILT)
TOP OF TANK=70.26 _
° INV. IN=68.86
N78°05'2 INV. OUT=68.61 EXISTING EFFLUENT PIPE TO BE ,. , E a
µ 20 ,5 REMOVED.
EXISTING DISTRIBUTION BOX a
' °'
/ Nn
TO BEFITTED WITH NEW 4"INLET PIPE
INV. IN EL. =65.97 MATCH / \ _ '
EXISTING INVERT) / ,. :� '' '�' •� 15
INV.OUT EL. =65.80
•>
, - 4) �
10 _ 4 SCH 40 PVC
L=12 1 , S /o
51
R&D D-BOX z
1
�k
CY)
v
a�
s,
LOCUS
y�
,
Po ,
m�
�. N T
4"SCH 40 PVC pJ .. .w.. f NOT O SCALE y m Y
�, EXISTING SEPTIC TANK TO REMAIN
L=1.5', 8=2% 4" SCH 40 PVC "INV. IN = 70:57 r
c
L=19.1', S 13%
INV OUT =70.32 c
-. ._.. . _, w .._. O T r�
WASTEWATER NOTES ea m ti
l"� PROPOSED AIR PUMP _ A 16. UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR Y
15.255(3). ANY ADDITIONAL AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL 0
FINAL LOCATION TO BE O O ° ' �,. 1. ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON A SHALL BE REPORTED TO THE ENGINEER. v
1 FIELD DETERMINED �~ / SURVEY CONDUCTED BY THE HORSLEY WITTEN GROUP,INC.ON NOVEMBER 20,2020. � p 4 � q
f � _ e �,y 17. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. ' �y o O k
2• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS '�' fi a o D
SHALL BE IN ACCORDANCE WITH THE STATE ENVIRONMENTAL CODE AND THE RULES AND 18. ALL SEPTIC TANKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS W Q o o N
f O � o �
REGULATIONS OF THE LOCAL BOARD OF HEALTH. s Q ro i
� , '°� ,..� . ._ -.,. MATERIAL.. � � H m .,as s- �
Vµ -t;: tO M
` 317 LAKESIDE DRI E _.
3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE:THE INFORMATION NECESSARY TO �- O M M m
19. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION ► ,� M M
ONE-STORY , WOOD d LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON AFTER CONSTRUCTION IS COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL L fi j
f f f FRAME
�� q µ ,,? IT AND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. BE LEFT NATURAL THE CONTRACTOR SHALL TAKE CARE TO PREVENT DAMAGE TO = y oT �p ip o Z
' ,y f SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE
f 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED
NG S I S R BY THE ENGINEER
q A ANDlOR THE LOCAL
3O7 LA PLANS D NOT HOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONSMUST
II' � � '� LAKESIDE LA O N S LAN EA
2-BEDROOM DWELLING - �'' DRIVE ,Ex N BE
_.P--- (� - ,� �. F BOARD OF HEALTH(BOH)STAFF. VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK. '
o
j I 5. PRIOR TO CONSTRUCTION,THE CONTRACTOR SHAALL COORDINATE WITH THE PROPERTY 20. ALL UNPAVED AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF ..I
OWNER AND ENGINEER ON THE CONSTRUCTION S31TE ACCESS AND MATERIAL STOCK PILE
LOAM INSTALLED AND BE SEEDED WITH GRASS SEED AS SHOWN ON THE PLAN AND/OR
-" AREAS. DIRECTED BY THE ENGINEER. THE CONTRACTOR SHALL BE RESPONSIBLE FOR WATERING
f d - - -- "'p ✓ ANY LOAM AND SEEDED AREAS UNTIL LAWN GROWTH IS ESTABLISHED AND APPROVED BY
6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY THE ENGINEER AND/OR OWNER. v J W
P ss �r s
f ✓ '
rn f f LOCAL AND/OR STATE PERMITS REQUIRED FOR THE TRENCH WORK. THIS WORK MAYBE
' REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL(HOURS OF OPERATION FOR THE 21. AN INNOVATIVE&ALTERNATIVE TREATMENT SYSTEM IS PROPOSED FOR THIS SITE. THE 0
FACILITY.THE CONTRACTOR SHALL PLAN ACCORDINGLY. SYSTEM MUST BE INSTALLED AND MAINTAINED IN ACCORDANCE WITH THE DEPARTMENT
OF ENVIRONMENTAL PROTECTION(DEP)PROVISIONAL USE APPROVAL. 'W
° f 7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM w Z
THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. �W}
f _ = J = z r in 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEIPTIC TANKS AND TREATMENT SYSTEM
a ! OR CHANGES TO EFFLUENT FLOW,GRADING,OR LANDSCAPING,EITHER ON-SITE OR
ADJACENT TO THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE SEPTIC AND
EXISTING OVERHEAD EXISTING S ' LEACHING SYSTEM(S).
� d
r-
f ELECTRIC, TELEPHONE GRAVEL Z 9. CALL"DIGSAFE"AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT LLI Q"
r f & CABLE SERVICE DRIVEWAY s 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF 0 U) U) I-
s f EXISTING UTILITIES.
LL
•a f I 10. THIS ON-SITE WASTEWATER TREATMENT SYSTEMI IS NOT DESIGNED FOR USE WITH A 1v��� O O
GARBAGE GRINDER. W EXISTING ATER
EXISTING GAS I I W
ERVICE ,� q 11. THE OWNER SHALL HAVE THE SYSTEM INSPECTED AND HAVE THE SEPTIC TANK PUMPED U) I-
I SERVICE (TYP.) O O I EVERY 3-8 YEARS. M LJJ
LU p �� I 00
12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHIRINK GROUT AT ALL POINTS WHERE Q w I
PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES, r Q
n/
LU I -- - -� _ - _ - - - W
� 1 1$. USE SCH.40 PVC PIPING WITH WATERTIGHT JOINTfS UNLESS OTHERWISE NOTED ON PLAN. M
ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE.
...I 72.62 Z 14. ALL STONE TO BE DOUBLE-WASHED AND FREE OF-DIRT,DUST,AND FINES.
LJ..
Imo- S7103' 05"W I _ N71° 33 05"E Q
15. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE
78.36' INFORMATION FOR THE SEPTIC SYSTEM TO THE EENGINEER,IF NECESSARY, m L�
N
�- BENCH MARK
O
TOP OF IRON PIP
EL: 78.08,NAVD88 m
G G GENERAL NOTES. a a
- G O 153" 1. NITROE 2KS TANK TOP TO HAVE THREE-24",TWO-12"HOLES AND
O TOTAL TANK LENGTH MULTIPLE 4 HOLES WITH RISERS AND COVERS FOR MAINTENANCE
3 G G G OUTS>IDE WALL TO OUTSIDE WALL OUTLET TROUGH(OT) AND SAMPLING.
2. FOR THE 24"HOLES;PROVIDE 24"DIA,ADS PIPE(CORRUGATED) +r
WITH POLYLOK(OR EQUIVALENT)COVER(OR EQUIVALENT >�
N
TANK WALL ¢' " `' •d `' Y w CONCRETE RISER AND COVER)TO 12"BELOW GROUND SURFACE �•
V THICKNESS z a
a - AND SECURE TO TANK TOP.
G�
LAKESIDEDRIVE AT TOP a 3. FOR THE 12"HOLES;USE ADS PIPE(CORRUGATED)AND POLYLOK CU
J (3 TYP) O`U OR EQUIVALENT)COVERS TO 12"BELOW GROUND SURFACE AND N LO °p
N ( T) � rr
a
-� MIDDLE s. 40 a' o O SECURE TO TANK TOP. U co -!
V �' = w INLET ROUGH --- Fn J 4. PROVIDE THREE 4"DIA.SAMPLING PORT(1"BELOW GROUND N
o MT F-
�+=' p u� EFFLUENT TROUGH SU : RGED ( DEN[ CATI �a SURFACE)WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH Q s` � � g o i
!� W
W FROM SEPTIC (IT) A NI HAMB O WITH GROUND SURFACE. v N L
m m x
5. I P _ -
O
FOR EX STING SE TIC TANK;PROVIDE 2 DIA.SAMPLING PIPE THAT
W ..
Y TANK C A B (DC) i tU m e
81 za O O S C) IS CEMENTED OR ANCHORED TO THE TANK TOP AND EXTEND 2" 0CU o
_ J EFFLUENT OUT BELOW THE TANK TOP AND BE POSITIONED 6-12"FROM THE EDGE n` m U oco a O ii
OF THE OUTLET END OF THE SEPTIC TANK OR IN THE SEPTIC TANK
OH W OH W OH W OH W � '® i.,W ta- CONCRETE OUTLET COVER.ON THE TOP SIDE OF THE SEPTIC TANK,
V ° y ^-� -� w THE 2"DIA.SAMPLING PIPE SHOULD EXTEND TO 2"BELOW THE
00 N71 33 05 E - '
1 GROUND SURFACE AND HAVE A 6"DIA.PLASTIC ROUND BOX AND
N COVER AT GROUND SURFACE.
GRAPHIC SCALE TANK WALL
e- THICKNESS e
N
10 0 5 10 20 40 AT BOTTOM
ZONING & RESOURCE PROTECTION NOTES (41/2°TYP) d... '.
o ..a
N
C) 1. PARCEL ID:1021145 LOT SIZE:0.24 AC
(in feet)
-N 2. OWNER OF RECORD:BLONDIN,JESSALYN P
1 INCH = 10 FEET CL
•� 3. ADDRESS:317 LAKESIDE DRIVE,MARSTONS MILLS 6��P B � 'i PLASTIC BOX AND COVER WITH 4
CIL 4. THE LOCUS IS IN LOCATED IN FLOOD ZONE X(AS SHOWN ON F.I.R.M.MAP 25001 C0542J DATED JULY 16,2014). SEE NOTES 31 AND 4(TYP)
SEE NOTES 3 AND 4(TYP) MONITORING PIPE;SEE NOTE 2 AND 4(TYP) o 0
5. THE SITE IS LOCATED IN A WELLHEAD PROTECTION DISTRICT. SEE NOTIE 2(TYP) m c`w c i
EXISTING LEACHING CHAMBER SIZING CALCULATION GROUND SURFACE P EL.72.00t 24"ACCESS HOLE WITH COVER SEE NOTE 2(TYP). o cn
RISER TO WITHIN 3"OF (TYP) Q CO v
SEE NOTE 2 TYP
FINISHED GRADE o ., ca L o >
>, SfDEWALL CAPACITY \V EL.70.0t _ 5 1/2"TANK TOP(TYP) TO SOIL a` °3 `r' o Z
.n (L+VV)(2 SIDES)(2.0'HIGH)(0.74 GPD/SF) -
r- (25'+9.83'+4.24'+19'+4.24'+9.83')(2)=144.28(0.74)=106.8 GPD _ _ V - - 'LOAM AND SEED ABSORPTION SYSTEM L 0 3 hi v-H
N PROVIDE PLASTIC _ _ _ _ _ � c v
(SAS) p c o i<
- =EL.67.76 EL.70.02 U _ M U) a U_ o
IRRIGATION BOX TO - - CLF�11V - - - - - " -
a• .. ,S l ';.
BOTTOM AREA 4-INCH PVC - - - - - - - - EFFLUENT FROM SEPTIC
GRADE -BACKFIILL- - - - - - - - YQ'STATIMA-MROEPTH d d EFFLUENT Registration:
THREADED GAP _ _ _ _ _ _ _ _ _ _ _ � TANK �
t (25'x12.83')-(3x3)=311,75(0.74)=230.7 GPD -
r --I I - w
TOTAL AREA - -FLOW �1 FLOW _ - w
LL
337.5 GPD EXISTING - - �,D _ _ _ _ _ - O 9
1' EL.66.17 - - - - - 6„OF 3/4" t- a �' z --
++ 330.0 GPD REQUIRED _ - - - _ - _ _ p ow t3 JOSEPH E.
DE I IFI I BE E.
SUBMERGEID N TR CAT ON CRAM R w
a
COMPACTED w o- I a
•�= WASTEWATER INSTALLATION INSPECTION NOTES _ > i ~ AERATIONI z (DC) " W _-
CRUSHED 0 C9 ( ) w �"o q -o
L1. PROVIDE ADAPTER TO ¢ z O CHAMBER 0 0 - 0 CIVit,
STONE BASE O > z w z '
1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE JOIN SEWER OR LATERAL 45 DEGREE PVC BEND AT - I I J f f O z O (SAC) w E- 8 Z w
ENGINEER AND LOCAL BOARD OF HEALTH FOR ANY INSPECTION. TO 4-INCH ELBOW ;n- �' F- O-i O gs
THE END OF LINE WYE w LL w c t- C3
_ rn Ln H- LL E
CONNECTION FOR IN I I I I I I j
N 2. ALL WASTEWATER COMPONENTS SHALL BE INSPECTED BY THE ENGINEER AND THE LOCAL `° `. uJ" p M iv w z
Lam{) BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL LINE w �? "'
CD BE INSPECTED:
NOTES: z
r•- 2.1 SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL
1. PROVIDE 3 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL
STABLE BASE: EL.64,27 "•.. • .�: ••• .. �'.' s• .. . ;...
e- 2.2. LEAKAGE TEST ON PRECAST TANKS(MIN.24 HR) ■ l ea n T u L L C Project Number: Sheet:
2.3. DESIGNEDSTART UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS 2. BLOCK TWO OIUTLETS. TANK BOTTOM 12"CRUSHED AGGREGATE OR APPROVED
THICKNESS 4' 20112 1 Of 1
2.4. FINAL INSPECTION OF BACKFILLED SYSTEM MATERIAL;ON LEVEL,COMPACTED AND
0 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN DRAWINGS AND PROPOSED H-10 DISTRIBUTION BOX DETAIL TANK WALL THICKNESS AT BOTTOM(4') STABLE BASE
Q TANK WALL THICKNESS AT TOP(3") Sheet Number:
E NOTES INDICATING THE HORIZONTAL.AND VERTICAL LOCATION WTHTWO TIES OF ALL SYSTEM TYPICAL CLEANOUT DETAIL ACME PRECAST OR EQUIVALENT NitROE 2KS 2,000 GALLON WASTEWATER TREATMENT SYSTEM (WWTS)
COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND NOTES WILL BE UTILIZED BY THE NOT TO SCALE \/�/�/�/
ENGINEER FOR THE PREPARATION OF RECORD PLANS. NOT TO SCALE `/,/ �/1/
N-ASST20M-H10
I