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Home My Public Portal AboutBOH11.16.22packet1/6 WS d A d P < ��DER 0 co *Co 'IC9 Z�z pea. I "P01% go is �Imo\ Pearson Amy von Hone Sherrie McCullough �n; rnn nrf�nn+ Tammi Mason own of Brewster Board of Health Vo TvIam bt., Brewster, NUA 02661 brhealth@brewster�ma.gov (508) 896-3701 ]VI %87 fm%%67 L; Cli" I WVF pplicable law. This means that members of the public body may access this meeting in person or via virtual means. In person ftendancewill beatthe meeting location listed above, and itis possible that any or all members ofthe public body may attend remotely, o in-person attendance of members of the public will be permitted, and public participation in any public hearing conducted during is meeting shall be by remote means only. Members of the public who wish to access the meeting may do so in the following manner: o request to speak: Press *9 and wait to be recognized. om Webinar.0 hfti)s://usO2Web.zoom,us/'/82043944509?i)wd=M)di)M2kvUExKbUlRSOhmMOlZb3dQZzO9 asscode: 979174 o request to speak: Tap Zoom "Raise Hand", then wait to be recognized, hen required by law or allowed by the Chair, persons wishing to provide public comment or otherwise participate in the meeting, may o so by accessing the meeting remotely, as noted above. Additionally, the meeting will be broadcast live, in real time, via Live roadcast (Brewster Government TV Channel 18), Livestream (fivestream.brewster-ma.gov) orVideo recording (tv,brewster-ma.gov) Chairman's announcements Citizen's forum: Members of the public may address the Board of Health on matters not on the meeting agenda for a maximum 3m5 minutes at the Chair's discretion. Under Open Meeting Law, the Board of Health is unable to reply but may add items presented to a future agenda Consent Agenda: 1. 10 A.P. Newcomb Road Jitle 5 Variance Request Discuss I/A Local Regulation/Monitoring of Onsite System/Review enforcement policy Discuss BOH practices/policies regarding I/A technology Liaison Reports Matters not reasonably anticipated by the Chair Items for next agenda 0. Next meeting: December 7, 2022 1. Informational items: a. Monthly report for Pleasant Bay Health & Living Center b. Maintenance report for 200 Brier Lane c. Routine Inspection form for 200 Brier Lane d. Monthly inspection report White Rock Commons e. Routine Inspection form for 39 McGuerty Road f. Monthly report for Kings Landing 2. Adjournment rn :A73 :\Health\BOH Agendas and Minutes and Remote Schedule\BOH Agendas\ v1622a.d6ex Received: /D' aide Abutter Deadline: /Q -/7 �ZZ Date: 10/3/2022 TOWN Or BREWSI'ER 2198114AIN STREET BRr11's"11F.R, NIA 02631 PHONE: (508) 896-3701 Ex•r 1120. FAx: (508) 8964538 BR HEALTHG)BRr.WSTER-MA.G0Y W w W.13REWST ER-\IA.GOV DECEIVED cr o 3 21QZ1 E3REVVSTER HEALTH DEPARTPOENT Application for Board of Health Variances �In-House Local Upgrade Approval ❑Public Hearing SUBJECT PROPERTY ADDRESS: 10 A P Newcomb Road Map: 26 Parcel; 4 Book: 26785 Page; 207 LC Certificate: LC Plan: Lot; 4 Name of Applicant: Stephen B. Jones (Attorney) Mailing Address: P.O. Box 1069, Brewster, MA 02631 Telephone # 508-II96-9100 Email: sbjones.atty@gmail.com Owners) of Record : Estate of Sebastian Greco c/o Stephen B. Jones Maili ng Address: same Design Engineer/Sanitarian: John O�Reilly, P.E., P.L.S. Firm/Company Name: J.M. O�Reilly &Associates, Inc. Mailing Address: P.O. Box 1773, Brewster, MA 02631 Telephone #; 508-896-6601 Email address: joreilly@jmoreillyassoc.com Signature. 'ftAppIleo ngineer New Construction ❑ Voluntary Upgrade ❑Addition/Alteration ❑ Failed system 60Real Estate Transfer ❑ Design flow of existing system: 330 Design flow of proposed system: Sas Total sewage flow of site: 330 Conservation Commission approval required: yes El no Cd Order of Conditions/Det. Of Applicability attached El Reason for failure: Failed Leach Pit Total lot size (Soo 20,970 sf Date of ConCom hearing: n/a List of all Variances from State and Local codes Ladd sheets if neededl TITLE 5 Sec. #: .Brewster Reg. #: Description of Variance(s) Descri tion of Variance s 310 CMR 15.221 Depth of System: The Proposed S.A.S. is greater than 36" below grade, 60 Inches provided, 24 Inch variance requested Approved by: Date: Health Department _ N:\Health\BOH regs\InHouse Septic Local Upgrade Approval 2019Warianceapplicatiou FINAL NONF[LLABLE FORM 12.18.I9.doex M U O J ti 0 N a) a' n LD ti N 0 0 M a� a� 0 Town of Brewster 2198 MAIN STREET BREWSTER, MASSACHUSETTS 02631-1898 PHONE: 508.896.3701 EXT. 1120 FAX: 508.896.4538 brhealth�brewster-ma.Qov W W W.BREW STER-MA. GOV Health Department Amy .von one, Director Sherrie McCullough, R.S. Assistant Director Tammi Mason Senior Department Assistant Notice of Board of Health Variance Approval/Deed Restriction November 2, 2022 Attorney Stephen B. Jones PO Box 1069 100 Independence Drive, Suite 7-623 Brewster, MA 02631 RE: 10 AP Newcomb Road, Brewster, MA Map: 26 Parcel: 4 / Book: 26785 Page: 207 Estate of Sebastian Greco c/o Stephen B. Jones Dear Attorney Jones: On October 28, 2022, the Brewster Health Department reviewed and approved the following variance for the septic system upgrade at the above address per engineered plans by J.M. O'Reilly & Associates, Inc, dated September 29, 2022: Title 5: 310 CMR 15.221 (7) (General Construction Requirement for All System Components) a. 24" variance, 60.0" of final fill over the Leach Facility Town of Brewster: None In granting the above variance, the Health Department imposes the following Order of Conditions: 1. The property consists of an existing three (3) bedroom dwelling. No additional bedrooms allowed without frther review by the Board of Health. 2. Prior to issuance of the Certificate of Compliance, this Variance Approval Letter must be properly recorA ed at the Barnstable County Registry of Deeds and a recorded copy of same shall be furnished to the Brewster Health Department as proof of the recording. 3. Variances shall expire within one (1) year of the date of this approval. Please feel free to contact me if ou have any comments or questions on the above. I can be reached at the Health Department, 508-896-370, ext. 1120. Sincerely, '-, Sherrie McCullough, R.S. Assistant Health Director cc: J.M. O'Reilly &Associates, Inc., Brewster, MA 02631 File N:\Health\BOH Decision Letters\Septic Variance In -House Decisions\Title 5 Brewster Approvals\10 AP Newcomb Rd InHouseApproval 10.04.2022. doc 0 YO rm VV a i //� �,r J xy�) D �ALVN�c ORPOIRIO es a, 19 1 A llr"So own of Brewster 21981VI INSTREET �EWSTER, MASSACHUSETTS 026314898 0 0 & FAX: 5084896,4538 rhealth@brewster�ma.gov 9 [n�House Local Upgrade Approval 0 Other. Department VVII one, Director Assistant Director r Department Assistant Project Location, 10 A.P. Newcomb Road Map & Parcels 26/4 Owner's Name & Address* Sebastian Greco Living Trustee (Estate) c/o Stephen B. Jones 10 A.P. Newcomb Road Brewster, MA 02631 Date Isequesteds dober 3. 2022 Title 5 Variance Request: Yes FA No F1 Board of Health Variance Request, YesEl NoM ther: Yes 0 No F -I 1. Outside Zone 11 and the DCPC, existing Town water 0 a a In 0�� V XVJL4LJL6 Cul %WAJ%. a I.Lrn IV%J.LJL.L dwelling WfxAlt'k T)1rPr%fnr'<! (nrnmi�nfee A-n"rnxr� xrif-k -F�%11 ,7; A A,+, 1. The existinQ DrODerty consists of an existing 3. bedroom dwelling serviced bv town wat X 6' Leach Pit with stone. The applicant proposes to upgrade the system to a Maximum Feasible Compliant Title 5 septic system. The proposed septic system will consist of the existing 1000� gallon septic tank, a new H�20, DB�3 distribution box, two 500�gallon Hm20 loadmrated Leach Chambers with 4400t of stone system, and a sweet�air vent for a maximum 3� bedroom capacity septic system. 2. Due to the existing depth of the main sewer line exiting house foundation and the depth of the existing septic tank, the leach facility will be greater than 3' below the final grade. 3. The following variance is requested: Title 5: a. 24.0 variance, proposed 6.0 of final fill over the SAS facility Town of Brewster: none 4. Approval with the following conditions: a. Approve the septic variance as requested above with the following conons: i. There will be no addition of the number of bedrooms in the residential structure without further BOH review. A copy of the BOH Approval Letter must be recorded at the Barnstable County Registry of Deeds prior to issuance of the Certificate of Compliance upon completion of the septic system installation. A copy of the recorded letter to be placed on file at the BOH. ii. Variance will expire one (1) year from the date of the BOH Approval, N:\Health\BOH Meeting Notes\BOH Hearing Notes\10 AP Newcomb Road M26 P4 Agenda.Variance Action Item Form 10.03.2022.docx J.M. OREILLY & ASSOCIATES, INC. PROFESSIONAL ENGINEERING, LAND SURVEYING & ENVIRONMENTAL SERVICES Site Development •Property Line • Subdivision • Sanitary �. r 3, 2002 Land Court nvironmental Permitting J M 0-9340 Brewster Health Department Attn: Amy von Hone 2198 Main Street Brewster, MA 02631 RE: Depth Variance Request— In -House 10 A.P. Newcomb Road, Brewster, MA (Assr's Map 26, Parcel 4) Sebastian Greco Living Trust (Estate) Dear Ms. von Hone, On behalf of our client, The Estate of Sebastian Greco and care of Attorney Stephen Jones, J.M. O'REILLY & ASSOCIATES, INC. is requesting the Health Department to review and approve the following requested variance for the replacement of an existing failed leach pit with a new Soil Absorption System (S.A.S.) (existing septic tank to remain in use). No change in design flow is proposed. No additions or alterations to the existing dwelling are proposed. State and Local Variances Requested: Variances: 310 CMR —15.221 (7) — Cover Depth • Soil Absorption System (SAS) is not within 36" of finish grade o 60" depth is proposed, 24" variance requested, vent is proposed The existing dwelling is athree-bedroom dwelling and is currently served by a 1000 -gallon septic tank and a 10'x4' leach pit. upon a real estate inspection, the leach pit was found to be in a state of failure. As such, our office has completed a new design which includes keeping the 1000 gallon septic tank and proposing a 25' x 12.83' x 2.0' leaching chamber. The soil testing revealed that suitable sands were encountered in the southeast corner of the parcel. Given the length of run from the existing septic tank to the area of the suitable material, the top of the S.A.S. will be greater than 36 inches below the existing grade. As outlined with Title 5, the S.A.S. rated for H-20 loads and a vent is provided Enclosed please find three (3) copies of the Sewage Disposal System Design Plan, Floor plan, a copy of the certified abutters list, and a copy of the letter sent to the abutters, and Filing fee of $75.00. Very truly yours, J.M. O'REILLY &ASSOCIATES, INC. John M. O'Reilly, P.E., P.L.S. Principal CC: Client 1573 MAIN STREET, P.O. BOX 17%3, BREWSTER, MA oa631 •PHONE: (508) 896-66oI •FAX: (508) 896-66oa WWW.JMOREILLYASSOC.COM CERTIFIED MAIL RETURN RECEIPT REQUESTED BREWSTER IN-HOUSE SEPTIC LOCAL UPGRADE APPROVAL NOTICE: Date: 10/3/2022 Re: 10 A P Newcomb Road Map: 2s Lot' 4 Subject Address Dear Abutter: Please be advised that an application for septic local upgrade approvals from the regulations of the Massachusetts Department of Environmental Protection, Title 5 and/or the Town of Brewster Regulations for Subsurface Disposal of Sewage, has been submitted to the Brewster Health Department for approval. The following variances are requested: List of all variances from State and Town Codes Title 5, Sec # Description of Variances) 310 CMR 15.221 Depth of System: The Proposed S.A.S. is greater than 36" below grade, 60 inches provided, 24 inch variance requested Brewster Re . # Descri tion of Variances) The application and plans are available for review and comment at the Brewster Health Department, Brewster Town Offices, 2198 Main Street Brewster, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:00 p.m. Sincerely, John O'Reilly, P.E., P.L.S. (J.M. O'Reilly &Associates, Inc.) Applicant/Representative CC: Brewster Health Department N:\Health\BOH regs\InHouse Septic Local Upgrade Approval 2019\inhousevarianceabutternotification NONFILLABLE FORM 12.11.19.docx TOWN OF BREWSTER, MA BOARD OF ASSESSORS 2198 Main Street Brewster, MA 02631 Abutters List Within 65 feet of Parcel 26/4/0 26114!0 577. MAIN, STREET 26/4/0 dA P.NEWCOMB 26/3/0 597.MAIN.STREET Certified by: James M. Gallagher, MAA Deputy Assessor 26169!0 MAIN. STREET Key Parcel ID Ovmer Location Mailing Street Mailing City ST ZipCd/Count 2534 26-3-0-R WHITEHEAD RALPH JR &ELIZABETH 20 A P NEWCOMB ROAD 20 A P NEWCOMB ROAD BREWSTER MA 02631 (2236-5) 2533 26-4-0-R GRECO SEBASTIAN TRUSTEE 10 A P NEWCOMB ROAD C/O STEPHEN B JONES BREWSTER MA 02631 (2238-4) PO BOX 1069 ' 2532 26-5-0-R TYLDESLEY MARCI & 564 MAIN STREET 564 MAIN STREET BREWSTER MA 02631 (22383) TYLDESLEY RICHARD 2512 26-14-0-R TOBIN NINA TRUSTEE 577 MAIN STREET 577 MAIN STREET BREWSTER MA 02631 (22-26-2) TOBIN FAMILY REVOCABLE TRUST _ ---- - .------------- -- -- ---- ----- - - - - ---- — 2515 26-15-0-R CONNOLLY MICHAEL F & MONICA B 597 MAIN STREET 11 CRAIG HILL LANE MILTON MA 02186 (22-26-5) 2529 26-69-0-R DRAKE KEVIN T 598 MAIN STREET 300 PRENTICE STREET HOLLISTON MA 01746 (22-37) 10/3!2.022 Page 1 26-3-0-R 26-4-0-R 26-5-0-R WHITEHEAD RALPH JR & ELIZABETH 20 A P NEWCOMB ROAD BREWSTER, MA 02631 26-14-0-R GRECO SEBASTIAN TRUSTEE C/O STEPHEN B JONES PO BOX 1069 BREWSTER, MA 02631 26-15-0-R TYLDESLEY MARCI & TYLDESLEY RICHARD 564 MAIN STREET BREWSTER, MA 02631 TOBIN NINA TRUSTEE TOBIN FAMILY REVOCABLE TRUST CONNOLLY MICHAEL F & MONICA B DRAKE KEVIN T 577 MAIN STREET 11 CRAIG HILL LANE 300 PRENTICE STREET BREWSTER, MA 02631 MILTON, MA 02186 HOLLISTON, MA 01746 26-69-0-R / C) Town of Brewster BREWSTER, VLASSACHUSETTS RECEIVED J U N 0 H 2022 BOA 3 OF (50.8) BREWSTER HEALTH DEPARTMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM APPENDIX BREWSTER REGULATION Map Lot Property Address: 10 A P Newcomb Rd Other Address: Name of Inspector: Darrell Stone Company Name, Address, and Phone Number: Cape Cod Septic Inspection (508)-2404500 PO Box 1466, East Harwich MA 02645 Date of Inspection: 5/25122 This inspection represents (Check One) X Real Estate Transfer ,(� A) System Passes B) System Conditionally Passes Septic tank covers are more than 12 inches below the finished grade. C) Further Evaluation is required by the Board of Health The leaching facility or facilities are located within 300 feet of a pond or lake. 'ICE OF: HEALTH 3701 EXT.#20 Alteration/Addition Records show excessive pumping three or more times within any eighteen (18) month period for residential or commercial property; except for required grease trap maintenance for commercial property. X D) System Fails (Brewster Real Estate Transfer Regulation requirements) \ f) X The system is in a state of disrepair such that it cannot function as it was originally intended: 2� The lack of a 4 food protective zone between the bottom of the system and the groundwater; Any other problem as defined by the Board of Health or its Director; The sewage disposal system consists of a single cesspool, or cesspools. The Brewster Health Department has reviewed and accepted this report based on the information contained thereinI This inspection reflects the present condition of the Sanitary System and is not any guarantee as to the life or future condition of said system. Date Approving Authority Please be advised of ADDITIONAL BOARD OF HEALTH REGULATIONS: 1. All private wells are required to be analyzed prior to approval of the Subsurface Sewage Disposal System Inspection Form, and sixty (60) days prior to transfer of property. 2. All underground tanks must be registered with Board of Health and are subject to testing requirements. Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key, e76 iTRILM Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 5/25/22 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Inf®rmati®n Darrell Stone Name of Inspector Cape Cod Septic Inspection Company Name P.O. Box 1466 Company Address Harwich City/Town (508) 240-2500 Telephone Number B. Certification Ma State S14995 License Number 02645 Zip Code I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); I have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs FuV 4. ® Fails er E�ialuation by th Inspe•�Cor's Signature 5/29/22 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board ;U ealth or DEP) within 30 days of completing this inspection. If the system has a design flow of 101000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc • rev. 7/26!2016 Title 5 Official Inspection Form: Subsurf ace Sewage Disposal System •Page 1 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection F(uv l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 5/25/22 City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 6. 1j System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc •rev. 7/28/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 2 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): Ma 02631 State Zip Code 5/25/22 Date of Inspection ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipes) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment. t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 3 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 CitylTown State Zip Code C.Int specion Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water 5/25/22 Date of Inspection ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well", Method used to determine distance: �`* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal colifoI m bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal towor less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool l5insp.doc •rev. 7/28/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 5/25/22 City[Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surf ace water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any port ion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ElThe system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section C.4, Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well t5insp.doc • rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 City/Town State Zip Code C. Inspection Summary (cont.) 5/25/22 nate of Inspection If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or "no" for each of the following for a/I inspections: ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc •rev. 7!26/2018 Tille 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 6 of 18 M Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 5/25/22 City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Description: 3 bedroom residential dwelling Number of current residents: Does residence have a garbage grinder? Does residence have a water treatment unit? If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: 3 330 D ❑ Yes ® No ❑ Yes ® No ❑ Yes ® No 2021 t5insp.doc •rev. 7!26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal Syslem •Page 7 of 18 W Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection FQvm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owners Name Brewster Ma Clty/Town State D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: 3. l5insp.doc •rev. 7/26/2018 Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft.I Grease trap present? Water treatment unit present? If yes, discharges to: Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if avail ast d able: Late of occupancy/use: Other (describe below): Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Unknown 02631 Zip Code 5/25/22 Date of Inspection per day (gpd) Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 8 of 18 M Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1H A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster City/Town 5/22 D. System Information (cont.) 4. Type of System: Ma 02631 State Zip Code ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overtlow cesspool 5/2 Date of Inspection ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 1985 per BOH Were sewage odors detected when arriving at the site? 5. 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: Comments (on condition of joints, venting, evidence of leakage, Apparent good condition t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 9 of 18 Owner information is required for every page. t5insp.doc •rev. 7/26/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma City/Town State D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑metal ❑ fiberglass 02631 Zip Code 32" feet 5/25/22 Date of Inspection ❑ polyethylene ff tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 1000 gallon Sludge depth: It Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 12 20" 6" 5" 12" Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence f l Grade to inlet cover 12" oeakage, etc.): Normal liquid level No sign of leakage The septic tank is overdue for maintenance pumping Recommended maintenance pumping every 2-3 years ❑ other (explain) F Tiile 5 Official Inspection Fonn: Subsurface Sewage Disposal System •Page 10 of 18 W Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Estate of Sebastian Grecco Owner's Name Brewster City/Town D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal Dimensions: Scum thickness Ma State ❑ fiberglass Distance from top of scum to top of outlet tee or baffle 02631 Zip Code Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: 5/25/22 Date of Inspection feet ❑ polyethylene ❑other (explain): Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal Dimensions: Capacity: Design Flow: ❑ fiberglass ❑polyethylene ❑other (explain): gallons gallons per day t5insp.doc •rev. 7/26/201 B Title 5 Official Inspection Fonn: Subsurface Sewage Disposal System •Page 11 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 5/25/22 Clty/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑Yes ❑ No Alarm level: Date of last pumping: Alarm in working order: Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? 9. Distribution Box (if present must be opened) (locate on site plan): ❑ Yes ❑ Yes ❑ No ❑ No Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): '`. Due to the failure of the system the D -box was not located during the inspection t5insp,doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 12 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma 02631 5/25/22 City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber (locate on site plan): Pumps in working order: ❑Yes ❑ No* Alarms in working order: ❑Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits ❑ leaching chambers ❑ leaching galleries ❑ leaching trenches ❑ leaching fields ❑ overf low cesspool ❑ innovative/alternative system Type/name of technology: number: number: number: number, length: number, dimensions: number: 1 t5insp.doc •rev. 7 /2612 0 1 8 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 13 of 18 hP Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 10 A P Newcomb mu Property Address Estate of Sebastian Grecco Owner's Name Brewster Ma CitylTown State D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) 02631 Zip Code 5/25/22 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1, (4x6') pit with stone Grade to SAS 54" Bottom 98" Dry Sidewall staining into the inlet pipe This leach pit is in hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, l5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System •Page 14 of 16 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster Citylrown D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Ma 02631 5/25/22 State Zip Code Date of Inspection Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection form: Subsurface Sewage Disposal System •Page 15 of 18 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb ma Property Address Estate of Sebastian Grecco Owners Name Brewster Ma 02631 5/25/22 City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately t5insp.doc •rev. 7/26/2018 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page A $ (0 3 --- .7, '6, 5 6 16 of 18 WIN Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner's Name Brewster City/Town D. SybLt:110 s�f®1mCMU" (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Ma State 02631 Zip Code >4 feet 5/25/22 Date of Inspection Please indicate all methods used to determine the high ground water elevation: ►1 Obtained from system design plans on record If checked, date of design plan reviewed: 1985 Date Observed site (abutting property /observation hole within 150 feet of SAS) Checked with local Board of Health Plan on file -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Elevations from the design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc •rev. 7/26/2018 Tille 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 17 of 18 Z Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface. Sewage Disposal System Form - Not for Voluntary Assessments 10 A P Newcomb Rd Property Address Estate of Sebastian Grecco Owner Owner's N� information is Brewster required for every City/Town page. Ma State E. Report Completeness Checklist 02631 Zip Code Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank —Pumping contract attached 5/25/22 Date of Inspection For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 15insp.doc •rev. 7!26/2018 Tille 5 Official Inspection Form: Subsurface Sewage disposal System •Page 18 of 18 TOWN OF BREWSTER ADDENDUM TO DEP SEPTIC INSPECTION REPORT Inspection Location 10 A P Newcomb Rd 1. Residential Property Bedrooms (incl. den, sewing room, office) +3 Family Rooms 1 Living Rooms 1 Bathrooms 2 Dining Rooms 1 Kitchens 1 Other: 0 Total: 9 2. Floor Plan: Show all floors including basement: Map (x Parcel Commercial Property Employees Toilets Rooms with Bath Square Feet l 1 tel'. kA XLi Lk�g M 3. Is the septic system, as inspected, in full compliance with either Yes No x the 1978 or 1995 ) Title S�eode? If not, list deficiencies draulic fail re 4. Is the system in the Zone I Water Rurce Protection Yes No X_ District)? Lot size: 1 TOWN OF BREWSTER ADDENDUM TO DEP SEPTIC INSPECTION REPORT Inspection Location 10 A P Newcomb Rd Map & Parcel 5. Is there a 4' separation (1978 code) ora 5' separation (1995 code) between the bottom of the S.A.S. and adjusted groundwater? TOP OF FOUNDATION Yes 6. Town Water (� or Private Well (� Distance from nearest septic system component: 10'+ 7. Wetlands or surface water within 100' of septic system? Yes Distance from nearest septic system component: 1009+ 8. Groundwater flow direction N 9. Type of pipe used in system PVC X Orangeberg Other 10 Sanitary tees or baffles in place (Yes — No — N/A?) Septic tank inlet Yes Septic tank outlet Yes Pump chamber inlet n/a D -box inlet if pumped system n/a Grease trap inlet n/a Grease trap outlet n/a Risers — 1978 code within 12 inches of grade on septic tank no Risers — 1995 code within 6 inches of grade on all components n/a One inspection port on S.A.S. (1995 code) Yes No X 2 OWN OF BREWSTER 2198 MAIN STREET BREWSTER, MA 02631 PHONE: (508) 896-3701 EXT 1120 FAx:(508)896-4538 BRHEALTH Cl BREWSTER-MA.GOV LOCAL REGULATION TO SUPPLEMENT TITLE 5 STATE ENVIRONMENTAL CODE MONITORING OF INNOVATIVE/ALTERNATIVE ON-SITE SEWAGE TREATMENT SYSTEMS OFFICE OF HEALTH DEPARTMENT 1. Authority — In considering the permitting and use of various alternative septic treatment technologies in the Town of Brewster, the Brewster Board of Health recognizes that there may be specific local circumstances which warrant the Board to require more stringent conditions for the installation and monitoring of these alternative systems than may be required by the Massachusetts Department of Environmental Protection. As allowed under Massachusetts General Laws, Chapter 111, Section 31 and as permitted by 310 CMR 15.003 (3), 15.285 (2), 15.286 (5) and 15.288 (4), the Brewster Board of Health hereby adopts the following regulations concerning all innovative/alternative sewage treatment technologies and all systems where the soil absorption system is designed for pressure distribution of effluent. 2. Purpose —The purpose of this regulation is to provide a greater degree of protection to environmental and public health, to protect groundwater from contamination, prevent the spread of disease and provide specific reporting and monitoring requirement for the use of innovative/alternative sewage treatment technologies and pressure -distribution systems. 3. Monitoring Requirement —The Brewster Board of Health hereby requires that all pwners and operators of innovative/alternative sewage treatment technologies and pressure -distribution systems approved for use in Brewster submit for approval to the Board of Health a proposed monitoring and reporting plan to evaluate the performance of the system. This plan shall include a description of any long-term operation or maintenance requirements of the alternative system and any education, financial assurance or other mechanism proposed to ensure effective long-term operation and maintenance. 4. Reporting of Monitoring and Maintenance Results —The Brewster Board of Health hereby requires that owners and operators of all innovative/alternative sewage treatment and pressure -distribution systems shall report the results of all operation, maintenance and monitoring activities required by the foregoing provision or by the Department of Environmental Protection to the Brewster Board through the Barnstable County Department of Health and Environment. Such reporting must be performed in the manner specified by the Board of Health in imposing the monitoring requirement or in the form approved by the Barnstable County Department of Health and Environment and must occur within 15 days after each maintenance or monitoring event. 5. Reporting of Malfunctioning Systems —The Board of Health hereby further requires that when a system operator performs a system inspection and finds that a sewage treatment technology has malfunctioning components which have comprised the system's ability to treat sewage as designed, the operator shall report on the system's status and any planned corrective action, including a proposed deadline WWW.BREWSTER-MA.GOV for said corrective action, to the Brewster Board of Health and the Barnstable County Department of Health and Environment within 48 hours of inspection. 6. Malfunctioning Systems — If at any time a monitoring or maintenance report indicates that an innovative/alternative system or system using pressure distribution is in need of corrective action, the Brewster Board of Health may hold a hearing to inquire as to whether corrective action is needed. If at such hearing, the Brewster Board of Health determines that such system is in need of corrective action, it may take enforcement action, including but not limited to the imposition of fines, orders to take corrective action or cease operation of the system, or any other action otherwise necessary to protect public health, safety, welfare and the environment. 7. Right to impose Additional Conditions Reserved —The Brewster Board of Health hereby reserves the right to impose any additional conditions, effluent water quality standards and/or monitoring and reporting requirements it views as necessary to ensure the safe performance of any innovative/alternative sewage treatment systems and all pressure -distribution systems permitted within the Town of Brewster. Such conditions may include, without limitation, specification of site or effluent characteristics; flow limitations; monitoring, testing and reporting requirements; a requirement that a certified operator operate the system; or financial assurance mechanisms. 8. Certified Operator Requirement — If a condition of approval for an innovative/alternative system or pressure -distribution system is that it be operated by a certified systems operator, the owner or operator shall provide the Brewster Board of Health with documentation verifying that said system will be operated by an operator certified by the Board of Certification of Operators of Wastewater Treatment Facilities pursuant to the provisions of Massachusetts General Laws, Chapter 21, Section 34A. A list of such certified operators doing business within the Town of Brewster shall be on file with the Brewster Board of Health for inspection or examination by any person. 9. Enforcement— In addition to the remedies described in the preceding sections, the Board of Health may enforce this regulation or enjoin violations thereof through any lawful process, and the election of one remedy shall not preclude enforcement through any other lawful means, including but not limited to the following: Whoever violates any provision of this regulation may be penalized by indictment or on complaint brought in the district court. Except as may be otherwise provided by law and as the district court may see fit to impose, the maximum penalty for each violation shall Be a fine of not more than $1,000. Whoever violates any provision of this regulation may be penalized by anon -criminal disposition process as provided in Massachusetts General Laws, Chapter 40, Section 21D and the Town's non -criminal disposition bylaw. If non -criminal disposition is elected, then any person who violates any provision of this regulation shall be subject to the following penalties: • A fine of $30.00 for a first offense not corrected within 60 days of notice of the violation; • A fine of $60.00 for a second offense or failure to correct a prior offense within 120 days of notice of the violation; • A fine of $90.00 for a third offense or failure to correct a prior offense within 180 days of notice of the violation; • A fine of $120.00 for a fourth or subsequent offense or failure to correct a prior offense within 240 days of the notice of violation; and • An additional fine of $120.00 for failure to correct after each additional offense or 60 day period thereafter until compliance is met. Each day any violation exists shall be deemed to be a separate offense. Dr. Carmen Scherzo, Chairman Joe Ford Board Of Dr. Mary Chaffee Health Annette Graczewski Anne Bittner Adopted: December 20, 2005 Effective: Upon publication Amended: November 15, 2017 Effective: December 1, 2017 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.254: Pressure Dosing and Pressure Distribution (1) Gravity Distribution. (a) Dosing systems employing gravity distribution to the soil absorption system shall be restricted to systems designed to accept less than 2,000 gpd. (b) The dosing chamber and pumps shall be designed in accordance with 310 CMR 15.231. (c) Distribution lines to the soil absorption system shall have a minimum diameter of two inches and shall otherwise be in conformance with the provisions of 310 CMR 15.251(Trenches). (d) Septic tank effluent shall be dosed to the soil absorption system at a rate based on volume and number of doses that prevent the ponding of the effluent in the soil absorption system. (2) Pressure Distribution. (a) Pressure distribution of septic tank/recirculating sand filter effluent to the soil absorption system shall be required for: a system to serve a facility with a design flow of 2,000 gpd or greater; a system that is not designed to discharge by gravity either from the septic tank or to the soil absorption system; a system designed for intermittent discharge of effluent to the soil absorption system; and a system with a multiple soil absorption system, unless otherwise determined in writing by the Approving Authority. (b) The pumping chamber and pumps shall be designed in accordance with 310 CMR 15.231. (c) The pressure distribution system shall be designed in accordance with Department guidance. (d) Pumps, alarms and other equipment requiring periodic or routine inspection and maintenance shall be operated, inspected and maintained in accordance with the manufacturer's and the designer's specifications. hi no instance shall inspection be performed less frequently than once every three months for a system serving a facility with a design flow of 2,000 gallons per day or greater and annually for a system serving a facility with a design flow of less than 2,000 gallons per day. The system owner shall submit the results of such inspections to the Approving Authority annually by January 31" of each year for the previous calendar year. 15.255: Construction in Fill (1) Any system where fill is required to replace topsoil, peat or other unsuitable or impervious soil layer above the requisite four feet of naturally occurring pervious material is a system constructed in fill. Any system constructed in fill which extends either wholly or partially above natural grade for the purpose of complying with 310 CMR 15.212 (depth to groundwater) is a mounded system. All soil absorption systems constructed in fill shall be sized using the soil class of the underlying naturally occurring pervious material. (2) The finished side slopes of a mounded system shall not be steeper than 3:1 (horizontal:vertical). A minimum 15 foot horizontal separation distance shall be provided between the soil absorption area and the adjacent side slope as measured from the edge of the top of the two inch layer of to '/z inch washed stone aggregate or geotextile fabric cover. The toe of the slope shall be a minimum of five feet from any property line, or a swale or other drainage system directing runoff away from the adjacent property shall be installed. Adjustments to the above horizontal separation maybe allowed if a suitable impervious barrier is installed to prevent potential sewage breakout. The impervious barrier shall meet the following requirements: (a) the impervious barrier shall be designed by a Massachusetts Registered Sanitarian or a Massachusetts Registered Professional Engineer. (b) construction of the impervious barrier shall be supervised by the designer. (c) prior to issuance of a Certificate of Compliance, the applicant shall submit to the Approving Authority an as -built plan prepared and certified by the designer that the impervious barrier has been constructed in accordance with the approved design plan. (d) the elevation of the top of the impervious barrier shall be no lower than the "breakout" elevation, which is the elevation of the top of the two inch layer of 1/a inch to %2 inch washed stone aggregate cover. (e) the recommended distance from the impervious barrier to the edge of the soil absorption system closest to the barrier should be at least ten feet. Effective 9/9/2016 IOC R: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.286: continued (10) Should the Department disapprove general use of the alternative system which was provisionally approved, any person wishing to use such system may file a permit application for use of the alternative system pursuant to 314 CMR 5.00: Ground Water Discharge Permit Program. Disapproval under 310 CMR 15.286 shall not prejudice any action on an application pursuant to 314 CMR 5.00: Ground Water Discharge Permit Program. (11) The conditions established in 310 CMR 15.287 apply to any use of a proved alternative alternative system. (12) If at any time the Local Approving Authority or the Department determines that an alternative system that has been installed pursuant to a provisional approval is failing or has failed, enforcement action may be taken. (13) It shall be a violation of 310 CMR 15.000 to make a false representation that an alternative system has been approved for provisional use. 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 or an agent authorized by the Department and approved by the Department prior to initiation of the use. Monitoring and sampling shall be performed in accordance with a plan approved by the Department. 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 written approval of the Department. 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 altern ative system and the system itself shall be open to inspection and sampling by the Department, any agent authorized by the Department, and the Local Approving Authority at all reasonable times. (4) The Depart ment 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) Prior to the transfer of any ownership interest in an altern ative system, or of any right or responsibility to operate an alternative system, the owner or operator shall provide written notice to the proposed 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. In addition, the owner shall include either a copy in full or a reference to the notice of the alternative system described in 310 CMR 15.287(l 0), and the recording information for that notice, in the instrument of transfer of any such ownership interest. In the event of the transfer of any such right or responsibility without a transfer of ownership interest, the owner or operator shall include a copy in full or a reference to the notice of the alternative system described in 310 CMR 15.287(10), and the recording information for that notice, in the agreement transferring such right or responsibility. (6) The owner or operator, or the proponent of the alternative system, shall obtain and provide the Department or an agent authorized by the Deparhnent with a determination fr om 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. Effcc�ivc 9/9/2016 . 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.287: continued (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: Ground Water Discharge Permit 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: Certification of Operators of Wastewater Treatment Facilities, 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 form of Notice approved by the Department disclosing the existence of the alternative on-site system and its approval. The system owner shall provide evidence of such recording to the Approving Authority. 15 288• Certification of Alternative Systems for General Use (1) Certification for general use is intended to facilitate the use, under appropriate conditions, of alternative systems that have been demonstrated to provide levels of environmental protection at least equivalent to those of conventional on-site systems. (2) The Department shall certify an alternative system for general use when the Department determines that the applicant has demonstrated that the alternative system in general usage will provide a level of environmental protection at least equivalent to that of a conventional on site system designed and constructed in accordance with 310 CMR 15.100 through 15.255. Such demonstrations shall include the evaluation of broad scale field use in Massachusetts pursuant to 310 CMR 15.286, or comparable use in one or more states where relevant physical and climatological conditions are similar to those in Massachusetts. The required demonstration of comparable use in one or more states shall include, at a minimum, system use and system monitoring, and operation and maintenance information at least as comprehensive as the in-state protocols outlined in 310 CMR 15.280 through 310 CMR 15.288. When relying on system performance in other states, all available information including but not limited to a copy of the other state's written approval, testing and performance data shall be provided. The applicant shall be considered to have demonstrated effective performance of the out of state systems when the applicant has demonstrated to the Department's satisfaction that at least 90% of the systems have performed at a level at least equivalent to that of a conventional on-site system. (3) The Department may establish any special conditions necessary, to ensure adequate protection of public health, safety, welfare and the environment in its certification of an alternative system for general use. Such conditions may include without limitation: specification of site or effluent characteristics; flow limitations; monitoring, testing, and reporting requirements; operation and maintenance contracting requirements; a requirement that a certified operator shall operate the system; or financial assurance mechanisms. The Department may also specify changes or modifications of requirements otherwise applicable to conventional systems that are appropriate for use of the alternative system. (4) A Local Approving Authority may impose additional conditions on the use of alternative systems certified for general use under 310 CMR 15.000 only in accordance with regulations adopted pursuant to 310 CMR 15.003(3). (5) Systems with performance superior to conventional systems: (a) If the Department determines that an altern ative system is more effective than conventional systems in removing nitrates, the Department shall establish the nutrient removal credit which will be allowed for use of such system pursuant to 310 CMR 15.217, based on the nutrient removal performance of the approved technology. Effective 9/9/2016 ALTERNATIVE SYSTEMS 10 127 Beach Plum Lane — M331 L87 Bioclere System — Provisional qU( b03 306 Blueberry Pond Drive — M27 1.754 Presby Environmental — General 10 (- 1D 200 Brier Lane — M48 L45 Perc Rite Drip Field Micro Fast 0.5 - Remedial _ m!5 110 Burning Bush Way — M33, L267 Bioclere System — Provisional 34 Captain Connolly Rd — M51 L57 Perc-Rite Drip Dispersal -General `Q. 2q :)*Larson s Way — M36 1.37-101 Micro Fast 0.9 system -General 1.3 -laD if Carson's Way — M36 L37404 H600A WSeries Hoot 23-(P3 (pQ 9 Carson's Way — M36 L37-105 Micro Fast 0.9 System — General Z3'1.o4 5(p 6 Carson's Way — M36 L37406 Micro Fast System - General 7,3" lad 14 Carson's Way— M23 L67 -Micro Fast 0.5 system - General 2,54#1 26 Carson's Way — M36, 1.37-109 Micro Fast 0.51. System —General L3 -'lo $ 35 Carson's Way — 3- M36, 1.37-103 Fast 0.50 Treatment General 2LZ 40 Carson's Way — M36, L37407 Micro Fast 0.5 - General 2,3-44 19 Cedar Hill Road — M2 L52 Perc-Rite Drip Tubing 377 2D 40 Cranview Road — M38 L74 EC -P Waterloo Biofilter System IDwLpU 300 Foster Road — M6 L8 Microfast 0.5 — General lq-26 75 Johnson Cartway — M61 L20 Perc Rite - General U I-Zb 158 Jonathan's Way — M42, 1.1124 Singulair System — General w/nitrogen requirements 4t 85 Hamilton Cartway — M47 1.75 Advantex A20 q5 �q 88 Hamilton Cartway— M93 L11 Bio Microbics Fast System/Drip Dispersal 9Z' H 42 Konohassett Cartway — M41 1.11 Micro fast 0.5 w/ UV— General l Z� ZS Long Pond Road — M42 1.10 4000 gallon Septi Tech -General $'rj � 1 1 1597 Long Pond Road — M47, 1.114 Bioclere System —Provisional Rlj�q 3 15 Lower Road — M20, L39, Fast4.5 Unit — General 57~ ( S� 1 540 Main Street — M22, 1.38-1 Fast -Micro System W/ UV —General with nitrogen requirements �G "v� 2907 Main Street — (Ocean Edge) Amphidrome System — Pilot 54 Mates Way — M16, L94 Sludge Hammer — remedial V� 39 39 McGuerty Road — M47 L107 Micro Fast 0.5 General q4 1 J 56 McGuerty Road — M47, L93 Singulair System — Pilot ggqg 26 Nancy May Path — M7 L11-4 Perc Rite c1(' jq{ gC l 78 Old Red Top Road — M38, L116 Singulair System — Remedial with nitrogen requirements IZ-"IZ �54AId _-�irtgtr}a.ir�y�ter�---p+le#- g�Old Owl Pond Road - M31 1.17 Perc-Rite Dispersal System 13-j-7 65 Pell's Fishing Road- M29 1.18-22 White Knight system 125�5� 255 Robbins Hill Road- M19 1.3-3 Perc Rite system 3$-J`�� Wk 298 Robbins Hill Road - M2 L8 Advantex AX25RT 3$-? 2 17 Russell's Path - M33, L57 Waterloo Biofilter - Provisionald� V13 0 Sachemus Trail M15 1.125-2 Bioclere with Cultex leach field- General 1�- <j0 Sarah Maker Lane - M41 L32-11 FAST Micro %dS- I3$ lVSamoset Road - M33 L117 Fast system (Not installed yet) 75w 13� 52ULet+2 Satucket Road - M37, L29-2 - Singulair 960 NR (?j -1O3 50 Sea Meadow Lane - M19, Lot82 - SeptiTech - provisional (not installed yet) 301 � 1 6 Seaman's Lane - M38 L 118 0.5 Micro Fast 53 Sheep Pond Circle - M41 1.71- Biotube ProPak Pump 42 Six Penny Lane - M19, L10 Fast - Remedial 3141 157 South Orleans Road- M52, 1.314 & 33-2 - Septi -tech M3000N Vn..pU C.essof=being-instaFled) 1 DI Z � I6Z, 842 Stony Brook Road- M36 1.20 -Single Use, Fast Remidial 35-�j l0 75 Swift Lane - M5 L21 Sludgehammer (never installed) 7 -)�-� � Thousand Oaks Drive - M42, 1.73-21 Advantex 101- Z l 54 Thousand Oaks Drive - M42 1.73-4 Microfast .9 1 Og 4A Trevor Lane (Ocean Edge), system 12-3, -White Knight system 42 Warren's Road M2 L33 - Perc Rite Drip Dispersal System 3q; 1,15 120 Woodlands Lane - (Pleasant Bay Assisted Living) M45, L67 - Amphidrome JH3- 2. s 4 Alden Drive M 56 L 89 Bay Pines System 9(Ocean Edge) 9-11 Breakwater Road - M17 L67 141 Brewster Road, M24 L45 94 Cedar Hill Road - M2 L35 19 Cedar Hill Road - M2 L52 102 Cedar Hill Road - M2 L34 40 Cranview Road - M38 L74 46 Featherbed Lane - M38 L36 121 Fiddlers Lane, M18 L55 169 Fiddlers Lane - M18 L38 PRESSURE DISTRIBUTION SYSTEMS Fletcher Village System 2-1(Ocean Edge) 11 Frederick Court M56 L67 1000 Freeman's Way - M52 L6 Granite State Court - M30 L30-7 199 Hamilton Cartwy-M47 L33-1 62 Harvest Lane - M5 L238 John Wings Lane - M36 L204 42 Konohassett Cartway - M41 L11 1646 Main Street - M24 L21 1671 Main Street 2639 Main Street M15 L107 2639 Main Street M15 L107 (CF) 3260 Main Street - M13 L43-1 & 2 89 Main Street - M21 L4 1990 Main Street, M17 L474 1993 Main Street, M17 1,24 2298 Main Street, M16 L80 3057 Main Street, M8 L8 3057 Main Street, M8 L8 523 Main Street -M22 L94 Lot 6 Mill Pond Drive - M34 L48 119 North Pond Drive - M 89 L61 254 Robbins Hill Road - M2 L12 255 Robbins Hill Road- M19 L3-3 371 Robbins Hill Road - M2 L32 242 Seaway Road -M6 L24 53 Sheep Pond Circle - M41 L71 42 Six Penny Lane -M19 L10 & 12 56 Six Penny Lane -M19 L67 157 South Orleans Road -M52 L314 36 Southern Eagle Cartway M30 L18-1 Stony Brook_Road, M22 L83 842 Stony Brook Road -M36 L20 102 Susan Lane -M24 L404 4 90 The Channel Way - M4 L384 93The Channel Way- M4 L48 57 The Channel Way- M17 L7 The Latham 5chool-M24 L21 (2010) 2003) Brewster Senior Housing (2009) (2012) (2017) (2018) (not installed yet) (2013) (2009) (2015) (Not installed yet) ????? (2018) (2012) (2015) (not installed yet) (2006) (2008) (2016) (Not installed yet) (2008) (2015)(Not installed yet) (2017) (Not installed yet) (2017) (Not installed yet) (2017) (Not installed yet) (2007) Cobies (2008) (2015) (Not installed yet) (2005) The Brewster Inn (1995) Eddy Elementary School (2005) Cape Cod Sea Camps (2009) Cape Cod Sea Camps (2006) (2017) (not installed yet) (2019) (not installed yet) (2017) (2014) (2011) (2006) (2013) (2006) (2016) (not installed yet) (2007) Paraclete Press (2002) Our Lady of the Cape Church (2007) (2006) (2008) (2013) (2008) (2005) 4 Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: SFARRENKOPF TCanSaCtlOn ID: 1443423 DOCument: Groundwater Discharge Monitoring Report Forms Size of File Status of Transaction Date and Time Created 1317.56 K In Process 11/4/2022:12:18:34 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DAILY LOG SHEET A. Facility Information Important:when filling out forms on 1. Facility name, address: the computer, use IPLEASANT BAY HEALTH CTR only the tab key to a. Name move your cursor - 383 SOUTH ORLEANS ROAD do not use the return key. b. Street Address BREWSTER ray C. City lk AV 2. Contact information: r�axrn JOSEPH SMITH a. Name of Facility Contact Person 7742125005 b. Telephone Number 3. Sampling information: 10/1 /2022 746 -----� 1. Permit Number 2. Tax identification Number 2022 OCT DAILY 3. Sampling Month & Frequency MA 02631 d. State e. Zip Code jsmith@NSUWater.com c. e-mail address NOT APPLICABLE a. Date Sampled (mm/dd/yyyy) b. Laboratory Name BEA NSU PERSONNEL c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month &Frequency Daily Log Sheet - 2022 Oct Daily 1— All forms for submittal have been completed. This is the last selection. 3. )_ Delete the selected form. gdpols 2015-09-15.doc •rev. 09/15/15 Groundwater Permit Daily Log Sheet •Page 1 of 1 Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Massachusetts Department of Environmental Protection 746 Bureau of Resource Protection - Groundwater Discharge Program 1. Permit Number Groundwater- Permit DAILY LOG SHEET 2. Tax identification Number 022 OCT DAILY 3. Sampling Month & Frequency C. any Readings/Analysis Information Effluent Flow GPD 8912 8912 9374 13292 8461 10640 8882 8882 8882 11354 8115 13408 9711 9104 9104 9104 11453 8679 10483 10476 10646 10646 10646 15800 10849 14633 17110 10311 10311 10311 8761 gdpols.doc •rev. 09/15/15 Reuse Irrigation Turbidity Influent pH FIowGPD Flow GPD Effluent pH 7.1 7uI 7.0 6.8 7.0 Chlorine Residual (mg/1) UV Intensity 66.6 66.6 66.6 69.1 66.7 74.5 69.2 66.5 66.7 74.3 66.7 74.2 67.1 66.6 69.2 74.3 69.1 66.6 69.1 66.5 Groundwater Permit Daily Log Sheet • Page 1 of 1 Important:when filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q retun 46� I] Massachusetts Department of Environmental Protection 1746 Bureau of Resource: Protection - Groundwater Discharge Program Groundwater -Perm -it DISCHARGE MONITORING REPORT A. Facility Information 1. Facility name, address: PLEASANT BAY HEALTH CTR -!�FfiT 383 SOUTH ORLEANS ROAD b. Street Address BREWSTER MA c. City d. State 2. Contact information: I. Permit Number 2. Tax identification Number 2022 OCT MONTHLY 3. Sampling Month & Frequency 02631 e. Zip Code a. Name of Facility Contact Person 7742125005 jsmith@NSUWater.com b. Telephone Number 3. Sampling information: 10/14/2022 c. e-mail address HA ANALYTICAL a. Date Sampled (mm/dd/yyyy) b. Laboratory Name ALPHA ANALYTICAL PERSONNEL c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month &Frequency Discharge Monitoring Report - 2022 Oct Monthly � — All forms for submittal have been completed. This is the last selection. 3. C- Delete the selected form. gdpols 2015-09-15.doc •rev. 09/15/15 Groundwater Permit Daily Log Sheet •Page 1 of 1 Massachusetts Department of Environmental Protection 746 J Bureau of Resource -Protection - Groundwater Discharge Program Groundwater Permit = DISCHARGE MONITORING REPORT D. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled 1. Parameter/Contaminant Units BOD MG/L TSS MG/L TOTAL SOLIDS MG/L AMMONIA -N MG/L NITRATE -N MG/L TOTAL NITROGEN(NO3+NO2+TKN) MG/L OIL & GREASE MG/L FECAL COLIFORM /100 ML CHLORIDE MG/L 2. Influent 330 — - ------ - 620 --- --� 2.14 1. Permit Number 2. Tax identification Number 2022 OCT MONTHLY 3. Sampling Month & Frequency 3. Effluent 4. Effluent Method Detection limit 1.0 infeffrp-blank.doc •rev. 09/15/15 Groundwater Permit Discharge Monitoring Report •Page 1 of 1 Massachusetts Department of Environmental ProtectionI746 Bureau of Resource Protection - Groundwater Discharge Program 1., Permit Number J groundwater Permit MONITORING WELL DATA REPORT 2. Tax identification Number 2022 QUARTERLY 4 3. Sampling Month & Frequency A. Facility Information Important:When filling out forms on 1. Facility name, address: the computer, use PLEASANT BAY HEALTH CTR only the tab key to a. Name move your cursor 383 SOUTH ORLEANS ROAD do not use the return key. b. Street Address BREWSTER raj C. City 2. Contact information: rew A I JJOSEPH SMITH a. Name of Facility Contact Person 7742125005 b. Telephone Number 3. Sampling information: 0/10/2022 MA 02631 d. State e. Zip Code �jsmith@NSUWater.com c. a -mail address ANALYTICAL a. Date Sampled (mm/dd/yyyy) b. Laboratory Name ALPHAANALYTICAL PERSONNEL c. Analysis Performed By (Name) B. Form Selection 1. Please select Form Type and Sampling Month &Frequency Monitoring Well Data Report - 2022 Quarterly 4 1— All forms for submittal have been completed. This is the last selection. 3. r Delete the selected form. gdpols 2015-09-15.doc •rev. 09/15/15 Groundwater Permit Daily Log Sheet •Page 1 of 1 Massachusetts Department of Environmental Protection 746 Bureau -of Resource dProtection - Groundwater Discharge Program 1. Permit Number Groundwatef Permit- - : i MONITORING WELL DATA REPORT 2. Tax identification Number 2022 QUARTERLY 4 J 3. Sampling Month & Frequency C. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled • DRY = Not enough water in well to sample. Parameter/Contaminant DG -1 DG -2 DG -4 UG -1 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 MGVL TOTAL NITROGEN(NO3+NO2+TK4.2 1.5 --- I --- I ._.2 --- - I- - - - MG/L TOTAL PHOSPHORUS AS P 0.443 0.013 1.22 0.080 MG/L ORTHOPHOSPHATE 0.006 � !0.007 -_--1 1.17 MG/L Well #: 5 Well #: 6 mwdgwp-blank.doc •rev. 09/15/15 Monitoring Well Data for Groundwater Permit •Page 1 of 1 Massachusetts Department of Environmental Protection 1746 Bureau of Resource Protection - Groundwater Discharge Program 1...Permit Number �r-oundwater Permit: MONITORING WELL DATA REPORT 2: Tax identification Number 2022 OCT MONTHLY 3. Sampling Month & Frequency A. Facility Information Important:when filling out forms on 1. Facility name, address: the computer, use IPLEASANT BAY HEALTH CTR only the tab key to a. Name move your cursor - 383 SOUTH ORLEANS ROAD do not use the return key. b. Street Address BREWSTER Q C. City 1k AV 2. Contact information: Iun A JOSEPH SMITH MA 02631 d. State e. Zip Code a. Name of Facility Contact Person 7742125005 jsmith@NSUWater.com b. Telephone Number 3. Sampling information: � 10/10/2022 a. Date Sampled (mm/dd/yyyy) BEA NSU PERSONNEL c. Analysis Performed By (Name) B. Form Selection c. e-mail address NOT APPLICABLE b. Laboratory 1. Please select Form Type and Sampling Month &Frequency Monitoring Well Data Report - 2022 Oct Monthly r All forms for submittal have been completed. This is the last selection. 3. r- Delete the selected form. Name gdpols 2015-09-15.doc •rev. 09/15/15 Groundwater Permit Daily Log Sheet •Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater -Discharge Program Groundwater Permit MONITORING WELL DATA REPORT C. Contaminant Analysis Information • For , below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS = Not Sampled • DRY = Not enough water in well to sample. 1. Permit Number 2. Tax identification Number 2022 OCT MONTHLY 3. Sampling Month & Frequency Parameter/Contaminant DG -1 DG -2 DG -4 UG -1 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 S.U. STATIC WATER LEVEL f 10.13 10.20 10.13 10.41 FEET SPECIFIC CONDUCTANCE 1254 l 33 357 133 UMHOS/C Well #: 5 Well #: 6 mwdgwp-blank.doc •rev. 09/15/15 Monitoring Well Data for Groundwater Permit •Page 1 of 1 Important:when filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Any person signing a document under 314 CMR 5.14(1) or (2) shall make the following certification If you are filing electronic -ally and want to attach additional comments, select the check box. F Massachusetts Department of Environmental Protection Bureau of Resource.Protection -.Groundwater Discharge Program s oundwater Permit Facility Information (PLEASANT BAY HEALTH CTR a. Name SOUTH ORLEANS ROAD b. Street Address BREWSTER c. City Certification 746 1. Permit Number . 2. Tax identification Number MA 02631 d. State e. Zip Code "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that the are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." SAMANTHA FARRENKOPF 11/4/2022 a. Signature b. Date (mm/dd/yyyy) rtin Comments BENNETT ENVIRONMENTAL ASSOCIATES, LLC. (BEA) HAS COMPLETED THE OCTOBER 2022 MONTHLY INFLUENT AND EFFLUENT SAMPLING OF THE AMPHIDROME WASTEWATER TREATMENT SYSTEM, MONTHLY WASTEWATER SAMPLING WAS COMPLETED ON 10/14/22, LABORATORY RESULTS REPORTED ALL PARAMETERS WITHIN DISCHARGE PERMIT LIMITATIONS. EFFLUENT PH WAS REPORTED WITHIN THE 6.5-8.5 RANGE THROUGHOUT THE MONTH, FLOW VOLUME MEASUREMENTS WERE ASSESSED DURING THE MONTH FROM THE SYSTEM'S EFFLUENT FLOW METER. DAILY FLOW REMAINED WITHIN THE 26,500 -GPD LIMITATION THROUGHOUT THE MONTH. THE MINIMUM, MAXIMUM AND AVERAGE GPD FLOWS REPORTED OVER THE COURSE OF THE MONTH WERE 8,115 GPD, 171110 GPD AND 103557 GPD, RESPECTIVELY. gdpols 2015-09-15.doc •rev. 09/15/15 Groundwater Permit •Page 1 of 1 J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO: DATE: Brewster Board of Health 2198 Main Street Brewster, MA 02631 Shipping Method: Regular Mail ❑✓ Federal Express El Certified Mail El UPS F] Priority Mail F] Pick Up F Express Mail F1 Hand Deliver El COPIES I DATE I DESCRIPTION 1 � 09/01/22 � Perc-Rite Maintenance Checklist 10/03/2022 LETTER OF TRANSMITTAL .FOCT r r) F-7 s — rH; i JOB NUMBER: 8206W For review and comment: � For approval: � As Requested: � For your use: I7*,rX17FaIRS cc: John M. O'Reilly P.E., P.L.S Oakson, Inc. Client From: GJB If enclosures are not as noted, kindly notify us at once ROUTINE OPERATION AND MAINTENANCE CHECKLIST FOR PERC-RITE DRIP DISPERSAL SYSTEM Address: 200 Brier Lane, Brewster Homeowner: Drake Residence Operator: Greg Brehm 1/WVfO Lic #:16149 ]Ob #: 8206W HISTORICAL DATA and CURRENT READINGS Previous flow meter reading: 57,2ea Current flow meter reading: 86,100 Start-up dose rate ZONE 1: 2.0 GPM ZONE 2: ZONE 3: ZONE 4: FIELD CONDITIONS Date : 09/01 /2022 Design flow: aao Calculated water usage: Current dose rate 2.0 G P M Date of last visit: osiloi2ozl 28,816 gallons, 77.05 gpd A. Drip dispersal field: visible wet spots YES ❑ NO � Comments: B. Air release valves: erosion YES ❑ NOD leakage/spraying YES❑ NO❑✓ Comments. PUMP CHAMBER/FLOAT OPERATION A. Floats match pin lights in control panel YES❑✓ NO❑ Comments: B. Alarm float working YES❑✓ NO❑ Comments: C. Solids or scum present YES[:] NO❑✓ Comments: CONTROL PANEL A. Switches in AUTO position YES❑✓ NO❑ Comments: B. Peak Level light on Comments: C. Power and Run lights on (microprocessor) Comments: PUMP and VALVE OPERATION A. Pump in HAND position: flow meter running Comments: B. Zones 1-4 (one at a time): flow meter running dose rate correct flush rate > dose rate Comments: C. Disc filter back flushing: working properly Comments: D. Disc filter inspection: excessive residue cleaning required Comments: cleaned E. Switches returned to AUTO position Comments: F. RESET/CYCLE START: functioning properly Comments: G. Hydraulic Unit: leaks, crimps, or other issues Comments: SEPTIC and/or PRE-TREATMENT TANKS A. Examine and clean effluent filter: excessive residue Comments: NiA B. Septic tank pumping recommended 1. Sludge depth: $" 2. Scum depth: 0.25" Comments: C. Service pre-treatment system Comment Operator signature Com ments/Observations: System appears to be operating correctly at this time. YES❑ YES❑✓ YES❑✓ YES❑✓ YES ❑ YES ❑✓ YES ❑✓ YES❑✓ YES ❑ YES ❑ YES ❑ YES❑✓ N O❑✓ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO❑ NO ❑ NOS NO ❑ NO Q NO❑ License No. �sias 5 J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO Department of Environmental Protection Attn: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 Shipping Method: Regular Mail �✓ Federal Express Certified Mail El UPS M Priority Mail F] Pick Up Express Mail F-1 Hand Deliver D DATE: 10/03/2022 LETTER OF TRA.NSIVIITTAL JOB NUMBER: 8206W COPIES For review and comment: F7 For approval: F�] DATE DESCRIPTION 1 09/01/22 Routine Inspection Form DEP Approved Inspection Form Lab Results cc: John M. O'Reilly P.E., P.L.S Board of Health Client From: MJW As Requested If enclosures are not as noted, kindly notify us at once For your use: REMARKS: 1 1I( 1111 11 SAO 18 wastewater treatment systems INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address 200 Brier Lane NameJ.M. O'Reilly & Associates, Inc. Owner Name Jack and Nancy Drake Street 1573 Main Street, Brewster, MA Mail Address P.O. BOX 939 city Brewster state MA zip 02631 Phone 508-896-5984 Fax e-mail jackdrake200@comcast,net INSTALLATION Mail Address P.O. BOX 1773 city Brewster State MA zip 02631 Phone 508-896-6601 Fax 508-896-6602 a -mail mwrobel@jmoreillyassoc.com INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MicroFast 0.5 Unknown 8/6/19 unknown EQUIPMENT Electrical Panels YES NO MAINTENANCE PERFORMED AND COMMENTS System is operating correctly mechanically. Visual Alarm Operating Audio Alarm Operating ifpresent)X x Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment Units Effluent quality passed field test Unusual Odor x Effluent samples collected for lab analysis. Pum out Required: Primary Settling Zone Aerobic Treatment Zone x x a" sludge, .25" scum 4" sludge, 0" scum EFFLUENT(options) Estimated Daily Flow pH (Standard Units) Color LINIIT 6-9 S.U. Clear RESULT 7.0 Clear Alk = 40, NO3 = 5.0, NO2 = 0 Temperature 76.1 F Odor Slightly Musty odor (not septic) Earthy DO= 4.0 mg/L Turbidity= 6.59 NTU OWNER SIGNATURE TECHNICIAN SIGNATURE SERVICE DATE 09/0112022 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Jack and Nancy Drake Owner 200 Brier Lane Facility Street Address Brewster City Mailing address of owner, if different: P.O. Box 939 Street Address/PO Box: Brewster City (508) 896 - 5984 ext. Telephone Number MA State B. Authorized Service Provider O'Reilly &Associates, Inc. O&M Firm 1573 Main Street Street Address Brewster City (508) 896 - 6601 ext. Telephone Number John O'Reilly Certified Operator Name MA State C. Facility/System Information BREW-Bri200-FAS DEP ID 8/6/19 Installation Date Bio-microbics Manufacturer ID 02631 Zip 17746 Certification N 8/6/19 Start of Operation Approval Type: ❑General ❑Provisional ❑Piloting Seasonal Residence — used less than 6 mo./year: ❑ Yes D. Operating Information 09/01 /2022 Inspection Date 8" sludge, .25" scum Sludge Depth (to be checked yearly) t5aiom.doc •rev. 04-11-13 09/10/2021 02631 zp 02631 Zip Microfast 0.5 Model Number ® Remedial Previous Inspection Date Pumping Recommended ❑ Yes ®No Page 1 of 3 iAassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field testing Field Inspection: Color: ❑ gray ❑brown ❑ Other (specify): Odor: ❑musty ®earthy Effluent Solids: ® no ❑ some ® clear ❑turbid ❑ moldy ❑offensive ❑ turbid pH 7.0 SU DO 4.0 mg/L Turbidity 6.59 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑Influent ®Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: Parameters sampled: ❑ pH ❑BOD ❑ CBOD ❑TSS ❑ TN ❑Other (list below) see lab results Other 1 Other 2 G. Inspection and Maintenance Other 3 Description of any maintenance performed since previous inspection &during this inspection: maintenance completed per manufacturer's checklist Notes and Comments: System appears to be operating correctly at this time. t5aiom.doc •rev. 04-11-13 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and ®&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00, 10/03/2022 Operator Signature System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health as follows for each inspection performed: Remedial Use — by January 31S4 of each year for the previous calendar year Piloting Use -within 45 days of inspection date Provisional Use — by March 31th of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 t5aiom.doc •rev. 04-11-13 Page 3 of 3 �� ; � ; + , is - (� r"�� l i :, I t � i �� < <�ii - - � G22234700 Recipient: Greg Brehm Order No.: JM O'Reilly Assoc. Report Dated: 09123/2022 PO Box 1743 Submitter: JM O'Reilly Assoc. Brewster, MA 02631 Description: 8206W Labaratory I®#: �,�23��®®�0� Matrix: Water- Waste Water Sample #: Sampled: 09101!2022 11:15 ey: GJB Collection Address: Drake - 20o Brier Lane, Brewster Received: 0910112022 11:50 By: Sample Location: Turn Around: Standard %st Parameters ITEM RESULT UNITS RL MCI. METHOD # TESTED TIME Nitrate as Nitrogen 9.6 mg1L 0.10 10 EPA 300.0 0910212022 BOD (5 DAY) TEST 31 mglL 2.0 SM 5210 B o9l03/2022 Nitrite as Nitrocden p,31 mglL 0.050 1.0 EPA 300.0 09/0212022 TKN 2.4 mg1L 0.25 EPA 351.2 0911512022 8:44 Total Suspended Solids 14 � mg1L 2.o SM 2540D os1o112i722 r Attached please find the laboratory certlfled parameter list, Approved �v .��-��?� (Lab Director) ND =None Detected RL =Reporting Limit MCL =Maximum Contaminant Level 3195 Main S4reet, P®. fox 427, Barnstable, MA 02630 Ph: 50843756605 Page; 1 of 1 J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO Department of Environmental Protection Attn: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 Shipping Method: Regular Mail �✓ Federal Express Certified Mail El UPS Priority Mail F] Pick Up Express Mail F�] Hand Deliver El COPIES I DATE DESCRIPTION 1 09/01/22 DEP Approved Inspection Form SeptiTech Form Lab Results LETTER OF TRANSMITTAL DATE: JOB NUMBER: 10/03/2022 8082W REGA For review and comment: � For approval: � As Requested: � For your use: REMARKS: cc: John M. O'Reilly, P.E., P.L.S. Board of Health Client From: GJB If enclosures are not as noted, kindly notify us at once Site/Address: White Rock Commons Subdivision White Rock Road Brewster, MA 02631 Date: 09-01-2022 Time: 9:15 am Rep: Greg Brehm 1. Remove lids &covers on processor. Visually inspect media &spray pattern. 2. Exercise entire system in maintenance mode. a. Recirculation pumps) b. Pumpback pumps) c. Discharge pumps) 3. Perform maintenance/cleaning tasks required for proper operation of unit. a. Spray headers b. Media c. Screen 4. Take effluent sample from sample tube 5. Record following values from controller read-out (Discharge Pump) Days Runtime: 11 11 Hours Runtime: z 1 Seconds Runtime: �os.z 1988.8 6. Record controller program version: Commercial 7. Record controller firmware version: V121 GJB GJB GJB GJB .e�ilf3 (Initial) (Initial) (Initial) (Initial) (Initial) GJB (Initial) GJB (Initial) 8. List parts and supplies used: GJB (Initial) 9. Return system to "run" mode GJB (Initial) 10. Re -install covers and lids on processor. GJB (Initial) 11. Check air intake muffler for obstruction and proper draw. GJB (Initial) General Notes and Remarks: The system is operating correctly mechanically. Effluent quality passed field tests. Effluent sample collected for lab analysis. C:\Users\ndmWppDam\Loeal\Microso8\Windos�s\Temporary Intemel Files\ContmLOuBookV.Q2TP8QY\scµitah.doc Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 4:1 renin Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation White Rock Commons Subdivision Owner White Rock Road Facility Street Address Brewster 02631 City Zip Mailing address of owner, if different: P.O. Box 3843 Street Address/PO Box: New Haven City (203) 312 - 3484 ext. Telephone Number CT State B. Authorized Service Provider O'Reilly &Associates, Inc. O&M Firm 1573 Main Street - P.O. Box 1773 Street Address Brewster City (508) 896 - 6601 ext. Telephone Number Greg Brehm Certified Operator Name MA State C. Facility/System Information BREW-Sou157 DEP ID Unknown Installation Date Septitech Manufacturer ID 16149 Certification Number January 2016 Start of Operation Approval Type: ®General ❑Provisional ❑Piloting ❑ Seasonal Residence — used less than 6 mo./year: ❑ Yes D. Operating Information 09/01 /2022 Inspection Date Sludge Depth (to be checked yearly) 06525 Zip 02631 Zip M3000N Model Nur Remedial .1 • 05/23/2022 Previous Inspection Date Pumping Recommended ❑ Yes ® No t5aiom.doc rev. 04-11-13 Page 1 of 3 assaGhusetts Depa ment of •nmental Protection ureau of Resource Protection � Title 5 - Freatment and Disposal �. Field testing Field Inspection: Color: ❑ gray ❑brown ❑ Other (specify): Odor: ❑musty ®earthy Effluent Solids: M no ❑ some ® clear ❑turbid ❑ moldy ❑offensive ❑turbid PH 6.0 SU DO 4.0 mg/L Turbidity 0.83 PTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. sampling Information Samples Taken: ❑Influent ®Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: Parameters sampled: ❑ pH ®BOD ❑ CBOD ®TSS ®TN ❑Other (list below) See attached lab results Other 1 r2 G. Inspection and Maintenance Other 3 Description of any maintenance performed since previous inspection &during this inspection: Maintenance com Notes and Comments: manufacturer's checklist. The system is operating correctly mechanically. t5aiom.doc •rev. 04-11-13 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment Cl"d disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is trueJ accurate, and complete as of the time of the inspection. I am a Massachusetts oerfied oo'eRa or in accordance with 257 CMR 2.00, Operator 10/03/2022 Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health as follows for each inspection performed: Remedial Use — by January 31 s' of each year for the previous calendar year Piloting Use -within 45 days of inspection date Provisional Use — by March 31'h of each year for the previous 12 months General Use — by September 30'h of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 t5aiom.doc •rev. 04-11-13 Page 3 of 3 CERTIF CATE OF ANALYSIS arnstable County Health Laboratory (M=MA00! Order No.: 622234702 Recipient: Greg Brehm JM O'Reilly Assoc. Report Dated: 09123/2022 PO Box 1743 Submitter: JM O'Reilly Assoc. Brewster, MA 02631 Description: 8082W Laboratory IM 22234702=01 Matrix: Water - Waste Water Sample #: Sampled: 09/01/2022 9:45 By: GJB Collection Address: White Rock Rd HOA, Brewster Received; 09/01/2022 11:50 By: Sample Location: Effluent Turn Around: Standard 'fest Parameters ITEM RESULT UNITS RL MCL METHOD # TESTED TIME Nitrate as Nitrogen 6,9 mg/L 0.10 10 EPA 300,0 09/0212022 BOD (6 DAY) TEST III mg/L 2.0 SM 5210 B 09/02/2022 Nitrite as Nitrogen 0.43 mg/L 0.050 1.0 EPA 300;0 09/02/2022 TKN 2,Q mg/L 0.25 EPA 351.2 09/15/2022 8:44 Total Suspended Solids 3.2 mg/L 2.0 SM 2540D 09/0112022 Attached please find the laboratory certified parameter list. L ��© Approved fay: (Lab Director) ND =None Detected RL =Reporting Limit MCL =Maximum Contaminant Level 395 Main Street, PO. I3o�c 427, Barnstable, MA 02630 i�h: 508=3i5�6605 Page; 1 of 1 J.M. O'Reilly & Associates, Inc. Engineering & Land Surveying Services 1573 Main Street, 2nd Floor, P.O. Box 1773 Brewster, MA 02631 (508) 896-6601 Fax (508) 896-6602 TO Department of Environmental Protection Attn: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 Shipping Method: Regular Mail �✓ Federal Express Certified Mail El UPS F] Priority Mail F] Pick Up F1 Express Mail Hand Deliver COPIES I DATE DESCRIPTION 1 09/01/22 Routine Inspection Form DEP Approved Inspection Form Lab Results DATE: 10/03/2022 GARDIN 39 McGuerty Road Brewster, MA 02631 LETTER OF TRANSMITTAL JOB NUMBER: 8248BW For review and comment: � For approval: � As Requested: � For your use: cc: John M. O'Reilly, P.E., P.L.S. Board of Health Client From: GJB If enclosures are not as noted, kindly notify us at once I I h JL_jII) 1171 n if`i ( I IW 0 n P: 7 i( tXj I';°Vj _L (V>I� I FASTe wastewater treatment systems INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address 39 McGuerty Road NameJ.M. O'Reilly & Associates, Inc. Owner Name Lowell & Susan outslay Street 1573 Main Street, Brewster, MA Mail Address 39 McGuerty Road Mail Address P.O. Box 1773 city Brewster state MA zip 02631 city Brewster state MA Zip 02631 Phone 508-237-2106 Fax Phone 508-896-6601 Fax 508-896-6602 e-mail susanbaker715@9mail.com INSTALLATION e-mail gbrehm@jmoreillyassoc.com INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MicroFast 0.5 Unknown unknown unknown MAINTENANCE PERFORMED EQUIPMENT YES NO AND COMMENTS Electrical Panels System is operating correctly mechanically. Visual Alarm Operating X Audio Alarm Operating if resent X Blower(s) Air Inlet Filter Clean X Blower Hood Vents Clear X Excessive Noise X Excessive Vibration X Treatment Unit(s) Unusual Odor x Effluent samples collected for lab analysis. Pum out Re uired: Primary Settling Zone x taken 5-23-2022 Aerobic Treatment Zone X EFFLUENT(options) LIMIT RESULT Effluent quality passed field testing. Estimated Daily Flow pH (Standard Units) 6-9 S.U. 6.5 Alkalinity = 40, NO3 = 5.0, NO2 = 0. Color Clear Clear Temperature 77.36 F Odor Slightly Musty odor (not septic) Musty DO= 3.0 mg/L Turbidity= 10.61 NTU OWNER SIGNATURE TECHNICIAN SIGNATURE SERVICE DATE 09/01/2022 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rah Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Lowell &Susan Outs Owner 39 McGuerty Road Facility Street Address Brewster City Mailing address of owner, if different: Street Address/PO Box: (508) 237 - 2106 ext. Telephone Number 02631 Zip State Zip B. Authorized Service Provider J. M. O'Reilly &Associates, Inc. O&M Firm 1573 Main Street Street Address Brewster City (508) 896 - 6601 ext. Telephone Number Greg Brehm Certified Operator Name State C. Facility/System Information BREW-McG039-17 AS DEP ID Bio-microbics unknown Installation Date Manufacturer ID 16149 Certification Number unknown Start of Operation Approval Type: ®General ❑Provisional ❑Piloting Seasonal Residence — used less than 6 mo./year: ❑ Yes D. Operating Information 09/01/2022 Inspection Date Sludge Depth (to be checked yearly) 02631 Microfast 0.5 Model Number ❑ Remedial ►1 • 05/23/2022 Previous Inspection Date Pumping Recommended ElYes ® No t5aiom.doc •rev. 04-11-13 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and ®&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑gray ❑brown ❑ Other (specify): Odor: ®musty ❑earthy Effluent Solids: ® no ❑ some ® clear ❑turbid ❑ moldy ❑offensive ❑ turbid J pH 6.5 SU DO 3.0 mg/! Turbidity 10.61 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑Influent ®Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: Raw Parameters sampled: ❑ pH ®BOD ❑ CBOD ®TSS ®TN ❑Other (list below) see lab results Other 1 Other 2 C. Inspection and Maintenance K3 Description of any maintenance performed since previous inspection &during this inspection: System is operating correctly mechanically. Notes and Comments: M1 t5aiom.doc •rev. 04-11-13 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and ®&M Form for Title 5 IIA Treatment and Disposal Systems Fi. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00, Operator Signature 10/03/2022 Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health as follows for each inspection performed: Remedial Use — by January 31St of each year for the previous calendar year Piloting Use -within 45 days of inspection date Provisional Use — by March 31th of each year for the previous 12 months General Use — by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 5th Floor Boston, MA 02108 t5aiom.doc •rev. 04-11-13 Page 3 of 3 `f � i `� � �~� �� '� t�) � ��; �`� � r ` � f i cam. 4., I�i� r;� ! psi--i� � _ �� _� � �J Recipient; Greg Brehm Order No.: 622234698 JM O'Reilly Assoc. Report Dated; 09/23/2022 PO Box 1743 Submitter: JM O'Reilly Assoc. Brewster, MA 02631 Description: 8248BW Laboratoryl®#: ��9�=Q� Matrix: Water -Waste Water Sample #: Sampled: 09101!2022 10:20 By; GJB Collection Address: Outstay - 39 McGuerty Rd, Brewster Received: 09/01/2022 11:50 By: Sample Location: Effluent Turn Around: standard ��Sg b��Y�PiaT��6"S ii ITEM RESULT UNITS RL MCL METHOD # ANALYST TESTED TIME Nitrate as Nitrogen 12 mglL 0,10. 10 EPA 300.0 .CL 09/0212022 BOD (5 DAY) TEST 19 mg/L 2.o SM 5210 B CL 09/02!2022 Nitrite as Nitrogen ©.%9 mg1L 0.050 1.0 EPA 300.0 CL 09/0212022 TKN �,g mg/L 0.25 EPA 351.2 AB 09/07/2022 11:41 Total Suspended Solids 13 mglL z.o SM 2540D LAP 09/01/2022 Attached please find the laboratory certified parameter list. Approved fay: �i �--a�--,�St��.� (Lab Manager) ND =None Detected RL =Reporting Limit MCL =Maximum Contaminant Level 399 ►Main Street, �®. fou 4a7, i3arnstable, NiA 0630 fah; 508-3i5-6605 Page: 1 of 1 COASTAL engineering ca. TECHNICAL SERVICES 260 Cranberry Highway Orleans, MA 02653 508.255.6511 p 508.255.6700 F Orleans (Sandv,�ich I Nantucket coastalengineeringcompany.com To: Jacquelyn Linehan, Property Mgr. King's Landing Apartments 1200 South State Street Brewster, MA OZ631 via email; jlinehonCOpoohcommunities.com Subject: King's Landing Apartments 3 State Street Brewster, MA Permit #934-1 Plans Copy of Letter Specifications we are sendine the followine Items: OCT 312022 r3REVVSTER HEALTH DEPARTMENT Date: 10/27/2022 Project No. WBR007.00 ®Email Pick up Certified EFed Ex ®Other Copies Date No. Description 1 09/2022 934-1 Daily Log Sheet 1 09/29/2022 934-1 Monthly Discharge Report w/Laboratory Test Results 1 09/07/2022 934-1 Quarterly 6 Monthly Monitoring Well Report (Field-tested Data) 1 10/27/2022 934-1 eDEP Electronic Receipt These are transmitted as checked below: for approval ®for your use ®as requested for review az comment 0 Remarks: Enclosed are the recent reporting forms for the wastewater treatment facility at the above -referenced location. Monthly system test results indicate high levels of Total Nitrogen that exceed the upper discharge limit due to elevated levels of TKN. We will adjust the system settings and use of process control chemicals to help improve treatment of the system. None of the monitoring wells exceeded the upper containments limits for any of the tested parameters. HW -4 was dry during the time of sampling. The average daily flow was approximately 9,192 gpd. If you have any questions regarding this report or the WWTF, please do not hesitate to contact us. CCR Brewster Board of Health By: Chad A. Simmons, WWTPO CC Commission Joe Henderson, Horsley Witten Group, Inc. (via email) AquaPoint.3 LLC NOTE: If enclosures are not as noted, please contact us at (508) 255-6511 D:\DOC\W\W BR\007\FILE CDPY\TRANSMITTAL (SEPTEMBER 2022).DDC Orleans I sandvrich [ Ftantitc[<et Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DAILY LOG SHEET C. Daily Readings/Analysis Infurmat1011 Date Effluent Reuse Irrigation Turbidity Influent pH Flow GPD Flow GPD Flow GPD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 10,604 8,792 7,675 8,553 7,938 9,438 18,242 9,742 9,221 8,647 9,176 9,196 8,597 9.452 81337 7,854 7,931 9, 057 9,233 9,138 8,598 8, 005 9,091 8,793 9,336 9,165 gdpols.doc •rev. 09/15/15 7.18 7.02 6.63 6.78 6.76 6.81 6.79 6.88 79 6.72 16. 6.91 6.76 6.84 6.67 6.88 6.94 6.93 6.91 6.84 7.07 7.04 Effluent pi ermit Number x identification Number - DAILY ampling Month & Frequency 7.61 7.58 j - I 7.46 7.61 7.60 7.58 7.61 7.60 7.63 7.58 7.47 7.55 7.59 7.54 7.55 7.38 7.65 7.58 7.61 7,70 7.66 Chlorine Residual (m9/1) uv Intensity Groundwater Permit Daily Log Sheet •Page 1 of 1 _tom _^_ Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit DISCHARGE MONITORING REPORT D. Contaminant Analysis Information • For "0", below detection limit, less than (<) value, or not detected, enter "ND" • TNTC = too numerous to count. (Fecal results only) • NS = Not Sampled 1. Parameter/Contaminant Units CO MG/L TSS MG/L TOTAL SOLIDS MG/L AMMONIA -N MG/L NITRATE -N MG/L TOTAL NITROGEN(NO3+NO2+TKN) infeffrp-blank.doc •rev. 09/15/15 MG/L GREASE MG/L 160 40 510 39.2 2. Influent ermit Number - S 3. Sampling Month &Frequency 3. Effluent 4. Effluent Method Detection limit 0.10 I 0.050 Groundwater Permit Discharge Monitoring Report •Page 1 of 1 ANALYTICAL REPORT Lab Number: L2253865 Client: Coastal Engineering Company 260 Cranberry Highway Route 6A Orleans, MA 02653 ATTN: Chad Simmons Phone: (508)255-6511 Project Name: KINGS LANDING BREWSTER Project Number: WBR007,00 Report Date: 10/18/22 Serial No: 10182216:24 The original project reporUdata package is held by Alpha Analytical. This report/data package is paginated and should be reproduced only in its entirety. Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original. Certifications &Approvals: MA (M-MA086), NH NELAP (2064), CT (PH -0574), IL (200077), ME (MA00086), MD (348), NJ (MA935), NY (11148), NC (25700/666), PA (68-03671), RI (LA000065), TX (T104704476), VT (VT -0935), VA (460195), USDA (Permit #P330-17-00196). Eight Walkup Drive, Westborough, MA 01581-1019 508-898-9220 (Fax) 508-898-9193 800-624-9220 - www.alphalab.com F fL�L2f't�L Page 1 of 20 Serial No:10182216:24 Page 5 of 20 Project Name: KINGS LANDING BREWSTER Project Number: WBR007.00 SAMPLE RESULTS Lab ID: L2253865 01 Client ID: INFLUENT (COMPOSITE) Sample Location: 3 STATE ROAD, BREWSTER, MA Sample Depth: Matrix: Water Dilution Parameter Result Qualifier Units RL MDL Factor Serial No:10182216:24 Lab Number: Report Date: Date Collected: Date Received: Field Prep: Date Date Prepared Analyzed L2253865 10/18/22 09/29/22 09:00 09/29/22 Not Specified Analytical Method Analyst General Chemistry - Westborough Lab -- -- Solids, Total 510 mg/I 40 NA 4 10/05/22 05:37 1211254013 DW ....... _ __._._..__----- .____.—._.-_-- Solids, Total Suspended 40. mg/I 10 NA 2 10/06/22 12:22 12112540D CVN Nitrogen, Ammonia 39.2 mg/I 1.50 20 10/17/2221:05 10/18/2214:17121,4500NH3-131-1 KEP Nitrogen, Total Kieldahl 4200 mg/I 3.00 10 10/17/22 05:35 10/17/22 17:15 121,4500NH3-H AT BOD, 5 day 160 mg/I 30 NA 15 09/30/22 23:30 10/05/22 18:00 121152106 JT Page 6 of 20 Project Name: KINGS LANDING BREWSTER Project Number: WBR007,00 SAWirLE RESULTS Lab ID: L2253865-02 Client ID: EFFLUENT (COMPOSITE) Sample Location: 3 STATE ROAD, BREWSTER, MA Sample Depth: Matrix: Water Parameter Result Qualifier Units Serial No:10182216:24 Lab Number: L2253865 Report Date: 10/18/22 Date Collected Date Received Field Prep: Dilution Date RL MDL Factor Prepared General Chemistry - Westborough Lab Solids, Total Suspended 21. mg/I 10 NA 2 Nitrogen, Ammonia 5.21 mg/I 0.150 2 Nitrogen, Nitrite 0.19 mg/I 0.050 1 Nitrogen, Nitrate 0.76 mg/I 0.10 1 Nitrogen, Total Kjeldahl 8.94 mg/I 0.300 1 BOD, 5 day 15. mg/I 2.0 NA 1 Page 7 of 20 Date Analyzed 09/29/22 09:00 09/29/22 Not Specified Analytical Method Analyst - 10/06/2212:22 121,2540D CVN 10/17/22 21:05 10/18/22 09/30/22 23:30 10/05/22 18:00 121,52108 JT 1418 121,4500NH3-BH KEP 03:45 44,353.2 KAF — - 09/30/22 03:45 44,353.2 KAF - 09/30/22 121,4500NH3-H AT 10/17/2205:35 10/17/2217:14 Project Name: KINGS LANDING BREWSTER Project Number: WBR007,00 SAMPLE RESULTS Lab ID: L2253865-03 Client ID: EFFLUENT (GRAB) Sample Location: 3 STATE ROAD, BREWSTER, MA Sample Depth: Matrix: Water Parameter Result Qualifier Units RL MDL General Chemistry -Westborough Lab Oil & Grease, Hem-Grav ND mg/I 4.0 Page 8 of 20 Serial No:10182216:24 Lab Number: L2253865 Report Date: 10/18/22 Date Collected: 09/29/22 08:30 Date Received: 09/29/22 Field Prep: Not Specified Dilution Date Date Analytical Factor Prepared Analyzed Method Analyst 1 10/12/2211:00 10/12/2217:00 1401166413 JM U` 2 R L'• V O P t+ al Q x J 1 Q0® Daa Y�GB�V3 �!V �t�t�,'t�l � ❑ £oN'ZON'SffQa ❑ ❑ C SSl ❑�❑ pp cp � m q N' V 9 03 O Fry. 19 1 i I. w c7 5 a r� c; Y�GB�V3 �!V �t�t�,'t�l � ❑ £oN'ZON'SffQa ❑ ❑ C SSl ❑�❑ pp cp � m q N' V 9 03 O Fry. 19 1 i I. Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit MONITORING WELL DATA REPORT C. Contaminant Analysis Information • For 2 below detection limit, less than (<) value, or not detected, enter "N D" • TNTC = too numerous to count. (Fecal results only) • NS = Not Sampled • DRY = Not enough water in well to sample. Parameter/Contaminant HW -1 HW -2 HW -3 HW�3 Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 Well #: 5 Well #: 6 NITRATE -N 1.1 0.94 1.4 � ;DRY MG/L TOTAL NITROGEN(NO3+NO2+TK1.1 0.94 11.4 'DRY Y MG/L TOTAL PHOSPHORUS ASP 0.510 0.595 i0.43i 0 ;DRY MG/L ORTHO PHOSPHATE 0.007 0.012 ;0.005 ;DRY MG/L mwdgwp-blank.doc •rev. 09/15/15 Monitoring Well Data for Groundwater Permit •Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Groundwater Discharge Program Groundwater Permit MONITORING WELL DATA REPORT C. Contaminant Analysis Information • For , below detection limit, fess than (<) value, or not detected, enter "N D" • TNTC = too numerous to count. (Fecal results only) • NS =Not Sampled • DRY = Not enough water in well to sample. Parameter/Contaminant HW -1 HW -2 HW -3 HW -4 ermit Number ii Numberx identification 2 SEP • Frequency Units Well #: 1 Well #: 2 Well #: 3 Well #: 4 � 6.11 5.86 X5.78 ;DRY S.U. STATIC WATER LEVEL 23 28 20.96 (21.60 � DR� FEET SPECIFIC CONDUCTANCE 410 300 370 � DRr Y UMHOS/C Well #: 6 mwdgwp-blank.doc •rev. 09/15/15 Monitoring Well Data for Groundwater Permit •Page 1 of 1 ANALYTICAL REPORT Lab Number; L2248849 Client: Coastal Engineering Company 260 Cranberry Highway Route 6A Orleans, MA 02653 ATTN: Chad Simmons Phone: (508) 255-6511 Project Name: KINGS LANDING BREWSTER Project Number: WBR007.00 Report Date: 09/22/22 Serial No:09222216:42 The original project report/data Certifications &Approvals: MA (M-MA086), NH NELAP (2064), CT (PH -0574), IL (200077), ME (MA00086), MD (348)9 package is held by Alpha Analytical. This report/data package is paginated and should be reproduced only in its entirety. Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original. Eight Walkup Drive, Westborough, MA 01581-1019 508-898-9220 (Fax) 508-898-9193 800-624-9220 - www.alphalab.com Page 1 of 19 NJ (MA935), NY (11148), NC (25700/666), PA (68-03671), RI (LA000065), TX (T104704476), VT (VT -0935), VA (460195), USDA (Permit #P330-17-00196). Eight Walkup Drive, Westborough, MA 01581-1019 508-898-9220 (Fax) 508-898-9193 800-624-9220 - www.alphalab.com Page 1 of 19 Serial No:09222216:42 Page 5 of 19 Project Name. KINGS LANDING BREWSTER Project Number: WBR007,00 SAMPLE RESULTS Lab ID: L2248849-01 Client ID: HW -1 Sample Location: 3 STATE ROAD, BREWSTER, MA Sample Depth: Matrix: Water Parameter Result Qualifier Units RL General Chemistry - Westborough Lab Nitrogen, Nitrite ND mg/I 0.050 Nitrogen, Nitrate 1.1 mg/I 0.10 Nitrogen, Total Kjeldahl ND mg/I 0.300 Phosphorus, Total 0.510 mg/I 0.010 Phosphorus, Orthophosphate 0.007 mg/I 0e005 Page 6 of 19 Serial No:09222216:42 Lab Number: L2248849 Report Date: 09/22/22 Date Collected: 09/07/22 12:00 Date Received: 09/08/22 Field Prep: Not Specified Dilution Date MDL Factor Prepared Date Analytical Analyzed Method Analyst 1 09/09/22 04:31 449353.2 KA 1 09/09/22 04:31 4413532 KA 1 09/21/2222:22 09/22/2212:14 121,4500NH3-H JO 1 09/19/2211:20 09/20/2209:27 121,4500P -E AA 1 09/09/22 08:51 1211450OP-E KA Serial No:09222216:42 Project Name: KINGS LANDING BREWSTER Lab Number: L2248849 Project Number: WBR007.00 Report Date: 09/22/22 SAMPLE MMOULTS Lab ID: L2248849-02 Date Collected: 09/07/22 13:30 Client ID: HW -2 Date Received: 09/08/22 Sample Location: 3 STATE ROAD, BREWSTER, MA Field Prep: Not Specified Sample Depth: Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst 7 General Chemistry - Westborough Lab F� Nitrogen, Nitrite ND mg/1 0.050 1 09/09/22 04:32 4413532 KA Nitrogen, Nitrate 0.94 mg/I 0,10 1 09/09/22 04,32 44,353.2 KA Nitrogen, Total Kjeldahl m. ND mg/I 0,300 1 09/21/2222:22 09/22/2212:15 121,4500NH3_H JO Phosphorus, Total 0.595 mg/I 0,010 1 09/19/22 11:20 09/20/22 09:28 121,4500P -E AA Phosphorus, Orthophosphate 0,012 mg/I 0,005 1 09/09/22 08:51 121,4500P -E KA Page 7 of 19 Project Name: KINGS LANDING BREWSTER Project Number: WBR007.00 SAMPLE RESULTS Lab ID: L2248849-03 Client ID: HW -3 Sample Location: 3 STATE ROAD, BREWSTER, MA Sample Depth: Matrix: Water Serial No:09222216:42 Lab Number: Report Date: Date Collected: Date Received: Field Prep: L2248849 09/22/22 09/07/22 14:00 09/08/22 Not Specified Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry - Westborough Lab Nitrogen, Nitrite ND mg/I 0.050 1 09/09/22 04:33 44,353.2 KA Nitrogen, Nitrate 1.4 mg/I 0.10 1 09/09/22 04:33 441353.2 KA Nitrogen, Total Kjeldahl ND mg/I 0.300 1 09/21/2222:22 09/22/22 12:16 121,4500NH3-H JO Phosphorus, Total 0.430 mg/I 0.010 1 09/19/22 11:20 09/20/22 09:29 121,4500P -E AA Phosphorus, Orthophosphate 0.005 mg/1 0.005 1 09/09/22 08:52 121,4500P -E KA �_A1, � F��l• Page 8 of 19 ai 4 t� n m uu E I�Il�tlrti�`�ll�lhi ®`®' e}eydsai{dogpo ACON'a©N e „ EL v C 0 v < < LL a x m Al tv n 0/27/22,12:29 PM eDEP - MassDEP's OnlineFiling System MassDEP Home i Contact i Privacy Policy A1assDEP's Online Filing System �. l JgPrnnmP..'r'.ASnKAP Receipt Forms �T Signature Receipt a Summary/Receipt print receipt Exit Your submission is complete. 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DEP Transaction ID: 1440950 Date and Time Submitted: 10/27/2022 12:28:10 PM Other Email : DEP Transaction ID: 1440950 Date and Time Submitted: 10/27/2022 12:28:10 PM Other Email : DEP Transaction ID: 1440950 Date and Time Submitted: 10/27/2022 12:28:10 PM Other Email : DEP Transaction ID: 1440950 Date and Time Submitted: 10/27/2022 12:28:10 PM Other Email : DEP Transaction ID: 1440950 Date and Time Submitted: 10/27/2022 12:28:10 PM Other Email : Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432096 location: 3 STATE STREET Address: BREWSTER ZIP: 02631 Daily Log Sheet(2022 SEP DAILY) Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432096 location: 3 STATE STREET Address: BREWSTER ZIP: 02631 https://edep.dep.mass.gov/eDEP/Pages/PrintReceipt.aspx 1/2 10/27/22, 12:29 PM eDEP - MassDEP'S OnlineFiling System Discharge Monitoring Report(1 - 2022 Sep Monthly) Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432096 location: 3 STATE STREET Address: BREWSTER ZIP: 02631 Monitoring Well Data Report(1 - 2022 Quarterly 3) Form Name: Groundwater Discharge Monitoring Report Forms Facility Information: Tax Identification Number: 352432096 location: 3 STATE STREET Address: BREWSTER ZIP: 02631 Monitoring Well Data Report(1 - 2022 Sep Monthly) Form Name: Comments MassDEP Home � Contact � Privacy Policy MassDEP's Online Filing System ver.16.2.0.0© 2022 MassDEP https://edep.dep.mass.gov/eDEP/Pages/PrintReceipt.aspx 2/2