HomeMy WebLinkAboutCorrespondence - 114 REA STREET 4/15/2008 DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Tuesday, April 15, 2008 1:55 PM
To: Sawyer, Susan
Subject: FW: Failure to inspect Septic System Notice
-----Original Message--___
From: Shelley I:idntundson [rii:txlto:sedii,i�,indsoii(�r), astewate ialtei,natives:ie.con,i]
Sent: Tuesday, April 15, 2008 1:52 PM
To: I)elleC:'.h.iaie, Panie1a
Subject: Failure to inspect Septic Systern Notice
'-l'o the North Andover Board ot`l-Iealth,
We mould like to report Ryan H w a n g o f t 14 Rea Street (North Andover)
for failing to sign a Maintenance Agreement for his alternative
septic system, The Clean Solution, installed by our company,
Wastewater Alternatives of New England, C.LC;.
We informed Mr. Hwang of this required maintenance October 2007 and
again :February 2008, We have explained that he, may opt to use other
inspection conil.mnies, as long;as the required maintenance is
performed insuring that our system is maintained properly. No
progress has been achieved and the systern is now overdue on its
hispection schedule.
Thank you. If you have any, question, please contact, Wes Brighton hton at
(C 17) 877-41.57,
Sincerely,
Shelley Edniundson
Wastewater Alternatives ot'N ,, LI_C
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4SSACHUS�
PUBLIC HEALTH DEPARTMENT
Community Development Division
John Soucy
P.O. Box 4158
Andover, MA 01810
Re: 114 Rea Street
May 1, 2007
Dear John,
This letter is a follow up to our conversation in regards to a recent septic system installation at
114 Rea Street. The specific issue discussed was the proposed new building sewer that was
shown on the Board of Health approved septic plan. After careful review of the events that
occurred during installation the following facts were determined.
1) John Soucy was the licensed installer on this project
2) The approved septic plan showed that the existing building sewer was to be replaced with
a new building sewer to accommodate the elevations proposed for the septic tank
3) The building sewer was located underneath an existing porch at the rear of the building
4) The engineer's final inspection notes show that the building sewer had been covered up
prior to inspection and that there was no new elevation to show on the as-built plan
5) The installer admits that due to his experience with prior similar situations, assumptions
were made that an installer could safely adjust the elevation of the septic/pump tank and
maintain the use of the existing pipe to the house. In addition to reducing the difficulty to
the installer, the intended result in this case was likely: avoiding disturbance to the porch
and maintaining the integrity of the existing foundation.
6) Other results were; a new building sewer was not installed and the new tank was installed
almost a foot lower than proposed.
7) This decision was made without the consultation of the engineer or the Health Staff. Such
consultation would have provided the installer with new information on this subject and
could have prevented this situation.
The Installation Certification Form, signed by you, states that this system was installed per the
approved plan. This statement was incorrect in respect to the above detailed issue. The Health
Department has discussed the issue with Mr. Osgood, the engineer. He has determined that this
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
change will most likely have no negative effect on the function and longevity of the septic tank
as this was a long standing practice until Title V changes in 2006; therefore this Department will
order no corrective action.
This correspondence serves as a warning. As indicated in all approval letters, installers and
engineers must contact the Health Department if any significant changes to the plans are
considered. Please note that the Health Department strives to provide all homeowners with a
septic system that is in compliance with all regulations and assures protection of public health
and the environment of North Andover.
7Th y�,
usan Sawyer,REHS/RS
Public Health Director
Cc: Ben Osgood Jr.,NEES
Installer Files
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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Health Department
October 19,2006
Benjanvn Osgood
New England Engineering Services
1600 Osgood Street
Building 20, Suite 2-64
North Andover, MA 01845
Re: K 2jt4 On-Site Wastewater Systesss Des�,f?for 1114 Rea Sts°eet 111a 9�A Lot 8
Dear Mr. Osgood:
The proposed on-site wastewater system design plans for the above site dated.June 13,2006, revised September 11,
2006 and received by this office on September 20,2006 has been reviewed. Unfortunately,the plans cannot be
approved as submitted. The following items are in need of attention prior to approval,with the section offitle 5
(3 10 CMR 15.000)or North Andover(NA)regulation noted:
:. 1. Please show the waterline location which services the house--310 CMR 15.220.
�,°2. Please include a note on the plan stating that;sewer line is to be laid oil continuous grade in a straight: line
and on a compact firm base—310 CMR 15.222
Please include buoyancy calculations for the tanks—310 CMR 15.221(8)
i < Please provide the elevation for the percolation test—NA 8,02n
5. Please revise note 1 on Pump Notes to remove references to a. 1000 gallon pump chamber,unless one is to
be provided
s' 6. Please note that all excavation extends 6"into natural soil--NA 9,02
7. Please provide a draft:operation and maintenance agreement and a draft notice of deed recording(final
copies will need to be signed and recorded prior to issuance of a Disposal Systems Construction Permit)—
see approval letter to Waslewater Alternatives of New England, LLC
Please feel free to contact the office with any questions you may have. We look forward to working with you to
obtain a replacement,septic system which will be in compliance with all regulations and assure protection of public
health and the environment of Andover.
Sincerela�,
V'
/Us Sa�
wyer
Public Health Director
cc: Homeowner
CD&S Dir.
File
1600 Osgood Street HEALTH DEPARTMENT
Building 20;Suite 2-36 E-Mail:healthdept @townofnoi,thKarsdover,com Page 1 of 1
North Andover,IIAA 01845 Rhone:978.688.9 540
Fax:9713.61313.8476
TOWN OF NORTH ANDOVER %40RTH
'.0
Office of COMMUNITY DEVELOPMENT AND SERVICES "'.do
HEALTH DEPARTMENT 0
/,6500 .400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 CHUS
Susan Y.Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.8476—FAX
E-MAIL:healthdept@townofnortliandover.com
WEBSITE:ht!p://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM .................
Date of Submission: �idlo 2 0 N()G
Site Location:
Engineer:
New Plans? Yeses L--$225/Plan Check#_ (includes 1" submission and one re-
review only)
Revised Plans? Yes $75/Plan Check#
Site Evaluation Forms Included? Yes U,"', No
Local Upgrade Form Included? Yes No
Telephone#: Fax
2A 9, "5 72- - V
E-mail:
Homeowner
T
11
Name: el 4)4j
OFFICE USE ONLY
When the submission is complete(including check):
➢ —Date stamp plans and letter
Complete and attach Receipt
Copy File; Forward to Consultant
Enter on Log Sheet and Database
Iii-,w ENGl.AND ENGI E'EdIEUNG ERVIC � , INC.1600 ��good..�treet .__.�...�_...�... ...o..�.....�. ..-.... .�._�__.., ....._.._._.._.._......__ ....
Building 20 Suit, 2-64
North Andover, MA 0184
Tel: (978) 686-1768 o Fax: (978) 327-6138 September 18, 2006
Project# 1191
Mrs. Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 01845 � 1
w .k 2 0 Ek;k
T()Wkt
Re: 1 f 4 . ea Street, N Andover,ever°
Local Upgrade Approval Request
Dear Ms. Sawyer,
The purpose of this letter is to request that the above referenced property be included in
the upcoming Board of Health meeting agenda to discuss the following Local upgrade
approval request:
Local IJla rade�-Approvals R guired:
1. Reduction in offset distance between the estimated seasonal high groundwater and
the septic tank invert from 12" required by Title 5, Section 15.227(5)to 6".
. Reduction in offset distance leach area and a foundation from 20 feet required by
Title 5, Section 15.211(1)to 12 feet.
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
-1-
Benjamin C. Osgood, Jr. P.E.
President
1600 Osgood Street _ .......� ...._ _......... ._... _... _._... .
Building 20 Suite 2-64
North Andover, MA 01.845
Tel; (978) 686-1.768 o Fax: (978) 327-61.38 September 18, 2006
Project ## 1191
Mrs. Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 01815
Rem 1141F ea Street, No.Andover, MA.
Local Bylaw Variance Request
Dear Ms. Sawyer,
The purpose of this letter is to request that the above referenced property be included in
the upcoming ward of Health meeting agenda to discuss the following Local Bylaw
Variance request;
Local 1Bjlaw Variance Requesy
1. Reduction in offset distance between a leach are and a wetland from 100 feet
required to 87 feet.
2. Reduction in offset distance between a septic system tank and a wetland from 75
feet required to 71 feet.
If you have any comments or questions please do not hesitate to contact this offwice.
Sincerely,
/6 C 0
1 enjami . Osgood, Jr. P.E.
President
TOWN OF NORTH ANDOVER °e aoerH
SERVICES
Office of COMMUNITY DEVELOPMENT AND
1 1 O
HEALTH DEPARTMENT
400 OSGOOD STREET ' t�, «x:z .. •�+"
NORTH ANDOVER,MASSACHUSETTS 01845 �'S944
Susan Y.Sawyer,REHS/RS 978.688.9540—Phone
978.688.8476—FAX
Public Health Director E-MAIL:healthdept a.townofnorthandover.com
WEBSITE:htW://www.townofnorthandover.cQM
SEPTIC PLAN SUBMITTAL FORM
EC;EIVED
Date of Submission; 14 uln G , AQ
UN 16 2006
Site Location: f
r
TOWN
HE:ALTH� ANDOVER
DE AC�1 MENT
Engineer; C. .C
New Plans? Yes_,ff_$225/Plan Check# (includes lst submission and one re-
review only)
Revised Plans? Yes $75/Plan Check#
Site Evaluation Forms Included? Yes t' No
Local Upgrade.Form Included? Yes V' No
Telephone#• 9jL-JeX—171 g „ Fax#: 909
U•mail;
Homeowner .•JJ
Name: G
OFFICE USE ONLY
When the submission is complete(including check):
➢ -,/� Date stamp plans and letter
➢ r/ Complete and attach Receipt
➢ '! Copy File;Forward to Consultant
➢ ✓ Enter on Log Sheet and Database
Nii�',w I��NGJLAND E���(Jf1<<�l��l�l��li��G ����vl<CRS; , Ill c;n
100 os ood._......... .... _... _. .,-.W_........ ..
� w
Street
Building 20 Suite 2-64
North Andover, MA 01845
Tel: (978) 686-1768 e Fax: (978) 327-6138 June 13, 2006
Project ## 1191
Mrs. Susan Sawyer
North Andover Board of health
1600 Osgood Street (� �(
North Andover, MA 01 845
Rem 11.4 Rea Street, North Andover, MA
Septic System Design
Dear Mrs. Sawyer,
The following plans and enclosures for the above referenced property are being submitted
for approval.
1. (5) Copies of the Septic System Design Plans.
2. ( ) Copies of the Form 11 Soil Evaluator Sheets.
3. (2) Copies of the Textural Analysis Report
4. (2) Copies of the Form 9A—Application for Local Upgrade Approval
5. (1)Letter requesting for a Local Upgrade Approval and request to be heard at
the Board of Health Meeting
6. (1) Copy of the Septic Plan Submittal Form.
7. Check for plan review fee.
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
Benjamin C. Osgood, Jr. P.E.
President
NEw EN(( L VND 1�1N.C1111NEEMING' S"�l lr��vl�CIEl.. , III��t:;�
_..._.. . ..... .... .._. .o.... ...... _._........_....
�? 1600 Osgood Street
Suite 2-64
North Andover, MA 0134
'WI: (978) 686-1768 @ Fax: (978) ,327-6138 "
.Tune 13, 2006
Prof ect # 1191
Mrs. Susan Sawyer
North Andover Board of Health
400 Osgood. Street ° � x
North Andover, MA 01845 1
Re: 11.4 Rea Street, No.Andover, MA I ov\lr ::s.. ors i N"IDOVE'R
Local Upgrade Approval Request
Dear GIs. Sawyer,
The purpose of this letter is to request that the above referenced property be included in
the upcoming Board of Health meeting; agenda to discuss the following Local upgrade
approval request:
Local LJ Lade Al,)pLovals Re WreO.
1. Allow the use of a sieve analysis to determine loading;rate in lieu of performing;a
percolation test. 'Title 5, section 15.405(1).
2. Reduction in offset distance between the estimated seasonal high groundwater and
the septic tank invert from 12" required by "Title 5, Section 15.22'7(5)to (".
3. Reduction in offset distance between leach area and a property line from 10 feet
required by Title 5, Section 15.211(1)to 6 feet.
4. Reduction in offset distance leach area and a foundation from 20 feet required by
Title 5, Section 15.211(1)to 15 feet.
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
—P�C9 <�7 Benjamin C. Osgood, J I�,E.
.President
=O4gYltD AY��
O
SSACHUS�K
Health Department
June 30, 2006
Lester Young
114 Rea Street
North Andover, MA 01845
RE: Wastewater System Plan for 114 Rea Street, Map 98A, Lot 8
Dear Mr. Young,
The North Andover Board of Health has completed review of the onsite wastewater treatment
and dispersal system design plans for the above referenced property submitted on your behalf by
New England Engineering Services dated June 13, 2006 and received by this office on June 15,
2006.
The design has been approved for use in the construction of a replacement onsite wastewater
system. This approval is valid for three years from the date of this letter and during this time a
licensed septic system installer must obtain a permit and complete this work, and a Certificate of
Compliance must be endorsed by the installer, designer and the Town of North Andover. The
time period for which this plan is valid is reduced to two years from the date of an inspection of
the current wastewater system which did not meet the acceptable criteria in the state regulations.
The time period for which this plan is valid may be reduced by the North Andover Board of
Health in the event an imminent health problem such as sewage backup into the dwelling is
occurring.
This approval is subject to the following conditions:
1. If site conditions are found in the field to be different from those indicated on the design
plan and/or soil evaluation, the originally issued Disposal System Construction Permit is
void, installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit(3 10 CMR 15.020(1)).
2. It is the responsibility of the applicant and/or the applicant's designer, installer or other
representative to ensure that all other state and municipal requirements are met. These
may include review by the Conservation Commission, Zoning Board, Planning Board,
Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a
Disposal System Construction Permit shall not construe and/or imply compliance with
any of the aforementioned requirements.
'1600 Osgood Street HEALTH DEPARTMENT Wage 1 of 1
Building 20;Suite 2-36 E-Dail: healthdept @townofnorthandover.com
North Andover,MA 01845 Rhone:978.688.9540 Fax: 978.688.8476
3. An operation and maintenance agreement for the wastewater treatment and dispersal
system will need to be provided prior to issuance of a disposal systems construction
permit. This agreement will need to be for a minimum of a two year period. The system
itself must be under a maintenance agreement for the entire period of its usage until
replaced or abandoned.
4. The plan does not call for installation of a primary(septic) tank effluent filter but one is
recommended. Please be advised that only certain brands of filters are permitted for use
in Massachusetts and each is required to follow certain approval criteria. Your designer
or installer should work with you to assure a licensed brand is selected for use, if you
choose to install one.
Your effort to provide a properly functioning onsite wastewater treatment and dispersal system
for your property is greatly appreciated. The Health Department may be reached at 978-688-
9540 with any questions you might have.
Sincere,
>f
usan Y. Sawyer, REHS/RS�
Public Health Director
encl: List of licensed installers
cc: New England Engineering Services
file
Nr�w ENGI[Axp ENGANEEMING S1E11TVJK-'1]Fn-,,�, IN(C-A'�
.........................--...............................................................mm.......... --.................................... .................... ............ ............
1600 Osgood Street
Building 20 Suite 2-64
North Andover, MA 01845
Tel: (978) 686-1768 @ Fax: (978) 327-6138
Benjamin C. Osgood, Jr., P.E.
President October 24, 2006
Susan Sawyer
North Andover Board of Health
1600 Osgood Street RECEIVED
North Andover, MA 01845
0("T 2 4 2006
"TOWN OF NOR7+1 ANDOVeri
1—HEAL,r EP PAM
H I JR
—DI- ENI�
Re: 114 Rea Street,North Andover
Revised plans
Dear Susan:
Enclosed are three copies of revised septic system design plans for the above referenced
property. The following changes were made to address the comments in your letter dated
October 19, 2006.
1. The water line location has been added to the plans.
2. The note regarding the compact firm base has been added to the plans.
3. Buoyancy calculations have been added to the plans.
4. The perc. test elevation has been added to the plans.
5. The excavation note has been revised.
6. A draft maintenance agreement is enclosed. I would request that the plans be
approved subject to the submittal of an acceptable notice of deed recording being
submitted prior to the issuance of a disposal works construction permit.
If you have any questions, or need additional information, please do not hesitate to
contact this office.
Sincerely,
Benjamzin C. Osgood, Jr., P.E.
President
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 1/
Treatment o i I Systems
A. Installation R ci . H
Important:When R a I Iwan
filling out forms Owne - -- — —
on the computer,
use only the tab 114 Rae Street
key to move your Facility Street Address I9a �9p6 l� i���,r�t:C
cursor-do not North Andover 01$45 ��� I r T
use the return -- ^
key. City Zip
Mailing address of owner, if different:
Street Address/PO lox: —— — -- -- —
City State Zip —
_� - ext.
Telephone Number
B. Authorized Service Provider
Scott Kraihanze)
—
O&M Firm- — .
5 Susan Carsley Way
Street Address —
Sandwich MA 02563
City State Zip -- -
(508) 681 -8323 ext.
Telephone Number
Scott Kraihanzel _ 12580
Certified Operator-Nm
ae Certification Number
CH Facility/System Information
Clean Solution_
_-- —
DEP ID Manufacturer ID Model Number
Installation Date --
Start of Operation
Approval Type: ❑ General ❑ Provisional ❑ Piloting ® Remedial
Seasonal Residence–used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
4/25/2009 11/3/2008
nspectian Date Previous Inspection Date
{1"
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev. 11-07-05 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 ® clear ❑turbid
❑ Other(specify):
Odor: M musty F71 earthy El moldy ❑ offensive El turbid
Effluent Solids: ❑ no ❑ some
6.8 SU 2.1 mg/L 8 NTU
pH 6 to 9 DO 2 or greater Turbidity 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:
gpd
Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below)
Other 1 Other 2
Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection & during this inspection:
Notes and Comments:
System is operating as designed. Even pattern of growth throughout reactor.
t5aiom.doc•rev. 11-07-05
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 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 o erator in accordance with 257 CMR 2.00.
4/25/2009
Operator g'n3ture Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP 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 31st'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 Pro hgram
One Winter Street, 5t Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 3
Massachusetts a artmen of Environmental Protection
Bureau of Resource Protection - Title
LA
DEP Approved tl n and O&M Form for Title 5 I/
Tre atment and Disposal Systems
I w df
A. Installation
Important;When
Ryan
filling out forms % Owner — — ---- —
on the computer
use only the tab 114 Rae Street i ON1 & itii' �0 A V1&1� rr.i"
key to move your Facility Street Address i'I�% i i t IF:T �I i i OUII':III� --
cursor-do not North Andover
use the return �— 01845
key. City Zip - — ------ ----
Mailing address of owner, if different:
dab
❑_ Street Address/PO Bax: — — --- -- ---------- --
City — State ---— ---..— Zip -------------
ext, _
Telephone Number -
B. Authorized Service Provider
Scott Kraihanzel
O&M Firm ---
5 Susan Carsley WaY
Street Address — -- —__
Sandwich _ MA 02563
City State —
(508) 681 -8323 ext.
Telephone Number
Scott Kraihanzel 12580
Certified Operator Name __-.--_.
Certification Number `—
C. Facility/System Information
Clean Solution
DEP ID — -- —__ ------ -_-.
Manufacturer ID M— -- — ——_•odel Number
Installation Date -- - - -- .___
Stark of Operation _---
Approval Type: ❑ General ❑ Provisional ❑ Piloting ® Remedial
Seasonal;Residence–used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
10/11/2009 4/25/2009
Inspection Date — --
Previous Inspection Da#e --
<1"checked-in A ril_ —
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc e rev. 11-07-05
Page 1 of 3
Massachusetts Department of Environmental Protection
Ll Bureau of Resource Protection - Title 5
DP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ❑ some
pH 6.5 SU DO 2.0 mg/L Turbidity 10 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:
gpd
Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below)
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection & during this inspection:
Notes and Comments:
System is operating as designed.
t5aiom.doc•rev.11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and OM 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.
10/11/2009 -
Operator Signatur Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP 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 31 t of each year for the previous 12 months
General Use—by September 301h of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Prohgram
One Winter Street, 5t Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - 'Title 5
DEP Approved Inspection r for Title 5 I/
Treatment i I Systems
A. Installation RECEIVEL.,� .,�
Important: Mr. Ryan Hwang
When filling out Owner — -- —
forms on the 114 Rea Street FEB' 3 �������,
computer, use LN only the tab key Facility Street Address to move your �fit°�t DdTt� I� O�4��.
to move o not North Andover 01845 m m :r1 DEPARTMENT
a _
use the return City Zip
key. Mailing address of owner, if different:
Q
Street Address/PO Box:
- ----- ------- ------
renen City State Zip
ext. —
Telephone Number
B. Authorized ic Provider
WasteWater Alternatives of New England, LLC. _
O&M Firm
27 Kensington Road _--
Street Address
Hampton Falls _ NH 03844 _
City State Zip
(603) 926-9053 ext. --
Telephone Number
Scott K_raihanzel 12580 _
Certified Operator Name Certification Number
C. Facility/System Information
The Clean Solution _
DEP ID Manufacturer ID Model Number
Installation Date Start of Operation
Approval Type: ❑ General ❑ Provisional ❑ Piloting ® Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
11/2/2008 NA _---
Inspection Date Previous Inspection Date
NA -- Pumping Recommended ® Yes ® No
Sludge Depth(to be checked yearly)
t5aiom.doc a rev. 11-07-05 Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection o d O&M Form for Title I/
Treatment and Disposal Systems .
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid.--21,1 ��w emu
N t"
dk'rN� °I
r iw� ,V��V`W���' V"NV16„u
❑ Other(specify): — - --
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH s to g SU DO --or grey mrg/L Turbidity NTU
y 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 SOD 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:
gpd
Parameters sampled: ❑ pH ❑ SOD ❑ CSOD ❑ TSS ❑ TN ❑ Other(list below)
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection & during this inspection:
None
Notes and Comments:
The system appears to be working properly. The pressure dose field also appears to be working
properly--- - --
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Massachusetts ep rtment of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection r Ma ft e�sm
Treatment
Disposal
H. Certification rom,,u "NOR r ANUOVE R
LTH I certify: I have inspected the sewage treatment and disposal systeatt e fr e
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.
11/2/2008
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 318t of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31 t 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, 6t Floor
Boston, MA 02108
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