HomeMy WebLinkAboutCorrespondence - 534 BOSTON STREET 8/9/2007 tAORTH '9
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PUBLIC HEALTH DEPARTMENT
Community Development Division
August 9, 2007
Thomas Petraila
534 Boston Street
North Andover, MA 01845
RE: Septic System Design, 534 Boston Street, North Andover,Map 107D,Lot 81
Dear Mr:
The North Andover Board of Health has completed the review of the septic system design plans,
for the above referenced property, submitted on your behalf by New England Engineering
Services, dated August 2, 2007. This plan has been approved. The approval includes a Local
Upgrade Approval as found attached. This plan is valid for two years from the date of this
approval.
The design has been approved for use in the construction of an onsite septic system for a 4-
bedroom house (maximum room). During this time, a licensed septic system installer must
obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the
installer, designer and the Town of North Andover. In the event an imminent health problem
such as sewage backup into the dwelling is occurring,the North Andover Board of Health may
reduce the time period for which this plan is valid.
This approval includes the following:
Local Up rade Approval
Reduction in separation distance between the ESHGW and septic tank/pump chamber
inverts from 12 inches to 1.S inches
This approval is subject to the following conditions:
1. The owner shall keep the attached form 9b for their records
2. 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)).
3. 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.
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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.
4. The approval letter issued by the Massachusetts Department of Environmental Protection
(DEP) for the treatment unit which is part of this onsite wastewater system requires:
a) "Operation and Maintenance Agreement: Throughout its life, the Owner of the System
shall have the System properly operated and maintained in accordance with Company's
and designer's operation and maintenance requirements and this Approval and be under
an operation and maintenance agreement (O&M). No O&M agreement shall be for less
than one year." Maintenance shall consist of observing the system and monitoring
effluent from the system at least semi-annually.
A signed maintenance agreement must be returned to this office prior to issuance of a
Disposal Systems Construction Permit. The maintenance agreement is to be for all the
components of the on-site wastewater system including the tank, treatment unit and soil
absorption system.
b) "The owner of the System shall record in the appropriate registry of deeds a notice that
discloses the existence of this Remedial Use approved alternative system. A copy of the
book and page number of the recording must be provided to the local approving authority
and the Department of Environmental Protection prior to the issuance of the Certificate of
Compliance."
c) The owner of the System shall provide a copy of the DEP Approval letter, prior to the
signing of a purchase and sale agreement for the facility served by the System or any
portion thereof,to the proposed new owner.
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 978-688-9540 with any questions you
may have.
Sincerel ,
usan Y. Sawyer, REHS/�
Public Health Director
Encl: list of licensed septic system installers
Form 9B for owner records
Cc: New England Engineering Services
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 913
DER has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
k iportant:
When filling out 1. Facility Name and Address
forms on the
computer,use Thomas Petralia
only the tab key Name
to move your 534 Boston Street
cursor-do not Street Address
use the return
key. No.Andover MA 01845
City/Town State Zip Code
2. Owner Name and Address(if different from above):
Name Street Address
City/Town state
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: 440
gpd
5. System Designer: Ben Osgood ® PE ❑ RS
Name
1600 Osgood Street No Andover MA 01845
Address City/Town State,ZIP
B. Approval
1. Local Upgrade Approval is granted for
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
534 Boston Street form 9B 6.07•rev.7/06 Local Upgrade Approval* Page 1 of 1
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 913
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft
❑ Relocation of water supply well (explain):
® Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
North Andover Health Dept.
Approving Authority
Susan Sawyer, REHS/RS ._.June 28,2007
Print or Type Name and Title Sf ature _ Date
534 Boston Street form 9B 6.07•rev.7/06 Local Upgrade Approval• Page 2 of 2
1600 Osgood Street
Building 20 Suite 2-6
N 4
orth Andover, MA 0184,,,
TO: (978) 686-1768 ® Fax: (978) 327-6138
Benjamin C. Osgood, Jr.,
President
July 26, 2007
Susan Sawyer
North Andover Board of Health
1600 Osgood Street
North Andover, MA 01845
Re: 534 Boston Street, North Andover AUG 6 2007
Subsurface Sewage Disposal Design
� H X,fl-)OVER
()Ei-AF��MEN F
Dear Susan:
Enclosed are revised Subsurface Sewage Design plans for the property.
above referenced
These plans incorporate revisions to address the comments in You letter dated J
2007 as follows:
my 13,
1. A special design note has been added to the plans.
2. This design uses es bed in lieu of trenches to save trees. The area where the
is located is a wooded hillside. BY using trenches the footprint of the system system
would double, the slopes would require more area,
lost. In addition to the loss nd many more trees would be
dramatically due I Of the trees the cost of the system would increase
to the increased amount of septic sand needed.
3. The notes have been corrected.
4- The barrier location has been clarified
5* The Pipe layout detail on sheet 2 specifies an
downward facing orifice. 8"x 8"splash block beneath the
6- A draft maintenance agreement is enclosed,
7- A draft deed notice is enclosed.
Additional suggestions have been addressed as follows:
The system manufacturer has been contacted and he indicated that the tanks are
Provided with rubber boots. Rubber boots have been specified for both the pump
chamber and septic tank.
2. Although the loading rate could be higher we have elected to keep the size of the
system the same since the reduction would be minimal.
Page lofl
De|KeChiaie, Pamela
From: Dan Odanhsjnner[i iUriverconsu|dng.uon)
Sent Monday, July 1O. 2OO77:31AM
To: 'Dan Dbczut'; Grant, Michele; Marianne Peters; DeUeChimie, Pamela; Sawyer, Susan
Subject: 534 Boston Street Plan Review
Sue, Michelle, Pam—
We completed this review a while ago but had a question about this for New England Engineering. | called over a
week ago and never got g return call. |f they squawk about it, let them know we were waiting b) hear back from
them.
the design is | acceptable given the site conditions but enough problems were found tosuggest
they complete ana-deeign. VVe also gave them a few suggestions at the end of the letter which might be
beneficial b» the project.
Speak with you soon.
Dan
NIHI River
Daniel Ottemhmimer, President
Mill River Consulting, Inc.
On-Site Wastewater Management Services
7 Blackburn Center
Gloucester, MA0i030-225q
978-282-0014oz1-800-377-3044
fax: 978-282-0012
vV\m\m.nIit|riverc0nsLi\tiiig'co[V
daji0(6roiilriverc0n8Uhing.c8[V
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ate-
41
Health Department
July 13, 2007
Benjamin Osgood, P.E.
New England Engineering Services, Inc.
1600 Osgood Street- Building 20, Suite 2-64
North Andover, MA 01845
Re: Wastewater Treatment and Dispersal System Plan for 534 Boston Street, Map 107D, Lot 81
Dear Mr. Osgood:
The proposed wastewater system design plan for the above site dated June 5, 2007 and received
on June 11, 2007 has been reviewed. Unfortunately, the design cannot be approved until the
following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North
Andover regulation that is not met by this design follows each item.
I. It is implied on the design plan, and understood from the field investigation, that the
parent soil layer is not considered to be suitable. Please provide some type of written
notation to that effect on the design plan so future property owners or others reviewing
this plan will understand the site limitations and reasons for selecting the design approach
presented on this plan.
2. The design uses a field instead of trenches, and no explanation is provided as to why
trenches are not used (31.0 CMR 15.240)
3. Some of the notes on the plan refer to distribution boxes and other features not proposed
for this project
4. It is not clear where the impervious barrier is proposed to be installed as shown on the
site plan
5. Please provide a splash block or other means of preventing scouring beneath the down-
facing orifices in the pressurized soil absorption system
6. Please provide a draft maintenance agreement for the treatment unit and pressure
distribution system
7. Please provide a draft notice to be recorded on the deed indicating the presence of a
wastewater pre-treatment system
1600 Osgood Street 14 ALTH DEPARTMENT Page 1 of 1
Building 29p Suite -86 E-Mail: lie ithd pt@tow nofnortliandove>r.r,oiri
North Andover,MA 01845 phone:978.688.9540 Fax: 978.688.8476
Additionally,you are encouraged to consider the following items in the revised design plan:
Since a Local Upgrade Approval is proposed for reduced separation from the tank
openings to the seasonal high ground water table, it may be prudent to specify
tanks with cast-in-place rubber boot connections to help assure a water tight
connection.
It appears that a Long Term Acceptance Rate of 0.61 GPD/sq. ft. may be used in
this design rather than the 0.56 GPD/ sq. ft. shown
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Sincerey"
S4an Y. Sa�er, REVS/ "S
Public Health Director'
cc: Owner
File
OWN OI,, NORTH ANDOVER
Offt(',d: t IOI � q . D SERVICES
HA��I� DEPARTMENT
1600 OSG001) MASSACHUSETTS S t ley+,i' lC; Ill I [ING 20; SUITE 2-36
l
NORT A.NI)OVE;[�
978,688.9540—Phone
Susan V.Sawyer,REFI S/RS 978.688.8 176._.,FAX
f'tihlic Health Director" E-MAIL:healthde '?towiioltiorthai7dover.eom
WFE3Sl EE',:.hty://fix yxy.tow nofinorthandover.com
SEP'T'IC PLAN SUBMITTAL FORM
� r
Date of Submission:
Site Location: 3 o.5 � �f� 0 , /� ar. �
AVV
Engineer: '
New Plans? Yes 225/Plan Check# (includes I" submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? Yes No
Telephone#: D r ��Q°�1( Fax#:
E-mail: ® ijx
Homeowner
Na
Name:
OFFICE USE ONLY
When the submission is complete (including check):
Date stamp plans and letter ',,/v e . °
Complete and attach Receipt
Copy File; Forward to Consultant
Y ' Enter on Log Sheet and Database
Commonwealth of Massachusetts
City/Town of No. Andover
Form li inr Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
15.404(1), is not feasible.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.415.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
Important:
When filling out 1. Facility Name and Address:
forms on the
computer,use Thomas Petralia
only the tab key Name
to move your 534 Boston Street
cursor-do not
use the return Street Address
key. No Andover MA 01845
City/Town State Zip Code
2. Owner Name and Address (if different from above):
Same as Above
p" Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility(check all that-apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
Installation of a subsurface sewage disposal system
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach Field
Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local Upgrade Approval* Page 1 of 4
7/06
Commonwealth of Massachusetts
City/Town of No. Andover
Form Application l Upgrade Approval
` DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: 440
gpd
Design flow of proposed upgraded system 440
gpd
Design flow of facility: 440
gpd
B. Proposed Upgrade of System
1. Proposed upgrade is (check one):
❑ Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Unknown
Required following inspection pursuant to 310 CMR 15.301: date n of inspection
2. Describe the proposed upgrade to the system:
Replace leach field and system components
3. Local Upgrade Approval is requested for(check all that apply):
® Reduction in setback(s)—describe reductions:
Reduction in separation distance between the ESHGW and septic tank/pump chamber inverts from
12" required by Title 5 Section 15.227(5)to 1.5"
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft.
Percolation rate min./inch
Depth to groundwater ft.
Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local Upgrade Approval, Page 2 of 4
7/06
Commonwealth of Massachusetts
City/Town of No. Andover
Form Application r Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
® Use of a sieve analysis as a substitute for a perc test
❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a
member or agent of the local approving authority.
High groundwater evaluation determined by:
Armond Parrazzo 4-17-07
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
No other location on the lot
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
An alternative system would be cost prohibitive.
Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local Upgrade Approval* Page 3 of 4
7/06
Commonwealth of Massachusetts
City/Town of No. Andover
Form Application r Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
No other adjacent is available
4. Connection to a public sewer is not feasible:
Public sewer is not available in the area.
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
❑ Application for Disposal System Construction Permit
❑ Complete plans and specifications
❑ Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
acilit wner's Sign Date
Benjamin C. Osgood Jr. P.E. (Agent for Owner)
Print Name
New England Engineering Services, Inc. fl
Date
1600 Osgood Streeet No. Andover, MA
Preparer's address City/Town
01845 (978)686-1768
State/ZIP Code Telephone
Form 9A Application for Local Upgrade Approval revised.doc•rev. Application for Local Upgrade Approval* Page 4 of 4
7/06
Commonwealth of Massachusetts
City/Town of nJ®R-`rq /qvD® v c�z,
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important: A. Site Information
When filling out
forms on the
computer,use Thomas Petrallia
only the tab key Owner Name
to move your 534 Boston Street
cursor-do not Street Address or Lot#
use the return
key. Nrth Andover MA 01845
City/Town State Zip Code
rat
Contact Person(if different from Owner) Telephone Number
,ems B. Test Results
5-8-07 9:00 5-17-07 1:00
Date Time Date Time
Observation Hole# PT1 PT2 (B horizon)
Depth of Perc 33"718" 18"
Start Pre-Soak 9:28 1:20
End Pre-Soak 9:43 1:35
Time at 12" 9:43 1:35
Time at 9" 12:46 1:52
Time at 6" 4:25 (7") 2:26
Time (9"-6") Aborted @ 7" 32 Minutes
Rate (Min./Inch) Due to rate>90 MPI 15 min. /inch
Test Passed: ❑ Test Passed:
Test Failed: ® Test Failed: ❑
Thomas Hector
Test Performed By:
PT1 -Armand Parrazzo PT2- Randy Burley— Mill River Consulting
Witnessed By:
Comments:
t5form12.doc•06403 Perc Test•Page 1 of 1
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NEw ENqu�NDENGINEEPUNG SERVICES, INC.
. ................... .............. .................. .. ....
1600 Osgood Street
Building 20 Suite 2-64
North Andover, MA 01845
Tel: (978) 686-1768 e Fax: (978) 327-6138
June 7, 2007
Project 44 1 166
I T� I
Ms. Susan Sawyer
North Andover Board of Health
1600 Osgood Street
No. Andover. MA 01845
p-
Re: 534 Boston Street, No. Andover JUN 1 1 2007
Local Upgrade Approval Request TCAVe u; 'IRT"I d ArqDOVER
HEAL.'r H DEHIARI MENT
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 Upgrade Approvals Required:
I. Reduction in separation distance between the ESHGW and septic tank/pump
-cc
- . tuiredto 11.5".
chamber inverts from l2
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
g7
Benjamin C. Osgood, Jr. P.E.
President
Massachusetts Department of Environmental Protection
L Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 IC
Treatment and Disposal Systems
A. Installation R E C �
Important:When Gutman r pp fl filling out forms Owner , �
on the computer,
use only the tab 534 Boston Road
key to move your Facility Street Address t1 i �I 8 tai Ff t i r•I t ;t
����o
cursor-do not North Andover 01845
use the return
key. City Zip
f' Mailing address of Owner, if different:
Street Address/PO Box:
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 Zip
(508)681 -8323 ext.
Telephone Number
Scott Kraihanzel 12580
Certified Operator Name Certification Number
C. 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
10/11/2009 4/25/2009
Inspection Date Previous Inspection Date
Pumping Recommended Fl Yes ® No
Sludge Depth(ta be checked yearly)
t5aiom.doc•rev. 11-07-05 Page 1 of 3
Massachusetts Department of Environmental Protection
Ll 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 ® clear ❑turbid
❑ Other(specify):
Odor: M musty ❑ earthy El moldy El offensive El turbid
Effluent Solids: ❑ no ❑ some
6.9 SU 2.2 mg<L 16 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.
t5aiom.doc•rev. 11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Ll Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M dorm for Title 5 1/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 'j -
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 31St of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 311h 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 Department of Environmental Protection
L Bureau of Resource Protection - Title 5
DEP Approved Inspection for Title 5 1/
Treatment n i o I y t R ,
,
� ,y ���u�t�
Vft
A. Installation
Important:When Gutman
filling out forms Owner "/I4
pBI I�PgD I ���pl,�,t
on the computer,
use only the tab a :�', 534 Boston Road NIL I
key to move your Facility Street Address
cursor-do not {North Andover 01845
use the return
key. City Zip
§ f� Mailing address of owner, if different:
Street Address/PO Box:
--
city State Zip
( ) - ext. _
Telephone Number
B. Authorized Service Provider
Scott Kra ihanzel
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 Name Certifcation Number
C. Facility/System Information
Clean Solution_
DEP ID Manufacturer ID Model 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
4/25/2009 11/3/2008
Inspection Date Previous Inspection Date
2.5"+/- Pumping Recommended ❑ Yes ® No
Sludge Depth(to be checked yearly)
t5aiom.doc•rev.11-07-05 Page 1 of 3
Massachusetts Department of Environmental Protection
LlBureau 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 ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ❑ some
pH 7.1 SU DO 2.4 mg/L Turbidity 8 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
Ll 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 operator in accordance with 257 CMR 2.00.
4/25/2009'
Operat ignat 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 31 st 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, 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 and O&M Form for Title 5 I/A
Treatment and Disposal Systems
. Installation
Important: Mr. Daniel Gutman
When filling out Owner
forms on the ]7FEB] -fi
computer,use 534 Boston Street
only the tab key Facility Street Address TO WNU &V ER
to move your North Andover 01945 HEALTH DEPARTMENT
cursor-do not
use the return city Zip
key. Mailing address of owner, if different:
Street Address/PO Box:
City State Zip
j ext.
Telephone Number
B. Authorized Service 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 Kraihanzel 12580
Certified Operator Name Certification Number
C. Facility/System Information
The Clean Solution
DEP to Manufacturer ID Model Number
Installation Date Start of Operation
Approval Type: ❑ General ❑ Provisional ❑ Piloting Z Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes Z No
D. Operating Information
4/20/2008 NA
Inspection Date Previous Inspection Date
NA Pumping Recommended ❑ Yes No
Sludge Depth(to be checked yearly)
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 O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
"E]D
Field Inspection:
L-13 13 009
Color: ❑ gray brown clear turbid
4L�c
I0-
i/Ar- WDOVFR
❑ Other(specify):
Odor: 0 musty ❑ earthy 171 moldy ❑ offensive F-1 turbid
Effluent Solids: ❑ no F-1 some
pH SU DO m teg/L Turbidity NTU
6 to 9 2 or grear 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: F-1 Influent F-1 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)
—6—therl Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection &during this inspection:
None. The residence appears unoccupied. .......
Notes and Comments:
The system appears to be working as designed and to manufacturers specifications. --
t5aiom.doc-rev. 11-07-05 Page 2 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -`Title 5
DEP Approved Inspection and O&M Form f
Treatment and Disposal Systems TVED
H. Certification LLI 3 ?66 1
, W=W0rL
conducted the required Field Testing and/or sample collection in E '@
I certify: I have inspected the sewage treatment and disposal system L )
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.
4/20/2008
Op6�ator s7tdivgure' 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 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 Pro P ram
One Winter Street, 6t 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 and O&M Form
Treatment and Disposal Systems
A. Installation TOWN 0�-
,r�XVIER
Important: Mr. Daniel Gutman HEAL TH DE'
IiL�Vw'
When filling out Owner
forms on the
computer,use 534 Boston Street
only the tab key Facility Street Address
to move your North Andover 01945
cursor-do not city Zip
use the return
key. Mailing address of owner, if different:
VQ Street Address/PO Box:
Leman City State Zip
ext.
Telephone Number
B. Authorized Service 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 Kraihanzel 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 4/20/2008
Inspection Date Previous Inspection Date
NA Pumping Recommended ❑ Yes H No
Sludge Depth(to be checked yearly)
t5alom.doc•rev.11-07-05 Page 1 of 3
Massachusetts Department of nviron en I Protection
Ll DEP Bureau of Resource Protection ®Title 5
Approved Inspection r for Title I/
Treatment i I Systems
E. Field Testing
Field Inspection: " ". s? )
Color: ❑ gray F-1 brown ® clear ❑ turbi T � r .� .r`
.. � -R
❑ Other(specify): — --
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ❑ some
pH 6 to 9 SU DO 2 or greater Turbidity NTU
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:
None.
Notes and Comments:
The system appears to be working as designed and to manufacturers specifications. Went over
operation with the new homeowner.
t5aiom.doc.rev.11-07-05 Page 2 of 3
LlMassachusetts 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 6Gress AbMPhaVE
conducted the required Field Testing and/or sample collection in acc(rdance with Standard Met ds,
have completed this report and the attached technology operation an TnaWenanceicheckfi dr d
the information reported is true, accurate, and complete as of the tim
e
Massachusetts ce d operator in accordance with 257 CMR 2.00.
11/2/2008
Operator Silffature 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 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31 1h 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, 6th Floor
Boston, MA 02108
t5aiom.doc•rev.11-07-05 Page 3 of 3
Commonwealth of Massachusetts
Cityrrown of
Local Upgrade Approv I
Form 9B
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
Nnpwrtant:
When filling out 1. Facility Name and Address
forms on the
computer,use Thomas Petralia
only the tab key Name
to move your 534 Boston Street
cursor-do not
use the return Street Address
key. No.Andover MA 01845
Cityrrown State Zip Code
m
2. Owner Name and Address(if different from above):
�-x Name Street Address
Cityrrown state
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: 440
gpd
5. System Designer: Ben Osgood ® PE ❑ RS
Name
1600 Osgood Street No Andover MA 01845
Address Cityrrown State,ZIP
B. Approval
1. Local Upgrade Approval is granted for
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
534 Boston Street form 9B 6.07•rev.7/06 Local Upgrade Approval• Page 1 of 1
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 9B
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min.rnch
Depth to groundwater ft
❑ Relocation of water supply well (explain):
® Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
North Andover Health Dept. r
Approving Authority
Susan Sawyer, REHS/RS ,tune 28, 2007
Print or Type Name and Title Si ature Date
534 Boston Street form 9B 6.07•rev.7/06 Local Upgrade Approval• Page 2 of 2