HomeMy WebLinkAboutInspection - 100 RALEIGH TAVERN LANE 1/1/2005 /'ra�a�%�'�d."`��,��;1"�d"�" ,,��i''�„� i✓A�1�d:u4�a",ie.�f,;:m° 1�„dMf�",�.'e�'�%'� v s°',r"d,�..,'o.
44 COfflffiercia� Street
llayrfliaryy, MA
Tel: (508) 880-0233
Fax� (508) 880-7232
1 I
March 7, 2005 y G
A
TOMIN OF
North Andover Board of Health HEALI
a
27 Charles Street
North Andover, MA 01845
Attention: Health Agent
Reference: Single Home FAST`° Treatment System
Serial Number: 24277
Attached please find the Field Inspection & Service Report for services performed on
03/02/2005 at the property of Lucy Arsnow located at 100 Raleigh Tavern Lane ®North
Andover, MA.
Please call if you have any questions or require additional information.
Sincerely,
Wastewater Treatment Services, Inc.
Service Department
Enclosures
Copy to: Lucy Arsnow
Massachusetts DEP
Massachusetts Department of Environmental Protection
Bureau of Resource Protection ® Title 5
DEP Approved Inspection and O&M Form for Title 5 I/
Treatment and Disposal Systems
4458
A. Installation
Important: Lucy Arsnow
When filling out Owner
forms on the
computer,use 100 Raleigh Tavern Lane
only the tab key Facility Street Address
to move your North Andover 01845
cursor-do not
use the return City Zip
key. Mailing address of owner, if different:
VQ 119 Washington Street#3
Street Address/PO Box:
Marblehead MA 01945
City State Zip
(617-439-4876 X14 ext.
Telephone Number
B. Authorized Service Provider
Wastewater Treatment Services, Inc.
O&M Firm
44 Commercial Street
Street Address
Raynham MA 02767
City State Zip
(508)—880-0223 ext.
Telephone Number
Michael Dillen 11173
Certified Operator Name Certification Number
C. Facility/System Information
24277 Bio-Microbics, Inc. MicroFAST MicroFAST.5
DEP ID Manufacturer's Name&ID Model Name&Number
11/11/2004
Installation Date Start of Operation
Approval Type:_General _Provisional _ Piloting X Remedial
Seasonal Residence—used less than 6 mo./year:_Yes X No
D. Operating Information
03/02/2005
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly)
Pumping Recommended _Yes X No
Color: N/A Odor: None
Effluent Description
DEPMicroFASTnew.doc•3n105 Page 1 of 2
Massachusetts Department of Environmental Protection
LA DEP Bureau of Resource Protection - Title 5
Approved Inspection and O&M Form for Title 5 I/
Treatment and Disposal Systems
4458
E. Sampling Information
Samples Taken:_Influent _Effluent
Parameters sampled:_pH_BOD—TSS_TN_Other(list below)
Other 1 Other 2 Other 3
Description of any maintenance performed since previous inspection & during this inspection:
Cleaned Filter,,,Splash Recycle,
Notes and Comments:
Also tested: , , , .
Unit serviced but no test-covers buried in snow- unable to locate.
F. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, 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.
Michael Dillen 03/02/2005
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 Piloting & Provisional Use- General User by September
31St of each year for the within 30 days of inspection 301h of each year for the
previous calendar year date previous 12 months
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston. MA 02108
DEPMicroFASTnew.doc-317/05 Page 2 of 2
UC 1
INCORPORATEO
8450 Cole Parkway to Shawnee, KS 66227 m Phone 913-422-0707 m Fax: 912-422-0808 4458
e-mail: onsite(Wbiomicrobics.com m www.biomicrobics.com m 800-753-FAST(3278)
FIELD INSPECTION & SERVICE REPORT
For Bio-Microbics Single Home FASTO System
INSTALLATION AUTHORIZED SERVICE PROVIDER
100 Raleigh Tavern Lane
Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc.
Owner Name Lucy Arsnow Street
Mail Address: Mail Address 44 Commercial Street
119 Washington Street#3 Raynham, MA 02767
Marblehead,MA 01945 City State Zip
508-880-0233 508-880-7232
Phone 617-439-4876 X14 Fax e-mail Phone Fax e-mail
INSTALLATION INFORMATION
Model No. Serial No. Date of Installation Date of last pump out
MicroFAST.5 24277 11/11/2004
EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS
Electrical Panel(s)
Visual Alarm Operating X
Audio Alarm Operating X
if resent
Blower(s)
Air Inlet Filter Clean X
Blower Hood Vents Clear X
Excessive Noise X
Excessive Vibration X
Treatment unit(s)
Unusual Odor
Pum out Required: X
Primary Settling Zone
Aerobic Treatment Zone
EFFLUENT(optional) LIMIT RESULT
Estimated Daily Flow 4 Bedrooms
H Standard Units
Color N/A
Temperature
Odor None
Comments: Unit serviced but no test-covers buried in snow-unable to locate.
TECHNICIAN SERVICE DATE
Michael Dillen T03/02/2005
44 Cortirnercial Sfteat
Ray hai'i►, f
02767
TO: (508) 880-0233
Fax: (5 08) 880-723
May 31, 2005 b..
0 ' '200"5
North Andover Board of Health
27 Charles Street
North Andover, MA 01845
Attention: Health Agent
Reference: Single Horne FAST° Treatment System
Serial Number: 24277
Attached please find the Field Inspection& Service Report and test results for services
performed on 05/05/2005 at the property of Lucy Arsnow located at 100 Raleigh.Tavern
Lane -North Andover, MA.
Please call if you have any questions or require additional information.
Sincerely,
Wastewater Treatment Services, Inc.
Service Department
Enclosures
Copy to: Lucy Arsnow
Massachusetts DEP
Environmen=tal Chemistry Environmental Services
Site Assessment Rr Site Sampling
Quality Assurance Services AnV—F-A i iJGl.LL1. ce Data Auditing
C; O A T I O 1\'
CERTIFICATE OF ANALYSIS
Wastewater Treatment Services, Inc.
4 REPORTED: 05/17/2005
4 Commercial Street
Raynham, MA 02767 ORDER#: G0570772
COLLECTED BY: K. Usilton SAMPLE DATE: 5/5/2005
TIME: 11:15 DATE RECEIVED: 5/5/2005
LOCATION: 100 Raleigh Tavern Ln. SAMPLE ID: .-- Arsnow
Grab (24277) DESCRIPTION: WATER
RESULTS OF ANALYSIS
An�lytical� '� Date 'Units Det , Resul
IYlethod - Analyzed L�mtt*
,Test Parameters
LAB-IM: 0570772-01 —
BOD-- - -- - SM 5210B 05/11/2005 — m-/L —; 4 62.9
PH SM 4500 H+B 05/05/2005 'i S.U. 0-14 �� 6.8
Solids, Suspended SM 2540 D 05/09/2005 mg/L 4 23.0
NA=Not Applicable
ND=Not Detected Approved By: Js�
<' = Less Than La Manager / Date
*' = Detection Limit
---------------------------
Page l of l
Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225
Massachusetts Department of Environmental Protection
Li DEP Bureau of Resource Protection - Title 5
Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
4458
A. Installation
Important: Lucy Arsnow
When filling out Owner
forms on the
computer,use 100 Raleigh Tavern Lane
only the tab key Facility Street Address
to move your - North Andover 01845
cursor-do not City Zip
use the return
key. Mailing address of owner, if different:
Q 119 Washington Street#3
Street Address/PO Box:
Marblehead MA 01945
earn City State Zip
(617-439-4876 X14 ext.
Telephone Number
i
B. Authorized Service Provider
Wastewater Treatment Services, Inc.
O&M Firm
44 Commercial Street
Street Address
Raynham MA 02767
City State Zip
(508)—880-0223 ext.
Telephone Number
Kevin Usilton 12530
Certified Operator Name Certification Number
C. Facility/System Information
24277 Bio-Microbics, Inc. MicroFAST .5
DEP ID Manufacturer's Name&ID Model Name&Number
11/11/2004
Installation Date Start of Operation
Approval Type: _General _Provisional _Piloting X Remedial
Seasonal Residence—used less than 6 mo./year: _Yes X No
D. Operating Information
05/05/2005
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No
Color: N/A Odor: None
Effluent Description
DEPMicroFASTnew.doc•5/31/05 Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection m Title 5
DEP Approved Inspection and O&M Form for Title 5 I/
Treatment and Disposal Systems
--- 4458
E. Sampling Information
Samples Taken:— Influent X Effluent
Parameters sampled: X pH X BOD X TSS_TN_Other(list below)
Other 1 Other 2 Other 3
Description of any maintenance performed since previous inspection & during this inspection:
Cleaned Filter,,,Splash Recycle,
Notes and Comments:
Also tested: , , , .
Dividing wall cover not to grade. Unable to locate distribution box.
F. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, 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.
Kevin Usilton 05/05/2005
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 Piloting & Provisional Use - General Use—by September
31't of each year for the within 30 days of inspection 30`h of each year for the
previous calendar year date previous 12 months
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston. MA 02108
DEPMicroFASTnew.doc•5/31/05 Page 2 of 2
6401 r ' r 1 NCORPORATED
8450 Cole Parkway m Shawnee, KS 66227 Phone 913-422-0707 m Fax: 912-422-0808 4458
e-mail: onsite ftiomicrobics.com ro www.biomicrobics.com ro 800-753-FAST(3278)
FIELD INSPECTION & SERVICE REPORT
For Bio-Microbics Single Home FAST® System
INSTALLATION AUTHORIZED SERVICE PROVIDER
100 Raleigh Tavern Lane
Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc.
Owner Name Lucy Arsnow Street
Mail Address: Mail Address 44 Commercial Street
119 Washington Street#3 Raynham, MA 02767
Marblehead,MA 01945 City State Zip
508-880-0233 508-880-7232
Phone 617-439-4876 X14 Fax e-mail Phone Fax e-mail
INSTALLATION INFORMATION
Model No. Serial No. Date of Installation Date of last pump out
MicroFAST .5 24277 11/11/2004
EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS
Electrical Panel(s)
Visual Alarm Operating X
Audio Alarm Operating X
(if resent)
Blower(s)
Air Inlet Filter Clean X
Blower Hood Vents Clear X
Excessive Noise X
Excessive Vibration X
Treatment unit(s)
Unusual Odor
Pum out Required: X
Primary Settling Zone
Aerobic Treatment Zone
EFFLUENT(optional) LIMIT RESULT
Estimated Daily Flow 4 Bedrooms
H Standard Units)
Color N/A
Temperature
Odor None
Comments: Dividing wall cover not to grade. Unable to locate distribution box.
TECHNICIAN SERVICE DATE
Kevin Usilton 05/05/2005
//f { /✓,r/p p yr " ,.., w�,//}p A )e p p g p('/1 p p' y y { �-,/
6 6ap Perri, YM
02767
Fee (508) 880-0233
Fax: (5(..3) 880-7232
September 16, 2005
1`
North Andover Board of Health
27 Charles Street '
North Andover, MA 01845
Attention: Health Agent
Reference: FAST° Wastewater Treatment System
Serial Number: 24277
Attached please find the Field Inspection & Service Report and test results for services
performed on 08/22/2005 at the property of David Wondolowski located at 100 Raleigh
Tavern Lane -North Andover, MA.
Please call if you have any questions or require additional information.
Sincerely,
Wastewater Treatment Services, Inc.
Service Department
Enclosures
Copy to: David Wondolowski
Massachusetts DEP
Environmental Chemistry Environmental Services
Site Assessment ical �` Ce Site Sampling
An al
Quality Assurance Services Data Auditing
G O R P R A 'C I O N
CERTIFICATE OF ANALYSIS
Wastewater Treatment Services, Inc.
44 Commercial Street REPORTED: 08/29/2005
Raynham, MA 02767 ORDER#: G0575184
COLLECTED BY: K. Usilton SAMPLE DATE: 8/21/2005
TIME: 13:15 DATE RECEIVED: 8/23/2005
LOCATION: N. Andover(24277) SAMPLE ID:
Grab DESCRIPTION: WATER
RESULTS OF ANALYSIS
Test Parameters LAB-ID#: 0575184-01
BOD SM 5210B —� 08/24/2005 i mg/L � 4 26.7
pH SM 4500 H+B 08/23/2005 S.U. 0-14 7.6
Solids, Suspended SM 2540 D 08/26/2005 mg/L 4 13.0
NA=Not Applicable
ND=Not Detected Approved B x/63/
Less Than Pp Y' —
'*' = Detection Limit
La Tanager 0 AJ Date
AUG `� i " ,
A
�4'. t
.....................N1���
Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page I of I
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DP Approved Inspection and Form for Title I/A
Treatment and Disposal Systems
4458
A. Installation
Important: David Wondolowski
When filling out Owner
forms on the
computer,use 100 Raleigh Tavern Lane
only the tab key Facility Street Address
to move your North Andover 01845
cursor-do not
use the return City Zip
key. Mailing address of owner, if different:
100 Raleigh Tavern Lane
Street Address/PO Box:
North Andover MA 01845
City State Zip
(617-821-1617 ext.
Telephone Number
B. Authorized Service Provider
Wastewater Treatment Services, Inc.
O&M Firm
44 Commercial Street
Street Address
Raynham MA 02767
City State Zip
(508)—880-0223 ext.
Telephone Number
Kevin Usilton 12530
Certified Operator Name Certification Number
C. Facility/System Information
24277 Bio-Microbics, Inc. MicroFAST .5
DEP ID Manufacturer's Name&ID Model Name&Number
11/11/2004
Installation Date Start of Operation
Approval Type: _General _Provisional _Piloting X Remedial
Seasonal Residence —used less than 6 mo./year: _Yes X No
D. Operating Information
08/22/2005
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No
Color: Clear Odor: None
Effluent Description
DEPMicroFASTnew.doc•9/16/05 Page 1 of 2
Massachusetts Department of Environmental Protection
\ Bureau of Resource Protection o Title 5
DP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
4458
E. Sampling Information
Samples Taken:— Influent X Effluent
Parameters sampled: X pH X BOD X TSS—TN_Other(list below)
Other 1 Other 2
Other 3
Description of any maintenance performed since previous inspection & during this inspection:
Cleaned Filter,,,Splash Recycle,
Notes and Comments:
Also tested: , , , .
F. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, 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.
Kevin Usilton 08/22/2005
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 Piloting & Provisional Use- General Use—by September
31st of each year for the within 3 days of inspection 30th of each year for the
previous calendar year date previous 12 months
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston. MA 02108
DEPMicroFASTnew.doc•9/16/05 Page 2 of 2
URMI=PO N C 0 R R A T E 0
8450 Cole Parkway m Shawnee, KS 66227 tu Phone 913-422-0707 w Fax: 912-422-0808 4458
e-mail: onsite(a)biomicrobics.com zu www.biomicrobics.com m 800-753-FAST(3278)
FIELD INSPECTION & SERVICE REPORT
For Bio-Microbics Single Home FASTO System
INSTALLATION AUTHORIZED SERVICE PROVIDER
100 Raleigh Tavern Lane
Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc.
Owner Name David Wondolowski Street
Mail Address: Mail Address 44 Commercial Street
100 Raleigh Tavern Lane Raynham, MA 02767
North Andover,MA 01845 City State Zip
508-880-0233 508-880-7232
Phone 617-821-1617 Fax e-mail Phone Fax e-mail
INSTALLATION INFORMATION
Model No. Serial No. Date of Installation Date of last pump out
MicroFAST.5 24277 11/11/2004
EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS
Electrical Panel s
Visual Alarm Operating X
Audio Alarm Operating X
(if resent
Blower(s)
i
Air Inlet Filter Clean X
Blower Hood Vents Clear X
Excessive Noise X
Excessive Vibration X
Treatment unit(s)
Unusual Odor
Pum out Required: X
Primary Settling Zone
Aerobic Treatment Zone
EFFLUENT(optional) LIMIT RESULT
Estimated Daily Flow 4 Bedrooms
H(Standard Units)
Color Clear
Temperature
Odor None
Comments:
TECHNICIAN F SERVICE DATE
Kevin Usilton 08/22/2005
44 C:camrryeo'c.al ;street.
Raynha n7, MA
C)2767
TO: (508) 880-0233
Fax: (508) 880-7232
November 30, 2005
North Andover Board of Health
400 Osgood Street ��°xr ��O�i ���'�r
North Andover, MA 01845 m
Attention: Health Agent
Reference: FAST°Wastewater Treatment System
Serial Number: 24277
Attached please find the Field Inspection& Service Report and test results for services
performed on l]/10/2005 at the property of David Wondolowski located at 100 Raleigh
Tavern Lane -North Andover, MA.
Please call if you have any questions or require additional information.
Sincerely,
Wastewater Treatment Services, Inc.
Service Department
Enclosures
Copy to: David Wondolowski
Massachusetts DEP
Massachusetts Department of Environmental Protection
DEP LiBureau of Resource Protection - Title 5
Approved Inspection and O&M Form for Title 5 I/
Treatment and Disposal Systems
4458
A. Installation
Important: David Wondolowski
When filling out Owner
forms on the
computer,use 100 Raleigh Tavern Lane
only the tab key Facility Street Address
to move your North Andover 01845
cursor-do not City Zip
use the return
key. Mailing address of owner, if different:
100 Raleigh Tavern Lane
Street Address/PO Box:
North Andover MA 01845
City State Zip
(617-821-1617 ext.
Telephone Number
B. Authorized Service Provider
Wastewater Treatment Services, Inc.
O&M Firm
44 Commercial Street
Street Address
Raynham MA 02767
City State Zip
(508)—880-0223 ext.
Telephone Number
Michael Dillen 11173
Certified Operator Name Certification Number
I
C. Facility/System Information
24277 Bio-Microbics, Inc. MicroFAST .5
DEP ID Manufacturer's Name&ID Model Name&Number
11/11/2004
Installation Date Start of Operation
Approval Type:_General _Provisional —Piloting X Remedial
Seasonal Residence —used less than 6 mo./year:_Yes X No
D. Operating Information
11/10/2005
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No
Color: Clear Odor: None
Effluent Description
DEPMicroFASTnew.doc-11/30/05 Page 1 of 2
Massachusetts Department of Environmental Protection
L DEP Bureau of Resource Protection -Title 5
Approved Inspection and O&M Form for Title 5 I/
Treatment and Disposal Systems
4458
E. Sampling Information
Samples Taken:— Influent X Effluent
Parameters sampled: X pH X BOD X TSS—TN—Other(list below)
Other 1 Other 2 Other 3
Description of any maintenance performed since previous inspection &during this inspection:
Cleaned Filter,,,Splash Recycle,
Notes and Comments:
Also tested: , , , .
F. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, 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.
Michael Dillen 11/10/2005
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 Piloting & Provisional Use- General Use—by September
31 S`of each year for the within 30 days of inspection 30`h of each year for the
previous calendar year date previous 12 months
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston. MA 02108
DEPMicroFASTnew.doc•11/30/05 Page 2 of 2
Environmental Chemistry Environmental Services
Site Assessment �ry1 Site Sampling
Quality Assurance Services 11dyit A, *Balance Data Auditing
C (� R`P O N
CERTIFICATE OF ANALYSIS
Wastewater Treatment Services, Inc.
4 REPORTED: 11/16/2005
4 Commercial Street
Raynham, MA 02767 ORDER#: G0578387
COLLECTED BY: M.Dillen SAMPLE DATE: 11/10/2005
TIME: 12:00 DATE RECEIVED: 11/11/2005
LOCATION: 100 Raleigh Tavern.N.Andover,MA SAMPLE ID: Wondowloski
Grab(24277) DESCRIPTION: WATER
RESULTS OF ANALYSIS
Test Parameters LAB-ID#: 0578387-01
BOD SM 5210B 11/11/2005 mg/L 4 4.1
pH SM 4500 H+B 11/11/2005 S.U. 0-14 6.7
Solids,Suspended SM 2540 D 11/14/2005 mg/L 4 8.0
NA=Not Applicable
ND=Not Detected Approved B : f i�tc�vy
< = Less Than �bM.. / Date
*' = Detection Limit
NOV 1 8 2005
BY:--------------------
Page I of 1
Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225
U40=1NCORPORATE0
8450 Cole Parkway w Shawnee, KS 66227 w Phone 913-422-0707 m Fax: 912-422-0808 4458
e-mail: onsite(aD-biomicrobics.com w www.biomicrobics.com 0 800-753-FAST(3278)
FIELD INSPECTION & SERVICE REPORT
For Bio-Microbics Single Home FAST(R) System
INSTALLATION AUTHORIZED SERVICE PROVIDER
I
i
100 Raleigh Tavern Lane
Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc.
Owner Name David Wondolowski Street
Mail Address: Mail Address 44 Commercial Street
100 Raleigh Tavern Lane Raynham, MA 02767
North Andover,MA 01845 City State Zip
508-880-0233 508-880-7232
Phone 617-821-1617 Fax e-mail Phone Fax e-mail
INSTALLATION INFORMATION
Model No. Serial No. Date of Installation Date of last pump out
MicroFAST.5 24277 11/11/2004
EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS
Electrical Panel(s)
Visual Alarm Operating X
Audio Alarm Operating X
if resent
Blower(s)
Air Inlet Filter Clean X
Blower Hood Vents Clear X
Excessive Noise X
Excessive Vibration X
Treatment unit(s)
Unusual Odor
Pum out Required: X
Primary Settling Zone
Aerobic Treatment Zone
EFFLUENT(optional) LIMIT RESULT
Estimated Daily Flow 4 Bedrooms
H Standard Units
Color Clear
Temperature
Odor None
Comments:
TECHNICIAN SERVICE DATE
Michael Dillen 11/10/2005