HomeMy WebLinkAboutMiscellaneous - 43 MILL ROAD 10/26/2015 Massachusetts Department of Environmental Protection
} - Bureau of Resource Protection -Title 5 Form for Title 5 I/
DEP
Approved Inspection n
Treatment and Disposal Systems
A. f
Installation
Important:When Todd Stringer --- --------------- -- -------
filling out forms Owner
on the computer, 43 Mill Rd __ ----- -- —
use only the tab — --------
key to move your Facility Street Address 01845 —---—
cursor-do not N Andover ______--------------- --------------
use the return City Zip
key. EC RECEIVED
Mailing address of owner, if different:
00
Street Address/PO Box:
�en�n City _ — ----- State ------------ Zip HE-AU I DU f ME NT
-- �--— — ext. — —-----
Telephone Number
B. Authorized a ica Provider
Sewer Works ---- —-----------------------
O&M Firm
26 Hillside_A_ve.-------------------- -- -----------
S treet Address
Westford ----- Ma ------- 018_86----------
City
State Zip
1978 692 -4410 ext_—_ -- --_
Telephone Number
_David b Chandler _--__-- Certification— Number
Certified Operator Name
C. Facility/System Information
unknown - __- _---- 24428 Fast 0.5---_----_--
DEP ID Manufacturer ID Model Number
------------ 4/2005
4/2005 ----- ------
Installation Date Start of Operation
Approval Type: ❑
General ❑ Provisional ❑ Piloting ® Remedial
Seasonal Residence-used less than 6 mo./year: ❑ Yes ® No
D. operating Information
10/26/2015 - _----- --------- unknown --- --- ---
Inspection Date Previous Inspection Date
no measurable sludge-- --_---- pumping Recommended ❑ Yes ® No
Sludge Depth(to be checked yearly)
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t5aiom.doc^rev. 11-07-05
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
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ❑ musty ® earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ❑ some
pH 6.45 SU DO 4.0 mg/L Turbidity 11 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:
cleaned filter, checked motor amps
Notes and Comments:
t5aiom.doc•rev. 11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
` Bureau of Resource Protection - `title 5
DEP Approved Inspection r for Title 5 I/
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
M ,ssachusetts certified operator in accordance with 257 CMR 2.00,
10/26/2015
Operator Sidnaf 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 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Pro hgram
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc o rev. 11-07-05 Page 3 of 3