Loading...
HomeMy WebLinkAboutInspection - 67 RALEIGH TAVERN LANE 1/1/2013 a r' TOWN d :pgC)�ji HEALTH C)Er C REGIRCUI,A TING SSAND FILTER SYS'TEVI ROUTINE INSPECTION ADDRESS: 67 Raleigh Tavern Lane North Andover OWNER: Hamann DATE: June 12 2013 OPERATOR: Marls Cottrell SYSTEM STATUS" Septic Tank Effluent Filter: O.k. cleaned Scum Depth: 151/48" Sludge Depth 4 15/487' (Measured on June 1.2, 2013) Recirculating Pump Chamber Pump H-O-A Setting: Auto Pump Cycle Timer: 2 minutes on 15 minutes off Alarm Selector: On Level Alarm: Normal Exercise Pump: Yes Test & Clean Floats: O.k. cleaned Tank Condition: Good Dosing Pump Chamber Pump H-O-A Setting: Auto Pump Cycle Tinier: On Demand Alarm Selector: On Level. Alarm: Normal Exercise Pump: Yes Test & Clean Floats: O.k. cleaned Tank Condition: Good Sand Filter Sand Condition: Clean Diffusers Condition: Clear, flushed and brushed all (3) laterals Effluent Quality Visual Inspection: Clear, no odor Sample: pH = 6.5, Dissolved Oxygen= 5.02 mp/L Turbidity =4.73 NTU Comments: Flushed and brushed all five (5) laterals in SAS on June 12 2013 Signature: Certificate# 11739 PO Box 825, Ipswich, MA 01938 ® 978-356-0779 ® Fax 978-356-5500 ® www.clearwaterindustries,com LAMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 RSF System Ow%eration and Maintenance Inspection f A. Installation & Service Information 67 Raleigh Tavern Lane June 12, 2013 Facility Street Address Date of Service North Andover Mark Cottrell/Clear Water Industries City Operator/O&M Firm Inspect& note if . Septic tank(s) pumping is required. Sludge Pumping Required: Yes ❑ No ® ® Sludge Depth: 4" Inspect& clean effluent tee Effluent tee filter: Yes ® No ❑ If yes, inspect ® & clean at least yearly filter. Clean as C. Recirculation tank necessary. Inspect for ❑ Check if sludge accumulating Pumping required: Yes ❑ No sludge. Odor problems: Yes El No If yes,description sludge. Inspect for D. Equalization tank (if installed) ❑ Check if sludge accumulating Pumping required: Yes ❑ No ❑ Inspect pumps E. pumps, switches, floats, alarm system & electrical switches, test ®Pump Inspections (all units) as necessary. If problems,describe Run pumps in ® Test pump alternator, or record hours Not applicable for this system manual mode. Hours of operation Record ® Float switches 0.k. readings from Check all switches for operation meters & ® Test alarm counters. Note if weeds &F. Recirculation Sand Filter If non-functioning,corrective action(s) debris are present on bed. ® Inspect for ponding Ponding Present: Yes ❑ No Clean/maintain bed surface to ® Clean bed: Yes ® No ❑ allow proper operation of the ® Distribution pipes Flush: Yes ® No ❑ Brush: Yes ® No ❑ system. ® Check head loss in pipes 0.k. Headloss and comments G. Sample Collection (Field Sample) Yes ® No ❑ If yes: ❑ BOD ❑ TSS ® pH ❑ TN ® Other— Dissolved Oxygen and Turbidity rsfcheck•6/20113 Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/ LA Treatment and Disposal Systems A. Installation Important:When Darrell Hamann filling out forms Owner on the computer, use only the tab 67 Raleigh Tavern Lane key to move your Facility Street Address cursor-do not North Andover 01845 use the return City y Zip Mailing address of owner, if different: tab Street Address/PO Box: ietan City State Zip ( ) - ext. Telephone Number S. Authorized Service Provider Clear Water Industries O&M Firm P.O. Box 825 Street Address Ipswich MA 01938 City State Zip (978) 356 - 0779 ext. Telephone Number Mark Cottrell 11739 Certified Operator Name Certification Number C. Facility/System Information 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 June 12, 2013 December 11, 2012 Inspection Date Previous Inspection Date 41' 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 LA DEP Bureau of Resource Protection - Title 5 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 El offensive E] turbid Effluent Solids: ❑ no ❑ some 6.5 SU 5.02 mg/L 4.73 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: Field sample was clear with no odor. 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/ 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. June 12, 2013 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 31s`of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31`h of each year for the previous 12 months General Use—by September 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 µ .w r , September 9, 2013 Mr. Darrell Hamann 67 Raleigh Tavern Lane North Andover, MA 01845 RE: Maintenance and Service Contract for the Recirculating Sand Filter System located at 67 Raleit7lh Tavern Lane, North Andover Dear Darrell: Clear Water Industries (CWI)proposes to provide service and maintenance for the Recirculating Sand Filter (RSF) System at the above referenced address. The following maintenance and service schedule is for the next two (2) years of operation commencing upon receipt of signed contract and Annual Cost received in full. Scheduled Annual Service: Annual Cost: 1 inspection and 1 field effluent testing = $295.00 (Note: Access cover for- all components must be at the ground surface.) 1. Check scum and sludge depths in both compartments of the septic tarok. 2. Clean the effluent filter in the septic tank. 3. Check panel and alarm system. 4. Check ejector pump and float switches in Recirculating Pump Chamber and the Dosing Tank. 5. "fake effluent sample as required by Massachusetts D.E.P. Sample will be analyzed for the following: *Dissolved Oxygen, *Turbidity, and *pH. 6. Notify Client verbally of any problems encountered. (Dote: There may be instances when the high water alarm will sound. In the event of an alarm condition, you are requested to silence the audible alarm and contact (978) 356-0779 for instructions and/or a follow-up field visit by a CWl representative. See unscheduled service costs.) I have read and agree with the above Scope of Work: CWI's initials Owner's initials P� PO Box 825, Ipswich, MA 01938 m 978-856-0770 - Fax 978­356-5500 -www.clearwaterindustries.com r Page 2 Mr. Darrell Hamann September 9, 2013 Unscheduled service: 1. Unscheduled emergency service calls will be billed at the following hourly rates: *Monday through Friday lam— 5pm: $85 *Monday through Friday 12am— 7 am, 5 pm— 12pm: $ 00 *Saturday and Sunday: $100 with a minimum of a 2 hour charge. 2. If results of field effluent testing for pH, Dissolved Oxygen or Turbidity do not comply with Massachusetts Department of Environmental Protection limits, additional testing for Total Suspended Solids and Biochemical Oxygen Demand would need to be done at a certified laboratory. Owner would be contact prior to additional testing. Additional testing of effluent would be $95.00 per sample. Certified technician: The service technician shall be a Massachusetts Certified Operator. The certified operator will be David F. Clark, George F. Norris, Mark Cottrell or Mario Rosa. Reporting requirements: In accordance with DEP's Title V Regulations, CWI will file annual report with the property owner and the local Board of Health. Annual report will be forwarded to the DEP transmitting the data from the sampling of the effluent, as well as a review of any unscheduled service. Sincerely, Clear Water Industries It r elf�As L- David F. Clark Manager Acceptance by Owner: Darrell Hamann Date PO Box 825, Ipswich, MA 01938 ® 978-356-0779 ® Fax 978-356-5500 ®www.clearwaterindustries.com l ii4 ECI CULATING SAND FILTER SYSTEM ROUTINE INSPECTION ADDRESS: 4 OWNER: Hamann DATE: December 18 2013 OPERATOR: Mark Cottrell .SY,STE STATUS Septic Tank Effluent Filter: O.k. cleaned Scum Depth: 1"/48" Sludge Depth 4 5748" (Measured on June 12, 2013) Recirculating Pump Chamber Pump H-O-A Setting: Auto Pump Cycle Timer: 2 minutes on 15 minutes off Alarm Selector: On Level Alarm: Normal Exercise Pump: Yes Test & Clean Floats: O.k. cleaned Tank Condition: Good Dosing Pump Chamber Pump H-O-A Setting: Auto Pump Cycle Timer: On Demand Alarm Selector: On Level Alarm: Normal Exercise Pump: Yes Test & Clean Floats: O.k. cleaned Tank Condition: Good Sand Filter Sand Condition: Clean Diffusers Condition: Clear, flushed and brushed all (3) laterals Effluent Quality Visual Inspection: Clear, no odor Sample: pH = 7.1, Dissolved Oxygen = 4.5 mg/L, Turbidity = 5.78 NTU Comments: Flushed and brushed all five (5) laterals in SAS on June 12, 2013 Signature: %'` a Certificate 4 11739 PO Box 825, Ipswich, MA 01938 ® 978-356-0779 Fax 978-356-5500 a www.clearwaterindustries.com Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 RSF System and aint n Inspection a kl ist A. Installation & Service Information 67 Raleigh Tavern Lane December 18, 2013 Facility Street Address Date of Service North Andover Mark Cottrell/Clear Water Industries City Operator/O&M Firm Inspect& note if , Septic tank(s) pumping is required. Sludge Pumping Required: Yes ❑ No ® ® Sludge Depth: 4" Inspect& clean effluent tee Effluent tee filter: Yes ® No ❑ If yes, inspect ® & clean at least yearly filter. Clean as C. Recirculation tank necessary. Inspect for ❑ Check if sludge accumulating Pumping required: Yes ❑ No sludge. Odor problems: Yes ❑ No ® If yes,description Inspect for D. Equalization tank (if installed) sludge. ❑ Check if sludge accumulating Pumping required: Yes ❑ No ❑ Inspect pumps E. Pumps, switches, floats, alarm system & electrical switches, test ®Pump Inspections (all units) as necessary. If problems,describe Run pumps in ® Test pump alternator, or record hours Not applicable for this system manual mode. Hours of operation Record ® Float switches 0.k. readings from Check all switches for operation meters & ® Test alarm counters. If non-functioning,corrective action(s) Note if weeds & F. Recirculation Sand Filter debris are present on bed. ® Inspect for ponding Ponding Present: Yes ❑ No Clean/maintain bed surface to ® Clean bed: Yes ® No ❑ allow proper operation of the ® Distribution pipes Flush: Yes ® No ❑ Brush: Yes ® No ❑ system. ® Check head loss in pipes 0.k. Headloss and comments G. Sample Collection (Field Sample) Yes ® No ❑ If yes: ❑ BOD ❑ TSS ® pH ❑ TN ® Other— Dissolved Oxygen and Turbidity rsfcheck• 12/27/13 Page 1 of 1 Massachusetts Department of Environmental Protection \ Bureau of Resource Protection - Title 5 l DEP Approved Inspection n r for Title 5 I/ Treatment n i l Systems A. Installation Important:When Darrell Hamann filling out forms Owner on the computer, use only the tab 67 Raleigh Tavern Lane key to move your Facility Street Address cursor-do not North Andover 01845 use the return City Zip key. Mailing address of owner, if different: Street Address/PO Box: rerun City State Zip ( ) - ext. Telephone Number B. Authorized Service Provider Clear Water Industries O&M Firm P.O. Box 825 Street Address Ipswich MA 01938 City State Zip (978) 356 - 0779 ext. Telephone Number Mark Cottrell 11739 Certified Operator Name Certification Number C. Facility/System Information 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 December 18, 2013 June 12, 2013 Inspection Date Previous Inspection Date 4 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 I� DEP Approved Inspection and OW Form for itle 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 7.1 SU DO 4.5 mg/L Turbidity 5.78 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 C. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: Notes and Comments: Field sample was clear with no odor. t5aiom.doc•rev. 11-07-05 Page 2 of 3 DEP LAMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 Approved Inspection and O&M Form 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 Massachusetts certified operator in accordance with 257 CMR 2.00. December 18, 2013 Date Operator Signature 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"of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31`h of each year for the previous 12 months General Use—by September 301h of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6`h Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3