HomeMy WebLinkAboutInspection - 67 RALEIGH TAVERN LANE 1/1/2014 JAN 2 Z 2015
RECIRCULATING SAND FILTER SYSTEM r
ROUTINE INSPECTION
ADDRESS: 67 Raleigh Tavern Lane North Andover OWNER: Hamann
DATE: December 29 2014 OPERATOR: Mark Cottrell
S'YS'TEM S"TA T UI,S
Septic Tank
Effluent Filter: O.k. cleaned
Scum Depth: 1"/48"
Sludge Depth 9 5748"
(Measured on December 29, 2014)
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.1<. cleaned
Tank Condition: Good
Sand. Filter
Sand Condition: Clean
Diffusers Condition: Clear, flushed all (3) laterals
Effluent Quality
Visual Inspection: Clear, no odor
Sample: pH = 6.8 Dissolved Oxygen =N/A mg/L, Turbidity = 1.55 NTU
Comments: Flushed all five (5) laterals in SAS on December 29 2014
Signature: Certificate # 11739
PO Box 825, Ipswich, MA 01938 ® 978-356-0779 ® Fax 978-356-5500 ® www.clearwaterindustries,com
Massachusetts Department of Environmental Protection
Bureau of Resource Protection m Title 5
Inspection Checklist
I
RSF System Operation and Maintenance
A. Installation & Service Information
67 Raleigh Tavern Lane December 29, 2014
Facility Street Address Date of Service
North Andover Mark Cottrell/Clear Water Industries
City Operator/O&M Firm
Inspect& note if B. Septic tank(s)
pumping is
required. Sludge Pumping Required: Yes ❑ No ® ® Sludge Depth: 9"
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
O,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— Turbidity
rsfcheck•1/8/15 Page 1 of
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
1� DEP Approved Inspection n r for Title 5 I/
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 —
key. y Zip
Mailing address of owner, if different:
Street Address/PO Box:
m+an
City State Zip
( ) - ext.
Telephone Number
D. 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 29, 2014 December 18, 2013
Inspection Date Previous Inspection Date
9„
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev. 11-07-05 Page 1 of
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
i\ DEP Approved Inspection and OW Form it 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 6.8 SU DO mg/L Turbidity 1.55 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:
Field sample was clear with no odor.
t5aiom.doc•rev. 11-07-05 Page 2 of
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection n r for Title 5 II
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 29, 2014
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 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 30`h of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 61h Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 2