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HomeMy WebLinkAboutInspection - 121 RALEIGH TAVERN LANE 11/10/2005 44 Corn merc;ial Street flaynharn, M 02 767 TO (508) 880-0233 Fax: (508) 880-7232 November 30, 2005 _.. ( � �a I E D North Andover Board of Health . "�� r� �. .., 400 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST° Wastewater Treatment System Serial Number: 24747 Attached please find the Field Inspection & Service Report and test results for services performed on 1.1/10/2005 at the property of Michele Harrison located at. 121 Raleigh Tavern bane -North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Michele Harrison Massachusetts DEP 44 COmmerclal Street Raynham, MA 02767 DISTAL PRESSURE FORM Tel: (508) 880.0233 J Fax: (508) 880.7232 a� Customer Name: A/f?// �.�f1 WW v" Serial Number: 1�11 �7 �• Address:_/ol /zAGi/-d-d 7- Vim/ City: �4�/�DI/�� State: Date: Technician Signature: Comments: i!,,1(d1 ,D�S r�LG ���S.�v��-,� �d,✓f , ����i�-s l-`v r � Massachusetts Department of Environmental Protection Ll DEP Bureau of Resource Protection - Title 5 Approved Inspection and O&M Form for Title 5 I/ Treatment and Disposal Systems 5080 A. Installation Important: Michele Harrison When filling out Owner forms on the computer,use 121 Raleigh Tavern Lane only the tab key Facility Street Address to move your North Andover 01845 cursor-do not City use the return y Zip key. Mailing address of owner, if different: Q121 Raleigh Tavern Lane Street Address/PO Box: North Andover MA 01845 City State Zip 1978-794-9526 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 24747 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer's Name&ID Model Name&Number 05/24/2005 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 NO jM Massachusetts Department of Environmental Protection Li DEP Bureau of Resource Protection ® Title 5 Approved Inspection and O&M Form for Title 5 I/ Treatment and Disposal Systems 5080 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: , , , . Pump &floats working properly. Unable to take distal pressure-valve caps not to grade. 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 31st of each year for the within 30 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, 61h Floor Boston. MA 02108 DEPMicroFASTnew.doc• 11/30/05 Page 2 of 2 t INCORPORATEO 8450 Cole Parkway m Shawnee, KS 66227 Phone 913-422-0707 m Fax: 912-422-0808 5080 e-mail: onsiteabiomicrobics.com m www.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 121 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Michele Harrison Street Mail Address: Mail Address 44 Commercial Street 121 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978-794-9526 Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 24747 05/24/2005 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: Pump& floats working properly. Unable to take distal pressure-valve caps not to grade. TECHNICIAN F SERVICE DATE Michael Dillen 1 11/10/2005 41. Ce°wmmemiral StrEKA I"@aynhae n 02767 Tel: (508) 880-0233 September 20, 2005 j �j y ` ,1�� f 2��(.�5 I North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health. Agent Reference: FAST° Wastewater Treatment System Serial Number: 24747 Attached please find the Field Inspection & Service Report and test results for services performed on 08/21/2005 at the property of Michele Harrison located at 121 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: Michele Harrison Massachusetts DEP 1 `�x�.teu�rte�� ileafineerz��1u�rrue�% arc: 44 Commercial Street Raynham, MA 02767 DISTAL PRESSURE FORM Tel: (508) 880-0233 Fax: (508) 880-7232 Customer Name: f/� ti ,�, Serial Number: a-i`7�/ 7 Address: ^ City:_ J�/U, �QN,/ State: 41,p - FV Date: /d/IJ Time: r/ Technician Signature: Iz Comments: �v� lD�TS ne n•- vG��ti�'� n .,� T Environmental Chemistry Environmental Services Site Assessment Site Sampling Quality Assurance Services Ana fical Balnce Data Auditing C O R O N Wastewater Treatment Services, Inc. CERTIFICATE OF ANALYSIS 44 Commercial Street REPORTED: 08/29/2005 Raynham, MA 02767 ORDER#: G0575185 COLLECTED BY: K. Usilton SAMPLE DATE: 8/21/2005 TIME: 14:00 DATE RECEIVED: 8/23/2005 LOCATION: No. Andover(24747) SAMPLE ID: Harrison Grab DESCRIPTION: WATER RESULTS OF ANALYSIS Test Parameters LAB-H)#: 0575185-01 11301) SM 5210B 08/24/2005 mg/L 4 23.0 �pH SM 4500 H+B 08/23/2005 S.U. 0-14 7.5 olids, Suspended SM 2540 D 08/26/2005 mg/L 4 7,5 NA=Not Applicable ND=Not Detected Approved By: ¢� � '<' = Less Than *' = Detection Limit ab Manager Date MUG Page t or Atnrlytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Massachusetts Department of Environmental Protection Ll Bureau of Resource Protection e Title 5 DEP Approved Inspection and OM Form for Title 5 I/A Treatment and Disposal Systems 5080 A. Installation Important: Michele Harrison When filling out Owner forms on the computer,use 121 Raleigh Tavern Lane only the tab key Facility Street Address — to move your North Andover cursor-do not 01845 use the return City Zip key. Mailing address of owner, if different: Q121 Raleigh Tavern Lane Street Address/PO Box: North Andover _ MA _ 01845 "h0 City State Zip (978-794-9526 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 24747 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer's Name&ID Model Name&Number 05/24/2005 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 08/21/2005 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No Color: Clear Odor: None Effluent Description DEPMicroFASTnew.doc•9/20/05 Page I of 2 t Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 P Approved Inspection and O&M Form for Title 5 I/ Treatment and Disposal Systems 5080 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: , , , . Pump and floats in good condition. Unable to take distal pressure-the ends are not to grade. 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 08/21/2005 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 30 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•9/20/05 Page 2 of 2 CZEMIMCORPORATED 8450 Cole Parkway m Shawnee, KS 66227 w Phone 913-422-0707 w Fax: 912-422-0808 5080 e-mail: onsitena,biomicrobics.com w www.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 121 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Michele Harrison Street Mail Address: Mail Address 44 Commercial Street 121 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978-794-9526 Fax e-mail I Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 24747 05/24/2005 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: Pump and floats in good condition. Unable to take distal pressure- the ends are not to grade. TECHNICIAN SERVICE DATE Kevin Usilton 08/21/2005