HomeMy WebLinkAboutTitle V Inspection Report - 445 BOSTON STREET 6/1/2017 Commonwealth of Massachusetts
4-1 OWL Tootle 5 Offlocial InspectRon Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
445 Boston Road
Property Address
Owner �
� Owner's Name
information is
mqui��formva� N d Ma 01845
5/4/17
page. C�y���n State Zip Code Date ufInspection
Inspection results must be submitted wnthis form. Inspection forms may not bealtered |nany
way. Please see completeness checklist atthe end mfthe form.
Important:When A. ��«�U������k KU0�^n�00���^��U0
O|Un out forms °"^ General Information
~^
on the computer,
use only uthe utab 1 |Dmoack�c
�y�mo�ynm ' '
cursor-dorot Kevin Usilton
use the return
Name ofInspector
key. Wastewater Treatment Services
Company Name
�—� Commercial Street
Company Address
Ro h 02767
"--�---, City/Town State Zip Code
508-880-0233 S113528
Telephone Number Ucorise Number
B. Cert~f~ta*~on
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection.TheinapacUon
was performed based on my training and experience in the proper function and maintenance of on site �
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of �
Title (310 CMR Y5.0UO).The system: �
�� �l P�eoms Conditionally �] ��i|m
�� �^ �
R Nee,7,dsF rthyrEva/lu 14on by the Local Approving Authority �
AV1
Inspect PoGigoatbne/ Dote
/
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the systern owner shall submit the
report to the appropriate regional office of the DER The original should be sent to the system owner
and copies sent tothe buyer, ifapplicable, and the approving authority.
^a^^TN/areport only describes conditions atthe time ofInspection and under the conditions mfuse
otthat time. This inspection does not address how the system will perform inthe future under
the same ordifferent conditions ofuse.
�
mmo'noo Title sOfficial Inspection Form:Subsurface Sewage owposa/system'Page 1 of 17
Commonwealth of Massachusetts
Title i iInspection
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner owner's Name
information is
required for every North Andover Ma 01845 514117
page. CityfTown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
i Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
i
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND.(Fxplain below):
Page 2 of 17
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Commonwealth of Massachusetts
02. Title Official
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w� 445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is North Andover Ma 01845 514/17
required for every
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cant.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
9
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction Is removed ❑ Y ❑ N ❑ ND (Explain below):
is
I
C) Further Evaluation is Required by the Board of Wealth:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Wealth determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
ElCesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3113 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
uTitle iInspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is North Andover Ma 01845 514117
required for every
page. CityfTown State zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DFP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
i
i
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El ® Liquid depth in cesspool is less than 6" below invert or available volume is [ess
than %day flow
t5ins•3113 Title 6 Official Inspection Farm:Subsurfaco Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title iInspection
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is
required for every North Andover Ma 01845 514117
page. Cityrrown State Zip Cade Date of Inspection
B. Certification (cont.)
Yes No
El ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zane 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
j of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
❑ ® 10,000gpd.
❑ ® The system falls. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
is
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ® the system is within 400 feet of a surface drinking water supply
❑ ® the system is within 200 feet of a tributary to a surface drinking water supply
❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone Il of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-3113 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System Page 5 of 17
Commonwealth of Massachusetts
Title i iInspection
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.' 445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is
required for every North Andover Ma 01845 5!4117
page. Citylrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ElWere as built plans of the system obtained and examined? (If they were not
available note as N/A)
o ® ❑ Was the facility or dwelling inspected for signs of sewage back up?
V
® ❑ Was the site inspected for signs of break out?
i
D
® ElWere all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
i.
Was the facility owner(and occupants if different from owner) provided with
I ® ❑ information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorptions System (SAS)on the site has
is
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ElDetermined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
4
Number of bedrooms
Number of bedrooms (design): 4 (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
440gpd
i5ins•3113 Title 5 Official Inspection Form!Subsurface Sewage disposal system•Page 6 of 17
' Commonwealth of Massachusetts
Title icial Inspection
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
445 Boston Road
Property/address
Arnand Kulkarni
Owner Owner's Name
information is North Andover Ma 01545 514117
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
The system is designed for 440gpd. The system includes a 1500 gallon 2 compartment septic tank
with a IIA technology (FAST) system in the 2"'t compartment for treatment. The treated effluent flows
by gravity to a pump chamber that inlcudes a pump and 3 floats with a alarm panel located in the
basement.
1+
Number of current residents:
Does residence have a garbage grinder? El Yes ® No
Is laundry on a separate sewage system? (include laundry system inspection
it
Yes ® No
information in this report.) ❑
Laundry system inspected? ® Yes ❑ No
u: Seasonal use? El Yes ® No
Water meter readings, if available(last 2 years usage (gpd)):
est.50 pg d _
Detail:
system is under the design flow of 440g pd
Sump pump? ❑ Yes ® No
current
Last date of occupancy: Date
Commerciallindustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•all Title 6 Official Inspection Form:Subsurface Sewage Disposal System•page 7 of 17
' Commonwealth of Massachusetts
xTitle Official
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is
required for every North Andover Ma 01845 514117
page, CityFrown State Zip Code Date of Inspection
D. System Information (cont.)
nla
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? El Yes ® No
wIf yes, volume pumped: gallons
u
How was quantity pumped determined?
Reason for pumping:
Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
is
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
® Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the 11A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
' Commonwealth of Massachusetts
Title ici I Inspection
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is
required for every North Andover Ma 01845 514117
page. Citylfown State Zip Cade Date of inspection
D. System Information (cant.)
Approximate age of all components, date installed (if known) and source of information:
15 years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
3+'
Depth below grade: feet
Material of construction:
i
F-1cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
a
i
I Comments (on condition of joints, venting, evidence of leakage, etc.):
All piping looks good, no si ns of leaks a and venting is good.
i
Septic Tank(locate on site plan):
COT
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
These tic tank has access covers to rade for ins ectinn and um out.
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
1500 gallon
Dimensions:
8F1-aft
Sludge depth: O
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
' Commonwealth of Massachusetts
uTitle 5 Official
Subsurface Sewage Disposal System Form o Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is North Andover Ma 01845 514117
required for every
page CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
1"
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? sludge 'ud e
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
No pumpout recommended, the structural integrity of the septic tank is good. No signs of leakage or
infitration. The liquid level is at operating level throughout the system. The FAST unit is operating
as designed.
is
is
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
Elconcrete Elmetal Elfiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from tap of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
15ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
' Commonwealth of Massachusetts
uTitle 5 OfficialInspection
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
445 Boston Road
Property Address
Amand Kulkarni
Owner Owner's Name
information is North Andover Ma 01845 514117
required for eery
page. City[Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan).-
Depth
ian):Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
I
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alanyl and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
'Commonwealth of Massachusetts
FImille 5 Official
Subsurface Sewage Disposal System Form _Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner owner's Name
information is
required for every North Andover Ma 01845 514117
page- City/Town State Zip Code Date of Inspection
D. System Information (cant.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert n/a
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ® Yes El No*
Alarms in working order: ® Yes E] No*
i
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
'i The pump chamber is in good condition with no signs of leakage or infiltration. The pump,floats and
alarm were all tested.
i
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 0€17
' Commonwealth of Massachusetts
uTitle 5 Officialt C
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is North Andover Ma 01845 514117
required for every
page. City/Town State zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions:
1 - 34'x40'
❑ overflow cesspool number:
❑ innovativelalternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
No si ns of breakout of h draulic failure. The ve station looks normal.
I
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3
3
i
1
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pN
Il
d
0
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurtace Sewage rtisposal System•Page 13 of 17
Commonwealth of Massachusetts
uTitle 5 Official
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Y
M 445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is
required for every forth Andover Ma 01845 514117
page• City/Town State zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
B
Dimensions
B
Depth of solids
Y
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Wns•3113 Title 5 Official Inspectian Form:Subsuiface Sewage Usposal System•Page 14 of 17
' Commonwealth of Massachusetts
Title I
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is
required for every North Andover Ma 01845 514117
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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s a any.,
t51ns•3113 Title 5 Dfciat Inspection Form!Subsurface Sewage Disposal System•Page 15 of 17
' Commonwealth of Massachusetts
Title 5 Official Inspection
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r
w., 445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is
required for every North Andover Ma 01845 5/4117
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
depth to high round water: 4+
Estimated de
p g g feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 20Q2
Date
9
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
i.
❑ Accessed USGS database -explain:
I
You must describe how you established the high ground water elevation:
Established ground water from the design plan on record with the Board of Health.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
l5ins-3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
uTitle 5 Officiali
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
=4' 445 Boston Road
Property Address
Arnand Kulkarni
Owner Owner's Name
information is North Andover Ma 01845 514117
required for every
page, City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
9
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t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage DispoW System•Page 17 of 17
44 Commercial Street
Raynham,MA
02767
Tel: (508)880-0233 j
Fax: (508)880-7232
March 15, 2017
North Andover Board of Health
1600 Osgood Street
North Andover, MA 01845
T
Attention: Health Agent
Reference: FAST®Wastewater Treatment System - Serial Number: 21762
Attached please find the Field Inspection& Service Report with field test results for
services performed on 312117 at the property of Anand Kulkarni located at 445 Boston
Street,North Andover, MA.
i
Please call if you have any questions or require additional information.
Sincerely,
9
Wastewater Treatment Services, Inc.
Service Department
Enclosures
Copy to: Anand Kulkarni
Massachusetts DEP
l
^#
S N H i7 N Ho H 7k a
8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808
e-rnail:onsite biomicrobics.com,www.biomicrobics.com, 800-753-FAST(3278)
MASSACHUSETTS FIELD INSPECTION & SERVICE REPORT
For Bio-Microbics FAST'Systems
28121
INSTALLATION AUTHORIZED SERVICE PROVIDER
Installation Address: 445 Boston Street Name: Wastewater Treatment Services,Inc,
North Andover,MA 01845
Owner Name: Anand Kulkarni
Mail Address: 445 Boston Street Mail Address: 44 Commercial Street
North Andover,MA 01845 Raynham,MA 02767
Phone: Fax: e-mail: Phone: (508)880-0233 Fax: (508)880,7232 e-mail:
INSTALLATION INFORMATION
Model No. Serial No. Start�n)Date_ Date of last pump out
MicroFAST.5 21762 1/6/2003 826114
Annroval Tyne () General () Provisional () Piloting (x)Remedial () General Denite
Seasonal Residence O Yes (x) No
EQUIPMEN.T ACES NO MAINTENANCE PERFORMED AND COMMENTS
Electrical Panel(s)
Visual Alarm Operating x
Audio Alarm Operating x
(if present)
Bloiver(s)
3 Air Inlet Filter Clean x
Y
p Blower Hood Vents Clear x
Excessive Noise x
i
Excessive Vibration x
Treatment unit(s)
Unusual Odor x
Settleable Solids Test Performed
Pump out Required x
Primary Settling Zone Sludge Depth 14"
Aerobic Treatment zone Sludge Depth t8"
Thickness of Scum Layer
Sludge Level Distance to Outlet
i
Depth of Ponding Within SAS
Visual Observation Comments:
Measurement Comments:
EFFLUENT LIMIT RESULT
i
Estimated Daily Flow 440 gpd
pH(Standard Units) 6 to 9 1
Turbidity <40 NTU 7.88
Dissolved Oxygen >2 Mg/L 4.65
Calor Clear Clear
Temperature,
Odor Not Septic Earthy
Effluent Solids (x)None Q Some
Effluent Samples Taken:
Influent: ()pH ()BOD ()CE30D ()TSS ()TKN ()Nitrate ()Nitrite ()Total Nitrogen()Phosphorus()Spec.Cond, ()Ammonia ()Alkalinity
()Oil/Grease ()VOC ()Fecal Coliform
Effluent: ()pH ()BOD ()CBOD ()TSS ()TKN ()Nitrate ()Nitrite ()Total Nitrogen()Phosphorus()Spec.Cond. ()Ammonia ()Alkalinity
()Oil/Grease OVOC ()Fecal Coliform
Description of any maintenance performed since previous inspection&during this inspection: Cleaned Filter,Checked Splash Recycle,Pump(s)
Inspected,Float(s)Inspected
Notes and Comments: Pumps acid floats have been inspected and are operational.
CERTIFIED OPERATOR NAME CERTIFICATION NOMBER SERVICE DATE
John Medeiros 17549 312/17
OPERATOR SIGNATURE
i
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,44 Commercial Street
Raynham, MA
02767
TeL (508) 880-0233 1
Fax: (506) 880-7232
INSPECTION AND TESTING AGREEMENT
Agreement entered into by and between Wastewater Treatment Services,Inc. (herein called WTS)and the
FAST®System OWNER(herein called OWNER)for the inspection by WTS of certain equipment of OWNER
which is described below.
Upon acceptance of this agreement at WTSSIs office,WTS will render the following services only:
Equipment will be inspected at least 2 times per year that this Agreement remains in effect,with the first
inspections beginning . These inspections will include:
1) Testing of the sludge depth in the septic tank.
2) Inspection,power testing and clean/replace intake filter of the air blower.
3) Inspection of the alarm system.
4) Inspect overall condition of FAST®System.
5) Notify OWNER of any problems encountered.
b) Service other than routine maintenance will be billed at an hourly rate,plus travel and parts.
WTS shall notify the local Board of Health and Department of Environmental Protection in writing within 24
hours of a system failure or alarm event including corrective measures that have been taken.
OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any additional labor
time will be billed to the OWNER at current labor rates of$78.00 per hour.
Emergency service between regular inspections will be provided at standard labor rates during normal business
hours; at time and one-half after 5:00 PM and on Saturdays; and at double time on Sundays and holidays.
Emergency service charges will include a minimum four(4)hours of labor, plus standard WTS charges for parts,
plus mileage and travel charges. The annual rate includes routine maintenance,but does not include repairs
required for damages caused by abuse, accident,theft,acts of third persons,forces of nature, or alterations made to
the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor
disputes,non-cooperation by OWNER,or other factors beyond the control of WTS.
OWNER understands and agrees that WTS is not responsible for special,incidental or consequential damages,
including but not limited to loss of time, injury to person or property, or equipment failure.
OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas deemed by
WTS to be necessary or appropriate for WTS to perform its duties hereunder.
Current WTS practice is to send OWNER approximately 10 days before expiration of the term of the current
contract an invoice for one year of service. It is OWNER's responsibility to timely return the payment. WTS
must receive the payment before expiration of the current contract year to assure continuous contract coverage.
I
MANUFACTURER MODEL NO. SERIAL NO, LOCATION ANNUAL RATE PERMIT
Bio-Microbics MicroFAST 21762 North Andover,MA $370.00 Remedial
Includes Field Testing
EQUIPMENT OWNER ## Wastewater Treatment Services Inc.
*Signed by OWNER: t�Y 4`'1 !" 9 e
Anand Kulkarni .f''�l = Signed:Z;z
*Address:
445 Boston Street 44 Commercial Street
Raynham,MA 02767
Tele: (508)880-0233
,City: State: Zip: Fax:(508) 880-7232
North Andover MA 01845
Telephone Effective Date of Agreement
E-mail address: A-'j�]�� �� �Y3 Y/4i�rc-,
=•
OWNER understands that(1)ANNUAL RATE payment is for one year only commencing on the effective date set
forth above and is non-refundable; and(2) Current DEP Regulations require OWNER to maintain a service
agreement for the life of the FASTS Sy,.stem. I HAVE READ AND UNDERSTAND THE FOREGOING.
*Signed by OWNER: ; h"" -
4
Field Testing
Onsite testing performed l time per year will be used to demonstrate that the systems are operating at a secondary
treatment standard of 30 mg/L of BOD5 and TSS. The following will be performed:
1) Visual examination of the effluent for color,turbidity and effluent solids.
2) Settleable solids observation/measurement
3) Effluent pH to determine if the waste water is between 6 and 9 standard units.
4) Dissolved Oxygen,2mg/L or more,to ensure that the system is operating.
5) Turbidity, less than or equal to 40 NTU.
If the effluent does not meet effluent duality standards, a grab sample will be collected for laboratory analysis.
Results sent to state and local Agencies as well as the OWNER. OWNER is responsible for providing acceptable
access to effluent for field testing and/or to enable a grab sample to be taken for laboratory testing performed. If
such laboratory sample is required, OWNER will be responsible for charges incurred. IF REQUIRED,THE
COST FOR THIS ADDITIONAL TESTING WILL BE$190.00/VISIT.
*Approval for Additional Testing if Required' iK' ;
Owner's Signature
Operator assigned: Michael Moreau
Telephone: (508) 989-2744