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Home My WebLink AboutTitle V Inspection Report - 67 RALEIGH TAVERN LANE 2/2/2018 x �� as Q. RECIRCULATING SAND FILTER SYSTEM ROUTINE INSPECTION ADDRESS: 67 Raleigh Tavern Lane,North Andover OWNER: Hamann DATE: December 15 2017 OPERATOR: Mario Rosa SYSTEM STATUS Septic Tank Effluent Filter: O.k. cleaned Scum Depth: 15/485' Sludge Depth 85/485 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. clean 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 J Test & CIean Floats: O.k. clean Tank Condition: Good 1 Sand Filter f Sand Condition: Clean Diffusers Condition: Clear, unable to flush, caps frozen Effluent Quality Visual Inspection: Clear, no odor Sample: pH — 7.0, Dissolved Oxygen= 9.86 my/L, Turbidity =4.04 NTU Comments: Flushed all five (5) laterals in SAS on January 3, 2017 j i i Signature: Certificate 4 15652 PO Box 825, Ipswich, MA 01938 ® 978-356-0779 Fax 97$-356-5500 www.clearwaterindustries.com Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 RSF Systemperati®n and Maintenance Insecti®n Checklist A. Installation & Service Information 67 Raleigh Tavern Lane December 15, 2017 Facility Street Address Date of Service North Andover Mario Rosa/Clear Water Industries City Operator/O&M Firm Inspect& note ifg. Septic tank(s) pumping is required. Sludge Pumping Required: Yes ❑ No ® ® Sludge Depth: 8" 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 problerns: 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 tall units) as necessary. If problems,describe Run pumps in ® Test pump alternator, or record hours Nota licable 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 i debris are present on bed. ® Inspect for ponding Ponding Present: Yes ❑ No Clean/maintain bed surface to ® Clean bed: Yes ® No ❑ allow proper f operation of the ® Distribution pipes Flush: Yes ❑ No ® Brush: Yes ❑ No I system. i ® Check head loss in pipes O.k. Headioss and comments G. Sample Collection (Field Sample) Yes ® (Field Sample) No ❑ If yes: ❑ BOD ❑ TSS ® pH ❑ TN ® Other— Dissolved Oxygen, Turbidity rSfcheck•1122118 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 IIA Treatment and Disposal Systems A. Installation Important:When Darrell Hamann filling out forms Owner on the computer, s 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: renrn City State Zip ext. Telephone Number B. Authorized Service Provider Clear Water Industries ODM Firm P.O. Box 825 Street Address Ipswich MA 01938 I City State Zip 978 356- 0779 ext. i Telephone Number Mario Rosa 15652 Certified Operator Name Certification Number r E t C. Facility/System Information 1. i 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 15, 2017 January 3, 2017 Inspection Date Previous Inspection,Date 8" 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 Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 IIA Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown M clear ❑ turbid ❑ Other(specify): Odor: ❑ musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some p 7.0 SU DO 9.86 mg/L Turbidity 4.04 NTU 6 tog 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: i i Notes and Comments: Field sample was clear with no odor. I S C u: t5aiom.doc•rev. 11-07-05 Page 2 of 3 ,. Massachusetts Department of Environmental Protection i Bureau of Resource Protection - Title 5 DEP Approved Inspection and ®&M Form for Title 5 IIA Treatment and Disposal Systems H. Certification 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 15, 2017 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 W- by January 31$1 of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use-- by March 311h 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, 61h Floor Boston, MA 02108 I t5aiom.doo•rev. 11-07-05 Page 3 of 3