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HomeMy WebLinkAboutMiscellaneous - 151 R T L o Al Lo re,C-5p0 < / f NOTICE William D. Watson and Sandra J. Watson herewith on oath do state that the property located at 151 Raleigh Tavern Lane,North Andover,Mass.,more particularly described in North Essex Registry of Deeds Hook 1176,Page 136,has on the premises a fast waste treatment for purpose of Tile V which requires an operating and maintenance contract with an approved provider. _,Iu ,t4,- CA, William D.Watson Sandra J. Watson COMMONWEALTH OF MASSACHUSETTS Essex,ss NovemberL ' ®1998 When,personally appeared the above-named William D. Watson and Sandra J. Watson and acknowledged the foregoing instrument to be their flee act and deed,before me. Notary Ab My Commission Expires: Howard M.Berger tity NWarY Pubfic reK November 30.2WI 20:39dd 2bS6 889 80S:01 6568-SL17-8L6 :W0dJ 9ti:91 86 60-AON I �\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 JANE SWIFT Governor i � U1�1o0 / BOB DURAND P©eD OF HE�Zr Secretary LAUREN A.LISS JUN - nj Commissioner May 31, 2001 Paul Antinori 151 Raleigh Tavern Lane `North Andover, `,/Lk 01845 Re: Alternative On-site Sewage Treatment Monitoring and Reporting Requirement DEP Facility ID: MCF215 1�1 Raleigh=Tavern.Lane;_Noith_Paidover, MA Dear Mr. Antinori: The Department has received a letter from J&R Sales & Service, Inc., dated 3/26/2001, requesting reduction or elimination of monitoring and reporting of pH, BOD and TSS on a quarterly basis on the effluent from the alternative on-site sewage disposal system at the above referenced facility. The Department, having reviewed the monitoring data for this technology, in general, and your system, approves the request to reduce effluent monitoring of the system, from four times to one time per year. The change in monitoring requirements in no way changes the requirement that,throughout its use,the system shall be under an operation and maintenance agreement with a person or firm qualified to provide services consistent with the system's specifications. The operator must maintain the system at least every three months and anytime there is an alarm event. Additionally, as required by the Approval for the system, any time the operator changes,you shall notify the Department and the local approving authority, in writing,within seven days of such change. Please note that the Department is now requiring the use of a DEP approved inspection form and technology checklist. You must submit, by January 31St of each year, a copy of the "DEP Approved Inspection and FAST O&M Form for Title 5 I/A Treatment and Disposal Systems" and O&M checklist to the Department and local Board of Health for each O&M inspection performed during the previous calendar year. The certified operator under contract to operate and maintain the system must complete these.forms. Enclosed are copies of these forms. The annual sampling results must accompany the forms. If the concentration of either BOD or TSS in the annual effluent sample from your system exceeds 30 mg/L, within 45 days of the annual sample you must both have your system sampled again and submit the results to the Department. Provided that the second sample meets the 30 mg/L This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http:/twww.state.ma.us/dep 10 Printed on Recycled Paper I Re: Monitoring and Reporting Requirement Page 2 DEP Facility No.: MCF21 5 limit for.BOD and TSS, you may resume annual monitoring of your system. However, if the second sample does not meet the 30 mg/L limit for both BOD and TSS, you must resume quarterly monitoring of your system. Following four consecutive quarters of monitoring demonstrating the system meets 30 mg/L for both BOD and TSS, the Department would favorably consider another written request to reduce monitoring. This reduction in monitoring requirements is conditioned upon your compliance with the Approval and the requirements in this letter. Please be aware this change in monitoring does not apply to any local requirements. You should discuss any changes from the local monitoring requirements, if any apply to your system, with your local Board of Health officials. You should check with the local Board of Health pfiff to reducing effluent monitoring and reporting to ensure that the reduction would be consistent with any local requirements. Should you have any questions regarding this matter, please do not hesitate to contact Natalie Brown, of my staff, at (617) 292-5658. Sincerely, V G.�vL Lealdon Langley, Director Watershed Permitting Program Enclosures: 2 cc: J&R Sales&Service,Inc.,44 Commercial Street,Raynham,MA 02767 NERO,D.Ferris North Andover Board of Health,27 Charles Street, North Andover,MA 01845 samplered-ltr COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 o,� See ARGEO PAUL CELLUCCI BOB DURAND Governor Secretary JANE SWIFT LAUREN A. LISS Lieutenant Governor Commissioner November 9, 2000 Paul Antinori 151 Raleigh Tavern Lane North Andover,MA 01845 RE: Alternative On-Site Sewage Treatment Monitoring and Reporting Requirement 151 Raleigh Tavern Lane,North Andover DEP Facility No: MCF215 Dear Mr.Antinori: The Department has received a letter from J&R Sales and Service,Inc.requesting reduction or elimination of quarterly monitoring and reporting of pH,BOD,and TSS on the effluent from the alternative on-site sewage disposal system at the above referenced facility. The Department,having reviewed the monitoring data for your system,denies the request to reduce effluent monitoring of the system.The Department's technology approval.letters specify that the effluent from the FAST systems installed for Remedial Use must be monitored quarterly.There is no current sampling data for your system.Before the Department will review a request to reduce the monitoring and reporting requirements for your system,the Department requires that the system be sampled for two consecutive quarters. Moreover,the Department requires that the effluent concentration of both BOD and TSS for the four latest quarters average no greater than 30 mg/L in order for us to reduce sampling requirements. Should you have any questions regarding this matter,please contact Natalie Brown, of my staff,at (617)292-5658. Sincerely, G� Lealdon Langley,Director Watershed Permitting Program cc: J&R Sales and Service,Inc.,44 Commercial Street, Raynham,MA 02767 North Andover BOH DEP/NERO,D. Ferris This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http://www.magnet.state.ma.us/dep Z�J Printed on Recycled Paper b Town of North Andover t NORTH , OFFICE OF 3�°�<`�`� tioL COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street :�o North Andover, Massachusetts 01845 �9SSAcFHus��sy WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 April 21, 1999 Paul Antinori 151 Raleigh Tavern Lane North Andover, MA 01845 RE: Operation&Maintenance Requirements—FAST System 151 Raleigh Tavern Lane Dear Mr. Antinori: This Department has been advised that you have cancelled your operation and maintenance agreement with J&R Sales for the alternative septic system located at the site referenced above. To date the Health Department has not received any notice of change of operators and must assume that you do not have an agreement in effect. Please be advised that this type of agreement is an essential component of your on-site sewage disposal system. Lack of a current agreement for maintenance and operation of your system constitutes a violation of your on-site sewage disposal permit, a violation of 310 CMR 15.000 of the State Environmental Code, and an invalidation of your Certificate of Compliance. Continued neglect to employ a licensed contractor for operation and maintenance of your Fast septic system may result in fines and legal action. Please forward to this office within seven(7)days of receipt of this letter, a copy of your current contract and the name of the new operator. Feel free to call the Health Department at the number below if you have any questions. Sincerely, �1 Sandra Starr, R.S. Health Administrator Cc: DEP,NERO File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 C;�? �(� �o -Al, �15 794 397 Receipt for Certified Mail No Insurance Coverage Provided TED STATES Do not use for International Mail VOSTGLSEf c (See Reverse) Sent to — - - �,Streetr A. I P.O.,State and ZIP Code - —' - /N Postage $ 33 Certified Fee nh a, / / Special Delivery Fee Restricted Delivery Fee � Return Rece howiQQg�,�r to bdhom Date DelibE$r L Return p� tr ow ii to - 2 Date, - dr At}dre TOT Po abs.. &Feel C PostmGo to : 03 ELL li 0 N . a, STICK POSTAGUSTAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address 12 leaving the receipt attached and present the article at a post office service window or hand it to 1:1 b. ' your rural carrier(no extra charge). oa CC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return 2 address of the article,date,detach and retain the receipt, and mail the article. 0) L 3. If you want a return receipt,write the certified mail number and your name and address on a 2 return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. O 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. ff n 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 0_ 6. Save this receipt and present it if you make inquiry. 105603-93-13-0218 ai SENDER: I also wish to receive the a ■Complete items 1 and/or 2 for additional services. following services(for an rn ■Complete items 3,4a,and 4b. a> ■Print your name and address on.the reverse-of this form so that we can return this extra-fee)--' r i card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1.El Addressee's Address ■Wst Write"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date postmaster for fee. delivered. COf1SUlt P a o 3.Article Addressed to: 4a.Article Number CL 1014 a _T1 J 1 D A I / `4b.Service Type � �S 1 >�� J E f / v � ❑ Registered It�'Certified Mw [r d1 § ExpressMail ❑ Insured NO-An do ve r, MA— '' ` ❑ Return Re&ipt for Merchandise ❑ COD 3 o �f� 7. eof f r w 5. Received By: (Print Name) 8. ddres ee's Ad resS(O�dy a requested m and fee is paid) L 6.Signat e• Addressee Agent 15 199 IA ~ T X i y 2 PS Form 3811,December 1994 102595-98-13-0229 ornestic Return Receipt a - .First4t_as2 Mail___._ �h TED STATES POSTAL SERVICE �'t SS Postage&Fees.Paid USPS.. _ o a Permit.No.G-10 ®Print your n ,�sdc�i , and ZIP Code in this box-6 VCHAMSIRM 11.111 fill III fill 11111111££1 11-1££iil£££lt1i£III J & R SALES & SERVICE, INC. Please complete all items marked*. 00, 44 Commercial Street ' mail 66eck at4 signed RAYNHAM, MA 02767 original contract-to: TEL: (508) 823-9566 Shea Concrete Products,Inc. FAx: (508) 880-7232 773 Salem Street/Route 62 North Wilmington. MA 01887 INSPECTION& EFFLUENT TESTING AGREEMENT This Inspection Agreement is entered into by J&R Sales & Service, Inc. (herein call MR) and the FAST System OWNER(herein called OWNER), for the,purpose of setting forth terms and conditions governing J&R's obligations to inspect OWNER's equipment listed below. Upon acceptance of this agreement, J&R will render the following services only: Equipment will be inspected at least 4 times per year that this Agreement remains in effect, with the first IIS inspection beginning . These inspection 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 over-all condition of FAST System. 5) Notify OWNER of any problems encountered. 6) Service other than routine maintenance will be billed at an hourly rate plus travel and material. J&R shall notify the local board of health and the Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. It is understood that by this Agreement J&R is not obligated to supply any parts. Any additional labor time will be billed to the OWNER at standard labor rates of$ 64.00 per hour. Emergency service between regular inspections will be provided at standard rates for labor during normal business hours, after 5:00 PM and on Saturdays time and one-half, and double time on Sundays and holidays, minimum four(4) hours plus standard charges for parts plus mileage and travel charges. This agreement does not include expenses to repair damage caused by abuse, accident, theft, acts of a third person, forces of nature, or altering the equipment. J&R shall not be responsible for failure to render the service for causes beyond its control, including strikes and labor disputes. i try ,r OWNER understands and agrees that J&R is not responsible for special..or consequential:damages,uicludwg x loss of time, injury to person or property unit or equipment failure. This agreement is not assignable without the consent of J&R and will remain in force until canceled by either party through written notice. E This is a two year service contract to be billed annually in compliance with State regulations. Failure to comply will result in cancellation and nullification of any warranties. MANUFACTURER -MODEL NO: SERIAL;NO. LOCATION ANNUAL RATE Bio-Microbics Home FAST® $350.00 EQUIPMENT OWNER J&R Sales & Service, Inc. *Signed by: � tom.. -1�— a��,� Signed by: J&R Sales and Service, Inc. *Address: t 551 FLP-��` z' v'Y� 44 Commercial Street Raynham, MA 02767 td, Tel: (508) 823-9566 f� Fax: (508) 880-7232 *City: State!''# Zip:Q94-5 *Telephone: ~ ` Effect Date of Agreement Effluent Testing Effluent sample taken�4 times per year,delivered to a qualified testing lab for evaluation and with results being sent to State and local Agencies as well as the owner. Owner is responsible for providing acceptable access to effluent to enable a grab sample to be taken for laboratory testing performed: PERMIT : *(PLEASE CHECK ONE) ( ) GENERAL hA REMEDIAL ( ) PROVISIONAL *SPECIAL CONDITIONS PER LOCAL BOARD Or6ALTH (Y) or(I) If YES,please attached copy of permit BODS, TSS, PH ( ) pH, BOD5 ,•TSS, TKN,NO3 -N, Ammonia ('/) Other VS Please specify Testing Cost Imop Operator assigned: William Everett *Engineer: Telephone# (508) 823-9566 *Approval for Effluent Testing Homeowner's Signature r FROM : Panasonic FAX SYSTEM PHONE NO. May. 04 1999 08:20PM P1 May 03 19 02.,49P J&R Engineered Products 508 880-1232 p z Please complete all items madced• U1 At-k" mail sigled original contract to; W 1&R Seks 8t 3eivice 1 c ,f Q, a t'&'RON 44 omla�t�ttee�t � -lv"` j&R SALES A SERYIC6,INC, a%—CI'—ON, x�n 95'3jg� NT TESTING AG„ RL_ E11�NT This Inspection Agreement is entered into by J&R Sales&Service,Inc. in call J&R System OWNER(hcreia called OWNER),for the h )�the FAST AR's ob' ions to' q p of terms and conditions ovemin � utspect QWNER's equipment listed below. g >3 Upon acceptance of this agreement,AR will fender the following services only: Equipment will he inspected at least 4 times per year that this A inspection beginning Sit remains in effect,with the first . These inspection will include: 1) Testnig of the sludge depth in the septic tank. 2) Inspection,power testing and cleanlreplace int<b filter of the air blower. 3.) Inspectiols of the alarm system. 4) Inspect over-all condition of FAST®System. 5) Notlfy OWNER of ony problems encountered. Service other than routine ce will be billed at an hourly rate plus.travel and tnatetial, JU shall notify the local board of health and the Department of Environmental hotectiotl in writing hours of a system failure or alarm event including corrective meUUM that have ben taken wittlin 24 It is understood that by this Agreement J&R is not obligated to supply any paw Any additional labor time will be billed to the OWNER at standard labor rates of S hoof. Emergency service betweon regular hispections will be provided at standard rates;For labor during normal business hours,after 5:00 PM and on Saturdays time and one-half,and double time on Sundays enc!Holidays, minimum four(4)hours plus starlclard charges for parts pias mileage and travoi clwrges. This agreement does or not slate expenses to repair dame�:aused by abuse,accident,thele acts of a tttir+ct person,forces of nature, altering the cquipmeut_ dRcR shall not be responsible for Failure to render the service for causes beyond its control,including strikes and labor disputes_ . .. M COOunemyl ST. . RWftM,tap 01781 ... rek soe'sraasse �.. Oa'o0oa13[ FROM Panasonic FAX SYSTEM PHONE NO. May. 04 1999 08:21PM P2 Mab 03 19 02: 49P AR Engineered Products 508880-7232 • p. 3 ru! d n„ pemb v „ tQ tPteit41pct ... ; . went is not assignable WADI the GO t AA �y Will 1 J . ..�:_-____ crr ra.'+rorcrai-t�frrE�r� -��tlOno t��,y warran�e --a �_ �--rnK=etc.mrr,ncgnJ--- s. MAWACTURER MODEL N0. L.--. • S . $io-Mi47ohiCS � �A �1 KATE Home 1~AS� MCF215 N. Andover, MA $350.00 QUIP_—Pm F., OWKE ., J&R Mes&Service Inc. *Signed by: _ Signed b . Paul and Maria Arldwri 44 Comm at Str *Address: Rayn}tam,MA 02767 151 Raleigh Tavern bane Tch (508)823-9566 North Andover Fax.--'(508)880-7232 01845 *City: state: dip: 978-68 : . : z-4271 . T&phone: ffeci Date of Agre em t ( "I F.fA �pet'r��„.� • 'Effluent sample taken,4 times per year, delivered to a qualified testing lab for evaluation and with results bong sent to State and local Agencies as well as the owner. Owner is responsible far access to ciflu�t to,enable�� Pa providing acceptable grab satt�ple to be taken for laboratory testing performed: PER�NIIT : *PLEASE CHECK ONE) { } QM PAL (X ) R MLDIAL PROVISIONA.L *SPEC'AL CONDITIONS PER LOCAL BOARD f ) OF HEALTH (1)or(N)if YEs,pkease attached copy of permit (X )Bons,TSS,ptl ( )BOI1,,`ass,pH,NitratelMMgen, Ammonia,AN (X)Other: Phos haus Cost for testing S 160,00ivisit Opomtor asp red: William g verctt *Eq . Telephone: *APproval for Effluent Testing 7au,Q yyam�•• Homeownees Uplature FROM Panasonic FAX SYSTEM PHONE NO. May. 04 1999 08:41PM P1 Please ee41ete all items marked* mail signed ori rW co !'� At r � bract to: J&�S es Sem'Ce,E111c. �9 A . SALES&SERI/fCE, iNc. iNsp ��3f 49 EMON ND EFFLUENT TES A REEMENT r ' 7bis IInnso on AgIcement is entered into by J&R Sales&Service,Incstein 'VVNER( crcrq ca Ctl p ER (herein call j&R)Ud the]FAST 1&R's ob�gagons to inspect QVI NE � qa ip the hStedpUrPob of Seltmg hod terms and conditions governing OWNER's equipment fisted below, g wg IpII'"cptance of this agreement,AR will render tbo f0)ldUYIIIg 5eN1CgS day; Equipment will he inspected at least 4 times inspection be ' nin lir year fat thisreement zemains in e#'feet, with the Fust g—��. hese inspection will include: 1 Twin u!' g the Sludge depth ut the septic tastk. i 2) Inspection, power testin and c(eanld g ace intllce filter of tlic air blower. 3} Inspection of the alarm system. 4) Inspect over-all condition of FAS74 System. Cl XT-Ca.r%«71LI*- -' `NVUly V WALK orally problems encountered. d} Service other than routine mainteuance.will be biped at an hourly rate ply travel and materi4, 3&lt shah notify the local bw,d of heS�and the De arkm how S�of a system failure or alarm event i�cludin � cart of Fnviranniental Protectiatt in vvrititt� within Z4 rrective meas�s that have been taken. It is Under900d dlat bY this Agreement j&R will be billed to the OWIgR at standard labor rates of is not obli a tcd to supply any per• Any additional labor time $ 4_per hour. Emergency service bctwecn regular burin%u hall, ditC.r 5:00 FM and on gattuurdans will tip p�ov� �t StQtld d FW for I&r dur6 no al mtttimurn four(4)}touts p1u$S lard cl rgeS fanrm �l ne ' and double tittle oic Sundays and holidays, not iNlUde e n P Pus toile a an , . see to re � d travel Q�,tr Jam e I char es. or altering the � caused by abuse, acciBett the , acts g M. agreetzi�t does equipment. J&R shall not be res of a third person, forces of h.atiue control, including atikes and labor disputes. Ponsible for hilum to render the service for causes beyond ifs} 46 CCMMefp h,SL AD*—,Mq 02761 1aIB.'508.8Ys9S66 SOBbcn•773[ FROM Panasonic FAX SYSTEM PHONE NO. May. 04 1999 08:42PM P2 May 03 19 02:49p J&R Engineered Products 508 880-7232 P-3 OWNER w eta art r „ : :.-..>-c. �-,... �.:;�:"�..-;.r<:.....,..,.,z;.• ".i� ::'t';�'::,..'i°'.r J ► <;•= it M. .< .mciiiuig -ei(i�ipaii�ttfaiifu�re: This agreement is not assignable witho>n the consent of J&R and will 1�►t3'tiuough written notice. mn4'in force Until canceled by either. This is a One-year service conttacrtrr be billed anaiallyr-k.comphance with State MgWaons. Failare to comply will n'wlt in cancellation and nullification of any wanuties. MA ACTtJRER M0 Bio•1vlicrobksSERIAL NO, WCA M R AU Home 1:A MCF215 N.Andover, MA3 S 50.00 1v0U>�Mf� I f i & 'Signed by. Signed b . Patti and Maria Antinori 44 Comm tat Stxeet Address:. 151 Raleigh Tavetn I.aue ���MA 02767 Tol. (S08)823-9566 North AndoverMA 01845 Fare:(508)880-7232 Tity. State: Zip. 978.682.4271 'Telephone: . Effect Date of A gent s l qq Eftent law Ef aulnt sample taken 4'times per Yew,deiiveted to a q=lifted being sent to State and local �for evaluation and with results Agencies as well as the owner. Owner is responsible for providing acceptable aoccss to cfflurnt to enable a grab gample to be taken for laborato�r �- perf : #(PLEASE CHECK ONE) ( ) t.TWERAL (X ) REMEDIAL. ( ) PROVISIONAI, *SPECIAL CONDITIONS PER LOCAL BOARD OF HEALTH (y)or(N)if Ya>p1m81 .kd copy of pamit (X )BOD,,TSS,pI I ( )BOD-,TSS,pH,Nittate/Nitrogen,Ammonia,TKN (X)Other: Phosphorus Cost for tesdag 8).00/v ice-..._ Opentora�cigned.�� *Eggiaeer: Telephone: �?' 23�9� - V✓�.i1c. -Approval for En.,W Testing TQ"'-C HolnC"nP S sisnatsae a LY.�'lf'tiVal, 0- 97W1;- 7.C'Qt e- 'OV&7 ,, 44 Commercial Street Flaynham, MA 02767 Tek (508) 880-0233 Fax: (508)880-7232 March 6, 2006 North Andover Board of Health 400 Osgood Street North Andover,MA 01845 Attention: Health Agent Reference: FAST Wastewater Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report with field test results for services performed on 02/14/2006 at the property of Paul,Antinori located at 151 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: Paul Antinori Massachusetts DEP 0£Z—d 90/10'd 190-1 M10888091+ OOWN3ar—WOad Wd1£:Z0 90—Nnr-8Z 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 6967 A. Installation Important: Paul A_ntinori When filling out Owner forms on the computer,use 151 Releigh Tavern Lane only the tab key Facility Street Address to trove your North Andover 01845 cursor-do not City ZIP use the return key. Mailing address of owner, if different: 151 Raleigh Tavern Lane Street Address/PO Box: North Andover MA 01846 City State Zip 978 682 4271 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 608-880-0223 ext, Telephone Number Michael Dillen 11173 Certified Operator Name CertifiGatioh Number C. Facility/System Information MCF215 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer ID Model Number 09/21/1998 Installation date Start of Operation Approval Type: General Provisional Q Piloting ®Remedial Seasonal Residence—used less than 6 mo./year. []Yes No D. eratin Information p g 02/14/2005 _ Inspection bate Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended Q Yes dC No DEPMieroFASTnew.doc•3/6106 Page t of$ 0£Z-d 90/ZO'd 190-1 Z£Z10888091+ OOddnUdr-DYOdd Hdl£;ZO 9O-Nnr-8Z LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 UA Treatment and Disposal Systems 6967 E. Field Testing Field Inspection Color: gray Q brown Q clear turbld i i Q other(specify): i Odor: Q musty earthy Q moldy Q offensive Q turbid Effluent Solids: Ono Q some pH SU_ _ DO 8.13 mg/L. Turbidity 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 Q Influent 0 Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems, 440 gpd Parameters sampled, 0 pH 0130D O CBOD Q TSS Q TN 0 Other(list below) Other 1 Other 2 Other 3 C. Inspection and Maintenance Description of any maintenance performed since previous inspection and during this inspection Cleaned Filter, , , Splash recycle Notes and Comments: Pump chamber not to grade. Letter to owner DLPMicroFASTnew.doc•3iwo5 Page 2 of 3 0£Z-d 90/£O'd 190-1 Z£Z20888091+ (106ON3ar-WONd Ndl£:ZO 90-Nnr-8Z LlMassachusetts 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 6967 W. 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. Michael Diller 02/14/2006 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 at of each year for the previous calendar year Piloting Use—within 45 days of inspection date Provisional Use—by March 31 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, 6"h Floor Boston, MA 02108 DEPMicroFASTnew.doc-3/606 Page 3 of 3 HN 9000'd 190-1 ZEZ20888091+ 000017-ffldd lNdIE:ZO 90-Nnr-BZ n r � SII m INC0AP0RATF0 8450 Cale Parkway m Shawnee, KS 68227 m Phone 993-422-0707 w Fax: 992-422-0808 6967 e-mail: onsite biomicrobics.com mwww.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single ,dome FASTV System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover MA 01545 Nainc Wastewater Treatment Services Inc_ Owner Name Paul Antinori Street Mail Address: Mail Address 44 Cornmercial Street 151 Raleigh Tavern Lane Raynham4 MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of installation I Datc of last pump out MicroFAST.5 MCF215 09/21/1998 EQUIPMENT YES NO IvMAIN-MNANCE PLRFORMED AND COMMENTS Electrical Panel s Visual Alarm Operating X Audio Alarm Operating X if preseng Blower(s) Air Inlet Filter Clean X Blower food Vents Clear X Excessive Noisc X Excessive Vibration X Treatment unit(s) Unusual Odor Pum out Required- X Primary Settling Zone Aerobic Treatment Zone EFFLUENT o tionai LIMIT RESULT Estimated Daily Flow 440 jmd. H Standard Units Color Temperature Odor Comments: Fump chamber not to grade. Letter to owner TECHNICIAN DA'Z'E Michael Dillcn 02/14/2006 0£Z-d 90/90'd 190-1 Z£Z20888091+ a0ad9N3ar-IN0ad HdI£:ZO 90-Nnr-8Z 1//Cl6'� eJ�4'LZli i i�cJP�YX�P6'i� �/LG 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 May 12, 2005 A $ 2005 P�ppVER NpR�N 1MEN� - pO EN VA North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report for services performed on 05/05/2005 at the property of Paul Antinori located at 151 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: Paul Antinori Massachusetts DEP LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 4297 A. Installation Important: Paul Antinori When filling out Owner forms on the computer,use 151 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: -�I 151 Raleigh Tavern Lane Street Address/PO Box: North Andover MA 01845 City State Zip (978 682 4271 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 MCF215 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer's Name&ID Model Name&Number 09/21/1998 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 05/05/2005 Inspection Date Previous Inspection Date Sludge Depth (to be checked yearly) Pumping Recommended Yes X No Color: N/A Odor: None Effluent Description DEPMicroFASTnew.doc-5/12/05 Page 1 of 2 Ll Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 4297 E. Sampling Information Samples Taken:_ Influent _Effluent Parameters sampled:_pH_BOD_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: 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 05/05/2005 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 315`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-5/12/05 Page 2 of 2 INCORPORATED 8450 Cole Parkway Shawnee, KS 66227 m Phone 913-422-0707 m Fax: 912-422-0808 4297 e-mail: onsite(cDbiomicrobics.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 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Paul Antinori Street Mail Address: Mail Address 44 Commercial Street 151 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST .5 MCF215 09/21/1998 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 N/A Temperature Odor None Comments: TECHNICIAN SERVICE DATE Kevin Usilton 105/05/2005 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 March 15, 2005 m- . . r North Andover Board of Health TOWN OF p 27 Charles Street HEALTF: North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report and test results for services performed on 03/02/2005 at the property of Paul Antinori located at 151 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: Paul Antinori Massachusetts DEP II "Environmental Chemistry Environmental Services Site Assessment Site Sampling Quality Assurance Services Analytical Balance Data Auditing C 0 R P O R A T 1 n 1\T Wastewater Treatment Services, Inc. CERTIFICATE OF ANALYSIS 44 Commercial Street REPORTED: 03/08/2005 Raynham, MA 02767 ORDER#: G0568797 COLLECTED BY: M.Dillen SAMPLE DATE: 3/2/2005 TIME: 11:30 DATE RECEIVED: 3/2/2005 LOCATION: 151 Raleigh Tavern Ln.,N.Andover, MA SAMPLE I.D: Antanori Grab DESCRIPTION: WATER RESULTS OF ANALYSIS a Test Parameters LAB-ID#: 0568797-01 BOD SM 5210B 03/03/2005 mg/L 4 27.8 pH SM 4500 H+B .03/02/2005 S.U. I 0-14 6.5 (Solids,Suspended SM 2540 D 03/04/2005 mg/L 4 7.5 NA=Not Applicable ND=Not Detected Approved By: 3 � = Less Than *' = Detection Limit La�age�r / Date Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 4297 A. Installation Important: Paul Antinori When filling out Owner forms on the computer,use 151 Raleigh Tavern Lane only the tab key Facility Street Address to move your North Andover 01845 cursor-do not use the return City Zip key. Mailing address of owner, if different: rah 151 Raleigh Tavern Lane Street Address/PO Box: North Andover MA 01845 '8!101 City State Zip X978 682 4271 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 MCF215 - Blo Mlcroblcs, Inc. MicroFAST MicroFAST.5 DEP ID Manufacturer's Name&ID Model Name&Number 09/21/1998 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 03/02/2005 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended Yes X No Color: Clear Odor: None Effluent Description DEPMicroFASTnew.doc-3/15/05 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 4297 E. Sampling Information Samples Taken:_Influent _Effluent Parameters sampled:_pH_BOD_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: Alarm inside-not accessible. 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 03/02/2005 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 lase—by January Piloting & Provisional Use- General Use—by September 31 st 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 i DEPMicroFASTnew.doc-3/15/05 Page 2 of 2 l INC 0 R P 0 R A T E 0 8450 Cole Parkway m Shawnee, KS 66227 m Phone 913-422-0707 m Fax: 912-422-0808 4297 e-mail: onsite(Wbiomicrobics.com w www.biomicrobics.com W 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FASTO System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Paul Antinori Street Mail Address: Mail Address 44 Commercial Street 151 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 MCF215 09/21/1998 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating 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: Alarm inside-not accessible. i TECHNICIAN SERVICE DATE Michael Dillen 03/02/2005 44 Commercial Street Raynham, MA 02767 FNOV 233 P.EIVED Fax:((508)508) 8 80-07232 November 18, 2004 2 9 2004.7®�tTHANDOVER DEPARTMENT North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST° Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report (as req 'r6'd) for services performed on 11/11/2004 at the property of Paul Antinori locate at 151 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: Paul Antinori Massachusetts DEP i Massachusetts Department of Environmentai Protection Y7, Bureau of Resource Prote�tlon: Tltle 5 �r {:�`,` .3:,Y �r � ,' z.`' xti{ii i; ��.in�� ,: J Sri. • °,;?t.; i�i� � �`''R �i ���' �� t" �� �1• i`4CY`t.ai�`r�,a� c w,..n} ..- w t�.. :'!�i��.vyTD-rEePa.�.I�'rnw#+p,.a; pPwn{.a.r�o1,'i�a'e"�ri. a�,`y`i.gy�s�ma '�Ny�'y •�+s"aiSyol��B!�',`rs' y$ e�rn�C,a a_?..'��."..� r¢ ��k�ar � �. .AS,Fb ,N, A. Installation Important: Paul Antinori When filling out Owner forms on the computer,use 151 Raleigh Tavern Lane only the tab key Facility Street Address to move your North Andover cursor-do not 01845 use the return Cit' Zip key. Mailing address of owner, if different: 151 Raleigh Tavern Lane Street Address/PO Box: North Andover MA 01845 City State Zip (978 682 4271 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 MCF215 Bio-Microbics, Inc. MicroFAST.5 DEP ID Manufacturer's Name&ID Model Name&Number 3 09/21/1998 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 11/11/2004 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No Color: N/A Odor: None Effluent Description DEPMicroFASTnew.doc-11/18/04 Page t oft Massachusetts Department of Environmental Protection Resource Protection,,Tit �7r�F%'a't ` �� '�` y;; t w's �z `er;+,e ,s•_;a x g ,d,+we 3't'. ,s +,Y?_ ,c.,` 1/ .•t r;:.c t +1'a.,'' .4'17 �aF.g.5xi x r 3 c ro �i` i :ct �A :, � t �. .;, iat : at1MG- :dr+, v3,3`xi�q��yna.- t � '�{ {=..�.� : .� �ti:,,�� v., . 7,3, 'fe .� F 9�:ti4k�..'-8f✓a9�� 3 -i:m � � �� �CEt''{•, t i� � i/ xS_ `ty�: �spol KStems K v asgw.'Si� _ F 4297 r E. Sampling Information Samples Taken:_Influent _Effluent Parameters sampled:_pH_BOD_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: Alarm inside- not accessible. 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 11/11/2004 Operator Signature Date System owner must y 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 8 Provisional Use- General Use—by September 31 st 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 I DEPMicroFASTnew.doc• 11/18/04 Page 2 of 2 iii Pti"Anp w r 't a4 � v' .4 X 'B er n rA ,}v '4 Pa 8450 Cole Parkway w Shawnee, KS 66227 mtPhorie 913-422-0707 m Fax: 912-422-0808 4297 .' ,, ' e-mail: onsitee-biomicrobics.com w www.biomicrobics.com 800-753-FA8T(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Paul Antinori Street Mail Address: Mail Address 44 Commercial Street 151 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail INSTALLATIONINFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 MCF215 09/21/1998 EQUIPMENT YES NO. . MAINTENANCE PERFOR MD AND COMMENTS 7 Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating : 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 N/A Temperature Odor None Comments: Alarm inside-not accessible. TECHNICIAN SERVICE DATE Michael Dillen 11/11/2004 44 Commercial Street I Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 t March 11 2004 C =_ 1 North Andover Board of Health - " 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report and test results (as required) for services performed on 02/26/2004 at the property of Paul Antinori located at 151 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: Paul Antinori Massachusetts DEP I Environmental Chemistry Environmental Services Site Assessment Site Sampling Quality Assurance Services AnalyjtcalBalance Data Auditing C 0 R P O R ... A T I O 1 CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. 44 Commercial Street REPORTED: 03/05/2004 Raynham, MA 02767 ORDER#: G0456571 COLLECTED BY: D.Koshiol SAMPLE DATE: 2/26/2004 TIME: 12:00 DATE RECEIVED: 2/26/2004 LOCATION: N.Andover(MCF 215) SAMPLE ID: Antinori Grab DESCRIPTION: WATER r � RESULTS OF ANALYSIS 3 �I. ..� • _ h -.� dE& ef .� N 5 v n, Test Parameters LAB-ID#: 0456571-01 BOD SM 5210B 102/27/2004 1 mg/L 4 5.0 PH SM 4500 H+B 02/26/2004 S.U. 0-14 6.5 Phosphorus,Total SM 4500-P B/E 02/27/2004 j mg/L 0.01 5.17 Solids, Suspended ISM 2540 D 103/03/2004 mg/L I 4 <4.0 NA=Not Applicable ND=Not Detected Approved By: 3 g7i� <' = Less Than *' = Detection Limit La anager / ate Page I of Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 F, Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and 0&M Form for Title 5 I/A Treatment and Disposal Systems 2723 A. Installation Important: Paul Antinori When filling out Owner forms on the computer,use 151 Raleigh Tavern Lane only the tab key Facility Street Address to move your cursor-do not North Andover 01845 use the return City Zip key. Mailing address of owner, if different: 151 Raleigh Tavern Lane Street Address/PO Box: North Andover MA 01845 City State Zip (978 682 4271 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 X508)—880-0223 ext. Telephone Number David Koshiol 2976 Certified Operator Name Certification Number C. Facility/System Information MCF215 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer's Name&ID Model Name&Number 09/21/1998 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 02/26/2004 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No Color: Clear Odor: None Effluent Description DEPMicroFASTnew.doc•3/11/04 Page 1 of 2 I Massachusetts Department of Environmental Protection II Bureau of Resource Protection - Title 5 Ll DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 2723 E. Sampling Information Samples Taken:_ Influent X Effluent Parameters sampled: X pH X BOD X TSS_TN X Other(list below) Phosphorus, Other 2 Other 3 Other 1 Description of any maintenance performed since previous inspection & during this inspection: Cleaned Filter,,,Splash Recycle Notes and Comments: Alarm inside - not accessible. Cover 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. David Koshiol 02/26/2004 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 31"of each year for the within 30 days of inspection 301h 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•3/11/04 Page 2 of 2 QMINCORPORATED 8450 Cole Parkway II Shawnee, KS 66227 II Phone 913-422-0707 m Fax: 912-422-0808 2723 e-mail: onsite(Wbiomicrobics.com II www.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Paul Antinori Street Mail Address: Mail Address 44 Commercial Street 151 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation .1 Date of last pump out MicroFAST.5 MCF215 09/21/1998 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating (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 I i Comments: Alarm inside-not accessible. Cover not to grade. TECHNICIAN SERVICE DATE David Koshiol 02/26/2004 I �as,C' ���ea�r�zerzt cfe��,ce6% �iz� 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 RE:DEPAR :ANDOVER Fax: (508) 880-7232 August 30, 2004 SE TOWN OFHEALTT North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report(as required) for services performed on 08/26/2004 at the property of Paul Antinori located at 151 Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. Sincerely, I Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Paul Antinori Massachusetts DEP Massachusetts Department of Environmental Protection L\1�� I'ureau of Resource Protection -Title 5 DEP Approved Inspection and -0&M Formfor Title 5 I/A Treatment and Disposal. Systems -- 2723 A. Installation Important: Paul Antinori When filling out Owner forms on the computer,use 151 Raleigh Tavern Lane only the tab key Facility Street Address to move your North Andover cursor-do not 01845 use the return Cit' Zip key. Mailing address of owner, if different: VQ 151 Raleigh Tavern Lane Street Address/PO Box, North Andover MA 01845 City State Zip (978 682 4271 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 MCF215 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer's Name&ID Model Name&Number 09/21/1998 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 08/26/2004 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No Color: N/A Odor: None Effluent Description DEPMicroFASTnew.doc-8/30/04 Page 1 of 2 LlMassachusetts Department of Environmental Protection Yureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 2723 E. Sampling Information Samples Taken:_Influent _Effluent Parameters sampled:_pH_BOD_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, i Notes and Comments: 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 i p n accordance with 257 CMR 2.00. Michael Dillen 08/26/2004 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 31 rt of each year for the within 30 days of inspection 301h 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 D EP Micro FASTnew.doc-8/30/04 Page 2 of 2 i 1 INCORPORATED 8450 Cole Parkway m Shawnee, KS 66227 m Phone 913-422-0707 m Fax: 912-422-0808 2723 e-mail: onsitel�biomicrobics.com mwww.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Paul Antinori Street Mail Address: Mail Address 44 Commercial Street 151 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail 'INSTALLATION INFORMATION ._,. Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 MCF215 09/21/1998 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 N/A Temperature Odor None Comments: TECHNICIAN SERVICE DATE Michael Dillen 08/26/2004 Y Qd'l CG P�` 11T1W&'ZP/7fiVPi�, �/ZG 44 Commercial Street Raynham, MA � 02767 i Tel: (508) 880-0233 Fax: (508) 880-7232 May 19, 2004 a North Andover Board of Health _ TOl�!'sV OF NORTH ANEW°!9�$ 27 Charles Street POARD OF HEALTH North Andover, MA 01845 Attention: Health Agent { Y 2. 6 20 a Reference: Single Home FAST® Treatment System - Serial Number: MCF215 Attached please find the Field Inspection& Service Report(as required)for services performed on 0_5/11/2004 at the property of Paul Antinori located at 151 Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department i Enclosures Copy to: Paul Antinori Massachusetts DEP ApLlMassachusetts Department of Environmental Protection Bureau of Resource Protection itle 5 a fs x�- ..4 4` a ;+,:�� ? -_.! proved Inspectionandt0&M Forrrmfor'Titlf�x * Treatment ;jar ' d Disposal ?SVstems - 2723 A. Installation Important: Paul Antinori When filling out forms on the Owner computer,use 151 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: 151 Raleigh Tavern Lane Street Address/PO Box. North Andover MA 01845 City State Zip (978 682 4271 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 I C. Facility/System Information MCF215 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer's Name&ID Model Name&Number 09/21/1998 Installation Date Start of Operation Approval Type:_General _Provisional _Piloting X Remedial Seasonal Residence—used less than 6 mo./year:_Yes X No i D. Operating Information 05/11/2004 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No Color: N/A Odor: None Effluent Description DEPMicroFASTnew.doc•5/19/04 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection Title 5 }DER Approved Inspection and O&M form=for Titles VA ' f� °h � , Treatment and Disposal Systems s _ . 2723 E. Sampling Information Samples Taken:_Influent _Effluent Parameters sampled:_pH_BOD_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: Control panel in basement-not accessible 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 05/11/2004 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 301h 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•5/19/04 Page 2 of 2 w , Q NC0RPDRATED 8450 Cole Parkway Shawnee, KS 66227 Phone 913-422-0707 m Fax: 912-422-0808 2723 e-mail: onsitea-biomicrobics.com m www.biomicrobics.com m 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FASTO System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc. Owner Name Paul Antinori Street Mail Address: Mail Address 44 Commercial Street 151 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION. Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 MCF21509/21/1998 EQUIPMENT YES NO MAINTENANCE"PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating 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 N/A Temperature Odor None Comments: Control panel in basement-not accessible. TECHNICIAN SERVICE DATE Michael Dillen 05/11/2004 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 September 3 2003 "" ` p -; SEP North Andover Board of Health 27 Charles Street - - �'"`� North Andover, MA 01845 "" Attention: Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection & Service Report(as required) for services performed on 08/25/2003 at the property of Paul Antinori located at 151 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: Paul Antinori Massachusetts DEP { A COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292.5500 DEP Approved Inspection and O&NI Form for Title 5 VA Treatment and Disposal Systems Installation Authorized Service Provider Installation Address: O&M Firm: 151 Raleigh Tavern Lane: j North AndoverB,4 A � J&V.5;XP, ,9n,W i Owner Name: Mail Address: Paul Antinori 44 CommereW Street,Fiaynham,MA 02767 Mail Address: 151 Raleigh Tavern Lane Tel:(508)880.0233 Fax:(508)880-72M North Andover,MA 01845 Telephone No. Telephone No.: 9786824271 Certified Operator Name: DEP No.: Mfr.No . Cert.No.: _ MCF215 Model No.: Installation Date: rn(C ro FRS r start of Operation: f 9/21/98 1 Approval Type: (Circle) Seasonal dente-used less than 6 moJyear: (Circle) General Provisional Piloting Remedial Yes No Operating Information j Previous Inspection Date: Inspectio Date: Sludge Depth:(to be checked yearly) Pumping Recommended(Circle) i "b Yes No Effluent Description: Attach copy of certified lab results. Check all that are required Samples:Influent Effluent Parameters: pH BOD TSS TN Other Other Other Description of Overall System Condition: Description of any Maintenance Performed since Previous Inspection and During this Inspection: Notes and Comments: - I certify: I have inspected the sewage treatment and disposal system at the address above, have completed this report and the attached manu7einspection. is operation and ainte nce checklist, and the information reported is true, accurate, and complete as of the time of t I am a sac sets certified operator in accordance with 257 CMR 2.00. �'�y��3 Op r ignature Date Syste ner must submit Remedial Use-by January ;1"of Department of Environmental this report, manufacturer's each year for the previous calendar Protection O&,NI checklist, and any yew o_ Attn: Title 5 Program required sampling results Piloting Ai Provisional Use - within One Winter Street 6'" 30 days of inspection date Floor to the local Board of Health Boston, NIA 02108 and DEP as follows for General Use-by September 30'h of each inspection performed: each year for the previous 1 2- months 511.'01 � f Q 1 MOR NCPORATED 8450 Cole Parkway . Shawnee, KS 66227.Phone 913-422-0707. Fax: 912-422-0808 e-mail: onsitetMbiomicrobics.com ■www.biomicrobics.com . 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 4�ast�u�at� �is�crtireeaG�Iu�ice�, STir�, Owner Name Paul Antinori Mail Address 151 Raleigh Tavern Lane 44 commercialsweet.kse nham IWA 02767 " North Andover, MA 01845 T� (tee)880-QM 'Fax lsoel 880-72M city State Zi 9786824271 508-880-7232 - Phone Fax e-mail Phone Fax e-mail Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating if resent Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment units) Unusual Odor Pumpout Required: Primary SettlingZone Aerobic Treatment Zone ML EFFLUENT Mn RESULT Estimated Daily Flow 4 Bedrooms H Standard Units 6-9 S.U. Color Clear Temperature Odor Slightly musty odor not tic) /TECHNICLAN SIGN ERVICE DATE 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 November 24, 2003 . North Andover Board of Health _. 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report (as required) for services performed on 11/11/2003 at the property of Paul Antinori located at 151 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: Paul Antinori Massachusetts DEP i 7 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 2723 A. Installation Important: Paul Antinori When filling out Owner forms on the computer,use 151 Raleigh Tavern Lane only the tab key Facility Street Address to move your North Andover 01845 cursor-do not City Zi use the return p key. Mailing address of owner, if different: r� 151 Raleigh Tavern Lane Street Address/PO Box: North Andover MA 01845 City State Zip (978 682 4271 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 Certified Operator Name Certification Number C. Facility/System Information MCF215 Bio-Microbics, Inc. MicroFAST .5 DEP ID Manufacturer's Name&ID Model Name&Number 09/21/1998 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 11/11/2003 Inspection Date Previous Inspection Date Sludge Depth (to be checked yearly) --- Pumping Recommended _ Yes X No Color: Clear Odor: None---- Effluent Description DEPMicroFASTnew.doc• 11/24/03 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 �\ DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 2723 E. Sampling Information Samples Taken: _ Influent _ Effluent Parameters sampled: _pH_BOD_TSS_TN_Other (list below) Other 1 Other 2 Other 3 Description of any maintenance performed since previous inspection & during this inspection: Cleaned Filter,,,, Notes and Comments: Covers 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. Operator Signature 11/11/2003 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 31"of each year for the within 30 days of inspection 30`h of each year for the previous calendar year date previous 12 months Department of Environmental Protection Attention: Title 5 Program One Winter Street, 61 Floor Boston. MA 02108 DEPMicroFASTnew.doc• 11/24/03 Page 2 of 2 ty. f it IG I N C 0 R P 0 R A T E 0 8450 Cole Parkway Shawnee, KS 66227 n Phone 913-422-0707 w Fax: 912-422-0808 2723 e-mail: onsite(d�biomicrobics.com u3 www.biomicrobics.com u3 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North AndoverMA 01845 Name Wastewater Treatment Services,Inc. Owner Name Paul Antinori Street Mail Address: Mail Address 44 Commercial Street 151 Raleigh Tavern Lane Raynham, MA 02767 North Andover,MA 01845 City State Zip 508-880-0233 508-880-7232 Phone 978 682 4271 Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MicroFAST.5 MCF215 09/21/1998 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: Covers not to grade. TECHNICIAN SERVICE DATE 11/11/2003 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 May 13, 2003 W R%' t MAY 16 M f North Andover Board of Health 27 Charles Street " North Andover, MA 01845 Attention: wHealth Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report (as required) for services performed on 05/06/2003 at the property of Paul Antinori located at 151 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 I Copy to: Paul Antinori Massachusetts DEP all COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �r. DEPARTMENT OF ENVIRONMENTAL PROTECTION �.-;ice+• r.i,:. ONE WINTER STREET, BOSTON. MA 02108 617.292.5500 DEP Approved Inspection and O&M Form for Title 5 UA Treatment and Disposal Systems Installation Authorized Service Provider j Installation Address: U&lel Firm: 151 Raleigh Tavern Lane: i North Andover MA �a6G�ualer�5rieatine�eG cru uice6 9n�. Owner Name: Mail Address: I'—'----I Paul Aritinori 44 Commercial Street,Raynham,MA 02787 I Mail Address: Tel:(508)880.0233 Fax:(508)880-7232 151 Raleigh Tavern Lane North Andover,MA 01845 Telephone No. I j 9786824271 Certified Operator Name: Telephone No.: DEP No.: Mfr.No.: Cert.No.: MCF215 I Model No.: Installation Date: Start of Operation: rYl i cro F145 r I 9/21/98 Approval Type: (Circle) SeT--asonal dente—used less than 6 mo./year: (Circle) General Provisional Piloting Remedial Yes No Operating Information j Previous Inspection Date: Inspectio ate: Sludge Depth:(to be checked yearly) Pumping Recommended(Circle) © Yes No Effluent Description: . Attach copy of certified lab results. Check all that are required Y Samples:Influent Effluent Parameters: pH BOD TSS TN Other Other Other Description of Overall System Condition: Description of any Maintenance Performed since Previous Inspection and During this Inspection: Notes and Com.-nents: [ rectify: I have inspected the sewage treatment and disposal system at the address above, have completed this report and the attached manufacturer' aeration and mainte ante klist, and the information reported is true, accurate,and complete as of the time of the insp ction. I a Massa sett ifred operator in accordance with 257 CMR 2.00. Operator Si afore Date System owner m 't submit Remedial Use–by January 31"of Department of Environmental this report, manufacturer's each year for the previous calendar protection O&NI checklist,and any year Attn: Title 5 Program required sampling results Piloting& Provisional Use - within One Winter Street, 6'h Floor to the local Board of Health 34 days of inspection date Boston, NIA 02108 and DEP as follows for General Use–by September 30 of each inspection performed: each year for the previous 12 months 5/1/01 I , aim= INCORPORATED " 8450 Cole Parkway■ Shawnee, KS 66227■Phone 913-422-0707. Fax: 912-422-0808 e-mail: onsite@biomicrobics.com a www.biomicrobics.com■ 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System - � ..rr���'arti'�F�'"✓''�x'w 'T''� ��.3 c?�is�> ".+�u''�.L`5�,'kt..'� �'a`,�.�"x#�s��'''§k �' �:,. `°' r 0­­ T'CE pR0 + t - s 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Wa9ezzc�� ff�1-e&' YW Owner Name Paul Antinori Mail Address 151 Raleigh Tavern Lane 44 Commercial sweet,Fiaynham,iNA 627'6"7"" - North Andover, MA 01845 Tei:15081,880-0233.. .Fax 15681 e8oa232 City State Zi 9786824271 —.__ 508-880-7232 _ Phone Fax e-mail Phone Fax e-mail .W Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 Qhx. Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating n if resent f Blower(s) Air Inlet Filter Clean , Blower Hood Vents Clear Excessive Noise 7'4 Excessive Vibration Treatment unit(s) Unusual Odor Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LEVIIT RESULT Estimated Daily Flow 4 Bedrooms H Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor not se tic) `TECHNICIAN SIGN SERVICE DATE 4 l+ r ry _ 44 Commercial Street Raynham, MA 02767 FEB 2 8 2003 1 Tel: (508) 880-0233 1 E Fax: (508) 880-72321' February 25,2003 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST° Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report and test results(as required) for services performed on 02/11/2003 at the property of Paul Antinori located at 151 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: Paul Antinori i COMMONWEALTH OF MASSACHUSETTS lop EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 DEP Approved Inspection and O&NI Form for Title 5 UA Treatment and Disposal Systems Installation Authorized Service Provider Installation Address: O&M Firm: 151 Raleigh Tavern Lane: North Andover � � � �Jt ve;xv, 96 MA Owner Name: Mail Address: Paul Antinori 44 commercial Street,Raynham,MA 02767 Mail Address: Tel:(508)880-0233 Fax:(508)880-7232 151 Raleigh Tavern Lane North Andover,MA 01845 Tele hone No. Telephone No.: 9786824271 Certified Operator Name: DEP No.: Mfr.No.: MCF215 Cert.No.: l� 6 Model No.: Installation Date: M i Cro FOS T start of Operation: 9/21/'98 Approval Type: (Circle) Seasonal dence-used less than 6 mo./year:(Circle) General Provisional Piloting Remedial Yes No Operating Information Previous Inspection Date: Inspection Date Sludge Depth:(to be checked yearly) Pumping Recommended(Circle) ' vl d Yes No Effluent Description: Attach copy of certified lab results. Check all that are required Samples:InflurAm Effluent t` Parametersp OD SS TN Other r Other Description of Overall System Condition: Description of any Maintenance Performed since Previous Inspection and During this Inspection: r� s Notes and Comments: / I certify: I have inspected the sewage treatment and disposal system at the address above, have completed this report and the attached manufactur s operation and ma tenance checklist, and the information reported is true, accurate, and complete as of the time of the in ectiod. I am a Ma achuse certified operator in accordance with 257 CMR 2.00. / 3 Op or Itgnature - Date System owner Must submit Remedial Use—by January 3 l"ofDepartment of Environmental this report, manufacturer's each year for the previous calendar Protection O&NI checklist, and an year ar Attn; Title 5 Program required sampling results 3Provisional sionI Use - within thin One Winter Street, 6�n Floor to the local Board of Health 30 days of inspection date Boston, NIA 02108 and DEP as follows for General Use—by September 30 of each year for the previous (_ months each inspection performed: 511101 .�.•nl�y J'ys} INCORPORATED 8450 Cole Parkway■ Shawnee, KS 66227■Phone 913-422-0707■ Fax: 912-422-0808 e-mail: onsitelaD_biomicrobics.com.www.biomicrobics.com■800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INS Y kk. d Z ?l'� yw� s' A TAL O N�x rr + ° T f AUTHORIZED SERVICEPRQ 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 4�ast�:conte� ,�� lasvice�, STicr. - i Owner Name Paul Antinori Mail Address 151 Raleigh Tavern Lane 44 Commercial street,Raynham,tits 02767 North Andover, MA 01845 Tei.IsOsl 88D-0M Fax(5e)WO-7232 city State Zi 9786824271 -_ --- 508-880-7232 Phone Fax e-mail Phone Fax e-mail ..: INSTLI.ATON IIJFC?RMTIQNU>l :, Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 -E IJIPMI a5o ?►>rrlArExFOR1D Arm co Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating if resent Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit(s) Unusual Odor Pum out Re aired: L✓ G Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LIMIT RESULT Estimated Daily Flow 4 Bedrooms H Standard Units 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septi TECHNICJAN VGNA12RESERVICE DATE Environmental Chemistry Environmental Services Site Assessment An l 1cal Balance Site Sampling Quality Assurance Services a, Data Auditing G Q R P O R — A '1' I n N' CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. 44 Commercial Street REPORTED: 02/21/2003 Raynham, MA 02767 ORDER#: G0344299 COLLECTED BY: D. Koshiol SAMPLE DATE: 2/11/2003 TIME: 12:15 DATE RECEIVED: 2/12/2003 LOCATION: MCF 215 N. Andover SAMPLE ID: Antinori Grab DESCRIPTION: WATER RESULTS OF ANALYSIS .. N 00). Test Parameters LAB-IDN: 0344299-01 BOD SM 5210B 02/12/2003 mg/L 4 <4.0 pH SM 4500 H+B 02/12/2003 S.U. 0-14 6.8 Phosphorus,Total SM 4500-P B/E 02/20/2003 mg/L 0.01 5.76 Solids,Suspended SM 2540 D 02/18/2003 mg/L 4 4.0 NA=Not Applicable ND=Not Detected Approved By: = Less Than *' = Detection Limit ` Lid Manager / Date Page l of I Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 February 25, 2002ION ®�� ��� North Andover Board of Health ` 27 Charles Street 'J North Andover, MA 01845 Attention: Health Agent ' Reference: Single Home FAST° Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report and test results (as required) for services performed on 2/8/2002 at the home of Paul Antinori located at 151 Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. Si rely, I ` anet M. Whitman Enclosures "''-C,opy to: Paul Antinori vi ` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 0'3108 617.292.5500 DEP Approved Inspection and O&NI Form for Title 5 UA Treatment and Disposal Systems Installation Authorized Service Provider Installation Address: U&NI Firm: 151 Raleigh Tavern Lane: North AndoverMA Was&ecoatrl- �i eabitr�0 J cea, Jrit� Owner Name: Mail Address: Paul Antinori 44 Commercial Street,Raynham,MA 02767 Mail Address: 151 Rrel:(508)680-0233 Fax:(508)880-7232 Raleigh Tavern Lane North Andover,MA 01845 Telephone No. Telephone No.: 9786824271 Certified Operator dame: DEP No.: Y.No.: MCF215 Cert.No.: Model No.: Installation Date: Start of Operation: M t c r0 FOS r 19/21/98 Approval Type: (Circle) Seasonal dence—used less than 6 mo./year: (Circle) General Provisional Piloting Remedial Yes No Operating Information Previous Inspection Date: Inspection Date- Sludge Depth:(to be checkedPumping Recommended(Circle) yearly) Yes No I Effluent Description: ^�� Attach copy of certified lab results. Check all that are required / Samples:Influent Effluent V t SS Parameters: pH 0O SS TN Other Other Other Description of Overall System Condition: Description of any Maintenance Performed since Previous Inspection and During this Inspection: G I� �� AJT� Notes and Comments: I certify: I have inspected the sewage treatment and disposal system at the address above, have completed this report and the artacoed manufacturer's ope tion d maintenance checklist, and the information reported is true, accurate, and complete as oft time of the ' s ectio ./I Massachusetts certified operator in accordance with 257 CMR 2.00. �� ;2 6.2- Operator Signature Date System owner must submit Remedial Use-by January 3 I"of Department of Environmental this report, manufacturer's each year for the previous calendar Protection O&NI checklist, and any year Attn: Title 5 Program required sampling results Piloting& Provisional Use - within One Winter Street, 6`' Floor to the local Board of Health -days of inspection date s Boston, NIA 02108 and DEP as follows for General Use—by September 30 of each inspection performed: each year for the previous 12 months 511101 Environmental Chemistry Environmental Services Site Assessment D gTM ly Site Sampling Quality Assurance Services Analvfica Balance Data Auditing C O POR _. A T I O N FEB 2 U 2002 CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. --------------------------- 44 Commercial Street REPORTED: 2/15/2002 Raynham, MA 02767 ORDER#: G0232627 COLLECTED BY: D. Koshiol SAMPLE DATE: 2/8/2002 TIME: 12:40 DATE RECEIVED: 2/8/2002 LOCATION: Andover, MA (MCF 215) SAMPLE ID: Antinori Grab DESCRIPTION: WATER RESULTS OF ANALYSIS ate ��,. ,.�,,h " ,y! ;i '",z,''.y. y .:'� � •'. GyGy���,�, x� ��4 Rs�¢ca's -e... .� �� k 1�. �� E��,:� aT rn�j�?���,.q�, 3.p a Test Parameters LAB-ID#: 0232627-01 BOD SM 5210B 2/8/2002 mg/L 4 7.4 pH SM 4500 H+B 2/8/2002 S.U. 0-14 6.6 Solids, Suspended SM 2540 D 2/14/2002 mg/L I 2 <2.0 NA=Not Applicable ND=Not Detected Approved By: * = Less Than Lab ager ate = Detection Limit Page i or i Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 4 Q RU:IX 'CORPORATED 8450 Cole Parkway a Shawnee, KS 66227 a Phone 913-422-0707 a Fax: 912-422-0808 e-mail: onsit -biomicrobics.com ■www.biomicrobics.com a 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System i INSTALLATION AUTHORIZED SERVICE PROVIDEIi �'. ..�, J r, �. ; i.S, "� T,rT i yffii..,a i d e& !•., 2pt 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 `mask coater�ir�urtinenG�llUuice�, yrrc Owner Name Paul Antinori Mail Address 151 Raleigh Tavern Lane 44 commercial Street,Raynham,MA 02767 North Andover, MA 01845 rel:lsoel 880-0233 Fax:Isoel 880-7232 i city State Zi 9786824271 _ _ 508-880-7232 - Phone Fax e-mail Phone Fax e-mail Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 E UIPM1rNT r .;, � `YES0 t CEEItFQR14iED,AND tv Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating if resent) Afk Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit's' Unusual Odor Pum out Required: 1 Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LINM RESULT Estimated Dailv Flow 4 Bedrooms H Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) j TECHNICIAN SIGNATURE SERVICE,DATE a- IS s i j 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 November 22, 2002 NOV 2 7 2002 Jj � North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attentions Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report (as required) for services performed on 1 l/13/2002 at the property of Paul Antinori located at 151 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: Paul Antinori Q COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 DEP Approved Inspection and O&NI Form for Title 5 UA Treatment and Disposal Systems Installation Authorized Service Provider Installation Address: O&NI Firm: 151 Raleigh Tavern Lane: � North Andover MA 4�asG�euate�STreatnrieo Ju�vic��, ,�itG Owner Name: Mail Address: 44 Commercial Street,Raynham,MA 02767 Paul Antinori Tec(508)880-0233 Fax:(sob)WO-7232Mail Address: 151 Raleigh Tavern Lane North Andover,MA 01845 Telephone No. Telephone No.: 9786824271 Certified Operator Name: DEP No.: Mfr.No. Cert.an.No.. 2 9 G Model No.: Installation Date: of Operation: I ►11 CXO FRS Start I 1 1 9/21/98 Approval Type. (Circle) Seasonal 'dence-used less than 6 mo./year:(Circle) General Provisional Piloting Remedial Yes No Operating Information Previous Inspection Date: Inspection Date: Sludge De :(to be chocked arty) ing Recommended(Circle) L (S G V S /L/- �G Yes No Effluent Description: Attach copy of certified lab results. Check all that are required C� Samples:Influent Effluent Parameters: pH BOD TSS TN Other Other Other Description of Overall System Condition: Description of any Maintenance Performed since Previous Inspection and During this Inspection: C' � 2 Notes and Comments: I certify: I haye.inspected the sewage treatment and disposal system at the address above, have completed this report and the attached Z:0 er's eratio rand ma(ntenance checklist, and the information reported is true, accurate, and complete as of the tim pe to I a M s chusetts certified operator in accordance with 357 C�N[R 2.00. erator Signature Date System o ner must submit Remedial Use-by Ianuary 31"of Department of Environmental this report, manufacturer's each year for the previous calendar Protection O&M checklist, and any year Attn: Title 5 Program required sampling results Piloting & Provisional Use - within One Winter Street, 6'" Floor to the local Board of Health 's days of inspection date General Use -by September 30`h of Boston, NIA 0..108 and DEP as follows for each inspection performed: each year For the previous 13 months 511/01 INCORPORATED 8450 Cole Parkway a Shawnee, KS 66227 m Phone 913-422-0707 a Fax: 912-422-0808 e-mail: onsiteO-biomicrobics.com n www.biomicrobics.com a 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FASTS System "M U-M �L' a IS I Raleigh Tavern Lane Installation Address North Andover,MA 01845 Owner Name Paul Antinori Mail Address 151 Raleigh Tavern Lane 44 Commercial Street,Raynham,MA 02767 North Andover, MA 01845 Tel:(SM)880-= ,Fax:(508)880-7232 City State Zip 9786824271 508-880-7232 Phone Fax e-mail Phone Fax e-mail Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 W -iV 0-09-1 Electrical Panel(s) Visual Alarm Operating Pkl/ Audio Alarm Operating (if present) Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit(s) Unusual Odor Pum out Required: Primary Settling Zone Aerobic Treatment Zone A/ 7- EFFLUENT(optional) LEWr RESLfLT Estimated Daily Flow 4 Bedrooms pH(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) TECHNICIAN SIGNATURE SERVICE DATE Z2 r E. 44 Commercial Street rj5.� to Raynham, MA _ '..•; 02767 /` `��� 6 Tel: (508) 880-0233 ?�D2 Fax: (508) 880-7232 August 28, 2002 North Andover Board of Health 27 Charles Street North Andover, MA 01845 .Attention: Health Agent Reference: Single Home FAST® Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report (as required) for services performed on 8/8/2002 at the property of Paul Antinori located at 151 Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. 7S' rely, net M. Whitman Enclosures Copy to: Paul Antinori COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 DEP Approved Inspection and O&NI Form for Title 5 I/A Treatment and Disposal Systems Installation Authorized Service Provider Installation Address: r?Kvlail 151 Raleigh Tavern Lane: ; North Andover i 4�a�Gecuate�9.reatin e��rr�icea, ,1rizG j Owner Name: Paul Antinori 44 Commercial Street,Haynham,MA 02767 Mail Address: 151 Raleigh Tavern LaneTel:(sob)880-0233 Fax:(508)680.7232 North Andover,MA 01845[��EP ehone No.: 9786824271 tor Name: - No.: Mfr.No.• Cert.No.: J l _]3 MCF215 Model No:: Installation Date: Start of Operation: rYl i cro FAS r Approval Type: (Circle) 9/21/98 I General Provisional Piloting Remedial Seasonal No 'dence-used less than 6 mo./year: (Circle) Operating Information -' Previous Inspection Date: Ins ection Date: P � / � LDescrniption epth:(to be checked yearly) Pumping Recommended(Circle) E Yes No Effluent Descnphon: opy of certified lab results. hat are required { ^/A :influent Effluent rs: pH BOD TSS TN Other Other Description of Overall System Condition: on of any Maintenance Performed since Previous Inspection g this Inspection: Notes and Comments: I certify: I have inspected the sewage treatment and disposal system at the address above, have completed this report and the attached manufacturer's operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the ins ction. I am a Massachusetts certified operator in accordance with 257 CiVlR 2.00. � a---, Operator Signature Date System owner must submit Remedial Use-by January 31"of Department of Environmental this report, manufacturer's each year for the previous calendar Protection O&M checklist, and any year Attn: Title 5 Program required sampling results Piloting& Provisional Use • within 30 days Mate One Winter Street, 6`" Floor ays of i to the local Board of Health Boston, NIA 02108 and DEP as follows for General Use-by September 30",of each inspection performed: each year for the previous 12 months 51 l '01 1 ' Q 1 I 1 INCORPORATED 8450 Cole Parkway■ Shawnee, KS 66227■Phone 913-422-0707■ Fax: 912-422-0808 12-422 0808 e-mail: opsit biomicrobics m ■www.biomicrobics.com■800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System A"'2 INST 151 RaleighXaveffane Installation Address North Andover,MA 01845 Owner Name Paul Antinori Mail Address 151 Raleigh Tavern Lane 44 c66mai6W sweet,Raynham,MA 02767 North Andover, MA 01845 Tel:(5M)ee0-OM Fax(50e)880-7232 Ci 271 State Zi 9786824 508-880-7232 880 7232 Phone Fax e-mail Phone Fax e-mail - '��� .:::..,..t4 .� .,..:~x Sw'�:4<3}'��,,,,�, e : � �N} � �t"„+��w'tr- J•'�,Rf" �;, Model No. Sepal No. Date of Installation Date of last pumpout MCF215 E I JIPMLNT ¢ - 9 1/98 Electrical Panels Visual Alarm Operatin Audio Alarm Operating (if resent) Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit s Unusual Odor Pum out Re-. .--) e aired: Prima Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LEWr RESULT Estimated Daily Flow 4 Bedrooms H Standard Units 6-9 S.U. Color Clear Temperature Odor Slightly musty odor not cent G� A.o T TECHNICIAN SIGNATUtESERVICE DATE J 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 December 17, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST° Treatment System Serial Number: MCF215 Attached please fmd the Field Inspection& Service Report (as required) for services performed on 11/29/01 at the home of Paul Antinori located at 151.Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. cerely, anet M. Whitman BOq tU®R7...-I. Enclosures RD OFH� V O Copy to: Paul Antinori Jp arn k � COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 0':108 617.2925500 DEP Approved Inspection and O&M Form for Title 5 UA Treatment and Disposal Systems Installation Authorized Service Provider Installation Address: O&M Firm: 151 Raleigh Tavern Lane: North Andover MA `�aste�uatr��ieatment cfuucces. ✓�iu. Owner Name: Mail Address: 44 commercial Street,Ra nham,MA 02767 Paul Antinori . Tel:(508)880-0233 Fax:(508)880.7232 j Nail Address: 151 Raleigh Tavern Lane North Andover,MA 01845 Telephone No. Telephone No.: 9786824271 Certified Operator Name: DEP No.: Mfn No.: MCF215 Cert.No.: Model No.: Installation Dace: M(Cr0 FRS T Start of Operation: 9/21/98 Approval Type: (Circle) Seasonal Bence-used less than 6 mo./year: (Circle) j General Provisional Piloting Remedial Yes No Operating Information Previous Inspection Date: Inspection Dat : Sludge Depth:(to�checked yearly) Pumping Recommended(Circle) 1 02`Z � / Yes No Effluent Description: Attach copy of certified lab results. Check all that are required { Samples:Influent Effluent VA / Parameters: pH BOD TSS TN I Other Other Other Description of Overall System Condition: Description of any Maintenance Performed since Previous Inspection and During this Inspection: Notes and Comments: I certify: I have inspected the sewage treatment and disposal system at the address above, have completed this report and the attached manufacturer's 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 CNIR 2.00. Operator Signature Date System owner must submit Remedial Use-by January;I"of Department of Eavironmental this report, manufacturer's each year for the previous calendar Protection O&VI checklist.and any year Attn: Title 5 Program required sampling results Piloting& Provisional Use- within One Winter Street, 6''' Floor to the local Board of Health 3O days of inspection date Boston, NIA 02108 and DEP as follows for General Use-by September 30 of each inspection performed: each year for the previous 12 months 5/1/01 OtMINCORPORATE0 8450 Cole Parkway■ Shawnee, KS 66227■Phone 913-422-0707 a Fax: 912-422-0808 e-mail: onsiteAftiomicrobics.com a www.biomicrobics.com. 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane -- __.-...._._.. Installation Address North Andover,MA 01845 Owner Name Paul Antinori Mail Address 151 Raleigh Tavern Lane 44 Commercial street,Raynham,MA 02767 North Andover, MA 01845 rel:(506)660-0233 Fax (5W)NO-7232 city State Zi 9786824271 508-880-7232 Phone Fax e-mail Phone Fax e-mail INSTAtIEtiTION.IIVFORMk1TION.. Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 EQUIPMENT ]ti0 .r kms, GE PERFQRiVIED AND GO Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating if resent Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit s` Unusual Odor Pum out Required: Primary.Settling Zone Aerobic Treatment Zone EFFLUENT(options]) LEWIT RESULT Estimated Daily Flow 4 Bedrooms H Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) TECHNI SIGNATURE SERVICE DATE r tir A' V J&R SALES & SERVICE, INC. May 15, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 I , Attention: Health Agent Reference: Single Home FAST° Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report (as required) for services performed on 5/10/01 at the home of Paul Antinori located at 151=Raleigh Tavern-L-ae- North Andover, MA. Please call if you have any questions or require additional information. rely, ._ 1 2001 anet M. Whitman Enclosures Copy to: Paul Antinori 44 Commercial Si: Aaynham,MA 02767 Tele.508.823.9566 Fax 508.8607232 i � -,1ju 11 Q= t I NCO R P OR AT EO 8450 Cole Parkway a Shawnee, KS 66227 a Phone 913-422-0707. Fax: 912422-0808 e-mail: onsit biomicrobics.com ■www.biomicrobics.com ■ 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover,MA 01845 Name J&R Sales&Service, Inc. Owner Name Paul Antinori Street Mail Address 151 Raleigh Tavern Lane Mail Address 44 Commercial Street North Andover, MA 01845 Raynham, MA 02767 City State Zip City State Zi 9786824271 508-823-9655 508-880-7232 Phone Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating r if resent) N Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise F,xcessive Vibration i L Treatment units Unusual Odor Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LEVIIT RESULT Estimated Daily Flow 4 Bedrooms H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) /fECNNICIAN SIGNATU RE SERVICE DATE � D i March 26; 2001 J&R SALES & SERVICE, INC. Division of Water Pollution Control Department of Environmental Protection One Winter Street— 6th Floor Boston, MA 02108 Attention: Ms. Natalie Brown Subject: Request for Testing Reduction FAST Treatment System Reference: Serial Number MCF215 1 f571W@—ggh Tavern Lan-North Andover, MA Dear Ms. Brown: Attached please find test results for two additional quarters of testing as requested per Mr. Langley's letter of denial dated September 21, 2001. The testing was-performed*-at the property of Paul Antinori, 151 Raleigh Tavern Lane,North Andover, MA. As the operator of this system we are requesting the testing requirements be reduced or eliminated for this unit. Please forward a copy of your decision to our office. Thank you. ;net ely, TO'kiM OF f, M. Whitman 1 APR 2 2001 Cc: North Andover Board of Health Homeowner Mailing Address: Paul Antinori 151 Raleigh Tavern Lane 44 Commercial St. North Andover, MA 8aynham,MA 02767 Tele.508 823-9566 Fax 508-880-7232 J&R SALES & SERVICE, INC. March 26, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST° Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report and test results (as required) for serviceserformed on 2/26/01 at the home of Paul Antinori located at 151 Raleigh P g Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. Sincerely, )Janet M. Whitman Enclosures Copy to: Paul Antinori OWN OF NORTfi Aid t,IF`i _BOARD OF HEALTH APR `200I 44 Commercial St. p' Raynham,MA 02767 A Tele.508-823-9566 fax 508880.7232 t I N C 0 R P 0 R A T E 0 8450.Cole Parkway . Shawnee, KS 66227 a Phone 913-422-0707 @ Fax: 912-422-0808 e-mail: onsite(a-biomicrobics.com ■www.biomicmbics.com . 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FASTO System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover, MA 01845 Name J&R Sales&Service, Inc. Owner Name Paul Antinori Street Mail Address 151 Raleigh Tavern Lane Mail Address 44 Commercial Street North Andover, MA 01845 Raynham, MA 02767 City State Zip City I State Zi 9786824271 508-823-9655 508-880-7232 Phone Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating if resent) 1J,4 I Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit(s) Unusual Odor Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LIMIT RESULT Estimated Daily Flow 4 Bedrooms H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) ,-TECHt4lClAN SrrjNATU& I SERVICE DATE \1al Chemistry Environmental Services t Site Sampling urance Services Analvtical Balance Data C O R P O R �,. Auditing A '1' I O 1\' CERTIFICATE OF ANALYSIS J&R Sales & Service REPORTED: 3/5/2001 44 Commercial Street Raynham, MA 02767 ORDER #: G0121727 COLLECTED BY: D. Koshiol SAMPLE DATE: 2/26/2001 TIME: 13:00 DATE RECEIVED: 2/26/2001 LOCATION: MCF 215 N. Andover SAMPLE ID: Grab Antinori DESCRIPTION: WATER RESULTS OF ANALYSIS Test Parameters LAB-ID#: 0121727-01\ BOD SM 5210B 2/28/2001 mg/L 4 16.7 PH SM 4500 H+B 12/27/2001 S.U. 0-14 1 7,0 Solids, Suspended SM 2540 D I 3/1/2001 1mg/L 2 10.6 NA=Not Applicable — ND=Not Detected <' = Less Than Approved By: �/ D.Yk' o *' = Detection Limit Lab ager I l 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Pine' � "'Environmental Chemistry Environmental Services Site Assessment ' Ba1mce Site Sampling Quality Assurance Services Analvfic Data Auditing C n R ' P O R A T I O CERTIFICATE OF ANALYSIS J&R Sales& Service REPORTED: 3/16/2001 44 Commercial Street Raynham, MA 02767 ORDER#: G012215 l COLLECTED BY: D. Koshiol SAMPLE DATE: 3/14/2001 TIME: 13:00 DATE RECEIVED: 3/14/2001 LOCATION: N. Andover, MA(MCF 215) SAMPLE ID: Antinori Grab DESCRIPTION: WATER RESULTS OF ANALYSIS VRIIP ' 3 '� .' - '.'. 5 u.�,r ,a iv..:, ... ..aR' ,,: t �. G'_ _.:F;,. � � ... .n:, .�4s._•� � r... f'sz jTest Parameters LAB-[D#: 0122151-01 LPhosphorus,Total SM 4500-P B/E 3/15/2001 mg/L 0.20 4.82 NA=Not Applicable / ND=Not Detected Approved By:—9c�� , <' = Less Than M Mana.-el U / Date *' = Detection Limit I Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page' 1 J&R SALES & SERVICE, INC. September 11, 2000 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST°Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report and test results(as required) for services performed on 8/29/00 at the home of Paul Antinori located at 151 Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. S' erely, et M. Whitman Enclosures ra t'r- y_ t 7'" 4 F Cc: Paul Antinori _ 44 Commercial St. Aaynham,MA 02767 Tele.508823.9566 Fax 508.6807232 C ' 191'N I I N 0 R ,P O R A T E O 8450 Cole Parkway ■ Shawnee KS 66227 ■Phone 913-422-0707 ■ Fax: 912-422-0808 e-mail: onsitenubiomicrobics.com ■www.biomicrobics.com a 800-753-FAST(3278) FIELD INSrECTION & SERVICE RETORT For Bio-Microbics Single Nome FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover, MA 01845 Name J&R Safes&Service, Inc. Owner Name Paul Antinori Street Mail Address 151 Raleigh Tavern Lane Mail Address 44 Commercial Street North Andover, MA 01845 Raynham, MA 02767 City State Zip Citv State Zi 9786824271 508-823-9655 508-880-7232 Phone Fax e-mail Phone Fax --e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating A-V11- Audio Alarm Operating �1 (if resent) Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment units Unusual Odor Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LLMT RESULT Estimated Dailv Flow ; 4 Bedrooms H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) �5CHNJQIAN GNAT SERVICE DATE i J&R SALES & SERVICE, INC. May 19, 2000 North Andover Board of Health 27 Charles Street North Andover, MA 01845 'Attention: Health Agent Reference: Single Home FAST°Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Reports and Testing Results(as required) for services performed on 5/3/002/14/00 at the home of Paul Antinori located at '151 Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. Sincerely, i Lillian Ferreira Enclosures cc: Paul Antinori 44 Commerc`1St 1,?,5 Aaynham,MA 02767 Tele.508-823:9566 Fax .508-8B0-7232�`*� r s 0=1 N C OR P 0 RATED 8450.Cole Parkway ■ Shawnee, KS 66227■Phone 913-422-0707 ■ Fax: 912-422-0808 e-mail: onsite0biornicrobics.com ■www.biomicmbics.com ■ 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover. MA 01845 Name AR Sales&Service, Inc. Owner Name Paul Antinori Street Mail Address 151 Raleigh Tavern Lane Mail Address 44 Commercial Street North Andover, MA 01845 Raynham, MA 02767 City State Zip City State Zi 9786824271 508-823-9655 508-880-7232 Phone Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating (if resent) Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit(s) Unusual Odor i Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LIMIT RESULT Estimated Dailv Flow 4 Bedrooms I H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) CHNICIAN SIGNATUR,5 SERVICE DATE I Environmental Chemistry Environmental Services rte, • Site Assessment Site Sampling Quality Assurance Services Analytical y Balance Data Auditing C O R P O R A T I n N' CERTIFICATE OF ANALYSIS J&R Sales& Service REPORTED: 5/11/00 44 Commercial Street Raynham, MA 02767 ORDER#: G0012040 COLLECTED BY: D. Koshiol SAMPLE DATE: 5/3/00 TIME: 11:45 DATE RECEIVED: 5/3/00 LOCATION: MCF 215 -North Andover,MA SAMPLE ID: Antinuri DESCRIPTION: WATER RESULTS OF ANALYSIS Test Parameters LAB-m#: 0012040-01 BOD SM 5210B 5/5/00 mg/L 4 23.2 pH SM 4500 H+B 5/3/00 S.U. 0-14 6.4 Phosphorus,Total SM 4500-P B/E 5/4/00 mg/L 0.20 5.48 Solids, Suspended SM 2540 D 1 5/10/00 mg/L 2 22.0 NA=Not Applicable ND=Not Detected <' = Less Than Approved By: A4Ltl '*' = Detection Limit Manager / Date MAY7 � � Page' Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 i J&R SALES & SERVICE, INC. May 22, 2000 Division of Water Pollution Control Department of Environmental Protection One Winter Street—6h Floor Boston, MA 02108 Attention: Mr. Steve Corr Subject: Request for Testing Reduction FAST Treatment System Reference: Serial Number: MCF215 151 Raleigh Tavern Lane -North Andover, MA Dear Mr.Corr: Attached please find the testing results for the first year of testing, four (4) samples, performed at.the.property of, Paul Antmori, 151 Raleigh Tavern Lane,North Andover, MA. As the operator of this system we are requesting the testing requirements be reduced or eliminated for this unit. Please forward a copy of your decision to our office. Thank you. Sinc rely, - Cil Lillian Ferreira MAY' cc: North Andover Board of Health , =Homeowner'Mailing Address:. Paul Antinori 151 Raleigh Tavern Lane Aa commel'aai S1. North Andover, MA Raynham,MA 02161 Tele.508 8239566 Fax 508 880 7232 ANALYTICAL BALANCE CORP. 422 WEST GROVE STREET Environmental Chemistry MIDDLEBORO, MA 02346 Environmental Services Site Assessment 50&946-2225 Site Sampling Quality Assurance Services Fax 508-946.3335 Data Auditing 5 January 1999 J&R Sales & Service 44 Commercial Street Raynham,MA 02767 COLLECTED BY: B. Everett SAMPLE DATE: 12/28/98 TIME: 1000 DATE RECEIVED: 12/28/98 LOCATION: Watson- MCF 215 SAMPLE ID: 98-12-11708 North Andover, MA RESULTS OF ANALYSIS Parameter Analytical Date: Units Det. : :: : .Result. Method. Anal.:zed Lunit. pH Std.Meth.,4500-H`B 12/29/98 SU N/A 7.8 Total Suspended Solids Std.Meth.,2540 D 1/04/98 mg/L 2.0 24.2 Biochemical Oxygen Demand Std. Meth., 5210B 12/30/98 m--/L 2.0 21.4 Standard Methods, 18'edition, 1992. 1 aboratory ager/'Date I �ironmental Chemistry Environmental Services mite Assessment Site Sampling Quality Assurance Services Balance Data Auditing C O R P O R A T I O N CERTIFICATE OF ANALYSIS Ja&R Sales&Service REPORTED: 2/22/2000 44 Commercial Street Raynham, MA 02767 ORDER 9: G0009733 � COLLECTED BY: D.Koshiol SAMPLE DATE: 2/I4/2000 TIME: 12:30 DATE RECEIVED: 2/15/2000 LOCATION: Andover, MA(MCF 215) SAMPLE ID: Antinori f DESCRIPTION: WATER RESULTS OF ANALYSIS Test Parameters LA&in#: 0003s-oi BOD SM 5210B 2/16/2000 mg/L, 4 5.4 pH SM 4500 H+B 2/16/2000 S.U. 0.1 6.4 Phosphorus,Total SM 4500-P B/E 2/16/2000 mg/L 0.20 4.9 Solids,Suspended SM 2540 D 2/17/2000 mg/L 5 6.0 NA=Not Applicable ND=Not Detected Approved By: Llia/dp '<' = Less Than Lab Mana r it Detection Limit Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page' � . .omental Chemistry Environmental Services i,%ssessment Site Sampling uslity Assurance Services f An"d BData Auditing . . G A R P O R A T I O N CERTIFICATE OF ANALYSIS J&R Sales&Service REPORTED: 5/11/00 44 Commercial Street Raynham, MA 02767 ORDER#: G0012040 COLLECTED BY: D.Koshiol SAMPLE DATE: 5/3/00 TIME: 11:45 DATE RECEIVED: 5/3/00 LOCATION: MCF 215 -North Andover,MA SAMPLE ID: Antinuri DESCRIPTION: WATER RESULTS OF ANALYSIS +Y r i CStI Test Parameters LAs-ma: 0012040-01 BOD SM 5210B 5/5/00 MgfL---F 4 23,2 pH SM 4500 H+B 5/3/00 S.U. 0-14 6.4 Phosphorus,Total SM 4500-P B/E 5/4/00 mg/L 0.20 5.48 Solids, Suspended SM 2540 D 5/10/00 mg/L 2 22.0 NA=Not Applicable ND=Not Detected Approved By:, -i_/ .r/� rxZ100 '--eLess Than d _ Manager 3Date Detection Limit MAY 17 n t1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page: 1 I 422 WEST GROVE STREET PrAssessment nmental Chemistry MIDDLEBORO, MA 02346 Environmental Services 50&946-2225y Assurance Services Fax 50&946.3335 Site Sampling Data Auditing 1 September 1999 J&R Sales & Service 44 Commercial Street Raynham, MA 02767 COLLECTED BY: D. Koshiol SAMPLE DATE: 08/11/99 TIME: 1100 DATE RECEIVED: 08/11/99 LOCATION: Antinori -North Andover SAMPLE ID: 99-08-06776 MCF 215 RESULTS OF ANALYSIS Parameter. Anatyttcal Date Umts . . Det Result Method i 'Analyzed '' I,mtt _ :` pH Std. Meth., 4500-WB 08/16/99 SU NA 6.6 Total Suspended Solids Std. Meth.,2540 D 08/19/99 mg/L 2.0 23.8 Biochemical Oxvgen Std Meth., 5210B 08/12/99 mg/L 2.0 23.9 Demand Total Phosphorus Std. Meth., 4500-P B/E 08/20/99 mg/L 0.20 9.76 Std.Methods, 18'edition, 1992. Labdratory M ' a er/Date a J&R SALES & SERVICE, INC. September 9, 1999 Andover Board of Health Town Offices Bartlet Street Andover, MA 01810 Attention: Health Agent Reference: Single Home FAST°Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Reports and Testing Results (as required) for services performed on 8/11/99 at the home of Paul Antinori located at 151 Raleigh Tavern Lane. Please call if you have any questions or require additional information. Sincerely, az't4 Candy G yares attachments cc: Paul Antinori ' 44 Commercial St. Aaynham,MA 02767 Tele.508823.9566 ' � y Fax 508-8110-7232 i I > INCORPORATED 8271 Melrose Orive -Lenexa. KS 56214 - Phone: 913-492-4707 - Fax: 913-492-4808 e-mail: onsite®biomicrobics.com - www.biomicrobics.com - 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTFIORIZED SERVICE PROVIDER Raieigh Tavern Lane Installation Address North Andover, MA 01845 I Name J&R Sales and Service Owner Name ?aui Antinori I Street Mail Address Mail Address 44 Commercial St. City State Zip Ciry Raynham, MA S&&767Zio (978) 682-4271 (508) 823-9566 880-7232 Phone Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. I Date of Installation Date of last pumpouc MCP 9219 E UIPI4fENT YES ;. 1v[AII�TEi AxcPFORND°car��>E:vZ Electrical Panels) Visual Alarm Oneratin :(. Audio Alarm Operating (if present) Blower(s) Air iniet r"iter Crean Blower:food Vents Clear I Excessive Noise Excessive Vibration Treatment unit(s) Unusual Odor Pumnout Required: Primary Sealing Zone Aerobic'r--a tent Zone E: LUENT(optional)` ;LINE RESULT ..,... . 'Estimated Dailv FIow H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) OWNER SIGNATURE TE4C1-12N9CIAN SIGNATURE SERVICE DATE I ` ANALYTICAL BALANCE CORP. 422 WEST GROVE STREET Environmental Chemistry MIDDLEBORO, MA 02346 Environmental Services Site Assessment 508-946-2225 Site Sampling Quality Assurance Services Fax 508-946-3335 Data Auditing 1 September 1999 J&R Sales & Service 44 Commercial Street Raynham, MA 02767 COLLECTED BY: D. Koshiol SAMPLE DATE: 08/11/99 TEME: 1100 DATE RECEIVED: 08/11/99 LOCATION: Antinori -North Andover SAMPLE ID: 99-08-06776 MCF 215 RESULTS OF ANALYSIS Parameter Analytccal Date Umts 'i Det Result Method Anal ed€ Limit pH Std. Meth., 4500-HB 08/16/99 SU NA 6.6 Total Suspended Solids Std. Meth., 2540 D 08/19/99 mg/L 2.0 23.8 Biochemical Oxygen Std. Meth., 5210B 08/12/99 mg/L 2.0 23.9 Demand Total Phosphorus Std. Meth., 4500-P B/E 08/20/99 mg/L 0.20 9.76 ' Std.Methods, 18'edition, 1992. LabVratory M er/Date �- &R SALES & SERVICE, INC. November 8, 1999 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST®Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Reports and Testing Results(as required) for services performed 11/2/99 at the home of Paul Antinori located at-151 1 Raleigh Tavern Lane. Please call if you have any questions or require additional information. Sincerely, Cand jares attachments cc: Paul Antinori Tc'. .r'd' C I 3 `+ 44 Commercial St. -- Raynham.MA 02767 Tele.508.823.9566 '' �� Fax 508-880-7232 I � ti sf I N C 0 R P 0 R A T E 0 3271 Melrose Orive -Lenexa, KS 66214 - Phone: 913-492-0707 - Fax: 913-492-4808 :-mail: onsite®biomicrobics.com • www.biomicrobics.com - 800-753-FAST(3278) FIELD PECTION & SERVICE REPORT For Bio-Microbics Single Hoke FAST® System INSTALLA27ON AUTHORIZED SERVICE PROVIDER D1 RaIeigh Tavern Lane Instailation.address North Andover, `7A 01845 I Name J&R Sales and Service Owner Name au-L Antinori I Street Mail Address Mail Address 44 Commercial St. City State Zip Ciry Raynham, MA S&&767ZID (978) 682-4271 (508) 823-9566 880-7232 Phone Fax e-maiI Phone Fax e-mail INSTAhLATIONINFORMATIOI }.-._ Model No. I Serial No. I Date of Installation ( Date of last pmovour I M 9/21/98 �"'NO .: .�•:�i�[AII�}TEI�FAN�'EPE�tF.0It2G11�e�ND-GO1YIIy1FidT.�'..,- Electrical Panel(s) 1 I Visual Alarm Ooeratine I f I I Audio Aiatm Operating (if present) Blowers) I I I :air Inlet Filter Crean I v I I Blower Hood Vents Clear I Excessive Noise I I I Excessive Vibration I I I Treatment units) I I Unusual Odor I Pumuout Required: Primary Seniin,Zone I I X Aerobic Treatment Zone I L:�'rLIlE.IT(uutionaA �L` b=.7 RESULT I .•_•• , 24dmated Dailv FIow I 3 off(Standard Uuics) 1 6-9 S.U. Color Clear Temperature I Odor Slightly musty odor (not septic) OWNER SIGNATURE - 1 .-CHIYICLkN SIGN TURE SER`JICE DAIS &R SALES & SERVICE, INC. November 8, 1999 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST° Treatment System Serial Number: SBF 13 Attached please find the Field Inspection& Service Reports and Testing Results (as required) for services performed 11/2/99 at the home of Amit Banerji located at 3.69 Salem Street. Please call ifou have an questions or require additional information. Y any Sincerely, Candy Ga ares v Y attachments cc: Amit Banerji 01 2 1999 44 Commercial St. Aaynham,MA 02767 Tele.508-823-9566 Fax 508.880.7232 0= 1 NCO RPOR ATE 0 8271 Melrose Drive -Lenexa, KS 66214 - Phone: 913-492-0707 - Fax: 913-492-0808 e-mail: onsite®biomicrobics.cam - www.biamicrobics.com - 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED'SERVICE PROVIDER 369 Salem Street Installation Address North Andover. MA 01845 Name J&R Sales & Service Owner Name Amit Bener'i Street '44 Commercial St. Mail Address 369 Salem Street Mail Address North Andover, MA 01845 city State Zip Ciry Ra ham StateMA Zi 978-557-9154 508-823-9566 Phone Fax e-mail I Phone Fax e-mail _-`INSTAhhA�.TON_INFORMA'ITON=- ` Model No. Serial No. Date of Installation Date of Iast pumpout SHF13 9-4-98 1VfAINTE2�FANeEPIl2EOR A§NDCONIMENTS _ Electrical Panel(s) Visual Alarm Operating Audio Alar Operating (if resent) Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration ✓ Treatment unit(s) Unusual Odor Pum out Required: Primary Sealing Zone Aerobic Treatment Zone Fk'1r: FZf T..option( al RESItTI Estimated Daily Flow 3 H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septic) OWNER SIGNATtTRE. TE CIAN SIGMA SERVICE DATE %� ld _ 9 q� /� � .��� � � t �a� � �i ��U� � � � �,7G'� � �� ����f�- U� �a� l 5 � ��_ f TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE November 10, 1998 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (x) by North Andover Licensed Installer Benjamin C. Osgood, Jr. y at 151 Raleigh Tavern Lane,North Andover, MA has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# 1026 dated June 4, 1998. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector COMMONWEALTH OF MASSACHUSETTS u EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS p � d DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 SYo�,S Tf3VU1V OF err r, r A,-I COVER/ RC -:ALTH ARGEO PAUL CELLUCCI a BOB DURAND Governor 4 x APR 1 FA Secretary 1 JANE SWIFT � EDWARD P.KUNCE Lieutenant Governor Acting Commissioner April 12, 1999 Paul Antinori 151 Raleigh Tavern Lane North Andover, MA 01845 Re: 151 Raleigh Tavern Lane, North Andover DEP Facility No: MCF215` Operation,& Maintenance Requirements Dear Mr. Antinori: As you are the owner of an alternative on-site sewage treatment and disposal system regulated under Title 5 of the State Environmental Code, 310 CMR 15.000, I am writing to remind you of your operation and maintenance obligations. According to the Department of Environmental Protection's records, a FAST system has been installed at the above referenced location. The Department's approval for this system requires that, throughout the system's life, the system owner must maintain an agreement with a person or firm competent in providing services consistent with the system's specifications, the operation and maintenance required by the design engineer and any specified by the Department. In addition, every time the operator or operators are changed, the owner shall notify the Department and the local Board of Health_ , in I writing, within seven days of such change. The Department has received information indicating that your contractor has terminated the contract for operation and maintenance of your system. Pleasenotify the Depar'iment, in writing, within seven days of receipt of this letter, of the name of the new operator for your system an su mlt a copy of your current contract. Please submit the information to: Department of Environmental Protection Title 5 Program Watershed Permitting Program One Winter Street, 6th floor Boston, MA 02108 This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http://www.magnet.state.ma.us/dep L� Printed on Recycled Paper i .y Facility No: MCF215 If you have any questions concerning your operation and maintenance requirements or need additional information on operation and maintenance contractors, please feel free to contact Steven Corr, of my staff, at (617) 292-5920. Sincerely, Lealdon Langley, Director Watershed Permitting Program cc: North Andover Board of Health DEP,NERD no contract-99 MCF215 I I G J&R SALES & SERVICE, INC. December 14, 2000 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST° Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report and test results(as required) for services performed on 11/21/00 at the home of Paul Antinori located at 151 Raleigh Tavern Lane -North Andover, MA. Please call if you have any questions or require additional information. cerely, I � et M. Whitman Enclosures Cc:Paul.Antinori 44 Commercial St. Raynham,MA 02767 Tele.508-823-9566 DEC 2 2 Fax 508.880 7232 Environmental Chemistry Environmental Services Site Assessment Ankitcal Ba1mce Site Sampling Quality Assurance Services Data Auditing C 0 R P O T I 0 1\' CERTIFICATE OF ANALYSIS J&R Sales & Service REPORTED: 12/8/2000 44 Commercial Street Raynhatn, MA 02767 ORDER#: G0019174 COLLECTED BY: J. Peterson SAMPLE DATE: 11/21/2000 TIME: 13:45 DATE RECEIVED: 11/21/2000 LOCATION: North Andover- MCF215 SAMPLE ID: Antinori Grab DESCRIPTION: WATER RESULTS OF ANALYSIS I Test Parameters LAB-ID#: 0019174-01 BOD SM 5210B 11/22/2000 mg/L 4 7.4 pH SM 4500 H+B 11/27/2000 S.U. 0-14 6.06 Phosphorus,Total SM 4500-P B/E 12/6/2000 mg/L 0.10 5.59 jSolids, Suspended SM 2540 D 111/28/2000 mg/L 2 15.6 j NA=Not Applicable NU=Not Detected Approved By: <' = Less Than L Manager / ate *' = Detection Limit i I I I i Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page: 1 t � I Q i I N C 0 R P 0 R A T E 0 8450.Cole Parkway . Shawnee, KS 66227 .Phone 913-422-0707 a Fax: 912-422-0808 e-mail: onsit biomicrobics.com a www.biomicrobics.com ■ 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover, MA 01845 Name J&R Sales&Service, Inc. Owner Name Paul Antinori Street Mail Address 151 Raleigh Tavern Lane Mail Address 44 Commercial Street North Andover, MA 01845 Raynham, MA 02767 City State Zip city State Zi 9786824271 508-823-9655 508-880-7232 Phone Fax e-mail Phone Fax e-mail INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 EQUIPMENT YES NO MANTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating (if resent Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit(s) Unusual Odor Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LEVIIT RESULT Estimated Daily Flow 4 Bedrooms H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not se tic) ECHNIC N SIGNATURE SEIRVIC9 DATE Berger and Hyde P.C. Date: i 15 f- 90 Main Street voice Phone; (978) 475-0756 Andover, MA 01$10 Far Phone: (978).475-8959 FAXAwln4, eo-, o To: 1°1YWdyC- 4161%4T7� From: It MA!LIAM Number of Pages: (Including Cover Sheet) �QMQAQAr,,,t,�✓►1Z � (9�L V .L�tGO�th The material in this facsimile is strictly confidential between the sender and the receiver. If you received this transmission accidentally please contact us at (978) 475-0756. To confirm or to let us know if you did not receive the number of pages specified,please contact us at the same number. Thank you. TO:3J)Ud at% 889 8OS:01 6S68-SLb-8L6 :aOd8 Sti".9T 86 60-(04 T9VVNQPN0PTW/�NQQNXP/ I ,&Olt .EVALUATOR FORM FORM 11 - Page I of 3 i JUN 2 6 L Commonweal h of Massachusetts Massachusetts "oil Suitabill I Assessment or On- it Date: PerformedBy: ........................ .......................... Witnessed By: ............ . .......... Z LA=Iion Address Of z Address.And A-31 Lot I Telephone I �7ta:e)40< ew Construction ❑ ReTpalcrV .0fric Re—view Y Published soil Survey Available: No esSoil Map Unit ..... Year Published .............. Publication Scale ................... oil Limitations Drainage Class le' '-�- . . Surficial Geologic Report Available: No E Yes ❑ Year Published Publication Scale ....... Geologic Material (Map Unit) .................................................................... ........... Landform, ................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year I flood boundary No El Yes El Within 100 year flood boundary No 0 Yes ❑ WetlandArea: (map unit) ............................................................ ....... .... National Wetland Inventory Map ........ Wetlands Conservancy Program Map (map unit) ...... ....... ..................................... Current Water Resource Conditions(USGS): Month pct Range :Above Normal ONormal Ehelcw Normal Other References Reviewed: DEP APPROVED]FORM 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2of3 ll Location Address or Lot lJo. /-!57/ /C G:GI�/ 7/ '4- 11' LSU. On-site Review 1"��/q7 Time:.�� Weather Deep Hole Number Date:.:. Location (identify on site planywll.: TG.tiE.::-. l� T.::...::....:...::. :::.. .:..:::._..:..:.::.. . . . .. ..:.:........ Land Use Slope Surface Stones Vegetation Landform .... :: ..:. Position on landscape (sketch on the back) . TLm .. Distances from: Open Water Body feet Drainage way feet feet Possible Wet Area feet Property Line ...20 feet Drinking Water Well .... feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface finches) (USDA) IMunsefl) Mottling (Structure,Stones, Bounders, Consistency, % z� _¢o Z-s Parent Material (geologic) �,�Q�LO� 70 DepthtoBedrock: Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: --5 �� --- DEP APPROVED FORM-12107/95 FORM 11 - SOIL EVALUATOR FORNi Page 2of3 Location Address or Lot iso. /Y7 o. 7�l''I� A11-1 On-site Review 0 Deep Hole Number Z... Date:.f0 0 Q' Time:.//•/!!5- WeatherA91e—. Location (identify on site plan) �. her. •.: Land Use ..��r1T�'¢L Slope Surface Stones . !�y Vegetation , Landform Position on landscape (sketch on the back) ..� ...: Distances from: Open Water Body �� feet Drainage way Z��a. feet Possible Wet Area 24010feet Property Line feet Drinking Water Well feet Other .. ::.......,....,. DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) A�w • Parent Material (geologic) pthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: t)EP APPROVED FORM-12107195 1 J � - .�.....-.-..•... .�-... a ...._"........�_� .-.vac..Y'avyC 1 FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot loo. On-site Review Deep Hole Number ✓ Date'A/®/Q/7 Time:�� �''/� Weathe � � Location (identify on site plan)74 .... D :... :.Z.::..:.:....:...::. .:.....:...:..:.... _.::...:::.. . . . .. ..:.:........ Land UseX77.44 Slope (%)K� ...G Surface Stones i4ky. Vegetation : .. � :.. �... :.:. .:.:::..... .::..: Landform -... .. ::....::..::...:.:.:.... Position on landscape (sketch on the back) .:",� Distances from: Open Water Body ',�Wo feet Drainage way. :. ..... feet Possible Wet Area .Zd52 feet Property Line -- .. feet Drinking Water Well ..::.`. ... feet Other :. .w.. DEEP OBSERVATION HOLE LOG! Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches} (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) SSE- . Z/ �� Parent Material (geologic) 7D xz'�'���`�'L DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole:— Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 X. i FORM 11 - SOIL LVALUATOR FOR Page 3 of 3 i Location Address or Lot No. Determination for Seasonal Iii h Water Table Method Used: ❑ Depth observed standing in observation hole.................. inches ❑ Depth weeping from side of observation hole .......... .... inches © Depth to soil mottles .. .` inches ;!>//- � Z Sz ❑ Ground water adjustment ................. feet Index Well Number .................. Reading Date ................... Index well level ......._.......... Adjustment factor .................... Adjusted ground water level .................................................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? No If not, what is the depth of naturally occurring pervious material? � ---90 , Certification I certify that on (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis } was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 4�ZWDate Signature-- - DEP APPROVED FORM• 12/07/95 FORMU1 SOILL VA`LUATpR FORM Date: page 1 of 3 !JUN - I No. • 58 / Y Commonwealth Massachusetts No AIS , Massachusetts Soil Suitability Assessment for ®n-site Sewage aD4pQsa Performed By: ��•��.1...... ........... Date: Witnessed By: ......... X1 ........ rw¢. .. ... .......... ................. _.. ......... . ... ._ .. ,�lL�..... ................ ......... ....................... LAxstion A4drcs$Or 1r1 l � Ovrcr's Nemc, ��uI �/ Address,and � -e Te Q ew Construction ❑ Repalr Office Review Published Soil Survey Available: No ❑ Yes Year Published lee /.................. Publication Scale l/� Soil Map Unit Drainage Clas .���../ Soil Limitations T '..........1��5f� - i...........:................... ................_......... Surflcial Geologic Report Available: No R1 Yes ❑ Year Published „� ... .... Publication Scale GeologicMaterial (Map Unit) ................................................................................................................_................ .. .._...._.... ........................................................................_..................... Landform ............................................................ .._._....__._. a Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Q Within 500 year flood boundary No Dyes ❑ Within 100 year flood boundary No [--]Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ......................................._.............. _.:....._-__.... Wetlands Conservancy Program Map(map unit) ................................................................................................. Current Water Resource Conditions(USGS): Month Ate• ?0-6, 4.._.,.. Range :Above Normal ONormal ❑Belay Normal ❑ Other References Reviewed: DEP APPROVED FORM•MOMS , FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Z / On-site Review Deep Hole Number .,... Date; .: � Time:..�.�.��� Weatherby _ Location (identify on site plan) -AAW ��2­11E Land Use :.,. :firt77dL Slope M Surface Stones Vegetation : :. . ..... :... _ w : �... .. ... . , . Landform ..::.!�. Position on landscape (sketch on the back) Distances from: a Open Water Body .L feet Drainage way.-� feet Possible Wet Area �` . feet Property Line .. : .......... feet Drinking Water Well ...."' feet Other . .. ....,..�" DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, % Gravel) ly oYvZ .fi'v� ,✓'� -�C,�.�Cotes G S /te a. MINIMUM OF 2 HOLES REQUIRE5 AT EVERY PROPUtU Ul�il`UbAL AREA Parent Material(geologic) 7151 _ &Kl< DepthtoBedrock: /04f�? Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: d Eslimated Seasonal High Ground Water: e��6 a � { DEP APPROVED FORM-12/07/93 1 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot On-site Review Deep Hole Number -�....:. Date: / Time:AOior Weatherl/7ae-o—/-` Location (identify on site plan) G...,. > ... Land Use /2-:M /,44 Slope M ....--. Surface Stones -.-:. Vegetation ��`.. :... .... . . .. . . . .... . .... . .�. . . . . .. . . . Landform Position on landscape (sketch on the back) '::..: G �.. ..�,...��, Distances from: Open Water Body . jOva feet Drainage way 4�`'r7 feet Possible Wet Area feet Property Line .. . .......... feet Drinking Water WeV....7. feet Other .__.. .....,.w, DEEP OBSERVATION HOLE LOG` Depth from Solt Horizon Soil Texture Soil Color Soil Other Surface(inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) �� MINIMUM UF.2 HOLES REQU)RED AT EVERY PRUPOSED DISPOSAL AHEA Parent Material(geologic) 7� -��'%_ � DepthtoBedrock: Depth to Groundw,Rj2r: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 5l I , DEP APPROVED FOR.ht-12/07/95 I Ili . `t FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. determination ,for Seasonal I�il�h Water T Method Used: ❑ Depth observed standing in observation hole................... inches ❑ Depth weeping from side of observation hole... inches ® Depth to soil mottles ....: ..:, inches 91W ` ......moo .❑ Ground water adjustment ................... feet4"'4'-1- :�7 Index Well Number .................. Reading Date .................. Index well level ................ Adjustment factor.................... Adjusted ground water level ....................,.....- Depth of Naturally Occurring n Pervious Material Does at least four feet of naturally occurring pervious material existin all areas observed throughout the area proposed for the soil absorption system? AA� If not, what is the depth of naturally occurring pervious material? Certification I certify that ont� QS (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date // DEP APPROVW FORM•12/07/95 J&R SALES & SERVICE, INC. August 27, 2001 North Andover Board of Health 27 Charles Street North Andover, MA 01845 Attention: Health Agent Reference: Single Home FAST°Treatment System Serial Number: MCF215 Attached please find the Field Inspection& Service Report (as required) for services performed on 8/15/01 at the home of Paul Antinori located atx1-51=Raleigh Tavern-L-ane- North Andover, MA. Please call if you have any questions or require additional information. Sincerely, v net M. Whitman Enclosures Copy to: Paul Antinori S. TOWN OF NANDOVER/ i 44Commercial St. r001Raynham,MA 02767 Tele.508.823.9566 Fax 508.8801232 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 0'2108 617.292.5500 DEP Approved Inspection and 0&1*vI Form for Title 5 I/A Treatment and Disposal Systems Installation Authorized Service Provider Installation Address: 0&,Ivl Firm: 151 Raleigh Tavern Lane: North Andover J & R Sales & Service, Inc. Owner Name: MA Mail Address: 44 Commercial Street Mail Address: Paul Antinori Raynham, Ma 02767 151 Raleigh Tavern Lane North Andover,MA 01845 Telephone No.: (508i 823-9566 j Telephone No.: 9786824271 Certified Operator dame: DEP No.: Mfr. No.: MCF215 Cert.No.: Model No.: Installation Date: Start of Operation: -7rYl i cr0 FRS T 9i21/98 Approval Type: (Circle) Seasonal jLa4dence-used less than 6 mo./year: (Circle) General Provisional Piloting Remedial Yes No Operating Information Previous Inspection Date: Inspection Dat : Sludge Depth:(to be checked yearly) Pumping Recommended(Circle) ' l 1 Yes o f Effluent Description: Attach copy of certified lab results. Check all that are required Samples: Influent Effluent Parameters: pH BOD TSS TN Other Other Other Description of Overall System Condition: Description of any Maintenance Performed since Previous Inspection and During this Inspection: Notes and Comments: I certify: I have inspected the sewage treatment and disposal system at the address above, have completed this report and the attached manufacturer's 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 CNIR 2.00. Operator Signature Date System owner must submit Remedial Use-by January 31"of Department of Environmental this report, manufacturer's each vear for the previous calendar Protection O&M checklist,and any year Attn: Title 5 Program required sampling results Piloting& Provisional Use - within One Winter Street, 6'" Floor to the local Board of Health 'Flays of inspection date each vear for the General Use- byprevious 12 months September 30'"of Boston, -MA 02108 and DEP as follows for iOVVi�, II teORTil,fit jC- PO RD OF HET„ each inspection performed: - �- -� -- ' 5/IXI 2001 A TOWN OF NORTH ANDOVER/ '•� BOARD OF HEA1-T I-1 S' �5 2001 I N C 0 R P 0 R A r E 0 8450 Cole Parkway . Shawnee, KS 66227 .Phone 913-422-0707. Fax: 912-422-0808 e-mail: onsite(&-biomicrobics.com a www.biomicrobics.com a 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST® System INSTALLATION AUTHORIZED SERVICE PROVIDER 151 Raleigh Tavern Lane Installation Address North Andover, MA 01845 Name AR Sales& Service, Inc. Owner Name Paul Antinori Street Mail Address 151 Raleigh Tavern Lane Mail Address 44 Commercial Street North Andover, MA 01845 Raynham, MA 02767 City State Zip City State Zi 9786824271 508-823-9655 508-880-7232 Phone Fax e-mail Phone Fax e-mail INSTALLATIbN INFORMATION Model No. Serial No. Date of Installation Date of last pumpout MCF215 9/21/98 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual AlarmOperating .j Audio Alarm Operating (if resent) / Blower(s) Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment unit(s) Unusual Odor Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT(optional) LEMT RESULT Estimated Daily Flow 4 Bedrooms H(Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly musty odor (not septi TE 1 [ SIGNATU E SERVICE DATE J & R SALES & SERVICE, INC. January 8, 1999 p TOWN OF NORM ANDOVER/ ! BOARD OF HEALTH re RECEIVED Andover Board of Health FEB - 3 t Town Offices t `jw 14 ��`� Bartlet Street _- Andover, MA 01810 t EAILT H j Attention: Health Agent Reference: Single Home FAST Treatment t System Serial Number: MCF215 Attached please find the Field Inspection& Service Reports and Testing Results (as required) for services performed on 12/28/98 at the home of William Watson located at irS=l`al�leigh--avers mane Please call if you have any questions or require additional information. Sincerely, Candy Gayares attachments cc: William Watson 44 Commercial St. Raynham,MA 02767 Tel:508-823-9566 Fax:508-880.7232 ANALYTICAL BALANCE CORP. _ 422 WEST GROVE STREET Environmental Chemistry MIDDLEBORO, MA 02346 Environmental Services Site Assessment 508-946-2225 Site Sampling j Quality Assurance Services _ Fax 508-946-3335 Data Auditing -5 January. 1999 J&R Sales & Service 44 Commercial Street Raynham, MA 02767 COLLECTED BY. B. Everett SAMPLE DATE: 12/28/98 TIME: iOOH DATE RECEIVED 12%28/98 LOCATION:. Watson- MCF 215 SAMPLE ID: 98-12-1-1708 North Andover, MA RESULTS OF ANALYSIS Parameter Analytical Date Units Det Result .! Method Anal';zed Lunn pH Std.Meth.,4500-H+B 12/29/98 SU N/A 7.8 Total Suspended Solids Std.Meth.,2540 D 1/04/98 mg/L 2.0 24.2 Biochemical Oxygen Demand Std.Meth., 5210B 12/30/98 mg/L 2.0 21.4 Standard Methods, 18'edition, 1992. •¢, i. s f �y ahcrato.; .,,,..ager, Date i I INC0RP0RATE0 .8271 Melrose Drive -Lenexa, KS 66214 • Phone: 91.3-492-0707 • Fax: 913-492-4808 e-mail: onsite®biomicrobics.com • www.biomicrobics.com • 800-7534AST(3278) - FIELD INSPECTION& SERVICE REPORT _ For Bio-Microbics Single Home FAST® System - a INSTALLATION AUTHOR=7SERMICE PROVIDER 151 Raleigh Taven Lane �tallation Address Name ?�'. c a f e s Service Inc. Owner Name William Watson Street 44 CommercialStreet Mail Address 151 Raleigh -Tavern Lane Mail Address North Andover, MA .01845 City State Zia Citv:?apnha-*1 - State'',A i 027 6 7 978-682-3400 508-823-9566 Phone Fax e-mail Phone Fax e-mail FSTAELATIONI FORMATTON- Modei No. Serial No. Date of Installation Date of last pumpout- 1 MCF215 9/21/98 E`UIEti1II1' - T` 1� KN€EPERTOKfiZEL�2iND CON Electrical Panels) Visual Alarm OperaiT9 Audio Alarm Operating i (if resent) Slower(s) Air Inlet Filter Clean r% , Blower Hood Vents Clear Excessive Noise ci Excessive Vibration Treatment unit(s) l Unusuai Odor Pumoout Required: Primary Settling Zone v Aerobic Treatment Zone ✓ ` EFFT UEl`fT°:o tional ;LIlY)FI - I�SUTL Estimated Daily Flow H Standard Units) 6-9 S.U. Color Clear Temperature Odor Slightly - musty odor (not septic) i OWNER SIGNATURE TECW,. IAN SIGNATURE- SET..VTCE DATE 1 & R SALES & SERVICE, INC. October 6, 1998 RE C L D���� Andover Board of Health LC _ 9 Town Offices -- Bartlet Street [IB:l AA R 0 F E A L i 11 Andover, MA 01810 i Attention: Health Agent Subject: Single Home FAST Treatment Serial Number: MCF215 Attached please find a copy of the Product Registration Report for the FAST Treatment System for work perform on 9/21/98 at the home of William Watson located at 151 Raleigh Tavern Lane. Also, attached is a copy of the fully executed Inspection& Effluent Testing Agreement. If you have any questions or required additional information please do not hesitate to call. Sincerely, Candy Gayares" Attachments 44 Commercial St. Raynham,MA 02767 Tel:508-823-9566 Fax:598-880-7232 IryJ & R SALES & SERVICE, 1NC. Please complete all items marked 44 Commercial Street mail check and signed RAYNHAM. MA 02767ginal ------ TEL: (508) 823-9566RECEIVED SheaCon�ncre Produces.Inc. FAX: (508) 880-7232 773 Salem Street!Route 62 " �✓ i North Wilmington, MA 01887 INSPECTION & EFFLUENT TESTING AGREEMENT This Inspection Agreement is entered into by J&R Sales & Service,Inc. (herein call MR) and the FAST'S System OWNER(herein called OWNER), for the purpose of setting forth terms and conditions governing J&R's obligations to inspect OWNER's equipment listed below. Upon acceptance of this agreement, J&R will render the following services only: Equipment will be inspected at least 4 times per year that this Agreement remains in effect, with the-first inspection beginning These inspection 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 over-all condition of FAST' System. 5) Notify OWNER of any problems encountered. 6) Service other than routine maintenance will be billed at an hourly rate plus travel and material. J&R shall notify the local board of health and the Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. It is understood that by this Agreement J&R is not obligated to supply any parts. Any additional labor time will be billed to the OWNER at standard labor rates of S 64.00 per hour. Emergency service between regular inspections will be provided at standard rates for labor during normal business hours, after 5:00 PM and on Saturdays time and one-hall; and double time on Sundays and holidays, minimum four(4) hours plus standard charges for parts plus mileage and travel charges. This agreement does not include expenses to repair damage caused by abuse, accident, theft, acts of a third person,forces of nature, or altering the equipment. J&R shall not be responsible for failure to render the service for causes beyond its control, including strikes and labor disputes. c OWNER understands and agrees that J&R is not responsible for special or consequential damages, including loss of time, injury to person or property unit or equipment failure. This agreement is not assignable without the consent of J&R and will remain in force until canceled by either party through written notice. This is a two year service contract to be billed annually in compliance with State regulations. Failure to comply will result in cancellation and nullification of any warranties. MANUFACTURER MODEL NO: SERIAL;NO: OCATION ANNUAL RATE Bio-Microbics Home FAST �''��� 4 $350.00 EQUIPMENT OWNER J&R Sales & Service. Inc. *Signed by: W41 Lo-, a �•�, Signed by: J&R Sales and rvice,Inc. *Address: "Icvh Li11 44 Commercial Street Raynham, MA 02767 Tel: (508) 823-9566 �j Fax: (508) 880-7232 *City: StateNlt Zip:084-5 *Telephone:— —� 1 � 4cO Effect Date of Agreement q -a �g Effluent Testing Effluent sample taken 4 times per year,_delivered-to a qualified testing lab for.evaluation and with results being sent to State and local Agencies-as-well as the owner. Owner is responsible for providing acceptable access to effluent to enable a grab sample to be taken for laboratory testing performed: PER-NET ' *(PLEASE CHECK ONE) OGENERAL �Q REMEDIAL O PROVISIONAL- *SPECIAL CONDITIONS PER LOCAL BOARD OF HEALTH (Y) or(N) If YES,please attached copy of permit- ' BOD,, TSS,PH ( ) pH;BOD5 ,-TSS, TKN,NO3 -N, Ammonia `N OtherV5- Pim"Spec;ry Testing Cost 160dV 9 Operator assigned: William Everett *Engineer: Telephone#(,508) 823-9566 *Approval for Effluent Testing <<�- � Homeowner's Signature INCORPORATEO 8271 Melrose Drive -Lenexa, KS 66214 - Phone: 913-492-0707 - Fax: 913-492-0808 e-mail: onsite®biomicrobics.com - www.biomicrobics.com - 800-753-FAST(3278) PRODUCT REGISTRATION REPORT Product Registration Report must be completed and retumed to Bio-Microbics, Inc. in order to effect warranty. Date of Installation Date Shipped to End User 9/2/98, Serial No. MCF215 OWNER NAME William Watson ADDRESS 151 Raleigh Tavern Lane CITYISTATEIZIP North Andover, MA 01845 PHONEIFAX 978-682-3400 B106MICROBICS DISTRIBUTOR NAME ADDRESS CITY/STATEIZIP Ra ham MA 02767 PHONE/FAX 508/823-9566 FAX 508/880-7232 INSTALLER` NAME opmpnt ADDRESS CITY/STATE.!ZIP PHONE/FAX 978-346-8291 CON.SULTING>ENGINEER, ifa hcable;_. NAME ADDRESS 1 CITY/STATE/ZIP PHONEIFAX Good Bad NA Good Bad NA ELECTRICAL PANEL(S) TREATMENT UNIT(S) Visual Alarm Operating [ Q Air vent clear Audio Alarm Operating [ Q Septic tank level Q BLOB^JER(S) Septic tank meets min. size -W/ [1 Wired for correct voltage Septic tank filled to operating level Inlet/outlet piped correctly Q Air Lift Operation Filter element installed Recirculation tube in place (� Blower hood secure L2r f Fasteners tight �/ Q Blower works correctly WATER-TIGHT JOINTS Blower`located within 100'of Treatment unit to septic tank treatment unit Air line clear [ Entrance tube to insert cover Q Air inlet screen clear r'7 Insert to insert cover - (� Blower hood vents clear_ gr - 0 Discharge line connection (� Q Factory Authorized Personnel: _ Title: Service Manager Firm: J&R Sales and Service, nc. Date: zu ow