HomeMy WebLinkAbout- Title V Inspection Report - 43 MILL ROAD 1/22/2019 Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 6 VA
Treatment and Disposal Systems
RECEIVED
A. Installation JN' � U
Important:When Todd...St(i Stringer -'r('�WN ANDOVER
filling out forms Owner HEAD]fl DB51V777ENT
on the computer,
use only the tab 43 Mill Rd - ------
key to move your Facility Street Address
cursor-do not N Andover 01845
use the return City Zip
key.
Mailing address of owner, if different:
Street Address/PO Box:
ranun
City State Zip
) -—-------- ext.
Telephone Number
B. Authorized Service Provider
Sewer Works
O&M Firm
26 Hillside Ave
Street Address
-Westford Ma. O I 8_86
City State- Zip
_(978)692 -4410 ex't._____Telephone Number
David Chandler
Certified Operator Name Certification Number
C. Facility/System Information
.6if 24428 0.5
ID Manufacturer ID Model Number
4/2005 4/2005
,_____.............
Installation Date Start of Operation
Approval Type: E General El Provisional [:1 Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: El Yes No
D. Operating Information
12/18/2018 12/14/2017
Inspection Date Previous Inspection Date
12" aerobic-- zone Pumping Recommended ❑ Yes No
Sludge epth(to be checked yearly)
t5aiom.doc-rev.04-11-13 Page 1 of 3
LMassachusetts Department of Environmental Protection
ry Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
H. Certification
I certify: I have inspected the sewage treatment and disposal system at the address above, have
conducted the required Field Testing and/or sample collection in accordance with Standard Methods,
have completed this report and the attached technology operation and maintenance checklist, and
the information reported is true, accurate, and complete as of the time of the inspection. I am a
MasDnhusetts certified operator in accordance with 257 CMR 2.00.
12/18/201_8 ..............
C7pe "-r Sign-tu—re Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health as follows for each inspection performed:
Remedial Use—by January 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31 th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 5"' Floor
Boston, MA 02108
t5aiom.doc rev.04-11-13 Page 3 of 3
asholaAnalytical. LLC Tel 978-391-4428 Fax:978-391-4643 LabNumber: 197636
.................--
31A Willow Road,Ayer MA 01432 Website:http://www.NasliobaAnalytical.com Use this number with all correspondence
Client:
Sewer Works ReportDate: 12/19/2018
26 Hillside Ave.
Westford, MA 01886
Certificate of Analysis
43 Mill Road, N.Andover, MA
Parameter Method Result M11L Date of Analysis Analyst
- Pump Chamber
Sampled., 1211812018 1:00:00 PM by D. Chandler
Turbidity, NTU EPA 180A 5 0"1 12/1812018 M-MAI 118
MRL=Minimum Reporting Level,ND=None Detected(<MRL)
Analysis performed according to 310CIVIR42.00
Massachusetts Certified David L.Knowlton
Laboratory#M-MAI 118 Laboratory Director Page I of 1