HomeMy WebLinkAboutDEP Approved Inspection & O&M Form - Title 5 - Title V Inspection Report - 43 MILL ROAD 12/11/2020 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
A. Installation
Important:when Philip Wilson
RECE�VE�
filling out forms -- - -- —"— --
Owner `t0
on the computer, 43 Mill Rd DEC 1 1
use only the tab
key to move your Facility Street Address ,WR A A
cursor-do not N Andover 01845 TpWN %TN pEpPAW
use the return --
key. City Zip
Mailing address of owner, if different:
Street Address/PO Box:
rewn
City State Zip
Telephone Number
B. Authorized Service Provider
Sewer Works
O&M Firm
26 Hillside Ave
Street Address
Westford Ma 01886
City State Zip
(978)692-4410 ex_t._ -
Telephone Number
David Chandler
Certified Operator Name Certification Number
C. Facility/System Information
24428 0.5
DEP ID Manufacturer ID Model Number
4/2005 4/2005
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence-used less than 6 mo./year: ❑ Yes ❑ No
D. Operating Information
11/5/2020 9/13/2019
Inspection Date Previous Inspection Date
18" aerobic zone,
Sludge Depth(to be checked yearly) Pumping Recommended ® Yes El NO
t5aiom.doc•rev.04-11-13 Page 1 of 3
Massachusetts Department of Environmental Protection
'l Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ❑ musty ® earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
8.04 SU 3 _ _ 2.2 NTU
pH 6 to 9 DO .0 mg/I 2 or greater Turbidity 40 or less
Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected
per Standard Methods and analyzed for BOD and TSS.
F. Sampling Information
Samples Taken: ❑ Influent ® Effluent
Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use
nitrogen reducing systems:
gpd
Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below)
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection &during this inspection:
blower amps 3.3, cleaned filter
Notes and Comments:
t5aiom.doc•rev.04-11-13 Page 2 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
i 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
M ac setts certified operator in accordance with 257 CMR 2.00.
(/w 11/05/2020
Operator Signature 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"of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th 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, 5t Floor
Boston, MA 02108
t5aiom.doc•rev.04-11-13 Page 3 of 3
Nashoba Analytical, LLC Tel:978-391-4428 Fax:978-3914643 LabNumber. 221504
31A Willow Road,Ayer MA 01432 Website:http:/,www.NashobaAnalytical.com Use this number with all correspondence
Client:
Sewer Works ReportDate: 11/6/2020
26 Hillside Ave.
Westford, MA 01886
Certificate of Analysis
43 Mill Road, N. Andover, MA
Parameter Method Result MRL Date of Analysis Analyst
- Pump Chamber
Sampled. 11/5/2020 10:00.00 AM by D Chandler
Turbidity, NTU EPA 180.1 2.2 0.1 11/5/2020 M-MA1118
MRL=Minimum Reporting Level,ND=None Detected(<MRL) r.
Analysis performed according to 31 OCMR42.00 `r
Massachusetts Certified David L.Knowlton
Laboratory#M-MA1118 Laboratory Director Page 1 of 1