HomeMy WebLinkAboutMiscellaneous - 45 BRIDGES LANE 1/14/2016 (2) Massachusetts Department of Environmental Protection
Ll Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
5211
A. Installation
Important: Michael Koenig
When filling out Owner
forms on the
computer, use 45 Bridges 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:
r� 29 Berry Patch Lane
Street Address/PO Box:
Boxford MA 01921
City State Zip
(978-561-5007 exi.
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
24751 Bio-Microbics, Inc. MicroFAST .5
DEP ID Manufacturer's Name&ID Model Name&Number
05/17/2005
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
08/24/2005
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended _Yes X No
Color: Clear Odor: None
Effluent Description
DEPMicroFASTnew.doc-9/13/05 Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
5211
E. Sampling Information
Samples Taken: — Influent X Effluent
Parameters sampled: X pH X BOD X 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 08/24/2005
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
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
DEPMicroFASTnew.doc•9/13/05 Page 2 of 2
i
8450 Cole Parkway m Shawnee, KS 66227 m Phone 913-422-0707 of Fax: 912-422-0808 5211
e-mail: onsite(cD.biomicrobics.com m www.biomicrobics.com 0 800-753-FAST(3278)
FIELD INSPECTION & SERVICE REPORT
For Bio-Microbics Single Home FASTO System
INSTALLATION AUTHORIZED SERVICE PROVIDER
45 Bridges Lane
Installation Address North Andover,MA 01845 Name Wastewater Treatment Services,Inc.
Owner Name Michael Koenig Street
Mail Address: Mail Address 44 Commercial Street
29 Berry Patch Lane Raynham, MA 02767
Boxford,MA 01921 City State Zip
508-880-0233 508-880-7232
Phone 978-561-5007 Fax e-mail Phone Fax e-mail
INSTALLATION INFORMATION
Model No. Serial No. Date of Installation Date of last pump out
MicroFAST.5 24751 05/17/2005
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 units
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:
TECHNICIAN SERVICE DATE
Kevin Usilton 08/24/2005
Environmental Chemistry Environmental Services
Site Assessment Ana Site Sampling
Quality Assurance Services L Ina lll.(L�VA�Balance Data Auditing
G O R Y R 0 N'
CERT IFICATE OF ANALYSIS
Wastewater Treatment Services, Inc.
4 REPORTED: 08/31/2005
4 Commercial Street
Raynham, MA 02767 ORDER#: G0575307
COLLECTED BY: K. Usilton SAMPLE DATE: 8/24/2005
TIME: 11:45 DATE RECEIVED: 8/25/2005
LOCATION: 45 Bridges Ln.,N. Andover, MA SAMPLE ID: Koenig
Grab(2475 1) DESCRIPTION: WATER
RESULTS OF ANALYSIS
Test Parameters LAB-ID#: 0575307-01
IBOD ISM 5210B 08/25/2005 mg/L 4 1 4.2
pH ISM 4500 H+B 08/25/2005 S.U. 0-14 8.7
iSolids, Suspended ISM 2540 D 08/30/2005 mg/L 4 4.0
NA=Not Applicable
i
ND=Not Detected Approved B
<' = Less Than a Manager V / Date
*' = Detection Limit
Page 1 of 1
Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225
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�..-. _..._,,. ., ...�-...�...__ 4 ,a>rr�rr�a;rcial Street
ayrr4r ern,
MA
02767
Tel: (500) 80-0200
Faux: (508) 880-7232
September 13, 2005
(.r aW
North Andover Board of Health
27 Charles Street
North Andover, MA 01845
Attention: Health Agent
Reference: FAST°Wastewater Treatment System
Serial Number: 24751
Attached please find the Field Inspection & Service Report and test results for services
performed on 08/24/2005 at the property of Michael Koenig located at 45 Bridges 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: Michael Koenig
Massachusetts DEP