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Massachusetts Department of Environmental Protection ��GC�b�D
� Bureau of Resource Protection - Title 5
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�'�, DEP Approved Inspection and O& M Form for Title I/A
Treatment and Disposal Systems HEALTH DEPT.
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A. Installation B. Authorized Service Provider
7Q Breezy.Point Rd South Yarmouth 02G64 Stephen B.Nelson
Facility Street Address O&M Firm
Owner: 175 S rin Street Rockland,MA 02370
Dana Spada Street Address
28 Glen St
Whitman MA 02382- 781-g�8-3849
Telephone Number
Daniel 17153
Telephone: (781)447-0872 Certified Operator Name Certification Number
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'; C.FacilitylSystem Information
Jet-500 4/29/2003 5/1/2003
DEP ID Manufacturer ID Model Number Installation Date Start of Operation
� __
Approval Type ,General !Provisional _ ',Piloting X J Remedial Seasonal Res-used less than 6 mo./yr ,_f Yes i X i No
___ _- __ _____ __-- ---_ __ _-- ----- -- - _-------_ _.__ _-._-
._
D.Operating Information
11/24/2015 6" �L-_--;Yes �X,No
Inspection Date Previous Inspection Data Sludge Depth(to be checked yearly) Pumping Recommended
_--- -____------ --
_ _ -------- -__----- ----
E. Field Testing
Field Inspection; . '-
. _.
'. Color i ;gray �J brown"`�]clear [�turbid ❑otfier:
_.,
Odor: � �musty � ;earthy !, �moldy � .:i offensive '�x i other: Odorless
Effluent Solids: x 'no _�some pH 7 SU p0 4��•--•- Turbidity �•92NTU
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 StandaTd Methods and anatyzed for BOD and TSS.
_ ___ __ _ _ _ __ __ _ __.._ _ ---.. ____ . _ _ _
F.Sampling Information Parameters sampled: Commercial systems or G. Inspection and Maintenance
Samples: systems with a design flow performed routine operations and
of 2000 gpd and greater, maintenance service.System operating
Influent and General User nitrogen normally at this time.
reducing systems:
Effluent
220.00
gPd
�
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H.Ceri�cation
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 CMR 2.00.
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I c�,y"" ui"-���-'" -_..__. . l l/24/2015_ -
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Operator Signature Date
i
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_ -,I
, __ �
� Service Checklist
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� Company Name �Stephen B._Nelson -__ ---- -._----- __- ----_. _._-- ----__----I
_ _ _ __ _ __ .
j - -- __ - -- - -- __ _ __
Job ID 70 Breezy Pomt Rd, South Yarmouth, MA �
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- - -- -- --
, Aerator Serial# � _ _ _ _ _ _ _ _ _
� Date of Service 11/24/2015 _ _�
Technician �aniel �
Control Panel Tank(Generall
Switch Operation Access cover secure Yes �X� No i ,'
� Continuous Run Yes ,_X; No L, Risers Condition C3K Yes �; No ; _;
Timer Settin � x I '�x'� �
S On i_�� Off;_ Inlet open Yes I_, No L]
Alarm Outlet open Yes � No I_]
Alarm OK Yes � No [� � Effluent Turbid or Foamy Yes � No �
f X ' Effluent Sample Odor Yes �
; Control Panel Accessible Yes �_.; No �_.J �, No ,'x,I
� _ - ___ _
' Voltage to Aerator(volts) L123 2 ' Effluent Sample Color �Clear ;
� -_ .
Current to Aerator(amps) '3.6 ' Media in position Yes ,X; No �� ;
; _ . ____ __ �
' -
E Media Air Cleaned (Yearly) Yes I No ;�x i
� Aerator& Castin� _ _ _ ___ ,
Sludge Level Pretreatment L"__ _ �
Vent cap openings Yes [X�' No '� �
Scum Depth 4" �
Excessive Vibration Yes ❑ No ❑X �
Tank Pumpout Required Yes � No
Plug/Connector watertight Yes � No ❑ �-,
Effluent Pump OK Yes �] No �_�'
Foam Restrictor Clean Yes �X� No [J
j Shaft Cl�an yes (X i No ! __,�� Effluent Sam�le Data
Aspirator Tip clean Yes �X� No ,_; pH L�,pp !
--
--, ,-_,
Motor shaft clean Yes I X i ' DO �
__, No ! .J �4.00 I
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�_ _--- ____ � -
Air Flow reading(CFM) �2.1____ _ __ � Turbidity ��2 —i
----�
Lab Sample Yes ❑ No �X]
� ..� _- _. _
I SIGNATURE: �� ""' �
�_�
1
� ,� 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. tnstallation B.Authorized Service Provider
70 Breezy Point Rd Sou[h Yarmouth 02664 Stephen B.Nelson
Facility Shee[Address O&M Firm
Owner: I75 Spring Street Rockland,MA 02370
Dana Spada Street Address
28 Glrn St
Whi[man MA 02382- 781-878-3849
Telephone Number
Stephen 3891
Telephone: (781)447-0872 Certified Operator Name Certifica[ion Number
I C. Facility/System Information
Jet-500 4/29/2003 5/1/2003 '
DEP Ip Manufacturer ID Model Number [nstallation Date Start of Operation
Approva]Type: j �General C Provisional U Piloting �Remedial Seasonal Res-used less than 6 mo./yr �Yes u No
D.Operating Information
7/29/2015 2" �Yes �,��No
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Inspection Date Previous Inspection Date Sludge Depih(to be checked yearly) Pumping Recommended
—._.__ ..__ ..
_._ . .... . . . . _. ._. _ ... ... . __ __. . _. .. . . _.______.
E. Field Testing
Field Inspection:
' Color: �gray �brown �cleaz ❑turbid ❑other:
Odor: �musry '�earthy �moldy ❑offensive �other: Odorless
Effluent Solids �no ❑some pp 6.8 SU p� 3.5 me/L Turbidity 3.23NTU _
� 6 to 9 2 or greater 40 or less
Should a Remedial or Grneral Use system fail the Field Testing,ettluent samples shall be collec[ed per Standard Methods and analyzed for BOD and TSS.
F.Sampling Information Parameters sampled: Commercial syscems or G Inspection and Maintenance
Samples: systems with a design Flow p�formed routine operations and
of 2000 gpd and greater, mainrenance service and system is operating
� Influenl and General User nitrogen nofmally at this time.
reducing sysrems:
Effluent
— 220.00
8Pd
____ .__. ._.
H.Cerdication
I certify: 1 have inspected the sewage ueatment and disposai system at the address above,have completed[his report and the attached ,
manufacturer's operation and maintenance checklis4 and[he information reported is true,accurate,and complete as of the time of the I
inspection. I am a Massachusetts certifieA operator in accordance with 257 CMR 2.00. I
�"'7r`� ��� 7/29/2015
Operator Signature Date
i
� T � Service Checklist
Company Name Stephen B.Nelson �
Job ID 70 Breezy Pomt Rd South Yarmouth, MA
�---- '
� �
Aerator Serial# i�
___ __.____ __
Date of Service 7/29/2015 �
� --- __ ______ --- - —J
_ — - -_ _-- -- --- - _
Technician Stephen �
Control Pauel Tank(General?
�
Switch pperation Access cover secure Yes � No I__ 1
Continuous Run yes n No ❑ Risers Condition OK Yes [X] No [ ;
Timer Setting On [I Off n Inlet open Yes � No ❑
' Alarm putlet open Yes � No �I
Alarm OK Yes �,xJ' No i�J Effluent Turbid or Foamy Yes ❑ No '�
Control Panel Accessible Yes �I No ❑ Effluent Sample Odor Yes ❑ No !�
Voltage to Aerator(volts) 120.4 � Effluent Sample Color �Clear �
Current to Aerator(amps) 4.6 1 Media in position Yes � No ❑
Media Air Cleaned(Yearly) Yes ��� No �
Aerator& CasNoe
Sludge Level Pretreatment 2"__ _ _ ,'
Vent cap openings Yes ',x! No __ $cum De th 5" �
P I —___ ._�
Excessive Vibration Yes �_i No ;_X'
u Tank Pumpout Required Yes � No [�
Plug/Connector watertight Yes � No �
Effluent Pump OK Yes � No
Foam Restrictor Clean Yes ❑X No ❑
Shaft Clean Yes � No ❑ Effluent Sa�le Data
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Aspiretor Tip clean Yes u No J pH �6.80 �
Motor shaft clean Yes �] No ❑ DO 3.50
_ _ _ _ J
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Air Flow readin CFM 2.1 ' Turbidi 3.23 �
B� ) � ----- - tY -- -
Lab Sample Yes [__i No �X I
,�'�" t3��.—
SIGNATURE: