HomeMy WebLinkAbout2016 Sep 13 - I/A Inspection and O&M Form with Additional Inspection Notes Massachusetts Department of Environmental Protection
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", Bureau of Resource Protection - Title 5
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DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When Mathew B. Homer
filling out forms Owner
on the computer,
use only the tab 56 Jills Path
key to move your Facility Street Address
cursor-do not West Yarmouth
use the return /
key. ��� C�7 �7'T � �7 � `' ��7lv Z1p
�11 Mailing address of owner, if different:
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� Street Address/PO Box:
� Ciry State Zip
( ) - ext.
Telephone Number
B. Authorized Service Provider
Siegmund Environmental Services Inc
O&M Firm
100 Lafayette Street, Suite 303
Street Address
Pawtucket RI 02860
City State Zip
�01) 785-0130 e�.
Telephone Number
Winston A. Steadman II 13182
Certified Operator Name Certification Number
C. Facility/System Information
X240509 Norweco Singulair 960-500 DN
DEP ID Manufacturer ID Model Number
8/12/2016 8/12/2016
Installation Date Start of Operation
Approval Type: ❑ General � Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes � No
D. Operating Information
8/12/2016 N/A
Inspection Date Previous Inspection Date
� Pumping Recommended ❑ Yes � No
Sludge Depth(to be checked yearly)
t5aiom.doc•rev.04-11-13 Page 1 of 3
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
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown � clear ❑turbid
❑ Other(specify):
Odor: ❑ musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ❑ some
pH 6 to 9 Su �� 2 or grea eg/L Turbidity qo or IesNTU
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:
220
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:
Installation of Mechanical equipment, inspection and programming of panel, observation of pumps,
aerator and alarms for proper operation.
Notes and Comments:
Please see additional notes dated 8/12/2016(to be made part of this inspection document)for more
information pertaining to this inspection and certification. System is read to receive flow.
t5aiom.doc•rev.04-11-13 Page 2 of 3
Massachusetts Department of Environmental Protection
���;"1 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
Massachusetts certified operator in accordance with 257 CMR 2.00.
Digitally signed by Winston A.Steadman II
WI ClSt011 A.St2dC�llld 11 �� DN:cn=Winston A.steadman ll
Date:2016.09.1313:38:58-04'00' 9�13�2�16
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 315�of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31�h of each year for the previous 12 months
General Use—by September 30t''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
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SITE 56 Jill's Path West Yarmouth
Date: September 12, 2016
Re: Inspection additional notes
Components installed per plan except for the following;
• 1"Recirculation Pipe—Schedule 40 PVC pipe specified, non-rigid poly pipe used.This
will not affect the proper treatment of recirculate. In time pipe could collapse stopping
flow back to head works which will cause removal and replacement of pipe at owner's
expense.
• Recirculation Chamber Penetrations - foam around penetrations of recirculation
chamber was used instead of the rubber grommets that were supplied tank. Foam may
degrade over time and does not allow for ease of shifting pipe movement.
Neither of these two items will effect proper operation of the treatment unit as a whole.
Owner's rep was notified as to the possible future premature failure of these components.
There is no warrantee expressed or implied with acceptance of these items.
Digitally signed by Winston A.Steadman II
Winston A. Steadl�Y�al� II DN:cn=WinstonA.Steadmanll
Date:2016.09.13 13:40:06-04'00'