HomeMy WebLinkAbout2003 09-24 P r� - �,� ,,�- �� �
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� Massachusetts D�partment of Environmentai Protection
� Bureau of Resoutce Proteetion-Title 5
� QEP AN�roveci Ins�ection and O�M Form �or T�tie � I/A
Treatment and �isposal Systems "
A. �nsta�liation -
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forms on the L � (111 [1->
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to ewve you�
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use tha ratum
key. Mailing a dress of owner,if di�Ferent:
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Telephone Nomber
B. Au#ho�ized �ervice Pr�►vider ,,,� �
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. O&M Fxm � � �Q� �1�I•t�/� �-Q.— _
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Certtfied Opa�Name Certiricatfort Numbar �
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G.•FaciiitylSystem tntormation �
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�EP ID Man a�urer tD ���'R'� :
lnstaqauon D'abe
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Apprcva!Type: [f General 0 Pravisional i{at�ng� Rer�edial i
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Seasvnal Residencs—used leSs than 6 ma:tyear:[]Yes l.allo ;
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D. Operating 4nformation �
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�nevectlo�oate ' pr�wi�s� ae�on ate
si �e ote (�o�e c�,edoe�yea I �'umPing Recammended [�Yes�o f
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- � Massachusetts Depa�+-tment of Environmental Protection ��"��O Z--
. � Bureau ofi Resource Protection -Title 5
�� DEP Approved Inspecfiion and 0&M Farm for Title 5 1/A
Treatme�nt and Disposai Systems
E. Samp{ing tnformati
Samples Taken: ❑ Influent Effluent ����
Parameters sampled: �pH �BOD TSS TN [j Other(list below)
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Other 1 Other 2 Othe
Description of any maintenance perfoRned since previous in pection 8�during this inspection:
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Notes and Comments:
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F. Certifica#ion
I certify: 1 have inspected the sewage treatment and disposal system at the address above, have ;
completed this report and fhe attached technology operation and maintenance checklist, and the
mation reported is true, accurate, and complete as of the time of the inspection. I am a
Mas achu s ified o rator in accordance wifh 257 CMR 2.00.
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ra or Sign e Date �
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System owner must submit this report,te�+mology O&M checklist, and any required sampling results ;
to the local board of health and DEP as follows for each inspection performed: i
�a;;;��ial !;sf�-�•�t�anu3nr E'i�etir�g � Provis9onal Use- General Use—by September
31�"of each year for the within 30 days of inspection 3U'''of each year for the
previous calenda�year date previous 12 months �
Department of Environmental Protection f
Attention: Title 5 Program i
One Winter Street, 6�' Floor ;
Boston. MA 02108 �
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T51AOM1 •1/2/03 Page 2 of2
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SiNGULAIIt SERYICE C��CK LIST
����E���� Sa filta upright in tub,run
cleas:watet itlto it until the
SESI NO.__. /J',�.A'�� � /�a Y�O3 watet flows wu of d�e hole en
DATE�F SERVICE:,_„ f ttw f�ange.inaut compressed
� 5ERVICE PERF(?RMED BY:�M air hose and agitate with air.
{imNvs)
Kap agitating wit6 ckan '
watcr s3owly fbweng until the '
L.ocadoa Work to be o�fostped �ne exitipg water is cttar. j
�rst Remmre ooncrcce cova,chec# Fic�ish bosiag down filter �
c6smber for nortns[�vater 1evc1
ScraQc hcPper I
�st�ae�h e�r Appty lubricsnt to filru.ftaage
Yar ��
Secoud Remove ooaaece cover �
�p��. Plta filter in phce,fill vrith i
� ckxr w�eer aad sink it �
Co�a o�n�a s���corrr' . 1
anter pcxitioa� _ Turn o�t locking tabs.i+epiace '�
fihar(x�ver •
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Ur►plug x�ana Iifc ouc _ FinY iteplaoe conaece co•�
. •- t�mi�ar i
C;Seck Por worn rubber pads .
Sceond Plug in aen�4*
C7�adc for wear vc pcvMem.� c6am6a' : ;
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Check wite in siser f��af�s, Cn;i witz so it is not m contact
tape if nxded ��cn anything ' ,�
WesL of!aeretrf p�a it bsck Replace eonaece oower .
x��.����x c� ��;«�on"AUTO~ :
cu�rnu r+c�n aerator ivoning. o�r position I �
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ciose�sd�ock�ovcr , .
Tldmd Ra�tovc oo�e rnver snd I
s�smber re�fiove filoer top_ Ttead and:eaond hour metcr I
11sn D►blsdc Ixlung tabs Paper ].cavs ootioc of savicc with � ,
.rork ow�er v.Q�:i
Iastall pomp aad statt Qutnpi� I
from fila�r to fusr ettuaber. ' Note m mmper�*fiie anY �
Lift tilter with mpe at icregulat'sry or�vbiem � ;
n�rcY- � i
l'ndicate if aery follow-up is �
i.�t otu ftt0er,pat it�tub �y i p
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C1qu det w0side of filtet with Be s�ur to coatpieo�file oa {
wate�diaia bsdc oo first SCcvicz.rctusn it co office ,
. chamber
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TOTAL P.01
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GROUNDWATER
ANALYTICAL
Inorganic Chemist
rY
Field ID: FE
' Matrix: Aqueous
Project: 64 Mellville S.Yarmouth Received: 09-25-03 17:20
Client: Siegmund Environmental Services
Lab ID: 65308-01 Sampled: 09-24-03 16:00 co�w+�:500 mL Plastic Preservation: H2SO4/Coo)
����.:
Nitrogen,Total Kjeldahl(fKN) 10 mg/L 0.5 7 20 mL 1606-03 11:02 TKN-1792-W EPA 351.2 7 AVB
Lab ID: 65308-02 Sampled: 09-24-03 16:00 co�a;�,: � �p��t�� Preservation: Cool
N�� - �. ,
.4= :. �. , �..-. �;,,.:, ;� ;�k',:w . r�rz:_'�" "�`�� ' � � � . . . .. .�.� +n�"y�
Biochemical Oxygen Demand 25 mg/L �� 60 5 mL 09-26-03 18:23 BOD-1437-W SM 5270 B 3 DDW
Lab ID 65308-03 Sampled: 09-24-03 16:00 container: 1 L PlastiC Preservation: Cool
�,� �� ��,�,� �, . _ ., ,
s � � r ,� � �m����;; � � ,� � = - __.,� „.„
, a :,,,�. F �_. �. �}� . -: :���a�,,„, ,�" '`' ,��:. ,.���� !1�N�ysC
Solids,Total Suspended 1T mg/L 10 i �s m� io-0i oa oa:ao rss-oa�9-w sr.�zsao o a nnw
PH 7.5 pH NA 1 50 mL 09-25-03 22;70 PH-1545-W SM 4500-N+B 2 DDW
Lab ID 65308 04 Sampled 09 24-03 16 00 Contamer � �p��t�� Preservation Cool
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a,x. �s�°.' .V ��§:'� �-,. ,, ,. <R�ti,[�, 1�i�i�� ,�,1:,-. '`" �1 �-'� ' F„�c�+ss4�;', t��'!4lr9i��st
Nitrate(as Nitrogen) 0.8 mg/L 0.1 s i m� 09-25-0322.21 NI-1893-W SM4500-NO3 F i �ow
Nitrite(as Nitrogen) 11 mg/L 0.1 s i m� 09-25-03 22:21 NI-1893-W SM 4500-NO3 F i oow
Method Reference: Methods for Chemical Analysis of Water and Wastes,US EPA,EPA-600/4-790-020(Revised 1983),and Methods for the
Determination of Inorganic SubsWnces in Environmental Samples,US EPA,EPA/600/R-93/100(1993),and Standard
Methods for the Examination of Water and Wastewater,APHA,Twentieth Edition(7998),and Test Methods for Evaluating
Solid Waste,US EPA,SW-846,Third Edition,Update III(1996).
Report Notations: BRl Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be
reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution.
RL Reporting LimiL
DF Dilution Factor.
1 Instrument ID: Lachat 8000 Autoanalyzer
2 Instrument ID: Accumet AR50
3 Instrument ID: Y51 5100
4 �nstrument ID: Mettler AT 200 Balance '
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Croundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532