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HomeMy WebLinkAbout2021 Annual Report - Shaw's #22 dala 260 Cranberry Highway .••-J./, Orleans,MA 02653 TRANSMITTAL 508.255.6511 P 508.255.6700 F COASTAL Orleans I Sandwich I Nantucket engineering co. coastalengineeringcompany.com To: Bruce G. Murphy Date: 12/28/21 Project No. WYA024.00 Yarmouth Board of Health 1146 Route 2877 Via: Hist Class Mail ElPick up IXIDelivery IFed Ex South Yarmouth, MA 02664 Subject: Yarmouth Shaw's Supermarket 1106 Route 28 South Yarmouth, MA n Plans n Copy of Letter I I Specifications n Other We are sending the following items: Copies Date No. Description 1 12/28/21 WYA024.00 2021 Annual Operation & Maintenance Report These are transmitted as checked below: nfor approval jfor your use Has requested nfor review& comment Remarks: By: Chad A. Simmons CAS/acc Cc: DEP, Title 5 Program Shaw's Supermarket, Inc. D:\DOC\W\WYA\024\Annual Reports\2021\2021Annual Report Transmittal.doc NOTE:If enclosures are not as noted,please contact us at(508)255-6511 CEC File No.: WYA-024.00 YARMOUTH SHAW'S SUPERMARKET WASTEWATER TREATMENT PLANT 2021 ANNUAL OPERATION & MAINTENANCE REPORT _ YARMOUTH SHAW'S SUPERMARKET 1106 Route 28 South Yarmouth, Massachusetts DEP Transmittal No.: W033722 Prepared for: SHAW'S SUPERMARKETS, INC. 750 West Center Street West Bridgewater, MA 02379 Prepared by: COASTAL ENGINEERING CO., INC. 260 Cranberry Highway Orleans, MA 02653 d2cL COASTAL engineering co. D:IDOCIIMWYA10241Annual Reports1202112021 Annual Report S1.doc da#11 COASTAL engineering co. Project No. WYA-024.00 December 28, 2021 Bruce G. Murphy Yarmouth Board of Health 1146 Route 28 South Yarmouth, MA 02664 RE: Yarmouth Shaw's Supermarket 1106 Route 28 South Yarmouth, Massachusetts Transmittal No.: W033722 Dear Mr. Murphy: In accordance with the approval dated 1/30/03 for the Innovative/Alternative wastewater treatment system at the location referenced above, enclosed please find documentation for the operation and maintenance of the treatment system for the year 2021. Included with this report are: • Tables and graphs summarizing the analytical testing and the performance of the facility • Appendix A— Plans showing the treatment system location and details • Appendix B - Monthly Field-Testing Logs • Appendix C - Field Inspection Reports prepared by the system's wastewater treatment plant operators, which summarize the measures conducted to adjust and maintain the system • Appendix D - Copies of the monthly Discharge Monitoring Reporting Forms, which summarize the monthly analytical test results • Appendix E - Laboratory data sheets for the monthly analytical test results The purpose of the wastewater treatment system is to provide for the collection and treatment of sanitary wastewater resulting from the commercial uses of the Yarmouth Shaw's Supermarket in South Yarmouth. The system has been designed and sized to treat wastewater from the Shaw's Supermarket. The site is supplied with water by the Yarmouth Water Department. The wastewater treatment system, as approved, includes two 1,500-gallon grease traps, one 3,000-gallon grease trap, one 16,000-gallon septic tank, one 3,759-gallon media filled pre-aeration tank, two Bioclere treatment units, one 2,000-gallon equalization tank, one 2,000-gallon anoxic denitrification tank filled with filter media, one 2,000-gallon settling tank and a 5,000-gallon pump chamber prior to subsurface disposal by pressure distribution. The treatment system also has provisions for alkalinity adjustment and supplemental carbon addition through chemical dosing systems. Yarmouth Board of Health Yarmouth Shaw's Transmittal No.: W033722 2021 Annual Report The wastewater treatment system was commissioned 5/19/05. It operated until the end of November 2005 when it was shut down for remodeling of the supermarket. The building was demolished, rebuilt and the existing treatment system was reconnected to the newly completed building. The reconstruction was completed, and the treatment system was turned back on in June 2006. The system has been under the supervision of certified wastewater treatment plant operators, Grade 4 and above, making weekly, regularly scheduled operation and maintenance (O&M) visits and inspections through December 2021. OPERATION & MAINTENANCE The facility has been serviced by wastewater treatment operators weekly during the year, more often when indications required adjustments to the wastewater process, in response to alarms or to correct equipment settings, timing, and feed rates. During each O&M visit, standard Bioclere maintenance tasks were performed. These tasks included in part: • Check condition and appearance of the system components including covers, gaskets, latches, and locks • Check fan operation and fan wiring • Check and characterize biomass • Check dosing and recycle pumps for proper operation including spray nozzles, effluent clarity and spray pattern • Check control box switches, alarms, timers, relays, etc. • Check the pre-aeration tank general condition and operation • Check and adjust chemical feeds as necessary • Check grease traps, septic tanks, EQ tank and pump chamber for solids accumulation. • Check the operation and condition of the anoxic tank, and backwash as necessary. Appendix A includes plans from the original permit submission set showing the location of the system and the details of the system's components. Appendix B includes the field testing logs that document the recording of flow, various settings and the field test results for key parameters. Appendix C includes the individual Field Reports completed by the wastewater treatment plant operator which detail the findings and results of each O&M visit, including problems observed, corrective measures taken and adjustments to the system's timers and chemical feed supplements. Except for two Bioclere dosing pumps and two Bioclere fans requiring replacement during September, the Bioclere Wastewater Treatment System operated properly through the year. WASTEWATER SAMPLING On 7/8/09, the Department of Environmental Protection (DEP) approved a reduction in sampling based on the solid performance of the treatment system. From July 2009 forward only effluent total nitrogen has been sampled monthly, in accordance with the DEP-approved reduction. The effluent sample is collected after the anoxic denitrification tank. Field testing of key parameters has been conducted during regular O&M visits to make adjustments to the system for process control. Table 1 summarizes the 2021 sampling history at the site. This table includes the monthly sample results. Appendix D includes copies of the Discharge Monitoring Report Forms, which have been submitted in the monthly reports to the DEP. The laboratory data sheets for the analytical test results are included in Appendix E. The sample results for total nitrogen have been graphed to show the results for this parameter since the plant has been operating. The months of January, February, March, October, November, and December tested below the discharge limit of 25 mg/L. Overall, effluent total nitrogen tested above the discharge limit of 25 mg/L for the months of April through September 2021. During September two Bioclere dosing pumps and two Bioclere fans were replaced, immediately after these replacements the system tested below the discharge limits for total nitrogen. Sodium bicarbonate is being added to the Yarmouth Board of Health Yarmouth Shaw's Transmittal No.: W033722 2017 Annual Report system to raise the pH and alkalinity to enhance BOD and TSS reduction and nitrification of the wastestream. Methanol is added to provide supplemental carbon to promote denitrification. Field testing is conducted regularly to guide adjustments to the chemical dosing systems and to adjust timers and settings. Sampling of the wastewater treatment system will continue to be conducted in accordance with the DEP approval, and as needed in order to achieve and maintain process balance and control. WATER USAGE Water is supplied to the supermarket by the Yarmouth Water Department, which maintains a town-wide water distribution system. The flow is calculated using the pump starts and pump run time. Table 2 summarizes the average effluent flow through the facility. This table shows that the approximate total yearly flow through the system was 1,186,656 gallons, averaging 3,190 gpd, which is below the design flow of 5,040 gpd. PUMPING No pumping was conducted during 2021. Per Jeff Wall, pumping is scheduled for next quarter. O&M visits to the system will continue to be performed weekly, and more frequently as necessary. Monitoring of the system, including monthly sampling for effluent total nitrogen and interim grab field testing will be conducted in order to assist in process control. Based on the sample results, the system's chemical supplements and equipment settings will be adjusted to provide maximum treatment of the wastewater. Please do not hesitate to contact me directly if you have any questions regarding this report. Very truly yours, COASTAL ENGINEERING CO., INC. .' ? (, 7 Chad A. Simmons CAS/acc cc: DEP, Title 5 Program Shaw's Supermarket, Inc. 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V1 r-+ -1 r-I r-' r-i ,-i N N N r-i ,-y N Li. V1 ,-4 r-i r-i r-1 ,--i N N N ,-i r..1 r-I r-I NO CO -- W CC G a >' ? Q y 7r v l v v �t . v in in Ln Ln Ln Ln Ln Ln Ln V1 O 0 D O O O o 0 0 0 0 0 r� O O O CC CA N V N N N N N N N N N N N N O N N O O N N N N Q l0 .("Z;5 + tT }' CO N Ln n V ,�-� m O1 LA LU �-' \ \ N Ql O V N r\-+ f l \ \ \ o V=1 OO .-+ N INN ,, , el I'- O N , m N N c--, O 0. 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Cl m N Cf .N-i O - w In v N \ O L=/1 .~-1 d 0 < J N m V L i LOO N. co\m Q\1 ,-�-. ,N-i N 0 ,J ,\-I N m v in LO N co\ cn ,moi N N N M o M 0 0 N O a a > o z z ,_, J C J C Q Q1 m O N N. LI) Cr) Q W N. Lf1 LD in i D d- N. o o ‘-I o ‘-, 01 ,-( Ln CO I O LD N. r\ m rn m N m p O Lo p p N Lf) 06 r-i O 6 ao N Ln 0 u, N. Lf) O O N LD - N n m - F- W N r .--i V .--i N m N N .--i .-i .--i nl I- W N Ol -I -1 4m n -, .�-. ul m n r: C C r Q) Z D o 4 o o ' LD m m LI - co Z D O N. RI m N. LLo O m LD W W Y m n Lfl .--i 00 n-j Ln ti Lrl Y ' 0) N N in N LD .`-i O J H W LO Ol - .-+ N m N .- m v m m F- W al ti m m n .N-1 CO Lf) m N. LD CO— Q F- W w ~ ~ C — Q aiO •• '• O O O Q a1 IX D -i o 0 .--i r-i p o N = D .--i p Ln O O p o 0 0 0 COO V 0) f- f Ln 0 0 0 0 O lD N CU O p F- m `� �t N. O r._; Up .-± 0 Z W o .-i v v v v v LD N. r-i O) v Z LU O o C) O v v N m v V V O I cLU o LD LD O O o C O o O - D CO Ln 0 o tri Ln Lfl CJ In N LoLD Ln L) O O O o o N N- Ln Lo p cc D O N o o 01 N. LD ^ p Lfl N - H 0 0 N N r-i 4 F- d O d m m m .--i .--i O N N Z LU O p• 0 v 0 0 O O o O O v Z W v o v 0 0 0 0 o V O o 0 C Ol I vN. Lf D o 0 0 0 m m O D d' m 01 LO O O .--i N V m LD O = l u1Lf1 O Lf) Lfl Ill Lf) Cr Lfl 2 LO d- r---- V o .--1111 m m d' V Lfl 0 G LU N. N. N N N. N. N N: 0. W N N. N. N. N. N. LD N N. N. N. r< r< N. N. N. X x Q N y a) 2 CrI- 2 O > o 0 LD LI1 01 CO N. n LO '1- 4 N O 0 m Lrl m Lp 00 CO n 00 lD N LI1 ti F- 0 0 d. 0) Lrl 0 •-i m O 01 .-i N N LN.n al O d, m p d' Ln LD 1t .-i Lf) m LO p LD r� O N J O O O O �t Ol O 0) VD N Ln 01 J O N. N. 0 c-+ 0 t O CO V O .-i 01 LL L(1 N rrl m rrl m rrl rrl rr1 M. LL rr1 N N Lf1 N N m rr rn rr rV rrl rri rr1 m rrl p 00 ci > _ 2 W d } M a CO o CO CO o ao ago co CO CO CD cy)01 rn al rn rn 01 01 01 rn N o C n (2 RI N RI p N N ni O N rp N O A rO�J p N N O N O O p N O OCO W �. \ 01 n \ Ln \ \ \ \ W }, \ N \ \ \ \ N N N \ O - a O 7C:-; . 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Ln pmor1 Z 6iO mo Ln 06 o fllDLJ I- LU � IN Z L F- LU m LO Ln 0 - 0 0 ^ 0 0 0 LD 0 M Q • rLn ,--4C1 r1 1 COrr-, Ln O I- O ri 0 0 0 0 0 0 N 0 w w ._ Q 0O Q v CC 7 0 0 0 o o r1 o 0 p CC C F- w r1 r1 VI o N Ln 0 N N m N F- w Z W r1 O N N .--, Z v m n %--1O Ln r1 Z W — O CO Ln 0 d" 0 0 0 LD Cr Lf) - N Lf1 N r1 Ln CO Lf1 InLl1 Cl 0) O o O O O N O O O o O p O O O O O O O O _ _ V V v V V v I- C O LD FW- 0 CU N r\ N 0 a) CC C Ln N O N N. 0 .-1 0 01 CO 0 CC C - F- r1 0 0 Ln Ln lJ1 W6 Oz Z W � LD - Ln L) 0 Ln 0 0 0 0 0 LU cr In 7r `-! 0 0 N N N LD N- n ti n ^ n n n n n n n C C aJ a) = C 0 In 01 0 N 0 p 0 m 0 r1 C F- = w m 71- '72- CO O O Cl r1 m N Ln Ln = w 0 Cl. W N rN N LD N N LD rN N N rN N 0. W - = LD Ln co a> -' m N LD ‘-' 71- L11 x Ct N LI) LIl m LD 00 LD rN Ln VI N m 0 } co- ni N ni n'1 m rr1 n'1 n"1 ni frl N 2 a = m > O N Ln p Ln r~ ' r---, N r-., m o o my F- 0 p v. O 0 r1 p LD N C1 CO LD apO �, N r� c1 .-t N C1 N N O O r- J O LL in mi. N m m frl N (rl m m m m N LL in NO ce N O Lu G o O O r♦ a O r1 O Q O O N N N O NOjr\J r r1 N N N N N N N N N CC {� O0.0p N N 0 0 0 0 p N 0 N 0 N N p 0 p o p p O O O N cc n N O O N N N N \ N \ \ N n O N N \ Nr N N N \ O Q W O N F- _ V \ \ o r\1 0 O I� \ Ln m r L W ar \ N N Ct N 0 N. N N1 LO N O _ = O E r1 N N .1 r1 N CO \ \ N CO N N N .-1 N m N \ c1 \ O V1 .~-1 d N 0 J r\-, N In V Ln LD N CO C\1 O� r-1 .N+ N 0 J N N m In LD N CO\ 01 0� .•'ii rN-, TABLE 2 Yarmouth Shaw's Supermarket Bioclere Wastewater Treatment Facility 2021 Effluent Flow Reporting Monthly Effluent Days Average Daily Month Flow(Gallons) Effluent Flow (GPD)';_ January 2021 105,726 35 3,021 February 2021 88,368 28 3,156 March 2021 91,524 35 2,615 April 2021 96,258 28 3438 May 2021 91,524 28 3269 June 2021 118350 35 3381 July 2021 102,570 28 3,663 August 2021 121,506 35 3,472 September 2021 88,368 28 3,156 _ October 2021 99,414 28 3,551 November 2021 97,836 29 3,374 December 2021 85,212 35 2,435 2021 Flow 1,186,656 372 3,190 D:\DOC\W\WYA\024\Annual Reports\2021\2021 Table 2 Report 52.doc Li o a o o0 11 M N N .- u, O i L I .. L ,_ .. 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I 1, 1 : 1 • I i 1 , 1 I 1 2021 Annual Report WYA024.00 Shaw's Supermarket, Inc. — APPENDIX C — 2/11/2021 Permitlnspections Barnstableeo e i is* Austin Cahill-Coastal Engineering, Co.Inc. 9:06 am Main Submit My Clients My Reports Help Home>Jnspections>View llnspmcbon , la Cancel , pror,erty Details "Inspectonj i i Address 1106 Route 28,Yarmouth ' , 3 P nt lily*1 Owner Shaws Supermarkets,Inc. inspection Details Component: Bioclere Date: 2021-01-04 — Time: 09:15:00 Operator Name: Kevin Rezendes License#: 17282 t G Comments Operation and maintenance conducted—system operational at the time of the visit. ( 3 Field Testing Color: Clear Odor: Musty Effluent Solids: No — pH: 7.6 SU Dissolved Oxygen: mg/L Turbidity: NTU 1.. j Settleable Solids: { Site Conditions i Seasonal Residence: No I Air Temperature: °E l Weather Conditions: ' [ —_ __ i Operating Information – --• I Sludge Depth: in Scum Layer Thickness: in Pumping Recommended: J No Soil Absorption System Observations Signs of Breakout: No I Depth of Pending: in Ponding Above Invert: No Maintenance Issues Any Apparent Violations of the Approval? None Reported Any Cleaning or Lubrication of Parts None Reported Performed? I Any Control Adjustments Made? None Reported — https:/iseptic.barnstatalecountyhealth.arg/app/permit_inspectionslview/M IhN8jLIZu el3D PIDvYr1 w 112 L2/11/2021 Permitlnspections L ' , Pumps,Switches,Alarms Tested? Checked panels,timers,amps,switches,tank levels, alarms,and general condition of the system. E I Any Equipment Failures? None Reported L j Any Parts Replaced? None Reported ii.. Any Recommended Corrective Actions? None Reported Li Inspection Completion.. li Inspection Completed? Yes ��i I :Technology Checklist Odor Around Sitel Yes!` ;No £ Source of Odor Not Reported. L Odor Descraptton "rv^ . tg= MustySeptic L 1Check all that apply I 1 I L ` Scum Depth in Primary Tank Not Reported. i Sludge Depth in Primary Tank Not Reported. I 3 ; Does Grease Trap Need Pumping '=Yes::'No I jUnit 1 .. .. Y.�: , Wiz, ; Air Passing Through Vent y Fan Operating v General I — External Damage ` Yes�.No ICover/Fan Box/Ctrl Panel Locked tJYesl J No Flies on the Unit ? ,Yesa_,No Number of Flies [3 Few Many ILocation of flies Not Reported. Locks/Latches/Handles Ok ',1/Yes 7.No _..f t Lid Gasket Ok Yes` No i Standing Water in Fan Box Yes"..?..)No L L L. https://septic.barnstablecountyhealth.org/app/permit inspections/view/MlhHBjLIZueI3DPIDvYrlw 2/2 e•• Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 l/A Treatment and Disposal Systems Important:When filling out forms on A. Installation "' the computer,use only the tab key to Shaws Supermarkets. Inc. move your cursor Owner do not use the 1106 Route 28 return key. Facility Street Address Yarmouth 02664 /tab City Zip Mailing address of owner, if different: P.O. Box 600 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information -- W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: General jJ Provisional X. Piloting 0 Remedial Seasonal Residence- used less that 6mo.lyear: ❑ Yes XII No D. Operating Information 2021-01-04 1 Inspection Date Previous Inspection Date Pumping Recommended 11 Yes X No Sludge Depth Massachusetts Department of Environmental Protection — Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 IIA Treatment and Disposal Systems E. Field Testing Field Inspection: Color: Gray 7 Brown X Clear 7 Turbid Other(specify) Odor: X Musty 71 Earthy �_ Moldy 7 Offensive Turbid Effluent Solids: XI No l..T. Some pH 7.6 SU DO 0 mg/L Turbidity 0 NTU 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 Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: 7 Influent , Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 3,021 qpd Parameters sampled:? pH Pi BOD J CBOD TSS 7 TN 11 Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: Operation and maintenance conducted—system operational at the time of the visit. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Massachusetts Department of Environmental Protection '- Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 1/A Treatment and Disposal Systems H. Certification I certify: 1 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. - r 2021-01-04 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 315t of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use-by March 31st of each year for the previous 12 months General Use-by September 31St of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street 5th Floor Boston, MA 02108 3/10/2021 Permitlnspections Barnstable County Septic Management Program — w Austin Cahill-Coastal Engineering,Co.Inc. 1:15 pm Main Submit My Clients My Reports Help — iicme>Inspections>View Inspection m $ ! = Cane Property Details Insp�ti�tf [-- ' , ;. ,1: Address 1106 Route 28,Yarmouth '� ;tint Inion ; Owner Shaws Supermarkets Inc - Inspection Details ' Component: Bioclere Date: 2021-02-08 Time: 11:00:00 I Operator Name: Kevin Rezendes L ! License#: 17282 1 Comments `,. g 'Operation and maintenance conducted—system operational at the time of the visit. 1 i Field Testing 1 t } Color: Turbid it Odor: Musty f ! Effluent Solids: No Imo i fpH: 7.4 SU Dissolved Oxygen: mg/L M I Turbidity: NTU ... Settleable Solids: i r Site Conditions, .. j Seasonal Residence: No ' Air Temperature: °t= Weather Conditions: Operating Information Sludge Depth: in Scum Layer Thickness: in I i Pumping Recommended: No ?I Sod Absorption System Observations Signs of Breakout: No Depth of Ponding: in Ponding Above Invert: No Maintenance Issues — Any Apparent Violations of the Approval? None Reported " 1'Any Cleaning or Lubrication of Parts IPerformed? None Reported Any Control Adjustments Made? i None Reported i i — httpsa/septic.bamstablecountyhealth.org/app/permit inspections/view/OxUg2mCxK1 U9PR_mZ6j1 nw 1/2 L3/10/2021 Permitlnspections Checked panels,timers,amps,switches,tank levels, Pumps,Switches,Alarms Tested? alarms,and gene-al condition of the system. Any Equipment Failures? None Reported Li f gj Any Parts Replaced? None Reported Any Recommended Corrective Actions? None Reported l ' � f Inspection Completion � Inspection Completed? Yes j - 1 Technology Checklist Odor Around Site 3 Yes. `No r i Source of Odor Not Reported. t dor Description thrid Medium Stronet Must y Septic Li Check all that apply i ( Scum Depth in Primary Tank Not Reported. } t iI Sludge Depth in Primary Tank Not Reported. Does Grease Trap Need Pumping �, Yes2 No '- Unit 1 NI!cIetc Vents Air Passing Through Vent Fan Operating General. .. . .. ( External Damage Yes rte--No j I Cover/Fan Box/Ctrl Panel Locked LJYes(;No { 1 Flies on the Unit Yes; No Number of Flies Few, Many j Location of flies Not Reported. 1 Locks/Latches/Handles Ok `.... Yes;, )No } Lid Gasket Ok YesNo r:t Standing Water in Fan Box [IYes': t No https://septic.barnstablecountyhealth.org/app/permit_inspections/view/OxUg2mCxK1U9PR_mZ6jlnw 2/2 Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/ATreatment and Disposal Systems Important:When filling out forms on A. Installation "' the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 _ return key. Facility Street Address Yarmouth 02664 rah City Zip Mailing address of owner, if different: IIP.O. Box 600 Street Address/PO Box: _ East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: `L] General [ Provisional Piloting '`i Remedial Seasonal Residence- used less that 6mo./year: LI: Yes X No D. Operating information 2021-02-08 1 Inspection Date Previous Inspection Date Pumping Recommended LI Yes X] No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 IIA Treatment and Disposal Systems E. Field Testing Field Inspection: Color: L Gray -J Brown ill Clear X Turbid L Other(specify) Odor: 'X, Musty L Earthy r- Moldy L Offensive L Turbid Effluent Solids: Xi No H Some pH 7.4 SU DO 0 mg/L Turbidity 0 NTU 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 Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: —I Influent V Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 3156 gpd Parameters sampled:Vi, pH C BOD J CBOD TSS 7' TN 7 Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Operation and maintenance conducted—system operational at the time of the visit. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Massachusetts Department of Environmental Protection Bureau of Resoure 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. j 2021-02-08 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 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use-by March 31st of each year for the previous 12 months General Use-by September 315`of each year for the previous 12 months Send to: Department of Environmental Protection Attention:Title 5 Program One Winter Street 5th Floor Boston, MA 02108 " 3131/2021 Permitlnspections y;,�■ {moi- ]$�$� �y■���■ ._ ., ..,_�.�..._.,.._..,._.,_,.,-: Bair-r table�c_ounty Septic Management Progra.l i -_ iw Austin Cahill-Coastal Engineering, Co. Inc, 12:25 pm L [Main Submit[My Clients My Reports Help Home>1pspecttons 'View Ipspection ._ •_ :7''.1..:'"":7. 0 1.1: Li „.. r.._ .. - ._,,.,, --- _ _ lsr�,perty-Detatils ;. _ x s-".. . :. ;Address ;1106 Route 28,Yarmouth 5 Owner Shaws Supermarkets Inc L r:':-•'21: -.,......,.--,....:....,.t-....Inspection Details= - Component: l Bioclere I '' Date __,_..„_._.____.,______,._____+2...0.._21-03•-22: LL: Time '09AO:OU'- -__._.__ _.._. _ :-•; -. [Operator Name:: ° :';i. is: - <.Kevin.Rezendes-,_>:::::: ---- - — • ___.____ License#: '17282 Ft Gvr3>Iment ` :'"-:=1.7::7i-.7:7,,,":::,,....„,,.,,,,.::,,,, L ,,, ,,, Operation and maintenance conducted—system operational at the time of the visit. Notified manager of high EQ.Field-tested&sampled effluent. L ,,,._... . _ . . - Fri d Testing L . Color: Clear ...__________________.____-_________., ,..._______ ..._.,.. _,::,.,_.,.„.7. ...,...., . . .._ .: .., :.... . . .:.:.:..: ry.. :is:, Odor Mus ,:. , ,... Effluent Solids: 1No , 4_ FOK 7:5 St! - Dissolved Oxygen: IL Turbidity NTU ' _ Settleable Solids: LSite Conditions Seasonal Residence No , = ______. AlrTeniperature _.... _ F - Weather Conditions: __ m __ _,,,_..„:„...,.._.:...!.,...„._._,:...„.....:...,.........„...._ ,.._.. ........7....,:..._?...._.,:.._ ..... . . , .....,.... .,..:.. ... ..: :_ , ,-. Operating Information ._ !Sludge Depth. in • :Scum Layer Thicknessin } _. i Pumping Recommended: No i . '� Soil Absorption"System Observations 1. :Signs of Breakout No _ = i Depth of_Pondlhg: . . -_ i ;in --:. - i Ponding Above Invert: ;No - Maintenance Issues .: !Any Apparent Violations of the Al?pprovaNone Reported I L E Any Cleening or Lubrication of.Paris--..!• . .' ' fo .: .._'.. -. _ None ReportedY Perrmed : ._._,.:-.,:-,:-.....,-;..i,:..,:.,,.., F. L. ;Any Control Adjustments Made? — - - i E httpsJ/septic.barnstablecountyheatth.orglapp/permit_inspections/view/ePpt7vY1CQCCPXs9RJsthQ 1/2 L3/31/2021 Permitlnspections • "' I None Reported .k.,. „.. ,_, . ... "• • ." ' . . . . . . ' ` . . . . . Checked panels,timers amps switches,tank evels s>- i Pumps,Switches,Alarms.Tested? c :..:_ . , • alarms, general_condition oflhe system. . L 1,,,!: Any Equipment Failures? None Reported _ ...,. L .: ,Any Parts Replaced None Reported ... . . .. . ... •.. . . . _.. ,..... , _ . u 'Any Recommended Corrective Actions? ,None Reported 1s. _Jrispectron Go...,,,mpleton Inspection Completed? YesL „.,., ,, , , „. ....„,,.,,,..„ _ . , . _.:E.,,i,4.:.ri,,,:c.,.'i,i-.9.-1,......:---•ri,..7:4-'•:Pii,';',..-iiiiiii..i.i,'Fi'...1,:-r';C z.......,....-J--'1,',',..1...v.i'u:it:5A.-- -.,..::,5,,5.:. ...,. Technology. necklrst li ; Odor Around Site J Yes�_.NO —_i Source of Odor j Not Reported, • ,,. i .j ... ,„ is „:„„_,,,,,, . �3dorDeecrtptlolt l ild � edwm Sig Musty r0.oxit . Check all that apply Q 0 O 0 c_--j i : Li. . _ i Scum Depth in Primary Tank Not Reported. i Sludge Depth in Primary Tank- .: : •.,:.••ot Reported. L ,„ , • Does Grease Trap Need Pumping i[]Yes No ,r unit 1 L ,,. ,,...„. ..„: ,,_ t ttereVentso . • Air Passing Through Vent j - LCDt Fan Operating -- -- �: : _. _.� •..,._. , __w , — O_~ c. j General External Damage ' --......---„,;-:,:-.-::,...!.:.i...-.:4-. YesQ No L ,_..e.... Cover/Fan Box/Ctrl Panel Locked OYes[]No t:" - : : rsoe . :: L :-.. Number of Flies []Few 0 Many Locahon,9f flies_. ? :: ` ;;-;.•;= Not Reported, _ : - Locks/L.atches/Handles Ok Q t Yes0 No i Lid.Gasket.Ok::.:. c:: :...;::- .:::.:: ;+rQYeN4 .:.:::..: ..,:.. ,_ - .:,;:.: ....... ,.... ... :..:....... ..::: ::_:. .- .; .:. . .:` Standing Water in Fan Box ( Yes®No _________ _ __• L L 1.-. https://septic.bamstablecountyhealth.org/app/permit inspections/view/ePpt7vY1CQCCPXs9RJsthQ 2/2 Massachusetts Department of Environmental Protection Bureau of Resoure Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems Important:When filling out forms on A. Installation the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 return key. Facility Street Address Yarmouth 02664 �I City Zip —' Mailing address of owner, if different: iI P.O. Box 600 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip _ 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: ❑ General [1 Provisional © Piloting ❑ Remedial Seasonal Residence- used less that 6mo./year: ❑ Yes ® No D. Operating Information 2021-03-22 1 Inspection Date Previous Inspection Date Pumping Recommended ❑ Yes R] No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure 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: X❑ No ❑ Some pH 7.5 SU DO 0 mg/L Turbidity 0 NTU 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 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: 2,855 gpd Parameters sampled:® pH ❑ BOD ❑ CBOD ❑ TSS j 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: Operation and maintenance conducted—system operational at the time of the visit. Notified manager of high EQ. Field-tested&sampled effluent. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit.Notified manager of high EQ. Field-tested&sampled effluent. Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A -- u 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 Massachusettcertified operator in accordance with 257 CMR 2.00. 03/22/2021 • 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 31St of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use- by March 31St of each year for the previous 12 months General Use-by September 31St of each year for the previous 12 months Send to: Department of Environmental Protection Attention:Title 5 Program One Winter Street 5th Floor Boston, MA 02108 L5/2612021 Permitinspections .:, :.-4.'t'-',...!',i•:'•:_-. :Z;ii•L'iZ;f7.i.:1:;:-.C.C,:.-327,'!K. _ ... .N;r.ig.r...i-ft2-,:;!0:.44i,-.' .'. ,:..1:.•11.•.1f711.$1011;72.11. .;:.i':;.:•;::; ',..,if -!:::T".irf'111',T1;!;:-:1:,..:1-:,;':;•'....;:g7;'7:._ ....tii'.-.14:1',::i...3 Li i,...:11.1-...,.?!.....;."1,1-.7!n"1:1;:•:,.:::_. - --•• - __pt_..-,_,,,,..., __ g _ _._... „ .L... . ... . .. .:3'•1;:-1;1:i,--:ii.,-3;.,,:::-.4--3.,•-,..,•••::::*••••,?:.;:r.:";.-:-i'3.1•1113:,.."..11.... illarn stabletounty se teiviana -etnentfirogram--.'-'----'----- -------- ----- . ,. .ii,,i.........„:„,„:„:.„ _ !=1 Austin Cahill-Coastal Engineering, Co.Inc. .,,..-: . 1:01 pm LI . li Main'Submit,'My Clients I My Reports I Help l: :-2 4 Home>Inspections->,View Inspection -.:-...-._--...:.......:7_:- ...:-..-_,..........f7Z:1::J-..i. .- :,-----f-.., - , -....- ; . .-- ... ,.... ..,-:'-7.,':-....'-'.,..,..-.:;,.::-4).:1 ....tb. .....,:„-.......:::.,..-.:.::.-.r. : .:-.:.;....,:_:,:_,,.......„...................... :....,... ..ii.,..--, :.„.:., .:,::..:„......_.... . ....,.. ... 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"'''' iAddress [1106 Route 28,Yarmouth • I.,;- ,•„- - -, ...--.,...ek.4 ; -I-• I , 1 Inspection1,-7--cDetails-I-I----''IIT'-=='-i!'';I;II'-.!-5F.-7:.":.-.I''.:I4:'':'I'II-''''.::I'.'-'-:'-,'-',4-2.I.,I=.r'=:.=='.-'-.I'-I:--:•'"..:,-.'-'--'.''2''-. 7I:''--'I,'.'•=::',•-..Tn.'i'1==7!.•:-".-.y:.•11,.'-..15,.'.4.•:g'-1:3•-.1•--7'::3:=,:1!!";:1. - .:•41,-.021••:7•-":.I.''fk,::-..s-i-.7f.:3.::,7'17..:•tr•13t0'.111:N-_1:.-.;.--_.,-:..-=...:--..I-4.::.,-..T__r.11.'.....:.."!i':'i..'..11;:"=i.:=.•:..-!'=i_..•..:.:,1!!';3:.-4.1-„-:C..]=.1-1,2:1,•1.3.3.:I"L..7..‘113,.A..';.I..!.:,: L [-: „., _ 5, 1 Component: iBioclere ...... . .. .... •• • - - -- - - • Date2021_04_27 . . . .. . . . . ' lime: ' --:-- : : ' --... :•.:-: . ......-:..::-.-.....:.. 103000 -':-.. . .:•...... ---.:-.: --... .. -: •-• 5 Li.- ,Operator:Isleme: ..:- . - , - •••••:-.--:•F-'••:-.:!:.. .kevin Rezendes •''. •-••••••-• •:.: ::.:: •.....:•••.... .: II-2 , i •'I" !License#: 17282 !-: ... Ni.H,„..---------,-----_---:------:. .:!':!7ff i::!!: ::!'"-. ."-/I -I::II=I.I,r'I'iI....:I.'_:-I._is......ii•:',.,..iF,',.P''''II.--'='-='.-'-'I=•ii..5::-..I,II--' -=.•=r-..=:.:::-.I.,,II,....III I.-:-...,=.-.:.' •-•-...--.:.•.----..:7-,,I...... 11)11101entS'IF'''''''=f.:iIIIIIII:PFI'IrIH.:"I41 •:;.:-.u.•=:•.., -Stirl'-'7!"'Iri-I':4';-'i.:'- '% II' :'14:' !:"-!.--,,i:.4.:; ni'II.''I:'.!:Ii=Y.,--I.i.4,-..,:i.f. '==--iIIIII-',F,!..-.I- .•If-i!C":"==%':::•%:Ig.=';IIII:I=.!:ii== =.1==4'.:=r-iir,..I.,It,-,I--•:--,..-I.:.F.-:..5.".".F,..:=7.7c It..,-,14.-,,,i7,F.:,..,..=i,....7„,.,,,,,..„,:,,,,,,„.;.,,,,,.,,.•:,,,,,. F.?i„:: Li 1. :',1 • t Operation and maintenance conducted—system operational at the the of the visit. Field-tested& 1 ,;•;•. sampled effluent. i•::: L _ . .. _ . ....... .... . .„.„.,.........:...,.:_,.:__„...„....,::,,,:,....,..:,..„,„,....:.„.„,.,..,..,„„,,,,...,_:..,...,.„__,,:. :...:.......,,,,„„:.„..::„..,.,,,:„,,t,,,..,,,...:,..„..__..„„.„.....,...,. ._,,, ,. _ _.. . - ::..: „......_... .... Field;Test(rig!-....:-.,--L.,. .-.1,-..!:_.-...- Tasting Color: 7...''.---:...—..--...---....,.- '... ''.. ...,.''''...•'.—'''—'7,',--'':'''''.—'"--''.'''.----7)—',-,—,7'''.--.‘—'.,:—..".:,,,--..; `:'.:''.-.'..—'— -: : L.'. ....... _ '. .' , . . „ . Color: [Clear L. :!odor;..,.•.. .---.. -: ....• • : .- •.. .:...-.:-...-. -:;musty ,-.•••••:.•:•.-.....-.,],. •..:-...:-: :::-::.:.. •- • .. •..- • •. . .-'-: 5- 1- !Effluent Sellds:— [No z...-- Ipiii--. --;---' :•':-:'••7; --':..!'::''-1'.' !...--.....”.......17.6Sli, -f-'.. , .-.]:.::_.-- is..: —i L Dissolved Oxygen: tmg/L 7-: F Turbidity: -''.--- - .: • . • -• , ,• -=. 4., - .1•Ku Settleable Solids: I , ' . s -'- .---:- Site-Ciid....."tion.., s. -...:..............=.:1-.:- ...L:.:.--•1. :':'•i'''•'''"-''''''-''•" •'3'---.. ..-•. ... .. . ,. .: ... -' --.-., ...,.:.:..-,-.-.. Ilmil , - -. ..= 33:11-13',1.3•'•••• -3-3:•3:: •' . .:•':'-'1:"::•.1•::r:'-'1'7.1::':- L-::.. .:.. ...... :...• ..:: .. -- •- :,- '',-,3 7:-:, .-..- : • • . - - : ., Seasonal Residence: i No , L Air:1070eiitiii •-.-" - _ E ,- _ _ ... .. . ...... . •. Weather Conditions: .... g• _.............._____........„ _....„..,............... ii. i Sludge Depth: 1ln ...... :r .. qdum:,1,:ayer,-..Tfiimes;.;:-31 3". 3.. '-.........f I:71_71:::in,..-,,-,--...,-,...,r•:!m=:•,_.L:f-7.I.,.i'.1:--I:" -II ._ ,_ .. ':-:,=,--: ..::f''I-:-:': !Pumping Recommended: - No : ::. 1 i..... ,. Soil Absorption System Obsel.Vatibris .- '-'-,--- ' ' - '•...-' r--- - .. - ... it ,... Signs of Breakout: I No a•,, I F.: Depth o- poticfii-of,Fir.'...;.---...:::.:..:.;.-:::-:.::E.:,,i:.-E:::, tii;:•,::::-E.:,71.7:7_7:•..7:-.7.:-.- ....._..:... : . ,. -.:.7..L;:. --,'....-2--'..''''''"'—'•_—_—.—.....,',....el • 410.••• 7..' ......__.a I No iPonclIng Above Invert . .. i....1.: ._ Maintenance Issues = vi'--:,-•-'--...-_.,.,.!..:....,!....:!:.:.;.:.... -.7-7 1.7::..,...i....--.7.77....7.',.7:......:.....- --..'7.27.171:-:................,',:.'. - - .. . L . _ . ;Any Apparent Violations of the Approval? . .None Reported . li Any Cleaning or Lubrication of Parts - ;,, . , •--. -...:, ---—- -!,..- ••'-: --. -------!• '.:. Ire i Pefform-ed?_:•:;- ;!!i!.*.;'_!.:a --- ----,:! ,NOrie Illiptortea!:.!7. .. ::::!: _!.....:'!!'i :*'=-..... ... ... , =.. II.=..,....,I.,-;,„,•':-IH.,.=::.-=,,.,-..:,•:.!-..,.:4-..':::.:-.:::::i.II.-...:..,::- --- - --- f''- Any Control Adjustments Made? ,_ 'I.:,I,...-.I.'-:'-.:- -.:::-.:::II:::::::":71:'-''"''•-•:••."..: ....-."-I--- '' I-- -'I'.: I , 1 ; . .; I https://septic.bamstablecountyhealth.org/a pp/permitinspections/view/U6So nO5VfAiI303SR8FEEA 1.... 1/2 'i..' 5/26/2021 Permitlnspections None Reported L IL., ,. ,.., ,..,.... ii, . ,..,_ . , . .. ••. •... . . . . . .. . ... .......... " . ..... .. . ., L ,,ri,,,,„i„. i..•: Pumps,Switches,Alarm•s.Tested?•;•.;.:...._........i.i.;.2.. .•::.,:i Checked panels timers,amps,•switches,_lank levels,. I? .: alarms,and general condition of the system. t:z ..i, Any Equipment Failures? None Reported t V▪.- • L .„, .rA,...„..„. . ny Parts Replaced? None Reported . .. t ..„ __ , , ,, ,Any Recommended Corrective Actions? None Reported LI 5..i.. Eii Inspection ComtIetion - - . w Inspection Completed? Yes L 1.1.' Technoko y Checklist Odor Around Site yes*0- L No _” „ „..„. , r Source of Odor Not Reported. i• • L Tiz- t Qt�or l pilon Mild,, MediumYi Strong IUst�► Septic �~ Check all that apply LScum Depth in Primary Tank `Not Reported, iSlud - , geepth in Primary Tank ,.:;Not l3e•portsd.:. .. ... ..: :_;,,.-. I- Does Grease Trap Need Pumping ,QYesQ No _ -- i Unit 1 BiocIere Vents ;: = Yes No Air Passing Through Vent Q 0 ri Fan Operating t_I `" General T --N� .-I • External Damage - -- Yes .No 6 ''Lit i Cover/Fan Box/Cfrl Panel Locked �Yes Q No • Flies an the Und QYesQ No Number of Flies QFewQMany li Location of flies..;:,;.:•.:;.::::::=:::::,:!•:.i::--i--i•-••,••—•:ii..-::-:._:..Not Reported : _ .; Lacks/Latches/Handles Ok 1.. : ®Yes QNo I ii :: fad Gasket Ok .... •N2 __-.-tt- _ I ;Standing Water in Fan Box .QYes�No L L i ._ https://septic.barnstablecountyhealth.0rg/app/permit_inspectionsly ev„'U6So_nO5VfAiB03SR8FEEA 2/2 Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 iti DEP Approved Inspection and O&M Form for Title 5 I/A _ Treatment and Disposal Systems Important:When filling out forms on A. Installation the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner " do not use the 1106 Route 28 return key. Facility Street Address Yarmouth 02664 II City Zip Mailing address of owner, if different: Ia11 P.O. Box 600 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: ❑ General ❑ Provisional El Piloting ❑ Remedial Seasonal Residence-used less that 6mo./year: ❑ Yes ® No D. Operating Information 2021-04-27 1 Inspection Date Previous Inspection Date Pumping Recommended ❑ Yes ® No Sludge Depth Massachusetts Department of Environmental Protection — Bureau of Resoure Protection -Title 5 r`. DEP Approved Inspection and O&M Form for Title 5 1/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 7.5 SU DO 0 mg/L Turbidity 0 NTU 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 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: 3438 gpd Parameters sampled:M pH ❑ BOD ❑ CBOD ❑ TSS V 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: Operation and maintenance conducted--system operational at the time of the visit. Field-tested& sampled effluent. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Field-tested& sampled effluent. Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 (�t.` 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. 4 2021-04-27 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 315t of each year for the previous calendar year Piloting Use-within days of inspection date Provisional Use-by March 3181 of each year for the previous 12 months General Use-by September 31St of each year for the previous 12 months Send to: Department of Environmental Protection Attention:Title 5 Program One Winter Street 5th Floor Boston, MA 02108 i L.. 6/15/202' PermitInspections L ..„:„.10„...saist.4„—_,:.,, L.,,,, ,,,,,,...u„.,,,,J..,..:,,,,,,...,....,._.:,,.VOC.471,.:.---1-,---- ,;',;....l'''AIV-2. e a�+ Austin Cahill -Coastal Engineering, Co. Inc. 1 33 pm i Main`Submit My Clients My Reports Help 'Horne>Inspections>Y` action = _ ! Property 'eE r w ; - nsnncfion h A Address 1106 Route 28,Yarmouth i ' I '''''''' Otiwner Shaws Supermarkets. Inc Print tns .�,ctioa t ,� _ : „ ..nspectiorOat _ Component: 6ioclera i ... Date: 2021-05-24 ( l time: 09:45:00 I Operator Name: Kevin Rezendes License#: 17282 Comments •' d ! I Operation and maintenance conducted—system operational at the time of the visit.Field- tested/sampled. I I Field Testing i I Color: Clear Odor: Musty — ( Effluent Solids: No i pH: 7.5 SU l Dissolved Oxygen: mg/L ? Turbidity: NTU Settleable Solids: Site Conditions — l Seasonal Residence: No 3 Air Temperature: *F , Weather Conditions: Operating information Sludge Depth: in Scum Layer Thickness: in Pumping Recommended: No -� Soil Absorption System Observations Signs of Breakout: Nc Depth of Ponding: in Pending Above Invert: No , alAny Apparent Violations of the Approval? None Reported _ ... Any Cleaning or Lubrication of Parts Performed? None Reported Any Control Adjustments Made? I r.. https://septic.barnstablecountyhealth:org/app/permit_inspections/view/ME3eWoo9L8g6eP2Te4le$g 1/2 I' i 6/15/2021 Permitinspections i I None Reported l... Checked panels,timers,amps,switches,tank i Pumps,Switches,Alarms Tested? levels, alarms,and general condition of the system. Any Equipment Failures? None Reported 1... - ‘ 1. Li Any Parts Replaced? None Reported 1 Any Recommended Corrective Actions? None Reported L I . __ , .__ _ _____,.. . .._ _ __ ...__ , ........ I __ ___.. _r. ..,„,..,.....,..„..._.„.„. -",4.•..11,,,',.., --',,,'; -,;:-,40:',1-if-'9'••,,ii:::‘',..•i,iv.1,`-', '"-T"-,-...,,`,, tiglite: ''7'1''' ,;.>- 7;15: ,•;?';' '"'^:"nni47 :=. :•,..;,,,,,,es.... .,r4.,'•'•,,,'W4k=4.4,-. .4?-,.., '^=3.f:-",--- " ;2,-,-,MilA-$:::-.%7.71,f ,t-I- --7:: InspectIon Completed? Yes i I ; Odor Around Site Yes_-/.. No Source of Odor Not Reported_ L i , ..„,...„.„..... f.gf•V•:•,,, -'„:" • L ... ,..-.xik.: Od' or l'.'1ortiii',1,---.."'"'"-'-' Mild ''-'Medium StrongrlVrugilv,. - .. --Se,Ptic i ci-i-_,ail th3t 3,7_-7„,, LI; El_ ni Scum Depth in Primary Tank Not Reported. L : Sludge Depth in Primary Tank Not Reported, !.. ; Does Grease Trap Need Pump1ng 1Yesi 'No , ,—. Unit 1 '-_tl-i=i1-*%°-inagleifkici ,-,,, I -.„r,',:./WP,44.44,,;..,,,,,„,, e'e :i.',:',2,L...,4'04;7V-4V5614JVKItritt) 27.571Z,,,i144,421-- 1..... AT Pai,,,,:nc M-.7,1,;"" Fan ope-a;,- , General ... External Damage Yes N o Cover/Fan Bo)detrl Panel Locked ‘.....1Yes 0 No ii .-- Flies on the Unit Yes 4.'No Number of Flies i Few:, Many 1 ..... ...., I Location of flies Not Reported, , I Locks/Latches/Handles Ok ' Yes' i No i Lid Gasket Ok .i•iii Yes ,No - , 1 I Standing Water in Fan Box Yes.../..i No ...._ ; ; ____ „, , • ___. _ _ , I I l.. 1 I https://septictamstablecountyhealth.org/app/permit_inspections/view/ME3eWoo9L8g6eP2Te4le$g 2/2 Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 i DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems Important:When filling out forms on A. Installation the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 - return key. Facility Street Address Yarmouth 02664 City Zip Mailing address of owner, if different: P.O. Box 600 LA.4 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: [ General 7 Provisional X Piloting 11 Remedial Seasonal Residence-used less that 6mo./year: Yes {- No D. Operating Information 2021-05-24 1 Inspection Date Previous Inspection Date Pumping Recommended ❑ Yes X No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure 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 `I Turbid Other(specify) Odor: XI Musty -1 Earthy Moldy LI Offensive (-. Turbid Effluent Solids: X No [ Some pH 7.5 SU DO 0 mg/L Turbidity 0 NTU 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 Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: 7 Influent f Effluent Commercial systems or systems with a design flow of 2000 gpd and greater,and General Use nitrogen reducing systems: 3269 gpd Parameters sampled:V pH ❑ BOD —. CBOD "': TSS 7 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: Operation and maintenance conducted—system operational at the time of the visit. Field- tested/sampled. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Field- tested/sampled. i . 6/15/2021 Pemiitlnspections _ Barnstable s C County Septic. Management Program T ,w Austin Cahill -Coastal Engineering, Co. Inc 1:33 pm I Main Submit My Clients My Reports'!Help ' . i, N a spection T` � ff Cancel ?(PPierty - M ars e^fi n fi,ddress 1106 Route 28,Yarmouth Pr -# I � eoticrr Owner Shaws Supermarkets.Inc tnspe+Gtia _ F Component: Bioclere — Date: 2021..05-24 Time: 09:45:00 Operator Name: Kevin Rezendes License#: 17282 Comments 6•• I Operation and maintenance conducted—system operational at the time of the visit.Field- tested/sampled. Field Testing` Color: Clear Odor: Musty — Effluent Solids: No pH: 7.5 SU Dissolved Oxygen: mg/L Turbidity: NTU Settleable Solids: l Site Conditions jj I Seasonal Residence: No Air Temperature: *P Weather Conditions: l ..._... Operating Information 1 Sludge Depth: in '. Scum Layer Thickness_ in Pumping Recommended: No — Soil Absorption System Observations Il Signs of Breakout: No Depth of Paneling: in Ponding Above Invert: No l L i; ............ ........ Any Apparent Violations of the Approval? None Reported L Any Cleaning or Lubrication of Parts Performed? None Reported i Any Control Adjustments Made? I L, https:l/septic.barnstablecountyhealth.org/app/permit_inspections/view/ME3eWoo9L8g6eP2Te4le$g 1/2 1 L6/15/2021 Permitinspections None Reported L '', Pumps,Switches,Alarms Tested? Checked panels,timers,amps,switches,tank levels, alarms,and general condition of the system, LAny Equipment Failures? None Reported Any Parts Replaced? None Reported Any Recommended Corrective Actions? None Reported L _. ttsutt p#etio ; I l Inspection Completed? Yes — h aaology Checkiist .-INi_w m W :� .s Odor Around Site Yes iY''No Source of Odor Not Reported. Odo!,w►, ,.44, a �itd 1113:n Strongleu L Check all that a ' Scum Depth in Primary Tank Not Reported. L t 3 ;'Sludge Depth in Primary Tank Not Reported. il Does Grease Trap Need Pumping °Yes'C3 No Unit 1 L , -iiiiiiiiiiliv\'!L*-i"S"'"'",iii.--,:iIiiirili:iiqIil4sliilliii-iiaiiisiri- ,--iii,siTri. iiSti-"*.*:.,:iviltiiavrglil,54itizii.*::4.. ,i ,,-,..„:-.1: , i I Air Passing Through Ye I rt Fan Operating L t i. General External Damage 'T"es No L Cover/Fan BoxlCtrl Panel LockedYes' No f Flies on the Unit Yes`_'" No i I ,Number of Flies Few Many I Location of flies Not Reported. l I 1 Locks/Latches/Handles Ok viYes ;No I 1 ( Lid Gasket Ok " Yes No Standing Water in Fan Box .yes I.v No L L Lhttps://septic:barnstablecountyhealth.org/app/permit inspections/view/ME3eWoo9L8g6eP2Te4le$g 2/2 Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems Important:When filling out forms on A. Installation — the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 return key. Facility Street Address Yarmouth 02664 rib \ City Zip Mailing address of owner. if different: NAM P.O. Box 600 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway -- Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: C General ^ Provisional X Piloting 7 Remedial Seasonal Residence-used less that 6mo./year: ❑ Yes X No D. Operating Information 2021-05-24 1 Inspection Date Previous Inspection Date Pumping Recommended ❑ Yes X No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 1/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: J Gray Brown X Clear - Turbid Other(specify) Odor: X Musty 7 Earthy - Moldy - Offensive l Turbid Effluent Solids: X No [ Some pH 7.5 SU DO 0 mg/L Turbidity 0 NTU 6to9 2orgreater 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 c/_ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 3269 gpd Parameters sampled:% pH i___l BOD CBOD I TSS TN H Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Operation and maintenance conducted—system operational at the time of the visit. Field- tested/sampled. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Field- tested/sampled. Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 l/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. 2021-05-24 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 31St of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use-by March 31st of each year for the previous 12 months General Use-by September 315t of each year for the previous 12 months Send to: Department of Environmental Protection Attention:Title 5 Program One Winter Street 5th Floor Boston, MA 02108 L8/10/2021 PermitInspections ...,;!,.,.4-..#i:,,,•,.,: --_::!;:-:1,..,,,-:- -riii.:'.-"'.--••.:,..T.::::: ::: ,.; .--,..--„- ,.., ..._...... Barnstable County -• -Septic • atag:enaeint,EIRtogram ..„....7_,:,..............1...,.;:,2 : ..:,:r.;._,.:.,,....„,-,..H..., ....,.„2.: :,.. _ . ri-.1,40 Chad Simmons -Coastal Engineering, Co. Inc. 12:30 pm ..., . • ..i.—i i '1 L ,, Main'Submit I My Clients I My Reports'Help! -- .,_,....,_..,,,...:. ...,., :.... ' - •'.. • n :- ---------::-:- :_,--- --„-,-_--: ---.-,-,-.,:.....,,,_-:1.-- -;;;;;;;; : ' ; ;.; :;T-;.;.-!.7'..;,;;,q•.:.;;......:::::..:.:;,;..:.F_...!..,: . . . . 411Y......... Heirie>Inpections>View Ineppctio „.,.,.„..._,.„_........ ..,,....:,... . . ...,....._..._......_.., ........,......,...,...,..., : •.• •.-..-- , .. ......... ...... . i,--- L _.„.....,......____.,.__ , ,._....,:,.., ,„.r i.*-r•-•':"•••••:•..- 7: ,7''' 7"..:•:_.7,7,...7..:.7.1,:;.;:_;:::,„:„.:::.:_i_..i7,i;:,:;•.::::;,.:::,...,..,..„...,„......,„,,,k,,j5,4!,,.7..:;.• 41 1 7-.4;.!M,!;,-- ":":7;;'-'4.-------:----.'-'4''''.7"-'s. --1- :PrOijitiititfetalli -';''. ',---;'i.,..S;;4).L.i.::i.;.....'.',.: :!;,?!'.';'..7;,E,7•71t;4;.:';;;";;- ;;'''-;;' ;...7.7'...--: :.!: :....::::i:'.i'.:::'.::',.::;r:._!*.7::_:-..:.;,:n:7:z--7. ;;F:.;;-1.4,-..;..4..::;;;t.:t....-4::.!.,.-• ,,-, g-gwr........--s-t:t•-„,2..._,....,..,-,...-4.--- - ..., ',. -:,,-----7----- - • -.v., ---:---1 Address I 1106 Route 28,Yarmouth L....---.—.•— - L """:.-''''''.41,- -'-'4"..''''':;1*-7::•;,.44d,--- Owner Shaws Supermarkets,Inc. et--4---., 1:: - ,.,.. . ,..-: ....... tilt ....w...x,..___. L , „...,.............„„_.....,...,............ , ,_:,___m .._ , - - -- --- ,.. .. .__.,____...,..r.:_.,,,.:":,....„ ,,,„.,:„--„..."..„.. - :,:..„:„.„::_.....,..:,,...,:_,....,:...:,..,..........,.,.........,...:,_..„,„:,„.„.„...,,..„,„,.....„..,_:_„..„...„,........._.....__ ' ,rispew...-.,....-„, , „.4,,„,,i,-..:.--,„„,,,,„..., „.„..,......„..,,,....„..„..,7::i..„:„.7.:,;,...„..,;..._:,„,.,,„:„.„ :,.. .____:..„.,7!5.7i:77i-!:F477", ..:,.?.•!::7::-:7-:=2-:'.7.:.':-.:t.-''..-1.:F_::::.:....•A .,; ::...:::,-,-.. . ..,... .. ....:......_ ,_....... .:..z.. .., L. i Component: :Bioclere ::::. ,,,..1,-.- • pate: - . - ... - -- , - .. ...... ..:• , 2021.06-07 L ,......, ........ _ . .....4 .. ,........ [Time: '084000 r'' —..------------- Operator NameKevin:.. .... d :- '''.: :. .. .;:•,....-.. .., , ..2 7 ; - : .. ..-'.,;..,..,..1 i :• - L L- . I License#: 17282 .. . ....... . _...L., It G Comments --"-1-"-'"'-'-'"",'. '•""i'.'. ,- ..=.--_-,-,--,--, - ,;,th,.'. ,..:1-,,, ,_:'..:,i.;_.,,7_,:.:.:---ITi..-, -.--;:g;.,-,,.,..„,..;....,:3„-.,..,,.:,,r,•T:•,...„..,..;..,..,-;.:,,;-,9..,..,.,-, LOperation and maintenance conducted—system operational at the time of the visit. Field-tested and sampled. ..r: ,.: L i-7. t-t:-. rT: . - - - _......„,..,._„...,.,..._.„..,:......„. :,-.,,-. ..Fielit-Taiiiting,--.i:-, .-7.•?i- .'.:r2..7 • ..,'' ''' ' ... .if, r;'icr-y.:ri.,'.!;1. - ,-.- ........... : 5 . . : r I Color: i Clear 1 G? FF ;;' .-.... ... .. . . ...1 .. .. ------ -7-- : 1 7——.-: •. E y , . ......_ _ . . P:- i Effluent Solids: ,No A •''':•. '•' ::•.' . •. . '. -'- .-. • , ..--. . ;su---:,,;:1 ..:-.:..—,,.,...-...-...-........ .:.:!.- . . . --..:_•..:. - ::-...:. ._... ..•..........:, . . . iii Dissolved Oxygen: „ • .. Img/L — L ' ' - '' . . - ',1,-:'.::::--....---.''.....-:T.,!!';:.]..::.-..L!.....:!r. .....'.!. - . ..-..::'- .7'..:::•; :!":::.:,!:-.•;...,i1 ,. . . !.. __ [Settleable Solids: i ..................... L „-, I'1 ,,, g ti - --.” -....::":. •7' .- -7 7------7-,-.....:[-.....:.....-.:'..'..!..';;‘1-.'.-':'.'.7.: ; .-....:.-mf: ::;.;;--:-7 - !. 11aittOrils - - - ; ,1.',...: .....f. ....i.. -7:'''T.T'ii.7: r.'.-,:'F.,,. .,-.-,::.,-...... .,.,.....•: •• ,....„,.::..,i,,,..,.,..,,--.. --=:--.7::.„....,..,.......:1,:,.. . . . . ' Seasonal Residence: No ,...-..i : g: ......: "Air'''' ''''' ' ''''''---- -777.:'..7...:?..17':' •-•;F..1!:';::'1'ir.f. .. -.:'....1 '7 i 1.'.._ ,,;.1-i ...:::;•;:;"1 L., !Weather Conditions: :.-- !Olittiatrfkinfortriation-- ---: - ----'-1:-.:----------: b..... --- 1 t, .1.-• . ..: [Sludge Depth: in i 1 ---- .. ,Stiwn'I-11Yer:Tfircitneis;::- -. -:- :-:- - .'-- in-- — F.' Pumping Recommended: No 1, .— 1 . _.. F.7 Soil Absorption System - - :,-... .. .. .. .. . ..- . .- . . .. ....._. . rNo- , E! [Signs of Breakout: i ,'------------..: --7 - - • 7:--77-s------ -------rf--'-':-----.7'---'----77--7----r---------.:--';--, .... .:...; .: - - Depth Or POnding:-::',::::-:::'".":-.".:-;.-: i:[... ::;:71-7!....7':;. in; . ,: _----- -------•, . - :•-::• - • ___. • -.. ----,-....,. . ._, . %Imo 'z'ii i Ponding Above invert: ___ No 1 -- -..- r..-. Maintenance IM165--- .:-.-.----..-.....- __ 1 . i i--;-: !Any Apparent Violations of the Approval? I:None Reported ic.. L. :,.:-....nr•=,=:-.-,-...., At.1,!;biiii...iii.14.14g. 31.L]ii.0.:-IFIca' ''10-n;*---''-of Parts.... ....-.-:.ir-::.I.::::::;:::!::.!!! ".'!:...::.:-:.''''i'; .::...77.:....:.7.•:.,..,.:....._.....!. _.„.. ......: _::: -... -....: .._.. ::..,:i :I:'..----';2 None ilep6ti&At'..!:--......;'!.::...-;'''.1'!..,.'t.:-!.,..., - - . :-•....:::...... -:'..-.:-........!;;.::::.:;:i I... V- _.,,...._. E: [Any Control Adjustments Made? 1 . , . i — https.ilseptic.barnstablecountyhealth.org/app/permitinspections/view/p_IfKkejdAITdwOKVCbjVSw 1/2 L8/10/2021 Permitlnspections • L „. I I None Reported 1. ;Pumps,Switches;Alarms Tested?. -Checked panels,timers,amps,switches,tank levels, ` alarms,and generatcondltlon of the system. . Irr. F Any Equipment Failures? None Reported • i Any.Parts Replaced? None Reported _ I Any Recommended Corrective Actions? i None Reported L ,., :_ - r>ispectron._Gom}ietton-:_- = ,_:=:_-_=:_ __._ L • = ,Inspection Completed? Yes ::: Technolb Chet klls� " !Oder Around Site ::= [ Yes 14o L tc: Source of Odor Not Reported, L fi odmr iesciF titi+iri Mud : b tl1utn f strong - Mei p3f ..,;,. Check all that apply Q I., --- — L ;Bourn Depth in Primary Tank Not Reported. F y t 1 sr STudge Depth in Primary Tank: _ . .: :;: •,..: Not Reported::.::: - L t'.• r Does Grease Trap Need Pumping ![YesQ No Unit 1 • L ?.] Bicc;ere Vents ,:!itis No • • iAir•Passing Through Vent Fan Operating —......... — L ,. I O'` General 1 k' External Damage [ YesNo.-:- `„.. i,: Cover/Fan Box/Ctrl Panel Locked QYes Q No $= EFlles Qn the Unit QYes Na � -- ... _ Number of Flies ,a Fewa Many -- Lgcat�on of:flies . _:.;:: Not R e - I Locks/Latches/Handles Ok .®Yes No ... `= ;LidGasketOk - ?QY • — -r---- - (Standing Water in Fan Box la YesO No f https://septic.barnstablecountynealth.org/app/permit_inspections/view/jUfKkejdAlTdwOKVCbjvSw 2/2 Massachusetts Department of Environmental Protection t' Bureau of Resoure Protection - Title 5 it DEP Approved Inspection and O&M Form for Title 5 I/A -- Treatment and Disposal Systems Important:When filling out forms on A. Installation the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 return key, Facility Street Address Yarmouth 02664 City Zip '— Mailing address of owner,if different: ( �I P.O. Box 600 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 —' Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: ❑ General ❑ Provisional ® Piloting ❑ Remedial Seasonal Residence -used less that 6mo.lyear: ❑ Yes ® No D. Operating Information 2021-06-07 1 Inspection Date Previous Inspection Date Pumping Recommended ❑ Yes ® No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure 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 XX' Earthy ❑ Moldy ❑ Offensive ❑ Turbid Effluent Solids: ® No ❑ Some pH SU DO 0 mg/L Turbidity 0 NTU 6to9 2orgreater 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: 3381 Gen 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: Operation and maintenance conducted—system operational at the time of the visit. Field-tested and sampled. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Field-tested and sampled. Massachusetts Department of Environmental Protection Bureau of Resoure 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'#• open for in accordance with 257 CMR 2.00. 2021-06-11 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 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use- by March 31st of each year for the previous 12 months General Use-by September 31St of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street 5th Floor Boston, MA 02108 9/1/2021 Permitlnspections _..._ .._: :....... := -:: _ _ = __ - B r stab � .oun� �� SICa� a� bra r Fa Chad Simmons -Coastal Engineering, Co. Inc. 2:06 pm Main Submit My Clients My Reports Help L Home>inspections>View inspection,; 3 L •::::: ..-.77: 74..e':' ,"7:7.7-417'...-417":;77:71.7.5.7.: r:.,w're....1.Y:I. I..7;'..r-.....'-'-'-'''.-'f.'..:'.7-....;.... ...-..:,. .''......:.:-',.:-'7.''.7‹...'-i,•••• ,-..- --..:-..:.: .:-.._-i-,:;;•:;,-.,t'ii:.:.F.,...--,':-,",,7-7:7:77-:,-:7:::-.-7t;',:'.::::::'-.7:::4:, a- Rte'._ ,Address ;1106 Route 28,Yarmouth '' = Owner Shaws Supermarkets,Inc.L _ .....„....„ . - _ s` to7 _ . .. . .__. .„..._______.. .: ‘, --_-__=--,-,_,-_,-------,-------------,---,:- __ ..„:.,„:...„,,,,,,i,„.„.::„.„-,:„:....,.__...._.„., ,,_;...::„.,,,...:.„,:,,,„„,,,.,..„:„,„„ ,_ W Inspection Deta..... ils __ _ Component Bioclere L ,- - -- z Date___._. . . ......„. . 2027.Q7.19 Time: 09:00:00 Operator Name Kevin Rezende,... s L ,_ ... g, License# 17282L ,.. r_ Operation and maintenance conducted—system operational at the time of the visit. Field-tested INF/EFF. _ ..„,...,,,..._..............._______,....................________________ L ..1.1 r:....ield Tesin iColor. !Clear L ., .,-- _ - - :Odor y, Eartf. :•.,:_ Effluent Solids: No PHs :'..-..,'.,::,1.i''.:"...":":'::::,- SIf L Dissolved Oxygen: I mg/L Turbidity Ni u Settleable Solids: Lv Site Conditions .' ;Seasonal Residence: No w iAlrTetnperature F Weather Conditions: ; Operating;information L ...... ,. = (Sludge Depth in - - _ 'Scur Laye.Tjtickoess ..,,,-.--.7,-7.7.71'.77:7:77:7-:7.177,'...,...In tz Pumping Recommended: No — r... ' Soil-Absorption-System bser rations. _ SIgns of Breakout I No Depthof PQrldii3g _ : In Ponding Above Invert I No Maintenance Issues -: ::-7..:-_-1T:.:,:-_:=':---r ,c......-......7:,:::.-:7:--:.:.- - !Any Apparent Violations of the Approval? None Reported , AnyCleaning ar Lubrication of Part6 -..- None Reported;: - ism r3 ,Performed?- :,..'.':,-,.....A.;::17::: ::-..... . F. I1Any Control Adjustments Made? L.. hkfps:llseptic.bamstablecountyhealth.orgJapp/permit Inspections/view/23ekcDAjTjexJ91-II-INYTp4w 1/2 L9/1/2021 PermitInspections E.K . 1None Reported ,,,,..... L _ . ::: :,4 ,._ . ... . - ...• . ..,.... •.. . . .. . . , ,. • .. " . .. . . . .. . ...: ,t'•-.‘3. b u"....'''' '.,.'„"",es 7",',.•,"S !es'•..'„;• • • .„•••„ •.•,Checked panelt Jittersamswth •tlevels, . . .!alerrn s and general Conditiciii of the system. •:••.•• . ••• . •• ,• L-,.• c L i7 ',Any Equipment Failures? i None Reported F.,.. - 1 -•• •• "-•••:•-••:;-: •-:-. ...- .....::.;•;.-.:-.....::... ' :.:•. :::.....:-:...::::. .:.: :. :..'.::::::•:-.:i...::H-:.•••Ei:'.:•.;.. .:•..-:: •:.'":•:.:"-.-:••-:. . . ...„:: ,...... Any PartsR AiliA66i d2.- '-.---,--• L. ••-. ..:..-:..- -,•:. Repo .. -------- - :;:-.:.......L- :.: •••:•:,:::,,, .: ,..None . .. ...,.. ....:....,.,. •.•• •...•..:.::•:••••.: ,..•••... . . . _::•:- :.:...: '.. 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Ins pecti on Completed? i Yes • L F-: -a. ;,. - : echnotogychecklist L- - •• .. .. _ ... . __ .. ______ _ ri . . --'d Sri''" -' • '• ''- - --'----'•' Y.-0 N''' : •.:-•"••' •-•''''''''''''''''''''''''''•• --"- : ••'-'' -:••••••---!',1 ..0...or Aroun .: ...e•••• .-•.:-••••:::'•..,•::.•••...,,••••:.1:-",--•-•:. :."•-•:-.... op . ,... o,.. ...,,,....,.....„....,.....:,•-"....,.....,..i..i:.•:•.::•••••-....,.•....:• ,.......,....,....::1 L. ... .... - . , • ...f. i Source of Odor 'Not Reported. . . .• . ....- L .., ,. .,--.:....„..,„:::,..„..„: ,...,..:._.......:„.:„...,:::„.,„:.,:,..,....E.:,.,..„..„,.,:g......„.„..:• ,,,.,,,„,,,,.....::.. _...s"...„.,:__, ...,,,•,,,.,...„._,r.„„,,;.:, :---------„•:-. orDeserititicsh-.77.±-.2,-.7,.: jViiiiii..:,.;;,, ;;.Mediiiiit.f.;,:,..,:t 7!.Sti`000::_1-;:.'„„.....,.MY4t..*.4, .],..„ 0.1?_,, ,,,j,..,.. ,-4'4.,' •.• • -,-.,--:,',..-'''''' 4,.:P"..:!!..... .E.. -..:-.:.-,..:,..-::-.,...,::: ••-:: : . ... .....,.. ,7 . ... C Check all that apply - - - . F.} . :: .: , ,.. O. ::. :„.,..:,:: .:..:.: ..,...... ..::.CD••,....,,:•.•• - — ' — -: D ' • : : ' • , s.... :„.. ..., 1 : , . L , ,•Fil.' =Li Scum Depth in Primary Tank i i ,.- Not; Reported. I . Sludge Depth in Primary Tank Not Reported ".--• f.---•': -'•:',..'''''''":•-•!''.:r.'''":::";:;:::•:•:'••••:•-•'•':!-:-:•::::'•:•:::•:',:•:::.::•:..::•••: ••••'• •:'••-..•':::-:':".:-•.:.•••,...i:'.:,:-.,•:,-..,..,..i.:....,'.•.•.::::.:,:-..••..•••••.••;,..-::::•.•.....•:::::•,......,•,...,.„..„:::::::::...:,:•.........•••.....::.....„.. L ..,...., „...„. E FS k:......:'Z.:.*:...±.:22.'.......L4L1-.:!:4'44'...''''''''''':: :.=:- 'r...-...'.L'Z..........j...,:_.::::......'.._1 --"' •-• . _,...,..,_......_-..c.,--,____.......-..............,,...:.______---1 !Does Grease Trap Need Pumping 0 Yes 0 No ....-•-•!• I Ti Unit 1 , . ._._......._._ • L ..... .,....,,, . . ,..._:::-.„-..,....,,,,,,;,,,,•,...,•:„._,,,,,,,.:.,,,,,.,,,,,_ . .,.„,..„,..„..B.,. : , ---- ' , - - -- ---; ---.-:- teclereVentis-• . __ _. . _,,.. .. . . Yes . No ....., ' kl ,.,"....',',- -...,2.j.;:.•.ff•:: ::.;:,...7:::: '' "" F.-;.... .. ...:,.--.. . . . P tl Air PasSingT.hrengnant:::::: : :::,...::.2..7 : :,.:- :q..i.i4:::_..:,.....:....?.-.. ....,..• ,...-.;::...,..,:,,,..,:..,.: .....,......, .. ... . i- Fan Operating a fg-141;,;4;=.....-;..-..........r.,...T.Z.....zz... .. .....e... L E gi. -,... .F., i 1 General : I 1 /4 - in bkiZ.-1t-671.!iiiiiiiii0:"::.....:'.;:;..:••••.7.. 7!It.7,1'...ii ;i;:i' ili:.:,.....i:.:.';';'..i:.:':',76!.i0......-.:Y.:.8 S..,i2D173N ti:..,,,:. , :;;;.:7„1, ..'.': ;;_..;..:::.1.-::.::: . . i•: :;.-:,•i.,...yi. ...:i''.::-::,ii,....',..i:,:,,1 . ta, r-''....'''''•---':'' ':---- ''.......:....Z.:,;.;:;.;.:;;:........,;.i,..J.-.:.:;;-•-:::-.:,.,•,-'-,1 ."• -'•':iri-..i._,.:4;,i;.,.:;;..,, ,ii.3.i,ii-.,-;.',1.,:i..2,i.:2,.....-••••••..7.,..._•••••• . •-.,.....,_.........-..,.....„.u:.,,i e-: •Cover/Fan Box/Ctrl Panel Locked 1C3Yes 0 No F 11r . I ' 77:77 r,.. '0iiiiiiiiiti':.(iniC45._',.!;:,...;•:N . .f.:::::::t•„.:;i:',....i. .irisiegeNolii•:..117,,.--,,,;.!ti':::.I.;,:::,..il.ivri-:.:.,;: ii ,..J:';;E,fik:.i.,;.'.,::''....:,..-:...;-. .-;.:,:;;!..-:..,:.7!:::,!..iii.:± i, .f..F.-.- r..--.-. !Number of Flies lcj Few I:]Many : , :...-,. : E ---''::::-7-:'''';'-4r:';';!•::.:.:; ..,..-.--,-:,:,:r,,,,,,,--,`':::::'''.-'.i:•.1-'.21.:,'..4.i...:4'.'4';141..:::,-;,:",:•-'';'.-.i.- -.:;:•:.,.:;-::: ;.!'..i•-:L;;::.:::.:4,.:-'.....Z.,Li:_-,..--..,:...::,,:;,;;.2rY4'-:.:,....?:.,±:....;,.::::-., :..-1:: ::,. - imi E t; 4168 .118F.0.-iii0S- 7.01 .:e:!': ,,-]±•.44.'.. ,!.::..,.;.e•f,.f:. 1..1s-:-:::.y.,i1100:00.6.4,irt..7.!Lf.:....i.r....a:..,..:i.....:-. .,..,,,i..:.y.:.6:2vt..:..zc,..:::.4.:,?.:-..:.;, ,,,,f....,_,!...,.::., reo ,--,-,-ii-,•...,-:-.•,,,v,,-,.,-":"..,-..,-.-.7:-...7......,3:T.-.:-..,-.,-..,:Fr:,a,,-,277,:,,,, ,,,,-.1 ,f.:.],,,,,,,:,..,:::; .,,,,,,,.,.-...-.,:.....::....-:•,.,..„.,1.,....:, .:..,,,..;,,.,...5,.....-..:.........,..:.......„...:.........i;..:,. , 1:.;.a,Fi:,.4,-..: --•:•'''.".'",:'.'.;.:i' -',--,-•.',..F:.::.*.:-.:-..,.::.;,:."..•...-.7...,..::.,,...:-•,,,,,..,:IF::.,•,,,,.:::::.:,...,:,......,...,..:,:,....:::.:.•..y,••.....,:,...:::•::-:•;::::!, ..:::::,•_::::.•:::,,:::::-,,-.:- !:.:1... ,. r. F•.::rii'..n1,--....-..,,LLL--.,...:.:.:i::::_.=_M:::..,..=,_..,,,...,.:..:-._....,,,,......,:21,t;............:,....• • • Locks/Latches/Handles Ok IC)Yesa No ., • .-: ! . ..... D-:' l'Lid'-';',17 Gasket'''''''''''' -‘'-'77.7!,117..:7.7-..7.771-,77.7:77:. ::!":•:.:.:S"-::....:.':.‘:','.:'•-•!!...'::',:'!.:4-0 ' .:..;•71,:.:.::.:,: - . 7-,,r7::',.7.7.7..„.7.:;;.7. 7.:E7,'''. 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L. . https://septic.bamstablecountyhealth.org/app/permit_inspections/view/23ekcDAjTjoxJ9HHNYTp4w 2/2 Massachusetts Department of Environmental Protection Bureau of Resoure Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems Important:When filling out forms on A. Installation the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 return key. Facility Street Address Yarmouth 02664 ``` 1I City Zip Mailing address of owner, If different: P.O. Box 600 Street Address/PO Box: IMMO East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: ❑ General ❑ Provisional X❑ Piloting ❑ Remedial Seasonal Residence - used less that 6mo./year: ❑ Yes ® No D. Operating Information 2021-07-19 1 Inspection Date Previous Inspection Date Pumping Recommended ❑ Yes X❑ No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure 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 jI Earthy ❑ Moldy ❑ Offensive ❑ Turbid Effluent Solids: ® No ❑ Some pH SU DO 0 mg/L Turbidity 0 NTU 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 Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: Influent i2 Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 3663 gpd Parameters sampled:® pH ❑ BOD ❑ CBOD ❑ TSS 2 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: Operation and maintenance conducted—system operational at the time of the visit. Field-tested INF/EFF. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Field-tested INF/EFF. Massachusetts Department of Environmental Protection Bureau of Resoure 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 certifi-+ ope ..tor in accordance with 257 CMR 2.00. ,, ►,,�. � 2021-07-19 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 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use-by March 31st of each year for the previous 12 months General Use-by September 31st of each year for the previous 12 months Send to: Department of Environmental Protection Attention:Title 5 Program One Winter Street 5th Floor Boston, MA 02108 I 6`-- 9/9/21,3:47 PM Permitinspections I letCam mgr : fir _ . _ r, re Chad Simmons -Coastal Engineering,Co. Inc. 3:47 pm L E. Main Submit,My Clients:My Reports;Help ------------ - :.. - _ 1/47".-R'.� Home> tst�ectlons>leLW lnspecjtorf ? 1. . i. ::.......: 1 Pro @ s _. S--o stiOn �. .m.v. . ._.. _ _."_:, �_____ Address ;1106 Route 28,Yarmouth L ,. ' 9 nape Owner !Shaws Supermarkets Inc —.., ,Inspecfion=betails. _- -_ _ - Component: Bioclere L Date. 2t}2 f-08 30 !Time: [09:20:00 Operator Name Kevin Rezendes License# 17282 ... =comments'•-"- _ n. :- --_ - L .. .: 1 Operation and maintenance conducted—system operational at the time of the visit. Field-tested n. INF/EFF. ..4: �I@�rI @Sti ..................__________________ _ .... t° _,.. . . : . ...:.. ..:•_ .,..... ... ...._................:,..........,..._. . ..:......,._,. ,. . __ ____ _... ....__. iColor Clear Ltg Earthy::. l Effluent Solids: !No yi ( • ;;I.75SU:• • E...., Dissolved Oxygen: _._:.' --. _— - • L ._ .; . :._ :: _ : .. Turbidity :; .. _. :NTU : .. . .... . : ....:. .... .:.: . F',.: ,Settleable Solids: —....... .............. L ....„.„,...„.1,,,,,r.it. _______________.............. SEto Conclrt�ons ,Seasonal Residence: i No • ` 1Air fmperature F — .. .,;;•;;;•:::.:::::,7....:::;;;;!: :::::::;.;.:i _..._. .._i (Weather Conditions: --- ____ ri Operating lnformatrcn -.:.. Sludge Depth: ;In — fikiS&- ri.Laer:Thcness n - 'Pumping Recommended: No •• ., Soil Absorption System;Observations Signs of Breakout: ;No Depth of Ponding .: ::...,.. --- ..........:... it 1 Ponding Above Invert: !No 1 Maintenance issues Any Apparent Violations of the Approval? .None Reported • L r: ?_.. ,• Arty.Cteantrt�or LUbncation of Parts � °° �"-�- - • None Reported:::.:;::.: Performed?;' -.:.: _ ..: ..: : : . .:. . . • Any Control Adjustments Made? I haps:/septic.barnstablecountyhealth.org/app/permit inspections/view/McnlSg4oIXWEeh5bWaH08A 1/2 j L919121,3:47 PM Permitlnspections € 1 i i None Reported . , _ .. T___-- _ ._ m _� _ _ .�_ _.-.__ _ Li 1 ., . . . .. . . .. .. -: • . . . ...... • . .. ••• ..• • _. •-• ••••• • Pumps,Switches,Alarms Tested? •Checked panels,timers,amps,switches,tank.levels, alarms,and general condition of the system.• . • Li ,.„. 4, Any Equipment Failures? I None Reported i Li it „r„, „..: :7.4 • Any Parts•.._. ..,....•.R..eplaced? .....,..::: : .. .:_,.:_,••.:• •• None Reported Anyif Recommended Corrective Actions? INone Reported Li iz . Inspection,Completion.-,: U ,..:, .., I[is pection Completed? Yes :. .. l Technology Checklist ........, .. Odor.Around Srte Q Yes No .„.., , I1.r. Source of Odor Not Reported. LI :„.1. = �?dot#7+eercnp-tbon= RA'illd Medkim. ; $fin stat -fi>z is Check all that apply ScumLi ....:: Depth in Primary Tank INot Reported. r�; F ISlud9e Depth in Primaryy Tank Not Reported ,:';,'..f;''.:::::.:•-:-.,..:...;... .L ,„4:.._„,....„ 1 Does Grease Trap Need Pumping QYesCD No i Unit 1 L ;:::: If. .. it ehts = •s .- Yetfi }Air Passing Through Vent 0 0. i Fan Operating 1.____.. ..L ..s. ��.____ _ General • • iiFs LtEx;.te_..7rrr...•al•Damage HQYesvNo ...._ __ :Cover/Fan Box/Ctrl Panel Locked 10Yes No Flies on'the Und . ::.. QYes--- - . �. Number of Flies W L E., Q Few Many- Location t..i • .:......::: : .:.: ::Not ae rted:::._.:.:::::: ::,:°;::°:`:'[;::::.�:`� :::;; ....:::::,:7...,•::::Po 5. Locks/Latches/Handles Ok Q Yes Q No 171▪, ,7777.7.7.7.7.77... s ® -- Ld.Pketbk Yes ] ::..;.;..:.:::::ioa ;Standing Water in Fan Box Q Yes®No — i -o "` { IIMM - httpsJ/septic.barnstablecountyheaith.orglapp/permit_inspections/view/Mcnl$g4oEXWEeh5bWaROSA 2/2 i Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems Important:When filling out forms on A. Installation the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 return key. Facility Street Address Yarmouth 02664 r� City Zip _ Mailing address of owner, if different: (� ) P.O. Box 600 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: ❑ General ❑ Provisional Piloting ❑ Remedial Seasonal Residence - used less that 6mo./year: ❑ Yes No D. Operating Information 2021-08-30 1 Inspection Date Previous Inspection Date — Pumping Recommended ❑ Yes C No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure 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 X Clear ❑ Turbid ❑ Other(specify) Odor: ❑ Musty X Earthy ❑ Moldy ❑ Offensive ❑ Turbid Effluent Solids: X No ❑ Some pH 7.5 SU DO 0 mg/L Turbidity 0 NTU 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 Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent b Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 3,663 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: Operation and maintenance conducted—system operational at the time of the visit. Field-tested INF/EFF. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Field-tested INF/EFF. Massachusetts Department of Environmental Protection Bureau of Resoure 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 certifi-s opera •r in accordance with 257 CMR 2.00. 2021-08-30 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 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use- by March 31st of each year for the previous 12 months General Use-by September 31st of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street 5th Floor Boston, MA 02108 L10120/21,11:01 AM Permitinspections -..---,--..-:-..'-- -------•----,-- - -.--.-i:,.E:-....,-:-:---7._--..::-- --:.--,-------.:vt,F-,-..,,..-,..----;-. " -.': -''..-.-..-: '.-",-'".......r.:T.7,,,_-.- .--..-... .„.. _,,._- ... ._-......_......_. ..........._,..,.,..._:. .,. .. ._ ...., ip, .!-A.;''A;.•:',vi::-s ,ft. - ,'.-4iP7-4.. ...2.:2. 71--Wii7.7Y..:2'Nif. .1-, :;,.... .i.i4-1i ....,:i-z:E3..r,:.i2:.:,.,',Nility:4T4T4-iz5-47::'.r.i... 101:41:rilttalCilltaourity oeptie-nnanagerilenti!tfrograml::4F'_-;-E-1.112Y.-!lq:::::::_,•;•••:!...i?:;„:4,:i:::-Jit.1 . ..-4....,:,:k=r,,,, •.,, .:'.7: : . : ."- .-, ..,...-.-- ..... ....-- --..--_-;'7-'",,....".;,, •-,,"".'",--,' ..-'•-•',''.',•.'.-.,-'•,.."='. `.,..;".1.- =-,-.,..s.....‘,.........m....7.:. . . .._..,_ 1:1 pi Chad Simmons -Coastal Engineering,Co.Inc. 11:01 am 1 1....! Main'-7-Submit My Clients My Reports!Help i „.. L ;j'L.)4' :4....Li 4''”t",4''.-ili'... gticligti,,4].,"7 .--t ' -_-;•••A.,""*--,. ..,,-'•`.."--""..".-±,:.-",--'"..--...5... i Address ;1106 Route 28,Yarmouth L F.i tir-'7. "--4,-.,t--,,----- .--.,..i. Owner ---t- ,Shaws Supen-narkets,Inc. ._ ,..:,„,, . 0 CI .. . , ............_.....____________•.......______ ,_,.,,...., ...........,__ • • ••--• ..,:.. 1 .6.: ... .1): ...I- i.,:''-'"..,;.Nrk%:;7'...'=-F'''',''',-=':.,. :"' " -'" -,",i':;".4, . "'-?".":•:i,i',....:i!:,:".:7n.ni.:' ,:--,:::,i,-,:,!;.::ii:_i!i;.7„:,... a: .,:i";:i7,:;:,...r.:."_:,,..-',,......'.:::41ii'.4'.!.. .;...Z.:::ir,:,,,74inliglit:S.,,J.u.=.,,...: _ _ - ,... -._' -z-..,r-...--7-:',.4.',:'!i.4.:÷•,:iii,!.!,::-....--!.;:,;; ;:=1'. .',1- --------- ---- _ i ,_.... ... L .... , :„.., ,::: .,:, com nent: L.,-- P° ................,.....,.- •.- ...._.......,.-.._-_, -..:..._-_____.-..-.....,.._-_____ i Bloclere a- lime: '09:00:00 i ,._. L „-, V :.:. .:::.: :‘,.: ' Operator Name: - ...- ..... .. ... !License#: - *-- Kevin Rezendes--... :-..--: ...... -17282 • • i ... -2, .2_'' __.;,.,... -7,,--, IIIITIeJ11.51?-1'"r- :1:':5';-7t:-':i.':74';--: :iN .:;-....J,..::.,:','-.1::;!,:;.!•2Li':.;::::,-•- -•,-.:.-•'-ii71:1'..?r.;...e..71P-1-:',l1-'zi7:-.I.EF,Pi,..:....,..-i,..-•=l•q•,i,U:xijff?5;PT.,..p..;... ,•.lii.41;;i:,11 ,,L ..,---.;•,,----- -E,,,..."i.'PiPc-,E1;,•24,-..- .:4....e...4l.k-..J.:._';:iz.i..tk...S".''' ,....... ...- „-; Operation and maintenance conducted—system operational at the time of the visit. Field-tested. L ,...„, ,,.... __. ,, ,,..„..,..._,....„,„,_..:„...,..::_•,... ,:r!,..!;ii,t,4i,;:i,:;;:i.:::".....1j newt ISSiung,-:--:,--:-.-1-: .,=4;it,;j,,i.,..I'Yj. . "":.:_m.::.,:::.;,:-!..,:',.'E.-..",_. t.,..,......,:,,-,.,;f1,1•',"!,.. .,,,,,..:7,....±1,F.,, -.-__.-----._-.--,--...-- .. !Color: ,Clear -.3.! ;.:.. wo--;o---l: 77----"--------7777"---------,-”.: .—tir.TY. - ]-.---.::—:::7:':----". .." *.'.''.'....."'-."i:"'.."....'..-':-'-..!;!•'..:•i:'!..:!.:.:*.::"ii.--."1.-,,F-;''" .:..'...,......-:. ... L F.,?• Effluent Solids: i No pH: .-_ ---:--..:. .... ...:. .-.....:. ..:."... ...............:17.5SLI--- -- . . _• -... : - .;..:::: .--..- ..,...-:::;:;--.-L . .- - . r--; -- . a., Dissolved Oxygen: Img/I. rtd Turbidity NTU :÷.., L. .... 15 .....,.7.: Settleable Solids: r--. . i L ,..„, f•11' P. ;Seasonal Residence: !No -----li i E- 'Afteiti-e1-Lrattire: _.- .--.-.:::::-:-.;.-:-::-: -..;“..:,... -„,-..:. -,..i.!.E...--.E,jr.:.- :,:::-.z-__:..--:,:::-.L.:-.• - -_..- -.. ,- - ....•.-...--.-.- .,..... ..,....."... . , :Weather Conditions: ,.. _ ,.. ... . .. ,• _ • _ • • . op.rat...nformation - , r_ _ — Sludge Depth: i in , '067iiiiiii:0yiii•:thiokii66s: -:.:::•Ei-1-.:-.-:.-- iii-',":.::H'.:: . -:-FEa.+.: -- - - ------------------------------------- --::.' ‘.. Pumping Recommended: No Soil Absorption System ObtOfiratibiis:_----y- .-,.. .,..-3... • - -7-r.:!';.-•-•`,..-c-,-.. .-,ff-:,-. . .i-7:.”-.-----,:;- --':::.:•-..- . t _ .... E-.. Signs of Breakout: No Depthof Ponding .'.---.''. i _ . - . ..-E)iiiHi'f.--'...1-..i.--.r.i:. '.- I .. I,Ponding Above Invert: !No ':- . IVIairitenanpe 1st-ties ---'. - :.,..7,...-..:•3:.::: :.... .. .. :.,---- .: , --'-',.-;-r-.-...,.-••••L.. ','-- '' _' I ''t IC^ '..-....' — - - . . . '' ...- • - -''.."'".-- ='.. . L. •!1 Any Apparent Violations of the Approval? ,None Reported i 1 1 L ... . ,, AnY.:Cieaning or Lubrication of Parts '_.- .. .:.:.. __ _ , . .......,....... _ None Rapotted :Any Control Adjustments Made? None Reported ,_ 1 L https://septic.barnstablecountylalth.org/app/permit_inspectionsiview/jcZYsHjtozyTxAX7_6ERJO 1/2 I l 1 10/20/21,11:01 AM Permitinspections I .Primps.Switches,Alarms Tested? Checked panels,timers amps;swltches,tank levels; .•.. alarms,and general condition of the,system: .•. . ;Any Equipment Failures? None Reported `Any Parts Replaced?.• •.: • .: None Reported !Any Recommended Corrective Actions? None Reported iinspecti!orf C9m eu.ori::,= _ - -- Inspection Completed? _ -- IYes • Technology Checklist _ Odo0Around_Site • Yes0 No 'Source of Odor ;Not Reported. i • 4. 0t 6 .t~ t 0 iitlitd 7YCeit,lit€ti Strong Maud''. ::':...-:::.•:;::,-,-;',.".,.,...:. talc `'L':::*'.:':'.' I.Check all that apply O U - : L3. 's =Scum Depth in Primary Tank ;Not Reported. l L.. ;Sludge Depth In Prima Tank . ,I Not Repgited. ...::1.1!:.-..........:.....:.7..'..":.2.'.'!:1::::...:•.:-.,-. .. -. - rY ;Does Grease Trap Need Pumping �Yes[�No – Unit 1 .: Biocaote-,,.....--,_,• erd - i. – • Air Passing`I"hrough•Vent— 0 ti Fan Operating I ,� {- ` General �____�� .__,..w,_:.�:..:. External Dama a :Q [ '....:.:".....-.!•:.:::..::.:::-..!. 9 Yes No_ = , FCover/Fan Box/Ctrl Panel Locked 'QYes[l No • (Flies on ttie volt:. "...,,..*....i1:::•.:,!..::••••!:!•,.::• -:: s2 No -= 1Number of Flies 0 Few°Many location of flies _Not Reported Locks/Latches/Handles Ok 0Yes0 No ! . :Lr]Gasket Ot :?..• z - �Yes�No. — ;Standing Water in Fan Box i°Yes°No • _ https://septic.barnstablecountyhealth.crg/app/permit_inspections/viewIjcZYsHjtozyTxAX76ERJQ 2/2 _ Massachusetts Department of Environmental Protection Bureau of Resoure Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems Important:When filling out forms on A. Installation WWI the computer,use only the tab key to Shaws Supermarkets, Inc. move your cursor Owner do not use the 1106 Route 28 return key. Facility Street Address Yarmouth 02664 ISI City Zip Mailing address of owner, if different: I1 P.O. Box 600 Street Address/PO Box: East Bridgewater 02379 City State Zip Telephone Number B. Authorized Service Provider Coastal Engineering, Co. Inc. O&M Firm 260 Cranberry Highway Street Address Orleans MA 02653 City State Zip 508-255-6511 Telephone Number Kevin Rezendes 17282 Certified Operator Name Certification Number C. Facility/System Information W033722 30 Series DEP ID Manufacturer ID Model Number 2005-06-03 2005-06-03 Installation Date Start of Operation Approval Type: ❑ General ❑ Provisional ® Piloting ❑ Remedial Seasonal Residence-used less that 6mo./year: ❑ Yes ® No D. Operating Information 2021-09-07 1 Inspection Date Previous Inspection Date Pumping Recommended ❑ Yes Q No Sludge Depth Massachusetts Department of Environmental Protection Bureau of Resoure 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 7.5 SU DO 0 mg/L Turbidity 0 NTU 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 Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: Influent Qj Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: • 0.00 .^ gpd Parameters sampled:0 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: Operation and maintenance conducted—system operational at the time of the visit. Field-tested. Notes and Comments: Operation and maintenance conducted—system operational at the time of the visit. Field-tested. Massachusetts Department of Environmental Protection — r Bureau of Resoure 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 jf opera-or in accordance with 257 CMR 2.00. 2021-09-07 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 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use- by March 315t of each year for the previous 12 months General Use-by September 31st of each year for the previous 12 months Send to: — Department of Environmental Protection Attention:Title 5 Program One Winter Street 5th Floor _, Boston, MA 02108 LPermitlnspections Barnstable Septic 3 nr Mt Chad Simmons-Coastal Engineering,Co. Inc. 1.42 pm i.. Main Submit My Clients My Reports Help Homeinspections View inspection - `.'"'4::''''''' Property Details �=� Address 1106 Route 28,Yarmouth int li _,. ,. Owner Shaws Supermarkets,Inc. I Component: Bioclere Date: 2021-10-12 Time: 09:00:00 Operator Name: Kevin Rezendes License#: 17282 , Operation and maintenance conducted—system operational at the time of the visit. ldTestin Color: Clear 1 Odor. Earthy 1 ; Effluent Solids: No pH: 7.2 SU I Dissolved Oxygen: mg/L 1 Turbidity: NTU Settleable Solids: i i Site Conditions L Seasonal Residence: No Air Temperature: 1 Weather Conditions: i. Operating Information I Sludge Depth: in ` ( Scum Layer Thickness: in il Pumping Recommended: No Soil Absorption System Observations Signs of Breakout: No Depth of Ponding: in l Ponding Above Invert: No I L Any Apparent Violations of the Approval? None Reported LMips://septic.barnstablecountyheaith.orglapp;permit_inspecttonsiviewi_y1130CaP465bi0lokTBlAwt1111912021 1:43:26 PMI