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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E A3
v
Property Address
Joseph & Diane Cabral
Owner Owner's Name / a.
information is required for every Marston Mills �/ MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information 54 (4J3:F�f
on the computer,use only the tab Winston A Steadman II
key to move your Name of Inspector
cursor-do not All Cape Environmental Inc
use the return Company Name
key.
PO Box 235
w Company Address
Yarmouth Port MA 02675
AkA City/Town State Zip Code
feneo (508776-6219 SI 13405
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
WW 02/06/2020
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. CityTrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
�M1 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
V�
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I; Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
u
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
c � Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped: 0.
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 16,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 377 avg/ggpd 2yr
9 ( Y 9 (9P ))�
Detail:
2019 - 140,000 gallons used, 2018- 135,000 gallons used
Sump pump? ❑ Yes ® No
Uknown
Last date of occupancy: Date
Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
V
Property Address
Joseph & Diane.Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commerciallindustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
c Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
w Subsurface Sewage Disposal System Form Not for Voluntary Assessments
c.., 195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
® Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
17 years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 3.25feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: <50'feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Joints appear to be tight
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
l;
u
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 2.8
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gallon
Sludge depth:
11"
Distance from top of sludge to bottom of outlet tee or baffle (48"-(14"+11")= 23"
Scum thickness 2
Distance from top of scum to top of outlet tee or baffle 3
Distance from bottom of scum to bottom of outlet tee or baffle 11
How were dimensions determined? Measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank does not need to be pumped at this time
t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�. 195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
195 Route 149 Unit E
V` Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City(rown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert N/A
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
�n 1, ,w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ® Yes ❑ Nci*
Alarms in working order: ❑ Yes ❑ No"
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
There is no alarm on pump chamber. If pump fails water will back up into Recirculation Tank and use
up storage space until alarm sounds
*If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
SAS is pressure dosed
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
® innovative/alternative system
Type/name of technology: Pressure dose
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
c Commonwealth of Massachusetts
�r Title 5 Official Inspection Form
0 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D: System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SAS is well graded and landscaped. SAS consists of 2 -30' long 1"diameter pvc laterals with ten 1/4"
holes spaced 3' o/c total length of trench is 65 long
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
�0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
195 Route 149 Unit E
V�
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
c Commonwealth of Massachusetts
�x ,e Title 5 Official Inspection Form
tI Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
., 195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: �7
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 9/12/02
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Bottom of SAS is 57.7 bottom of test hole is 50.7
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 18
c Commonwealth of Massachusetts
�d Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
195 Route 149 Unit E
Property Address
Joseph & Diane Cabral
Owner Owner's Name
information is required for every Marston Mills MA 02648 Febuary 6, 2020
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
. 1 5 Rt 149 Unit
A B
1500 gal 1000 gal
Recirculation
Septic Tank Tank Pump
Pod _ _ __._____ Chamber
1) 0 2) O
Pod
SAS
6 0
c
Pods are at grade
Covers 2,3,4, & 5 are at grade
Al — 1 5' 0" B1 — 37' 0"
A6 - 45' 0" B6 - 23' 0"
A7 - 32' 0" B7 - 57' 0"
N.T.S.
I/A System Inspection �``�Of B
195-E Route 149, Barnstable a
Barnstable County Department of Health and Environment �9SSACFnysQ
P.O. Box 427, Barnstable, MA 02630
Field Testing
Color ❑ Gray ❑ Brown ® Clear ❑ Turbid ❑ Other
Odor ® Musty ❑ Earthy ❑ Moldy ❑ Offensive ❑ Turbid
Effluent Solids ® No ❑ Some
pH 7.5 SU D.O. 9.730 mg/L Turbidity 3.61 NTU Settleable Solids 0.000 ml/L
Site Conditions
Seasonal Residence ® No ❑ Yes
Air Temperature degress F
Weather Conditions
Operating Information
Sludge Depth 11.00 inches
Scum Layer Thickness 2.00 inches
Pumping Recommended ® No ❑ Yes
Soil Absorption System Observations
Signs of Breakout ® No ❑ Yes ❑ Unknown
SAS Ponding Above Invert ® No ❑ Yes ❑ Unknown
Depth of Ponding inches
Maintenance Issues
Inspection Completed? ® Yes ❑ No
Approval Violations None
Cleaning/Lubrication Performed None
Control Adjustments None
Test Pumps/Switches/Alarms All Equipment Tested
Equipment Failures None
Parts Replaced None
Corrective Actions Recommended None
Other Comments
Comments None
Septic Tank
Sludge Pumping Required ❑ Yes ® No
Effluent Tee Filter ❑ Yes ❑ No
If yes, inspect ❑
Clean at least yearly ❑
Re-circulation Tank
Check if sludge accumulating ❑
Odor Problems ❑ Yes ® No
Effluent Tee Filter ❑ Yes ❑ No
Pumping Re Yes ® No
p 9 Required ❑
If yes, inspect ❑
Clean at least yearly ❑
Equalization Tank (if installed)
Sludge Pumping Required ❑ Yes ® No
Effluent Tee Filter ❑ Yes ❑ No
If yes, inspect ❑
Clean at least yearly ❑
Pump Chamber/Vault (if installed)
Pump Inspections (all units) ❑
If problems, describe:
Float Switches
Check all switches for operation:
Pumps, Switches, Floats, Alarm Systems
Pump Inspections (all units) ❑
If problems, describe:
Test pump alternator, or record hours ❑
Hours of operation
Float switches ❑
Check all switches for operation
Test alarm
If not functioning, corrective action(s)
Filter Modules ("Sand Filters")
Inspect for ponding ❑
Ponding Present ❑ Yes ® No
Clean Bed: ® Yes ❑ No
Distribution pipes ❑
Flush ❑ Yes ® No
Brush ❑ Yes ® No
Any obstruction of airflow to filter modules ❑ Yes ® No
If yes, explain below (i.e. snow, dirt)
Sample Collection
Yes
No
If yes: ❑ BOD ❑ TSS ® PH ® TN ❑ Other
I/A System Sample Report
195-E Route 149, Barnstable
Barnstable County Department of Health and Environment ��ssAcxu
P.O. Box 427, Barnstable, MA 02630
Physical Address 195-E Route 149, Barnstable
Technology- Model OMNI Recirculating Sand Filter- RSF System
Sample Date and Time 01/02/2020 @ 02:45 pm
Sampling Parameter Result Unit Range
Nitrate (Nitrate) _ _ _ 2.30000 mg/L <19 00
Nitrite (Nitrite) Below Recordable mg/L <19.00
Limit.
TKN (Total Kjehldahl Nitrogen) 0.88000 :mg%L <19 00
TN (Total Nitrogen) 3.18000 mg/L <19.00
BRL - Below Recordable Limit, DNS - Did Not Sample, NR - Not Reported
(ES. BCDHE
A B ,FY A TA6L MY E CW DEPARUIENT OF HEALTH An ENYIRONMEfdT
;'- - PROMOTE-PROTECT-SUPPORT
kh •0 YEARS OF SERVICE
•
October 26th, 2017
Joseph and Diane Cabral
PO Box 352
Marstons Mills, MA 02648
RE: Operation and Maintenance Contract for the Innovative/Alternative Septic System Installed at 195-E Route 149 in
the town of Barnstable.
Dear Joseph and Diane Cabral,
Our records indicate that the operation and maintenance contract with Bennett Environmental Associates, Inc.for your
innovative/alternative wastewater treatment system may have expired or was canceled as of October 13th, 2017. To date we
have not received evidence that you have entered into a new operation and maintenance contract.
I am writing to remind you that the Massachusetts Department of Environmental Protection (MA DEP)and the Town of
Barnstable require you to keep an operation and maintenance (O&M)contract in effect at all times for your system.
Information about these requirements may be found at https:Hseptic.barnstablecountyhealth.o[g. You can access the list of �!
wastewater operators of whom we are aware do business in Barnstable County. This septic database also provides further
explanation about your I/A septic system, as well as any sample and inspection history for the performance of your system,
as entered by previous service providers.
My department oversees I/A septic system management and compliance efforts for the Board of Health in your town. We are
authorized by your Board of Health to contact you to inform you of the above requirement and to request your compliance.
Accordingly, please forward a copy of a signed contract via mail, fax, or e-mail within fifteen (15)days of receipt of this
letter. For your convenience,•I have enclosed a list of wastewater operators we are aware of that do business in Barnstable
County. The firms listed operate multiple types of I/A technologies and are not associated with any particular technology or
vendor.
Please be advised that if you do not respond within fifteen (15)days of your receipt of this letter by forwarding a copy of a
signed contract, you may be referred to the Barnstable Board of Health for further enforcement action.
I can be reached at 508-375-6901; my fax number is (508)362-2603. 1 can also be reached via email at
emilymichele.omsted@barnstablecounty.org.Thank you for your prompt attention to this matter.
Sincerely,
Emily Michele Olmsted
CC: Barnstable Board of Health
Enclosures (2): Certified Wastewater Treatment System Operators List, Inspection and Testing Requirements
BARNSTABLE COUNTY COMPLEX A
3195 MAIN STREET/PO BOX 427
BARNSTABLE,MASSACHUSETTS 02630
Phone:(508)375-6613 1 Fax:(508)362-2603 1 TDD:(508)362-5885
Web:barn stablecountyhealth.org I Twitter:@BCHDCapeCod
Town of Barnstable Barnstable
�t r �
ftV
Board of Health 1 �c i
sa`F� 200 Main Street, Hyannis MA 02601
i639. 2007
AjfD MA'S p
Office: 508-862-4644 Wayne Miller,M.D.
FAX: 508-790-6304 Paul Canniff,D.M.D.
Junichi Sawayanagi
Mr. and Mrs. Cabral October 15, 2014
P.O. Box 352
Marstons Mills, MA 02648
RE: Correction to Sampling of Wastewater Effluent from your Innovative/Alternative(OMNI)
System at:
195 Route 149 #E,Marstons Mills : A= 078-018440E
Herring Run Place Condo
Dear Mr. and Mrs. Cabral,
You are granted permission to reduce the frequency that you monitor your system consisting of
innovative/alternative technology (OMNI 2000 Recirculating Sand Filter system) at 195 Route
149, #E, to twice�a year:
The following requirements are an update from the November 12, 2013 Board of Health letter.
Permission is granted for the I/A system at your property with the following conditions:
❖ The wastewater effluent shall be tested for TotalbNitrogen twice per year.
❖ Operation and Maintenance Inspections can be reduced to twice a year, but shall
include field testing for pH, DO, and turbidity.
Sincerely,
Wayne Miller, M.D., Chairman
BOARD OF HEALTH
rrection Cabral unit#E 2014.doc
Q:\[A systems\195 Rt149\Final co ,
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS
1573 Main Street,P.O.Box 1743 (508)896-1706
Brewster,MA 02631 fax(508)896-5109
LETTER OF TRANSMITTAL
TO: DATE: JOB NUMBER:
Massachusetts Department of Environmental Protection 9/24/14 BEA12-10453
Attention:Title 5 Program
1 Winter Street-6th Floor
Boston,MA 02108 REGARDING:
Cabral Residence
195 Herring Run Place Unit E[Route 149]
SHIPPING METHOD: Marstons Mills,MA
Regular Mail ❑ Pick Up ❑
Priority Mail ❑ Hand Deliver ❑
Express Mail ❑ Other ❑
Certified Mail 0 Green Card/RR ❑
COPIES DATE DESCRIPTION
1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(March and
September 2014)
1 OMNI Environmental Systems,Inc.RSF Operation and Maintenance Inspection Checklist(March and
September 2014)
1 9/22/14 Alpha Analytical Laboratory Report >w�
For review and comment: ❑ For approval: ❑ As requested: ❑ For your use.--.
REMARKS: C_
Please find enclosed the DEP Inspection and O&M Form,OMNI RSF Operation and Maintenance Inspection Checklist and laboratory
analytical results for operation and maintenance conducted during the reporting period at the above referenced property. The Barnstable
Board of Health approved a reduction in inspection frequency from quarterly to semi-annual in 2013. It is noted that inspection ports or
cleanouts for the pressure dosed leach field laterals are not accessible for inspection. If you have any questions or require additional
information,please contact us at your earliest convenience. Thank you.
cc:Barnstable Board of Health
Mr.and Mrs.Joseph and Diane Cabral,Property Owners
David C.Bennett,Principal [Internal]
FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529
If enclosures are not as noted,kindly notify us at once
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When Joseph and Diane Cabral
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return City Zip
key.
Mailing address of owner, if different:
P.O. Box 352
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508) 744-7328 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/ PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
8/25/03 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
3/6/14 9/11/13
Inspection Date Previous Inspection Date
6" Sludge, 1" Scum Pumping Recommended ❑ Yes ® No
Sludge Depth(to be checked yearly)
t5aiom.doc•rev. 11-07-05 Page 1 of 3
'w
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 7.0 SU DO 6.0 mg/L Turbidity 9.08 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:
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:
The recirculation pump was replaced on 9/30/13. Conduct an operation and maintenance event on
3/6/14. Collect effluent samples for field testing.
Notes and Comments:
The system is operating correctly. Effluent quality passed field testing parameters.
t5aiom.doc•rev.11-07-05 Page 2 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
Ho Certification
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.
2 ������
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 315t of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use-by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When Joseph and Diane Cabral
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return
City Zip
key.
Mailing address of owner, if different:
P.O. Box 352
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508) 744-7328 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/ PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
8/25/03 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
9/15/14 3/6/14
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev. 11-07-05 Page 1 of 3
I Lll�
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 7.0 SU DO 5.0 mg/L Turbidity 2.24 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:
gpd
Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ® Other(list below)
NO3 NO2 TKN
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection &during this inspection:
Conduct an operation and maintenance event. Collect effluent samples for field testing and
laboratory analysis.
Notes and Comments:
The system is operating correctly. Effluent quality passed field testing parameters.
t5aiom.doc•rev. 11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
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.
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31"of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc rev. 11-07-05 Page 3 of 3
4
OMNI RSF Operation and Maintenance Inspection Checklist
A. Installation & Service Information
I-\e- Mlk �C� - 1� A C� I I I , "0
Facility Street Address Date of 8ervlce
City Operator/O&M Firm
System Startup Date Weather Conditions
B. Septic Tank
Sludge Pumping Required: Yes❑ No Sludge Depth: to N Scum Depth:
Effluent tee filter: YeSANo❑ If yes, inspect(o&clean at least yearly A
If the sludge layer is within 12'of the outlet invert,recommend that the homeowner have the septic tank
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule
depending on how heavily the system is used.
C. Recirculation Tank
Check if sludge accumulating Pumping required: Yes❑ Na
Odor problems: Yes❑ No�k If yes,description
Effluent tee filter: Yes❑ Noo If yes, inspect❑ &clean at least yearly❑
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed,may need servicing.
�J D. Equalization Tank(if installed)
Sludge Pumping Required: Yes ❑ No❑ ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Yes❑ No❑ If yes, inspect❑&clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber I Vault(if Installed)
%Pump Inspections(all units)
If problems,describe
Float switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken.
F. Pumps, Switches, Floats, Alarm System
Pump Inspections(all units)
If problems,describe
,Test pump alternator, or record hours
Hours of operation
Float switches
Check all switches for operation
Nest alarm
If non-functioning,corrective action(s)
Make sure pump(s), Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made. \
G. Filter Modules ("Sand Filters") So\�O
Inspect for ponding NZ Ponding Present: Yes❑ NJU
Clean bed: Yes❑ N
Distribution pipes Flush: Yes ElNo� Brush: Yes❑ Not
Any obstruction of airflow to filter modules: YesQ4 No ❑ If Yes,explain below(i.e. snow, dirt)
To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on It and should have a brownish shaggy coloration. If the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
Yes❑ NA DU
If yes: ❑BOD ❑TSS ❑pH [:ITN ❑Other
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e. rubber gloves).
System Notes:
,,r
1
M
Envlr'onmentol Systems,Inc.
OMNI RSF Operation and Maintenance Inspection Checklist
A. Installation &Service Information
lktl
Facility Street Address Date of Service
city Operator/O&M FirmT
System Startup Date Weather Conditions
B. Septic Tank
Sludge Pumping Required: Yes ❑ Noi,$ ❑Sludge Depth: ❑ Scum Depth:
Effluent tee filter: Yes No❑ If yes,inspect ]&clean at feast yearly,]
If the sludge layer is within 12'of the outlet invert,recommend that the homeowner have the septic tank
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established with a licensed septage hauler, if not recommend a two to four year pumping schedule
depending on how heavily the system is used.
C. Recirculation Tank Sli(, \,,, `� s `\`
❑Check if sludge accumulating Pumping required: Yes❑ NoX
i
Odor problems: Yes❑ NOQ� If yes,description
Effluent tee filter: Yes❑ NO If yes, inspect❑&clean at least yearly❑
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
D. Equalization Tank (if installed)
Sludge Pumping Required: Yes❑ No❑ ❑Sludge Depth: ❑ Scum Depth:
Effluent tee filter: Yes❑ No❑ If yes, inspect❑&clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber/Vault(if Installed)
Pump Inspections(all units)
If problems,describe
loat switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate i
corrective actions need to be taken.
i
i
I
i
f
F. Pumps, Switches, Floats, Alarm System
Pump inspections(all units)
If problems,describe
Test pump alternator, or record hours
Hours of operation
Float switches
� Check all switches for operation
Test alarm
If non-functioning,corrective action(s)
Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made.
G. Filter Modules ("Sand Filters") '�
�]Inspect for ponding Ponding Present:Yes❑ No
Clean bed: Yes❑ No
Distribution pipes Flush:Yes❑ No� Brush: Yes❑ NoTq
6(Any obstruction of airflow to filter modules: Yes❑ No Q�If Yes,explain below(i.e.snow, dirt)
To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the and of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration.if the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
YJ�O No❑
If yes:❑BOD ❑TSS ❑pH 'ATN Z40ther W';
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers. In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e. rubber gloves).
System Notes:
. i
'" �s-�--.tip. � •o.t.. ���.°�1�L, .�; � �.. i
� 1
1
Serial No:09221409:06
HAk,
: AY sYTfCAL
ANALYTICAL REPORT
Lab Number: L1421316
Client: Bennett Environmental Associates
1573 Main Street
Brewster, MA 02631
ATTN: David Bennett
Phone: (508)896-1706
Project Name: CABRAL RESIDENCE
Project Number: BEA12-10453
Report Date: 09/22/14
The original project report/data package is held by Alpha Analytical.This report/data package is paginated and should be reproduced only in its
entirety.Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original.
Certifications&Approvals: MA(M-MA086),NY (11148),CT(PH-0574),NH(2003),NJ NELAP(MA935),RI(LA000065),ME(MA00086),
PA(68-03671),USDA(Permit #P-330-11-00240),NC(666),TX(T104704476),DOD(1-2217),US Army Corps of Engineers.
Eight Walkup Drive, Westborough, MA 01581-1019
508-898=9220 (Fax)508-898-9193 800-624-9220-www.alphalab.com.
Page 1 of 15
Serial No:09221409:06
Project Name: CABRAL RESIDENCE Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
Alpha Sample Collection
Sample ID Client ID Matrix Location Date/Time Receive Date
L1421316-01 EFFLUENT WATER MARSTONS MILLS, MA 09/15/14 13:45 09/16/14
Page 2 of 15 �
Serial No:O9221409:O6
d
Project Name: CABRAL RESIDENCE Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
Case Narrative
The samples were received in accordance with the Chain of Custody and no significant deviations were encountered during the preparation
or analysis unless otherwise noted.Sample Receipt,Container Information,and the Chain of Custody are located at the back of the report.
Results contained within this report relate only to the samples submitted under this Alpha Lab Number and meet all of the requirements of
NELAC,for all NELAC accredited parameters.The data presented in this report is organized by parameter(i.e.VOC,SVOC,etc.).Sample
specific Quality Control data(i.e.Surrogate Spike Recovery)is reported at the end of the target analyte list for each individual sample,
followed by the Laboratory Batch Quality Control at the end of each parameter.If a sample was re-analyzed or re-extracted due to a
required quality control corrective action and if both sets of data are reported,the Laboratory ID of the re-analysis or re-extraction is.
designated with an"R"or"RE",respectively.When multiple Batch Quality Control elements are reported(e.g.more than one LCS),the
associated samples for each element are noted in the grey shaded header line of each data table.Any Laboratory Batch,Sample Specific%
recovery or RPD value that is outside the listed Acceptance Criteria is bolded in the report.All specific QC information is also incorporated in
the Data Usability format of our Data Merger tool where it can be reviewed along with any associated usability implications.Soil/sediments,
solids and tissues are reported on a dry weight basis unless otherwise noted.Definitions of all data qualifiers and acronyms used in this
report are provided in the Glossary located at the back of the report.
In reference to questions H(CAM)or 4(RCP)when"NO"is checked,the performance criteria for CAM and RCP methods allow for some
quality control failures to occur and still be within method compliance. In these instances the specific failure is not narrated but noted in the
associated QC table.The information is also incorporated in the Data Usability format of our Data Merger tool where it can be reviewed
along with any associated usability implications.
Please see the associated ADEx data file for a comparison of laboratory reporting limits that were achieved with the regulatory Numerical
Standards requested on the Chain of Custody.
HOLD POLICY
For samples submitted on hold,Alpha's policy is to hold samples(with the exception of Air canisters)free of charge for 21 calendar days
from the date the project is completed.After 21 calendar days,we will dispose of all samples submitted including those put on hold unless
you have contacted your Client Service Representative and made arrangements for Alpha to continue to hold the samples.Air canisters will
be disposed after 3 business days from the date the project is completed.
Please contact Client Services at 800-624-9220 with any questions.
I,the undersigned, attest under the pains and penalties of perjury that,to the best of my knowledge and
belief and based upon my personal inquiry of those responsible for providing the information contained
in this analytical report, such information is accurate and complete. This certificate of analysis is not
complete unless this page accompanies any and all pages of this report.
oc �c Lura L Troy
Authorized Signature:
Title: Technical Director/Representative Date: 09/22/14
Page 3 of 15 - �A
Serial No:09221409:06
INORGANICS
MISCELLANEOUS
.a:
Page 4 of 15
Serial No:09221409:06
Project Name: Lab Number:
1 CABRAL RESIDENCE L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
SAMPLE RESULTS
Lab ID: L1421316-01 Date Collected: 09/15/14 13:45
Client ID: EFFLUENT Date Received: 09/16/14
Sample Location: MARSTONS MILLS,MA Field Prep: Not Specified
Matrix: Water
Dilution Date Date Analytical
Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst
General Chemistry Westborough Lab _
r..,._
Nitrogen,Nitrite ND - mg/I 0.050 _ 1 - 09/17/14 04:09 44,353.2 DB
.._..._..._ - ._ .._.__. --- ----- . ....._-
Nitrogen,Nitrate 3.9 mg/I 0.10 -- 1 - 09/17/14 04:09 44,353.2 DB
_.... ........... ........ ..... . ...... __..__. .............. _.....-_ ....... ---. _ .._....... ... ..... .. .-_... _.......
.. _,......_._
Nitrogen,Total Kjeldahl 1.88 mg/I 0.300 -- 1 09/17/14 12:18 09/18/14 22:07 30,4500N-C AT
Page 5 of 15
Serial No:09221409:06
Project Name: CABRAL RESIDENCE Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
Method Blank Analysis
Batch Quality Control
Dilution Date Date Analytical
Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst
General.Chemil istry-Westborough Lab,fo samples) 01 'Batch`.-WG722M1-1,
Nitrogen,Nitrate ND mg/I 0.10 1 09/17/14 01:49 44,353.2 DB
General Cliemistry Westborough Lab for sample(s): 01 .Batch: ,W670!5M 1 ;
Nitrogen,Nitrite ND mg/I 0.050 1 09/17/14 01:52 44,353.2 DB
General Chemistry'=Westborough L* 6 for'sample(s)y 01 , Batch: W6722791-1 L_
Nitrogen,Total Kjeldahl ND mg/I 0.300 1 09/17/14 12:18 09/18/14 21:53 30,4500N-C AT
s r�
L L?HA
Page 6 of 15
Serial No:09221409:06
Lab Control Sample Analysis
Project Name: CABRAL RESIDENCE Batch Quality Control Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
LCS LCSD %Recovery
Parameter %Recovery Qual %Recovery Qual Limits RPD Qual RPD Limits
General Chemistry ;Westborough Lab Associated samples) 01 Batch W.G722581 2
Nitrogen,Nitrate 100= 90-110
General Chemistry Westborough'Lab Associated sample(s):.01 Batch WG722584 2
- i, .: ..�_.. ., _._ . w._. _ .... .. _ m ..... . _ .
Nitrogen,Nitrite 96: 90-110 - 20
General Chemistry .Westborough Lab 'Associated samples) 01 ,Batch WG722791 2
Nitrogen,Total Kjeldahl 100'. - 78-122
Page 7 of 15 �� ��
Serial_No:09221409:06
Matrix Spike Analysis
Project Name: CABRAL RESIDENCE Batch Quality Control Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
Native MS MS MS MSD MSD Recovery RPD
Parameter Sample Added Found %Recovery Qual Found %Recovery Qual Limits RPD Qual Limits
General Chemistry-Westborough Lab Associated sample(s): 01• QC Batch ID: WG722581-4. QC Sample: 1-1421265-01 Client ID:=MS Sample
Nitrogen,Nitrate 0.32 4 4.3 99 83-113 - 6
General Chemistry ;WestboroughLab Associated sample(s). 01" QC Batch ID WG722584 4' QC-Sample. L1421296 01 Client 1D:'',MS Sample
Nitrogen,Nitrite ND 4 3.9 99 - 80-120 - 20
y ry , g 4 QC Sample: L. p142128101 Client ID MS'Sam pie
General Chemist �Westborou h Lab sample(s): 01 QC Batch ID: WG722791 A ..._ . .._..:,..h- �.,� , , ,:......, .w .....,.. . . ... : � . _..
Nitrogen,Total Kjeldahl 1.53 8 10.1 107 - 77-111 24
Page 8 of 15
Serial No:09221409:06
Lab Duplicate Analysis
Project Name: CABRAL RESIDENCE Batch Quality Control Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
Parameter Native Sample Duplicate Sample Units RPD Qual RPD Limits
Geheral Chemistry 1N.estborough,Lab Associated sampl W QC ample L1421265 01 Client ID DUP.Sample
Nitrogen,Nitrate 0.32 0.28 mg/I 13 Q 6
General:Chemistry ;Westborough Lab Associated sample(s). `01 ,QC.Batch ID ':VVG722584-3 Y 'QC Sample: L1421296 01:'Client ID: DUP:Sample .
Nitrogen,Nitrite ND ND mg/I NC 20
General Chemistry Westborough Lab Associated sample(s): 01 QC Batch�tD: WG722791 3 QC Sample L1421281;-01 Client ID. DUP,Sam'ple ,
Nitrogen,Total Kjeldahl 1.53 1.85 mg/I 19: . 24
5-,
Lq HA
Page 9 of 15 �_,.„;� ,,,
Serial No:09221409:06
Project Name: CABRAL RESIDENCE Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
Sample Receipt and Container Information
Were project specific reporting limits specified? YES
Reagent H2O Preserved Vials Frozen on: NA
Cooler Information Custody Seal
Cooler
A Absent
Container Information Temp
Container ID Container Type Cooler pH deg C Pres Seal Analysis(*)
L1421316-01A Plastic 250ml H2SO4 preserved A <2 4.8 Y Absent TKN-4500(28)
L1421316-01 B Plastic 250m]unpreserved A 7 4.8 Y Absent NO2-353(2),NO3-353(2)
*Values in parentheses indicate holding time in days �;�
Page 10 of 15
Serial No:09221409:06
J
Project Name: CABRAL RESIDENCE Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
GLOSSARY
Acronyms
EDL Estimated Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated
values,when those target analyte concentrations are quantified below the reporting limit(RL).The EDL includes any
adjustments from dilutions,concentrations or moisture content,where applicable.The use of EDLs is specific to the analysis of
PAHs using Solid-Phase Microextraction(SPME).
EPA Environmental Protection Agency.
LCS Laboratory Control Sample:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes
or a material containing known and verified amounts of analytes.
LCSD Laboratory Control Sample Duplicate:Refer to LCS.
LFB Laboratory Fortified Blank:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes
or a material containing known and verified amounts of analytes.
MDL Method Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values,
when those target analyte concentrations are quantified below the reporting limit(RL)-The MDL includes any adjustments from
dilutions,concentrations or moisture content,where applicable.
MS Matrix Spike Sample:A sample prepared by adding a known mass of target analyte to a specified amount of matrix sample for
which an independent estimate of target analyte concentration is available.
MSD Matrix Spike Sample Duplicate:Refer to MS.
NA Not Applicable.
NC Not Calculated: Term is utilized when one or more of the results utilized in the calculation are non-detect at the parameter's
reporting unit.
NI Not Ignitable.
RL Reporting Limit: The value at which an instrument can accurately measure an analyte at a specific concentration.The RL
includes any adjustments from dilutions,concentrations or moisture content,where applicable.
RPD Relative Percent Difference: The results from matrix and/or matrix spike duplicates are primarily designed to assess the precision
of analytical results in a given matrix and are expressed as relative percent difference(RPD). Values which are less than five
times the reporting limit for any individual parameter are evaluated by utilizing the absolute difference between the values;
although the RPD value will be provided in the report.
SRM Standard Reference Material:A reference sample of a known or certified value that is of the same or similar matrix as the
associated field samples.
Footnotes
1 The reference for this analyte should be considered modified since this analyte is absent from the target analyte list of the original
method.
Terms
Total:With respect to Organic analyses,a'Total'result is defined as the summation of results for individual isomers or Aroclors.If a'Total'
result is requested,the results of its individual components will also be reported.This is applicable to'Total'results for methods 8260,8081
and 8082.
Analytical Method:Both the document from which the method originates and the analytical reference method.(Example:EPA 8260B is
shown as 1,8260B.)The codes for the reference method documents are provided in the References section of the Addendum.
Data Qualifiers
A Spectra identified as"Aldol Condensation Product".
B The analyte was detected above the reporting limit in the associated method blank.Flag only applies to associated field samples that
have detectable concentrations of the analyte at less than ten times(l Ox)the concentration found in the blank.For MCP-related
projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(10x)
the concentration found in the blank.For DOD-related projects,flag only applies to associated field samples that have detectable
concentrations of the analyte at less than ten times(10x)the concentration found in the blank AND the analyte was detected above
one-half the reporting limit(or above the reporting limit for common lab contaminants)in the associated method blank.For NJ-
Air-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte above the
reporting limit.For NJ-related projects(excluding Air),flag only applies to associated field samples that have detectable
'. concentrations of the analyte,which was detected above the reporting limit in the associated method blank or above five times the
reporting limit for common lab contaminants(Phthalates,Acetone,Methylene Chloride,2-Butanone).
` C Co-elution:The target analyte co-elutes with a known lab standard(i.e.surrogate,internal standards,etc.)for co-extracted
analyses.
D Concentration of analyte was quantified from diluted analysis.Flag only applies to field samples that have detectable concentrations
of the analyte.
E Concentration of analyte exceeds the range of the calibration curve and/or linear range of the instrument.
Report Format: Data Usability Report
Page 11 of 15
Serial No:09221409:06
Project Name: CABRAL RESIDENCE Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
Data Qualifiers
G The concentration may be biased high due to matrix interferences(i.e,co-elution)with non-target compound(s).The result should
be considered estimated.
H The analysis of pH was performed beyond the regulatory-required holding time of 15 minutes from the time of sample collection.
I The lower value for the two columns has been reported due to obvious interference.
M Reporting Limit(RL)exceeds the MCP CAM Reporting Limit for this analyte.
NJ Presumptive evidence of compound.This represents an estimated concentration for Tentatively Identified Compounds(TICS),where
the identification is based on a mass spectral library search.
P The RPD between the results for the two columns exceeds the method-specified criteria.
Q The quality control sample exceeds the associated acceptance criteria.For DOD-related projects,LCS and/or Continuing Calibration
Standard exceedences are also qualified on all associated sample results. Note:This flag is not applicable for matrix spike recoveries
when the sample concentration is greater than 4x the spike added or for batch duplicate RPD when the sample concentrations are less
than 5x the RL.(Metals only.)
R Analytical results are from sample re-analysis.
RE Analytical results are from sample re-extraction.
S Analytical results are from modified screening analysis.
J Estimated value.This represents an estimated concentration for Tentatively Identified Compounds(TICS).
ND Not detected at the reporting limit(RL)for the sample.
Report Format: Data Usability Report
�f° HA
Page 12 of 15
• Serial—No:09221409:06
s -
Project Name: CABRAL RESIDENCE Lab Number: L1421316
Project Number: BEA12-10453 Report Date: 09/22/14
REFERENCES
30 Standard Methods for the Examination of Water and Wastewater.APHA-AWWA-
WPCF. 18th Edition. 1992.
44 Methods for the Determination of Inorganic Substances in Environmental Samples,
EPA/600/R-93/100, August 1993.
LIMITATION OF LIABILITIES
Alpha Analytical performs services with reasonable care and diligence normal to the analytical testing
laboratory industry. In the event of an error,the sole and exclusive responsibility of Alpha Analytical
shall be to re-perform the work at it's own expense. In no event shall Alpha Analytical be held liable
for any incidental, consequential or special damages, including but not limited to, damages in any way
connected with the use of, interpretation of, information or analysis provided by Alpha Analytical.
We strongly urge our clients to comply with EPA protocol regarding sample volume, preservation, cooling,
containers, sampling procedures, holding time and splitting of samples in the field.
Page 13 of 15
Serial-No:09221409:06
Certification Information
Last revised April 15,2014
The following analytes are not included in our NELAP Scope of Accreditation:
Westborough Facility
EPA 524.2: Acetone,2-Butanone(Methyl ethyl ketone (MEK)),Tert-butyl alcohol, 2-Hexanone, Tetrahydrofuran,
1,3,5-Trichlorobenzene, 4-Methyl-2-pentanone (MIBK), Carbon disulfide, Diethyl ether.
EPA 8260C: 1,2,4,5-Tetramethylbenzene, 4-Ethyltoluene, lodomethane(methyl iodide), Methyl methacrylate,
Azobenzene.
EPA 8330A/B: PETN, Picric Acid, Nitroglycerine, 2,6-DANT, 2,4-DANT.
EPA 8270D: 1-M ethyl naphthalene, Dimethyl naphthalene,1,4-Diphenylhydrazine.
EPA 625: 4-Chloroaniline,4-Methylphenol.
SM4500: Soil:Total Phosphorus,TKN, NO2, NO3.
EPA 9071: Total Petroleum Hydrocarbons, Oil&Grease.
Mansfield Facility
EPA 8270D: Biphenyl.
EPA 2540D: TSS
EPA TO-15: Halothane, 2,4,4-Trimethyl-2-pentene, 2,4,4-Trimethyl-1-pentene,Thiophene, 2-Methylthiophene,
3-Methylthiophene, 2-Ethylthiophene, 1,2,3-Trimethylbenzene, Indan, Indene, 1,2,4,5-Tetramethylbenzene,
Benzothiophene, 1-Methylnaphthalene.
The following analytes are included in our Massachusetts DEP Scope of Accreditation,Westborough Facility:
Drinking Water
EPA 200.8: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI; EPA 200.7: Ba,Be,Ca,Cd,Cr,Cu,Na; EPA 245.1: Mercury;
EPA 300.0: Nitrate-N, Fluoride, Sulfate; EPA 353.2: Nitrate-N, Nitrite-N; SM4500NO3-F: Nitrate-N, Nitrite-N; SM4500E-C,
SM4500CN-CE, EPA 180.1, SM2130B,SM4500C1-D, SM23206, SM2540C, SM4500H-B
EPA 332: Perchlorate.
Microbiology: SM9215113; SM9223-P/A, SM9223B-Colilert-QT, Enterolert-QT.
Non-Potable Water
EPA 200.8:AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn;
EPA 200.7: AI,Sb,As,Be,Cd,Ca,Cr,Co,Cu,Fe,Pb,Mg,Mn,Mo,Ni,K,Se,Ag,Na,Sr,Ti,TI,V,Zn;
EPA 245.1, SM4500H,B, EPA 120.1, SM2510B,SM2540C,SM2340B, SM2320B, SM4500CL-E, SM4500E-BC,
SM426C, SM4500NH3-BH, EPA 350.1:Ammonia-N, LACHAT 10-107-06-1-B:Ammonia-N, SM4500NO3-F,
EPA 353.2: Nitrate-N, SM4500NH3-BC-NES, EPA 351.1, SM4500P-E, SM4500P-B, E, SM5220D, EPA 410.4,
SM5210113, SM5310C, SM4500CL-D, EPA 1664,SM14 510AC, EPA 420.1, SM4500-CN-CE, SM254013.
EPA 624:Volatile Halocarbons&Aromatics,
EPA 608: Chlordane, Toxaphene,Aldrin, alpha-BHC, beta-BHC, gamma-BHC, delta-BHC, Dieldrin, DDD, DDE, DDT,
Endosulfan I, Endosulfan ll, Endosulfan sulfate, Endrin, Endrin Aldehyde, Heptachlor, Heptachlor Epoxide, PCBs
EPA 625: SVOC(Acid/Base/Neutral Extractables), EPA 600/4-81-045: PCB-Oil.
Microbiology: SM9223B-Colilert-QT; Enterolert-QT, SM922213-MF.
For a complete listing of analytes and methods, please contact your Alpha Project Manager.
Page 14 of 15
Serial_N o:Q9221409:06
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CHAIN OF CUSTODY PAGE, OF „A)�PHA'pJob,;#t )r1r' •,;,
r�'Itfi;;+[tE.,.CProject Information +�'�:tt..,:�n+.,: ..3•�" ;°f�'u.+�k{ d�,e�,rf,'��-'�°�a'�
y • Report InformationIL
El FAX a EMAIL ® Same as.client info PO#:10453 ;—
Westborough;MA Mansfield,MA
Project Name:Cabral Residence.
TEL:506.98-9220 TEL•:508-822-9300 ❑ ADEx ❑ Add1 Deliverables j
'FAX:508-898-9193.. FAX:508-822.3288 "' I
Regulatory • ••
Client Information Project Location:Marston Mills,MA: Statafed Pro ram Critena
Client:Bennett Environmental Associates Project.#:BEA12-10453
Address:1573 Main Street I.P.O.Box 1743 Project Manager:David C,Bennett
Brewster,MA 02631 ALPHA Quote.#:
Phone:508-896-1706 Turn-Around Time - ....
ANALYSIS .
Fax:508-896 5109 ®Standard ❑Push(ONLY IF PRE-APPROVED) SAMPLE HANDLING
Filtration:
Email:sfarrenkopf@bennett-ea.com
P.:Dona
❑These samples have been Previously analyzed by Alpha' Due.Date:�� Time: M Not Needed.
❑ L
Other Project Specific Requirements/Comments/Detection:Limits: a . do
Preservation •
❑ Lab fo do.
(Please specify '
below)
N:
ALPHA:LatiylF�`'(;re Sample ID Collection Sample sampler's. 'z:
Date Time Matrix Initials
.. Sample Specific
. Z. }•- .. Comments ,
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FORM NO:01.01(1-NJ)
(r-2•.APR-09) ... .. ^'^'4f / �'•AIPhe'•.S;Fayrttent',e%Tns'%�'�Es;; ,
..' Page 15 of 15
1
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS
1573 Main Street,P.O.Box 1743 (508)896-1706
Brewster,MA 02631 fax(508)896-5109
LETTER OF TRANSMITTAL
TO: DATE: JOB NUMBER:
Massachusetts Department of Environmental Protection 9/25/13 BEA12-10453
Attention:Title 5 Program
1 Winter Street-6th Floor
Boston,MA 02108 REGARDING:
Cabral Residence
195 Herring Run Place Unit E[Route 149] 7
SHIPPING METHOD: Marstons Mills,MA
Regular Mail ❑ Pick Up ❑
Priority Mail ❑ Hand Deliver ❑
Express Mail ❑ Other ❑
Certified Mail 0 Green Card/RR ❑
COPIES DATE DESCRIPTION
1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(December
2012;March,June and September 2013)
1 OMNI Environmental Systems,Inc.RSF Operation and Maintenance Inspection Checklist(December
2012;March,June and September 2013)
1 9/17/13 Alpha Analytical Laboratory Report
For review and comment: ❑ For approval: ❑ As requested: ❑ For your use:
REMARKS:
Please find enclosed the DEP Inspection and O&M Form,OMNI Environmental Systems,Inc.RSF Operation and Maintenance Inspection
Checklist and laboratory analytical results for operation and maintenance conducted during the reporting period at the above referenced
property. It is noted that inspection ports or cleanouts for the pressure dosed leach field laterals are not accessible for inspection. If you
have any questions or require additional information,please contact us at your earliest convenience. Thank you.
cc:Barnstable Board of Health
ME and Mrs.Joseph and Diane Cabral,Property Owners
David C.Bennett,Principal [Internal]
Matthew Costa-OMNI Environmental Systems,Inc.[via email]
FROM: David C.Bennett,WWTO#6243/SamanthaFarrenkopf,WWTO#13265/Joseph Smith,WWTO#12529
If enclosures are not as noted,kindly notify us at once
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When Joseph and Diane Cabral
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return
key. City Zip
Mailing address of owner, if different:
t� P.O. Box 352
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(774)228-2050 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/ PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
8/25/03 8/25103
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
12/27/12 9/6/12
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev.11-07-05 Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 6.5 SU DO y 3.5 mg/L Turbidity 22.4 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:
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:
Conduct an operation and maintenance event. Collect effluent samples for field testing.
Notes and Comments:
Effluent quality passed field testing parameters.
t5aiom.doc•rev. 11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
H. Certification
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.
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc•rev.11-07-05 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When Joseph and Diane Cabral
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return
key. City Zip
t�
Mailing address of owner, if different:
P.O. Box 352
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508) 744-7328 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
8/25/03 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
3/6/13 12/27/12
Inspection Date Previous Inspection Date
3"sludge, 1"scum Pumping Recommended ❑ Yes ® No
Sludge Depth(to be checked yearly)
t5aiom.doc•rev.11-07-05 Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown M clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 6.5 SU DO 4.0 mg/L Turbidity 11.96 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:
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:
Conduct an operation and maintenance event. Collect effluent samples for field testing.
Notes and Comments:
Effluent quality passed field testing parameters.
t5aiom.doc•rev. 11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
H. Certification
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.
Operator signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Pro ram
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When Joseph and Diane Cabral
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return City Zip
key.
Mailing address of owner, if different:
P.O. Box 352
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508)744-7328 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/ PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
8/25/03. 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
6/5/13 3/6/13
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ® Yes ❑ No
t5aiom.doc•rev. 11-07-05 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 7.0 SU DO 4.0 mg1L Turbidity 17.3 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:
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:
Conduct an operation and maintenance event. Collect effluent samples for field testing.
Notes and Comments:
Effluent quality passed field testing parameters. Recommend the owner have recirculation tank
pumped out this year.
t5aiom.doc•rev.11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
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.
Operator Signature Date
System owner must submit this report, technology O&M checklist and an required sampling results
Y p 9Y � — Y q p 9
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6'h Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When Joseph and Diane Cabral.
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return
key. City Zip
Mailing address of owner, if different:
P.O. Box 352
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508) 744-7328 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/ PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
8/25/03 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
9/11/13 6/5/13
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev. 11-07-05 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ❑ clear ®turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 7.5 SU DO y 1.0 mg/L Turbidity 57.8 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:
gpd
Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ® TN ® Other(list below)
NO2 NO3 TKN
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection &during this inspection:
Conduct an operation and maintenance event. Collect effluent samples for field testing and
laboratory analysis.
Notes and.Comments:
Effluent quality did not pass field testing parameters due to high turbidity. Faulty recirculation tank
pump requires replacement.
t5aiom.doc•rev.11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
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.
tag
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Pro ram
One Winter Street, 6t Floor
Boston, MA 02108
t5aionn.doc•rev. 11-07-05 Page 3 of 3
Enviropme to/systems;Inet
OMNI RSF Operation and Maintenance Inspection Checklist
A. Installation &Service Information
R-Az
Facility Street Address ^� Date bf Servi e
mc�)' Z )L\,�V s 1`r\ y 2e- Is Yam.
City Operator/O&M Firm
System Startup Date Weather Conditions
B. Septic Tank 5`v
Sludge Pumping Required: Yes❑ N ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Ye No El If yes,inspecMN&clean at least yearl�
If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule
depending on how heavily the system is used. \
C. Recirculation Tank
❑Check if sludge accumulating Pumping required: Yes❑ No
Odor problems: Yes❑ N If yes,description
Effluent tee filter: Yes❑ No If yes,inspect❑ &clean at least yearly❑
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
D. Equal ization'Tank(if installed)
Sludge Pumping Required: Yes❑ No❑ ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Yes❑ No❑ If yes,inspect❑&clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber/Vault(if Installed)
Pump Inspections(all units)
If problems,describe
Float switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken.
t
F. Pumps,Switches, Floats,Alarm System
Pump Inspections(all units)
If problems describe
I VI Test pump alternator,or record hours
Hours of operation
Float switches
Check all switches for operation
Test alarm If non-functioning,corrective action(s)
Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made.
G. Filter Modules ("Sand Filters")
Inspect for ponding Ponding Present:Yes❑ NoRl
Clean bed: Yes❑ N4
Distribution pipes Flush:Yes ElNoo Brush: Yes❑ NoM
Any obstruction of airflow to filter modules: Yes❑ No ElIf Yes,explain below(i.e.snow,dirt)
r
To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with'a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
Yes❑ No�
If yes: ❑BOD ❑TSS ❑pH ❑TN ❑Other
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves).
System Notes:
Y UCH
Di T)is
t
OMNI RSF Operation and Maintenance Inspection Checklist
A. Installation &Service Information
14,Ac i l-N I I S F,- .3 13 E� ( � C
Facility Street Address Date of S rvi e !
i.J ,t
City Operator/O&M Firm
System Startup Date Weather Conditions
B. Septic Tank f NJ31`
Sludge Pumping Required: Yes❑ No ,Sludge Depth. Scum Depth:
Ll
Effluent tee filter: NK No❑ If yes, inspects]&clean at least yearly
If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule
depending on how heavily the system is used.
C. Recirculation Tank 3 4S`V
Check if sludge accumulating Pumping required: Yes❑ NdA
Odor problems: Yes❑ No If yes,description
Effluent tee filter: Yes❑ No If yes, inspect❑&clean at least yearly❑
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
t.� D. Equalization Tank(if installed)
Sludge Pumping Required: Yes❑ No❑ ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Yes❑ No❑ If yes, inspect❑&clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber/Vault(if Installed)
Pump Inspections(all units)
If problems,describe
Float switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken.
i
F. Pumps, Switches, Floats,Alarm System
Pump Inspections(all units)
If problems,describe
Test pump alternator,or record hours
Hours of operation
Float switches
Check all switches for operation
Test alarm
If non-functioning,corrective action(s)
Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made.
G. Filter Modules ("Sand Filters")
Inspect for ponding Ponding Present:Yes❑ No
Clean bed: Yes❑ No
Distribution pipes Flush:Yes❑ NoO Brush: Yes El No
Any obstruction of airflow to filter modules: Yes❑ No&lf Yes,explain below(i.e.snow,dirt)
To inspect the condition of the filter modules remove the mulch layer atone corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
Yes❑ Not(
If yes:❑BOD ❑TSS ❑pH ❑TN ❑Other
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves).
System Notes:
C)
-,ov<, CA rs GyG
")I
Enr�i'rQnimentnl'�Sys �xt5, `nc;
OMNI RSF Operation and Maintenance Inspection Checklist
A. Installation &Service Information
Facility Street Address Date of S ice r�
City Operator/O&M Firm
JQVN
System Startup Date Weather Conditions
B. Septic Tank
Sludge Pumping Required: Yes❑ Nk. ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: YedA No❑ If yes,inspect&clean at least yearly
If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule
depending on how heavily the system is used. L
C. Recirculation Tank
❑Check if sludge accumulating Pumping required: Yes❑ N
Odor problems: Yes❑ NAN If yes,description
Effluent tee filter: Yes❑ Nou If yes,inspect❑&clean at least yearly❑
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules. Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
VAS D. Equalization Tank(if installed)
Sludge Pumping Required: Yes❑ No❑ ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Yes❑ No❑ If yes,inspect❑&clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber/Vault(if Installed)
�]Pump Inspections(all units)
If problems,describe
Float switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken.
F.V
Pumps, Switches, Floats,Alarm System
Pump Inspections(all units)
If problems,describe
Test pump alternator,or record hours I ZZ,e-- ���I k U
Hours of operation
Float switches
Check all switches for operation
Test alarm
If non-functioning,corrective action(s)
Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made. `
G. Filter Modules ("Sand Filters")
Inspect for ponding Ponding Present:Yes❑ Nc(X
Clean bed: Yes❑ NcK
Distribution pipes Flush:Yes❑ No Brush: Yes❑ No[N
Any obstruction of airflow to filter modules: Yes❑ No If Yes,explain below(i.e.snow,dirt)
To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
Yes❑ Nk[YJ
If yes:❑BOD ❑TSS ❑pH ❑TN ❑Other
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves).
System Notes:
O .rt �c0
" :` S OJ i ak'S - K W
�P %0
a
Olin M -
Eii-viionrnentirl Systems, Inc.
®MNI RSF Operation and Maintenance Inspection Checklist
A. Installation &Service Information
ilk �G�!� „ , �'� (( t P (D 1,6, > V
Facility Street Address Dail,of S rvice
City Operator/O&M Firm
System Startup Date Weather Conditions
D. Septic Tank Sludge Pumping Pumping Required: Yes❑ N , ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Ye No❑ If yes,inspect&clean at least yearly❑
If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established.with a licensed septage hauler,if not recommend a two to four year pumping schedule
depending on how heavily the system is used.
C. Recirculation Tank � �-� � �`'� 3 0
❑Check if sludge accumulating Pumping required: Yes❑ NdU4
Odor problems: Yes❑ N If yes,description
Effluent tee filter: Yes❑ No If yes,inspect❑&clean at least yearly❑
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
D. Equalization Tank(if installed)
Sludge Pumping Required: Yes❑ No❑ ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Yes❑ No❑ If yes, inspect❑&clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber/Vault(if Installed)
40 Pump Inspections(all units)
If problems,describe
Float switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken.
F. Pumps, Switches, Floats,Alarm System
Pump Inspections(all units) ?yW4 �:r F,\' .
If problems,describe
Test pump alternator, or record hours
Hours of operation
Float switches
Check all switches for operation
Test alarm
If non-functioning,corrective action(s)
Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made.
G. Filter Modules ("Sand Filters")
Inspect for ponding Ponding Present:Yes❑V No�JClean bed: Yes❑ No
Distribution pipes Flush:Yes❑ N Brush: Yes❑ Nd,U
Any obstruction of airflow to filter modules: Yes❑ N If Yes,explain below(i.e.snow,dirt)
To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
Yes No❑
If yes: ❑BOD ❑TSS ❑pH OTN Other J�b-3 1 ' 7�
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves).
System Notes:
J ��w� a`'�-.� ra`z tr.R.s.. •,�•e.,�4-s�t.'v-^�--�y'� ..
Ck
r
�� .$�.�•,/� S titer � ��w.��� �� -
r
Serial_No:09171310:46
HA
AN AL'Y T ICAL
ANALYTICAL REPORT
Lab Number: L1317798
Client: Bennett Environmental Associates
1573 Main Street
Brewster, MA 02631
ATTN: David Bennett
Phone: (508)896-1706
Project Name: CABRAL RESIDENCE
Project Number: BEA12-10453
Report Date: 09/17/13
The original project report/data package is held by Alpha Analytical.This report/data package is paginated and should be reproduced only in its
entirety.Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original.
Certifications&Approvals: MA(M-MA086),NY (11148),CT(PH-0574),NH(2003),NJ NELAP(MA935),RI(LA000065),ME(MA00086),
PA(68-03671),USDA(Permit #P-330-11-00240),NC(666),TX(T104704476),DOD(1-2217),US Army Corps of Engineers.
Eight Walkup Drive,Westborough, MA 01581-1019
508-898-9220 (Fax)508-898-9193 800-624-9220-www.alphalab.com
Page 1 of 19
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Alpha Sample Collection
Sample ID Client ID Location Date/Time
L1317798-01 EFFLUENT MARSTONS MILLS, MA 09/11/13 12:00
Page 2 of 19
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Case Narrative
The samples were received in accordance with the Chain of Custody and no significant deviations were encountered during the preparation
or analysis unless otherwise noted.Sample Receipt,Container Information,and the Chain of Custody are located at the back of the report.
Results contained within this report relate only to the samples submitted under this Alpha Lab Number and meet all of the requirements of
NELAC,for all NELAC accredited parameters.The data presented in this report is organized by parameter(i.e.VOC,SVOC,etc.).Sample
specific Quality Control data(i.e.Surrogate Spike Recovery)is reported at the end of the target analyte list for each individual sample,
followed by the Laboratory Batch Quality Control at the end of each parameter.If a sample was re-analyzed or re-extracted due to a
required quality control corrective action and if both sets of data are reported,the Laboratory ID of the re-analysis or re-extraction is
designated with an"R"or"RE",respectively.When multiple Batch Quality Control elements are reported(e.g.more than one LCS),the
associated samples for each element are noted in the grey shaded header line of each data table.Any Laboratory Batch,Sample Specific%
recovery or RPD value that is outside the listed Acceptance Criteria is bolded in the report.Performance criteria for CAM and RCP methods
allow for some LCS compound failures to occur and still be within method compliance.In these instances,the specific failures are not
narrated but are noted in the associated QC table.This information is also incorporated in the Data Usability format for our Data Merger tool
where it can be reviewed along with any associated usability implications.Soil/sediments,solids and tissues are reported on a dry weight
basis unless otherwise noted.Definitions of all data qualifiers and acronyms used in this report are provided in the Glossary located at the
back of the report.
In reference to questions H(CAM)or 4(RCP)when"NO"is checked,the performance criteria for CAM and RCP methods allow for some
quality control failures to occur and still be within method compliance. In these instances the specific failure is not narrated but noted in the
associated QC table.The information is also incorporated in the Data Usability format of our Data Merger tool where it can be reviewed
along with any associated usability implications.
Please see the associated ADEx data file for a comparison of laboratory reporting limits that were achieved with the regulatory Numerical
Standards requested on the Chain of Custody.
HOLD POLICY
For samples submitted on hold,Alpha's policy is to hold samples free of charge for 21 calendar days from the date the project is completed.
After 21 calendar days,we will dispose of all samples submitted including those put on hold unless you have contacted your Client Service
Representative and made arrangements for Alpha to continue to hold the samples.
Please contact Client Services at 800-624-9220 with any questions.
SIX
Page 3 of 19 y! ��.
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Case Narrative(continued)
Nitrogen,Total Kjeldahl
The WG635627-4 MS recovery, performed on L1317798-01, is above the acceptance criteria (115%);
however,the associated LCS recoveries were within criteria. No further action was taken.
1,the undersigned,attest under the pains and penalties of perjury that,to the best of my knowledge and
belief and based upon my personal inquiry of those responsible for providing the information contained
in this analytical report, such information is accurate and complete. This certificate of analysis is not
complete unless this page accompanies any and all pages of this report.
C���u-�_. Cynthia McQueen
Authorized Signature:
Title: Technical Director/Representative Date: 09/17/13
✓d �
Page 4 of 19 ` °•
Serial No:09171310:46
INORGANICS
MISCELLANEOUS
Page 5 of 19
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
SAMPLE RESULTS
Lab ID: L1317798-01 Date Collected: 09/11/13 12:00
Client ID: EFFLUENT Date Received: 09/11/13
Sample Location: MARSTONS MILLS,MA Field Prep: Not Specified
Matrix: Water
Dilution Date Date Analytical
Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst
General Chemistry-Westborough Lab
Nitrogen,Nitrite ND mg/I 0.050 - 1 09/12/13 01:09 44,353.2 DB
Nitrogen,Nitrat. _ _.._ . .....---. - _........-... ._. - -- _.....- ... - -- --._..__...-
Nitrogen,Total Kjeldahl 41.6 mg/I 0.300 1 09/12/13 10:56 09/13/13 21:25 30,4500N-C AT
Page 6 of 19
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Method Blank Analysis
Batch Quality Control
Dilution Date Date Analytical
Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst
General Chemistry-Westborough Lab for sample(s): 01 Batch: WG635443-1
Nitrogen,Nitrate ND mg/I 0.10 — 1 09/12/13 00:45 44,353.2 DB
General Chemistry-Westborough Lab for sample(s): 01 Batch: WG635446-1
Nitrogen,Nitrite ND mg/I 0.050 — 1 09/12/13 00:48 44,353.2 DB
General Chemistry-Westborough Lab for sample(s): 61 Batch:-WG635627-1' 4. _...
Nitrogen,Total Kjeldahl ND mg/I 0.300 — 1 09/12/1310:56 09/13/13 21:12 30,4500N-C AT
Page 7 of 19
Serial No:09171310:46
Lab Control Sample Analysis
Project Name: CABRAL RESIDENCE Batch Quality Control
1 Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
LCS LCSD %Recovery
Parameter %Recovery Qual %Recove
rY Qual Limits RPD Qual RPD Limits
- . .- --- --
_ sample(s): 01 Batch: WG635443-2
General.Chemistry-Westborough Lab Associated"
Nitrogen,Nitrate 102 90-110
General'Chemistry-Westborough Lab Associated sampfe-s- : 01 Batch-WG63544612
Nitrogen,Nitrite 101 90-110 20
General Chemisst -Westborough Lab Associated'sample(s): 01 '~Batch:WG635627-2 _.,_._
Nitrogen,Total Kjeldahl _ 95 78-122
Page 8 of 19
/y� ha
Serial No:09171310:46
Matrix Spike Analysis
Batch Quality Control
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Native MS MS MS MSD MSD Recovery RPD
Parameter Sample Added Found %Recovery Qual Found %Recovery Qual Limits RPD Qual Limits
General Chemistry`Westborough Lab Associated sample(s): 0 Q Batch ID:WG635443-4 QC Sample: L1317789-01 Client ID: MS Sample
Nitrogen,Nitrate 4.0 4 7.8 96- - 83-113 - 6
General,Chemistry-W6stborough.Lab Assoclated;sample(s): 01 QC Batch ID:WG635446=4 QC Sample:.L1317789-01 Client ID:..MS Sample
Nitrogen,Nitrite 0.075 4 4.3 105— 80-120 - 20
General Chemistry-Westborough.Lab Associated sample( 01µ QC Batch ID: WG635627s-4 QC Sample: L1317798=01 -Client.ID: EFFLUENT - -
Nitrogen,Total Kjeldahl 41.6 8 50.8 1.15— Q - 77-111 24
Page 9 of 19 PHA
Z:
Serial No:09171310:46
Lab Duplicate.Analysis
Project Name: CABRAL RESIDENCE Batch Quality Control Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Parameter Native Sample Duplicate Sample Units RPD Qual RPD Limits
General Chemistry-Westborough Lab. Associated sample(s): 01 QC Batch iD: WG635443-3 QC Sample: L1317789-01 Client ID: DUP Sample
Nitrogen,Nitrate 4.0 3.8 mg/I 4— 6
General Chemistry-Westborough Leb Associated'sample(s). _01 Q'C Batch ID: WG6-k-46-3 QC Sample: 1.1'317789=01 Client,ID- DUP Sample M
Nitrogen,Nitrite 0.075 0.064 mg/I 16- 20
General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG635627-3' QC Sample: L1317798-01 Client'ID: EFFLUENT
Nitrogen,Total Kjeldahl 41.6 44.8 mg/I 7 24
Page 10 of 19 � '?��
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Sample Receipt and Container Information
Were project specific reporting limits specified? YES
Reagent H2O Preserved Vials Frozen on: NA
Cooler Information Custody Seal
Cooler
A Absent
Container Information Temp
Container ID Container Type Cooler pH deg C Pres Seal Analysis(*)
L1317798-01A Plastic 250ml unpreserved A 7 4 Y Absent NO2-353(2),NO3-353(2)
L1317798-01 B Plastic 250ml H2SO4 preserved A <2 4 Y Absent TKN-4500(28)
*Values in parentheses indicate holding time in days
Page 1.1 of 19
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
GLOSSARY
Acronyms
EDL Estimated Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated
values,when those target analyte concentrations are quantified below the reporting limit(RL).The EDL includes any
adjustments from dilutions,concentrations or moisture content,where applicable.The use of EDLs is specific to the analysis of
PAHs using Solid-Phase Microextraction(SPME).
EPA Environmental Protection Agency.
LCS Laboratory Control Sample:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes
or a material containing known and verified amounts of analytes.
LCSD Laboratory Control Sample Duplicate:Refer to LCS.
LFB Laboratory Fortified Blank:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes
or a material containing known and verified amounts'of analytes.
MDL Method Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values,
when those target analyte concentrations are quantified below the reporting limit(RL).The MDL includes any adjustments from
dilutions,concentrations or moisture content,where applicable.
MS -Matrix Spike Sample:A sample prepared by adding a known mass of target analyte to a specified amount of matrix sample for
which an independent estimate of target analyte concentration is available.
MSD Matrix Spike Sample Duplicate:Refer to MS.
NA Not Applicable.
NC -Not Calculated: Term is utilized when one or more of the results utilized in the calculation are non-detect at the parameter's
reporting unit.
NI Not Ignitable.
RL Reporting Limit: The value at which an instrument can accurately measure an analyte at a specific concentration.The RL
includes any adjustments from dilutions,concentrations or moisture content,where applicable.
RPD Relative Percent Difference: The results from matrix and/or matrix spike duplicates are primarily designed to assess the precision
of analytical results in a given matrix and are expressed as relative percent difference(RPD). Values which are less than five
times the reporting limit for any individual parameter are evaluated by utilizing the absolute difference between the values;
although the RPD value will be provided in the report.
SRM Standard Reference Material:A reference sample of a known or certified value that is of the same or similar matrix as the
associated field samples.
Footnotes
1 The reference for this analyte should be considered modified since this analyte is absent from the target analyte list of the original
method.
Terms
Analytical Method:Both the document from which the method originates and the analytical reference method.(Example:EPA 8260B is
shown as 1,8260B.)The codes for the reference method documents are provided in the References section of the Addendum.
Data Qualifiers
A Spectra identified as"Aldol Condensation Product".
B The analyte was detected above the reporting limit in the associated method blank.Flag only applies to associated field samples that
have detectable concentrations of the analyte at less than ten times(1 Ox)the concentration found in the blank.For MCP-related
projects;flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(10x)
the concentration found in the blank.For DOD-related projects,flag only applies to associated field samples that have detectable
concentrations of the analyte at less than ten times(IOx)the concentration found in the blank AND the analyte was detected above
one-half the reporting limit(or above the reporting limit for common lab contaminants)in the associated method blank.For NJ-
Air-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte above the
reporting limit.
C Co-elution:The target analyte co-elutes with a known lab standard(i.e.surrogate,internal standards,etc.)for co-extracted
analyses.
D Concentration of analyte was quantified from diluted analysis.Flag only applies to field samples that have detectable concentrations
of the analyte.
E Concentration of analyte exceeds the range of the calibration curve and/or linear range of the instrument.
G The concentration may be biased high due to matrix interferences(i.e,co-elution)with non-target compound(s).The result should
be considered estimated.
H The analysis of pH was performed beyond the regulatory-required holding time of 15 minutes from the time of sample collection.
I The lower value for the two columns has been reported due to obvious interference.
Report Format: Data Usability Report
IL]L�Fi?.
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Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: L1317798
Project Number: BEA12-10453 Report Date: 09/17/13
Data Qualifiers
M Reporting Limit(RL)exceeds the MCP CAM Reporting Limit for this analyte.
NJ Presumptive evidence of compound.This represents an estimated concentration for Tentatively Identified Compounds(TICS),where
the identification is based on a mass spectral library search.
P The RPD between the results for the two columns exceeds the method-specified criteria.
Q The quality control sample exceeds the associated acceptance criteria.For DOD-related projects,LCS and/or Continuing Calibration
Standard exceedences are also qualified on all associated sample results. Note:This flag is not applicable for matrix spike recoveries
when the sample concentration is greater than 4x the spike added or for batch duplicate RPD when the sample concentrations are less
than 5x the RL.(Metals only.)
R -Analytical results are from sample re-analysis.
RE -Analytical results are from sample re-extraction.
S -Analytical results are from modified screening analysis.
J Estimated value.This represents an estimated concentration for Tentatively Identified Compounds(TICS).
ND Not detected at the reporting limit(RL)for the sample.
Report Format: Data Usability Report
Page 13 of 19
Serial No:09171310:46
Project Name: CABRAL RESIDENCE Lab Number: 0317798
Project Number: BEA12-10453 Report Date: 09/17/13
REFERENCES
30 Standard Methods for the Examination of Water and Wastewater.APHA-AWWA-
WPCF. 18th Edition. 1992.
44 Methods for the Determination of Inorganic Substances in Environmental Samples,
EPA/600/R-93/100,August 1993.
LIMITATION OF LIABILITIES
Alpha Analytical performs services with reasonable care and diligence normal to the analytical testing.
laboratory industry. In the event of an error,the sole and exclusive responsibility of Alpha Analytical
shall be to re-perform the work at it's own expense. In no event shall Alpha Analytical be held liable
for any incidental,consequential or special damages, including but not limited to,damages in any way
connected with the use of, interpretation of, information or analysis provided by Alpha Analytical.
We strongly urge our clients to comply with EPA protocol regarding sample volume, preservation,cooling,
containers,sampling procedures, holding time and splitting of samples in the field.
Page 14 of 19
Serial No:09171310:46
Certificate/Approval Program Summary
Last revised August 29,2013 -Westboro Facility
The following list includes only those analytes/methods for which certification/approval is currently held.
For a complete listing of analytes for the referenced methods, please contact your Alpha Customer Service Representative.
Connecticut Department of Public Health Certificate/Lab ID: PH-0574. NELAP Accredited Solid Waste/Soil.
Drinking Water (Inorganic Parameters: Color, pH, Turbidity, Conductivity, Alkalinity, Chloride, Free Residual Chlorine,
Fluoride, Calcium Hardness, Sulfate, Nitrate, Nitrite, Aluminum, Antimony, Arsenic, Barium, Beryllium, Cadmium,
Calcium, Chromium, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Nickel, Selenium, Silver, Sodium, Thallium,
Zinc, Total Dissolved Solids, Total Organic Carbon, Total Cyanide, Perchlorate. Organic Parameters: Volatile Organics
524.2,Total Trihalomethanes 524.2, 1,2-Dibromo-3-chloropropane (DBCP)504.1, Ethylene Dibromide (EDB)504.1, 1,4-
Dioxane (Mod 8270). Microbiology Parameters: Total Coliform-MF mEndo (SM9222B), Total Coliform - Colilert
(SM9223, Enumeration and P/A), E. Coli. - Colilert (SM9223, Enumeration and P/A), HPC - Pour Plate (SM9215B),
Fecal Coliform-MF m-FC(SM9222D), Fecal Coliform-EC Medium (SM 9221 E).
Wastewater/Non-Potable Water (Inorganic Parameters: Color, pH, Conductivity, Acidity, Alkalinity, Chloride, Total
Residual Chlorine, Fluoride, Total Hardness, Silica, Sulfate, Sulfide, Ammonia, Kjeldahl Nitrogen, Nitrate, Nitrite, 0-
Phosphate, Total Phosphorus, Aluminum, Antimony,Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium,
Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium,
Selenium, Silver, Sodium, Strontium, Thallium, Tin, Titanium, Vanadium, Zinc, Total Residue (Solids), Total Dissolved
Solids, Total Suspended Solids (non-filterable), BOD, CBOD, COD, TOC, Total Cyanide, Phenolics, Foaming Agents
(MBAS), Bromide, Oil and Grease. Organic Parameters: PCBs, Organochlorine Pesticides, Technical Chlordane,
Toxaphene, Acid Extractables (Phenols), Benzidines, Phthalate Esters, Nitrosamines, Nitroaromatics & Isophorone,
Polynuclear Aromatic Hydrocarbons, Haloethers, Chlorinated Hydrocarbons, Volatile Organics, TPH (HEM/SGT), CT-
Extractable Petroleum Hydrocarbons (ETPH), MA-EPH, MA-VPH. Microbiology Parameters:Total Coliform-MF mEndo
(SM9222B), Total Coliform-MTF (SM9221 B), E. Coli-Colilert (SM9223 Enumeration), HPC-Pour Plate(SM9215B),
Fecal Coliform-MF m-FC(SM9222D), Fecal Coliform-A-1 Broth (SM9221 E), Enterococcus- Enterolert.
Solid Waste/Soil(Inorganic Parameters: pH, Sulfide,Aluminum,Antimony,Arsenic, Barium, Beryllium, Boron, Cadmium,
Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury,
Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Thallium, Tin, Vanadium, Zinc, Total Cyanide, Ignitability,
Phenolics, Corrosivity, TCLP Leach (1311), SPLP Leach (1312 metals only), Reactivity. Organic Parameters: PCBs,
PCBs in Oil, Organochlorine Pesticides, Technical Chlordane, Toxaphene, CT-Extractable Petroleum Hydrocarbons
(ETPH), MA-EPH, MA-VPH, Dicamba, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Dalapon, Volatile Organics (SW 8260), Acid
Extractables (Phenols) (SW 8270), Benzidines (SW 8270), Phthalates (SW 8270), Nitrosamines (SW 8270),
Nitroaromatics & Cyclic Ketones (SW 8270), PAHs (SW 8270), Haloethers (SW 8270), Chlorinated Hydrocarbons (SW
8270). )
State of Illinois Certificate/Lab ID: 003155. NELAP Accredited.
Drinking Water (Inorganic Parameters: SM2120B, 2320B, 2510B, 2540C, SM4500CN-CE, 4500E-C, 4500H-B,
4500NO3-F, 5310C, EPA 200.7,200.8,245.1,300.0. Organic Parameters: EPA 504.1, 524.2.)
Wastewater/Non-Potable Water (Inorganic Parameters: SM2120B, 2310B, 2320B, 2340B, 2510B, 2540B, 2540C,
2540D, SM4500CL-E, 4500CN-E, 4500E-C, 4500H-B, 4500NH3-H, 4500NO2-B, 4500NO3-F, 4500P-E, 4500S-D,
4500S03-B, 5210B, 5220D, 5310C, 5540C, EPA 120.1, 1664A, 200.7, 200.8, 245.1, 300.0, 350.1, 351.1, 353.2, 410.4,
420.1. Organic Parameters: EPA 608, 624, 625.)
Hazardous and Solid Waste (Inorganic Parameters: EPA 1010A, 1030, 1311, 1312, 6010C, 6020A, 7196A, 7470A,
7471 B, 9012B, 9014, 9038, 9040C, 9045D, 9050A, 9065, 9251. Organic Parameters: 8011 (NPW only), 8015C, 8081 B,
8082A,8151A,8260C, 8270D, 8315A, 8330.)
Maine Department of Human Services Certificate/Lab ID:2009024.
Drinking Water(Inorganic Parameters: SM9215B, 9222D, 9223B, EPA 180.1, 353.2, SM2120B, 2130B, 2320B, 2510C,
2540C, 4500CI-D,4500CN-C, 4500CN-E, 4500E-C, 4500H+B, 4500NO3-F, 5310C, EPA 200.7, EPA 200.8,245.1, EPA
300.0. Organic Parameters:504.1,524.2.)
Wastewater/Non-Potable Water (Inorganic Parameters: EPA 120.1, 1664A, 300.0, 350.1, 351.1, 353.2, 410.4, 420.1,
8315A, 9010C, SM2120B, 2310B, 2320B, 2510B, 2540B, 2540C, 2540D, 426C, 4500CI-E, 4500CN-C, 4500CN-E,
4500E-B, 4500E-C, 4500H+B, 4500Norg-C, 4500NH3-B, 4500NH3-H, 4500NO2-B, 4500NO3-F, 4500P-B, 4500P-E,
4500S2-D, 4500S03-B, 5540C, 5210B, 5220D, 5310C, 9010B, 9030B, 9040C, 7470A, 7196A, 2340B, EPA 200.7,
6Q010C, 200.8, 6020A, 245.1, 1311, 1312, 3005A, Enterolert, 9223B, 9222D. Organic Parameters: 608, 624, 625, 8011,
Page qQ o1fq,98082A,8330, 8151A,8260C,8270D, 3510C, 3630C,5030B, ME-DRO, ME-GRO, MA-EPH, MA-VPH.)
Serial_No:09171310:46
Solid Waste/Soil (Inorganic Parameters: 9010B, 9012A, 9014, 9040B, 9045C, 6010C, 6020A, 7471 B, 7196A, 9050A,
1010, 1030, 9065, 1311, 1312, 3005A, 3050B, 9038, 9251. Organic Parameters: ME-DRO, ME-GRO, MA-EPH, MA-
VPH,8260C,8270D,8330, 8151A,8081 B, 8082A, 3540C,3546,3580A, 3620C,3630C, 5030B, 5035.)
Massachusetts Department of Environmental Protection Certificate/Lab ID: M-MA086.
Drinking Water (Inorganic Parameters: (EPA 200.8 for: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI) (EPA 200.7 for:
Ba,Be,Ca,Cd,Cr,Cu,Na,Ni) 245.1, (300.0 for: Nitrate-N, Fluoride, Sulfate); (EPA 353.2 for: Nitrate-N, Nitrite-N);
(SM4500NO3-F for: Nitrate-N and Nitrite-N); 4500E-C, 4500CN-CE, EPA 180.1, SM2130B, SM4500CI-D, 2320B,
SM2540C, SM4500H-B. Organic Parameters: (EPA 524.2 for: Trihalomethanes, Volatile Organics); (504.1 for: 1,2-
Dibromoethane, 1,2-Dibromo-3-Chloropropane), EPA 332. Microbiology Parameters: SM9215B; ENZ. SUB. SM9223;
ColilertQT SM9223B; MF-SM9222D.)
Non-Potable Water(Inorganic Parameters:, (EPA 200.8 for: AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn); (EPA 200.7
for: AI,Sb,As,Be,Cd,Ca,Cr,Co,Cu,Fe,Pb,Mg,Mn,Mo,Ni,K,Se,Ag,Na,Sr,Ti,TI,V,Zn); 245.1, SM4500H,B, EPA 120.1,
SM2510B, 2540C, 2340B, 2320B, 4500CL-E, 4500E-BC, 426C, SM4500NH3-BH, (EPA 350.1 for: Ammonia-N),
LACHAT 10-107-06-1-B for Ammonia-N, SM4500NO3-F, 353.2 for Nitrate-N, SM4500NH3-BC-NES, EPA 351.1,
SM4500P-E, 4500P-B,E, 5220D, EPA 410.4, SM 5210B, 5310C, 4500CL-D, EPA 1664, SM14 510AC, EPA 420.1,
SM4500-CN-CE, SM2540D.
Organic Parameters: (EPA 624 for Volatile Halocarbons,Volatile Aromatics),(608 for: Chlordane,Toxaphene,Aldrin,
alpha-BHC, beta-BHC,gamma-BHC, delta-BHC, Dieldrin, DDD, DDE, DDT,Endosulfan I, Endosulfan II, Endosulfan
sulfate, Endrin, Endrin Aldehyde, Heptachlor, Heptachlor Epoxide, PCBs-Water), (EPA 625 for SVOC Acid Extractables
and SVOC Base/Neutral Extractables), 600/4-81-045-PCB-Oil. Microbiology Parameters: (ColilertQT SM9223B;
Enterolert-QT:SM9222D-MF.)
New Hampshire Department of Environmental Services Certificate/Lab ID:200307. NELAP Accredited.
Drinking Water(Inorganic Parameters: SM 9222B, 9223B, 9215B, EPA 200.7, 200.8, 300.0, SM4500CN-E, 4500H+B,
4500NO3-F, 2320B,2510B, 2540C,4500E-C, 5310C,2120B, EPA 332.0. Organic Parameters: 504.1,524.2.)
Non-Potable Water(Inorganic Parameters: SM9222D, 9221 B, 9222B, 9221 E-EC, EPA 3005A, 200.7, 200.8, 245.1, SW-
846 6010C, 6020A, 7196A, 7470A, SM3500-CR-D, EPA 120.1, 300.0, 350.1, 350.2, 351.1, 353.2, 410.4, 420.1, 426C,
1664A, SW-846 9010B, 9010C, 9030, 9040B, 9040C, SM2120B, 2310B, 2320B, 2340B, 2540B, 2540D, 4500H+B,
4500CL-E, 4500CN-E, 4500NH3-H, 4500NO3-F, 4500NO2-B, 4500P-E, 4500-S2-D, 4500S03-B, 5210B, 5220D,
2510B, 2540C, 4500E-C, 5310C, 5540C, LACHAT 10-204-00-1-A, LACHAT 10-107-06-2-D, 3060A. Organic
Parameters: SW-846 3510C, 3630C, 5030B, 8260C, 8270D, 8330, EPA 624, 625, 608, SW-846.8082A, 8081 B, 8015C,
8151A,8330,8270D-SIM.)
Solid& Chemical Materials (Inorganic Parameters: SW-846 6010C, 6020A, 7196A, 7471 B, 1010, 1010A, 1030, 9010C,
9012B, 9014, 9030B, 9040C, 9045C, 9045D, 9050, 9065, 9251, 1311, 1312, 3005A, 3050B, 3060A. Organic
Parameters: SW-846 3540C, 3546, 3050B, 3580A, 3620D, 3630C, 5030B, 5035, 8260C, 8270D, 8270D-SIM, 8330,
8151A, 8015B, 8015C, 8082A, 8081B.)
New Hampshire Department of Environmental Services Certificate/Lab ID: 2064. NELAP Accredited.
Drinking Water(Organic Parameters: EPA 524.2: Di-isopropyl ether(DIPE), Ethyl-t-butyl ether(ETBE),Tert-amyl methyl
ether(TAME)).
Non-Potable Water(Organic Parameters: EPA 8260C: 1,3,5-Trichlorobenzene. EPA 8015C(M): TPH.)
Solid&Chemical Materials(Organic Parameters: EPA 8260C: 1,3,5-Trichlorobenzene.)
New Jersey Department of Environmental Protection Certificate/Lab ID: MA935.NELAP Accredited.
Drinking Water (Inorganic Parameters: SM9222B, 9221E, 9223B, 9215B, 4500CN-CE, 4500NO3-F, 4500E-C, EPA
300.0, 200.7, 200.8, 245.1, 2540C, SM2120B, 2320B, 2510B, 5310C, SM4500H-B. Organic Parameters: EPA 332,
504.1, 524.2.)
Non-Potable Water(Inorganic Parameters: SM5210B, EPA 410.4, SM5220D, 4500CI-E, EPA 300.0, SM2120B, 2340B,
SM4500E-BC, EPA 200.7,200.8, 351.1, LACHAT 10-107-06-2-D, EPA 353.2, SM4500NO3-F, 4500NO2-B, EPA 1664A,
SM5310B, C or D, 4500-PE, EPA 420.1, SM510ABC, SM4500P-B5+E, 2540B, 2540C, 2540D, EPA 120.1, SM2510B,
SM15 426C, 9222D, 9221B, 9221C, 9221E, 9222B, 9215B, 2310B, 2320B, 4500NH3-H, 4500-S D, EPA 350.1, 350.2,
SW-846 1312, 7470A, 5540C, SM4500H-B, 4500S03-B, SM3500Cr-D, 4500CN-CE, EPA 245.1, SW-846 9040B,
9040C, 3005A, 3015, EPA 6010B, 6010C, 6020, 6020A, 7196A, 3060A, SW-846 9010C, 9030B. Organic Parameters:
SW-846 8260B, 8260C, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 3510C, EPA 608, 624, 625, SW-846 3630C, 5030B,
8011, 8015C, 8081 A,8081 B, 8082, 8082A, 8151A, 8330, 1,4-Dioxane by NJ Modified 8270,8015B, NJ EPH.)
Page' ll A li ,Chemical Materials(Inorganic Parameters: SW-846, 6010B, 6010C, 6020, 6020A, 7196A, 3060A, 9030B, 1010,
, 1030, 1311, 1312, 3005A, 3050B, 7471A, 7471B, 9010C, 9012B, 9014, 9038, 9040B, 9040C, 9045C, 9045D,
Serial No:09171310:46
9050A, 9065,,9251. Organic Parameters: SW-846 8015B, 8015C, 8081A, 808113, 8082, 8082A, 8151A, 8330, 82606,
8260C,8270C, 8270D, 8270C-SIM,8270D-SIM, 3540C, 3546, 3580A, 3620C,3630C, 50306, 5035L,5035H, NJ EPH.)
New York Department of Health Certificate/Lab ID: 11148. NELAP Accredited.
Drinking Water (Inorganic Parameters: SM922313, 92226, 921513, EPA 200.8, 200.7, 245.1, SM5310C, EPA 332.0,
SM23206, EPA 300.0, SM212013, 4500CN-E, 4500E-C, 4500NO3-F, 2540C, SM 2510B. Organic Parameters: EPA
524.2,504.1.)
Non-Potable Water (Inorganic Parameters: SM9221 E, 9222D, 9221 B, 92226, 92156, 521013, 5310C, EPA 410.4,
SM5220D, 231013, 2320B, EPA 200.7, 300.0, SM4500CL-E, 4500E-C, SM15 426C, EPA 350.1, SM4500NH3-BH, EPA
351.1, LACHAT 10-107-06-2, EPA 353.2, SM4500-NO3-F, 4500-NO2-B, 4500P-E, 2340B, 2540C, 2540B, 2540D, EPA
200.8, EPA 6010C, 6020A, EPA 7196A, SM3500Cr-D, EPA 245.1, 7470A, SM21206, 4500CN-CE, EPA 1664A, EPA
420.1, SM14 510C, EPA 120.1, SM251013, SM4500S-D, SM5540C, EPA 8315A, 3005A, 3015, 9010C, 9030B. Organic
Parameters: EPA 624, 8260C, 8270D, 8270D-SIM, 625, 608, 8081B, 8151A, 8330, 8082A, EPA 3510C, 503013, 8015C,
8011.)
Solid&Hazardous Waste(Inorganic Parameters: EPA 1010A, 1030, EPA 6010C,6020A, 7196A, 747113, 8315A, 90126,
9014, 9065, 9050A, 9038, 9251, EPA 1311, 1312, 3005A, 30506, 9010C, 903013, 9040C, 9045D. Organic Parameters:
EPA 8260C, 82701), 8270D-SIM, 8015C, 808113,8151A, 8330, 8082A,3540C, 3546, 3580A,5035A-H, 5035A-L.)
North Carolina Department of the Environment and Natural Resources Certificate/Lab ID:666. (Inorganic
Parameters: SM23106,232013,4500CI-E,4500Cn-E,901213, 9014, Lachat 10-204-00-1-X, 1010A, 1030, 4500NO3-F,
353.2,4500P-E,4500SO4-E, 300.0,4500S-D, 5310B,5310C, 6010C, 6020A, 200.7,200.8,3500Cr-B, 7196A,245.1,
7470A, 7471 B, 1311,1312. Organic Parameters: 608,8081 B,8082A, 624, 826013,625, 8270D,8151A, 8015C, 504.1,
MA-EPH, MA-VPH.)
Drinking Water Program Certificate/Lab ID: 25700. (Inorganic Parameters: Chloride EPA 300.0. Organic Parameters:
524.2)
Pennsylvania Department of Environmental Protection Certificate/Lab ID : 68-03671. NELAP Accredited.
Drinking Water(Inorganic Parameters:200.7,200.8, 300.0, 332.0,2120B, 2320B,2510B, 2540C,4500-CN-CE,4500E-
C,4500H+-B, 4500NO3-F, 5310C. Organic Parameters: EPA 524.2, 504.1)
Non-Potable Water(Inorganic Parameters: EPA 120.1, 1312, 3005A,3015, 3060A, 200.7,200.8,410.4, 1664A,
SM2540D,5210B, 5220D, 4500-P,BE,245.1, 300.0, 350.1, 350.2, 351.1, 353.2,420.1, 6010C,6020A, 7196A, 7470A,
903013, 212013,2310B, 2320B,2510B, 2540B, 2540C,3500Cr-D,426C,4500CN-CE, 4500CI-E, 4500E-B,4500E-C,
4500H+-B,4500NH3-H,4500NO2-B,4500NO3-F,4500S-D,4500S03-B,5310BCD, 5540C, 9010C,9040C. Organic
Parameters: EPA 3510C, 3630C, 50306, 625, 624, 608,8081 B, 8082A, 8151A, 8260C, 8270D,8270D-SIM,8330,
8015C, NJ-EPH.)
Solid & Hazardous Waste (Inorganic Parameters: EPA 350.1, 1010, 1030, 1311, 1312, 3005A, 305013, 3060A, 6010C,
6020A, 7196A, 747113, 9010C, 9012B, 9014, 9040B, 9045D, 9050A, 9065, SM 4500NH3-BH, 9030B, 9038, 9251.
Organic Parameters: 3540C, 3546, 3580A, 3620C, 3630C, 5035, 8015C, 8081B, 8082A, 8151A, 8260C, 8270D, 8270D-
SI , 8330, NJ-EPH.)
Rhode Island Department of Health Certificate/Lab ID: LA000065. NELAP Accredited via NJ-DEP.
Refer to MA-DEP Certificate for Potable and Non-Potable Water.
Refer to NJ-DEP Certificate for Potable and Non-Potable Water.
Texas Commisson on Environmental Quality Certificate/Lab ID:T104704476. NELAP Accredited.
Non-Potable Water(Inorganic Parameters: EPA 120.1, 1664,200.7,200.8,245.1,245.2, 300.0, 350.1,351.1, 353.2,
410.4,420.1, 6010,6020, 7196,7470, 9040,SM 21206,2310B,23206,2510B,2540B,2540C,2540D,426C,4500CL-
E,4500CN-E,4500E-C,4500H+B,4500NH3-H,4500NO2B,4500P-E,4500 S2 D,510C, 5210B, 5220D, 5310C,
5540C. Organic Parameters: EPA 608,624,625, 8081,8082, 8151, 8260, 8270,8330.)
Solid&Hazardous Waste(Inorganic Parameters: EPA 1311, 1312,9012,9014, 9040, 9045, 9050, 9065.)
Virginia Division of Consolidated Laboratory Services Certificate/Lab ID:460195.NELAP Accredited.
Drinking Water(Inorganic Parameters: EPA 200.7, 200.8, 300.0, 2510B,212013,2540C,4500CN-CE, 245.1,2320B,
4500E-C,4500NO3-F,4500H+B, 5310C.Organic Parameters: EPA 504.1, 524.2.)
Non-Potable Water(Inorganic Parameters: EPA 120.1, 1664A, 200.7, 200.8,245.1, 300.0,350.1, 351.1,351.2, 3005A,
3015, 1312, 6010B, 6010C,3060A, 353.2,420.1, 234013, 6020, 6020A, SM4500S-D, SM4500-CN-CE, Lachat 10-204-
Q 1- 7196A,7470A,2310B, 23206, 2510B,2540B,2540C,2540D,3500Cr-D,426C,4500CI-E,4500E-B,4500E-C,
Page
4 AIN3-H,4500NO2-B,4500NO3-F, 4500 S03-13,4500H-B, 4500PE, 510AC, 5210B, 5310B 5310C,5540C, 9010Cm
Serial No:09171310:46
9030B, 9040C. Organic Parameters: EPA 3510C, 3630C, 5030B,826013, 608, 624, 625; 8011,8015C, 8081 A, 8081 B,
8082,8082A,8151A, 8260C, 8270C, 82701),8270C-SIM, 8270D-SIM,8330, )
Solid&Hazardous Waste(Inorganic Parameters: EPA 1010A, 1030, 3060A, 30506, 1311, 1312, 6010B, 6010C, 6020, ,
7196A, 7471 A, 7471 B, 6020A,90.10C,9012B, 90306, 9014, 9038, 9040C, 90451), 9251, 9050A, 9065. Organic
Parameters: EPA 5030B,5035, 3540C, 3546, 35506, 3580A, 3620C, 3630C,6020A, 82606,8260C, 80156, 8015C,
8081 A,8081 B, 8082, 8082A,8151A, 8270C, 8270D,8270C-SIM, 827013-SIM, 8330.)
Department of Defense, L-A-B Certificate/Lab ID: L2217.
Drinking Water(Inorganic Parameters: SM 4500H-B. Organic Parameters: EPA 524.2, 504.1.)
Non-Potable Water (Inorganic Parameters: EPA 200.7, 200.8, 6010C, 6020A, 245.1, 7470A, 904013, 90106, 180.1,
300.0, 332.0, 6860, 351.1, 353.2, 9060, 1664A, SM 4500CN-E, 45001-1-13, 4500Norg-C, 4500NO3-F, 5310C, 2130B,
23206, 2340B, 2540C, 5540C, 3005A, 3015, 9056, 7196A, 3500-Cr-D. Organic Parameters: EPA 8015C, 8151A,
8260C, 8270D, 8270D-SIM,8330A, 8082A, 8081 B, 3510C,5030B, MassDEP EPH, MassDEP VPH.)
Solid&Hazardous Waste(Inorganic Parameters: EPA 200.7, 6010C,6020A, 7471 A, 6860, 1311, 1312, 3050B, 7196A,
904013,9045C, 9010C,901213, 9251, SM3500-CR-D,4500CN-CE, 2540G, Organic Parameters: EPA 8015C, 8151A,
8260C, 8270D, 8270D-SIM, 8330A/B-prep, 8082A, 8081 B, 3540C, 3546,3580A, 5035A, MassDEP EPH, MassDEP
VPH.)
The following analytes are not included in our current NELAP/TNI Scope of Accreditation:
EPA 524.2: Acetone, 2-Butanone (Methyl ethyl ketone (MEK)), Tert-butyl alcohol, 2-Hexanone, Tetrahydrofuran, 1,3,5-
Trichlorobenzene, 4-Methyl-2-pentanone (MIBK), Carbon disulfide, Diethyl ether. . EPA 8260B: 1,2,4,5-
Tetramethylbenzene, 4-Ethyltoluene. EPA 8260 Non-potable water matrix: lodomethane (methyl iodide), Methyl
methacrylate. EPA 8260 Soil matrix: Tert-amyl methyl ether (TAME), Diisopropyl ether (DIPE), Azobenzene. EPA
8330A: PETN, Picric Acid, Nitroglycerine, 2,6-DANT, 2,4-DANT. EPA 8270C: Methyl naphthalene, Dimethyl
naphthalene, Total Methylnapthalenes, Total Dimethylnaphthalenes, 1,4-Diphenylhydrazine. EPA 625: 4-Chloroaniline,
4-Methylphenol. Total Phosphorus in a soil matrix, TKN in a soil matrix, NO2 in a soil matrix, NO3 in a soil matrix. EPA
9071: Total Petroleum Hydrocarbons, Oil &Grease.
Page 18 of 19
Serial No:09171310:46
H�' DateRec'd.In:Lab:
C N OF CUSTODY... PAGE 1 OF 1 :..,..
f� HA y�SReport Information Data Deliverables Billing Information
❑ FAX. ® EMAIL ® Same as Client into PO#:10453 i
Westborough,MA Mansfield,MA Project Name:Cabral Residence 1
TEL:508-898-0220 TEL:SOM22.9300 ❑ ADEx ❑ Add'I Deliverables
FAX:508-898-9193 FAK 508-8223288 ,^
Regulatory Requirements/Report Limits
Client Information Project Location:Marstons Mills,MA State/Fed.Program Criteria i
Client:Bennett Environmental Associates Project#:BEA12-10453 j
Address: 1573 Main Street/P.O.Box 1743 Project Manager:David C.Bennett
Brewster,MA 02631 ALPHA Quote#:
Phone:508-896-1706Turn-Around Time
ANALYSIS
Fax:508-896-5109 ®Standard ❑Rush(ONLY IF PRE-APPROVED) SAMPLE HANDLING
Fueratron
Email:.sfarrenkopf@bennett-ea.com t✓1
{ U Done
❑These samples have been Previously analyzed by Alpha Due Date: Time: ® Not Needed
❑ Lab to de
Other Project Specific Requirements/Comments/Detection Limits: Preservation
❑ Lab to do.
(Please specify
below)
ALI?I 1A Lab.iD: Sample ID Collection Sample' Sampler's z
(Cali Use Ohly) Date Time Matrix Initials
•"L •" a= Y Sample speciac
Z 4— # comments
Effluent j �3 �ZMQ� WW ® El ?
7.
}
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 100 El El E
Container Type P P
0 D _ �Ptease prinFclea�fy;;legibly.*. {
Preservative aiiiic0mpletely:'Samples ban. _
n6ttie logged n entl ::' '
Reli ished OateMme Received By: Dater nme ibfiiarciund:ume clock will,.&t
C I stO Until,any,ambiguities ale,
nesdlyed:AlLsarhpleS'':";
w0Rf�d are subje&!to
FORM N0:01-01(1-NJ) / b ( I Ra!;PayinenQt"erms.
Page 19 of 19
y
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS
1573 Main Street,P.O.Box 1743 (508)896-1706
Brewster,MA 02631 fax(508)896-5109
LETTER OF TRANSMITTAL
TO: DATE: JOB NUMBER:
Massachusetts Department of Environmental Protection 9/23/11 BEA09-10138
Attention:Title 5 Program
1 Winter Street-6th Floor
Boston,MA 02108 REGARDING:
Walsh Residence
195 Herring Run Place Unit E[Route 149]-
SHIPPING METHOD: Marstons Mills,MA
Regular Mail ❑ Pick Up ❑
Priority Mail ❑ Hand Deliver ❑
Express Mail ❑ Other ❑
Certified Mail Green Card/RR ❑
COPIES DATE DESCRIPTION
1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(Jan-Sept
2011)
1 9/22/11 Alpha Analytical Laboratory Report
For review and comment: ❑ For approval: ❑ As requested: ❑ For your use:
REMARKS:
Please find enclosed the DEP Inspection and O&M Form,and laboratory test results of wastewater samples collected during this reporting
period for the above referenced property. If you have any questions or require additional information,please contact us at your earliest
convenience. Thank you.
cc:Barnstable Board of Health
Mr.and Mrs.Walsh,Owners
David C.Bennett,Principal[Internal]
Matthew Costa-OMNI Environmental Systems,Inc.
FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529
If enclosures are not as noted,kindly notify us at once
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When David and Francine Walsh
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return
City Zip
key.
V1 Mailing address of owner, if different:
V P.O. Box 302
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508)420-7963 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508)896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
11/15/02 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
1/5/11 9/9/10
Inspection Date Previous Inspection Date
6"of Sludge, and 1"Scum Layer
Sludge Depth(to be checked yearly) Pumping Recommended El Yes ® No
t5aiom.doc•rev.11-07-05 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and OW Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown M clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ® some
pH 6.89 SU DO 4.63 mg/L Turbidity 10.01 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:
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:
General O&M visit for system functionality and conducted field testing.
Notes and Comments:
System is functional and passed field testing.
t5aiom.doc•rev.11-07-05 Page 2 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
H. Certification
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 inaccordance with 257 CMR 2.00.
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31't of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Pro hgram
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc-rev.11-07-05 Page 3 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When David and Francine Walsh
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return City Zip
key.
Mailing address of owner, if different:
P.O. Box 302
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508)420-7963 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/ PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508)896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
11/15/02 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
3/8/11 1/5/11
Inspection Date Previous Inspection Date
5"of Sludge, and 1"Scum Layer Pumping Recommended ❑ Yes ® No
Sludge Depth(to be checked yearly)
t5aiom.doc•rev.11-07-05 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and OW Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 6.72 SU DO 4.03 mg/L Turbidity 9.58 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:
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:
General O&M visit for system functionality and conducted field testing.
Notes and Comments:
System is functional and passed field testing.
t5aiom.doc•rev.11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - TitleLl 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.
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use— by January 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston, MA 02108
t5aiom.doc•rev.11-07-05 Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When David and Francine Walsh
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return City Zip
key.
Mailing address of owner, if different:
P.O. Box 302
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508)420-7963 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508)896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems . OMNI RSF
DEP ID Manufacturer ID Model Number
11/15/02 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
6/10/11 3/8/11
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev.11-07-05 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ® some
pH 8.0 SU DO 2.35 mg/L Turbidity 9.08 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:
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:
General O&M visit for system functionality and conducted field testing
Notes and Comments:
System not functioning properly. Left a notice for owner to contact our office for access to dwelling to
inspect control panel. Effluent quality passed field testing.
t5aiom.doc•rev.11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
H. Certification
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.
qz(�„
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use— by January 31 n of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston, MA 02108
t5aiom.doc•rev.11-07-05 Page 3 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When David and Francine Walsh
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return City Zip
key.
Mailing address of owner, if different:
P.O. Box 302
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508)420-7963 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508)896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
11/15/02 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
9/14/11 6/10/11
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev.11-07-05 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify): .
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ❑ no ® some
pH 7.0 SU DO 6.85 mg/L Turbidity 1.78 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:
gpd
Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ®TN ® Other(list below)
Nitrate Nitrite TKN
Other 1 Other 2 Other 3
G. Inspection and Maintenance
Description of any maintenance performed since previous inspection &during this inspection:
Evaluated the control panel and recirculation tank pump on 6/24/11. Replaced the recirculation tank
pump on 7/26/11. General O&M visit for system functionality on 9/14/11. Conducted field testing and
collected effluent samples for laboratory analysis.
Notes and Comments:
System is functioning properly and passed field testing. Septic tank needs a new riser section.
t5aiom.do6•rev.11-07-05 Page 2 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
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.
C1Q- !6%M�� — 9'A 1
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use— by January 31 st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31 th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc•rev.11-07-05 Page 3 of 3
Serial No:09221112:04
HA
�AIN.A`L,YT 1 C A L
ANALYTICAL REPORT
Lab Number: L1114555
Client: Bennett Environmental Associates
1573 Main St.
PO Box 1743
Brewster, MA 02631
ATTN: David Bennett
Phone: (508)896-1706
Project Name: WALSH
Project Number: BEA09-10138
Report Date: 09/22/11
The original project report/data package is held by Alpha Analytical.This report/data package is paginated and should be reproduced only in its
entirety.Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original.
Certifications&Approvals: MA(M-MA086),NY NELAC(11148),CT(PH-0574),NH(2003),NJ(MA935),RI(LA000065),ME(MA0086),
PA(Registration#68-03671),USDA(Permit#S-72578),US Army Corps of Engineers,Naval FESC.
Eight Walkup Drive,Westborough, MA 01581-1019
508-898-9220 (Fax)508-898-9193 800-624-9220-www.alphalab.com
Page 1 of 17
Serial No:09221112:04
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
Alpha Sample Collection
Sample ID Client ID Location Date/Time
L1114555-01 EFFLUENT MARSTONS MILLS 09/14/11 12:05
Page 2 of 17
Serial No:09221112:04
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
Case Narrative
The samples were received in accordance with the Chain of Custody and no significant deviations were encountered during the preparation
P Y 9 9 P P
or analysis unless otherwise noted.Sample Receipt,Container Information,and the Chain of Custody are located at the back of the report.
Results contained within this report relate only to the samples submitted under this Alpha Lab Number and meet all of the requirements of
NELAC,for all NELAC accredited parameters.The data presented in this report is organized by parameter(i.e.VOC,SVOC,etc.).Sample
specific Quality Control data(i.e.Surrogate Spike Recovery)is reported at the end of the target analyte list for each individual sample,
followed by the Laboratory Batch Quality Control at the end of each parameter.If a sample was re-analyzed or re-extracted due to a
required quality control corrective action and if both sets of data are reported,the Laboratory ID of the re-analysis or re-extraction is
designated with an"R"or"RE",respectively.When multiple Batch Quality Control elements are reported(e.g.more than one LCS),the
associated samples for each element are noted in the grey shaded header line of each data table.Any Laboratory Batch,Sample Specific%
recovery or RPD value that is outside the listed Acceptance Criteria is bolded in the report.Definitions of all data qualifiers and acronyms
used in this report are provided in the Glossary located at the back of the report.
Please see the associated ADEx data file for a comparison of laboratory reporting limits that were achieved with the regulatory Numerical
Standards requested on the Chain of Custody.
For additional information,please contact Client Services at 800-624-9220.
I, the undersigned, attest under the pains and penalties of perjury that,to the best of my knowledge and
belief and based upon my personal inquiry of those responsible for providing the information contained
in this analytical report, such information is accurate and complete. This certificate of analysis is not
complete unless this page accompanies any and all pages of this report.
Elizabeth Simmons
Authorized Signature: "v'
Title: Technical Director/Representative Date: 09/22/11
Page 3 of 17 �°�`
Serial No:09221112:04
INORGANICS
MISCELLANEOUS
Page 4 of 17
Serial No:09221112:04
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
SAMPLE RESULTS
Lab ID: L1114555-01 Date Collected: 09/14/11 12:05
Client ID: EFFLUENT Date Received: 09/15/11
Sample Location: MARSTONS MILLS Field Prep: Not Specified
Matrix: Water
Dilution Date Date Analytical
Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst
General Chemistry-Westborough Lab
Nitrogen,Nitrite 0.21 mg/I 0.05 — 1 - 09/16/11 02:22 44,353.2 TH
Nitrogen,Nitrate 3.1 mg/I 0.10 1 - 09/16/11 02:22 44,353.2 TH
Nitrogen,Total Kjeldahl 6.2 mg/I 0.30 1 09/16/11 13:50 09/20/11 20:11 30,4500N-C AT
FiA
Page 5 of 17
Serial No:09221112:04
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
Method Blank Analysis
Batch Quality Control
Dilution Date Date Analytical
Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst
General Chemistry �WestboroughLab forsample(s):501; Batch: WG490293-2a,- s
Nitrogen,Nitrate ND mg/I 0.10 — 1 09/16/11 00:38 44,353.2 TH
General Chemistry Westborough Lat for sample(s) 0,1 Batcli:,IWG490295-2
Nitrogen,Nitrite ND mg/I 0.05 — 1 09/16/11 00:46 44,353.2 TH
General Chemistry'=Westborough Lab for sample(s): 01 Batch.WG490372-1
Nitrogen,Total Kjeldahl ND mg/I 0.30 — 1 09/16/11 13:50 09/20/11 20:02 30,4500N-C AT
Page 6 of 17
Serial No:09221112:04
Lab Control Sample Analysis
Project Name: WALSH Batch Quality Control
Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
LCS LCSD %Recovery
Parameter %Recovery Qual %Recovery Qual Limits RPD Qual RPD Limits
General Chemistry-Westborough Lab Associated`sample(s): 01 Batch: WG490293-1
Nitrogen,Nitrate 102 90-110
General Chemistry-Westborough Lab-Associated sample(s): 01" 'Batch:WG490295-1
Nitrogen,Nitrite 98 - 90-110 - 20
General Chemistry-Westborough Lab-Associated sample(s): 01 Batch:WG490372-2
Nitrogen,Total Kjeldahl 95 85-110
Page 7 of 17 �;a
Serial No:09221112:04
Matrix Spike Analysis
Batch Quality Control
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
Native MS MS MS MSD MSD Recovery RPD
Parameter Sample Added Found %Recovery Qual Found %Recovery Qual Limits RPD Qual Limits
General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch,ID:WG490293-3 �QC Sample: 1-11,14553-01 Client ID::VS.Sample
Nitrogen,Nitrate 5.9 4 9.8 98 - 83-113 - 6
General Chemistry-Westborough Lab Associated sample(s):,01 QC Batch JD:WG490295-3 QC Sample: L1114553-01 Client ID: MS+Sample
Nitrogen,Nitrite 0.06 4 4.1 101 80-120 20
General Chemistry-Westborough Lab Associated sample(s):;.01 QC Batch'ID:WG490372-3 QC Sample:"L1114558-01' 'Client ID: MS.Sample
Nitrogen,Total Kjeldahl 1.8 8 9.7 99 77-111 24
Page 8 of 17 _HA
Serial No:09221112:04
Lab Duplicate Analysis
Project Name: WALSH Batch Quality Control Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
Parameter Native Sample Duplicate Sample Units RPD Qua[ RPD Limits
General'Chemistry-Westborough'Lab Associated'sample(s): i01 "QC;Batch]D:=WG490293-4 QC Sample: L-1114553-01 'ClientM:: DUP Sample
Nitrogen,Nitrate 5.9 6.0 mg/I 2 6
General-'Chemistry—Westborough Lab_Associated;sample(s): .01 iQC;Batch ID: .WG490295-4 QC Sample: L1114553-01, Client ID: .DUP Sample
Nitrogen,Nitrite 0.06 0.06 mg/I 5. 20
General.Chemistry-Westborough:Lab Associated sample(s): 01 IQC.Batch ID: WG490372-4 QC Sample::L11.1L4507-03-Client.ID: 'DUP Sample -
Nitrogen,Total Kjeldahl 0.38 0.35 mg/I 8 24
Page 9 of 17 - '�
Serial No:09221112:04
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
Sample Receipt and Container Information
Were project specific reporting limits specified? YES
Reagent H2O Preserved Vials Frozen on: NA
Cooler Information Custody Seal
Cooler
A Absent
Container Information Temp
Container ID Container Type Cooler pH deg C Pres Seal Analysis(*)
L1114555-01A Plastic 250m]unpreserved A 7 3.9 Y Absent NO3-353(2)
L1114555-01 B Plastic 250ml unpreserved A 7 3.9 Y Absent NO2-353(2)
L1114555-01 C Plastic 250ml H2SO4 preserved A <2 3.9 Y Absent TKN-4500(28)
*Values in parentheses indicate holding time in daysh�
Page 10 of 17
Serial No:O9221112:O4
Project Name: WALSH Lab Number: L1114555
Project Number: BEAO9-10138 Report Date: 09/22/11
GLOSSARY
Acronyms
EPA Environmental Protection Agency.
LCS Laboratory Control Sample:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes
or a material containing known and verified amounts of analytes.
LCSD Laboratory Control Sample Duplicate:Refer to LCS.
LFB Laboratory Fortified Blank:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes
or a material containing known and verified amounts of analytes.
MDL Method Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values,
when those target analyte concentrations are quantified below the reporting limit(RL).The MDL includes any adjustments from
dilutions,concentrations or moisture content,where applicable.
MS Matrix Spike Sample:A sample prepared by adding a known mass of target analyte to a specified amount of matrix sample for
which an independent estimate of target analyte concentration is available.
MSD Matrix Spike Sample Duplicate:Refer to MS.
NA Not Applicable.
NC Not Calculated: Term is utilized when one or more of the results utilized in the calculation are non-detect at the parameter's
reporting unit.
NI Not Ignitable.
RL Reporting Limit: The value at which an instrument can accurately measure an analyte at a specific concentration.The RL
includes any adjustments from dilutions,concentrations or moisture content,where applicable.
RPD Relative Percent Difference: The results from matrix and/or matrix spike duplicates are primarily designed to assess the precision
of analytical results in a given matrix and are expressed as relative percent difference(RPD). Values which are less than five
times the reporting limit for any individual parameter are evaluated by utilizing the absolute difference between the values;
although the RPD value will be provided in the report.
SRM Standard Reference Material:A reference sample of a known or certified value that is of the same or similar matrix as the
associated field samples.
Footnotes
1 The reference for this analyte should be considered modified since this analyte is absent from the target analyte list of the original
method.
Terms
Analytical Method:Both the document from which the method originates and the analytical reference method.(Example:EPA 8260B is
shown as 1,8260B.)The codes for the reference method documents are provided in the References section of the Addendum.
Data Qualifiers
A -Spectra identified as"Aldol Condensation Product".
B -The analyte was detected above the reporting limit in the associated method blank.Flag only applies to associated field samples that
have detectable concentrations of the analyte at less than five times(5x)the concentration found in the blank.For MCP-related
projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(10x)
the concentration found in the blank.For DOD-related projects,flag only applies to associated field samples that have detectable
concentrations of the analyte at less than ten times(1 Ox)the concentration found in the blank AND the analyte was detected above
one-half the reporting limit(or above the reporting limit for common lab contaminants)in the associated method blank.For NJ-
Air-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte above the
reporting limit.
C Co-elution:The target analyte co-elutes with a known lab standard(i.e.surrogate,internal standards,etc.)for co-extracted
analyses.
D Concentration of analyte was quantified from diluted analysis.Flag only applies to field samples that have detectable concentrations
of the analyte.
E Concentration of analyte exceeds the range of the calibration curve and/or linear range of the instrument.
G The concentration may be biased high due to matrix interferences(i.e,co-elution)with non-target compound(s).The result should
be considered estimated.
H The analysis of pH was performed beyond the regulatory-required holding time of 15 minutes from the time of sample collection.
I The RPD between the results for the two columns exceeds the method-specified criteria;however,the lower value has been reported
due to obvious interference.
M Reporting Limit(RL)exceeds the MCP CAM Reporting Limit for this analyte.
NJ -Presumptive evidence of compound.This represents an estimated concentration for Tentatively Identified Compounds(TICS),where
the identification is based on a mass spectral library search.
Report Format: Data Usability Report
�L11"?HA
Page 11 of 17
Serial No:09221112:04
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
Data Qualifiers
P -The RPD between the results for the two columns exceeds the method-specified criteria.
Q -The quality control sample exceeds the associated acceptance criteria.Note:This flag is not applicable for matrix spike recoveries
when the sample concentration is greater than 4x the spike added or for batch duplicate RPD when the sample concentrations are less
than 5x the RL.(Metals only.)
R -Analytical results are from sample re-analysis.
RE -Analytical results are from sample re-extraction.
J -Estimated value.This represents an estimated concentration for Tentatively Identified Compounds(TICs).
ND -Not detected at the reporting limit(RL)for the sample.
Report Format: Data Usability Report
Page 12 of 17
Serial No:09221112:04
Project Name: WALSH Lab Number: L1114555
Project Number: BEA09-10138 Report Date: 09/22/11
REFERENCES
30 Standard Methods for the Examination of Water and Wastewater.APHA-AWWA-
WPCF. 18th Edition. 1992.
44 Methods for the Determination of Inorganic Substances in Environmental Samples,
EPA/600/R-93/100,August 1993.
.LIMITATION OF LIABILITIES
Alpha Analytical performs services with reasonable care and diligence normal to the analytical testing
laboratory industry. In the event of an error, the sole and exclusive responsibility of Alpha Analytical
shall be to re-perform the work at it's own expense. In no event shall Alpha Analytical be held liable
for any incidental, consequential or special damages, including but not limited to,damages in any way
connected with the use of, interpretation of, information or analysis provided by Alpha Analytical.
We strongly urge our clients to comply with EPA protocol regarding sample volume, preservation, cooling,
containers,sampling procedures, holding time and splitting of samples in the field.
Page 13 of 17
Serial No:09221112:04
Certificate/Approval Program Summary
Last revised September 19,2011 -Westboro Facility
The following list includes only those analytes/methods for which certification/approval is currently held.
For a complete listing of analytes for the referenced methods,please contact your Alpha Customer Service Representative.
Connecticut Department of Public Health Certificate/Lab ID: PH-0574. NELAP Accredited Solid Waste/Soil.
Drinking Water(Inorganic Parameters: Color, pH, Turbidity, Conductivity, Alkalinity, Chloride, Free Residual Chlorine,
Fluoride, Calcium Hardness, Sulfate, Nitrate, Nitrite, Aluminum, Antimony, Arsenic, Barium, Beryllium, Cadmium,
Calcium, Chromium, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium,
Silver, Sodium, Thallium, Vanadium, Zinc, Total Dissolved Solids, Total Organic Carbon, Total Cyanide, Perchlorate.
Organic Parameters: Volatile Organics 524.2, Total Trihalomethanes 524.2, 1,2-Dibromo-3-chloropropane (DBCP),
Ethylene Dibromide (EDB), 1,4-Dioxane (Mod 8270). Microbiology Parameters: Total Coliform-MF mEndo (SM9222B),
Total Coliform-Colilert(SM9223 P/A), E. Coli.-Colilert(SM9223 P/A), HPC-Pour Plate (SM9215B), Fecal Coiiform-
MF m-FC (SM9222D))
Wastewater/Non-Potable Water (Inorganic Parameters: Color, pH, Conductivity, Acidity, Alkalinity, Chloride, Total
Residual Chlorine, Fluoride, Total Hardness, Silica, Sulfate, Sulfide, Ammonia, Kjeldahl Nitrogen, Nitrate, Nitrite, 0-
Phosphate, Total Phosphorus,Aluminum, Antimony, Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium,
Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium,
Selenium, Silver, Sodium, Strontium, Thallium, Tin, Titanium, Vanadium, Zinc, Total Residue (Solids), Total Dissolved
Solids, Total Suspended Solids (non-filterable), BOD, CBOD, COD, TOC, Total Cyanide, Phenolics, Foaming Agents
(MBAS), Bromide, Oil and Grease. Organic Parameters: PCBs, Organochlorine Pesticides, Technical Chlordane,
Toxaphene, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Acid Extractables (Phenols), Benzidines, Phthalate Esters, Nitrosamines,
Nitroaromatics & Isophorone, Polynuclear Aromatic Hydrocarbons, Haloethers, Chlorinated Hydrocarbons, Volatile
Organics,TPH (HEM/SGT), Extractable Petroleum Hydrocarbons(ETPH), MA-EPH, MA-VPH. Microbiology Parameters:
Total Coliform - MF mEndo (SM9222B), Total Coliform - MTF (SM9221 B), HPC - Pour Plate (SM9215B), Fecal
Coliform-MF m-FC(SM9222D), Fecal Coliform-A-1 Broth (SM9221 E).)
Solid Waste/Soil(Inorganic Parameters: pH, Sulfide,Aluminum,Antimony,Arsenic, Barium, Beryllium, Boron, Cadmium,
Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury,
Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Thallium, Tin, Vanadium, Zinc, Total Cyanide, Ignitability,
Phenolics, Corrosivity, TCLP Leach (1311), SPLP Leach (1312 metals only), Reactivity. Organic Parameters: PCBs,
PCBs in Oil, Organochlorine Pesticides, Technical Chlordane, Toxaphene, Extractable Petroleum Hydrocarbons
(ETPH), MA-EPH, MA-VPH, Dicamba, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Volatile Organics, Acid Extractables (Phenols),
3.3'-Dichlorobenzidine, Phthalates, Nitrosamines, Nitroaromatics & Cyclic Ketones, PAHs, Haloethers, Chlorinated
Hydrocarbons. )
Maine Department of Human Services Certificate/Lab ID: 2009024.
Drinking Water(Inorganic Parameters: SM9215B, 9222D, 9223B, EPA 180.1, 353.2, SM2130B, 2320B, 2540C, 4500CI-
D, 4500CN-C, 4500CN-E, 4500E-C, 4500H+B, 4500NO3-F, EPA 200.7, EPA 200.8, 245.1, EPA 300.0. Organic
Parameters:504.1, 524.2.)
Wastewater/Non-Potable Water (Inorganic Parameters: EPA 120.1, 1664A, 350.1, 351.1, 353.2, 410.4, 420.1,
SM232013, 2510B, 2540C, 2540D, 426C, 4500CI-D, 4500CI-E, 4500CN-C, 4500CN-E, 4500E-B, 4500E-C, 4500H+B,
4500Norg-B, 4500Norg-C, 4500NH3-B, 4500NH3-G, 4500NH3-H, 4500NO3-F, 4500P-B, 4500P-E, 5210B, 5220D,
5310C, 9010B, 9040B, 9030B, 7470A, 7196A, 2340B, EPA 200.7, 6010, 200.8, 6020, 245.1, 1311, 1312, 3005A,
Enterolert, 9223D, 9222D. Organic Parameters: 608, 8081, 8082, 8330, 8151A, 624, 8260, 3510C, 3630C, 5030B, ME-
DRO, ME-GRO, MA-EPH, MA-VPH.)
Solid Waste/Soil (Inorganic Parameters: 9010B, 9012A, 9014A, 9040B, 9045C, 6010B, 7471A, 7196A, 9050A, 1010,
1030, 9065, 1311, 1312, 3005A, 3050B. Organic Parameters: ME-DRO, ME-GRO, MA-EPH, MA-VPH, 8260B, 8270C,
8330,8151A, 8081A, 8082, 3540C,3546, 3580A,3630C,5030B, 5035.)
Massachusetts Department of Environmental Protection Certificate/Lab ID: M-MA086.
Drinking Water (Inorganic Parameters: (EPA 200.8 for: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI) (EPA 200.7 for:
Ba,Be,Ca,Cd,Cr,Cu,Na,Ni) 245.1, (300.0 for: Nitrate-N, Fluoride, Sulfate); (EPA 353.2 for: Nitrate-N, Nitrite-N);
(SM4500NO3-F for: Nitrate-N and Nitrite-N); 4500E-C, 4500CN-CE, EPA 180.1, SM2130B, SM4500CI-D, 2320B,
SM2540C, SM4500H-B. Organic Parameters: (EPA 524.2 for: Trihalomethanes, Volatile Organics); (504.1 for: 1,2-
Dibromoethane, 1,2-Dibromo-3-Chloropropane), EPA 332. Microbiology Parameters: SM92156; ENZ. SUB. SM9223;
ColilertQT SM922313; MF-SM9222D.)
N nNable Water(Inorganic Parameters:, (EPA 200.8 for: AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn); (EPA 200.7
Page1?o ° al,Sb,As,Be,Cd,Ca,Cr,Co,Cu,Fe,Pb,Mg,Mn,Mo,Ni,K,Se,Ag,Na,Sr,Ti,TI, V,Zn); 245.1, SM4500H,B, EPA 120.1,
Serial No:09221112:04
SM2510B, 2540C, 2340B, 2320B, 4500CL-E, 4500E-BC, 426C, SM4500NH3-BH, (EPA 350.1 for: Ammonia-N),
LACHAT 10-107-06-1-B for Ammonia-N, SM4500NO3-F, 353.2 for Nitrate-N, SM4500NH3-BC-NES, EPA 351.1,
SM4500P-E, 4500P-B,E, 5220D, EPA 410.4, SM 5210B, 5310C, 4500CL-D, EPA 1664, SM14 510AC, EPA 420.1,
SM4500-CN-CE, SM2540D.
Organic Parameters: (EPA 624 for Volatile Halocarbons,Volatile Aromatics),(608 for: Chlordane,Aldrin, Dieldrin, DDD,
DDE, DDT, Heptachlor, Heptachlor Epoxide, PCBs-Water), (EPA 625 for SVOC Acid Extractables and SVOC
Base/Neutral Extractables),600/4-81-045-PCB-Oil. Microbiology Parameters: (ColilertQT SM9223B;Enterolert-QT:
SM9222D-MF.)
New Hampshire Department of Environmental Services Certificate/Lab ID:200307. NELAP Accredited.
Drinking Water (Inorganic Parameters: SM 9222B, 9223B, 9215B, EPA 200.7, 200.8, 245.2, 300.0, SM4500CN-E,
4500H+B,4500NO3-F,2320B,2510B, 2540C,4500E-C, 5310C, 2120B, EPA 332.0. Organic Parameters:504.1, 524.2.)
Non-Potable Water (Inorganic Parameters: SM9222D, 9221 B, 9222B, 9221E-EC, EPA 3005A, 200.7, 200.8, 245.1,
245.2, SW-846 6010B, 6020, 7196A, 7470A, SM3500-CR-D, EPA 120.1, 300.0, 350.1, 350.2, 351.1, 353.2, 410.4,
420.1, 1664A, SW-846 9010, 9030, 9040B, SM426C, SM2120B, 2310B, 2320B, 2540B, 2540D, 4500H+B, 4500CL-E,
4500CN-E, 4500NH3-H, 4500NO3-F, 4500NO2-B, 4500P-E, 4500-S2-D, 5210B, 5220D, 2510B, 2540C, 4500E-C,
5310C, 5540C, LACHAT 10-204-00-1-A, LACHAT 10-107-06-2-D. Organic Parameters: SW-846 3510C, 3630C, 5030B,
8260B, 8270C, 8330, EPA 624,625, 608, SW-846 8082,8081A, 8151A.)
Solid & Chemical Materials (Inorganic Parameters: SW-846 6010B, 7196A, 7471A, 1010, 1030, 9010, 9012A, 9014,
9030B, 9040B, 9045C, 9050C, 9065,1311, 1312, 3005A, 3050B. Organic Parameters: SW-846 3540C, 3546, 3550B,
3580A, 3630C, 5030B, 5035, 8260B, 8270C, 8330, 8151A, 8015B, 8082,8081A.)
New Jersey Department of Environmental Protection Certificate/Lab ID: MA935. NELAP Accredited.
Drinking Water (Inorganic Parameters: SM9222B, 9221 E, 9223B, 9215B, 4500CN-CE, 4500NO3-F, 4500E-C, EPA
300.0, 200.7, 200.8, 245.2, 2540C, SM2120B, 2320B, 2510B, 5310C, SM4500H-B. Organic Parameters: EPA 332,
504.1,524.2.)
Non-Potable Water (Inorganic Parameters: SM5210B, EPA 410.4, SM5220D, 4500CI-E, EPA 300.0, SM2120B,
SM4500E-BC, EPA 200.7, 351.1, LACHAT 10-107-06-2-D, EPA 353.2, SM4500NO3-F, 4500NO2-B, EPA 1664A,
SM5310B, C or D, 4500-PE, EPA 420.1, SM510ABC, SM4500P-B5+E, 2540B, 2540C, 2540D, EPA 120.1, SM2510B,
SM15 426C, 9222D, 9221 B, 9221 C, 9221 E, 9222B, 9215B, 2310B, 2320B, 4500NH3-H, 4500-S D, EPA 350.1, 350.2,
SW-846 1312, 6020, 6020A, 7470A, 5540C, 4500H-B, EPA 200.8, SM3500Cr-D, 4500CN-CE, EPA 245.1, 245.2, SW-
846 9040B, 3005A, 3015, EPA 6010B, 6010C, 7196A, 3060A, SW-846 9010B, 9030B. Organic Parameters: SW-846
8260B, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 3510C, EPA 608, 624, 625, SW-846 3630C, 5030B, 8081A, 8081B,
8082,8082A, 8151A, 8330, NJ OQA-QAM-025 Rev.7, NJ EPH.)
Solid& Chemical Materials (Inorganic Parameters: SW-846, 6010B, 6010C, 7196A, 3060A, 9010B, 9030B, 1010, 1030,
1311, 1312, 3005A, 3050B, 7471A, 7471B, 9014, 9012A, 9040B, 9045C, 9050A, 9065. Organic Parameters: SW-846
8015B, 8015C, 8081A, 8081B, 8082, 8082A, 8151A, 8330, 8260B, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 3540C,
3545, 3546, 3550B, 3580A, 3630C, 5030B, 5035L, 5035H, NJ OQA-QAM-025 Rev.7, NJ EPH.)
New York Department of Health Certificate/Lab ID: 11148. NELAP Accredited.
Drinking Water (Inorganic Parameters: SM9223B, 9222B, 9215B, EPA 200.8, 200.7, 245.2, SM5310C, EPA 332.0,
SM2320B, EPA 300.0, SM2120B,4500CN-E,4500E-C, 4500H-B, 4500NO3-F, 2540C, SM 2510B. Organic Parameters:
EPA 524.2, 504.1.)
Non-Potable Water (Inorganic Parameters: SM9221 E, 9222D, 9221 B, 9222B, 9215B, 5210B, 5310C, EPA 410.4,
SM5220D, 2310B-4a, 2320B, EPA 200.7, 300.0, SM4500CL-E, 4500E-C, SM15 426C, EPA 350.1, SM4500NH3-BH,
EPA 351.1, LACHAT 10-107-06-2, EPA 353.2, LACHAT 10-107-04-1-C, SM4500-NO3-F, 4500-NO2-B, 4500P-E,
2540C, 2540B, 2540D, EPA 200.8, EPA 6010B, 6020, EPA 7196A, SM3500Cr-D, EPA 245.1, 245.2, 7470A, SM2120B,
LACHAT 10-204-00-1-A, EPA 9040B, SM4500-HB, EPA 1664A, EPA 420.1, SM14 510C, EPA 120.1, SM2510B,
SM4500S-D, SM5540C, EPA 3005A, 9010B, 9030B.. Organic Parameters: EPA 624, 8260B, 8270C, 625, 608, 8081A,
8151A,8330, 8082, EPA 3510C, 5030B.)
Solid&Hazardous Waste(Inorganic Parameters: 1010, 1030, EPA 6010B, 7196A, 7471A, 9012A, 9014, 9040B, 9045C,
9065, 9050, EPA 1311, 1312, 3005A, 3050B, 9010B, 9030B. Organic Parameters: EPA 8260B, 8270C, 8015B, 8081A,
8151A, 8330, 8082, 3540C,3545,3546, 3580,5030B, 5035.)
North Carolina Department of the Environment and Natural Resources Certificate/Lab ID: 666. Organic
Parameters: MA-EPH, MA-VPH.
Drinkin Water Program Certificate/Lab ID: 25700. (Inorganic Parameters: Chloride EPA 300.0. Organic Parameters:
Page
Serial No:09221112:04
Pennsylvania Department of Environmental Protection Certificate/Lab ID : 68-03671. NELAP Accredited.
Drinking Water(Organic Parameters: EPA 524.2, 504.1)
Non-Potable Water(Inorganic Parameters: EPA 1312,200.7,410.4, 1664A, SM25401),5210B, 52201),4500-P,BE.
Organic Parameters: EPA 3510C, 3005A, 3630C, 503013, 625, 624, 608, 8081A,8082, 8151A,8260B, 8270C,8330)
Solid & Hazardous Waste (Inorganic Parameters: EPA 350.1, 1010, 1030, 1311, 1312, 3050B, 60106, 7196A, 7471A,
90106, 9012A, 9014, 904013, 9045C, 9050, 9065, SM 4500NH3-H. Organic Parameters: 3540C, 3545, 3546, 3550B,
3580A, 3630C, 5035, 8015B, 8081A, 8082, 8151A, 8260B, 8270C,8330)
Rhode Island Department of Health Certificate/Lab ID: LAO00065. NELAP Accredited via NY-DOH.
Refer to MA-DEP Certificate for Potable and Non-Potable Water.
Refer to NJ-DEP Certificate for Potable and Non-Potable Water.
Texas Commisson on Environmental Quality Certificate/Lab ID:T104704476-09-1. NELAP Accredited.
Non-Potable Water(inorganic Parameters: EPA 120.1, 1664,200.7,200.8,245.1, 245.2, 300.0, 350.1, 351.1, 353.2,
376.2,410.4, 420.1, 6010, 6020, 7196, 7470, 9040, SM 2120B,2310B,2320B,2510B,2540B, 2540C, 25401),426C,
4500CL-E,4500CN-E,4500E-C, 4500H+B,4500NH3-H,4500NO2B,4500P-E,4500 S2 D, 510C, 521013, 52201),
5310C, 5540C. Organic Parameters: EPA 608,624, 625, 8081, 8082, 8151, 8260, 8270, 8330.)
Solid&Hazardous Waste(Inorganic Parameters: EPA 1311, 1312,9012,9014, 9040, 9045, 9050, 9065.)
Department of Defense Certificate/Lab ID: L2217.
Drinking Water(Inorganic Parameters: SM 4500H-B. Organic Parameters: EPA 524.2, 504.1.)
Non-Potable Water(Inorganic Parameters: EPA 200.7,200.8, 6010B, 6020, 245.1, 245.2,7470A, 9040B, 300.0, 332.0,
6860, 353.2,410.4, 9060, 1664A, SM 4500CN-E,4500H-B,4500NO3-F, 52201),5310C, 2320B,2540C, 3005A, 3015,
9010B, 9056. Organic Parameters: EPA 826013,8270C, 8330A, 625, 8082, 8081A,3510C, 5030B, MassDEP EPH,
MassDEP VPH.)
Solid&Hazardous Waste(Inorganic Parameters: EPA 200.7, 6010B, 7471A,9010, 9012A, 6860, 1311, 1312, 305013,
7196A, 901013, 3500-CR-D,4500CN-CE, 2540G, Organic Parameters: EPA 826013, 8270C, 8330A/B-prep, 8082,
8081A, 3540C, 3546, 3580A, 5035A, MassDEP EPH, MassDEP VPH.)
The following analytes are not included in our current NELAP/TNI Scope of Accreditation:
EPA 8260B: Freon-113, 1,2,4,5-Tetramethylbenzene, 4-Ethyltoluene. EPA 8330A: PETN, Picric Acid, Nitroglycerine,
2,6-DANT, 2,4-DANT. EPA 8270C: Methyl naphthalene, Dimethyl naphthalene, Total Methylnapthalenes, Total
Dimethyl naphthalenes, 1,4-Diphenylhydrazine (Azobenzene). EPA 625: 4-Chloroaniline, 4-Methylphenol. Total
Phosphorus in a soil matrix, Chloride in a soil matrix, TKN in a soil matrix, NO2 in a soil matrix, NO3 in a soil matrix, SO4
in a soil matrix.
Page 16 of 17
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FORM NO:01.01(rev.14.00T-07) _ l>J'r y i rt <!a'k` > ti s? r<'"'"'+•'!•,
YY
�A
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS
1573 Main Street,P.O.Box 1743 (508)896-1706
Brewster,MA 02631 fax(508)896-5109
LETTER OF TRANSMITTAL
TO: DATE: JOB NUMBER:
Massachusetts Department of Environmental Protection 7/31/12 BEA12-10138
Attention:Title 5 Program
I Winter Street-6th Floor
Boston,MA 02108 REGARDING:
Former Walsh Residence
195 Herring Run Place Unit E[Route 149)
SHIPPING METHOD: Marstons Mills,MA
Regular Mail ❑ Pick Up ❑
Priority Mail ❑ Hand Deliver ❑
Express Mail ❑ Other ❑
Certified Mail Green Card/RR ❑
COPIES DATE DESCRIPTION
1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(Dec 2011-
June 2012)
1 OMNI Environmental Systems,Inc.SRF Operation and Maintenance Inspection Checklist(Dec 2011 -
June 2012)
For review and comment: ❑ For approval: ❑ As requested: ❑ For your use: ❑x
REMARKS:
Please find enclosed the DEP Inspection and O&M Forms completed during this reporting period prior to the sale of the above noted
residence. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you.
cc:Barnstable Board of Health
Mr.and Mrs.Walsh,Owners
David C.Bennett,Principal[Internal]
Matthew Costa-OMNI Environmental Systems,Inc.
FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO 413265/Joseph Smith,WWTO#12529
If enclosures are not as noted,kindly notify us at once
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When David and Francine Walsh
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key-to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return
City Zip
key.
Mailing address of owner, if different:
r� P.O. Box 302
Street Address/PO Box:
R� Marstons Mills MA 02648
City State Zip
(508)420-7963 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information '
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
11/15/02 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
12/21/11 09/14/11
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev. 11-07-05 Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 6.5 SU DO 11.04 mg/L Turbidity 0.40 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:
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:
Conduct a general operation and maintenance visit. The system functioning properly. Effluent quality
passed field testing parameters.
Notes and Comments:
The septic tank needs a new riser section.
t
t5aiom.doc•rev. 11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
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 d erator in accordance with 257 CMR 2.00.
17
Operator Signature Date
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When David and Francine Walsh
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return City Zip
key.
Mailing address of owner, if different:
P.O. Box 302
�I Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508) 420-7963 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896 - 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
11/15/02 8/25/03
Installation Date Start of Operation
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
3/12/12 12/21/11
Inspection Date Previous Inspection Date
5" Sludge, 1" Scum
Sludge Depth(to be checked yearly) Pumping Recommended Yes No
®
t5aiom.doc•rev. 11-07-05 Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 6.5 SU DO 15.46 mg/L Turbidity 6.13 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:
9Pd
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:
Conduct a general operation and maintenance visit. The system is functioning properly. Effluent
quality passed field testing parameters.
Notes and Comments:
The top polylok riser sections on the septic tank and the pump chamber were replaced.
t5aiom.doc•rev. 11-07-05 Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
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. erator in accordance with 257 CMR 2.00.
� Z
Operator Signature mj Dat�
System owner must submit this report, technology O&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use— by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6th Floor
Boston, MA 02108
t5aionn.doc•rev. 11-07-05 Page 3 of 3
-LIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and O&M Form for Title 5 I/A
Treatment and Disposal Systems
A. Installation
Important:When David and Francine Walsh
filling out forms Owner
on the computer,
use only the tab Route 149 Unit 195-E
key to move your Facility Street Address
cursor-do not Marstons Mills 02648
use the return
City Zip
key.
Mailing address of owner, if different:
t� P.O. Box 302
Street Address/PO Box:
Marstons Mills MA 02648
City State Zip
(508)420-7963 ext.
Telephone Number
B. Authorized Service Provider
BENNETT ENVIRONMENTAL ASSOCIATES, INC.
O&M Firm
1573 Main Street/PO Box 1743
Street Address
Brewster MA 02631
City State Zip
(508) 896- 1706 ext. 129
Telephone Number
Samantha Farrenkopf 13265
Certified Operator Name Certification Number
C. Facility/System Information
OMNI Environmental Systems OMNI RSF
DEP ID Manufacturer ID Model Number
11/15/02 8/25/03
Installation Date Start of Operation .
Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial
Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No
D. Operating Information
06/08/12 03/12/12
Inspection Date Previous Inspection Date
Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No
t5aiom.doc•rev. 11-07-05 Page 1 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
E. Field Testing
Field Inspection:
Color: ❑ gray ❑ brown ® clear ❑ turbid
❑ Other(specify):
Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid
Effluent Solids: ® no ❑ some
pH 6.5 SU DO 9.71 mg/L Turbidity 2.37 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:
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:
Conduct a general operation and maintenance visit. The system is functioning properly. Effluent
quality passed field testing parameters.
Notes and Comments:
t5aiom.doc•rev. 11-07-05 Page 2 of 3
f
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Title 5
DEP Approved Inspection and ®&M Form for Title 5 I/A
Treatment and Disposal Systems
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 certifie operator in accordance with 257}CMR 2.00.
/) I?-3 1 12-
Ope a or igroature Date'
System owner must submit this report, technology 0&M checklist, and any required sampling results
to the local board of health and DEP as follows for each inspection performed:
Remedial Use—by January 31st of each year for the previous calendar year
Piloting Use-within 45 days of inspection date
Provisional Use—by March 31th of each year for the previous 12 months
General Use—by September 30th of each year for the previous 12 months
Send to:
Department of Environmental Protection
Attention: Title 5 Program
One Winter Street, 6t Floor
Boston, MA 02108
t5aiom.doc•rev. 11-07-05 Page 3 of 3
7
nvi
as c�
0 NU
OMNI RSF Operation and Maintenance Inspection Checklist
X Installation & Service Information
/file l y e 1-212/Z2 o �P) 1, na
Facility Street Address Date of Service
s s /-r%/l S. lee Ste,/AL , 6�1, ev t,,, - 2,1_-4 -.
city Operator/O&M Firm
System Startup Date Weather Conditions
Y p
. I
J' I
��n��11 S 5'J rz�. 7 O. Gi ✓ tc S a",
B. Septic Tank
Sludge Pumping Required: Yes❑ No K ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Yes No❑ If yes, inspect I &clean at least yearly Y
If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank i
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping I
schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule
depending on how heavily the system is used.
i
C. Recirculation Tank
I
❑Check if sludge accumulating . Pumping required: Yes ❑ No i
I
Odor problems: Yes ❑ NO If yes,description
I
Effluent tee filter: Yes[ No❑ ]f yes, inspect( &clean at least yearly
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
D. .Equal ization Tank(if installed) f
Sludge Pumping Required: Yes❑ No❑ ❑ Sludge Depth: ❑Scum Depth: !
Effluent tee filter: . Yes ❑ No ❑ If yes, inspect❑&clean at least yearly❑
Same inspection criteria as septic tank: (
I
i
E. Pump Chamber 1 Vault(if Installed)
Pump Inspections(all units)
If problems,describe l
[� Float switches
( ' Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken. ;
i
i
i
t
i
i
F. Pumps, SWIches, Floats, Alarm System
Pump)nspections(all units)
If problems,describe
Test pump alternator, or record hours
Hours of operation
Float switches
Check all switches for operation i
Test alarm
If non-functioning,corrective action(s)
Make sure pump(s), Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made.
1
G. Filter Modules {"Sand Filters"}
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Inspect for ponding Ponding Present:Yes❑ No.9
LA
Clean bed: . Yes❑ No 9
[Distribution pipes. Flush:Yes❑ No Brush: Yes❑ NoW 1
[ Any obstruction of airflow to filter modules: Yes❑ No If Yes,explain below(i.e:snow, dirt)
To inspect the conditi':)n of the filter modules remove the mulch layer at one corner of the filter module area,' 1
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface i
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to i
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with !
a garden hose(with a pressure nozzle on it).Then.Recover the filter beds as they were found.
H. Sample Collection l
Yes ❑ NdO
. 1
If yes:❑BOD ❑TSS ❑pH ❑TN .❑Other
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
ry laborato supplied ccntainers. In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper'safety equipment while pulling samples(i.e.rubber gloves).
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System Notes: .
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OMNI RSF Operation and Maintenance Inspection Checklist
A. Installation &Service Information
A
M 00
C�b v j I-.? Z
Facility Street Address Date of ervice
City Operator/O&M Firm
System Startup Date Weather Conditions
-- 0V-'A
B. Septic Tank
Sludge Pumping Required: Yes 0 No -A Sludge Depth: VLScum Depth:
t W
Effluent tee filter: YeA 9 NOD If yes, inspec04&clean at least yearl
If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established with a licensed septage hauler, if not recommend a two to four year pumping schedule
depending on how heavily the system is used.
C. Recirculation Tank -t ti
*Check if sludge accumulating Pumping required: Yes❑ NoA
Odor problems: Yes El N If yes,description
Effluent tee filter: Yes E] No If yes, inspect El&clean at least yearlyE]
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
�' D. Equalization Tank (if installed)
Sludge Pumping Required: Yes El No El El Sludge Depth: El Scum Depth:
Effluent tee filter: Yes El No❑ If yes, inspect F1&clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber I Vault(if Installed)
Pump Inspections(all units)
If problems,describe
E(Float switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken.
F. Pumps, Switches, Floats, Alarm System
Inspections(all units)
XPump
If problems,describe
Test pump alternator, or record hours
Hours of operation
Float switches
Check all switches for operation
KTest alarm
If non-functioning,corrective action(s)
Make sure pump(s), Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made.
G. Filter Modules ("Sand Filters")
Inspect for ponding Ponding Present:Yes ❑ Noo�
Clean bed: Yes ❑ NCO
Distribution pipes Flush:Yes ElNO M Brush: Yes ElNo9q
t(Any obstruction of airflow to filter modules: Yes ElNo If Yes, explain below(i.e. snow, dirt)
To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration. If the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
Yes❑ N�k
If yes: ❑BOD ❑TSS ❑pH ❑TN ❑Other
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers. In order to prevent any cross-contamination from a previous sample rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves).
System Notes:
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OMNI RSF Operation and Maintenance Inspection Checklist
A. Installation & Service Information
Yj
Facility Street Address � Dat6 of ervice
city Operator/O&M Firm
System Startup Date Weather Conditions
B. Septic Tank �� �tU- � � � 11-L11, Q hR
Sludge Pumpirg Required: Yes❑ Not ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: YesTA No❑ If yes, inspect&clean at least yearl
If the sludge layer is within 12"of the outlet invert, recommend that the homeowner have the septic tank.
pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping
schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule
depending on how heavily the system is used.
C. Recirculation Tank Svc lv �`� ``� �Y�'`� ��`� '�\�`1�
❑Check if sludge accumulating Pumping required: Yes❑ NoQt
Odor problems: Yes❑ NON If yes,description
Effluent tee filter: Yes❑ NoQ2� If yes, inspect❑ &clean at least yearly❑
If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to
prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this
may indicate that the filter bed may need servicing.
D. Equalization Tank (if installed)
Sludge Pumping Required: Yes❑ No ❑ ❑Sludge Depth: ❑Scum Depth:
Effluent tee filter: Yes ❑ No❑ If yes, inspect❑ &clean at least yearly❑
Same inspection criteria as septic tank:
E. Pump Chamber/Vault(if Installed)
Pump Inspections(all units)
If problems,describe
(,Float switches
Check all switches for operation
Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate
corrective actions need to be taken.
F. Pumps, Switches, Floats, Alarm System
Pump Inspections(all units)
If problems,describe
�]Test pump alternator, or record hours
Hours of operation
Float switches
Check all switches for operation
Test alarm
If rion-functioning,corrective action(s)
Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective
actions can be made.
G. Filter Modules ("Sand Filters")
'JAny
nspect for ponding Ponding Present:Yes El No
Clean bed:: Yes❑ Noq .
Distribution pipes Flush:Yes❑ No Brush: Yes❑ No ]
obstru--tion of airflow to filter modules: Yes❑ No(V If Yes, explain below(i.e. snow, dirt)
To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area,
then lift the filter fabric so that the media can be inspected through the end of the contactor. The media
should have a thin biomass layer growing on it and should have a brownish shaggy coloration. If the surface
of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to
completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with
a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found.
H. Sample Collection
Yes❑ Nkcs,
If yes: ❑BOD ❑TSS ❑pH ❑TN ❑Other
All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile,
laboratory supplied containers.In order to prevent any cross-contamination from a previous sample.rinse the
dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained.
Make sure to wear proper safety equipment while pulling samples(i.e. rubber gloves).
System motes::