HomeMy WebLinkAboutTitle V Inspection Report - 145 BRADFORD STREET 4/7/2008 I
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rornrrion Are alth of Massachusetts
Tftle ,5 Official(� ion Form
Bn.rbsrrrfa CP Sewage Disposal Systerrn Forrrn - blot for Voluntary Assessments
145 BRADFORD ST.
Property Address
MARJORIE GAUDt I ,FE
Owner -
Owner's tVarmo
information is �
required for I\JO. ACS DOVl.�-i 1111A 01845 4/7/0th � 6 �
every page. City/Town State Zip Code Date of Inspection
Inspection results Must: be submitted orn this forrnn. Inns ectiorn forrrns may not be altered in any
way,
When filling out '" General Information
forms can the � � ri 3 2008
onlyueuse 1. Inspector
the tab key
-- __ V d - N(OF D
t i NIXM E,
a to move our JAMES I-d. CURRIER II REA a E'N I cursor-do not
use the return Nanle of Inspector
key. J's SEP-VIC & DRAIN
Cornpany Name
131 FOREST T ST.
Company Address -
- MIDDLET"ON MA 01940
J City/Town _
state Zip Code
978-774-668511
Telephone Number
License Nurmber
_. ------
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and than the
inforrnatior reported below is true, accurate and complete as of the tirne of the inspection. The inspection
was performed based on my training and experience irr the proper function and maintenance of on site
sewage disposal systerns. I a#rnn a DEP approved system inspector pur-suant to Section 15.340 of
Title 5 (310 CIVIR 16.000). The systern:
❑ Lasses ❑ C,onditionall C-
y asses ❑ f=ails
❑ Needs Ftirther Evaluation by the Local Approving Authority
In ctor's Signak e
Date
The systern inspector shall subrTnit a copy of this inspection report to the Approving Authority (Board
Of Health or DEP) within 30 days of cornnpleting this inspection. If the systern is a shared system or
has a design flow of 10,000 gpd of greater, the inspector and the systern owner shall strbrrrit the
report to the appropriate regional office of the DEP. The original should be sent to the systern owner
and copies sent to the buyer, if applicable, and the approving authority.
""This report only describes cornditiorns at tine tirrre of inspectionn and under the cornditiorns of use
at that tirnne. °T"Inis inspection does not address snow tine system will perform in the future under
the same or different conditions of rase.
TITLE v 2008.do(k •03/08
Title ru C7ffini;al Inspmhon Farm Subsul'tacL Seyvarp,.r71�arlosaf 6y+stl7rrr i-�ane�1()t 1
Ax .� Gomrrla rme lfl-� of l la a hu tt° „r
I �� . �
trrR urfface Sewage Disposal System) Form Not for VOlrr nta ry Assessments
meats '
145 BRAD FOR D ST.
Property Address
MARJOR III GAUD T°t"C:
Owner Owner's Narrie
inforrnatior)is
required for NO, ANDOVEI� _ MA _ 011345 4/7/0£3
every page. City/1-own -
State Zip Code Date of Inspection —
eitifica i (cant.)
Inspection) Summary: Check A,B,C,D or E /always cornplete all of Section) D
A) System passes:
EA I have not found any inforrnation which indicates that any of the failure criteria described
in 310 CMR 15.303 of-in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
...._.............
B) Systerf Conditionally Passes: �
one or- r re system components as described in the °Codit nal Bass" section need to be
replaced Ti epaired. The systern, upon Completion of Y6 replacement or repair, as approved by
the Board of ldealth, will pass.
`
Answer yes, no or nc eterrriined (Y, N, ND) in the ( h f for the following statements. if "not
determined," please elairl. /
(� The septic tank is meta(and over 10 yea old* or the septic tank (whether metal of-not) is
structurally Ullsound, exhi its sttt�stat�ti S infiltr tiol� or exfiltr-atiort or tank failure is imminent.
Systen'i will pass inspectiari F�f the ex sfing tank is replaced with ra complying septic tank as
approved by the Board of F-le,attla41S r"
* A metal septic tank will pass, rkctiar1 if it is structurally sound, not leaking and if a Certificate
of Compliance indicating t o the tar) is less than 20 years old is available,
ND Explain:
s
Gbservatiin of sewage backup or-break Out or high static ater level in the distribution box due
to broke or obstructed pipe(s) ar due to a broken, settled or neven distribution box. System will
pass t)lspection if(with approval of Board of Health):
Cif broken pipe(s) are replaced
r'
(W] obstruction is removed
TITLE v 2008.riw:.rraiars
Tith" i Official jnspwe ti.n Forl"i Dmposmi of'� i