HomeMy WebLinkAboutMiscellaneous - 60 LONG PASTURE ROAD 8/29/2012 Commonwealth of Massachusetts , u ,'�° r, �
Title Official Inspection
Subsurface Sewage Disposal System Form_Not for Voluntary Assessme s
60 Long Pasture IlCstIt�� ��C� 1-1`t
W
Property Address _.t Ill t7�f''/�V t��i
James Vitas -- - - l
Owner Owner's Name
information is
required for North Andover MA 01845 8/29/2012
— -
every 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: A. General Information
When filling out
forms on the
comptt u tab key 1. Inspector:
only to move your Neil James Bateson
cursor-do not
use the return Name of Inspector
key. Bateson Enterprises Inc.
Company Name
111 Argilla Road
Company Address
Andover MA 01810 - —
City/Town State Zip Code
978-475-4786 S115
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience,in'the'proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
NA - 8/29/2012
Inspector's Signatu 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 is a shared system or
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:DE,P. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
"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.
t5ins•11(10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17