HomeMy WebLinkAboutTitle V Inspection Report - 73 RIVERVIEW STREET 8/23/2002 E
I
PEARSON C . B D . F
CERTIF-IE70 TITLE V INsPE'CTIoNS
TE:L: 508/962-2687
l�IL7TE: THIS INSPECTION IS TO DETERMINE
COMPLIANCE WITH TITLE V REGLILATICINS ONLY. THIS
IS NOT AN INSPECTION TO DETERMINE LONGEVITY OF
THE SEPTIC SYSTEM.
SEAN PEARSON
L
CQMMQNWEALTI dt MASSACHUSETTS
EXECTJTIVE OF r Q �E�RdNNXEN'PAL AFFAIRS
,f DEPARTMP 11,&bNA&M' LPROTECTION
;
Ill r, AY 3'.Y"d�,:Zti. - ti
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OFFICIAL INSPECTION FORM; Cf �FOR VOhij�NTARY ASSESSMENTS
SUBSURFACE SE�W ►GE DISPOSAL SYSTEM FORM
CERTIFICATION
e0 16'jsttq59;���s�t>��ar11 HOld,U
'ri� t�j =It, 'ip.a�t�'t• '�L'k���ii^2ti1.[ ��7.Y]I3�`'��r1F1 �+'ifv t,�r
Property Address;.
Owner's Name: ��t,
YY �
Owner's Address:
r SE
Date of Inspection:
Name of Inspector:(please print) John:J. 'Secv
Company Nam
eSoucy' s Sewer ervi t r 1
Mailing ddress: �-' - a� it. ' ���, • lr ,tr.�fri i,� xt�, > s:
g 830 Living, 1`nne�;
''f s ��i,�!, [�t��tit�is��r 't �;f�,•.•r tf •t. •
Telephone Number: 7t
f7f (f
CERTIFICATION STATEMEI ' r � �v�uio �li
I certify that I have personally inspected the sew$ge dzspo al systemr at this address'and that the information reported
below is true,accurate and complete;as.of.thertune.of i e 00d.ionfJhe,nspection.was performed based on my
training and experience in the proper function andmazr}�eiianp��p£on site=sewage disposal systems. I am a DEP
approved system inspector.pursuant to Section l5. 40,�i�Title 5(310 CMR,15.000).,The system:. .
Conditionally Passes
Needs Fu_miter Evaluation by the Local Approving Authority
Fails
Inspector's Signature; '
The system inspector shall sub a copy of irtspectirtto theSA'ppto,irinj Authority(Board of Health or
DEP)within 30 days of coml g this inspection s If the sylham4&#shared;systetn or•has a design flow of 10,000
gpd or greater,the inspector and the system:owr►e shallillniGti~:reparC fb�t}ieeprapriate regional office of the
DEP.The original should be sent tot he system ov�i er and capias"sent to the:buyer,if applicable,and the approving
authority. 'S
Notes and Comments ,T, f'f i 9 fad t*#ib 1."
i
i c y5�y, tt
****This �' ', �, .is��sirsi�zt,► F1`r4�rif�t[ttzt+� �> ��`
This report only describes conditions at the.;ime of inspection and under the 0fiditions of use at that
time.This inspection does.not address hpw,the system Wlll perform.htthe future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page i
Page-2 of!1 yt }ah a l (a t
r:
`�t',ih''i'sr�{����sA•I�.1�J&3��•s.s"��'+[a- +1 #�, IY,��d'���+�4.``` .
ti h A . ,
OFFICIAL'TNF 'I +,1N' 'Q :' NQ 'Q 'VQLUNTARY ASSESSMENTS
'tUMN:INSPECTION FORM
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• 4 i �, ,ry r �, ..
Property Address: r
Y
,
Owner: A F
Date of Inspection. z x
-
Inspection Summa .xrC4ec ALW YS l t 'all of Section D
A. System Passes
d, i r, 9 f•'f�A tkf "T
n � �•i�4tsc s es��r'1' �'`�11;� 1 x r e r r r
, 1 have not found aay uafQ is lwl tc mdicat�s � y of Clue failure criteria described in 310 CMR
15,303 or in 310 CN!}t l , lt„day lure orite�aol + ted are indicated below.
+�
Comments:
77
B. System ConditiO4all�►
One or mare s}+sietnmpanet 'SS degcrtbecl ' ptiton� Pass”section need to be replaced or
repaired.The system,upaaompjettQ p , replaGemeat orp ,'$�♦�pprovgd by the Board of Health,will pass.
4 s 5 � .1%...,
�"I Vi
Answer yes,no or not dotr~tm► r
r
explain. P, 0 3 ezfplluwing statements. if"nut determined"please
JAM_ �,, st �� #���-ate S d i ° i i( +': �'k
{.� 6 f
slfilG�1�# ZI}v6aar� +. � � E t-
r yb f .`?te r4ln if �ihriA 7 •'1 ' �iThe septic ajW`J$ pe
bother metal or not)is structurally
unsound;exhibits substattbal} �tJ�i �p14 is imminent.System will pass inspection if the
+ 4 i a
existing tank is replaFdtt1t a o dpi E t opa +esy dte'Hoard'of Health.
*A metal septic♦the tank p a�`�p�Qt#����At 10,00c 1C �ly s �Apt ieakutg and if a Certificate of Compliance
indicating that ills KiiN1� l '# * i` b*Tx bl
rl 5 # f r i �� �.
ND explain; rt e ru, t & 56 � d &� k� i � ° AI )4v a
#(I,i.A-
T
Observation of s;we v,baClcn fi r b3 put k b p r level in the distribution box due to broken or
obstructed pipe(s),or.t( "
approval of Board aea�h�� System will pass inspection if(with a " r
i; lid v# tal�atttf t 1 � `
5 qtr#(
i[i.`YpE IF�rrA�y�Nf `r �. E _..♦.-r ('!'!'�p{[(°� „it`rYG�{}ipri�gi,�l!l�q �,
i ��f�yk
'J!V `aril r.C.IS�,# cif ylt � y�., r �#
ND ex la # � �i ) r{vrt�
p ' z stir. `t"
The system reams p ' g to t}m�s a Ye 9 to broken or obstructed pipe(s).The system will
pass inspection if
004r� � , �: f � ,
OR
dh +
f# Qb-
p removed , , k
IE$�di{�Ci �#l�lkr ! { �i.77�]�n+ d
�7ry''�
i �)f -'-', r
L
ND explain; t y Ti r i i t l k,n i
�t' f)�r !'r +� r�Y ti-r 1°1r " It • I S�..i Si w
b l I[
_ s` '! s i .lit ' @x s,�7 i, r=, fC •• .
$ )
t T yt` .�t1'ri '.sS, �f '�t�
Page 3 of"11
�l 7a ��}t r�}i �t4�r a�i11 r j r f r
rri,k:,..' t1 Vf1
OFCTAU �1Q�'' '�?�1i, QL
Y �INTARY ASSESSMENTS
SU
i POSAUMTEN INSPECTION FORM
FS
;iFl J. ia aljly�'�y4�� �����fraFr pe� Y g �tF
�'��'���` �.�c�AAtiaued}
` " 1 SrG rt "s
Property Address:
a
r
Owner:
Date of Inspection: '
o �
C. Further Evalua#ton `
r j ►, ark plPeas
r , s x
�E
' ! x��rJ•��,�` 4� f
Conditions exist whhte;� 1 + a of Health in order to determine if the system
is failing to protect public he11et� f� evote�tt 1
1. System will passµqj 4i;g, ", I , �e r illeeordauce with 310 CMR 15.303(1)(b)that the
system not fW & � �' 1t '1l1nb1lC health,safety and the environment:
- fx �,
i�3•
Cess al
Q�p � p{�t3 #�O►'}ff4 bgr4ermg yopt#f Wetland or a salt marsh
dl {�3'�krii�S�4 � 'M;,
t
40v Iaw , i�
�t#I1 [l1 lit1lf ; k! i'64,
2. System will fall prliesy t '
4e 10 r d 404411(and Public-WOor Supplier,if any)determines that the
system is functtanip lrt pert � � u� e� a tl},safety and environment:
ll tttllt�a"' Y f�a�vn� -W:N..4��t{r 3����r v.,
�' e.�YSt#t hit� spFarp #srSSAIi)ar►d the SAS is within 100 feet of a
swface watex��AAY� ^t
pip
_ e.5y;; ` ' ��+f �alifi?hri�+ aft a Zone 1 of a public water supply.
i �,+� I ttsi atttu�tx tlfl €itlt sst` 1atla t 14 ;�
The system has a F ' ' lid q0 of of a private water supply well.
—" Tha�Ystppt. ula a 4ll 110.0 feet but 50 feet or more from a
• - p�vate, r RA Y�V�
1'sat4 .�41 } r �',
e a#4 le Y r v
**This system
�s i � �' r' 1 �4., 'U, � *' st d
passed y` �l 'y '�lY ,`prr p X u;PAP certified laboratory, for coliform
6.
bacteria and Volatalo ,+� jn� � tgl�.i from pollution from that facility and
the presence ofQ �. � o .;# e1 t or less than 5
ppm,provided that no other
failure
'14
`04 ,;o:this form.
rig l i{ y P I n s
{tr one fiy� is'7� go
3. Other: p,� � ,tXt,
Z Y ! t -'.aii tt ,+'ro4�Itt6ill
u �o � ������>♦r�,�� s'aF`��?sk'j�-p:t1`<y,i.,�n:1;•s .
fr � (s[7t?(} iyz{ ry�tf1�1
.�.,� �7 �1' AR94
�, �
7
rd P ii iia
115owl, jr
ttu44z y.�W [ .
{ u of +
�, 3 .
t
-Page 4 of I 1
ag
OFF I4,L I1�1S ' , NOT`�' t<VOLUNTARY ASSESSMENTS
Su ' TEN NSPECTION FORM
We
T��•14 ICATIO IQQ:11�t1113e(�)
Property Address:
Owner: ",
Date of inspection-,
'y
Ey r,n.cy,
D. System " '�J, ,�i,���
m ailure Cri iri eP 14 sYi#+Fpts1 r � F z 1
You must tndiaato"yi~s;'$ ` � 1I1nf teGlaons; '
7�T _ 1 1 y S r'Y
YeS No 15 �a 4i F + a I 1 E
ialil ►�a �ampou#�dpe#o overloaded or clogged SAS or cesspool
?`;DnsahargG.,or, gl4 !4t or surface waters due to an overloaded or
Gio Wed SAS nr irte
,�-
Static liquid ley�plgp lox ebpv4°pletyert due to an overloaded or clogged SAS or
cesspool
Il
Liquid s
q depth. � $loW Y pr#. atlable volume is less than /2 day flow
Required pua[tlp NO due to clogged or obstructed pipe(s).Number
of times pump#!
r*-•�- a __��
JG �Y porn +� 14 : 5� a sF4gl f pnvy t5 bolo W ti�gh ground water elevation.
Any portion Rip lid t pf
' .,with�n400 fie#04 surface water supply or tributary to a surface
Water:supPjY4, � R
�Y pQrtiom Q ?ssp I , witbu a a ��41pj;lUQ well,
�Y portion,Qfesl pr► :s wxtbiri fed#of private water supply well.
porttan<Af1 �)e ,
pp y W l Q t grsater than SA feet from a private water
Su i .wait., t o, 1?#ebi9, 1 q �t s �' fs;system passes if the well water analysis,
performed it ce if Ftury,i'orl� Qr4 lbcteria and volatile organic compounds
ladeC ,tes flat#11 f 'l t
'1140,90W.-OW` :#'feeiiity and the presence of ammonia
nitrogea.aad nit
etkrpe `< ]uiil t4,ar lest;#fanpm�provided that no other failure criteria
arc$rgge e �#y� fora.]
Stit' :�t X''�5I4y'F"{.471E +"k ��f
(Yes/No)The•SY'ter#:
'410.40MO.£Q-of'tlle above failure criteria exist as
described i .��4 �1 �� � tyrepiy � ge.system owner should contact the Board of
Health to determ�a vvat Wa�tres ►t cu� lte$'aalwo.
I_bu'1 N����
E. Large Systems;
;=Eti± , �t �nx � ; � t�.; tPkiil, tars.
To be considered a lurge s
u.
gpd, design flow of 10,Oia(t gpd to 15, 00
�: Wr�z
You must indicate either t"Ye '� r "oo" pf a tlowu� � f
(The following criteria appj"' j dt�lpp 0 on ona.above)
yes no
S e F ap}t 71 K i e t 1a,= 1�7 1 x
e system is Wi e
ppiY
ad '�^may -
the system is wi S +ater supply
.the system is tAbat al!41t#r4ge = eglt4ve lea( , wellhead Protection Area—IWPA)or a mapped
Zone I1 of a pubho w t'spgp Wet
a Yjlq
If you have answered
'Y.. #A. } �14I4u SeetiQae syoti}.i; eQnsidered a significant threat,or answered
"Yes"in Section D above, iegp$ ste dcd,:ne'ue�;4fopeitgr of any large system considered a
significant threat under SeetEOp:) ;gar f 1pd u ¢ r Soo
tiQd ID shalt up�de:the system in accordance with 310 CMR
15.304.The system owner IdioutQ ro
• 1 ?n ��, , r y.� °{�,`�,u �pji prate regtQ ,��ice of the Department.
f ,
Page-5 of 1 I � }� L
rJ.f �AVV__ I L �� • li
OFF1�� 3 Q ` O
BEM,�,P�N. QR-V LUNTARY ASSESSMENTS
, A"; ��i��� � ' ')SAUSYSTEM INSPECTION FORM
b
Property Address;
Owner:
4 it
Date of inspectiop
Check if the owing have been done Xou mus(ta indicate`tF ex;�o rr��}no"as to each of the following:
d
Yes
--~ Pumputinfo1 �Y lQ or Board of Health
____ Were any of d s sl cQl Rents pulped aut tR tltq Vrevious two weeks?
Has the
oWS u#the preyious}vV9 week period 7
Have large,v0t1{ 3fs o W0ey t'$qp pod s�,skem recently or as part of this inspection?
Were as butlt glaps of tba;cyst abtatned g4 cxgrnuap4?.(jf they were not available note as NIA)
Wax the fac#Itty At' Weill Orlgss cWd for,stns 94� agg bae}C up 7
Was the site utspecto fQr } Qf brcA vat? f f
Were all system
Y eoapoPents,cxgiudtn Z the$AS,#P .v sate?
_ Were the septic t �Q1QS 4�Cp reds opep the interior of the tank inspected for the condition
of the baffles or tees,naatlDrtal Qf cPnstr # nenu�i�s, a p Jl-{iAtd,depth of sludge and depth of scum?
Was the faclltty mc' r(aU, 00PA
...if t e fl pyyner)provided with information on the proper
maintenance of subsurface seaq atom ,
The size apd locstiou a t>� it Absor ton st o
f site has been determined based-on:
Yes Y
� "'V! d ,
no
.� $xtsttng mfgrytt !FPr v� 1t p� at thod�1f ileaith;
a
' J!R
Deketmmed R1d� ►Y a f .4 t')4t#d to Part C is at issue approximation of distance
� 4
is unacceptable)[3 1.9 CMI } ;ar
G d ro�
-v3 Y l t �
''� \1 _'f t"�""'Ri.,��^•M'b- f 't M h=Iv.fi!'^^r .:C - .... ..
,, t F P
+S .hc>al tt rti a Ma ur ikr�u t PA.
z t
�•;,p-wm*-�Y+n'*MHr"'�y.c^+�+„+�-_.r r.a« .+„+a�I Ms„-.:-.- ..
L
t Sa
5 f. {
0
_.Page 6 of I 1 ' .4 ,
OFFIG "INS0 PTIO W NOT'Wf—VOLUNTARY ASSESSMENTS
5 �•� 'x �',�' SPOS�fV$TZM INSPECTION FORM
i �
SYSTN �NX� Ak `ION
Property s'
Addres ;
Owner:
Date of Inspection... ;F
'W C0 ITIQN
RESIDENTIAL
Number of bedrooms,(dos>ign); psi lir of badraotp ( tI 'k
DESIGN flow based oh r ��?�����a �l;i;: 1 l A,gad��of br~drooms):�-
Number of cuirent residents,
Does residence have a gri<r>a i3 Orly
Is laundry on a separatey>i � p); ' [t�y �ilweporate inspection required]
Laundry system inspectedy>< Qtr � if,3
Seasonal use:(yes or no),- �s � i iV r}4'� aril Ji f$i��>
Water meter readings;if 4v �(ia�2 y usage, `}•
Sump pump(yes or no) r�� ,,3 �� <
Last date of occupancy xi� c } �rJVI Vl
,
COMMERC �sIALJll►]IIrL� t ' I(ix rrr►1�' ,x <��r i��a�d .
y 7f {
Type of establishme (R,
Design flow(based on
Basis of design low
$n (sea
- t�l��ers�{}slsq�;e�,}�,�{
Grease trap present(yes
Industrial waste holding '
peseatyos ar no}
Non-sanitary waste 44� har$e.' system(yes air np):,*
Water meter readings,i.f aya
Last date ofaocupanay/usp;�r= Fri {s}irhu i
YY
OTHER(desgribe), , ,,„=,►„rt',3+ d°r ' r Isiisiiii ;.�
s',,itl, J�Ja��zi#�tell+eI+A> M 'ION,,
Pumping Records ,i 'as,,•,{:,,�
Source of infatuation:
Was system pumped r3s
If yes,volume pumped;° determined?
Reason for pumpi,ng, ,,s �
TYPE SYSTEM
eptic tank,distributioig�
Single cesspool3w
Overtla)ySS�I �I Jai' wiliiJ]JS s
Shared system(Yes or 09) f yes F �,tous l lQtt rends,if any)
Innovative/Altentativs t �p ►t �}� Qf4 o 1, e t apes tipn and maintenance contract(to be
obtained from s stem o ,. °� s,
Other )
_..,. (describe
i
Approxi;tiate age of all�a�Apgtt �tt [ (tf a �' sautcG of information:
JR
Were sewage odors detectedrwllcp ate ty? $ t die$i.(yes or.
{
Page 7 of 11
r•i C �f l '1 f ! •1 i`1 �i 4 CYj��# r
OFFICIAL INS ' '' 'X!` +'�Q VOLUNTARY ASSESSMENTS
SUB$TJ � �P�,,�,Q9=5PQ,$;p�,U$X$TEM INSPECTION FORM
t -- -
SX TF OW"TI �N(continued)
Property Address,
r\
Owner: +:
Date of Inspection;
p qQ, ,t
ti
1 '
BUILDING SEWER(IQ; to p In 'p� )Y rar tta??stekl Tai tr ie s��s r
it
�t
Depth below grade:
Materials of construction;}�' gl pn#ai }Q Y1 �:..okbef3(�xplAW)t
Distance from private:w# p &ppo der
Comments(on condition af,lo of ►:..V. dem of aC e,
fr r I as i,.a i
SEPTIC TANK: {locate on site l�l )'
Depth below grade.
Material of construe cgpore , et �,fiergls. plXethylene
_other(explain)
If tank is metal list age; age aopf>rttaod byernficate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions,
Sludge depth:
Distance from to of s ud e r`
P 0 bottom vfolulet tee of bafr]e, -
$cumthickness: o =al;�la,�s �rar s10 r �1...�
Distance from top of scum to top of outlet tee,or bade.
;A
Distance from bottom of§r,q W tto t1el ba
How were . onsion s deternl� 'R
Comments(on putnp;tg retpd �At1A &�tltd otlet or bye condition,structural integrity, liquid levels
as related to outlet ulYert,eYtdpe Qf Ioq ptc.}, rte//��l/()Fy�J jam/
C� S
s
__,t t !'I ' -
Ff
GREASE TRAP G 4 th X114;41ha`3o)10 till I r
i
ir��xv+acdm���iR -m�-r afr �,ww,.•�
Depth below grade `, „ �. >
Material of construction,, oon�
(explain): ber la o yethylene_other
Dimensions: 1 r
y 4
Scum thickness: T`
Distance from top of scum IQ Itpl�p�pt�ttt tee baffle,
Distance from bottom of 4C
Date of last um r
Comments(on pumping recom�el ti4ttsf and outlet tet#or b11�e condition,structural integrity, liquid levels
as related to outlet anYelt,pYtdcACe of(ea ,e E
t i
I I
� l
I= f
y? 1 �} , • 7
Page 8 of l l
OFFICIAL'"INSr%C�T10N,F0RMV=NQT� ; .R,VOLUNTARY ASSESSMENTS
SUBSURRF.A„CB'SEWWAf VDISPOS; YSTEMINSPECTION FORM
i4
PART UIa q
SYST9K INFORMATION(continued)
r,';
Property Address;
Owner
Date of Inspection,
TIGHT or HOLUING,TAKl{, (tattle'mist by pumped et limp of inspection)(locate on site plan)
Depth below grade ,
Material of construction-,'-,...,.,'
onstruction concrete '' 'metal '{f3€ as of ethylene other ex lain
Dimensions: eta S� �lt4�i tr,: s,
Capacity: gallons. '.
Design Flow' ,epljo "d
Alarm present(yes or no)`
Alarm level: Alai work Wei(yos or ng),
Date of last pumping: . ;
Comments(condition of alarm and floot sWttches,
DISTRIBUTION BOX; (tf presvat must be opened)(loeate on Site plan)
Depth of liquid level above outlet mvetl, ;rlttl d1�,
Comments(note if box is ley l aut3 d u4ou to outlets rggol any evidence of solids carryover,any evidence of
leakage into or out of boxy otG,). a+
� i f,,�l i,}ii,f���i l.��kt�,�o`t �,� ibl�� ll.i'�,,� ts;E����'�,�,k�ti�;G//;s, � • ,
PUMP CRADrIBBR/� �pn silo�lart� 3
-+d���*�f
Pumps in working order` rF,,
P rkmg (yes
• Alarms in working ordot'
Comments(note C(}ndltto *> +
� > p pl i T:eQ dttlo of ps an appurtenances,etc.):
4 ,
a
3Q 0.}1 3'11 316 i,r
i
r 7
� 6
Page 9 of l l `
1 { { l
OI'FICIAI,} .5 fic�UQN1 F�QR'. ,rfQZF)DR-VOLUNTARY ASSESSMENTS
�[&X$.1F()S T�i�0Y$TEM INSPECTION FORM
R
Property Address:
Owner:
Date of Iaspectioq;
SOIL ABSORPTIQIIJ$YS F (S ,S � (looato Qn sttg too,imavation not required)
If SAS not located-940014Y
j S
Type 't t r
leaching pits,numbot; °
aching ch ambers;otn
Ieaching'galleries,"nwnber,
leaching trenches,l Wnb.Qr,tort
leaching fields,nwnbCr►Oline ►
overflow cesspool,'tberr
innovative/alternative systom,<'fyp /n p of teclurplogy;
Comments(note condttrotl of sorl►s, tts 4f bdrauliv farluo,level of ponding,damp soil,condition of vegetation,
etc.):
CESSPOOLS; cossppol mjtst,bo propped as,part of inspsctign)(locate on site plan)
Number and con tgum ton,,
Depth—top of liquid tol+�t' �'Rr ; ;, r,
Depth of solids luyor;'
Depth of scum
{
Dimensions of cesspool,
Materials of construction, . :
Indication of groundwater unflow(yes of np){
Comments(note condttaoq o�gil#ss r W f1MIM. Ievol of ponding,condition of vegetation,etc.):
k I(
�]�� }� }�
Pxwa #:
Ate O §11N
{
Materials of constructQtt, `
Dimensions: t rY`, s:1 `.{ ,
Depth of solids, �r� '�; e,! #
Comments(no te,cotldttota�gfpll,sls o + ult fatluxc �ove�Rf ponding,condition of vegetation,etc.): F
{ d
�� } t p
3 I
kf di f .1 t
9 ; „#
1_
Page l o of l l
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OFFICIAI,INSPE 1 � F'Q YQQ `ARY-ASSESSMENTS
SUBSURFACE 5 ,' ,�,L;c��r�T��1+TINSPECTION FORM
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Owner: s ,
Date of Inspection; '1 ,
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SKETCH OF SEWAGE DISPOSA,4 Vii Mti��
Provide a sketch of the sewage dispp$ 9 p,;Manent reference landmarks or
benchmarks.Locate_all ells
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OFFICIAL,INSPECTIO CORM�' NOT FOR VOLUNTARY ASSESSMENTS
SUBSURF1RVAISPOS,P `SYTM INSPECTION FORM
FORMATION MMNItu`MVd 1
Property Address: ''I
Owner:—2Dn
Date of Inspection; j }}
SITE EXAM °t i
Slope
Surface water
Check cellar
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Shallow wells �,°`,,' '1��"ri r i M, ,
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Estimated depth to ground wir r` t' ,
Please indicate(check)all mprttuue file high mound water elevation:
btained from systet s3 1 .� d I G ecke ,date Qf design plan reviewed:
Observed site(abutixng prAprrtylusottiAn bade wai)a � �et of SAS)
Checked with.local:Bt} r -�DF.. ? A
Checked with laFal exoaya TO;1*WW-41 {attach doeuma tatt�n)
Accessed VSGS datab
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GILBORT RSA
JOB IS-C
44 Rea St. SHIMI NO. OF-
NO. ANDOMkR, MA 01845 �_
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2 Town of North Andover, MA
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Watrsrs23ed Septic system ,
servicing Report
Date:
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Homeowner: C�,a ��., ,�;� , Pumper r
Street " . ,. � '"` Address: j,,.
Phone Phone .<! �"d„"� 13M
Nature of Services Routine
Emergency
Observations: Good Condition
Full to Cover
Baffles in Place
u
Leachfield Runback
Excessive Solids '
Heaver Grease
Root:
other (Explain)
Description of Work
�v
Comments: