HomeMy WebLinkAboutTitle V Inspection Report - 951 FOREST STREET 6/5/2017 (2)�
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
q Su bsurface Sewage Disposal System Form Not for Voluntary Assessments
951 Forest Street
Property Address \V
Kevin Patterson
Owner Owner's Name
information is
required for every North Andover Ma 01845 5'10-17
page. City/Town State Zip Code Date n(Inspection
Inspection nasw|ta must he submitted on this form. Inspection forms may not be altered in any
vvmy' Please see completeness checklist mtthe end pfthe form.
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Important:When A.
filling out forms ~ ~ General ^^^^~^^^^^^~~^~^^
vnthe computer,
use only the tab 1.
�yh`mnvoynur Inspector:
cursor'uunot John DiVincenzo
use the return
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key. J and S
Development Corp Stewarts Septic Service
Company Name
vTk4l 58South Kimball St
Company Address
Bradford MA 01835
-------' City/Town State Zip Code
978-372-7471 s113386
Telephone Number License Number
B. Certification
| certify that | have personally inspected the sewage disposal system atthis address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
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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(31OCMR 15.O00). The system:
E Passes El Conditionally Passes El Fails
[] eeds Further Evaluation by the Local Approving Authority
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of alth or DEP)within 30 days of completing this inspection. If the system has a design flow of
0,0 0 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DER 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
atthat time.This inspection does not address how the system will perform inthe future under
the same ordifferent conditions ofuse.
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t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern-Page 1 of 17
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. Commonwealth of Massachusetts
Title 5 Official Inspection Form
4 Subsurface Sewage Disposal System Form Not for Voluntary Assessment?
951 Forest Street
Property Address k I
Kevin Patterson
Owner Owner's Name
information is
e�uimuhxeve�
North Andover ' Ma 01845 5-10'17
`City/Town —
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page. "'`,''` -- —'__- __-
bate of Inspection
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B. Certification /C0Of.\ �
Inspection Summary: Check A,8,C.DorE/always complete all ofSection O
A) System Passes:
| have not found any information which indicates that any of the failure criteria described
in31OCMR 15.303or|n31OCMR 1S.3O4exist, Any failure criteria not evaluated are
indicated below.
Comments: �
Distribution box was replaced —-----
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BA System Conditionally Passes:
F-1 one mmore system components as described in the "Conditional Pass" section need to be
replaced orrepaired. The system, upon completion ofthe replacement orrepair, omapproved bv
the Board of Health, will pass.
Check the box for"yea^. "no"or"not determined" /Y. N. ND)for the following statements. If"not
determ|ned." 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 orexf|tnadon ortank failure is imminent. System will pemn
inspection if th e existing tank is replaced with a complying septic tank as approved by the Board of
Health.
+Ametal septic tank will pass inspection ifitisstructurally nound. not|eakinQondif aCertificate of
Compliance indicating that the tank inless than 2Oyears old ioavailable.
El Y [_1 N NO (Explain be|uw):
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