HomeMy WebLinkAboutTitle V Inspection Report - 336 BOSTON STREET 3/8/2017 Commonwealth of Massachusetts
RECEIVED
Title5 Official
Inspection Form1 � i�
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330 Boston StreetTOWN OF NORTH
Property Address
Mark Ustik
Owner Owner's Name
information is
requiredfor every No Andover Ma 01845 3-8-17
pago. City/Town State Zip Code Date of Inspection
C. Checklist
Checkifthefo||VvvnQhswmbeandone. Ywumnustindioate "yes'n/"nu" emhoeachof(hefo||owing:
Yes No
0 [7 Pumping information was provided by the ovvner, occupant, or Board of Health
El M Were any ofthe system components pumped out inthe previous two weeks?
0 F-1 Has the system received normal flows in the previous two week period?
Fl �� Have large volumes ofwater been introduced tothe system reoendyoreapart of
�� �� this inspection?
�� VVereombuilt plans ofthe system obtained and examined?(If they were not
�� �� available note emN/4)
�� Fl
Was the facility ordwelling inspected for signs ofsewage back up?
M Fl Was the site inspected for signs ofbreak out?
N [l Were all system components, excluding the SAS, located on site?
N El 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?
�� Fl
Was the facility owner(and occupants ifdifferent from owner) provided with
information on the proper maintenance Vfsubsurface sewage disposal systems?
The size and location ofthe Soil Absorption System (SAS) pnthe site has
been determined based on:
E F1 Existing information. For example, a plan at the Board of Health. |
Determined in the field(if any ofthe failure criteria related to Pert (| is at issue
approximation ofdistance ieumeoceptab|e) [31OCMR 1S.3O2(5)]
D. System Information
Residential Flow Conditions:
44
Number ofbedr (design):n� (design): ------- Number ofbedrooms (actual): ------440
----
DE8|BNOmmbasedon31OCMR15.203(for example: 11OQpdx #ofbedrooms): ��---