HomeMy WebLinkAboutMiscellaneous - 115 SHERWOOD DRIVE 4/30/2018 (8) Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
it
i 115 Sherwood Drive
North Andover, MA 01845
Owner j
information is George E. Canellakis
required for 4/26/2011
every page. State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records: -:5� 17 C' P/
Source of information: IL14e47W
Was system pumped as part of the inspection? ❑ Yes �J No
If yes,volume pumped: gallons
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How was quantity pumped determined?
Reason for pumping:
Type of System:
X Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Altemative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑
Other(describe):
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