HomeMy WebLinkAboutMiscellaneous - 115 SHERWOOD DRIVE 4/30/2018 (9) t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
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F. 115 Sherwood Drive
North Andover, MA 01845
Owner c
information is George E. Canellakis
required for 4/26/2011
every page. State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed(if known)and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes R1 No
Building Sewer(locate on site plan):
ZIP
Depth below grade:
Material of construction:
❑cast iron Z40 PVC ❑other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints,venting,evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade:
Material of construction:
(concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
/52PO7 �&z z-OAV 5
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 0- 4�—���O.V
Sludge depth: o k'e!—L-
t5ms-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17