HomeMy WebLinkAboutMiscellaneous - 120 LACONIA CIRCLE 4/30/2018 (39) Commonwealth of Massachusetts
u W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Laconia Circle
Property Address
Karen Crawford
Owner Owner's Name
information is North Andover MA 01845 August 2 2013
required for every g ,
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
D-Box must be repaired to bring within 9" of finish grade in accordance with N. Andoever Regulations.
Pipe between tank and d-box must be repaired as it is crushed and not level. No evidence of issues
with the functionality of the system (no breakout, no odor, no other evidence of hydraulic failure).
Effluent level with inverts flowed system for 15 minutes du'ring inspection no backup
B) System Conditionally Passes:
® One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
eck the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not
dete ed," please explain.
The septic to i metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits s tantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less tha 0 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17