HomeMy WebLinkAboutMiscellaneous - 120 LACONIA CIRCLE 4/30/2018 (7) Commonwealth of Massachusetts
• - W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M0 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
D. System Information (cont.)
Last da ccupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: BOH - 1500 Gal 8/23/07
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: N/A
gallons
How wasuantit N/A
q y pumped determined?
Reason for pumping: N/A
I
Type of System:
® 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/Alternative 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 ch a copy of the DEP approval.
❑ Other(describe):
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