HomeMy WebLinkAboutMiscellaneous - 120 LACONIA CIRCLE 4/30/2018 (10) Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M °y 120 Laconia Circle
Property Address I
Karen Crawford
Owner Owner's Name II
information is North Andover I
required for every MA 01845 August 2, 2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
mments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liqu levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank nk must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
i
Dimensions:
Capacity:
allons
Design Flow:
gall s per day
Alarm present: ❑ Ye ❑ No
Alarm level: Alarm in wo 'ng order: ❑ Yes ❑ No
I
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ o
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