HomeMy WebLinkAboutMiscellaneous - 1423 SALEM STREET 4/30/2018 (33) Commonwealth of Massachusetts
Title 5 official Inspection Form
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M °p 1423 Salem Street _
Property Address
Courtney Scruggs
Owner Owner's Name
information is
required for Northy
Andover MA 01845 May 1, 2017
every page. City/Town State Zip Code Date of Inspection
Do System Information
Description:
owner and town
Number of current residents: 4 —
Does residence have a garbage grinder. ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
I
Water meter readings, if available(last 2 years usage(gpd)): l owti �AJ`�'
Detail:
i --
i
Sump pump? ❑ Yes ® No
current
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Typex-f Establishment: — �-
i
Design flow(base 310 CMR 15.203): Gallons per da )
Basis of design flow(seats/per /sq.ft., etc.): —
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tan sent? ❑ Yes ❑ No
Non-sanitary w discharged to the Title 5 system? El Yes No
�..
Water meter readings, if available:
t5ins-311 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17