HomeMy WebLinkAboutMiscellaneous - 1423 SALEM STREET 4/30/2018 (34) Commonwealth of Massachusetts
N F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 1423 Salem Street
Property Address
Courtney Scruggs
Owner Owner's Name
information is North Andover MA 01845 May 1, 2017
required for -- - —
every page. City/town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe
General Information
Pumping Records:
Source of information: Last pumped 6 years ago-owner
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1000 gallons
gallons
How was quantity pumped determined? by measurements _
Reason for pumping: heavy solids
Type of System:
® Septic tank, distribution box, soil absorption system P"'m ��' �
❑ 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 a copy of the DEP approval.
❑ Other(describe):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17