HomeMy WebLinkAboutMiscellaneous - 1423 SALEM STREET 4/30/2018 (38) Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1423 Salem Street
Property Address
Courtney Scruggs _
Owner Owner's Name
information is North Andover MA 01845 May 1 2017
required for y
every page.., CityTTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.): w"✓V —
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): W
Depth below grade.-
Material"-of
rade:Material`-of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylepLe ❑ other(explain):
Dimensions:
Capacity: 'i --
galt"ons
Design Flow: --
gallons per day
Alarm present: Yes ❑ No
Alarm level: Alarm ih working order: ❑ Yes ❑ No
F,
Date of last puZalarm
Date ~�
Comments(confloat switches, etc.): k"`<
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
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