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HomeMy WebLinkAboutMiscellaneous - 1423 SALEM STREET 4/30/2018 (49) ti ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROT d RECEIVER �t NOV 13 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1423 Salem Street North Andover,MA 01845 Owner's Name: Arnab&Kimberly Chakravarti Owner's Address: Same Date of Inspection: 10-29-2007 Name of Inspector:(please print)John Soucy Company Name: Soucy Sewer Service,Inc. Mailing Address: 78 North Broadway Salem,NII 03079 Telephone Number: 978-851-8839 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below i e s true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes e Conditionally Passes Needs Further Evaluation by the Local Approving Authority - Fails ,/� Inspector's Signature: ,��.�, , Date: 10'oDC11762 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different \ conditions of use. NOTE: This Title 5 is NOT a guaranteetwarranty of the future function of the septic system.