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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1423 Salem Street
North Andover,MA 01845
Owner's Name: Arnab&Kimberly Chakravarti
Date of Inspection: 10-29-2007
Check if the following have been doge.You must indicate"yes"or"no"as to each of the following:
Yes No
x — Pumping information was provided by the owner,occupant,or Board of Health
x Were any of the system components pumped out in the previous two weeks?
x _ Has the system received normal flows in the previous two week period?
x Have large volumes of water,been introduced to the system recently or as part of this inspection?
x Were as built plans of the system obtained and examined?(If they were not available note as N/A)
x _ Was the facility or dwelling inspected for signs of sewage back up?
x _ Was the site inspected for signs of break out?
x _ Were all system components,excluding the SAS,located on site?
x _ Were the septic tank manholes uncovered;opened,and the interior of the tank inspected for the
condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of
scum?
x Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
x _ Existing information.For example,a plan at the Board of Health.
X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable)[3 10 CMR 15.302(3)(b)]