HomeMy WebLinkAboutMiscellaneous - 1423 School Street (4) COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 1423 SALEM STREET �'«414 Or NORTH
NORTH ANDOVER, MA 01845 sO"Pn OF
Owner's Name: MICHAEL & ELAINE MORGILLO �< k
Owner's Address: '
Date of Inspection:. SEPTEMBER 24, 2001 _ _—
Name of Inspector: GORDON A. & JAYNE I. BROZ
Company Name: AMERICAN SEPTIC INSPECTIONS
Mailing Address: 49 ORCHARD STREET
MERRIMAC, MA 01860
Telephone Number: 1-800-830-4640
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of 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 15.00). The system:
_ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
X Fails
Inspector's Signature: Date: SEPTEMBER 24, 2001
The System Inspe for s I submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)
within thirty. (30) d s completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or
greater,the inspect and the system owner shall submit the report to the appropriate regional office of the Department of
Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and
i
the approving authority.
NOTES AND COMMENTS
SYSTEM FAILS DO TO AN OVERLOADED SAS.
****This report only describes conditions at the time of the 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.
Title 5 Inspection Form 6/15/2000
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