HomeMy WebLinkAboutMiscellaneous - 19 BEAVER BROOK ROAD 4/30/2018 (3) • ` Commonwealth of Massachusetts
.
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
wM
A. Certification (cont.)
19 Beaver Brook Road
Property Address
North Andover MA 01845
Cityrrown State Zip Code
Ron Novello 9/25/07
Owner's Name Date of Inspection
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
YES NO
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes"in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
9.25.07_19Beaver8rookRoad_NorthAndover.doc•11/2004 Title 5 official Inspection Form:Subsurface Sewage Disposal System-
Page 6 of 16