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HomeMy WebLinkAboutMiscellaneous - 59 ROCKY BROOK ROAD 4/30/2018 (20) 0 COMMONWEALTH OF MASSACHUSETTS ` b f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION OW I Vo TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS o SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM <` PART A CERTIFICATION Property Address: 59 Rocky Brook Road_ _North Andover_ Owner's Name:_Resse Powell_ r_j(,` Owner's Address:_59 Rocky Brook Road_ North Andover,MA 01845_ g 2003 Date of Inspection 9/27/2003 OC� Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:_(978)475-4786_ 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 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 Conditionally Passes Needs Further Evaluation by the Local Approving Authority F ' s Inspector's Signature: Date: _9/27/2003_ 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'conditio of u po y p ns 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.