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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 66 Colonial Avenue_
_North Andover_
Owner: Valentine
Date of Inspection:_10/31/2002_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_4— Number of bedrooms(actual):_4_
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_440
Number of current residents:
Does residence have a garbage grinder(yes or no): No_
Is laundry on a separate sewage system(yes or no):_No [if yes separate inspection required]
Laundry system inspected(yes or no): _
Seasonal use:(yes or no):_No
Water meter readings:
Sump pump(yes or no):_No_
Last date of occupancy:_Current
COMMERCIALIMUSTRIAL
Type of establishment:
Design flow(based on 310 CMR. 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:_Pumped three weeks ago,owner—
Was system pumped as part of the inspection(yes or no):_No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X_Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:_5 years old. 9/22/1997.
As built plan.
Were sewage odors detected when arriving at the site(yes or no): No