HomeMy WebLinkAboutTitle V Inspection Report - 21 ASH STREET 8/15/2018 <n
Commonwealth of Massachusetts
RECEIVED
Title 5 Official Inspection Form
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M
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
21 Ash Street T
U,IANDOVER
Property Address I)E pA F T-M 1.ENT—
Robin Colombosian
Ownere"r's N-a-..me..
-e .. ................... ................
information is
required for every North Andover MA 01845 8-7-2018
page. CitylTown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
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Important:
...........----
Important:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Neil J. Bateson
use the return Name of Inspector
key. Bateson Enterprises Inc.
Company ..........
111 Arc illa Road
Company Address
Andover MA 01810
City/Town State Zip-Code -- ----
978-475-4786 SI-15
Telephone Number License Number
B. Certification
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:
[Z Passes n Conditionally Passes El Fails
Ej Nee ris Furth Evaluation by the Local Approving Authority
8-7-2018
In poto's Signatu Date
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 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.
****This report only describes conditions at the time of 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.
t5ins.doc•rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection
nspecin
orm
Subsurface Sewage Disposal System Form
NotfnrV0|unbsry Aeeaeam�nto
21 Ash Street
Robin Cu|omboeian
Owner Owner's Name
information is
required for every North Andover MA O1845 8-7-�O18
page. S��-- Zip Code
B. Certification (cont.)
Inspection Summary: Check A.B,C.UnrE/always complete all ofSection D
A\ System Passes:
b�
1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15J04 exist. Any failure criteria not evaluated are
indicated below.
Comments:
After permit from B.O.H.^ replace d-box & riser on d-box, inspection from B.().H.. septic system now
passes Title 5Inspection.
13) System Conditionally Passes:
[] one or more system components as described in the"Conditional Pass" section need to be
replaced orrepaired. The system, upon completion ofthe replacement orrepair, esapproved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
deharmined,'' please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether nnmda| or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
°A metal septic tank will pmoa inspection if it is structurally sound, not leaking and if Certificate of
Compliance indicating that the tank is |ama than 20 years old is available.
El y [l N El NO (Explain ba|ow):