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Home My WebLink About- Title V Inspection Report - 542 SALEM STREET 9/24/2018 (3) Commonwealth of Massachusetts Title 5 Official Inspection Form = n Subsurface Sewage Disposal System Form Not for Voluntary Assessments 542 Salem Seet_..... _._pa y..... IJ1�C V i)G I l vi Jonathan Straus Owner Owner's Name information is required for every North Andover _._ MA _ 01810 _.....__. 9-7-201$ _......_...... page. City/Town State Zip Code Date of Inspection i 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. Important:When A. Inspector Information filling out forms on the computer, B Ja mes ames ateson use only the tab Neil ._.._._ _.._. _. __ ___....._...._.. key to move your Name of Inspector cursor-do not Bateson Enterprises Inc. use the return __._ _�....-----_ _............ _........__ .._._. -__ key. Company Name e 111 Argilla Road ray Company Address Andover MA 01810 City/Town State Zip Code rdrwn 978-475-4786 SI-16 Telephone Number License Number B. Certification — I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above„ the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. F� Conditionally Passes 3. © Needs Further Evaluation by the Local Approving Authority 4. © Fails 9-7-2018 Insp ct is ignature 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doe•rev.7/2612018 Title 5 Official hspection Form:Subsurface Sewage Disposal System•Fade 1 of 18 ^ Commonwealth of Massachusetts Title=0��N�� .��|~�~��N N��=�� n�h �� y� � �� Nmm��~��0��mm N—��mm� � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 542 Salem Street Pio"perty Address JnmathanOtnaus Owner Owner's Name information is No�hAndover MA Q181U 9-7-2018 mquimdfor avo� ��G� Code Date of Inspection — page. ~v''``~' . C. Inspection Summary Inspection Summary: Complete 1. 2, 3. or5 and all uf4 and 6. 1) System Passes: �� | have not found any �forn�aUonwh�hind�mtemthat any cf the f�lunaor� h criteria described �� in31OCK8R153O3o,in31O (}K0R15.3O4 exist. Any failure criteria not evaluated are indicated below. Comments: After permit from B.O.H., install new d-box &20' x 30' leach area, inspection from B.O.H., septic system now passes Title 6Inspection. 3) System Conditionally Passes: Fl (}neornoore system components us described in the"Cnndihona| Paag'' section need toUe -- replaced or repaired. The system, upon completion of the replacement or repair, as approved 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 determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal 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 pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank ie less than 2O years old inavailable. Fl y El N N0 (Explain be|ow):