HomeMy WebLinkAbout- Title V Inspection Report - 485 FOSTER STREET 10/19/2018 Commonwealth of Massachusetts REcEvVED
Tn Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
'Too Cr t4OR114 pNDOIJER
'3-- 485 Foster Street VJEA0A t)F_PARTMENV
Property Address
Konrad Miatkowski
Owner Owners Name
information is
required for every North Andover MA 01845 10-9-20-18
page. City/Town State Zip Code Date"Wlrispection
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
filling out forms Inspector Information
on the computer,
N
use only the tab Neil James Bateson
key to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return Company Name ------
key. 111 AMilla Road
4:1 Company Address
Andover MA 01810
Cityrrown State Zip Code
978-475-4786 SI-15
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. 0 Passes
2. F1 Conditionally Passes
1 R Needs Further Evaluation by the Local Approving Authority
4, El Fail
10-9-2018
----------- _...._._-
Inspector's Si-nature 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 DER 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.
Mnsp.cloc rev.7/2612018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
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` Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments
485 Foster Street
Property Address
Konrad yWiathovxski
Owner Owner's Name
information is North Andover MA 01045 10-9-2018 |
required for every �
page. ~'n''`~'^
State— Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1. 2, 8. or5 and all Vf4 and G.
1) System Passes:
| have not found any information which indicates that any of the failure criteria described
-- in 310 CKAR 15.303 or in 818 CK8R 15.304 exist. Any failure criteria not evaluated are
indicated ba|nxx.
Comments:
After permit from B.().H., install new outlet tee inseptic tank and new d-bnx. inspection from B.(].H..
septic system now passes Title 5Inspection.
� 2) System Conditionally Passes:
�l One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion nf the replacement nr repair, es approved bv
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 oxer2O 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 ifthe existing tank im replaced with a complying septic tank uo approved bythe Board of
Health.
^A0eta| septic tank will pass inspection if it is structurally sound, not leaking and if Certificate of
Compliance indicating that the tank im less than 20 years old is available.
F� y Fl N �l ND (Explain be|ovo :
t6insp.dc,c rev,7/2612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 2 of 18