HomeMy WebLinkAbout- Title V Inspection Report - 337 PLEASANT STREET 5/2/2019 Commonwealth of'Massachusefts,
P
. . T'Itle 5 Official Inspection Form
� Subsurface Sewage Disposal System Form Not for Voluntary Assessments
u J
337 Pleasant Street
Property Address
Alan Freedman
Owner Owner's Name
information is North Andover MA 018,10 - -2
required for eves ,,_- ...,,, . . ,.m rvry Zip m ®®
page
Ci'lt lTo r ate of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. P'lease see completeness checklist at the end of the form. Eli
RECI
Important:When
Inspector Information
filling out form `
on the computer,
Neil James, Bateson R
use only the tad
key to move your Name ofinspectorui-
ti
cursor not Bateson Enterprises Inc.,
key., Company, K/,
Name
1 1 Argiill Road
Company Address
Andover A 01810
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r
�itffon State Zip Code
Telephone um r License gum r
B, Certification
I certify that'. 1, am,a DEP approvedsystem inspectorin full,,compliance with Section 15.340 of Title
3 1 have personally inspected the sewage disposal system at time property address
listed above; time information reported below is true, accurate andcomplete as of the time of my
rns do n-, and the inspectionwas performed based on my training and experience in the proper function
and maintenance ofon-site sewage disposal systems. After conducting this inspection II have determined
that the systlelm.
1. Passes
2. Conditionally Passes
3. El Needs Further Evaluation, by the Local Approving ut w rit
a t
4. Ej
1
Fails
4-19-2019
m
Ir� ct fl- lal ura Date,
the system inspector r shall submit a copy of this inspection report to the Approving uth rit (Board
f Health or I within 30 days of completing this, inspection. If the system has a design flow of
101000 gpd or greater, the inspector and the s st rn owner shall submit the report to the appropriate,
regional office of the E' . the original forme should be sent to the system owner and copies sent to
the buyert if applicable, and the ro in authority.
t
Please mote: This report only describesconditions at the time of inspection and under
cond i1blrr ,of useat that,time. his 'Ir'Inspection does not address how the system will perform
in the future under the same or different conditions of use.
t Ire nn.rev.7/26/2018 Title 5 officiat Inspection,Form:Subsurface Sewage Disposal System "age 1 olf 1
Commonwealth of Massachusetts
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mmm
fficia
ti 1 Inspectnion Form
Sub
Not for Voluntary Assessments surface Sewage Dlisposal System Form
337 Pleasant Street
Property Address
Alan Freedman
Own r Owner's Name
information is North Andover MA 01810 4-18�-�201 9
required for every dii own State Zi�p Code D�ate of Inspection
I
G. Inspection Summary
Inspection Summary: Complete 1,, 21, 3, or 51 and all of 4 and 6.
1) System Passes:
1 have not found any information which, indicates that any of the,failure criteria, described
in 310 CAR 15,303 or in 310 CIVIR 15.304 exist. Any failure criteria not evaluated are
indicated, below.
Comments.
After permit from B.O.H., pumped septic tank, install new d-box, new outlet tee, in septic tank,
inspection from B.O.H., septic now pas,ses Title 5 Inspection
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2) System Con ditiona1ly Passes:
El One or more system components as described in the""Conditional Pass" section need to be
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 it not
determined," please explain.
The septic tank is metal and over 20 years,old* or the septic to whether metal or not) is str turally
unsound, exhibits substantial infiltration or elxfiltration 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 is less than 20 years old is available.
D Y N El ND (Explain below):
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151nsp,doc-rev.7126/201:8 Title 5 Official Inspection Form:Subsurface Sewage Displosal System-Page 2 of 18