HomeMy WebLinkAbout- Title V Inspection Report - 338 ABBOTT STREET 5/2/2019 Commonwealth of Massachusetts
APW&ZZ K, M
Title 5 icial Inspection arm
Subsurface,Sew aige Disposal System Form Not,for Voluntary Assessments
3,38 Abbott Street
Property Address
Plaull & Kai Burnm
Owner Owner's Name
information is North Andover M�A 01845 4-1-2019
required for every
City/Town State Zip Code Date of Inspection
page.
Inspection resullts, must be,submitted on this form. Inspection forms may not be altered win any.
way. Please see completeness,checklist at the end of the form.
Important:When
/( air l J`��!ems� 6
filling out forms A. Inspector Informiati,on
on the computer,
Ne�il James Bateson
use only the tab
,j,
key to move your Name of'Inspector , JV-T
cursor-do not Bateson Enterprises Inc.
use the return
key. Company Name
111 Argilla Road
W _b�op nly Address
Andover MA, 01810
.............................
City/Tolwn State Zip Code
978-4751-4786 SI-15 .......
�j"��fine Nlumber License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with,Section 115.340 of Title 5
(3 CMR 15.00,0); 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;nspection; 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. El Conditionally Passes
3. El Needs, Further Evaluation by the Local Approving Authority
A
4. 0 Fails
4-1-2019
Inspectorps Signat re Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)l 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 CEP. The original,form should be sent to the system, owner and copies sent to
the buyer if appilicable, and the approving authority.
Please note: This report only,describes conditions at the time of inn specUion and under the
conditions of use at that time. This inspection doles not address how the system will perform
ins the future under the same or,different conditions, It use.,
t5insp,doc rev.7/ /2018 Ti ffe 5 Officlat Inspection Fo=.,Slubsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Form
T1
Vic"
log
Subsurface Sewage Disposal System Form Not for voluntary Assessments
W
338 Abbott Street
Property Address
Paul & Kay Burnim
Ownier Owner's Name
information is North Andover MA 01845 4-1-2019
required for every ............... ..........
citynown State Zip Code Date of Inspection
page.
C. Inspection Summary
Inspection Summary. Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
Z I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CAR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
cton from B.O.H, septic system now
After permit from . install n se
B.O,,Hew ptic tank&d-box, inspe i
passes Title 51 Inspection.
2) System Conditionally Passes.:
Eli one or more system components as described in the"Conditional Passi) section need to be
replaced or repaired. The system, upon completion, f'the replacement or repair, as approved by
the Board ofHeialth, will pass.
Check the box for"yes", "no 1�or"not determined" (Y,, N, ND)for the following statements., If",not
determined,�1 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 exfiltratioin 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.
0 Y F-1 N ND (Explain below)-
...............
.............
t5insp.doc; rev,71 12018 Title 6 Official Inspection Form Subsurface Sewage Disposal System-Page 2 of 18