HomeMy WebLinkAbout- Title V Inspection Report - 500 REA STREET 5/2/2019 m y ij
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Commonwealth Massachusetts
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Subsurface Sewage Disposal S Mem Form Not for Voluntary Assessments
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a 5 Rea Street
............ Property Address
William 'McManus
Owner Owner's Na,m,e
Information i -21-2019
required for l'�lrtl r� ° �r � �I�"
..�Cit "rr 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.
Important:When
Inspector Informall
filling out forms
on the computer,pater bail James t son
use only the tad . .
key to move your Name of Inspector
cursor-do not Bateso,n 'Enterprises, Inc.
use the return Company Name
key,
111 Argilla1
[fib Company Address
Andover, 1 1
CityfTown State Zip,Code
Telephone Number
Liciense Number
B., Certification
I! certify that. I DES" approved system inspector i' full' compliance i t Title
3 CMR 15.000); l have personally inspected the sewage disposal system atthie property address
listed above; the information reported below is true, accurate and complete as of the time of m
,
inspection,; and the inspection was performed based n my training and experience in the proper function
and maintenance of ri-site sewage disposal systems„ After,conducting this inspection l have determined
that the system:
1. 1
'asses
2. El Conditionally Passes
3. El Needs Further Evaluation y the Local Approving Authority
4. Fai s
Inspector'sS nature ,�.
32 - �1 ,
Date
The system Inspector shall submit a copy of this inspec n report to the Approving Authority (Board
f Health or I within 30 days of completing this inspection. if the system has a,design flow of
1 alg g 'g pd or gr ter, the inspectoir and the system owner sill submit the report to the appropriate
regional office of the DER The original form should be sent to the system owner and, copies sent t
the buyer, if applicable, and the raring authority.
Please note: This report only describes n iti+ , at the time of inspection and under the
conditions of'use at that time. Thils, inspection does not address how the system will perform
in the future under the same or d*Iffe rent conditioris of use.
fbinsp.dioc rev.712,61 018Tilly 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 1
Commonwealth of Massachusetts
Tnie !5, utticial Inspection Form
Subsurface Sewage DIs,posall Sy� Form Not for Voluntary Assessments
500 Rea Street
Property Address
William McManus
mm
Owner Owner's Name
informatilon is
North Andover MA 011845 3-21-2019
requi�red for every
page. 61�t /—Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 11 1 21 3, or 5 and all of 4 and 6.
1) System Passes:
I have not'found any ma infortion which 'Indicates that any of the failure criteria described
in 3 10, CMR 15.3,03 or in 310,CIVIR 15.304 exist., Any failure criteria not evaluated are
indicated below.
Cornments:
After permit from B.O.H., pump septic tank install new d-boy, inspection from 13.0.1-1.,, septic system
niow passes Title 5 Inspection.
2) System, Conditionally Passes:
one or more,system components as described in the"Conditional Pass" section need to be
replaced or re paired. Thie system, upon completion of the replacement or repai"T,, as approved by
the Board of Health, will pass.
Check the box for"yes", "no," or"not determ,ined'�' (Y, N, ND),for the following statements,, If"not
determined,Ill 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
I
Compliance ,indicating that the tank is less than 20, years old is available.
I
D Y [I N El ND (Explain below):
t5insp.doc-rev,7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposat System-Page,2 of 18