HomeMy WebLinkAbout- Title V Inspection Report - 115 COLONIAL AVENUE 5/15/2019 Commonwealth of Massachusetts,
icia ion
itle 5 Off I I n specto Form
Subsurface Sewage Disposal System Form Not for Vol bunt ary Assessments
115 Colonial Avenue
............................................ ..............
PropertyAddress
Kimberly Caron
Owner Own �r�1 a................m.......I.I e
information is
North Andover MA 01845 5-3-210 19
required for every
page., City/Town State Zip Code Date of Inspection
Inspection results, must be submitted on this form. Inspection forms may "ilierl in any
Ig
way. Please see completeness checklist at thnd, m e e of the,for .
..........
Impodant:When
A. Inspector Information NA
filling out forms
on the computer,
use only the tab Nell,James Bateson
key to move your Name n-s p or
cursor-do not Batieson Enterprises Inc. .......
use the return Company Name
key. 111 Ar Ill a Road
Company ddress
Andover MIA 018110
cityrrown State Zip Code
978-475-14786 S115
......I......................
Telephone Number License Number
B. Certification
'I certify that: 11 am a DEP approved system inspector in full compliance with Section 15.340 of Title 6
(3110 CAR 164000); 1 have, personally' inspected the sewage disposal system at the property address
listed above; the information reported bellow 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 funiction
and maintenance of on-site sewage disposal systems. After conducting this, inspection 1, have determined
that the systell
1. Passes,
2. E] Conditionally Passes
3. F] Needs Further Evaluation by the Local Approving Authority
4. EI FailI
5-3-2019
...................lnspeCPr'VSibnatuire 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
101,0010 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the IDEP. The original forrn� 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
clon,ditions of,use at that time. Thils inspection does not address how the system will perform
in, the future under the same or different con,diflions of use.
(sin sp.doic-rev.7/26/2018 Title 5 Official inspection Form Subsurface Sewage Disposal System-Page 1 of 18
N Commonwealth ofWassachusetts
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V
P Not for V luntary Assessments Subsurface Sewage Disposal System Fo rm, 0
115 Colonial Avenue
Prop rty Add re s s
Kimberly Caron ..............
Owner Owner's Name
information is North Andover MA 01845 5-3-2019
required,for every —
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary- Complete 1, 21 3, or 5 and all of 4 and 6.
1), System� Passes:,
I have not found any information which indicates,that any of the failure criteria described
in 310 CIVIR, 15.303 or,in 310 CAR 15.304 exist., Any failure criteria not evaluated are
indicated below.
Comments,-
After permit from B.O.H., plump septic tank, install new inlet cover, new di-bo,x riser on d-box and
inspection,from B.O.H., septic system now passes Title 5, Inspection.
2) Systems Condft'lionalily Passes:
one or more system components,as described in the,"Conditional Pass I$ section, need to be
replaced or re paired. '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'l not determined" (Y, N, ND) for the following staternients., If"not
determined," pllase explain.
The septic tank is, metal and over 20 years old* or lthe septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is i'mminelnt. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board, of
Health.
1* 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.
F1 Y N ND (Explain below):
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t5insp.doc-rep.7/26/2018 Titl Official inspection Form,Subsurface Sewage Disposal System-Page�of 18,