HomeMy WebLinkAboutPass - Title V Inspection Report - 96 ABBOTT STREET 8/16/2021 - 6��osvP RecEivE
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�n Title 5 Official Inspection Form ro �U6 762021
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XVN 96 Abbott Street
Property Address
Michael Gillis
Owner Owner's Name
information is North Andover MA 01845 8-6-2021
required for every — _--
page. City/Town State Zip Code Date of Inspection
inspection results must be submitted on this form. inspection Torms may not be altered in any
way. Please see completeness checklist at the end of the form.
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filling out forms
on the computer, Neil James Bateson
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cursor-do not Bateson Enterprises Inc.
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key. Company Name
111 Arnilln Rnnri
rt Company Address
Andover MA 01810
City/Town State Zip Code
978-475-4786 S 1 15
Telephone Number License Number
B. Gertitication
certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(3 to CmR ia.vuu); I have pefsuildiiy IIIcIJCGLCU ll-IC ceWdyC UIJIJUSdI JyJICtfI di IfIC IIIUIJCIIy dUUICJJ
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
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that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
O-V-LVL I
Inspector's SI to 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 DEP. 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.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
iommonweaitn of rviassacnusetis
Title 5 Official Inspection Form
i� C,,hcsirfnra cawano nicnncni Cucf m Fnrm _ KIM fnr Vn[Iinfnrw Accaccmantc
96 Abbott Street
Property Address
Michael Gillis
Owner Owner's Name
information is required for every North Andover MA 01845 8-6-2021
page. CltyFrown State Zip Code Date of Inspection
A C. inspection Summary
Inspection Summary: Complete 1, 2, 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 GMK 15.303 or In 31U GMK 1b.304 exist. Any tallure criteria not evaluated are
indicated below.
Comments:
After permit from B.O.H., pumped septic tank, installed new pipe from tank to d-box, new outlet tee,
new d-box& riser on d-box. B.O.H. inspected, now septic system 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 repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
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determined," please explain.
The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally
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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.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18