HomeMy WebLinkAboutPass - Title V Inspection Report - 232 CANDLESTICK ROAD 8/30/2021 Commonwealth of Massachusetts
Tale 5 Official Inspection Form � c
Subsurface Sewage Disposal System Farm-Not for Voluntary luntary Assessments ��U �qi
232 Candlestick Road
-- - -- —._
Property Address - --
Owner Shihmei Chiang
information is Owner's Name - -------_— i--- —
required for every North Andover Ma. 01845 6/112021 _page. City/Town -- _ - __-
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 R
filling out forms A. Inspector Information
on the computer,
use only the tab _Warren Pearce
key to move your Name of Inspector — -- -----
cursor-do not Pearce Construction —
use the return -
key. Company Name ---
196 Park St
Company Address.
---
North Readin — —_ MA _ _ 01864
City/Town State Zip Code
_978-664-5264 — - _- --- S11959 - —
Telephone Number _ -----------—
License Number ---
B. Certification
I certify that: 1 am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CMR 15.000); 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; 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. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
Inspector's Signature --------
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.
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ge Disposal System•Page 1 of 18
-11 Commonwealth of Massachusetts
ATitle 5 official Inspection Form
1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
232 Candlestick Road
Property Address — --
Owner Shihmei Chian.
information is Owner's Name
required for every North Andover Ma. _ 01845 6/1/2021
page. CitylTown -- State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 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 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
_Repair completed 06/17/2021
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.
Check the box for"yes", "no"or"not determined'(Y, N, ND)for the following statements. If ,not
determined,"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
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
15insp.doc•rev.7/2&'2018
Title 5 Official Inspection Form Subsurface Sewage Diseosal System-Page 2 of 18
Commonwealth of Massachusetts
- i Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
232 Candlestick Road
Property Address _ _
Owner Shihmei Chian_
information is
Owner's Name —--— ---- — -- —
-------_-
required for every North Andover Ma. 01845 6/1l2021 __ _
page. --
City/Town -_--- --— _- - .
State Zip Code Date of Inspection
C. Inspection Summary (Cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
Pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ® N ❑ ND(Explain below).-
El obstruction is removed ❑ Y ® N ❑ ND(Explain below):
® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below):
The distribution box is rotted and must be replaced. Repair completed 06/17/2021
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below).-
obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
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