HomeMy WebLinkAboutPass - Title V Inspection Report - 90 LOST POND LANE 9/7/2021 %ommonweaitn of Massachusetts 503 VI
� Title 5 Official Inspection Form
1 1 suhcrerf ce sewage nicnncal svefem Fnrm _ Alnt fnr\/nli Ilnfant Accaccmantc
`�c, � 90 Lost Pond Road
Property Address
Kuljit Kalkat
Owner Owner's Name
information is required for every North Andover MA 01845 8-25-2021
--- _ .—_
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.
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Important:When A. Inspector Information
filling out forms
on the computer,
use only the tab Neil James Bateson Q 1 V
key to move your Naille VI ilia t:U101 Ct�
cursor-do not Bateson Enterprises Inc. �FNp�
use the return Company Name N
key.
111 llrmilla Rnari
VIRrab Company Address
Andover MA 01810
Cityrrown State Zip Code
r 978-475-4786 _ SI-15
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(3 i0 CMR 15.000)- i havtr puibutiaiiy ilispccitrd file Sewdytr diBNusdi sysidin di ii_Itr PI uPCtiy addles
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
11
2. u Conditionaiiy Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
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._I I11 14
UL J-GVL I
I11spect0 Slgnat re 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
%ommonweaitn of Massachusetts
Title 5 Official Inspection Form
n .1 Ciiih¢iirF2f Cnwano nicn�c21 Cvc4om Fnrrn _ nint fnr Vnhintani Acccccmcntc
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90 Lost Pond Road _
Property Address
Kuljit Kalkat _
vW11e1 owner's Name
information is North Andover MA 01845 8-25-2021
required for every _
page. City/Town State Zip Code Date of Inspection
�. 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 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
After permit from B.O.H., install new d-box with riser, inspection from B.O.H., septic system now
passes Title 5 Inspection.
2) System Conditionally Passes:
U 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.
Chr.r.L fhc box for"yc-." of dctcrmincaf /V AI KID\ for thr.follm.,ing statcmcnt If"nr.f
vi wvn un.. vv� ivy 7�.0 , ��iiv�� v� �riv♦u�.aa.���uiwu \ , , �.../ wi u��.. vuv rru�y JIGlVl1IVIw. Ewa
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 subsiantiai infiRraiion or exMiraiion or tank faiiure is imminent. System wiii 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):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18