HomeMy WebLinkAboutPass - Title V Inspection Report - 75 FOSTER STREET 8/13/2024 r Commonwealth of Massachusetts
Title 5 Official Inspection For
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
75 FOSTER STREET
Property ress
JOAN BAIRD
Owner .__.... ..__..___ ...__ _...... . _.._._..... _. ......... ......_..___.__ - ... .._..
CYwner s Name
information
rrfo Is NORTH ANDOVER MA 01848 AUGUST 8„ 2.024
required for every ..._ . ... ,_.......... ._._..__..... ..... ........ .._.. _ _. ....._ .
page, tyt owu�_ State Zip Code- Cate of Inspection
Cr
Inspection results must be submitted on this form. Inspection farms may not be furl in any
way. Please see completeness checklist at the end of the farm.
tmp r ar,t:When A. Inspector Information
filling out forms
on the computer, t B Todd Ja
mes aeson
use only the tab T
key
to move your Name of Inspector
cursor-do not Bateson Enterprises Inc.
use the return _..._. __ ..._.__ ...., ._....
Company Name
�cey. 111 Arilla Road
C .ny Address
_
omp ___ _. .... , .. _ _... a ___..._ _._ ._._....._._.... _....
eke _a
Andover MA 01810
Cctilt6wn hate e p Code
978-478-4786 St-16
'reVephon-a Number License Number
B. Certification
I certify that: l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CMR 16.000); 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. Z Passes
2, 0 Conditionally Passes
3. Needs Further Evaluation by the Local Approving Authority
4, Fails
M :. . ..
��- AUGUST 6, 2024
Insp or"s 6natur 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 flower 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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Commonwealth of Massachusetts
, . Title 5 Offol ci l Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
.:� 75 FOSTER STREET
Property Address
JOAN BAIRD
Owner 6wner"s Name
information is NORTH ANL70VER MA 01845 AUGUST 5, 2024
required for every _
page. City(Town State Zip Code gate of Inspection
_ _........ .. ....._......_._... ... .....m ._.. _.m.._.___._ ,_w.............._..__ _
C. Inspection Summary
Inspection Summary: Complete 1, 2„ 3, or 5 and all of 4 and 5.
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:
PERMIT- BOARD OF HEALTH
INSTALL NEW D-BOX
PUMP SEPTIC TANK
INSPECTION - BOARD OF HEALTH
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 Ieaking and if a Certificate of
Compliance indicating that the tank is less than 20 year's old is available..
El Y El N Q ND (Explain below):
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