HomeMy WebLinkAboutPASS-Top Pages - Title V Inspection Report - 195 CANDLESTICK ROAD 7/15/2025 Commonwealth of Massachusetts
-Q.
T"tle 5 Off"
icial Inspecti"on Form
>
0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
195 CANDLESTICK ROAD
Property drys
Owner, DON PICA ELL
information is 6—wn—er's�Name
required for every N TF1 ANDOVER
page. City/T'own M:A 01845 JULY 14, 2025
state Zip Code Date of inspection
Inspection results Must be submitted on thi's form. Inspection forms may not be altered In an
way. Please see comp yleteness checklist at the end of the form.
important:When A. Inspector Informat"
filling out forms ion
on the computer, Town OfNod Andover
use only the tab Todd James Bates on
key to move your Name Of Inspector
cursor-do not Bateson Enterprises Inc.
use the return Company Na 012025
key,
me
T'I
Argilla Road
Company Address
Andover mpealth D�-ejjartmq 01
Cityown
/T
relim 978-475stet 1-4786 Zip Code
— SI-16
Telephone Number License Number
B. Certification
I certify that*, lam a DEP approved system 'inspector in full compl*
iance with Section 15.340 of Tiftle 5
(310 CMR 15.000)$ 1 have personally inspected the sewage disposal
listed a system at the property are
bove; 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 main;tenance of oin-site sewage disposal systems. After conducting this inspection I have determined
that the system:�
I. Z Passes
2. E Conditionally Passes
3. El Needs Further Evaluation by the Local Approving Authority
4. 0 Falls
JULY 15, 2025
Inspedtor's,signatu date---
The system inspector shall submit a copy of this i'nspect,ion report to the Approving Authority (Board
of Health or DEP)within 30 days,of completing the inspection. If the system has a design flow of
1 0,0�00 gpd or greater, the inspector and the system owner shall su
regional bmit the report to the appropriIate
office of the DER The original form should be sent',to the system owner and
the buyer, if applicable, and the approving authority. copies sent to
Please note: This report,only describes:conditions at the time of inspection and und e
conditions of use at that time. Th"'s Inspection does, not address how the system will perform
in the future under the same or differ ofconditions of use,
t5insp.doo-rev.7/26/2018
Title 5 Official inspection Form:Subsurface Sewage Disposal,system,Page i of 18
Commonwealth of Massachusetts
in
Tl"tle 5 Offi"ci"al Inspection
Form
T
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
195 CANDLESTICK ROAD
Property Address
DON PIC,KRELL
Owner Owner's Name
information is NORTH ANDOVER
required for every MA 01845 JULY 14, 2025
page. dity/Town 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 asses:
1 have not found any informationi,which indicates that any of the failure criteria described
0
in 310 CIVIR 15.,303 or in 310 CAI R 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments,
PERMIT- BOARD OF HEALTH
PUMP OUT
INSTALL OUTLET TEE AND GAS BAFFLE IN TANK
INSTALL NEW D-BOX
INSPECTION - BOARD OF HEALTH
SYSTEM NOW PASSES TITLE 5 INSPECTION
2) System Conditionally Passes:
El 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 It yes", "no$$ or"not determined" (Y, N, ND) for the following statements. If"not
determined,it 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 b�y the Board of
Health.
*A metal septic tank will pass inspection if it Is structurally sound, not leaking and if a Certi ficate 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