HomeMy WebLinkAboutPASS - Title V Inspection Report - 2050 SALEM STREET 9/9/2025 Town of North Andover
Commonwealth of Massachusetts
SEP 19 2025
T'lotle 5 Off'i"cial Inspectimon Form
1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
2050 SALEM STREET Hca Ith Department
Property Address
DYLAN PETERS
Owner Owner's Name
information is NORTH ANDOVER
required for every - MA 01845 SEPTEMBER 9, 2,025
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 A. Inspector Information
filling out forms
on the computer,
use only the tab Todd James Bateson
key to move your Name of Inspector
cursor-do not Bateson Enter ��Inc.
use the return key Company Name
.
111 ArqLilla Road ._
lob
Com pany Address
Andover - MA 018101
Ci'tyfTown State ........ Zip Code,
978-475-4786 SI-16
Telephone Number License Number
Bu Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15-340 of Title 5
. * I have personally inspected the sewage disposal system at the property address
(310 CMR 1500,0)1
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:
Passes
2. El Conditionally Passes
3. El Needs Further Evaluation by the Local Approvi ng Authority
4. F-1 Fails
SEPTEMBER 9, 2025
Inspers Si-g-n-a-ture Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or CEP) within 30 days of completing this, inspection. If the system has a design flow of
101000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DER The original form should be sent to the system owner and copies sent LU
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 flime. This Inspection does not address how the system will perform:
Ins the future under the same or different conditions of use.
t5insp,doc rev.7/2612018 Title 5 Of inspection Form:SUbsurface Sewage Disposal sys,tem-page 1 of 18
Commonwealth of Massachusetts
r (t�pIInspectionForm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
h
2050 SALEM STREET
W
Property Address W
DYLAN PETERS
Owner owner's Name _
information is NORTH ANDOVER MA 01845 SEPTEMBER 9 2025
required for every ,
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 21 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:
WELL WATER ANALYSIS PASSED TEST CONDUCTED BY TOWN OF NORTH ANDOVER
WATER TREATMENT PLANT
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"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):
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
jr
11 d V1 1 R
D 111V",1"S"i ')'F'
111 VOS
0 1 C 9
'Jan'Ic"'Sf
Ti 1`,7ui-itruin
T )'/`("1'10' 6'88-�9.5 74
st/1")C/h'I te'n t
(S') 6 6 8(!-,9 5 75
id
Dear Dylan Peters,
The following are the results for the water sample at 2050 Salem St.North Andover,MA on September
8thl 20!25 at approximately 11:45 AM:
Analyte Sam,ple U In"ts
Total Coliform Absence Pi-esence/Absence
E.coli Absence Presence/Absence
MA Cei-fification foi-Bacterliologlical Analysis.-M-21054
If you have any questions,please contact us at 978-688-9574.You can also email rne at
.. ...........
Sincerely,
Maya ChIll
L aboratoty Director
Tomin of'Nortli Andover
Drinki'lig Water"Freatnusn't,Plant
r _
w
7
1
CHAIWOFu.-CUSTODY RECORD
CornpanY Name'a
Sx
Addres 0 1 ota I
4w CID I
proreat Name Phone: -� � - G0�� TM
pro}ems a er. -
Sampler(s)Name: -sae ��er.7-0�Bottles'�er•���e
.;� -CUEM SAMPLE ID e - _ -
dab use ors -
De . - +
jqotesf lnstrurfions�Type _
wafter DW=drinking water, - �-- .. _Cori
x � d �. �
Sw=surface vvater, --other(describe)
North Andover W`P Lab -
Lj
Reoaived-
_ Re � 420 Great Pond Road
_LL!�57
OF "MAW
-a 4
.............
n
kNTP Date ......
4�4°a��� ��Y`� � TOWN OF NORTH ANDOVER
0 °� WATER TREATMENT PLANT
E
34P C�riirlM t:Py1• EIPT
AF
Ayr
CHUS
This certifi es that a n
t
d,.., -2
has paid......�-J j
. ..... ...
for..
Received by....... a...c h.
w..6.... ................. ..........
Depariment.......N.
WHITE: Applicant CANARY:Department PINK:Treasurer