HomeMy WebLinkAboutPASS - Title V Inspection Report - 315 CANDLESTICK ROAD 1/5/2026 Commonwealth of Massachusetts
I Inspect" Form
T"tle 5 Off"
ion
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
315 CANDLESTICK ROAD
Property Address
MARK GOTOBED
Owner
information is Owner's amel
required for every NORTH NDOVE MA 01845 JANUARY 5, 2026
page. City/Town
�f to Zip Code Date of In—spe—ction"—
Ins pectic n results must be submitted on this,form. Inspecti. .
on forms may not be alteredin any
way. Please see com,p�leteness c hecklist at the end of the form.,
important:When
A. Inspector Informat"
filling out forms ion Town of Nofth Andover
on the Computer,
use only the tab Todd James Bateson
Ivey to move your Name of Inspector
cursor-do not Bateson Enterprises, Inc. JAB 2 82026
use the return — I
key, Company Name
111 1 A Alfa Road
Company A-d—dress
Andover
MA 01810
City/Town Mate Zip Code
978-475-,4786
SI-16
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
(310 CMR ,15.000); I 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 inspect�ion was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspe
that the system.-
ction lhave determined
I. Passes
2. Conditionally Passes
3. Needs Further Evaluation by the Local Approving Authority
4. Fails
JANUARY 6, 2026,
Inspectors ignatu 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
10,0010 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 copi,es sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the t,ime 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 I of 18
Commonwealth of NI, aseachusetts
rl'tle
ion Form
_ wI lnsv%ect"
� .._
10 Subsurface Sewage Disposal System� �� � p Y Form Not for Voluntary Assessments
315 CANDLESTICK CK ROAD
Property Address
MARK OOTOBED
Owner Owner's Name
information is NORTH AN D
required for every OVER MA 01845 JAN UARY 5 202
page. City/Town State Zip Cade Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
l have not found any information which indicates that an of the failure
in 3'I D CMR 15.303 Y lure criteria described
3 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
PERMIT- BOARD OF HEALTH
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 "
tonal Pass section need to be
replaced or repaired. The system, upon completion of the or replacement repair,
the Board of Health, will pass. P p as approved by
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following
determined " ( } g statements. If"not
please explain.
The septic tank is metal and over 20 years old* or the tank septic (whethermetal or not} is structurally
unsound, exhibits subs p
substantial infiltration or exfiltration or tank failure is imminent. System will ass
inspection if the existing tank is replaced with a complyings Y p
Health. septic tank as approved by the Board of
*A metal septic tank will pass inspection if it is structural) sound not leaking
Compliance indicatingthat the tan Y k ng and �f a Certificate of
k is less than 20 years old is available.
El Y Ej N Ej ND :(Explain below)
:
)
t5insp.doc rev.7/26/2018
Title 5 official Inspection Form,Subsurface Sewage Disposal System-Page 2 of 18