HomeMy WebLinkAboutPass - Title V Inspection Report - 534 BOSTON STREET 4/9/2026 41
uommonwealth of Massachusetts
I Insw%ection Form
-IT
icia
i
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
534 B ST N STREET"
Property Address
CLAN G TMAN
Owner Owner's Name
information is NORTH ANDO VER required for every I IA 01845 AP R I L 2 26
page. City/Town State dip Code Cate of Inspection
Inspection results must he submitted on this form. Inspection forms may not he altered in any
way. Please see completeness checklist at the end of the form.
Important:When n cto Information
Tf%I A I Lft j04 X A
fillingo out forms A.
1 V1 I'VORn Andover
on the computer,.
use only the tab Todd , alms ratan
Ivey to move your Name of Inspector 2026
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cursor-do net Bateson Enterprises Inc.
use the return......... � _ _� _�......__... ._._...__...___.._ ...�
C�om any Nome
key.
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111 Argilla Road Health,_.
tab Company Address Depftent
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Andover NSA 01810
City/Town State _..._.._ Zip Code
Telephone Number License Number
B. Certification
I certify that: I am a CEP approved system inspector in full compliance with Section 15.3,40 of Title
(310 CMR 15. 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 Can mar training and experience in the piraper function
and maintenance of Can-site sewage disposal systems, After conducting this inspection I have determined
that the system:
1. E Passes
2.. El' Conditionally Passes
3. Ej Needs Further Evaluation by the Local Approving Authority
4. Fails
APRIL 9, 22
Inspector's Sinecure Dote
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 flog of
101000 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 hover the system will perform
in the future under the same or different conditions of use..
t8insp.dcc.rev,.7/26/2018 Title 5 official Inspection Earn.Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
e i�ia ns ionForr�
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
- •s;+r�e�r 534 BOSTON STREET
Property Address
DAN OUTMAN
Owner owner's Name
information is NORTH AN DOVE R
required for every MA 01845 AP R I L 8, 2025
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 5.
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:
PLUMBER REPAIRED PIPE AT FOUNDATION
SYSTEM NOW PASSES TITLE 5 INSPECTION
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 b
the Board of Health, will pass. v
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 structural)
unsound, exhibits substantial infiltration or exfiltration or tank failure Is imminent. System will pass
v
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.
El Y El N El ND (Explain below):
t5insp.doc•rev.7/26/201 S Title 5 official Inspection Farm:Subsurface Sewage Disposal System•Page 2 of 18