HomeMy WebLinkAboutTitle V Inspection Report - 290 BARKER STREET 10/7/2015 Commonwealth of Massachusetts
` Title 5 Official Inspection F
orm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2SO Barker street
Property Address
Patrick Linbcluist
Owner Owner's Name
information i's
required for every North Andover Ma 01886 October 7 2015
page. City/Town 81a0a Zip Code Date ofInspection
Inspection results must be submitted on this form. Inspection forms may not bealtered in any
way. Please see completeness checklist at the end of the form.
Important:When A. ���������U U��������~��n
fiUinQout forms
°"~ General Information
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on the computer, ����D
use only the tab 1. Inspector:
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cursor-do not
JohnDK/|nconzo
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key. Name nf|nopodor T�0NOFNOHTHAMDOVER
Stewarts 8U8i
Company Name
"---�' 58 South Kimball street
Company Address
Bradford MA 01835
------- City/Town State Zip Code
978-372-7471 G113306
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is hue, accurate and complete as of the time of the inspection. The inspection
was podbnned based on my training and experience in the proper function and maintenance of on site
anvvnge disposal eyohsma, | am a OEP approved system inspector pursuant to Section 15.340 of �
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Title (310 CY0R16.OD0). The system: �
Z Passes El Conditionally Passes El Fails
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Needs Further Evaluation by the Local Approving Authority �
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J ey�ominspecb}reho|| mubmKaoopyofth� inopecUonnapodtotheApprovngAuUor�y (Board
HeaKhorOEP)vvhhin30doymofuompletingthiainapeotion. |fUhesynbemisaoharodayabemor
has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DER The original should be sent to the system owner �
and copies sent tn the buyer, if applicable, and the approving authority.
°°°°Thio report only describes conditions at the time of inspection and under the conditions of use
mt that time. This inspection does not address how the system will perform in the future under
the same or different conditions mfuse. �
t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
290 Barker street
Property Address
Patrick Linbquist
Owner Owner's Name
information is
required for every North Andover Ma 01886 October 7 2015
page. CityFrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) 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:
Replaced D-Box
B) 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 leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17