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Town of North Andover
'y'•�,,,,,.. �' HEALTH DEPARTMENTS dl
,SSACMUSE4
CHECK #: rap'�1 % 7
LOCATION: -�
H/O NAME:/�lVe/q1S3r.E
CONTRACTOR NAME:
Type
of Permit or License: (Check box)
❑
Animal
$
❑
Body Art Establishment
$
❑
Body Art Practitioner
$
❑
Dumpster
$
❑
Food Service - Type:
$
❑
Funeral Directors
$
❑
Massage Establishment
$
❑
Massage Practice
$
❑
Offal (Septic) Hauler
$
❑
Recreational Camp
$
❑
Sun tanning
$
❑
Swimming Pool
$
❑
Tobacco
$
❑
TrashlSolid Waste Hauler
$
❑
Well Construction
$
SEPTIC Systems
❑
Septic - Soil Testing
❑ Septic - Design Approval
❑ Septic Disposal Works Construction (DWC)
❑ Septic Disposal Works Installers (DWI)
❑ Title
e55Inspector
n'tle 5 Report
❑ Other: (Indicate) $
1824 ( 0 .fr
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d
DEPARTMENT OF ENVIRONMENTAL PROTECTION
5
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARYASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM
FORPART A
CERTIFICATION
Property Address: 22 Fuller Road
North Andover_
Owner's Name: Yiilliam Masterson
Owner's Address: 2F
Fuller Roaderg MA 01845_
Date of Inspection: 926/2006
Name of Inspector: Neil I Bateson_
Company Name: Bateson Enterprises Inc•_
Mailing Address: _1And rgillad
Roer, mA ad_
Telephone Number: J978) 4754780—
SEP 2 9 2006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
CERTIFICATION STATEMENT
I certify that I have personally inspected the sew
age disposal
inspection. em Thelinspection was that
based on my
rte
below is true, accurate and complete as of the time of the p stems. I am a DEP
training and experience in the proper function and maintenance of on site sewage disposal�e s stem:
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). Y
Passes
X Conditionally Passes Approving Authority
Needs Further Evaluation by the Local App g
Fails
9/26/2006_
Inspector's Signature:
of this inspection report to the Approving Authority (Board of Health or
The system inspector shall submit a copy P
DEP) within 30 days of completing this inspection. If thesubmit the report to the appsystem is a shared system ropriate egionalloffice of the
gpd or greater, the inspector and the system
0ewer land copies sent to the buyer, if applicable, and the approving
DEP. The original should be sent to the system
authority.
Notes and Comments:
tions of use at that
****This report only describes conditions at the time of winllsperform inthefuturunder e underlthe same or different
time. This inspection does not address how the syst
conditions of use.
Page 2 of 1 i
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _22 Fuller Road_
_ North Andover_
Owner: —Masterson—
Date
Masterson_Date of Inspection: 9/26/2006 _
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:
B. System Conditionally Passes:
X 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. Answer yes, no or not determined (Y,N,ND) in the for
the following statements. If "not determined" please explain . Outlet Tee & D -box needs replaced
N 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.
ND explain:
N Observation of sewage backup or break out or
high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or
uneven distribution box. System will pass inspection if (with approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
N The system required pumping more than 4 times a
year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _22 Fuller Road_
_ North Andover_
Owner: _Masterson_
Date of Inspection: 9/26/2006
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance _
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
• Page 4 of l l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 22 Fuller Road _
_ North Andover_
Owner: _Masterson_
Date of Inspection: 9/26/2006 _
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or `no" to each of the following for all inspections:
No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
No Liquid depth in cesspool is less than 6" below invert or available volume is '/2 day flow.
_No7 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
No_ Any portion of the SAS, cesspool or privy is below high ground water elevation.
No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_No_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
_No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described
in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to
determine what will be necessary to correct the failure
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either "yes" or "no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ _ the system is within 400 feet of a surface drinking water supply
_ _ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped
Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
!—page 5 of 11
SESSMEN
OFFICIAL IN
SPECTION FORM — NOT FOR VOLUNTARY SFORM TS
SUBSURFACE SEWAGE DISPOSAL BYSTEM INSPECTION
PAR
CHECKLIST
Property Address: 22 Fuller Road _
_ North Andover _
owner: Masterson_
Date of Inspection: 9/26/2406_
r•hPrk if the following have been done. You must indicate ` es" of "no" as to each of the
Yes No in information was provided by the owner, occupant, or Board of Health
Yes_ ____ pumping
No Were any of the system components pumped out in the previous two weeks ?
—revious two week period ?
Yes_ _ Has the system received normal flows in the p
_ large volumes of water been introduced to the system recently or as part of this inspection ?
_ _No Have g
N/A_ Were as built plans of the system obtained and examined?
Yes_ Was the facility or dwelling inspected for signs of sewage back up ?
Yes_ Was the site inspected for signs of break out ?
_Yes— — Were all system components, excluding
the SAS, located on site ?
Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the
Yes — ep depth of sludge and depth of
condition of the baffles or tees, material of construction, dimensions, depth of liquid,
scum ?
_Yes_ — Was the facility owner (and occupants if different from owner) provided with information on e
proper maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on.
Yes No roximation of
N/A_ ` Existing ed in the fie of the failure criteria related to Part C is at issue app
—yes _Determined in the field (if any
distance is unacceptable) [3 10 CMR 15.302(3)(b)]
Page 6 of l l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 22 Puller Road_
_ North Andover_
Owner: _Masterson_
Date of Inspection: _9/26/2006_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): _N/A Number of bedrooms (actual): _4_
DESIGN flow based on 310 CMR 15.203
Number of current residents: _3
Does residence have a garbage grinder (yes or no): Yes
Is laundry on a separate sewage system (yes or no). _ o_
Laundry system inspected (yes or no):
Seasonal use: (yes or no): _No
Water meter reading: Yes _
Sump pump (yes or no): Yes_
Last date of occupancy: _Current
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): ---Rd
Basis of design flow (seats/persons/sgft,etc.):
Grease trap present (yes or no):
Industrial waste holding tank present (yes or no):
Non -sanitary waste discharged to the Title 5 system (yes or no): —
Water meter readings, if available: ,
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped two years ago, owner _
Was system pumped as part of the inspection (yes or no): _Yes_
If yes, volume pumped: _1500 gallons -- How was quantity pumped determined? _Measured tank
Reason for pumping: Inspect tank & tees_
TYPE OF SYSTEM
_X_ Septic tank, distribution box, soil absorption system
Single cesspool _ Overflow cesspool
Privy
_ Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
_ Tight tank _ Attach a copy of the DEP approval
Other (describe): _
Approximate age of all components, date installed (if known) and source of information:_ Original, no plan at
B.O.H. _
Were sewage odors detected when arriving at the site (yes or no): _No
Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 22 Fuller Road_
_ North Andover _
Owner: _Masterson
Date of Inspection: 9/26/2006_
BUILDING SEWER _ X _ (locate on site plan)
Depth below grade: 22"
Materials of construction: _X_ cast iron —X-40 PVC other
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" Cast iron wall, 3" PVC in house, no
leaks.
SEPTIC TANKS: X
Depth below grade: _10" _
Material of construction: _X_ concrete — metal _fiberglass polyethylene
—other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of
certificate)
Dimensions: _10' x 5' x 4'
Sludge depth: —2" _
Distance from top of sludge to bottom of outlet tee or baffle: N/A _
Scum thickness: _411
_
Distance from top of scum to top of outlet tee or baffle: _ N/A _ N/A = Outlet tee corroded off.Distance from bottom of scum to bottom of outlet tee or baffle: _N/A_
How were dimensions determined: _Tape Measure _
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc _Pumped septic tank Inlet tee ok Outlet tee corroded off.
Depth of liquid at outlet invert. No evidence of septic tank leaking. _
GREASE TRAP: _(locate on site plan)
Depth below grade:
Material of construction: —concrete _metal _fiberglass _polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 22 Fuller Road_
North Andover
--
Owner: _Masterson_
Date of Inspection: 9/26/2006_
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOXS: _X_
Depth below grade _ 24"_
Depth of liquid level above outlet invert: _0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):_ D -bog level & distribution equal. Evidence of leakage. Evidence of
carryover. D -bog has bad corrosion, needs replaced._
PUMP CHAMBER: _ (locate on site plan)
Pump in working order (yes or no): _
Alarm in working order (yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Page 9 of l l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 22 Faller Road _
_ North Andover_
Owner: _Masterson_
Date of Inspection: _9/26/2006_
SOIL ABSORPTION SYSTEM (SAS): _X (locate on site plan, excavation not required)
If SAS not located explain why:
Type
leaching pits, number: _
leaching chambers, number:
leaching galleries, number:
_ leaching trenches, number, length:
X leaching field, number, dimensions: _18' x 40' field_
overflow cesspool, number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): _Soil ok. Vegetation oL No sign of ponding to surface.
CESSPOOLS:
Number and configuration: ,
Depth — top of liquid to inlet invert:
Depth of sludge layer: —
Depth of scum layer:
Dimensions of cesspool: _
Materials of construction:
Indication of groundwater inflow (yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Page 10 of l 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 22 Faller Road _
_ North Andover_
Owner: _Masterson_
Date of Inspection: _9/26/2006
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building
Garage I House
Driveway
A B
Water Meter
Septic
Tank
D -
Boz
A to Tank = 31'3"
A to D -Boz = 41'3"
B to Tank = 42'
B to D -Boz =36'
Page l l of l l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _22 Fuller Road _
_ North Andover
Owner: _Masterson
Date of Inspection: 9/26/2006
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water _ >6'_
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record - If checked, date of design plan reviewed: ,
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain:
Checked with local excavators, installers- (attach documentation)
X Accessed USGS database -explain: Essex County Soil Map_
You must describe how you established the high ground water elevation: _ Essex County Soil Map, Sheet # 36,
Hinckley Soil, Water > 6' Deep _
Summary Record Card generated on 9125QO06 2:28:46 PM by Lisa Warren
• Town of North Andover
Tax Map # 210-065.0-0073-0000.0
22 FULLER ROAD
MASTERSON, WILLIAM
22 FULLER ROAD
N. ANDOVER, MA
01845
Class 101 Single Family
Size Total 1.21 Acres
FY 2007
UB Mailing Index
Name/Address Type Loan Number
MASTERSON, WILLIAM Payor
22 FULLER ROAD
N. ANDOVER, MA
01845
UB Account Maint.
Property Type
Active/Inact. From
Account No Cycle Occupant Name
Bldg Id. 17215.0 - 22 FULLER ROAD Last Billing Date 7/5/2006
3160293
03 Cycle 03
UB Services Maint.
1/
210.90
Service Code
Brand
Rate
MISCFEE ADMIN FEE
w Water
0.635/8
WTR WATER
79-
01 ALL METER SIZE
UB Meter Maintenance
7/10/2006
Serial No Status
4/17/2006
Location
32707569 a Active
`17.3
ERT HH
Date
Reading
Code
9/6/2006
134
a Actual
6/12/2006
55
a Actual
3/17/2006
8
a Actual
2/10/2006
0
n New Meter
2/10/2006
6206
r Replacement
12/15/2005
6033
m Manual estimate
MSG
9/14/2005
5983
m Manual estimate
MSG
6/7/2005
5933
m Manual estimate
MSG
3/5/2005
5883
m Manual estimate
MSG
12/8/2004
5838
m Manual estimate
9/15/2004
5788
m Manual estimate
6/9/2004
5738
a Actual
Trouble Code:03
4/15/2004
5692
a Actual
Active/Inactive
Active
Charge
Multiplier/Users
7.82
1/
210.90
/1
Brand
Type
b Badger
w Water
Consumption
Posted Date
79-
47
7/10/2006
8
4/17/2006
0
4/17/2006
`17.3
4/17/2006-
50
1/17/2006
50
10/14/2005
50
7/15/2005
45
4/5/2005
50
1/14/2005
50
10/8/2004
46
7/30/2004
47
5/17/2004
Size
0.63 0.63
Page 1
1 Residential
Until
YTD Cons
Variance
70%
136%
-100%
-100%
458%
8%
5%
17%
-39%
135%
0%
BATESON ENTERPRISES, INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 22 Fuller Road, North Andover
Owner: Masterson
Date of Inspection: 9/26/2006
Tel: (978) 475-4786
Fax: (978) 475-5451
My report contained herein does not constitute a guarantee of future usage and the functionality of the existing
septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further
operation of your current septic system.
Neil J. Bateson
Bateson Enterprises, Inc.
f VkORTH
Y' A �tteo �8i BOO
3� �, a
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,bb
SAC
PUBLIC HEALTH DEPARTMENT
Community Development Division
Date: September 19, 2006
Address: 22 Fuller Road
Re: Application garage, master closet, bathroom renovations
Dear: Mr. And Mrs. Masterson,
Your application for a deck at has been reviewed by the Health Department. The application
was denied on, September 19, 2006, for the following reasons:
1. x Missing information
2. x Passing Title 5 inspection of septic system required per local N. Andover regulations
3. ❑ Location of structure not acceptable
4. ❑ Undersized septic system
To address the problem(s):
If #1 is checked, please supply:
a. Floor plan of existing and proposed addition — all rooms
'n. %ertitied plot plan showing house, septic system and proposed project in scale
If #2 is checked:
a. Have the septic system inspected by a certified Citle 5 inspector to determine the size
of the system and whether it is operating properly: OR
b. Tie-in to municipal sewer
If #3 is checked:
a. Relocate the project
H#4 is checked:
a. Provide additional information proving that the existing septic system meets current capacity
requirements. Please consult an engineer to determine the flow capacity of the septic system.
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
r,
Please feel free to call the Health Office at 978-688-9540 with any questions you may have,
Sincerely,
/ 9, an Sawyer, PublidVkalth Dir or
v
Cc: Building Department
File
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
PART F Title V System Inspectors
17.00 Title V System Inspector License: No person shall conduct a System Inspection
in the Town of North Andover without first obtaining a license with the Board of
Health. To be eligible to obtain the license the applicant must first be certified by
the MA Department of Environmental Protection (MA DEP). Inspections
performed by inspectors not licensed by the North Andover Board of Health will
not be accepted. A nonrefundable fee for annual licensure shall be paid to the
Town pursuant to the current fee schedule.
17.01 Application for licensing shall include a copy of the MA DEP's System Inspector
certification or equivalent documentation.
17.02 There will be a fee for each Title 5 inspection submitted to the Health Department
by a system inspector licensed by the town. The amount of the fee shall be
pursuant to the current fee schedule.
17.03 All Title 5 inspection submittals must be completed and submitted in accordance
with MA DEP 310 CMR 15.301(10)
17.04 A Title 5 system inspection is required when an addition or renovation to an
existing building, excluding decks and screened in porches, is proposed that
increases the footprint of the building and requires a building permit from the
building inspector. The inspection requirement shall be waived if a Certificate of
Compliance was issued or a Title 5 System Inspection was completed within the
previous 5 years or if the system is under an operation and maintenance contract.
17.05 Any Title V inspection that identifies the septic tank, pump tank or distribution
box at an elevation of greater than 36 inches below grade, without an access riser,
shall have a riser and cover installed within 9 inches to grade, by a N. Andover
licensed installer.
17.06 Any septic system that conditionally passes a Title 5 inspection due to a
component failure, which has resulted in the leaching area having not received
usual effluent flow, is required to have a second inspection conducted 6 months
later. A MA licensed septic inspector must conduct this inspection and a proper
report must be submitted to the Health Department.
17.07 Inspector License Revocation: The Board of Health may suspend or revoke for
cause any license as stated in 3.02 License Revocation of this regulation.
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Commonwe lth of Massachusetts
4A�,�Massachusetts
System Pumping Record
System Owner
Date of Pumping: �j -ted-�
Cesspool: No Yes []
System Pumped by: 64&4" 50avvia"
System Location
Quantity Pumped:
Septic Tank: No [ ]
License #
Contents transferred to: Greater Lawrence Sanitary District
Date
Inspector:
gallons
5
Yes