HomeMy WebLinkAboutPass - Title V Inspection Report - 404 SUMMER STREET 6/23/2025 Commonwealth of Massachusetts
m "-Ie 5 Offi 0 1 Inspection Form
rA cia
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 SUMMER STREET
..........
Property Address ent
KERSTIN GERDING
Owner Owner's Name
information is
required for every NORTH AI" MA 01845 JftE 231 2025
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, Todd James Bateson
use only the tab
Ivey to move your Name of Inspector
cursor-ado not Bateson Enterprises Inc.
use the return Compan y Name ......
key.
111 Argill'a Road'
tab Company Address
Andover MA 018101
City/Town State Zip Code
978-475-4786 -SI-16
Telephone N'umber 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 CM R 15.000); 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 on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting ng this inspection I have determined
that,the system:
1. Z Passes
2. D Conditionally Passes
3. Needs Further Evaluation by the Local Approving Authority
4. Fails
JUNE 2612025
Inspe is Signature, Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of
l-lealth or D,EP)within 30 days of completing this inspection. If the system 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 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 how the system will perform
in the future under the same or different conditions of use.
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t;ommon�wealth of Massachusetts
5 utticiai insmpokection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
1.
404 SUMMER STREET
Property Address
KERSTIN GEE INC
Owner
Owner's Name
in:formation is NORTH AN 'OVER MA 01845 JUNE 23 2025
required for every I
page. City/Town State Zip Code Date of Inspection
C. Inspecti gumimary
Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 6.
1) System Passes,-,
Z' I have not found any information which indicates that any of the failure criteria described
in 310 CIF 15.303 or in 310 CIVIR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Commients:
2) System Conditionally Passes.-
E] 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, wil'il pass.
Check the box for"yes", 11 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 exf'illtration 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..
0 Y 0 N F1 ND (Explain below):
t5inisp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 18
Commonwealth of Massachusetts
UT'T I c i a i,
p "tie 5 Insvp%ecti"on Form
Subsurface ,Sewage Disposal System Form - Not for voluntary Assessments
�i 404 SUMMER STREET
Property Address
KERSTIN G OR ING,
Owner Owner's Name
information is NOF TH''ANDO VEF CIA o1 45 DUNE�23.
required for every _ _ . ��
page City/Town State Zip Code [date of Inspection
C. Inspection Sa coat.
2) System Conditionally basses (cont.):
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired
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 boy. System will
pass inspection if(with approval of Board of Health):
[ broken pipe(s) are replaced E1Y 0 N EI ND (Explain below)
El obstruction is removed El' Y 0 N 0 NEB (Explain below):
El distribution box is leveled or replaced Y 0 N ND (Explain below).
F1 The system required pumplin more than 4 times a year due to broken or obstructed pipo(s). The
system will pass inspection if(with approval of the Board of Health):
El broken pipe(s) are replaced El Y El N Ej ND below):
(Exp�lain
F-1
obstruction is removed [:1 Y Ej N El ND (Explain below):
3 Further Evaluation is Required by the Board' of Health:
El 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.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.3 3 l ( that the system, is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc.rev.71 I 018 Title 5 official Inspection Farm:Subsurface Sewage Disposal'System•page 3 of 18
11^ i
Commonwealth of Massachusetts
fyp ulmtle 5 I I
al Inspmo%ection Form
J10 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 SUMMER STREET
Property Address
KERSTIN GERDING
Owner Owner's Name
information is NORTH ANDOVER required for e�very MA 0184,5 JUNE 231 2025
page. City/Town State Zip Code Date of Inspection
C.: I nspecti o n Summary (cont.)
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
b. System will fall unless the Board of Health (and Public Water Suppilier, if any)
determines that,the system is functioning in a manner that protects the public health,
safety and environment:
El The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tribuitary to a surface water supply.
0 The system has a septic tank and SAS and the SAS is within a Zone 1 of a publ'ic water
supply.
E:1 The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
El The system has, a septic tank and SAS and the SAS is less than 1010 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 51 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form,
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded' or
clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of' Massachusetts
111tie 5 Otticial Ins,r%ecti"on Form
_ 10 Subsurface Sewage Disposal System l,;'+orm Not for Voluntary Assessments
404 SUMMED STREET
Property Address
KE STIN GERDING
_�_......_�_.............
Owner Owner 1,s Name
information is NORTH AN DOVE M'A o 1 45 re uwred for every �. _�_._ lJN �, �o �
page. C ity/T wn State Zip code Cate of Inspection
C. Inspection Summary (cont)
) System Failure Criteria Applicable to All Systems (cant.)
Yes No
El E Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged. SAS or cesspool
1:1 Liquid' depth in cesspool is less than 6" below invert or,available volume is less
than Y day flow
Required pumping more than 4times in ""+the last year T due to clogged or
obstructed pipe(a . Number of times pumped:
Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
0 Any portion of a cesspool or,privy is within a Zone 1 of a public water supply
well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.0 .
Any portion of a cesspool or privy is less than 100 feat but greater than 50 foot
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 fecal coliform bacteria Indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprm,
pr ided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must he attached' to this form.,
The system is a cesspool serving a facility with a design flow of 2000 gp -
101000 gpd
El E 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.
5 Large Systems: To he considered a large ;system the,system must serge a facility with a
design flow of 10, 0O gpd to 1 , 0 gpd.
For large systems, you must indicate either"yes° or"no"to each of the fallowing, in addition to the
questions in Section CA.
'es No
R the system is within 400 feet of a surface drinking water supply
1:1 El the system is within Zoo 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 Il of a public water supply well
t5 nsp.doc rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 5 of 18
;"� Commonwealth of Massachusetts,
F I "tle !'5 'ufficial Inspection Form
b wiry
7
17 Subsurface Sewage Disposal stern Form - Not for Vol
untary Assessments
404 ,MINER STREET
Property Address
KERSTIN GIRDING
Owner owner's Nerve
information is
required for every NC���"N ANC yF� MA� 01845 J U N E 231 2025
page City/Town State Z Code e date of inspection
C. Inspection Summary (cont.)....
If you have answered "yes' to any question in Section C.5 the system is considered a significant
threat, or answered' It yes" to any question in Section C.4 above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C..5 or failed
under Sectio
n CA shall upgrade the system in accordance with 310 CMR 15,304. The system owner
should contact the appropriate regional office of the Department.
. You moat indicate "yes" or"no" for each oaf'thle following for all inspections:
'es No
0 1:1 Pumping information was provided by the owner, occupant, or hoard of Health
E] 0 Were any of the system components pumped out in the previous two weeks?
E] Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined? (If they were not
available note as NA
E E] Was the facility or dwelling inspected for signs of sewage back up'
E 1:1 Was the site inspected for signs of break out'
E E] Were ,all system components, excluding the SAS, located on site?
El Were the septic tank manholes uncovered, opened', and the Interior of the tank
inspected for the condition of the baffles or tees, material of construction,.
dimensions, depth of liquid, depth of sludge and depth of scum?
Z El Was the facility owner(and occupants if different from owner) provided with
information on the 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:
Existing information. For example, a plan at the Board of health.
E] Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptahl'e) [31 o CMR 15.302(5
t insp.doc.rev.7/2 /2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System.Page 6 of 1
Commonwealth of Massachusetts
itle 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 SUMMER STREET
Property Address
Owner KERSTIN GERDING
Owner's Name
information is NORTH ANDOVER MA 01845 2025
required:for every JUNE 23)
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design).- 5 Number of bedrooms (actual): 5
DESIGN flow based on, 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 GPD
Description:
Number of current residents: 6
Does residence have a garbage grinder? El Yes E No
Does residence have a water treatment unit? El Yes [I No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection!, El Yes No
information in, this report.)
Laundry system inspected' Yes No
Seasonaluse? El Yes [I No
Water meter readings, if available (last 2 years usage (gpd),): SEE ATTACHED
Detail:
...........
Sump pump? El Yes E No
Last data of occupancy: CURRENT
Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form,Subsurface Sewage,Disposal System-Page 7 of 18
Commonwealth of Massachusetts
. , Imtle 5 u icial Inspe tion Form
_,
fA C
Subsurface Sewage Disposal System Fora Not for voluntary Assessments
404 SUMMER STREET
Property Address
KERSTI'N G E I C I I G
Owner Owners s Name
information is NORTH AND OVER I
required for every �. �.�.._ � 4� J�ICI E 3! 2025
page. City/Town State ,Zip Code Date of Inspection
D. System Information (
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based pan 310 CI R `I 5,.C203): Gallons per day �d
Basis of deign flaw seatslparsens/sgntt., etc.}:
Grease trap present's El Yes [:1 No
Water treatment unit present? Ye [I N
It yes, discharges to:
Industrial waste holding tank present? El Yes F-1 No
Non-sanitary waste discharged to the Tithe 5 system? El Yes No
Water meter readings, if available:
Last date of occupancy/use:
Date
Other(describebelow),:
3. Pumping Records:
BATES ON ENTERPRISES INC
Source of information: p�I�� II ApIL;�! �
Was system pumped as part of the inspection' El Yes E No
If yes, veI'u me pumped: _..�.. _. __.... �.._ �
galloins
How was quantity pumped determined? _....
Reason for pumping.
t5insp.dcc.rev.7/6/2018 Title 5 official Inspection Farm:Subsurface Sewage Disposal System.Page 8 of 18
Commonwealth of Massachusetts
5 otticia
"tie I inswp%ectdimon Form
Subsurface Sewage Disposal' System Form Not for Voluntary Assessments
" 404 SUMMER STREET
Property Address
KERSTIN GERD'ING
Owner Owner's Name
information is NORTH AN'DOV R MA 1 45
required far every _ _�.._ DUNE " 3, 2025
it /Town
page. Y State Zip Code Date of Inspection
D. System Information, (cont.)
4. Type of System:
Septic tank, distribution box, soil absorption system
C Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (it 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 and a copy of latest
inspection of'the Il/A system by system operator under contract
EJ Tight tank. Attach a copy of the DEFT approval.
Other(describe):
Approximate age of all components, date installed if known) and source of information:
7 YEARS, INSTALLED 2018, DESIGN PLAN
Were sewage odors detected when arriving at the site` El Yes EI No
5. Building Sewer(locate on site plan):
Depth below grade: 3'
feet
Material of construction:
El cast iron E 40 PVC F
I other(explain):
Distance from private eater supply well or suction line:
feet
Comments on condition of joints, venting, evidence of leakage, etc.):
JOINT'S AND VENTING OK
NO EVIDENCE OF LEAKAGE
t8insp.dee•rev,7/26/2018 title 5 Official Inspection Form:Subsurface sewage Disposal System w Page 9 of 18
Commonwealth of Massachusetts
Ti %tticiai Insp Oki
tle ection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 SUMMER STREET
Property Address
KERSTIN GERDI'NG
Owner Owner's Name
information is NORTH ANDOVER required for every MA 018,45 JUNE 231 2025
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
Depth below grade: 2
feet
Material of construction:
concrete F1 metal El fiberglass El polyethylene El' other(explain)
If tank is metal, list age.:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes El No
Dimensions: -.10'X 5 X 4'
Sludge depth: 411
Distance from top of sludge to bottom of outlet tee or baffle 3411
Scum thickness
6
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle 1311
��.ry
How were dimensions determined? SLUDGE JUDGE AND 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.):
RECOMMEND PUMPING SYSTEM' 'AN E
D CLANING F R
FILTER YEAH
PLASTIC INLET AND OUTLET TEES OK
OUTLET TEE HAS FILTER
MAN HOLE COVER OVER FILTER EXPOSED
TANK IS OK
LIQUID LEVELS GOOD
NO EVIDENCE OF LEAKAGE
t5insp.doc-rev,7/26/2018 Title 8 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
uommonwealth of Massachusetts
Ir"tie 5 OTTIciail inspection Foirm
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
j
404 SUMMER STREET
Property Address
Owner KERSTIN GERDINIG
Owner's Name
information is NORTH ANDOVER MA 01845 2025
required for every JUNE 231
page. City/Town State Zip Code Date of Inspection
D. f I nformation (cont.)
7. Grease Trap (locate on site plan,):
Depth below grade:
Material of construction:
El concrete 0 metal E:1 fiberglass, E:1' 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: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural, integrity,
I liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade*
Material of construction:
El concrete El metal fiberglass polyethylene El other(exp�lain),:
Dimensions:
Capacity:
gallons
Design Flow: ......
gallons per day
t5insp.doc-rev,7/2,6/2018 Title 5 Official Inspection Form,Subsurface Sewage Disposal'System-Page 11 of 18
Commonwealth of Massachusetts
'd 0 AM AV%k AP ANN' Ni
ve oll utticia I Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 SUMMER STREET
Property Address
KERSTIN GE RDING
Owner Owner's Name
information is NORTH ANDOVER MA 01845 2025
required for every -JUN E 231
page. City/Tolwn State Zip Code Date of Inspection
D. System, Information (cont,.),
8. Tight or Holding Tank (cont.)
Alarm present.- El Yes 0 No
Alarm level: Alarm in working order: ® Yes EJ N1 o
Date of last pumping: Date ............
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping, contract(required). Is copy attach�ed? El Yes, El No
9. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equ,al, any evidence of solid's carryover, any
evidence of'leakage into or out of box, etc.):
D-BOX IS LEVEL AND DISTRIBUTION' IS EQUAL
NO, EVIDENCE OF SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
........... .........
.......... ......____.........
..........
t5 insp.doc-rev.7/26/2018 Title 5 Official,Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Ilk Commonwealth of Massachusetts
""a N
fA Inspo%ection Form
I ine utficia
ti Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 SUMMER STREET
Property Address
KERSTIN GERDING
Owner -
Owner's Name
information is NORTH ANDOVER
required for every MA 01845 JUNE 231 2025
page. City/Town State Zip Code Date of Inspection
D. System Information (cont)
10. Pump Chamber(locate on site plan),:
Pumps in working order.- 0 Yes El No*
Alarms in working order: Z Yes 0 No*
Comments (note condition of pump chamber, condition of pumps and: appurtenances, etc.):
PUMP CYCLED ON THEN OFF
FLOATS OK
ALARM PANEL ON SIDE OF HOUSE OK
MAN HOLE COVER EXPOSED
If pumps or alarms are not in working order, system is a conditional pass.
11. Sail Absorption System (SAS) (locate on site plan, excavation not required).-
If SAS not located, expilain why:
...............
Type:
El leaching pits, number:
El leaching chambers number:
El leaching galleries number:
leaching trenches number, length:
leaching fields number, dimensions.-, 1; 15'X 50'
overflow cesspool number:
innovative/alternative system
Type/name of technology.-
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
luommonwealth of Massachusetts
■ MEN go awn ■
7 U Ufficial Inswl
tiel ection Form
�0 Subsurface Sewage splosal System Form of for voluntary Assessments
p
04 SUMMER STREET
fn-+n
Property Address
K RSTl N GEF DING
Owner Owner's Marne
information is NORTH TH AN DO VEI MA
required for every _ _ 4� �IF �, �fl��
page. City/Town State Zip Code Date of Inspection
Di. System,, Information (coat.
11. Soil Absorption System (SAS) (cunt.)
Comments (mate condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.)
SOIL AND VEGETATION OK
NO EVIDENCE OF HYDRAULIC FAILURE OR PON INN
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration - �
Depth top of liquid to inlet invert _
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction .
Indication of groundwater inflow Ell Yes E] N o
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.
t5in sp.dcc«revs. / 6f 018 Title 5 Official Inspection Form:Subsurface Sewage Disposal l System.Page 14 of 1
Commonwealth of Massachusetts
ON ANN,
ritle 51 Uo"",TTIcial Inspection Form
w.
Iry
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
N7ZJ V 404 SUMMER STREET
...........
Property Address
KERSTIN GERDING
Owner Owner's Name . ........
information,is NORTH ANDOVER MA 01845 JUNE 23 20,25 required:for every I
page. City/Town State Zip Code Date of Inspection
D. System I n format ion (co nt.)
13. Privy (locate on site plan),:
Materials of construction: ......
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydrau'lic failure, level of pon,dingi, condition of vegetation,
etc.):
t5insp.doc-rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of'Massachiusetts
fitle o Otticiial Inspecti"oni Form
Subsurface Sewage Disposal System Form Not for'Voluntary Assessments
404 SUMMER STREET
Property Address
KERSTIIN GERDING
Owner Owner's Name
information is NORTHANDOVER
required for every MA 01845 JUNE 23, 2025
I age. City/Town State Zip Code Date of Inspection
D. System Information (cont.,)
14. Sketch Of Sewage Disposal System:
Provide a view 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 suppily enters
the building. Check one of the boxes below,#
hand-sketch in the area below
drawing attached separately
ofs
JA,
0 11500
Love-KI
000 cjeT,t,(Oil
pt) r Tciyl
iminN
Ire,
0
moo mn
'79
t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 1,8
15 0
Commonwealth of Massachusetts
AM& OR Iwo 0
itle 5 otticiai insp ion Form
FA ect
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Lq
404 SUMMER STREET
Property Address
KERSTIIN GE,RDING!
Owner Owner's Name
information is NORTH AN MA 01845 JUNE 23 2025 quired for every I
page. City/Town State Zip Code Date of Inspection
D. System Information (co nt.)
15. Site Exam:
Check Slope
Surface water
Check cellar
Shallow wells
Estimated depth to high! ground water: feet
Please indicate all methods used to determine the high, ground water elevation:
Obtained from system design plans on record
If checked, date of design plan: reviewed: ,CAM" 20 18 .....
Date
Observed site (abutting property/observatioln hole within 150 feet of SAS)
Checked with local Board of Health - explain:
PLANS ON' FI'LE
Checked with local excavators, installers - (attach documentation)
EJ Accessed U'SGS database -explain:
You must describe how you established the high ground water elevation:
DESIGN PLAN ON FILE
Before filling this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
t;ommonwealth o�f Massachusetts
Am& an AM M
tA
to Title 5 utticial Insp&4%ection Foirm
>
l Subsurface Sewage Disposal System Form Not for Voluntary Assessments
404 SUMMER STREET
Property Address
KERSTIN GE if
Owner Owner's,Name
information is NORTH ANDOVER MA 01845 J'UNE 231 12025
required for every
page. City/Town State Zip Code Date of Inspection
E,. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
Z A. inspector information: Complete all fields in this section.
Z B., Certification: Signed & Dated and: 1, 21 3, or 4 checked
Z C. Inspection Summary:
11 21 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
Z D. System Information':
For 8: Tight/Holding, Tank— Pumping contract attached
For 1'4: Sketch of Sewage Disposal System drawn on pg�. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.cloc-rev.7/26/2018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 18 of 18
Summary Record Card generated erg 6/23/2025 8:06:44 AM by Nanny~Viens Page I
Noah Town of Andover
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11a Map i-F zlO-107,A-0022-0000,0
Parce,l Id 17848
404 SUMMER STREET
LARS & KERSTIIN GERDI ICI G
404 SUMMER STREET
NORTH ANDOVER MA 01845
Class 1101 Single Family Property Type I Residential
Size Total 1.01 Acres
FY 2025
UB Mailing Index
Name/Address Type Loan Nlumber Active/Inact. From Until
LARS&KERSTIN GERDING Owner Active
404 SUMMER STREET
NORTH AND OVER MA 01845
VARNUM JR,THE' MAS Previous Customer Inactive 10/27/2017
410 BLUE RIDGE ROAD
NORTH AND OVER,MA
01845
PTARMIGAN LLC Previous Customer Inactive 5/10/2019
4 MONTCLAIR AVENUE
ANDOVER MA 01810
LEIGH&JAME SMYSER Previous Customer Inactive 8/12/2021
404 SUMMER STREET
NORTH ANDOVER MA 01845
UB Accouint Maine.
Account No Cycle Occupant Name Active/Inactive
Bldg Id.14239.0-404 SUMMER STREET Last Billing Date 6/3/2025
2100235 02 Cycle 02 Active
UB Services Maint,
Account No.210,0235
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN'FEE 0.635/8 7.82
WTR WATER 01 ALL METER SIZE 76.001
UB Metes Maintenance
Account No.210,0235
Serial No Status Location Brand Type Size YTD Cons
49557826 a Active HH#404 b Badger w Water 0.6250.625 622
Date Readings Code Consumption Posted Date Variance
5/2/2025 893 a Actual! 20 6/12/2025 2%
2/5/2026 873 a Actual 21 3/13,/2025 -52%
1115/2024 852 a Actual 45 12/12,/2024 -30%
8/2/20214 807 a Actual 62 9/12/2024 203%
5/2/2024 745 a Actual 20 6/13/2024 -2%
2/2/2024 725 a Actual 21 3/14/2024 -29%
11/1/2023 704 a:Actual 29 12/13/2023 -36%
8/2/2023 676 a Actual 46 9/18/2023 71%
5/2/2023 629 a Actual 26 6/14/2023 23%
2/2/2023 603 a Actual 22 3/14/2,023 -59%
11/1/2022 581 a Actual 52 12/19/2022 -36%
8/3/2022 629 a Actual 83 9/20/2022 287%
5/3/2022 446 a Actual 21 6/21/2022 -1%,
2/2/2022 425 a Actual 22 3/15/20122 -45%
11/1/2021 403 a Actua 1 36 12/13/2021 .45%
8/10/2021 367 f Final Bill 76 8/12/20121 541%
5/6/2021 291 a Actual 11 6/15/2021 26%
2/4/2021 280 a Actual 9, 3/16/2021 -89%
11/3/2020 271 a Actual 82 12/16/2020 82%