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HomeMy WebLinkAboutPASS - Title V Inspection Report - 301 SUMMER STREET 12/8/2025 Town of Noft Commonwealth of Massachusetts DECI 5 2025 •_ _ 1 eOfficial ForHeabI'1� f- 1.7 Subsurface sewage Disposal system FormNot for voluntary Assessments part ' 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover MA 01845 December 8,2025 required for every page. CitylTown 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:Men A. Inspector Information tilling out forms on the muter, use onlyQhe tab Benjamin"Janie"Prescott key to move your Name of Inspector cursor-do not DownEast Title V ins eGti©ns, LLC use the return Company Name key- PO Box 81 Company Address Rowley MA 01969 City/Town State Zip Cade 351)444-7672 S 113851 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 (31 fl CMR 16.000); l 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 this inspection I have determined that the system: 1, ® Passes 2. El Conditionally Passes 3. E] Needs Further Evaluation by the Local Approving Authority 4. E] Fails December 8,2025 Inspector' Signature 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 10,000 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 how the system will perform In the future under the same or different conditions of use. Wnsp.doc•rev.7/2612018 Tale 6 Official inspection Form:S€bsurfam Sewage Disposal System•Pace I of 1€3 Commonwealth of Massachusetts 5■ Official Inspecti 1 i —_ •, Titleon to W I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -° ; 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover MA 01845 December 8,2025 required for every page, Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2,3, or 5 and all of 4 and 0. 1) System Passes: ® 1 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: THIS SYSTEM MEETS THE REQUIREMENTS FOR A PASSING TITLE V INSPECTION AS DESCRIBED IN 310 CMR. 15.303. YEARLY CLEANING OF THE FILTER IN THE.SEPTIC TANK IS RECOMMENDED, 2) System conditionally lasses: ❑ 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","na,t or"not determined"(Y, N, ND)for the following statements. If"not determined,if 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. El Y ❑ N El ND(Explain below): Wnsp.doc t rev.7/2612018 Title 5 Ot iciat Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts 1S Title r• Subsurface Sewage Disposal System Form Not for Voluntary Assessments t , 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover MA 01845 December 8,2025 required for every page. Cityrrown state Zip Code Date of inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): El Pump Chamber pumpsialarms 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 box. System will pass inspection if(with approval of Board of Health): [1 broken pipe(s)are replaced Ej Y ❑ N Ej ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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): El broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed [1 Y ❑ N ❑ ND (Explain below): 3) 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. a. System will pass unless Board of Health determines In accordance with 310 CMR 16.303(l)(b)that the system is not functioning In a manner which will protect public health, safety and the environment: Wnsp.dvc•rev.7126/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 3 of 18 f 6 Commonwealth of Massachusetts i rp Title Official 10I .__ _ -- ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �t Summer Street Property Address Wark Owner Owner's Name information is North Andover MA 01845 December 8,2025 required for every page, City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) El 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. Systems will fall unless the Board of Health (and Public water Supplier, if any) determinos that the systems 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. El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. [l The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well, E] 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 fecal coliforrn bacteria indicates absent 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. 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 El 2 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5lnsp.doc►rev.7/2612018 Title 5 Offfclal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts -------- Twitle 5 Official Inspection For Subsurface Sewage Disposal System Form Not for Voluntary Assessments y 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover MA 01845 December 8,2025 required for every page. CityCTown state Zip Code Date of inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) 'des No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than S"below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipes). Number of times pumped: El 0 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. 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. ❑ ® 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprn, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpdw 101000 gpd. ❑ ® The system falls. 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 ghat will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flog of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No C] F-1 the system is within 400 feet of a surface drinking water supply ❑ 1:1 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—lVVPA)or a mapped Zone 11 of a public water supply well t5insp.doc•rev.7/2612018 Title 6 Official Inspection Form:Subsurfaoe Sewage Disposal System.Page 5 of 18 i C Commonwealth of Massachusetts z ., T itie 11 ion Subsurface Sewage Disposal System Form Not for Voluntary Assessments t ?; 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover ILIA 01345 December 8, 2025 required for every page, Cityrrown State Zip Code 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"yes"to any question in Section CA 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 Section CA shall upgrade the system in accordance with 310 CMR 15,304,The system owner should contact the appropriate regional office of the Department. 6. You must Indicate"yes" or"no"for each of the following for atf inspections: Yes No 0 El Pumping information was provided by the owner, occupant, or Board of Health D ED Were any of the system components pumped out in the previous two weeks? 0 ❑ 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 N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ( ❑ was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® C� 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? ® ❑ 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: ® E] Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) 310 CMR 15.302(5) t6insp.doc•rev.7/26/2018 Title 5 MOM Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts . - - V Title iiInspection rrl ii Subsurface sewage Disposal system Farm w Not for Volunta Assessments ry 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover MA 01345 December 8,2025 required for every page, Cityrrown State Zip Code Date of Inspection D. system Information 1. Residential Flaw Conditions: Number of bedrooms(design)., FOUR �- Number of bedrooms(actual): FGUR(!�)..— DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 GPD Description: PER THE DESIGN PLAN DATED AUGUST 16,2006, PREPARED BY MERRIMACK ENGINEERING SERVICES. Number of current residents: TWO (2) Does residence have a garbage grinder? ❑ Yes E No Does residence have a water treatment unit? ❑ Yes E No If yes,discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ED No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes 0 No Water meter readings, if available(last 2 years usage€gpd}�• SEE ATTACHED REPORT Detail: SEE ATTACHED WATER CONSUMPTION REPORT. Sump pump? 0 Yes ❑ No Last date of occu anc : CURRENTLY p Y OCCUPIED t6insp.dac•rev.712612018 Title 5 Official inspection Farm.Subsurface Sewage Disposal System-Page 7 of 18 S G Commonwealth of Massachusetts � dTi iciaFornrl � , Subsurface Sewage Disposal System Form Not for Voluntary Assessments �r + wI"i 1F .301 Summer ker Street Property Address Wark Owner Owner's Name information is North Andover MA 01345 December 8,2025 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Comm erciaillndustrial Flag Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day y(9p ) Basis of design flow(seatsfpersonsl'sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes,discharges to: Industrial waste holding tank present? ❑ Yes [1 No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): NIA 3. Pumping Records: Source of information: THE SYSTEM WAS LAST PUMPED ON OCTOBER 7, 20M Was system pumped as part of the inspection? Yes ❑ No If yes,volume pumped: 1,500 p gallons How was quantity pumped determined? PUMP TRUCK GAUGE q y Reason for pumping: CUSTOMER REQUEST t6insp.doc•rev.7t260018 Title 5 Offidal Inspection Fame:Subsurface Sewage Disposal System•Page 8 of 18 V Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal system Forms w Not for Voluntary Assessments 80 Summer Street Property Address Mark Owner C]wner`s Name information Is North Andover MA 01845 December 8,2025 required for every page, City/Town State Zip Code Date of inspection D. System Information (cont.) 4. Type of System: 1:1 Septic tank,distribution box,soil absorption system El Single cesspool 11 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)and a copy of latest inspection of the IfA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): SEPTIC TANK/PUMP CHAMBER, DISTRIBUTION BOX (D-BOX), SOIL ABSORPTION SYSTEM Approximate age of all components, date installed(if known)and source of information: THE AS-BUILT ON FILE WITH THE BOARD OF HEALTH IS DATED JANUARY 17,2007. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2,17 feet Material of construction: ❑ cast iron Z 40 PVC other(explain): Distance from private water supply well or suction line; N/A P PP y feet Comments (on condition of joints,venting,evidence of leakage,etc.): THERE IS NO EVIDENCE OF LEAKAGE AND THE BUILDING SEWER PIPE APPEARS TO BE IN GOOD CONDITION. t5insp.doc•rev.7/2612018 Tide 5 official Inspection Form:Subsurfeoe Sewage Disposal System•Page 9 of 18 L Commonwealth of Massachusetts � TitleIInspectionFor Ida Subsurface Sewage Disposal System Form M Not for Voluntary Assessments t ��r � . � 801 Summer Street Property Address Wark Owner Owner's Name information Is North Andover MA 01845 December 8, 2025 required for every page, GityCTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic"rank(locate on site plan): Depth belowgrade: 1.25 feet Material of construction: ® concrete [l metal [1 fiberglass [j polyethylene other(explain) If tank is metal, list age; years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) [l Yes [:] No Dimensions: 1 2`L x 5'W x 4`D 811 Sludge depth: e'� Ir Distance from top of sludge to bottom of outlet tee or baffle G3 Ort Scum thickness Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or bale NIA How were dimensions determined? TAPE MEASURE AND SLUDGE JUDGE Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK IS 15"BELOW THE CURRENT GRADE.THE LIQUID LEVEL IS NORMAL AND EQUALS THE OUTLET INVERT.THE INLET AND OUTLET PVC TEE'S ARE IN PLACE.THE FILTER IN THE OUTLET TEE WAS CLEANED DURING THE INSPECTION, THERE IS NO EVIDENCE OF LEAKAGE AND THE SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND. t5lnsp.doc-rev.712612018 Title 5 Official Inspection Form:Sohsorfaae Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts ... i icia 1 �'1 I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A. f'F`` 301 Summer Street Property Address wark Owner O mer's Name information is North Andover MA 01845 December 8,2025 required for every page, cityrrown State Zip code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete El 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): N/A 8. 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 per day t5insp.doe•rev.7126I2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page i i of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ell E Subsurface Sewage Disposal System FormNot for Voluntary Assessments 301 Summer Street Property Address Wark Owner er's Nave information is North Andover MA 01845 December 8,2025 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): NIA Attach copy of current pumping contract(required). Is copy attached? [l Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): off Depth of liquid level above outlet invert o 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.): THE DISTRIBUTION BOX(D-BOX) IS 12"BELOW THE CURRENT GRADE, IS IN GOOD CONDITION AND MEASURES 16"x 16". THERE IS A 2"SANITARY TEE AT THE INLET.THERE 18 EQUAL DISTRIBUTION BETWEEN THE FOUR (4) LINES LEAVING.THERE IS NO EVIDENCE OF SOLIDS CARRYOVER.THERE IS NO EVIDENCE OF LEAFAGE OR INFILTRATION AND THE D-BOX APPEARS TO BE STRUCTURALLY SOUND. THE OUTLET INVERTS ARE 22" BELOW THE CURRENT GRADE. t5lnsp.doc rev.712612018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System►Page:12 of IS Commonwealth of Massachusetts Title 5 Off Subsurface Sewage Disposal System Form -Not for Voluntary Assessments } ..t', ✓•'3f 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover MIA 01845 December 8, 2025 required for every page, City/Town state Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: E Yes ❑ No* Alarms in working order: 0 Yes [1 No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): THE FLOATS, PUMP AND ALARM ARE ALL IN WORKING ORDER. * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS)(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: leaching fields number,dimensions: ONE(1) 2g x 3? overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7126/2018 Title 5 Official Inspection Farm:5ubsurfaw Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts i Title Offidal Inspection �1 w� Subsurface sewage Disposal System Form -Not for Voluntary Assessments t � 301 Summer Street Property Address Wark Owner f3wner's Name information is North Andover MA 01845 December 8,2028 required for every page. City/Town State Zip Code Date of inspection D. System Information (cont.) 11. $oil Absorption System (SAS)(cont.) Comments (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THERE IS NO PONDING OVER OR SIGNS OF HYDRAULIC FAILURE WITHIN THE SAS, THE VEGETATION IS CONSISTENT WITH THE SURROUNDING AREA,THE SAS CONSISTS OF FOUR(4) LINES IN A LEACHING FIELD MEASURING 20'x 37'.THE BOTTOM OF THE SAS IS 28" BELOW THE CURRENT GRADE. 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 ❑ Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5Insp.doe•rev.7126f2018 Title 5 Oftiai Inspection Form:Subsurface Sewage€isposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspect _w Subsurfaco Sewage Disposal System Form M Not for Voluntary Assessments 301 Summer Street Property Address Wark Owner C)wner`s Name information is North Andover MA 01345 December 3,2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Priory(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,): N/A Wnsp.doc•rev.7/2612018 Title 5 olficiel Inspection Form:Subsurfaoe Sewage Disposal System r Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Iion For Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,�. ; 801 Summer Street Property Address wark Owner Owner's Name information Is North Andover MA 81845 December 8,2025 required for every page. cityrrown 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 too feet. Locate where public water supply enters the building.check one of the boxes below: 0 hand-sketch in the area below drawing attached separately tainspAoc•rev.712612418 Title 5 official Inspection Farm:S€rbsurfao&Sewage Disposal System•Page 16 of I Commonwealth of Massachusetts Title 5 Official Inspection Form W subsurface Sewage Disposal System -Not for Voluntary Assessments Ir• 301 Summer Street Property Address ark Owner Owner's Name information is North Andover MA 01845 December 8,2025 required for every page. Cityf"own state Zip Code Date of Inspection M system Information (cost.) 15. Site Exam: Check Slope ® Surface water ® Check cellar Shallow wells Estimated depth to high ground outer: 5 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: AUGUST 15,2005 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators,installers •-(aftach documentation) ❑ Accessed USGS database-explain: You must describe hour you established the high ground water elevation: SOIL TESTING WAS PERFORMED ON AUGUST 16,2006 AND ESHGW WAS DETERMINED TO BE AT 50"BELOW GRADE. PER THE DESIGN PLAN THERE IS 4'QF SEPERATION BETWEEN THE SAS AT ELEVATION 97.3 AND ESHGW AT ELEVATION 93.3. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lnsp.doc•rev.712612018 Title 5 official Inspection Form.Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface sewage Disposal System Form Not for Voluntary Assessments 301 Summer Street Property Address Wark Owner Owner's Name information is North Andover MA 01345 December 8,2025 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: ® A. inspector Information:Complete all fields in this section. ® B.Certification: Signed&Dated and 1,21 3,or 4 checked ® C. inspection Summary: is 2,3, or 5 completed as appropriate 4(Failure Criteria) and 6(Checklist)completed ® D.System Information: For S: Tight/Holding Tank Pumping contract attached For 14:Sketch of Sewage Disposal System drawn on pg. 15 or attached For 1 5: Explanation of estimated depth to high groundwater included Wnsp.doc"rev.//2612018 Tid!e 5 Official InsWfio i Form:Subsurface Sewage Maposa!System-Page 18 of 18 SUMMARY OF INVERTS BUILDING TIES SEINER 0 FDTN, 97.73 BLDG. CORNER AK9.9' D : THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK 1N 97.36 SEPTIC TANK 43.7 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT — PUMP TANK 44.7 SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK IN -- DIST, Box 48.7 AND ELEYATION OF THE EXISTING SYSTEM DIST. BOX IN 98.21 COMPONENTS, DIST. BOX OUT 98.03 END DIST. LINE 97.82 2 97,82 ►, 3 97.82 14 9 7,82 LOT ZA 1f H 11 p (47,861 S.F) SAND A v � 1 4R aXAN OUT DOMDQ 16A splc/pul p TANK 5� DIST. ` Box 2 aI flELo �1 SUMMER STREET AS BUILT PLAN OF 1 SUBSURFACE DISPOSAL SYSTEM-7,T _ a�y g'g LOCATED IN 3 NORTH ANDOVER, MASS./301 SUMMER STREET AS PREPARED FOR JACK SWIFT BATE: JANUARY 17, 2007 TM 107A SCALE: 1n=40' TL 178 Q za 40 sa MERRIMACK ENGINEERING SERVICES 68 PARK STREET ANDC VER, MASSA.0 HUSETTS 01810 —----------­---- -------- -------- ...........----------------- LOCUS 9A P 'vrCom Irv, �Ov�-f ITO f,�Sri'�M, X,�v 1-1'r!�VU- - ---------- ----------------------- ---------- -9"A+l, 70 A:---------------- .1y T j -------- 7 Pt --------------- f, ---------- 40 7......... .............. ------- ....... ... ....... .......­ ..................... ... ............. 3r jLw�, -­---------- ..................... I,P-.,w— Lv.,l I ................ ----------------------------------- ----------------------------------- ------------- ----------------- LEACH FIEW PUMP NOTES T'l nll�A�i... Ji ­Ca�ONL Gw,Fri iD, NOTES Oc�.,r Zo,,;�� 'IN Nl:51�1 I'l-"i 4411�F Arzla an:: flbyry l..cQc.-Ao dlzzi.2 M.;< le'7f C-sn -4T TO rjj%ry ----------- ..... .. q, LE40-SERIES --- fese RPM ;l<'ocrN)x V- , e�"A'rf -Y--------------- T Y, .......... ............... A.-V,'- 4-4- ........... - --------- ZP ------ --,F-.-vt NW.VA,.0, ------ ;N:.11,%­ !,­....... ........ 7 jo�Ago pof lr?­Ml:.. !A rfl+f.;�-.0w A-A��i�li ALL +':!A 7 vr 4,p-- <:-v DESIGN CALCULATIONS 4,k" pa e,"1! K ,d,�,k 4 QkLLDN COM90 OrTAR--vt ...­ z D—SOX Or-TAILS Z- ::MZ- --------- ix IZ; a-IrMl1w Njc..1!­` le;,f rEST RESULTS FERC TEST RESIM,$4. ?BEEF r ..................... 7, ............... ..... AML,�7 wry T L ......... .................... La P-c--wrf 77.i. o- ............ Pe,0-0, PLAN OF ............ ------ SUB-5URFA CP, SEWA GE D1,POSAL EM �!V —7- 4w =L I'All 12C­ 17, ................ -------- PLAN MERRW.CK WCENERNG SERWES 4 T ............. 4,K Summary Rewrd Card 0onerated on 12/412€326 12.6924 PM by Nancy Viens Pago I Town Of North Andover Tax Map # 210407-k-0170-4000-0 Parcel Id 17996 301 SUMMER STREET KATRINA WARK 01 SUMMER STREET NORTH ANDOVER MA 01$4 Class 101 Single Family property Type 1 Residential Size Total 1.1 Acres FY 2026 UB Malfing lnd,.C Name/Address Type Loan Number Activellnact, From Until KATRINA WARK Owner Active 301 SUMMER STREET NORTH ANDOVER MA 01845 SWIFT,JOHN A. previous Customer Inactive 1019/2006 301 SUMMER STREET N.ANDOVER,MA 01845 STEVEN TADIC Owner Inactive 7/812013 301 SUMMER STREET NORTH ANDOVER,MA 01845 STEVEN TAD1C Owner Inactive 12/18/2014 1029 S MAMMOTH RD.,UNIT 20 MANCHESTER NH 03109 U B Account Ma`tnt. Account No Cycle Occupant Name Activelinactive Bldg Id,14267.0»301 SUMMER STREET Last Billing Date 12/412025 2100263 02 Cycle 02 Active UB Services Maint. Account No.2100263 Service Cade Rate Charge Multlplier/Users MISCFEE ADMIN FEE 0.63 516 7.82 11 WTR WATER 01 ALL METER SIZE 281.36 11 UB Meter Maintenance Account No.2100263 Serial No Statue Location Brand Type Sloe STD Cony 32772934 a Active ERT HH b Badger w ouster 0.626 0,625 €349 Date Reading Code. Consumption Posted gate Variance 1115/2026 2748 a Actual 57 12/12/2025 -37% 81612025 2691 a Actual 96 9/1212025 121% s 5/212025 2595 a Actual 39 6/12/2025 7% 2i512025 2556 a Actual 39 3113/2025 -23% 111512024 2617 a Actual 62 12/12/2024 .5% 81212024 2465 a Actual 53 9/1212024 8% 51212024 2412 a Actual 48 611312024 18 2/212024 2364 a Actual 42 3114/2024 35'*/o 1111/2023 2322 a Actual 63 12/13/2023 55% 812I2023 2259 a Actual 37 9/18/2023 51% 6/11/2023 2222 a Actual 29 6114/2023 212/2023 2193 a Actual 30 3/14/2023 -52% 111112022 2163 a Actual 61 12119/2022 22% 81312022 2102 a Actual 51 9120/2022 138% 51312022 2051 a Actual 21 6/21/2022 -10% 2I212022 2030 a Actual 24 3/15/2022 -45% 1111/2021 2006 a Actual 42 1211312021 65% 8/412021 1964 a Actual 26 9/21/2021 43% 51512021 1938 a Actual 18 6/15/2021 "11%