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HomeMy WebLinkAboutConditional Pass - Title V Inspection Report - 381 SUMMER STREET 10/17/2026 Commonwealth of Massachusetts � ,w .. ion T1*t1e 5 Offi"ci'al Inspect' Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 381 SUMMER STREET Property Address MARY ELLEN OwnerOwner's Name information is NORTH N ER A 5 OC E ,2 26 requiredfor every ...... ...._......_.,..._........ .M_W .._. ...,._... ...µ...... ..... .._...... _ .... _.w. __..� _.mm.....,.. . .......,. .a.. _... _...... .......n,.�M page. City/Town State Zip Code Date of Inspection checklistInspection results must be subm*Itted on this form. Inspectlion forms may not be altered 'in any way. Please see completeness Tn IAM k I Important.,When filling out forms A. Inspector Information on the carter, Todd Bates on use only the to .. ... ..� .. _.. ..... _�,... �_. .w_..._....._ _..�, ..�. key to move your Name of Inspector 3 2026 cursor-do not Bateson Enterprises Inc use the return key, Company Name Argilla Road Health -De _....._ ,...._ _.. _._ _.. ...m_..W._. .... ,._._ ... �.w. .. ..._..._.....____ .._ .�� Company Address Andover MA 081 City/Town State Zip Code 978-475-4786 SI-16 Telephone Number License Umber B. Certification certify that: I am a DEP approved system inspector'in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property list e the informationto s true, accurate and complete as of the time of my inspection-, and the inspection was performedbased n my training and experience in the proper function and maintenanceon-site sewage disposalsystems. "ter conducting this inspection I have determined that the system: 1. Passes 2. Conditionally Needs3. 0 Further Evaluation by the Local ApprovingAuthority Falls4. OCTOBER 0 2026 '�' �1YMWNYwk'u lns ,r's Signature Date The st inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health, r within s of coniplefing this inspection. If the system his a design flow of 101000 gpd or greater, the inspector n the systern owner shall submit the report to the appropriate regional office of the DEP.The original form should be seat to the system owner andcopies sent t the buyer, if'applicable, and the approving auth,ority. Please ,, Thi's report only describes conditions at the time ofinspection 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. t5lns , •rev, d'1 f 'ritie 5 o ciai inspection Forn SUbsurface Sewage p l System-Pegs I of 1 Commonwealth of Massachusetts rA ion Tlile 5 Ufficial Inspect' Form .. Subsurface Sewage Disposal System Form Not for`voluntary Assessments 381 SUMMER STREET Property Address OwnerName information is R MA 01845 OCTOBER 17, 2026 required for aviary CCTh AIQCJ�/� page• city/Town state Zip code date of Inspection C. Inspection Summary Inspection Summary. Complete 1, 2, 3, or 5 and all of 4 and 6. 1 System Passes: El I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 C:MR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2 System Conditionally Passes: FOW 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" (" , N, )for the following statements. If``net 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. 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 Wj N ND . plain below): t5insp.doc rev.5/19/2026 "title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 J#W& 'Lh of Massachusetts I Inspect"ion Form T!, T"Itle 5 u'ff'icia � Su bsu�r ace Sewn a Dis osa System For Voluntary, ��e��rnent .m:. 381 SUMMER STREET Property Address Owner Owner's NameNO ... information is 01845 OC TOBER �`, 2 2 required for every pageCity/Town State Zip Code Cate of Inspection C. Inspection Summary ( 2 System Conditionally Passes (cont.): 0 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 dine to broken or obstructed pipe(s) or due to e broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s) are replaced El Y El N 0 N (Explain below)- obstruction is removed El Y D N M NCB (Explain below): distribution box is leveled or replaced W ' E] N El ND (Explain below): - oX IS ROTTED AND NEEDS REPLACED The system required pumping more than 4 times e year due to broken or obstructed ipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are re� leoed [] Y [:1 D (Explain below): obstruction is removed F_� Y 0 N ND (Explain below)* 3 Further Evaluation is Required by the Board ofHealth: Conditions exist which require further evaluation by the Board of health in order to determine if the system is felling to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 C R 5.303(l)(b) that the system is n functioning ing n a manner which will protect public health, safety and the environment: t insp.d ac-rev. /1 /2026 Title 5 Official InspectionForm:Subsurface Sewa i po l System.Page 3 of 1 A04L t;ommonwealth of Massachusetts T'Itle 5 U'T't'*IcI"aI Inspecti"on Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 381 SUMMER STREET iv Property Address MARY ELLEN MCQUATE Owner Owner's,Name information is NORTH AND ER MA 01845 OCTOBER 17,2026 required for every page. City/Town State Zip Code Date of Inspection C. Inspection 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 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. El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. El 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 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 coliform 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 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El N 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.5/19/2026 Title 5 Official lrispecflon Form-,Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts x J� _ Title 5 Official Form t Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments N W 381 SUMMER STREET . Property Addiess MARY ELLEN MCQUATE Owner Owner's Name information is NORTH ANDOVER MA 01845 OCTOBER 17,2026 required for eery -- required City/Town State Zip Code• Date of Inspection C. Inspection Summary (cont.) , 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool g9 p Liquid depth in cesspool is less than 6" below invert or available volume is less El than 1/ Y da flow Required pumping more than 4 times in the last year NOT due to clogged or El obstructed i e s . Number of timespumped: p p � � .� El © Any portion of the SAS, cesspool or privy is below high ground water elevation. 0 A 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 I of a public water supply ® well. El 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. El ic 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 ppm, 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 gpd- El OR 9P 10,000 d. The system fails. 1 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 be considered a large system the system must serve a facility with a f design flow 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 C.4. 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 1:1 ❑ Area--IWPA)or a mapped Zone 11 of a public water supply well lap t51nsp.doc•rev.5/19/2026 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts icia ion I Inspect' Form J� T"Itle 5 Off* I> „r Assessments o Sub►surfac:e Sewage Di Disposal System Form Not � Voluntary 381 SUMMER STREET Property Address MARY ELLEN MCQUATE Owner Owner's Larne information is NORTH ANDOVER MA 01845 OCTOBER 17,2026 required for every ."fate �i (bode page. City/Town own ate of Inspection C. Inspection Summary (coat.) 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 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 Section CA shall upgrade the system in accordance with 310 CIVIR 15.304. The system owner should contact the appropriate regional office of the [department. 5. You must indicate "yea"' or"no"for each of the following for all inspections, Yes No K 11 Pumping information was provided by the owner, occupant, or Board of Health X Were any of the system components pumped out in the previous two weeps? FOR F� Has the system received normal flows in the previous two week period? El O 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 K El 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's X 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? Was the facility owner(and occupants if different from owner)provided with information on the maintenance of subsurface sewage disposal systems? proper The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Q Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Fart is at issue approximation of distance is unacceptable) 310 '15.' 0 (5)] pp p ) t ins .doc•rev.5/19/202 Title 5 Official Inspection Form Subsurface Sewage Disposal Systern*Page 6 of 18 Commonwealth of Massachusetts wTitle 5 Official Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 381 SUMMER STREET Property Address MARY ELLEN MCQUATE Owner Owner's Name information is NORTH ANDOVER MA 01845 OCTOBER 17, 2025 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 4 � Number of bedrooms (design): Number of bedrooms (actual): 600 GPD DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): Description: . 2 Number of current residents: Does residence have a garbage,grinder? ❑ Yes © No Does residence have a water treatment unit? El Yes K No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes W No information in this report.) Laundry system inspected? X Yes ❑ No Seasonal use? El Yes A No ATTACHED Water meter readings, if available (last 2 years usage (gpd)}: Detail: Sump pump? El Yes RE No CURRENT Last date of occupancy: Date t5lnsp.doc•rev.5/19/2026 Title 5❑flidai inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth Massachusetts I Inspect" T*Itle 5 Off'i*cia ion Form Subsurface Sewage Dlrsposal System Form - of for Volluntar,y Assessments 381 SUMMER STREET Property Address ARC'ELLEN MCQUATE Owner Owner's Name required for every title State......._ Zip ..Code _. Inspection .m.... _�._µ...._ _.._ Date of D. System Information (cont.) 2. Commercial/industrial Flow Cron ditionso. Type of Establishment: Design flow(based on 310 C R 15.2 3): Gallons per d Ca d Basis of design flow setspersons/sp. ., etc. .- __ __._...�._..�. ._... �..�.._. ..._.. ._.mm�....�.�.�...�...._.w_...__._....._.�_�._.�....�.�. _.__._ Crease trap present? 'es o Water treatment unit present? El Yes No If yes, discharges to* Industrial waste holding tank present's El Yes Ej N Ikon-sanitary waste discharged to the`title 5 system? Yes N Water meter readings, i f available. _...w ...,_�.. ._._..� ... . _.......�..o...W�...��_�__..w.. .._._.�....�__..___.___ µ._�..�rv..�__..�.__�_........ at e Last date of occupancy/use: ...­_.__.._.._.._........�__...._._�._..�.w ._______.__��. .._.___ .w.._.�.......,_ .�........ Other(describe below): 3. Pumping Records:, Sourceof information: ......_._..�._._.._._ ......_.�.._.�...___.._w�_.._._.._.��._.�._��._._w..___._. _ .._....�.._____� . ..�. ....��...� ..�_..w.�..._ Was system `m pumped as part of the inspection? El Yes K No Ifyes, volume pumped* ��w � _..�. ...� ..___... ..�_m_......_. ._.._ �..._.W__..w�_.__.__._�µ� _.. ..____.._.._........�.........�._.... ..._mm__ ._...�._.�. How was quantity pumped determined? �. _.._..�.. ...�....._�� _M_�..__�w..�. ... .� . .�_�....__..__......�_..�.._..�_�..w. .._�...... .,�__.._.�. .�._._ ____..._._. Reasonfor pumping: .. ..�.._....._ ..... ..__�.���a�_.W ___ _..________.. M._ .�.... .... _..�,_,.....��.._ _.... ....�.._�....__.._w_�..�._...� t In la. c-rev.5119120,260 Titie S,Official inspection F om Subsuriace Sewage Disposal System•Page 9 of 1 ` Commonwealth of Massachusetts T"Itle 5 u'ff"ic"ial Inspect'ion Form Subsurface Sewage Dilsposal System Form Not for Voluntary Assessments Address381 SUMMER STREET Property Owner Owner's Name required for ever M page. ate Zip Code_ m� ��t�of Inspection D. System Inform l° ors (cont.) 4. Type of System ,Septic tank, distribution box, soil absorption system El Single cesspool El 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 he obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract Tight tank.Attach a copy of the DEP approval, Other (describe): Approximate age of all components, date installed (if known) and source of information: 48 YEAR OLD SYSTEM, INSTALLED MAY 1978, AS BUILT PLAN Were sewage odors detected when arriving at the site? Yes No 5. Buillding Sewer (locate on site plan): 8" Depth below grade: .�e I e...�.�..w_. .�.. �.._... .......... .�._._.....w_�.__..�.__. ._. . ...._.._ .�m_._._.�mm.__._.�. Material of construction: El cast iron W 40 PVC other (explain)- Distance from private water supply well or suction line: - _�.�. .__....._�.._._.. _µ..�_. ...��_...._.._....____._.._a _ _.n_..._._...�. Comments mrrments (on condition of joints, venting, evidence of leakage, etc.): JOINTS AND VENTING OK NO EVIDENCE OF LEAKAGE t insF,doc.rev.5/19/2026 Title 5 Official Inspection Form—Subsurface Sewage Disposal System.P.age 9 of 1 > , L; monweal h of Massachusetts ■ a .0, -P T"Itle 5 uTncial Inspect"ion Form �e Subsurface Sewage Disposal System Paean Not for Voluntary Assessments , . 381 SUMMER STREET Ix+" V, .......... Property Address MARY ELLENCQ. E Owner Owner's Name information is NORTH ANDVER MA 01845 OCTOBER 17, 2026 required for every M c� page. Cityl�`own State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate can site plan): "" Depth below grade- feet Material of construction- concrete El metal El fiberglass El polyethylene other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach e copy of certificate) Yes 7 No " X 5" X " 511 Sludge depth.- 33"" Distance from top of sludge e to bottom ofoutlet tee or baffle 6"" Distance from top of scum to top of outlet tee or daffy _..w...___..--___...w___ __ _.M_......._.... _ .. .._ ...._.. 3"" Distance from bottom of scum to bottom of outlet tee or baffle _..._ w__�_._.a_..� _.�..� _.w..��_..._....._..._ .....� Sledge Judge, Tape Measure How e re dimensions determined? ._...�w._.__.. �_____ ._w_......M.na�___._....�.......__.....w._...� _.... ._... Comments (erg Pumping recommendations, inlet and outlet tea or baffle condition, structural integrity" liquid levels as related to outlet invert, evidence of leafage" etc.): RECOMMEND PUMPING OLDER SYSTEMS YEARLY CONCRETE INLET "LE AFFLES OK TANK IS OK Lily LEVELS GOOD t5in .doc•rev.5/19/2026 Title 5 Official Inspection Forma:Subsurface Sewage Disposal System.Page 10 of 1 U mmonwe lth of Massachusetts _ - T"Itle 5 For Off'icial I"��,. + ., `ubsurface Sewage Disposal System Form - Clot o Voluntary ssessrnents w .. 31 SUMMER STREET Property Address MARS'ELLEN MCQUATE Owner owner's Larne information is NORTH ANDOVER MA 01845 OCTOBER 17, 2026 required for every City/Town page Mate Zip Code Gate of inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet__ Material of construction: [I concrete El metal F7 fiberglass F� polyethylene E] 'other(explain): DimenSys s 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 p'umping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leafage, etc.): . Tight or Holding Taal (tank roust be pumped at time of inspection) (locate on site plan)- Depth pth below grade: Material of construction:. concrete metal F1 fiberglass polyethylene Ej other(explain). Capacity: w a i i�o _._.... gns r Design Flow: gallons per day t5insp.doc.rev.5f1 12025 Title 5 official inspection Farm:Subsurface Sewage Disposal System. 'age 11 of 1 Commonwealth of Massachusetts ciaInspectionors mow._ 1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 381 SUMMER STREET �M Property Address MAE Y ELL EN MCQUATE Owner Owner's Name information is NORTH AND OVER MA 01845 OCTOBER 1 , 2 2 required for evTer�! State �_______ � page. City/Town Zip Cede [date of Inspection D. System nform l on (cont.) . Tight or Holding Tangy (coat.) Alarm present: Yes No Alarm level: _. ._._-____.____._ _.__._ _...__.._.__ Alarm in working order. F� Yes [I No Cate of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached` El Yes No . Distribution Box (if present roust be opened) (locate on site plan): 0 Depth pth of liquid level above outlet invert 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-BOX IS NOT LEVEL DISTRIBUTION IS NOT EQUAL LIGHT EVIDENCE OF SOLIDS No EVIDENCE OF LEAKAGE D-BOX IS ROTTED AND NEEDS REPLACED t5inspa.doc•rev,5/1912026 Title 5 official Inspection Form.Subsurface Sewage Disposal.System.Page 12 of 1 f;} Commonwealth of Massachusetts 14 x 5 OfficialForm Title �M Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 381 SUMMER STREET � V Property Address MARY ELLEN MCQUATE Owner Owner's Name MA 01845 OCTOBER 17, 2026 information is NORTH ANt70VER 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: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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: El leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: 2q'iC 45' 0 leaching fields number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name-of technology: t5insp.doc-rev.6/19/2026 Title 5 official inspection Form:Subsurface Sewage❑isposal System•Page 13 of 18 y W uo 1 monwealth of Massachusetts Z Title 5 Off"Icl*al Inion �10 Subsurface Sewage Disposal SystemForm -Not for Voluntary Assessments Property Address "iA Y ELLEN f C QUATE Owner Owner's Name information is NORTH ANDOVER A 01845 OC TOTE 1 T, 026 required for every page. city/Town State :dip code Cate of inspection D. System Information (cont.) 11. Sail ,Absorption System (SAS) (coat.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL AND VEGETATION GOOD NO SIGN of HYDRAULIC FAILURE of Fro DII C 2. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth --top of liquid to inlet invert ___�.�..._ ____ _._M._.._._ .......------ Depthof solids layer ....�. ___.__._�._.....__.._ __..__.. ....�....._____ .�..._ Depth of scorn layer Dimensions of cesspool Materials of construction w..._...�.. _.._. � __�......_____._. Indication of groundwater inflow El Yes o Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. : t insp.doc•rev,5/1 g/2026 Title 5 Official Inspection Form Subsurface Sewage Disposal.System-Page 14 of 18 Commonwealth of Massachusetts Title r� ■Officials Assessments o Subsurface Sewage Disposal System Form Not for Voluntary, „ss ss 381 SUMMER STREET Property Address MA Y ELLEN M QUATE Owner Owner's fame information is NORTHANDOVER MA 01845 OCTOBER 17,2 required for every page city/Town State Zip code Date of Inspection D. System Information (coat.) 13. Privy (locate can site plan): Materials of construction: Dimensions Depth of solids comments (note condition of soil, signs of hydraulic failure, level of pondin , condition of vegetation, etc.): t5insp.doc-rev,5/1 /2026 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 15 of 18 i Commonwealth of Massachusetts _ T"Itle 5 Off*icia InspectionForm A n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 381 SUMMER STREET Property Address MARY ELLEN MCQUATE Owner Owner's Name information is NORTH ANDOVER MA 01845 OCTOBER 17,2026 required for every page, City/Town State Zip Code Date of inspection D. System Information (coat.) 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 'log feet. Locate where public water supply enters the building. Check one of the boxes below: N hand-sketch in the area below ❑ drawing attached separately 5" 1 Box 330 36 6 f 0 X570 7 tainsp.doc-rev.511912026 Title 5 official inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth f Massachusetts T*Itle 5 Off"Icl'al Inspection For _._ Subsurface Sewage Disposal System Form Not for Voluntary Assessments r _m 381 SUMMER STREET Property Address f ARY ELLEN MCQUATE Owner Owner's Name information is NORTHANDOVER MA 01845CT E 17, 2026 required for even Cit ..�_. State _. i page City/Town ode Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope FOW Surface water Check cellar Shallow wells Estimated depth to high ro n d water: het___ 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: ____�_____._ Cate Observed site (abutting property/observation hale within 150 feet of SAS) Checked with local Board of Health - explain: PLAINS of FILE Checked with local excavators, installers (attach documentation) Accessed USGS database -explain:. you must describe how you established the high ground water elevation: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist list on next page. t5insp.doc-rev.5/1 / Q S Title 5 Official inspection Form-Subsurface Sewage Disposal System*Page 17 of 18 Commonwealth of Massachusetts x x Title icial InspectionForrn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 381 SUMMER STREET Property Address MARY ELLEN MCQUATE Owner owner's Name information is NORTH ANDOVER MA 01845 OCTOBER 17,2026 required for every City/Town/Town State Zip Code Date of Inspection page. Y E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: 1❑ A. Inspector information: Complete all fields in this section. B. Certification: Signed &Dated and 1, 21 3, or 4 checked © C. Inspection Summary: 1, 21 3, or 5 completed as appropriate 4 (Failure Criteria) and 6(Checklist)completed 0 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 ti t5iosp.doc rev.5/1912025 Title 5 official Inspection Form:Subsurface Sewage❑isposai System•Page 18 of 18 Summary Record Card generated on 1011/2026 7:21:35 AM by Nancy Viens Page I Town of North Andover Tax Map # 21 Oval 07*A,*0166v*0000*0 Parcel Id 17991 381 SUMMER STREET CRAIG MCQUAT MARYELLEN MCQUAT 381 SUMMER STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type I Residential Size Total 1.01 Acres Fy 2026 UB Mai-fing Index Name/Address Type Loan Number Active/Inact. From Until CRAIG M'CQUAT Owner Active MARYELLS N MCQUAT 381 SUMMER STREET NORTH ANDOVER,MA 01845 MARINO JR.,JOSEPH E. PreviOUS CUStomer Inactive 6/25/2004 381 SUMMER STREET N,ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id.14279.0-381 SUMMER STREET Last Billing Date 9/4/2026 2100275 02 Cycle 02 Active UB Services Maint. Account No.2100275 Service Code, Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63518 7.82 1/ WTR WATER 01 ALL METER SIZE 236.57 /1 UB Meter Maintenance Account No.2100275 Serial No Status Location Brand Type Size YTD Cons 16336140 a Active E�RT HH b Badger w Water 0,6250.625 609 Date Reading Code Consumption Posted Date Variance 8/5/2026 3592 a Actual 49 9/11/2026 379% 5/5/2026 3543 a Actual 10 6/11/2026 -8% 2/4/2026 3533 a Actual 11 3/12/2026 -65% 11/5/2025 3522 a Actual 31 12/12/2025 -24% 8/6/2025 3491 a Actual 43 9/12/2025 157% 5/212025 3448 a Actual 15 6/12/2025 0% 2/5/2025 3433, a Actual 16 3/13/2025 -68% 11/5/2024 3417 a Actual 51 "12/1212024 70% 8/2/2024 3366 a Actual 29 9/12/2024 136% 5/2/2024 3337 a Actual 12 6/13/2024 3% 2/212024 3325 a Actual 12 3/14/2024 -2% 11/1/2023 3313 a Actual 12 12/13/2023 -71% 8/2/2023 3301 a Actual 38 9/18/2023 199% 5/11/2023 3263 a Actual 15 6/14/2023 -11% 2/2/2023 3248 a Actu a 1 16 3/14/2023 -76% 11/1/2022 3232 a Actual 65 12/19/2022 -10% 813/2022 3167 a Actual 74 9/20/2022 624% 513/2022 3093 a Actual 10 6/21/2022 -21% 2/2/2022 3083 a Actual '13 3/15/2022 -41% 11/1/2021 3070 a Actual 21 12/13/2021 -48% 8/4/2021 3049 a Actual 41 9/21/2021 305% 5/5/2021 3008 a Actual '10 6/15/2021 -31% 2/4/202,1 2998 a Actual 15 3/16/2021 -48% 11/3/2020 2983 a Actual 28 12/16/2020 -60%