HomeMy WebLinkAboutTitle V Inspection Report - 72 WINDSOR LANE 2/7/2008 577 Main Street
Hudson MA 01749
800-499-1682
WIND RIVER
E f
N VI
TITLE V OFFICIAL INSPECTION
PROPERTY ADDRESS- 72 Windsor Lane, Norte Andover_
PROPERTY OWNER'S NAME: Louis & Susan Polizzotti
PROPERTY OWNERS ADDRESS: 72 Windsor Lane
CRATE OF INSPECTIONS Januar 1 , 2008
NAME OF INSPECTOR: Ore Fuller
Commonwealth of Massachusetts c K
Title ffi i I Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated
611512000. Inspection forms may not be altered in any way.
A. Certification
Important:
When filling out 1. Property Information:
forms on the
computer,use 72 Windsor Lane
only the tab key Property Address
to move your Louis& Susan Polizzotti
cursor-do not Owner's Name
use the return
key. 72 Windsor Lane
�. Owner's Address
North Andover MA 01845
Cityrrown State Zip Code
1/29/08
Date of Inspection: Date
2. Inspector:
Greg Fuller
Name of Inspector
Wind River Environmental
Company Name
163 Western Ave — --
Company Address
Gloucester MA 01931
State Zip Code
City/Town
978-282-7315 _
Telephone Number
Certification Statement:
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ ends Furth r Evaluates by the Local Approving Authority
02 7 to
In p or ature 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 is a shared system or
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 should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****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.
1.29.08_72WindsorLane_NorthAndover.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 1 of 16
Commonwealth of Massachusetts
Title i i I Inspection
a Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
�N
A. Certification (cont.)
72 Windsor Lane
Property Address
North Andover MA 0_1845
Cityrrown State Zip Code
Louis & Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) 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:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
1.29.08 72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 2 of 16
Commonwealth of Massachusetts
Title f i i l Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
72 Windsor Lane
Property Address
North Andover MA 01845
City/Town ----- --- State Zip Code
Louis & Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
B) System Conditionally Passes (cont.):
❑ 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:
❑ 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:
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
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 3 of 16
Commonwealth of Massachusetts
Title i i I Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
72 Windsor Lane
Property Address
North Andover MA 01845
City/Town State Zip Code
Louis & Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
C) Further Evaluation is Required by the Board of Health (cont.):
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:
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 4 of 16
Commonwealth of Massachusetts
Title ffi i I Inspection
a Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
72 Windsor Lane
Property Address
North Andover _ MA 01845
City/Town State ZipCodn
Louis & Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
D) System f=ailure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:.
Yes No
El ® 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
El ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
El ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). 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.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 cofiform 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.]
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.
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•
Page 5 of 16
Commonwealth of Massachusetts
Title ff i i I Inspection
a Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
A. Certification (cont.)
72 Windsor Lane _
Property Address
North Andover _ MA 01845
City/Town
State Zip Code
Louis & Susan Polizzotti _ 1/29/08
Owner's Name Date of Inspection
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.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
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.
1.29.08 72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
_ Page 6of16
Commonwealth of Massachusetts
Title ff i i I Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
B. Checklist
72 Windsor Lane
Property Address
North Andover MA 01845
City/Town State Zip Code
Louis& Susan Polizzotti 1/29/08 _
Owner's Name Date of Inspection
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
YES NO
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ 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?
® ❑ 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:
® ❑ 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(3)(b)]
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-
Page 7 of 16
Commonwealth of Massachusetts
Title 5 Official
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information
72 Windsor Lane —
Property Address
North Andover MA 01845
Cityrrown State Zip Code
Louis & Susan Poliz_zotti 1/29/08 _
Owner's Name Date of Inspection
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual):
4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x##of bedrooms):
440
2
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
see attached
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump? ❑
Yes ® No
current
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ 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):
1.29.08 72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal Page 8 of 16
Commonwealth of Massachusetts
F Title i i l Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
�M
C. System Information (cost.)
72 Windsor Lane
Property Address
North Andover MA 01845
City/Town State Zip Code
Louis & Susan Polizzotti 1/29/08 _
Owner's Name Date of Inspection
General Information
Pumping Records:
Source of information: owner
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? pump truck/measured
Reason for pumping: to check the tank's structural integrity
Type of System:
® 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:
8/2/86
Were sewage odors detected when arriving at the site? ❑ Yes ® No
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 9 of 16
Commonwealth of Massachusetts
Tit i i nspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
72 Windsor Lane
Property Address
North Andover MA 01845
Citylrown State Zip Code
Louis& Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
Building Sewer(locate on site plan):
6"
Depth below grade: feet
Material of construction:
® cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Good clean joints Good venting No evidence of leakage
Septic Tank(locate on site plan):
1'6"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No
certificate)
10'6"x 5'8"x 5'8"
Dimensions:
12"
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 12"
3"
Scum thickness
Distance from top of scum to top of outlet tee or baffle
5"
Distance from bottom of scum to bottom of outlet tee or baffle
20"
How were dimensions determined? Sludge judge, Rod, Ruler
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 10 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection
a Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
�N
C. System Information (cont.)
72 Windsor Lane —
Property Address
North Andover _ MA _ 01845
City/Town State Zip Code
Louis & Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Service annually. Inlet and outlet baffles in good condition. Liquid level at 0 to outlet invert. No
evidence of leakage Tank is structurally sound
Grease Trap(locate on site plan):
Depth below grade: feet
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: 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.):
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):
1.29.08_72WindsorLane NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 11 of 16
Commonwealth of Massachusetts
Title ffi i I Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
72 Windsor Lane
Property Address
North Andover MA 01845
City/Town State Zip Code
Louis & Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
Tight or Holding Tank(cont.)
Dimensions:
Capacity: gallons
Design Flow: gallons per day
I
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.):
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 equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D Box is level and distribution is equal No evidence of leakage Minimal solid carryover.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal 9y2 of 16
Commonwealth of Massachusetts
Title Official Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
'GSM
C. System Information (cont.)
72 Windsor Lane
Property Address
North Andover MA 01845
City/Town State Zip Code
Louis & Susan Polizzotti 1/29/08
Owner's Name Date of Inspection
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
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:
®
1 20'x25'
leaching fields number, dimensions: @
❑ 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 is clean and dry. No signs of hydraulic failure. Normal vegetation.
1.29.08_72WindsorLane_NorthAnd over.doe•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 13 of 16
Commonwealth of Massachusetts
f Title i l l Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information (cont.)
72 Windsor Lane
Property Address
North Andover MA _ 01845
City/Town State Zip Code
Louis & Susan Polizzotti 1/29/08
Owner's Name bate of Inspection
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.):
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.):
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 14 of 16
Commonwealth of Massachusetts
Title i i l Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System Information (cont.)
72 Windsor Lane
Property Address
North Andover MA _ 01845
Cityaown State Zip Code
Louis & Susan Polizzotti _ 1/29108
Owner's Name Date of Inspection
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.
C
■
D
E
frront drive
war
AteaD = 21 ' EtoA = 611 ' C=9._ keg
BtoD = 7' EtoB = 66' A & B = 2' kaici
CtoD = 35' EtoC = 69'
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 15 of 16
Commonwealth of Massachusetts
Title f i i I Inspection
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
C. System information (cont.)
72 Windsor Lane
Property Address
North Andover MA 0184_5
CityfTown State Zip Code
Louis& Susan Polizzotti 1/29/08_
Owner's Name Date of Inspection
Site Exam:
Slope yes
Surface water no
Check cellar yes
Shallow wells no
Estimated depth to ground water: 41+
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: 8/2/86
Date
® 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)
® Accessed USGS database -explain:
maps
You must describe how you established the high ground water elevation:
Listed on plans as 51"to 54". Checked abutting properties and accessed usgs website maps of area.
1.29.08_72WindsorLane_NorthAndover.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 16 of 16
w
MAKE PAYMENTS TO; Billing
o',"I0- �N Information
TOWN OF NORTH ANDOVER (978)688-9550
° x 120 MAIN STREET "BEFORE
Reading Information
NORTH ANDOVER MA 01845 01/13/06 $38.33
978-688-9550 (978)688-9570
�SncNUSe�� OFFICE HOURS ACCOUNT NO. :BILLING DATE
Mon to Fri.
8:30am to 4:30pm 2100062-416704929 12/14/2005
RETAIN THIS PORTION FOR YOUR RECORDS SERVICE DATES DUE DATE
MOVING?PLEASE CALL 978-688-9570 I N CE 9/1/2005 - 11/30/2005 01/13/06
1 SERVICE ADDRESS
72 WINDSOR LANE
POLIZZOTTI,LOUIS �� TRANSACTION THIS PERIOD.`` AMOUNT
72 WINDSOR LANE Previous Balance 75.62
N.ANDOVER,MA Payments Through 12/14/2005 (75.62)
01845 Adjustments/Late Charges -
Interest as of: 1/13/2006 -
Balance Forward
Previous current Consumption Nb of Current Bzll DPt �] Usagel(Tnit A mount
Reading Readmg Days
WATER USAGE WATER 9 30.51
S 7C:i
11/3/05 ADMIN FEE 7.82
2 388 2397 9 Actual 85
Sub-Total 38.33
Total EMEMNS
MESSAGE
PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P .O. BOX
184 , MEDFORD, MA 02155
Water rate : First 20 units @ $3 . 39 Over 20 units @ $5 . 30
Sewer rate : First 20 units @ $3 . 81 Over 20 units @ $5'. 49
Bypass Meter Water rate : all units @ $5 . 30
NfKK RAYMENTS TO Billing
Information
TOWN OF NORTH ANDOVER (978)688-9550
p 120 MAIN STREET =BEFORE
Reading Information 04/12/06 $55.28
K , NORTH ANDOVER MA 01845
ry (978)688-9570
978-688-9550
�ssnctK�sti OFFICE HOURS ACCOUNT NO.....,<T :.:BILI TNG DATE .,
Mon to Fri.
8:30am to 4:30pm 2100062-416704929 3/13/2006
DATES, DUE,DATE , ,
RETAIN THIS PORTION FOR YOUR RECORDS 12/1/2005 -2/28/2006 04/12/06
MOVING? PLEASE CALL 978-688-9570 IN ADVANCE
', z SERV,IC�ADDRESS
72 WINDSOR LANE
POLIZZOTTI,LOUIS," T1tANSACTION"1T�I5'PERXUI�':„ :AIvIUNT;`
72 WINDSOR LANE Previous Ba ance 38.33
N.ANDOVER, Yn Through MA � Pa cents Th h Q3/13/2006 (38.33)
g
01845 Adjusthnents/Late Charges
Interest as of:4/12/2006 -
Balance Forward
xevtnus ent Nb of
,< . ..:h,. Corisurilptiott C7rrrenfAt11 Det`arl Tlsaae/(1mt Ainoun'
MAKE PAYMENTS TO Billing
r „aRTn Information
TOWN OF NORTH ANDOVER (978)688-9550
° x 120 MAIN STREET Reading Information ON OR 07/20/06 $55.28
NORTH ANDOVER MA 01845 (978)688-9570 BEFORE
978-688-9550
OFFICE HOURS ACCOUNT N0, BILLING DATE
��e NUS 's
Mon to Fri.
8:30am to 4:30pm 2100062-416704929 6/20/2006
i
SERVICE DATES DUE DATE
RETAIN THIS PORTIONFOR YOUR RECORDS 3/1/2006-5/31/2006 07/20/06
MOVING?PLEASE CALL 978-688-9570 IN ADVANCE
'.SERVICE ADDRESS ''
n 72 WINDSOR LANE
POLIZZOTTI,LOUIS l�\ I/ TRANSACTION THIS PERIOD AMOUNT
72 WINDSOR LANE 1 Previous Balance 55.28
ANDOVER,MA '� Payments Through 06/20/2006 (55.28)
N.
N.A / Adjustments/Late Charges
01845 pj Interest as of:7/20/2006
Balance Forward
Previous urrent Consumption Nb of Current Bill Detail Usage/Unit, Amount
Reading Treading;, Days ,
WATER USAGE WATER 14 47.46
/M6 5/25/06 ADMIN FEE 7.82
8 22 14 Actual 106
Sub-Total 55.28
Total
MESSAGE
PAYMENTS SHOULD BE MADE: TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX
184 , MEDFORD, MA 02155
Water rate : First 20 units @ $3 . 39 Over 20 units « $5 . 30
Sewer rate : First 20 units C $3 . 81 Over 20 units « $5 . 49
Bypass Meter Water rate : all units (a) $5 . 30
.. - T1 i ACTT TTTT TTI—. Y TT(T Tl n� T! NT 111T' 17 P A XIT,
MAKE P66YMENTS TO Billing
,AORT4 Information
TOWN OF NORTH ANDOVER (978)688-9550 ,
° x 120 MAIN STREET r ON OR
Reading Inforf ration BEFORE 10/13/06 $42 25
' NORTH ANDOVER MA 0 184 5 (978)688.!9570
x
978-688-9550 Eh OFFIC O S
Ss�CH„sE " // ACCOUNT N0. BILLING DATE
Mog to F i. f"
8:30a2 to :30pm 2100062-416704929 9/13/2006
i
SERVICE DATES DUE DATE
RETAIN THIS PORTION FOR YOUR RECORDS ` � 6/1/2006- 8/31/2006 10/13/06
MOVING?PLEASE CALL 978-688-9570 IN ADVANG SER VICE ADDRESS
1 72 WINDSOR LANE
POLIZZOTTI,LOUIS TRANSACTION THHIS PERIOD AMOUNT'
72 WINDSOR LANE Previous Balance 55.28
N.ANDOVER,MA
Payments Through 09/13/2006
55.28
N.ANDOVER, /Late Charges
Interest as of: 10/13/2006
Balance Forward -
Previous ugent Consumption Nb'of '(�xrent,RillD etAil °ilsage/Llnit Amount
Reading Reading Day's
WATER USAGE WATER 11 34.43
5'5 8i21/06 ADMIN FEE 7.82
22 33 11 Actual 88
Sub-Total 42.25
Total
MESSAGE
PAYMENTS SHOULD BE MADE: TOWN HALL u) 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O. BOX
184 , MEDFORD, MA 02155
Water rate : First 20 units @ $3 . 13 Over 20 units @ $4 . 84
Sewer rate : First 20 units @ $3 . 45 Over 20 units n $4 . 96
Bypass Meter Water rate : all units @ $4 . 84
OAKE PAYMENTS TO Billing
i ,,nerH Information j
TOWN OF NORTH ANDOVER (978)688-9550
x 120 MAIN STREET Reading Information ON OR 01/22/07 $36.10
NORTH ANDOVER MA 01 845 BEFORE
(978)688-9570
978-688-9550
OFFICE HOURS ACCOUNT NO. BILLING DATE
Mon to Fri.
8:30am to 4.3 pm 2100062-416704929 12/22/2006
SERVICE DATES DUE DATE
RETAIN THIS PORTION FOR YOUR RECORDS 9/1/2006- 11/30/2006 01/22/07
MOVING?PLEASE CALL 978-688-9570 IN ADVAN E ��� r
SERVICE A DDRESS
' 72 WINDSOR LANE
POLIZZOTTI,LOUIS 0 TRANSACTION THIS PERIOD A 42 2
MOUNT
72 WINDSOR LANE 2 I / Previous Balance ante 42.25
42.25
N.ANDOVER,MA / /
/// Payments Through 12/22/2006 ( )
01845 Adjustments/Late Charges 0.11
Interest as of: 1/22/2007
Balance Forward 0.11
Previous unetit Coi�sutnptiot Nb gf Current Bill Detail I Usage/Unit Amount
treading keadtng Days
WATER USAGE WATER 9 28.17
9;211:1 i<� 11i2i06 ADMIN FEE 7.82
42 9 Actual 73
Sub-Total 35.99
Total
MESSAGE
PAYMENTS SHOULD BE MADE: TOWN HALL ci 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX a P .O. BOX
184 , MEDFORD, MA 02155
Water rate : First 20 units @ $3 . 13 Over 20 units u� $4 . 84
Sewer rate : First 20 units aQ $3 . 45 Over 20 units n $4 . 96
BYpass Meter Water rate : all units u, $4 . 84
MAKE PAYMENTS TO Billing
Information
:±4°o� TOWN OF NORTH ANDOVER (978)688-9550
120 MAIN STREET ON OR
Reading Information 04/23/07 $42.25
NORTH ANDOVER MA)I�4 BEFORE
978-688-9550 ' (978)688 9570
OFFICE HOURS `'ACCOUNT NO, BILLING DATE
Mon to Fri.
8:30am to 4:30pm 2100062-416704929 3/23/2007
113 SERVICE DATES DUE DATE
RETAIN THIS PORTION FOR YOUR RECORDS 12/1/2006-2/28/2007 04/23/07
MOVING?PLEASE CALL 978-688-9570 IN ADVANCE
SERVICE ADDRESS
72 WINDSOR LANE
POLIZZOTTI,LOUIS TRANSACTION THIS PERIOD AMOUNT
72 WINDSOR LANE Previous Balance 36.10
N.ANDOVER,MA Payments Through 03/23/2007 (36.10)
01845 Adjustments/Late Charges -
Interest as of:4/23/2007 -
Balance Forward -
Previous Current Consumption Nb of Current B ll Detail Usage/Uliit Amount
Reading Reading Days.,
WATER USAGE WATER 11 34.43
I Ii2A!6 2/21/07 ADMIN FEE 7.82
42 53 11 Actual 111
Sub-Total 42.25
Total
i
MESSAGE
PAYMENTS SHOULD BE MADE : TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX a P.O. BOX
184 , MEDFORD, MA 02155
Water rate : First 20 units @ $3 . 13 Over 20 units @ $4 . 84
Sewer rate : First 20 units @ $3 . 45 Over 20 units n $4 . 96
Bypass Meter Water rate : all units @ $4 . 84