HomeMy WebLinkAboutTitle V Inspection Report - 83 LOST POND LANE 8/2/2012 'romq OF NOF(11 ANDOVER
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Dean 0.Luseomb II& Sons
P.0,Box 135
Nfiddleton,M. 01949
078-774-4065
Licensed Plumber 420285
SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTIUN FORM
PROPERTY OWNERS NAME
//r
PROPERTY ADDRESS �•m;a
ADDRESS OF OWNER(ifaiff=t)
E.
DATE OF iNSPEcnON � � � �... � C"',
NAMEOFINSPECT0Rj2f_(, I-)
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QUALITY IS NIT vIBE.R ONE TO US.
Commonwealth of Massachusetts
Official Title 5
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2, 2012
required for State Zip Code Date of Inspection
every page. CitylTown
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: A. General Information
When filling out
forms on the
computer,use 1. Inspector:
only the tab key
to move your Dean G. Luscomb II
cursor-do not Name of Inspector
use the return
key. Dean G. Luscomb II & Sons
Company Name
P.O. Box 135
IL 10 Company Address
Middleton MA 01949
�nen Citylrown
State Zip Code
978-774-4065 S1848
Telephone Number License Number
B. Certification
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
❑ Needs Further Evaluation by the Local Approving Authority
August 2 2012
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 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.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2 2012
required for State Zip Code Date of Inspection
every page. Cityrrown
B. Certification (cont.)
Inspection Summary: ChecI A B,C,D or E/always complete all of Section D
A) System Passes:
S ® I have not found any information which indicates that any of the failure criteria described
/ in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ 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" (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 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.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2 2012
required for State Zip Code Date of Inspection
every page. Cityrrown
B. Certification (cont.)
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 ❑ Y ❑ N ❑ 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):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title e i
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2, 2012
required for State Zip Code Date of Inspection
every page. City/Town
B. Certification (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 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.
3. Other:
1
r
D) 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
a 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
❑ ® 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 Y2 day flow
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�M
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2 2012
required for
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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.
El ® 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 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 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
de ' n flow of 10,000 gpd to 15,000 gpd.
For large sys s, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Sectio
Yes No
❑ ❑ the system is wi 1 400 feet of a surface i ing water supply
❑ ❑ the system is within 200 fe f utary to a surface drinking water supply
❑ ❑ the system is located in I rogen s itive area(Interim Wellhead Protection
Area—IWPA) or a ped Zone II of a p 'c water supply well
If you have answered "yes"to an estion in Section E the system is c sidered a significant threat,
or answered "yes" in Section above the large system has failed. The own r operator of any large
system considered a si i cant threat under Section E or failed under Section all upgrade the
system in accordan ith 310 CMR 15.304. The system owner should contact the r` opriate
regional office o the Department.
t5ins-1 1110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
1M
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2, 2012
required for State Zip Code Date of Inspection
every page. City/Town
C. Checklist
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?
El ® 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(5)]
D. System Information
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 gpd
660 �' �• °��%'
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2 2012
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Owner and town
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
town water
Water meter readings, if available (last 2 years usage (gpd)):'1
Detail: �'_1 6h A
'�4 P av-
Sump pump? ❑ Yes ® No
Current
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of lishment:
Design flow(based on 0 CMR 15.203): Gallons per day(gpd
Basis of design flow(seats/person ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding to resent? ❑ Yes ❑ No
Non-sanita to discharged to the Title 5 system? ❑ Yes ❑ No
er meter readings, if available:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syste Page 7 of 17
Commonwealth of Massachusetts
Inspection Title 5 Official
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is
required for North Andover MA August 2, 2012
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
L s f occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Pumped every 1-2 yrs-owner
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
No need at this time
Reason for pumping:
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)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):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1y
83 Lost Pond Lane
Property Address
Madden
Owner Owners Name
information is North Andover MA August 2 2012
required for
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
System was installed in 1996, 16 yrs old -owner and town
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Ci Building Sewer(locate on site plan):
i
39
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.):
Main line and joints are in very good condition with no signs of any problems.
Septic Tank(locate on site plan):
Depth below grade: feet
/ Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
Precast rectangular concrete 1500 gallons
If tank is metal, list age:
y F
years
Ise confirmed by a Certificate of Compliance? (attach a Copyof certificate) o
5' Dx5'Wx10' L 1s00
Dimensions:
1"
Sludge depth:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2, 2012
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 34"
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle 6
Distance from bottom of scum to bottom of outlet tee or baffle
15"
How were dimensions determined? sticks 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.):
The septic tank and baffles are in very good condition. The solids in the tank are very light. The liquid
in the tank is running at it's correct working heigth. The tank does not require pumping at this time.
rease Trap (locate on site plan):
Depth be rade: feet
Material of construc
❑ concrete ❑ metal`°,- ❑ fiberglass ❑ polyethylene [5 other(explain):
Dimensions:
Scum thickness
Distance from top of scum to 100'8f outlet tee or baffle
Distance from bottonf of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Inspection Title 5 Official
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is
required for North Andover MA August 2, 2012
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments +pumping recommendations, inlet and outlet tee or baffle condition, structuTlinteoty,
liquid levels as rely utlet invert, evidence of leakage, etc.): —y
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Dep below grade:
Material o construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polZeEl er(exp lain):
Dimensions:
Capacity: aflons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: farm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of arm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title Official i
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is
required for North Andover MA August 2 2012
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
L� Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Zero"
/ 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 d-box is 44" below grade and is 16"x 16" square. it is structually sound and level. The liquid in
the d-box is running at it's correct working heigth. The soil in this area is clean and dry with no signs
of any problems
P mp Chamber(locate on site plan):
Pumps in wor rder: ❑ Yes El too
Alarms in working order: ❑— I_1 No
Comments (note condition of pump chamber, c io mps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
S.A.S. was located by d-box and level area of yard and asbuilt drawings.
t5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
Official Title 5 i
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
'0 83 Lost Pond Lane
M
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2 2012
required for State Zip Code Date of Inspection
every page. City/Town
D. System Information (cont.)
Type:
❑ leaching pits number:
5 5
❑ leaching chambers number:
❑ leaching galleries number:
® leaching trenches number, length:
3 -50' long
❑ 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.):
The S.A.S. is in very good condition with no signs of any problems. The soil in this area is clean with
no signs of ponding or breakout This area is covered with well maintained green grass.
i
C sspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and c ' uration
Depth —top of liquid to inlet I rt
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of ruction
In,d atlon of groundwater inflow ❑ Yes El No
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title Official i
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2, 2012
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
U Materials o struction:
Dimensions
Depth of solids
Comments (not dition of soil, signs of h ulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Official Title 5
Subsurface Sewage Disposal Sys m Form Not for Volunt Assessments
83 Lost Pond Lane
Property Address
Madden
Owner Owners Name Lr
information is
required for North Andover MA August 2, 2012
every page. CityFrown State Zip Code Date of Inspection
D. System Informatio cont.)
Sketch Of Sewage Di osal System: Provide a view of the sewage disposal system, including ties to
at least two perma nt reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public r supply enters the building. Check one of the boxes below:
hand-sketch in the area below
❑ drawing attached separately
�0L'rz C/
13toT_=9'01 15
Los Pend ,
141
-70
,�
��� R � Try .�
X ® Cl s.�r�G
-r�v-
b D-.p6k
v
r _
r
i
o
t
t5ins•11110 �� Pin ��t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is
required for North Andover MA August 2, 2012
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam: / L
® Check Slope
,�5� Pa d i�o 'Aw
® Surface water
® Check cellar 00 SCA"�o P"Mp
® Shallow wells I Ne ,
Estimated depth to high ground water: 11.5' below grade
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: 5-14-93 &4-25-95
Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Proposed, asbuilt and permit on file.
❑ Checked with local excavators, installers- (attach documentation)
® Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Deep hole test done 5-14-93 and 4-25-95 showed no ground water at 138" below grade and 140"
below grade. The basement is 8' below the grade of the front yard where the system is located, with
no water and no sump pump. Lost Pond sits to the far back of the property and is 24' below the
grade of the front yard where the septic system is located.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M
83 Lost Pond Lane
Property Address
Madden
Owner Owner's Name
information is North Andover MA August 2, 2012
required for g
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
X Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
08/06/2012 09:12 9786889573 WATER SEWER DEPT PAGE 01/02
Summery Roe*Card generated on 818 N2 8;51;07 AM by Meurenn McAuley page 1
Town of North Andover
Tax flap # 210-104.8-0218-0000.0
Parcel Id 16537
83 LOST POND LANE
MADDEN,ANNE
83 LOST POND LANE
NORTH ANDOVER, NIA
01845
Class 101 Single Family m Property Type 1 Rosldentl2l
Zoning2 1 residential Zoning3 1 Residential
Size Total 0.72 Acres
FY 2013
US Maii_lonc_!nd_ex
Nam®lAddress Type Loan Number Activeftact From Until
MADDEN,ANNE Payor
83 LAST POND LANE
NORTH ANDOVER,MA
01845
UB Account Ma_in_in_
Account No Cycle Occupant Name Activelinaetive
Bldg Id,18001.0.83 LOST POND LANE Last Billing Date 7/9/2012
$180030 03 Cycle 03 Active
UB Services Malint.
Account No,3180030
Service Code Rate Charge Multlpller/Users
MISCFEE ADMIN FEE 0.635/8 7,82 1/
WTR WATER 01 ALL METER SIZE 153.70 11
UB Meter Maintenance
Account No.3180030
Serial No Status Location Brand Typo Size YTD Cons
13242547 a Active 00 METE METE W Water 0.63 0.63 821
Date Reading Code Consumption Posted Date Variance
6/18/2012 12$8 a Actual 34 7/16/2012 58%
3/2012012 1204 a Actual 22 411412012 •14%
12119011 1182 a Actual 26 1/17/2012 .56%
9/16/2011 1156 a Actual 60 10/13/2011 78%
6/13/2011 1096 a Actual 32 7/20/2011 60%
3/1512011 1064 a Actual 20 4/13/2011 l •31%
12/15/2010 1044 a Actual 29 1/12/2011 -62%
9/16/2010 1015 a Actual 80 10/15/2010 127%
6/14/2010 935 a Actual 33 7/15/2010 t 68%
3/18/2010 902 a Actual 21 4/1412010 -26%
12/14/2009 881 aActual 27 1/1PJ2010 -38%
9/16/2009 854 a Actual 48 10/1512009 19°A
611 a Tcival 0:5 (/ZU 65%
311712009 771 a Actual 23 4/29/2009 -20%
12/15/2008 748 A Actual 28 1/20/2009 53%
9/16/2008 720 a Actual 65 10/10/2008 64%
6/10/2008 655 a Actual 38 7/16/2008 73%
3114/2008 617 a Actual 22 4/11/2008 •27%
12/17/2007 595 aActual 32 1/22/2008 .63%
9/14/2007 563 a Actual 79 10/12/2007 80%
6/20/2007 464 a Actual 49 7/20/2007 296%
3/1612007 435 a Actual 12 4/18/2007 43%
12/1312006 423 m Manual estimate 30 1119/2007 -65%
MSG
9/19/2006 393 a Actual 72 10/2012006 191
6/20/2006 321 a Actual 25 7/10/2006 9%
312012006 296 a Actual 19 4/17/2006 .11%
1/3/2005 277 a Actual 31 1/17/2006 -56%
9/1512005 246 a Actual 59 10/14/2005 42%
6/14/2005 187 a Actual 37 7/15/2005 90%