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HomeMy WebLinkAboutTitle V Inspection Report - 24 CARLTON LANE 9/18/2014 Commonwealth of Massachusetts RECEIVED � Tule 5 Official Inspection Form i 2014, 4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessment bar �.)i-vo, a s a i'vE"ro A ' 24 Carlton Lane l l A T t()F➢` il� I rroperty­Address Donald Mendenhall OwnerOwner's Name_........__.._....__ _._._ ........__..____.____....�...__ _. information is Horth Andover Ma 01845 9/8/14 required for ...._..,,_--... ... ...._._.._,,.r., - every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. general Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Dean Dynan ----_.......--_----_.. cursor-do not use the return Name of Inspector key. Company Name VQ 2 Suntaug Street __........ Company Address Lynnfield __. ,, __- Ma 01940,__._ _ rerun City/Town State Zip Code 508-726-9935 SI 12837 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 's Signature Ins eckor � ......._-___ . ._� ___._ — a,,...... .......w..w .._ p 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•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is North Andover Ma 01845 9/8/14 required for every page. CityTrown State Zip Code Date of Inspection B. Certification (cant.) Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D A) System Passes: ® 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: 4 bedroom single family.dwelling with pipe in stone drainfield in working order 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-3113 Tilla 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts n F Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 918114 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpstalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 918114 every page. CitylTown State Zip Code Date of Inspection 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: 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 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 '/day flow I5ins-3113 Title 6 Official Inspection Form:S0surface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "c 24 Carlton Lane Property Address Donald Mendenhall Owner Owners Name information is required for North Andover Ma 01845 918114 every page. Cityfrown 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. ❑ ® 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 targe 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. i t5ins•3113 Title 5 official Inspection Form:Subsurface sewage D3 sposal System•Page 5 of 17 i 3 i Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 98114 every page. City/Town State Zip Code Date of Inspection 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? ❑ ® 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 NIA) ® ❑ 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 t5ins 3113 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 6 or 17 i i Commonwealth of Massachusetts v Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 98114 every page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 gallon tank with 1140 SF pipe in stone drainfield 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 90 gpd ave 9 ( Y 9 (gpd)): Detail: see attached for water usage Sump pump? ❑ Yes ® No occupied Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/personslsq,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: Oins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is North Andover Ma 01845 918114 required for every page. CityT town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: Homeowner I Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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 IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DI=P approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Foran: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 24 Carlton Lane Property Address Donald Mendenhall Owner Owners Name information is required for North Andover Ma 01845 918114 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 1982 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" 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.): building sewer in good condition no evidence of leakage Septic Tank(locate on site plan): 10" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 concrete tank within 10"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 11'X5'10"X510" Dimensions: 0 -5" Sludge depth: 15ins•313 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts x y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 918/14 every page. CityfTown 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 35" Scum thickness 0-3" 6'r Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? infield with measure stick and tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 gallon concrete septic tank with concrete baffle inlet and PVC T outlet / Tank in working order with separation from inlet to outlet / no evidence of leakeage Liquid at bottom of outlet invert recommend pumping every three to five years depending on usage and number of occupants 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 l5ins•3113 Title 5 Official Inspaclion Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 918114 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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): Dimensions: Capacity: gallons Design Flow: gallons per day 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is North Andover Ma 01845 918114 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0"above 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.): 16" x16" Concrete box level with four outlet pipes 1 some evidence of solids carryover 1 no evidence of leakage into or out of box Leach field pipes are orangeburg Pipe locator was inserted into leach field pipe with no obstruction D Box is 24" below grade 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts n _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 918/14 every page. City[rown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 20 X 55 +/_ ❑ 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.): Leach field found in green lawn area with slight slope so not to hold rain water 1 soils in good condition 1 no signs of hydraulic failure 1 no ponding/ no damp soild/ grass is uniform in good condition Leach field is a pipe in stone conventional system in working order Leach field is a gravity mound 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 t5ins•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts i v Title 5 official Inspection Form h Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 918114 every page. Cityrrown State Zip Code Date of fnspecfion 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): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins-V 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i Y 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is required for North Andover Ma 01845 918114 every page, City[Town State Zip Code bate of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately L L � L/6 6 64 n--a IS) ' t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage Disposal System f=orm - Not for Voluntary Assessments 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information equir for is North Andover required for Ma 01$45 918114 every page. Citylrown State Zip Code Date of inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 60t' fee Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1982 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: plans on file dated 1982 for 24 Carlton Lane Checked abutter 44 Carlton Lane ESHGW more than 4' as per info on title V siting Soil Maps dated 2011 no sump pumpin basement Before filing this Inspection Report, please see Report Completeness Checklist on next page. tains-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ''t 24 Carlton Lane Property Address Donald Mendenhall Owner Owner's Name information is North Andover required for Ma 01845 91$/74 every page. City/Town State fip Code Date of Inspection E. Report Completeness Checklist ® 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ',. . Summary Record Card generated on 812612014 9:17:48 AM by Karen Hanton Wage 1 Town of North Andover Tax Map # 210-107.A-0010-0000.0 Parcel ld 17836 24 CARLTON LANE MENDENHALL, DONALD 24 CARLTON LANE N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zon1ng2 1 Residential Zoning3 1 Residential Size Total 1.01 Acres FY 2015 UB Mailing Index Name/Address Type Loan Number Activellnact. From Until MENDENHALL, DONALD Payor 24 CARLTON LANE N.ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 14203.0-24 CARLTON LANE Last Billing Date 6/3/2014 2100197 02 Cycle 02 Active UB Services Maint. Account No.2100197 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63518 7.82 11 WTR WATER 01 ALL METER SIZE 38.00 11 UB Meter Maintenance Account No. 2100197 Serial No Status Location Brand Type Size YTD Cons 13242550 a Active ERT HH METE METE w Water 0.63 0.63 362 Date Reading Code Consumption Posted Date Variance 8/1/2014 610 a Actual 11 12% 5/5/2014 599 a Actual 10 6/12/2014 19% 214/2014 589 a Actual 9 3/17/2014 7% 10/31/2013 580 a Actual 8 12/20/2013 -26% 8/1/2013 572 a Actual 11 9/18/2013 -10% 5/1/2013 561 a Actual 11 6/18/2013 -12% 2/7/2013 550 a Actual 15 3/13/2013 47% 10/30/2012 535 a Actual 9 12/13/2012 -21% 8/3/2012 526 a Actual 12 9/26/2012 -35% 5/2/2012 514 a Actual 18 6/20/2012 16% 2/2/2012 496 a Actual 16 3/14/2012 -25% 11/1/2011 480 a Actual 21 12/15/2011 25% 8/2/2011 459 a Actual 17 9/14/2011 34% 5/2/2011 442 a Actual 12 6/13/2011 -34% 2!412011 430 aActua1 20 3/15/2011 -61% 11/1/2010 410 a Actual 48 12/13/2010 250% 8/3/2010 362 a Actual 14 9/13/2010 7% 5/3/2010 348 a Actual 13 6/9/2010 0% 2/1/2010 335 a Actual 13 3/11/2010 8% 11/2/2009 322 a Actual 12 12/11/2009 -17% 8/3/2009 310 a Actual 14 9/11/2009 35% 5/7/2009 296 a Actual 11 6/16/2009 -27% 2/3/2009 285 a Actual 15 3/16/2009 18% 11/3/2008 270 a Actual 13 12/10/2008 -36% 8/1/2008 257 a Actual 20 9/12/2008 23% 5/1/2008 237 aActual 15 6/18/2008 22% 2/6/2008 222 a Actual 14 3/14/2008 -28% 11/1/2007 208 aActual 18 1/15/2008 30% 8/3/2007 190 a Actual 14 9/14/2007 11%