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Home My WebLink AboutTitle V Inspection Report - 22 FULLER ROAD 11/20/2017 RECEIVED Commonwealth of Massachusetts Title 5 Official Inspection Form 0 )'j Subsurface Sewage Disposal System Form Not for Voluntary Assessments IMN OF NOR11-I ANDOVER KALTF1 int; ARTMENT 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for 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:When A. General Information filling out forms on the computer, use only the tab 1 Inspector: key to move your cursor-do not Neil J. Bateson use the return ""Name of Inspector ---__m_-._. key. ------- key. Bateson Enterprises Inc.___...__.._._ _d"--h ------------ vtry=A Company Name 111 Arqilla Road -Company Address AndoverMA 01810 ---------------------- Cityrrown State Zip Code 978-475-4786 SI-15 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: E Passes [j Conditionally Passes El Fails EJNeeo Further Evaluation by the Local Approving Authority 11-13-2017 Tnsjec 6r'st8ignatuW Date ---------------- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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 p 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,doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts a Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information i's every requireed for North Andover MA 01845 11/13/2017 page. CityCrown State Zip Code Date of Inspection B. Certification (cant.) Inspection Summary: Check A,B,C,D or E/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: 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.doc•rev.6116 Title 5 Clidal Inspection Form;Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11113(2017 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms 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 4y 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.doc•rev.6116 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 dip Code Date of Inspection page. CityrFown State B. Certification {coat.} 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 DFP 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 El ® 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 Mns.doc•rev.6/16 Title 6 Oficial 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 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No E] ® 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 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 El ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—1WPA)or a mapped Zone 11 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. t5ins.doc rev.6116 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 Y 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information Is required for every North Andover MA 01845 11/13/2017 page_ Cityrrown State Zip Code Date of Inspection l 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 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): NIA Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NIA 0 t5ins.doo-rev.6116 Title 5 Official Inspec€'son Form:Subsurface Sewage Disposal System•Page 6 of 17 o- � ` Commonwealth of Massachusetts Title�B~°.�N�� N N��*�� N�@�� »� N0��N��0 0wm��*��N��mm Form ' SmbsurfacwSewaBmDUsposmUSyaWennFornm -NotfurVo|unbaryAsseoomento 22Fuller Road Property Address Bill Masterson Owner Owner's Name information is req u!red for every North Andover MA 01845 11/18/2017 Code Date of Inspection page, ~'v''~`^^ State Zip D. System Information Description: 2 Number ofcurrent residents: Does residence have mgarbage grinder? 0 Yes El No � Is laundry on a separate sewage system? (Include laundry system inspection �7 Yes �� No informoUon |nthis nypo�.) -- -- Laundry system inspected? El Yon Fl No 8eaaona| une? El Yea E No Water meter readings, ifavailable(last 3years usage(gpd)\: Yee Detail: Sump pump? Yes No Current Last date ofoccupancy: Date Commmerciwll]mdustrUmUFlww Conditions: Type ofEstablishment: ----- Design flow(based un31UCMR 1S.2O3): Gallons per day(gpd) Basis ofdesign fkmv na/aq.fL. et .): Grease trap F� Yea [� No Industrial waste holding tank present? 0 Yen F] No Non-sanitary waste discharged buthe Title 5system? El Yes Fl No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2014, owner _ Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees 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): 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Dispose$System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information isNorth Andover MA 01845 11/13/2017 required for 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: Originals stem, owner, Outlet tee &d-box was replaced in 2006 Were sewage odors detected when.arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1.7 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.): 4" cast iron through wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): 0.7 Depth below rade: 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 certificate) ❑ Yes ❑ No Dimensions: 10' x 5'x 4' 211 Sludge depth: t5lns.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page S or 17 s Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposals System Form - Not for Voluntary Assessments Y ° 22 Fuller Road Property Address Bill Masterson Owner Owner's Name e information is required for every North Andover MA 01845 11/13/2017 page Cityrrown 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 31" 2" 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 13" How were dimensions determined? 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.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Pumped septic tank. 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: 15ins.doc•rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Vo untary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) [[ Comments (on pumping recommendations, inlet and oGtlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): E 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 i tsins.doc-ray.fills Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 is Commonwealth of Massachusetts Title 5 Official Inspection Form g Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for every page. Cityfrown 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 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 level &distribution equal, has flow levelers. No evidence of leakage. Evidence of carryover, pumped d-box to clean 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.): 9 * 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: i t5ins.doe•rev.6116 Title 5 Oficial[nspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 22 Fuller Road Property Address Bill Masterson Owner Owners Name information is North Andover MA 01845 11/13/2017 requireq for every page. Cityrrown Stats 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 filed 18'x ' ❑ overflow cesspool number: ❑ innovative/alternative system Typetname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok: Vegetation ok. No sign of ponding to surface. 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owners Name inforrna{ion is North Andover MA 01845 11/13/2017 required for every page. CitY/Town State Zip Code Date of Inspection D. System Information (cant.) 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.doc-rev.6116 Title 5 Oficial 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 t y 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 dip Code Date of inspection page. City/Town State 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 3 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is North Andover MA 01845 11/13/2017 required for every page. Citylf'own State Zip Code Date of inspection D. System Information (cont.) Site Exam: ❑ Check Slope ® Surface water ® Check cellar ® Shallow wells >4 Estimated depth to high ground water: 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: Date ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Essex County Soil Map. You must describe how you established the high ground water elevation: Essex County Soil Map, Sheet#,*36, Hinckley Soil, Water> 6' Deep Before filing this Inspection Report, please see Report Completeness Checklist on next page. t51ris.doe rev.6116 Title 5 Official Inspection Form:Subsurface Sawagn Disposal System•page 16 of W Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 22 Fuller Road Property Address Bill Masterson Owner Owner's Name information is required for every North Andover MA 01845 11/13/2017 page. Citylrown State Zip 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.doc•rev.6116 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts C4[rown of System Pumping-Record Form 4 DEP has provided this form for use-by local Boards 6f-Health. Other forms may'be'used, but the information-must be substantially the same as that provided here. Before using.this form.,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted.to the local.Board of Health or other approving authority. A. FacElity lnfortinatlon t. System Lacatio Righ t, ou Left!Right rear of house, Left/right side of house, Left I Right side of bulfi� , Left!Ri hit front of buildiri Left 1 Right rear 9 9 g 9. 9 cif building, Under deck • Address cwrown State _ Zip Code I System Owner. Name' Address(if different from location) Cityfrown trip Cade r i� Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons �� 3. Type-of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4.. Effluent Tee Filter present? ❑ Yes am If yes, was it cleaned? ❑ Yes ❑ No, ' 6. Condition of System: 6: System Pumped By: Nell.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc, Company 7. Low e contents-were disposed: Lowell Waste Water SignfifelhuI Date 5form4.doa•08103 System Pumping Record•Page 1 of 7 Summary Record Card generated on 10/30/2017 2:43:19 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-065.0-0073-0000.0 Parcel Id 9931 22 FULLER ROAD MASTERSON, WILLIAM 22 FULLER ROAD N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1,21 Acres FY 2018 UB Mailing Index Name/Address Type Loan Number Activelinact. From Until MASTERSON,WILLIAM Payor 22 FULLER ROAD N,ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Activelinactive Bldg Id. 17215.0-22 FULLER ROAD Last Billing Date 10110/2017 3160293 03 Cycle 03 Active UB Services Maint. Account No.3160293 Service Code Rate Charge Multipl€erlUsers MISCFEE ADMIN FEE 0.63 518 7.82 11 WTR WATER 01 ALL METER SIZE 563.25 li UB Meter Maintenance Account No.3160293 Serial No Status Location Brand Type Size YTD Cons 32707569 a Active 00 b Badger w Water 0.63 0.63 2091 Date Reading Code Consumption Posted Date Variance 9/7/2017 2659 a Actual 108 10/18/2017 168% 6/5/2017 2551 a Actual 39 7/25/2017 324% 3/8/2017 2512 a Actual 9 4/12/2017 -66% 12/712016 2503 a Actual 27 1/23/2017 -89% 9/6/2016 2476 a Actual 260 10/24/2016 799% 6/3/2016 2216 a Actual 28 8/2/2016 274% 3/3/2016 2188 a Actual 7 4/22/2016 -88% 12/8/2015 2181 a Actual 63 1/20/2016 -43% 9/4/2015 2118 a Actual 105 10/16/2015 102% 6/5/2015 2013 aActua1 52 7/24/2015 378% 3/6/2015 1961 a Actual 11 4/28/2015 -81% 12/4/2014 1950 a Actual 53 1/15/2015 -56% 9/9/2014 1897 a Actual 133 10/15/2014 454% 6/6/2014 1764 a Actual 23 7/16/2014 22% 3/7/2014 1741 a Actual 19 4/11/2014 -48% 12/512013 1722 a Actual 36 1/17/2014 -32% 9/6/2013 1686 a Actual 52 10/15/2013 72% 6/1012013 1634 a Actual 33 7/24/2013 70% 3/6/2013 1601 a Actual 18 4/22/2013 -35% 12/7/2012 1583 aActual 29 1/9/2013 -71% 9/5/2012 1554 a Actual 99 10/15/2012 308% 6/6/2012 1455 a Actual 24 7/16/2012 39% 3/8/2012 1431 a Actual 18 4/1412012 42% 12/5/2011 1413 a Actual 12 1/17/2012 -86% 9/712011 1401 a Actual 89 10/13/2011 250% 6/6/2011 1312 a Actual 26 7/20/2011 83% 3/3/2011 1286 a Actual 13 4/13/2011 -76% 12/6/2010 1273 a Actual 56 1/12/2011 -73% 9/7/2010 1217 a Actual 219 10/15/2010 237%