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Home My WebLink AboutTitle V Inspection Report - 365 CANDLESTICK ROAD 4/19/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison Owner Owner's Name information is North Andover MA 01845 4-10-2018 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. tllu ...... pm tuA Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your ��gOZ cursor-do not Neil James Bateson use the return Name of Inspector key. Bateson Enterprises Inc. Company Name 111 Arqilla Road Company Address Andover MA 01810 .............. City/Town 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 6(310 CMR 15.000).The system: F] Passes 0 Conditionally Passes ❑ Fails E] N ds urther Evaluation by the Local Approving Authority N d urthe a 4-10-2018 ITnspecr's ignature 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 2 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. t6ins.doc•rev.6116 Title 5 official inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts �N�� N N�� U�N�� Title �� »� � ��N�� Inspection Form ^ Subsurface Sewage Disposal SysiwnmPornn -NotforVo|untmryAseemarngnta J65Candlestick Road Property Address VViUim[n Davison Owner Owner's Name information is required for every North Andover N1/\ 01845 4-10-2018 ��_ page. "'v''"~'' _, __- -_- — Inspection _ B. Certification (cont.) Inspection Summary: Check A.B.C.0 or E/a/maays complete all of Section D AJ System Passes: F-1 | have not found any information which indicates that any ofthe failure criteria described |n31OCMR 15.3O3o[|n31OCMR 15.3D4exist. Any failure criteria not evaluated are indicated hm|nvv. Comments: B\ System Conditionally Passes: One nrmore ovatem :onnponentaoedescribed |nthe"CundiUona| Pass" aoohoOneed t0be -- replaced mrrepaired. The system, upon completion ofthe replacement nrrepair, eaapproved 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 unmound, exhibits substantial infiltration orexfiknstion ortank failure is imminent, System will pass inspection if the existing bank is replaced with o complying septic tank an 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. Fl y N [l ND (Explain below): wm~o�'=°owo m�uum"am"�"�np��o��^�°o="o uw�o up*m'pgeemn | ^ � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison ------- Owner Owner's Name information is required for every 'North Andover ----—-- MA 01845 4-10-2018 page. City/Town o-w—n -- State Zip Code Date of 1nsp�e�tion .......... 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 [Z N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y E N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y M 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 Z N ❑ ND (Explain below); F-1 obstruction is removed ❑ Y E 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 t51ns.doc rev,6116 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts u =_: Title 5 official Inspection Form _ =n Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'° 365 Candlestick Road Property Address William Davison Owner Owner's Name isrequired for every ry NohAndoyer _.._,...___ Sa - 0045 0 18 page. YrtState ip8ode Date Inspection �._. B. Certification (cant.) 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. Q 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: Outlet tee in septic tank&d-box needs to be replaced i 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 El N 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 flaw t5ins.cloc rev.6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 | � ' Commonwealth of Massachusetts ��"��N�� .��/��0 0��~�� U��V Title �� y� � ��*�� Inspection Form ' Subsurface Sewage Disposal System Form ~Not for Voluntary Assessments 385Candlestick Road 'Property Address William Davison Owner Owner's Name ' information is required for every North Andover MA 01045 4-10-2018 _ page. ~'`,'^`~^ State —' Code Date of Inspection B. Certification (c0Dt.) Yes No Required pumping more than 4times inthe last year NOT due toclogged nr [� [� -- �� ubatruobodp|pe/e\. Number oftimes pumped: ____. Anyportionofthe SAS, cesspool orprivy iebelow high ground water elevation. Fl �� Any portion ofcesspool orprivy iswithin 100feet ofa surface water supply or tributary toasurface water supply. Fl �� Any portion ufacesspool orprivy iewithin mZone 1ofepublic well. El E Any portion of a cesspool or privy is within 50 feet of a private water supply well. El 0 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 ifthe well water analysis, performed mtaDEP certified laboratory,for fecal coliform bacteria indicates absent and the presence afammonia nitrogen and nitrate nitrogen Us equal tmorless than 6 ppm, provided that noother failure criteria are tdQgered. A copy mfthe analysis and chain mf custody must bwattached bmthis formm.1 The system ioa cesspool serving afacility with odesign flow of2OOOgpd- 10.000gpd. �� system�y�t� falls. | 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 ofHealth todetermine what will be necessary hncorrect the failure. � � E) Large Systems: To beconsidered olarge system the system must serve afacility with a design flow mf1@,00Ogpdto15,00O0pd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions inSection O. Yes No El n the system inwithin 4DUfeet ofmsurface drinking water supply F7 n the system is within 200 feet of a tributary to a surface drinking water supply Fl �l the system imlocated iDanitrogen sensitive area(Interim VVeUheadProtecUon �� Area—|VVPA\ oramapped Zone \| ofapublic water supply well If you have answered "yes" to any question in Section E the system is considered asignificant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large � system considered asignificant threat under Section E orfailed under Section Dshall upgrade the system inaccordance with 31OCMR 15.304. The system owner should contact the appropriate regional office ofthe Department. no°no�u°/moSubsurface o = °m°°"°mwpage m�u�'m~.mnv Commonwealth of Massachusetts ��N�� .��N 0��*��°�� U�� Title �� VN � �� Nmm��0��mm Form ^ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3U5Candle-stick Road roperty Address William Davison Owner Owner's Name information is required for every North Andover MA 01845 4-10-2018 Code Date of Inspection page. ~y''~~'' State Zip C. Checklist Check if the following have been done, You must indicate"yes" or"no" as to each of the following: Yes No 0 171 Pumping information was provided bvthe owner, occupant, orBoard ofHealth Fl 0 Were any ofthe system components pumped out inthe previous two weeks? �� Fl Has the system received normal flows \nthe previous two week period? [� d [� Have |argevolumes ofwater been introduced tothe system recently oraapauf �� this inspection? � �� ` VVaxaaabuilt p|anaofthe systernobtained and examined? (lftheyvvenenot � �� available note anNA\) �� Fl Was the facility mrdwelling inspected for signs Ofsewage back up? Was the site inspected for signs Vfbreak out? Z Fl Were all system components, excluding the SAS, located onsite? �� 171VVenathemmptictamkmanho|esuncovenad. opened. mndthe |nbariorofUhebank �- -- inspected for the condition of the baffles or tees, material of construction, dimensions, depth 0fliquid, depth ofsludge and depth Ofscum? VVasthe faci||tvowner(andoccupants ifdifferent from nwnehprovided vvith � Z 171 \nformaUono ^thapro `ernnmintanonmapfmubou�ooesewag' disposal systems? ' The size and location ofthe Soil Absorption System (SAS) onthe site has been determined based on: Z Fl Existing information. For example, a plan at the Board of Health, Determined inthe field (if any ofthe failure criteria related toPart Ciemtissue Z 171 approximation ufdistance |aunacceptable) [31OCMR 15.3O2(5)l D. System Information Residential Flow Conditions: 4 Nunnberofbedroorne /deaign\: N/A Nun0bnrnfbedronnOa (ao�um|\: ----------- N/A OE8{<�N �owbased on31OCK8R15.2O38nn (for bedrooms): --------- m�oommmm�o*w"mm�s�=��a~w�opup�ma�mm'p�mem« o�"�`°.�a ---- &\ Commonwealth of Massachusetts ---------- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 365 Candlestick Road iProperty Address William Davison Owner Owner's Name information is required for every North Andover MA 01845 4-10-2018 page. City[Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2_____ Does residence have a garbage grinder? F1 Yes Z No Is laundry on a separate sewage system? (Include laundry system inspection n Yes Z No information in this report,) Laundry system inspected? ❑ Yes ❑ Na Seasonal use? El Yes No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: --_ -�_ Sump -------- Sump pump? El Yes Z No Current Last date of occupancy: 7Date 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 F1 No Industrial waste holding tank present? ❑ Yes n No Non-sanitary waste discharged to the Title 5 system? El Yes 0 No Water meter readings, if available: 15insAoc-rev.6116 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 365 Candlestick Road Property Address William Davison Owner Owner's Name information is required for every North Andover MA 01845 4-10-2018 page. Cltyfrown State Zip Code Date of Inspection ®. :system Information (cont.) Last date of occupancy/use: —-------- Other(describe below): ............. .......... General Information Pumping Records: Pumped 2016, owner Source of information: —--------- ------- Was system pumped as part of the inspection? 0 Yes Z No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: z Septic tank, distribution box, soil absorption system El Single cesspool n Overflow cesspool El 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): Wns.doo rev.6116 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 365 Candlestick Road PropertyAddress William Davison Owner Owner's Name information is North Andover MA 01845 4-10-2018 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: 27 Years old, 5-18-1991, as buuilt plan Were sewage odors detected when arriving at the site? El Yes [D No Building Sewer(locate on site plan): 2.6 Depth below grade: feet Material of construction: Z 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 floor, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): 1.6 Depth below grade: 'ieet Material of construction: Z concrete ❑ metal El fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) n Yes E] No 10' x 5' x 4' Dimensions: Sludge depth: 15fns.doc rev.6116 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 365 Candlestick Road ........ Property Address William Davison Owner Owner's Name information is required for every North Andover MA 01845 4-10-2018 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 N/A Scum thickness Distance from top of scum to top of outlet tee or baffle NIA= outlet tee corroded off Distance from bottom of scum to bottom of outlet tee or baffle N/A 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 corroded off, needs to be replaced. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): �et Depth below grade: Material of construction: ❑ concrete R metal R fiberglass Fj 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 t5inb.doo-rev.0/16 Title 5 Official Inspection Form Subsurface Sewage UsIlDral SYMOM•page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form x I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison Owner Owner's Name information is required for every North Andover MA 01845 4-10-2018 page. 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: El concrete F-1 metal [j fiberglass El polyethylene El other(explain): Dimensions: Capacity: ns Design Flow: gallons per day Alarm present: 0 Yes E) No Alarm level: Alarm in working order: n Yes El 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 15tns.doc«rev,6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison Owner Owner's Name information is North Andover MA 01845 4-10-2018 required for every page. ty/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 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 cover broken, replaced it. D-box level & distribution equal. Evidence of soild carryover, outlet tee off in septic tank. Evidence of leakage, corrosion holes, d-box needs to be replaced. Riser needs to be installed on d-box. ---------- Pump Chamber(locate on site plan): Pumps in working order: El Yes E] No* Alarms in working order: n Yes n 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: t5ins.doc•rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison OwnerOwner's Name information is required for every North Andover MA 01845 4-10-2018 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: R leaching pits number: n leaching chambers number: F leaching galleries number: --- M leaching trenches number, length: 3 trenches 64' Ion R leaching fields number, dimensions: El 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 ok. Vegetaion 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 n Yes El No Wns.doc rev.6116 -true 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 365 Candlestick Road Property Address William Davison ---------- Owner Owner's Name information is required for every North Andover MA 01845 4-10-2018 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): Materials of construction: Dimensions ------ Depth of solids ....... Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins,doc,rev.61`16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Patie 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison ------ Owner Owner's Name information is required for every North Andover MA 01845 4-10-2018 page. d7t-YrTown�_ State Zip Code Date 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: Z hand-sketch in the area below drawing attached separately L_Jrff �kDU�U_ DL4 j\\&- V,,r9 f 16ins.doc-rev.6116 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System Peg.9 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison OwnerOwner's Name information is required for every North Andover MA 01845 4-10-2018 page. dity/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Z Check Slope Z Surface water Z Check cellar Shallow wells Estimated depth to high ground water: >4 feet Please indicate all methods used to determine the high ground water elevation: F-1 Obtained from system design plans on record If checked, date of design plan reviewed: -bate--- 0 Observed site (abutting property/observation hole within 150 feet of SAS) El Checked with local Board of Health -explain: F] Checked with local excavators, installers-(attach documentation) z 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, Canton Soil, Water >6' Deep. ---------- ---------- Before filing this Inspection Report, please see Report Completeness Checklist on next page. 16ins.doc rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Pape 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 365 Candlestick Road Property Address William Davison Owner Owner's Name information is North Andover MA 01845 4-10-2018 required for every page. State Zip Code Date of Inspection E. Report Completeness Checklist Z 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 officiat inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ........... ~' ,� North �n� |OVKO °. , .`°DVeF Tax Map # 210-1,06.A-0228_0000~0 Parcel |d17388 . 365 CANDLESTICK ROAD DAVISON, WILLIAM 365 CANDLESTICK ROAD NO. ANDOVER, MA 01845 C|asm 101 Single Family Property Type 1 Residential Znn|nS2 1Rosidontia| Zvn|ng8 1ReoidenUo| Size Total 1 Acres FY 2018 UB Mailing Index Name/Address Type Loan Number Adivoxnac,. From Until DAVISON,WILLIAM Payor 385CANDLESTICK ROAD N0,ANDOVER. MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg|d. 176410'365 CANDLESTICK ROAD Last Billing Date 1/18/2018 3170313 n3Cycle U3 Active UB Services Maint. Account No. 317O313 Service Code Rata Charge Multiplier/Users M|8CFEEADMIN FEE 0.035/8 7.82 1/ VVTRVV4TEn o1ALL METER SIZE UB Meter Maintenance Account No.317O31J Serial No Status Location Brand Typo Size YTD Cons 32945440 uAutivo ERT HH »uodge wVVeter 0.630m3 2478 Date Reading Code Consumption Posted Date Variance 3/7/2018 3122 aActua| 14 '4Y6 12/712017 3108 oAniva| 14 1/2ex201e '87Y4 9/12/2017 3094 aAotua| 121 10/18/2017 287% 8/8/2017 2873 eAntuo| 50 7/25/2017 93% 3/8/2017 2943 aAutua| 15 4/12/2017 -41Y6 121912010 2828 a8ctua| 26 1m3/2017 '89% 9/9/2016 2982 aActua| 221 10/24/2018 41396 6Y 13/2016 2681 aActuu| 47 8/2/2016 239% 3/9/2816 2634 u8ctua| 13 4/22/2010 '80% 12/10/3015 2621 oActua| 89 1/202016 '58% 9m/2015 2532 oActvo| 180 1018a015 19896 6/10/2015 2344 oActua| 03 7/24/2015 345"& 8/11/2015 2281 aAotuo| 14 4/28120,15 '12Y6 12/11/2014 2267 aAmum| 16 1/15/2015 '93Y+ 9n1m014 2251 a Actuai aoJ 10U5/20/4 763m 6/11o014 2018 umxop| 27 7/16/2014 91% 3/11/2014 1$91 aAcmm| 14 4/11/2014 15% 12x012013 1977 =Actuo| 12 1/17o01* -84% 9/11/2013 1866 oAmue| 71 1015/2013 115Y* 6/12/2013 1894 mActua| 33 7o4/2013 snm 3/1312013 1861 aActuo| 23 4122/2013 'oom 12/11/2012 1839 aActuo| 62 119/2013 '58% 9M3/2012 1777 eAoWa| 146 10/15/2012 167m 6V1212012 1681 aActoa| 53 7/102012 12896 3/14/2012 1578 uActua| 24 4/14/3012 40% 12/12/2011 1554 mActuo| 39 1/17/2012 '83% 912/2011 1515 uActuu| 133 1010/2011 316% 6/7/20 11 1382 axntual Jn 7/20/20 11 a^% 13 4/1312011 °u� 318/2011 1352 aAoma ^ ' 1 i O Town of North Andover HEALTH DEPARTMENT �s3gCH119k*S CHECK#: , LATE: _. � � ., e94) r w H/O NAME: v i CONTRACTOR NAME: Type of Permit or License: (Check.box) ❑ Animal $. ❑ Body Art Establishment ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service m. ❑ Funeral Directors $ ❑ Massage Establishment $_ ❑ Massage Practice $. — ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $— ❑ Sun tanning $ ❑ Swimming Pool ❑ Tobacco $ ❑ Trash/Solid Waste hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Tasting $ — ❑ Septic m Design Approval $ # Septic Disposal Works Corzstruction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector , $ Title 5 Report $ 5 ❑ Other.(Indicate)__ _..__._.____.__—_ $ Iiea'lth Agent Initials White-Applicant Yellow-health Pink- Treasurer } P