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HomeMy WebLinkAboutTitle V Inspection Report - 178 GRANVILLE LANE 6/14/2018 Commonwealth of Massachusetts RECEIVED Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments JUN 14 2018 178 Granville Lane TOWN OF NORTA ANDOVER Property Address 1�EALTH-DuARTMLNT-- Marc Bourassa Owner Owner's Name - information is North Andover MA 01845 6/9/2018 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. Important:When A. General Information filling out forms on the computer, use only the tab 1 Inspector: key to move your cursor-do not Anthony G. Campano use the return 1111............... - —------------------- Name of Inspector key. Campano Title 5 Inspections Company Name -_-___ _.__. 30A ame30A Elm St, ...........- - Company Address rely Pepperell MA 01463 City/Town State Zip Code 978-433-2212 3602 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 16.000). The system: Passes Conditionally Passes ❑ Fails Needs Further Evaluation by the Local Approving Authority Ye 06/11/2018 -depe-c't�s—S-i� 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 DER 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.doc-rev.6/16 Title 5 Official inspection Forn Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Granville Lane Property Address --— _.......-- Marc Bourassa Owner _...._... .._._..... Owner's Name information is North Andover MA 01845 6/9/2018 required for every _ _..........._._.� _.............. page, Cltylrown State Zip Code date of Inspection B. Certification (cont.) 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 I 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): The intermediate D-Box as shown in the attached photos needs to be replaced. The side walls have deteriorated and are caving in, i i t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts n : y Title 5 Official Inspection Form _= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'w 178 Granville Lane Property Address Marc Bourassa Owner — ........... _... _ -__ _ _........,.. Owners Name information is required for every North Andover MA 01845 6/9/2018 page. City!I own State Zip Code Date of Inspection B. Certification (cant.) ❑ 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 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 15.343(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 1.5ins.doc•rev.6116 Title 5 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 178 Granville Lane Property Address Marc Bourassa Owner Owner's Name information is required for every North Andover MA 01845 6/9/2018 page. City/Town 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: F-1 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. n The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. n 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 0 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El E 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 t5ins.doc-rev.6116 'rine 6 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 178 Granville Lane Property Address Marc Bourassa Owner Owner's Name information is required for every North Andover MA 01845 6/9/2018 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: E] 0 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. El E Any portion of a cesspool or privy is within a Zone I of a public well. n z 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 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.] El 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. E-1 0 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 16,000 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 E-1 0 the system is within 400 feet of a surface drinking water supply 11 F the system is within 200 feet of a tributary to a surface drinking water supply El El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) 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. 15ins.doe-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 178 Granville Lane Property Address Marc Bourassa Owner Owners Name information is North Andover MA 01845 6/9/2018 required for every page. cityff6v n 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 H M Pumping information was provided by the owner, occupant, or Board of Health El 0 Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (if they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? E El Was the site inspected for signs of break out? 0 EJ Were all system components, excluding the SAS, located on site? M F1 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? N El 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: E El Existing information. For example, a plan at the Board of Health. El E 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: 3 Number of bedrooms (design): 4— Number of bedrooms (actual): -...-- DESIGN -.DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts M" Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 178 Granville Lane ............ Property Address Marc Bourassa Owner ----Owner's Name information is North Andover MA 01845 6/9/2018 required for every page. CityfFown State Zip Code Date of Inspection D. System Information Description: .............. Number of current residents: Does residence have a garbage grinder? El Yes M No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? F1 Yes E No Water meter readings, if available(last 2 years usage (gpd)): 111.9 gpd Detail: 10,900 cubic ft x 7.48 gal/cubic ft/728 days= 111.9 gpd - - -__-__--------- ----------- Sump pump? D Yes 0 No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? D Yes n No Industrial waste holding tank present? El Yes El No Non-sanitary waste discharged to the Title 5 system? n Yes El No Water meter readings, if available: 15ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts _ p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k 178 Granville Lane Property Address Marc Bourassa OOwner _____wner's Name...... __.... _......__.... _— _........... .............. information is North Andover MA 01845 6/9/2018 required for every . ____. �._._. _... p p _....__.... — .........._ page. Y Clt /Town State Zi Code Date of Inspection � D. System Information (cont.) Last date of occupancy/use: Date....--...__ Other(describe below): General Information Pumping Records: Source of information: Summer of 2017 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: _ _lion..___ gas How was quantity pumped determined? - - _w...... ................ 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. i ❑ Other(describe): 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title ffi i t Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .p 178 Granville Lane Property Address Marc Bourassa Owner Owner's Name information is North Andover MA 01845 6/9/2018 required for every _...__... -- __.— Town State Zip Cade Dake of Inspection page. Clty/ i D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: See attached "As-Built"dated 11/21/79 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town Water feet Comments (on condition of joints, venting, evidence of leakage, etc.): All exposed joints were in good condition with no evidence of leakage or venting problems. Septic Tank(locate on site plan): 1" Depth below grade: feet—­­­­ Material eet __.._......,..Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Tank was in good condition, liquid level was at the outlet pipe invert. The inlet baffle was in place and composed of concrete. The outlet baffle was in place and composed of PVC.(See Attached Photos) ....._..__ ......... If tank is metal, list age: _..._ - years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 71 x 5'5"W x 5'D Dimensions: _............ ..... Sludge depth: t5ins.doc-rev.6/16 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 av 178 Granville Lane Property Address Marc Bourassa Owner Owner's Name information is required for every North Andover MA 01845 619/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 3411 Distance from top of sludge to bottom of outlet tee or baffle 311 Scum thickness 711 Distance from top of scum to top of outlet tee or baffle 161, Distance from bottom of scum to bottom of outlet tee or baffle ........ 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.): Tank was in good condition and should be pumped out every two to three years. The liquid level was at the outlet pipe invert. The inlet baffle was in place and composed of concrete. The outlet baffle was in place and composed of PVC.(See Attached Photos) ............. ............. ........------- Grease Trap(locate on site plan): Depth below grade: feet Material of construction: El concrete F] metal F] fiberglass El 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: t5ins.doc-rev.6116 Title 5 Official Inspection 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 178 Granville Lane Property Address Marc Bourassa Owner Owners Name information is required for every North Andover MA 01845 6/9/2018 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 - ------- Material of construction: F-1 concrete El metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: n Yes El No Alarm level: Alarm in working order: El Yes E] No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ............ Attach copy of current pumping contract(required). Is copy attached? El Yes F1 No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - -._ Title 5 OfficialInspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 178 Granville Lane Property Address Marc Bourassa Owner __..... _. _ _, ._....__..._ __............ Owner's Name information is North Andover MA 01845 6/9/2018 required for every _. __...._.._..... -- r_...___ page. City/Town State Zip Code Date of Inspection --------- ®. System Information (cont.) 1 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert None 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.): Both d-boxes are level with four lines each and all are receiving equal flow. No evidence leakage into or out of the boxes and no sign of solids carryover.(SEE ATTACHED PHOTOS) 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: l5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsu face Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts nw...._ r Title fiici l Inspection Form U Subsurface Sewage Disposal System Form - Not for Voluntary Assessments *p 178 Granville Lane Property Address Marc Bourassa _..._.._...___ _.......__...___ _....... .___. Owner _ ........._.._.. _.__ .__........_.__ ........_.___ Owner`s Name information is North Andover MA 01845 6/9/2018 required for every _..._ _..__ ...__.-1--.—..------ page City/Town State Zip Code Date of Inspection D. System Information (cant.) Type: ❑ leaching pits number: - - ❑ leaching chambers number: _.......-. __._. ❑ leaching galleries number: 8 ea 36' long ® leaching trenches number, length: --................._ ❑ 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.): There is no sign of hydraulic failure, ponding or damp soil. The vegetation above the trenches is mowed lawn.(See Attached Photo of SAS Area) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth -top of liquid to inlet invert _www._....._..._.............__.._ Depth of solids layer Depth of scum layer _.._----- Dimensions of cesspool Materials of construction _....._.....r.._.__—. Indication of groundwater inflow ❑ Yes ❑ No 15ins.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form Not for Voluntary Assessments 178 Granville Lane Property Address Marc Bourassa Owner Owners""Name information is North Andover MA 01845 6/9/2018 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): Materials of construction: Dimensions ............... .. ............. Depth of solids ........... Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ................. 15ins.doc-rev.6116 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 178 Granville Lane -Property Address Marc Bourassa Owner Owners Name information is required for every North Andover MA 01845 6/9/2018 page. Cityrrown - 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: D hand-sketch in the area below drawing attached separately ............ t5ins.doc-rev.6116 'ritle 5 Official inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form $3.) Subsurface Sewage Disposal System Form Not for Voluntary Assessments 178 Granville Lane Property Address Marc Bourassa Owner Owner's Name information is required for every North Andover--,,.......... MA 01845 ---- 6/9'/2018 page. Cityrrown Zip Code Date of Inspection D. System Information (cont.) Site Exam: El Check Slope Z Surface water N Check cellar Z Shallow wells 5'6" Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: z Obtained from system design plans on record 5/28/76 If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) El Checked with local Board of Health -explain: Checked with local excavators, installers-(attach documentation) El Accessed USGS database-explain: You must describe how you established the high ground water elevation: See deep hole data from pit#1 attached. It was conducted by done by Frank C. Gelinas &Ass. Engineers & Architects. ----------- .......... Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins.doe-rev.6116 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 178 Granville Lan ...........- Property Address Marc Bourassa ........... Owner dw-ner's Name information is required for every North Andover MA 01845 6/9/2018 page, ityrrown State Zip Code Date of Inspection ---—---------- --- -------- E. Report Completeness Checklist Z Inspection Summary: A, B, C, D, or E checked Z Inspection Summary D (System Failure Criteria Applicable to All Systems) completed Z System Information— Estimated depth to high groundwater Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 a i �,,,Qlt•-,jS� aria K qv V - • � e Summary Record Card 9(m0l(St6d on BMIMB 2i68:23 PM by Tara Hurley Page i Town of North Andover Tax Map # 210-106-C-0076-0000.0 Parcel Id 177111 178 GRANVILLE LANE BOURASSA, MARC, E. Since Jan 2016 MORRISSEY, PHYLLIS-ANN 178 GRANVILLE LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Prop"Type I Real aI al Zonlng2 1 Residential ZonIng3 I Residential Size Total 1.03 Acres FY 2018 UB Mailing Index Name/Address Type Loan Number Active/Inact, From Until MARC BOURASSA Owner 178 GRANVILLE LANE NORTH ANDOVER,MA 01845 CINSERULI,JOSEPH Previous Customer Inactive 111113/20111 178 GRANVILLE LANE N.ANDOVER,MA 01845 UB Account Maint. Active/Inactive Account No Cycle Occupant Name Bldg Id. 17389.0-178 GRANVILLE LANE Lost Billing Date 4/1012018 Active 3170059 03 Cycle 03 UB Services Maint, Account No.3170059 Service Code Rate Charge 11 Multiplier/Users MISCIFEE ADMIN FEE 0.63618 7.82 WTR WATER 01 ALL METER SIZE 45.60 UB Meter Maintenance Account No.3170059 Brand Type Size YTD Cons Serial No Status Location w Water 0.63 0.63 548 34644431 a Active ERT HH b Badger Consumption Posted Date Variance Date Reading Code 112 4123/2018 -12% 316/2018 565 a Actual 13 112512016 22% 1216/2017 563 aActual 12 10/1812017 -19% 9/1112017 640 a Actual 14 7/25/2017 3% 6/6/2017 528 aActual 13 4/1212017 -9% 3/6/2017 514 a Actual 16 1/23/2017 15% 12/8/20116 501 a Actual 13 10/24/2016 -24% 9/7/2016 486 a Actual 11% 6/7/2016 16 4122/2016 -5% 37120 456 a Actual 16 112012016 116% 015 -44-1 '—a—Xclui—1 14 10/11612016 -119% 9/8/2016 426 a Actual 17 7/24/2015 20% 6/8/20`16 411 a Actual 114 4/2812015 -22% 3/9/2016 394 aActual 18 111612016 9% 1219120 14 380 a Actual 17 10/1512014 4% 9/1012014 362 a Actual 16 7/16/20114 0% 61912014 345 a Actual 16 4/11/2014 -1% 3/1012014 329 a Actual 16 1/17120114 2% 12/912013 313 a Actual 16 10/1612013 22% 911012013 297 a Actual 13 7124/2013 3% 6/1012013 281 aActual 13 412212013 -9% 3/1112013 268 a Actual 13 119/2013 21% 1217/2012 255 a Actual 12 1011612012 -2% 911212012 242 a Actual 11 7/16/2012 2% 61812012 230 a Actual )0 o Summary Record Card genaraled an 611112018 206:23 PM by Tara Hurley Page 2 Town of North Andover Tax Map # 210-106.C-0076-0000.0 Parcel Id 17711 178 GRANVILLE LANE BOURASSA, MARC, E. Since Jan 2016 MORRISSEY, PHYLLIS-ANN 178 GRANVILLE LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type I Residential Zoning2 I Residential ZonIng3 I Residential Size Total 1.03 Acres FY 2018 3/1412012 219 a Actual 12 411412012 _8% 12/9/2011 207 a Actual 12 1/17/2012 34% 9/12/2011 195 a Actual 10 10/1312011 -17% 6/6/2011 185 a Actual 11 7/2012011 3/8/2011 174 a Actual 7 4/13/2011 -20% 1/1112011 167 f Final Bill 5 Il11/2011 12% 12/10/2010 162 aActual 13 1112/2011 22% 9/8/2010 149 a Actual 11 10/16/2010 -8% 6/4/2010 138 a Actu at 11 711512010 -15% 3/8/2010 127 a Actual 13 4/1412010 .35% 12/10/2009 114 a Actual 21 1/1212010 30% 9/912009 93 a Actual 17 10/15/2009 23% 6/412009 76 a Actual 112 7/2012009 7% 3/12/2009 64 a Actual 13 4/2912009 -2% 1216/2008 51 a Actu at 12 112012009 19% 918/2008 39 a Actual 11 10/10/2008 -7% 6/4/2008 28 a Actual 11 7/16/2008 -9% 3/7/2008 17 a Actual 12 4/1112008 34% 12/1012007 6 aActual 5 1/22/2008 0% 10/22/2007 0 n New Meter 0 1/22/2008 0% 10/2212007 1849 r Replacement -3 1/2212008 -100% 914/2007 1862 m Manual estimate 0 10/1212007 -100% ACTUAL IS 1843 9% 6114/2007 1852 m,Manual estimate 29 712012007 311512007MSG 1823 a Actual 29 4/1612007 126% 1216/2006 1794 a Actual 1111 1/19/2007 16% 9/12/2006 1783 a Actual 10 10/2012006 0% 6/1412006 1773 a Actual 11 7110/2006 6% 31712006 1762 a Actual 8 4M712006 -114% 12/211/2005 1754 a Actual 12 1117/2006 -1% 9114/2005 1742 a Actual 12 10/14/2005 14% 61912005 1730 a Actual 9 7115/2005 53% 3/18/2005 1721 a Actual 7 416/2005 -50% 1219/2004 1714 m Manual estimate 112 111412005 14% a,�,�' iwmw ooh ow:ui jai ewownowiw rvm� ,�rw.�'�✓�wr�«.w�ww�'u�w"'✓aa✓rv�� �www�,uw�w Fe I IN �oorc�rvwa�aNO�auhw;��Wnmifu anon ���� m(i��auwwuN�uVo orr��n �owu�uwruwawru��rRltu9�NmY� ��� �"�"� h 1005 1 ph ONE RA DAC �J r r I : �� r ar�� � 1 ua r t� a „ jr ry J �r„ � � � r � 6 r �,�� ui� �P ��w, ��,., a �` sty ' H srou c—^ ..;m ,ra. 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Title 5 Report Pa $" 0 Other. (Indicate)- LAI Hetx1-th-Agent Initialsl White-Applicant Yellow-Health Pink-Treasurer