HomeMy WebLinkAboutPass - Title V Inspection Report - 115 CANDLESTICK ROAD 7/9/2019 i
I'
Commonwealth of Massachusetts
Tl",,t,le 5 Offi'ci"aln w
Subsurface Sewage Disposal System Form Not for Voluntary ss ssm� ;s
Pry Address
Lii
Owner Mar
information is
reqnird for ..�.�
page State Zip Cody Date of Inspection
Inspection result must be submitted pitted this fora. inspection forms may not be altered in any
Please see l n r*s checklist at,the end of the form.
I filling out forms A. Inspector Information
n the cornpWer, Charles J. Rolu,x
use only thetad ,
key to rn olve your, Inspector
cursor-do not Charles J. Roux, LLC
use the return Company Name
213 Patten. Road
Company d r"
Tewksbury Mom. 01876,
City/Town State Zip,Cocle
978 IiM 6140 9984 S1891
Telephone Number License Number
B., Certification
1,certify that: I am a DEP approved system inspector,i ' l compliance with Section 16.340 of Title
(310 WR 15. ; i have personally inspected the sewage disposal system at thie property address
listed above; the information reported below is true, accurate and complete as of the time of m
inspection; and the Inspection was, erf rm d biased'on my training,and a periience in,the,proper function
nndl maintenance of on-siae sewage disposal s ns After conducting this inspection l have determined
that the system:
1. Passes
2. Conditionally 'asses
3. El Needs Further Evaluation bythe Local,App roving Authority
4. E] Emile
i
Ire rS S gnature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or wilthin 30,days of completingthis inspection. It the system has a design f1low
10,000 g d or greater,the inspector and the system owner shall submit the report,to the appropriate
regional office of the , The original form should be seat to the system owner and copies sent t
the buyer, if applicable, and the approving authority.
r
lease note This report onlydescribes conditions at the time of'inspection and under the t
conditions of use at that tw1me,,This Inspection does not address how the system will perform
the future under,the same or different conditions of use.
t6insp.doic, rev,7/26=18 Me 5 Mial Inspedon,Farm::, ubsu ce Sewage Disposal System-Page 1 0,1
1
i
Commonwealth of Massachusetts
i
T"Itle 5 Form
• Subsurface Sewage Disposal System Fora-Not for Voluntary Assessments
i
w+•
Property Address
Owner
Owner's Marne `
information is
required for every
page, RY Town State Zip Code Date of Inspection
C, Inspection Summary
Inspection Summary: Complete 1, 2t 3,or 5 and all of 4 and 6.
1) System Passes*
Ef I have not found any infomnation which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CIVIR 15.304 exist.Any failure criteria net evaluated are
indicated below.
Comments:
M L)0. 0 0 WOD I G*1
M M-IV e,
1 46-4 -At�c
) System Conditionally Passes:
❑ One or more system components as described its 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, I f for a following statements. If"not
determined,' please explain.
The septic tank i metal and over years old*or the se c tant (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration c nk failure is imminent. System will pass
inspection if the existing tank is replaced with a corm ing septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it i tructurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less t n 20 gears old is available.
0 Y N ND sin below :
ftsp.doe•rev.7l25=18 TTtla 6 OMdal Inspedon Form:Subsurface Sswage DispuW System•Page 2 of 10
Commonwealth of Massachusetts
T'Itle 5 Off'ic'ial Ins Fors
Subsurface Sewage Disposal system Form -Not for voluntary Assessments
Property Address
Owner Owner's Name
Information is
required for every
page, itylTown State Zip Code Date of Inspection
C. Inspection Summary (cons.)
System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
[j Observation of sewage backup or break out or high static water level in a distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven tribtion box. System will
pass inspection if(with approval of Board of Health):
El broken pipe(s)are replaced El Y [I El N (Explain below):
E] obstruction is removed 0 Y N El ND plain below):
❑ distribution box is leveled or replaced N El ND(Explain below):
E] The system required pump! more than 4 times a year due to broken or obstructed pipes . The
system will pass i spe do If(with approval of the Board of Health):
broken pipes re replaced E:1 Y El N E] N Explain below):
obstruct! is removed El Y 0 N N (Explain below):
Further Evaluation is Required by the Board of Health;
El Conditions exist which require f/ofalth
y the board f Health in order to determine if
the system is failing to protect publicty or the environment.
. System will pass unless Btermines in accordance with 1 t
6; o (l that the system iin a manner which will protect public health,
safety and the environment:
mn .dn ■rev.71 512D18 Tide 6 Offidal InspaMon Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
x Toltle 5 OffniciaInspect'imonForm
Subsurface sewage Disposal system Form -Not for voluntary Assessments
lip
ea od r.s
Property Address
Owner eras Name
information is
required for every
page, cityiTown State Zip Code Date of Inspection
C. Inspection Summary (coat.)
Ej Cesspool or privy is within 50 feet of a surface eater
[I Cesspool or privy is within 50 feet of a bordering ve etat wetland or a salt marsh
b, system will fall unless the Board of Health (and P bli ater supplier, if any)
determines that the system is functioning In a manner at protects the public health,
safety and environment:
The system has a septic tank and soil absorption yst m(SAS)and the SAS is within
100 feet of a surface water supply or tributary to a rfa a water supply.
El The system has a septic tank and SAS and t SAS is within a Zone 1 of a public water
supply.
[] The system has a septic tank and SAS a the SAS is within 50 feet of a private garter
supply well.
El The system has a septic tank and s and the SAS is less than 100 feet but 60 feet or
more from a private water supply well"
Method used to determine distance:
**This system passes if the well w er analysis, performed at a DEP certified laboratory, for fecal
c liform bacteria indicates absen and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided at no other failure criteria are triggered.A copy of the analysis must
be attached to this fora.
c. Other:
4) System Failure Criteria Applicable to All systems:
You must indicate"Yes" r"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
E] Discharge or pondina of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp,d -rev.71 6W18 Tide 5 modal EnspedJon Form:Subsurface Sewage Usposal System•Page 4 of 16
�. Commonwealth of Massachusetts
T'Itle 5 Off'ici'al Form
Subsurface Sewage Disposal system Fora Not for voluntary Assessments
Pr6perty Address
nrnef Ouner's Name
information is
required for every ^�
page, City/Town State Zip Code Date of Inspection
C. Inspection Summary (coat.
4) System Failure Criteria Applicable to All systems: (coat.)
Yes No
Static liquid level in the distribution box above outlet invert due to are overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than "below invert or available volume is less
than %day flow
E] [;3e Required pumping more than 4 times in the lest year NOT due to clogged or
obstructed pipes . Number of times pumped:
El 2"' Any portion of the SAS, cesspool or privy is below high ground water elevation.
An y 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 I of a public water supply
well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a ce spooi 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 D P certified
laboratory,for fecal collform bacteria indicates absent and the presence
f 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 most be attached to this fora.]
The system is a cesspool serving a facility with a design flow of 2000 pd-
10,00 gpd.
The system falls. I have determined that one or more of the above failure
* r 4
criteria exist as described 1n '10 CM R 15.303,therefore the system fails. The
system owner sho ld contact the Board of Health to determine what will be
necessary to correct the failure.
5 Large systems: To be considered a large system the system must serve a facility with
design flog of 101000 gpd to 15,000 gpd.
For large systems, you must indicate either"fires"cr"n o each of the following, in addition to the
questions in Section C. .
Yes No
E] 1:1 the system is withirn o feet of a surface drinking water supply
El El the system is hin Zoo feet of a tributary to a surface drinking water supply
the syste s located in a nitrogen sensitive area(interim wellhead Protection
El 11
Area—l PA) or a s n blic w
Aped Zone o a pu stet suply well
Wnsp,doc*rear,7 6MIB TWe 5 official Inspeaon Form Subudace gage Eftpa W Sy0m•Page 5 or 18
gL\ Commonwealth of Massachusetts
R i r Title 5cmiaRInspection ors
I , 0 d , t c- K/R
Subsurface Brae Disposal S stem Fora -Not for Voluntary Assessments
le eD
Property Address
Owner ownees Name
Inf T naUon I
required for every
page. City/Town State Zip Code Date of Ins ecUon
C. Inspection Summary (cont.)
If you have answered'eyes'to any question In Section C.5 the system is considered a significant
threat, or answered"yes"to any question ire Section C.4 above the larg a system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section C,4 shall upgrade the system in accordance with 310 C MR 1 .304. The system owner
should contact the appropriate regional office of the Department.
. You must indicate"Yes" or"no"'for each of the following for aft inspections:
Yes No
Pumping information was provided by the owner, occupant, or hoard of Health
Were any of the system components pumped out In the previous twoweeks?
❑ Has the system received normal flows in the previous two week period?
Have lame volumes of water been introduced to the system recently or as park of
this inspection?
[�f o Were as built plans of the system obtained and examined? If they were not
available mote as N/A)
Ej E] Was the facility or dwelling inspected for signs of sewage back up
Was the site inspected for signs of bread out*
Were all system components, excluding the SAS, located ors site`s
2"' El Were the septic tank manholes un overed, 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 cum?
9/ El 1Jlfas 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 n:
Existing information. For example,ple, a plan at the Board of health.
5�f Li Determined in the field if any of the failure cniteria related to Part C is at issue
approximation of distance is unacceptable)( 10 CMR 16.302(5)]
t5insp,doc*rev.M&2018 Title 5 Mdal Inspedon Form.substw aca Swag e Disposal SMem-Page 6 of 18
Commonwealth of Massachusetts
-4 ralff T*Itle 5 Off'
lc'lal Inspecs
Subsurface Sewage Disposal System For Not for Voluntary Assessments
11 15- eq
�.
Property Address
Omer Owners Name
Information I
required for every . . m .
page, City/Tom State Zip code Date of Inspection
U. System Information
1. Residential Flow Conditions;
Number of bedrooms(design): uT-,---
N tuber of bedrooms(actual):
DESIGN flow based on 310 CMR 16.203(for example: 110 gpd x#of bedrooms):
Description:
Number of current residents: -
Does residence have a garbage grinder? L-1 Yes E No
Does residence have a water treatment unit? Yes No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection Yes N�
information in this report.)
Laundry system inspected? El Yes [j No
Seasonal use? El Yes 2 No
Water meter readings, W available(last 2 years usage pd *
Detail:
)/)--4-krill
Sump pump Yes Ej N ,
f
0 ,(,IA &
Last date of occupancy: date
ti5,MP.der.•rev.V25018 T1tle 5 0Mda[Insped on Form Subsurface Sewup Dispasel system•page 7 of 18
Commonwealth of Massachusetts
t
Taitle 5
Offmicoial Ins Form
Subsurface Sewage Disposal System Fora Not for Voluntary Assessments
f
f
eqVid
aL 9-!5j� {
Property Address
r
r
i
3 #
mer Owners Name
Information Is
required for every
page. CityfTown State Zip Code Date of inspection
D., System Information (cont.
2. Commerciallindustrial Flaw Conditions:
`hype of Establishment* f
Design flow(based on 310 CMR 1 . Gallonsper day gp
Basis of design flow seatspernssq.ft,, etc, :
Grease trap resent? Yes No
Water treatment unit present's Yes N
If yes, discharges to:
Industrial waste holding tare resent? El Yes D No
Nan-sanitary waste discharged to the T t e stem? 0 Yes o
Water meter readings, if available:
Last date of occupancy/use: Date --Other(describe below):
3. Pumping Records
�A)4)T:_._
Source of information:
Was pumped s stem as part f the inspection Yes 0 o
y
If yes, volume pumped: gallons
How was quantity pumped determined?
-�---y
Reason forpumping: V
l5lnsp,doc•fear.U26=IS T19e 5 O idai lnspecfian ForM Subauface Sewage CA5paW System•Page 8 of 18
Commonwealth of Massachusetts
ec '
1 iciaIns
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
PropeTty Address
avid I f- cc,� I C
Owner
Owners Name
Information is
required for err
page. City/Tom State Zip Code Dame of Insp c on
U. System Information
4. 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.
El Other (describe),
Approximate age of all components, date installed if known and source of information:
P3
Were sewage odors detected when arriving at the site D Yes El No
. Building Sever(locate on siteplan):
Depth below grade:
feet
Material of construction:
cast iron 40 PVC El other(explain):
Distance from private water supply well or suction lime.
feet
Comments condition of joints, venting, evidence of leakage,age, etc.):
151risp.dor rear.7/26 018 We 5 of dvA Inspecdon Fmm Subsurface sewage Dfspsal System-Page 9 of 18
Commonwealth of Massachusetts
Title 5 0iconInspection ors
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
t
LC Rd
roperty Address
Owner Owner's Name
Information is
r qu Ired for every -
tyl'To tat: Zip Cede Date of Inspection
page. D. System Information (coat,)
. Septic Tank(locate on site plan):
Depth below grade; feet
Material of construction:
[31"'Concrete El metal El fiberglass El polyethylene El other(explain)
If tank is metal, list age, gears
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) El lies No
Z Q A__�-X
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness .
Distance from top f scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet toe or b ffle
How were dimensions determined
Comments(ors pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
"oz
ds
L e
t6lnsp.doe-rev.7125=18 Title 6 Ofridal Inspecbm Form:Subueace Sewage DisposW SYMOM•Page 10 Of 18
1
Commonwealth of Massachusetts
a Title 5 Official Ins ect*ion Fors
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
i
Property Address
vmer Owns Name --
Information is
required for ever
page. Cityown state Zip Code Date of Inspection
D. System Information (coat.)
. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
C1 concrete El metal fiberglass pl t ,rlene other(explain):
Dimensions:
ensions:
Scum thickness
Distance from top of scum to top of outlet tee or affle
Distance from bottom of scum to boftom of utlet tee or baffle
Date of last pumping: Date
Comments on pumping ecom me dafion , inlet and outlet tee or baffle condition, structural integrity,
liquid ievels as related to outlet' Vert,evidence of leakage, etc.);
. Tight or Holding Tar~ (tank rust be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
El concrete metal l fiberglass D polyethylene D other(explain)-
Dimensions:
Capacity: gallons
Design `low-, gallons per day
t5MV.do -rev.7125QI8 Tigit 6 Offidol[WecUon Form Subsurfaca Seta Em sposW System•Page I I of 16
Commonwealth of Massachusetts
Ti
iotle 5 Offocia �� �� ortions
rt Subsurface Sewage Disposal System Fora Not for Voluntary Assessments
3
roperty Address
Owner Owner's Nome
information is
required for every page. OityfTorr Stake of bete of Inpenn
, System Information (cont.)
. Tight or Holding Tank(cunt,)
Alarm present: es No
Alarm level.
- Alarm in working order: [ Yes No
Date of last pumping: Date
Comments (condition of alarm and float s `cbes, etc.):
*Attach copy of current pumping contract(required). is copy a ao ed Yes o
. Distribution Box if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
Comments(tote if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
0 Y �-e �ze
� �.
06z
0
,r7k
WnV.dvc-rev.742&W18 Tiffs 5 Official insp edon Form:Subsurface woe 01 sposal SYstem*P89e 12 of 18
I
Commonwealth of Massachusetts
Title 5 official Ins ection Form
Subsurface sews i et m Form Not for voluntary Assessments
lop
lip
yk
Property Address
Owner fees Dame
information Is
required for every
page.
ityrf"own State Zip Gods Date of Inspection
D. System Information (cons.)
10. Pu Char Cham ber(locate on site plan):
Pumps in working order: es No
Alarms in working order: lies Ne
Comments note condition of pump chamber, condition of pumps nd appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. soil Absorption System (SAS)(locate on site plan, excavation not required);
If SAS not located, explain why:
Type:
El leaching pits number-
El
leaching chambers number:
leaching galleries number: �..�
leaching trenches number, length: ..�-
i
leaching fields number, dimensions:
El ovefflow cesspool number:
El innovative/alternative system
Type/mane of technology;
#&MV.dW-rev.7126WI8 Title 6 Oft al Inapection f my Subsuface Swage Djsp oad System-Pap 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspectaion Form
Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments
}
}
'ropey Address
}
owner Ownees Name
informaflon Is
required for err
age. ity[Town State Zip Code Date of Inspe Uon
D. System Information (coat.)
11. Soil Absorption System (SAS)(coat.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc, ;
i Jt, c ~
~�
SAS
12. cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of!!quid to inlet'Invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow Ellies 0 No
Comments(note condition of soil, s s f hydraulic failure, level of pon in , condition of vegetation,
etc.). {.
t5lnw doc•rev.712MOI8 Ve 6 OfiCidA Inspc on Fomr subsuftce Sewage aspwal Systwn-Pa go 14 of 18
Commonwealth of Massachusetts
Title 5 Offici:al Fors
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
5' OC4 �
Property Address
Omer Ovmees Name _
Information I
required for even
page. City/Tom State Zip Cede Date of 11t pectlon
D. System Information (cont.) � ...____..
13. Privy(iodate on site lap):
Materials of construction'.
Dimensions
Depth of solids
Comments(note condition of soil}signs f Iyalicfail of level forrirfcondition of vegetation,
etc.):
int .doc-rev.71 5mis TIdo 6 Offidal inspedon Form Subsurface Sewage 01 spcsd System*Page 15 of 18
Commonwealth of schett
Title 5 Official Ins Fornn
• Subsurface era a Disposal System Foy -Not for Voluntary Assessment
Property Address
Comer C er's Marna
Information i
squired��r every
paget !"row State Zip Code Date of Inspection
D. System Information (count.)
14. Sketch of Sewage Disposal System:
Provide a view of the so age disposal system, including ties to at least two permanent reference
landmarks or benchmark.s. Locate all wells within 100 feat. Locate where:,pub fic water supply eaters
the building, Con k one of the es below:
band-sketch in the area below
drawing attached separately
t
c CVO
IL
1
t6insp.doc•rev.7125reDis Tads 5 Offidel Insp$cdon Form;$~ace Sewage DIBPOW System•Page 16 of M
Commonwealth of Ma a sett
T"Itle 5 icyl Inspection Fors
Subsurface Sewage Di posall System Form Not for Voluntary Assessments
OCA Ica
Property Address
Owner Owner's Name
Information is
required for every
page. Cltyffown State Zip Code Date of Inspection
D. System Information (cont)
. Site car :
El Check Slope
El surface water
0 Check cellar
Shallow wells
Estimated depth to high ground water: feet
at
Please indicate all methods used to determine the high ground water elevation
Obtained frOn system design plans on record
If checkedt date of design plan reviewed:
Date
Observed site(abutting proper y o sery ti n hole within 150 feet of SAS)
Checked with locals 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:
eS=IOJ
1�k 0�7
Before fling this Inspeption Report, please see Report Completeness Ch liet on next page,
t5insp.doe-rev.7I 5M18 Me 5 Official Inspecdon Form space Sewage Dfspos.af syrtem-paga 17 of 18
,
Commonwealth of Massachusetts
T'I*tle
Officilal Inspec
i Form
Subsuirface Sewage Dispoall system Form Not for Voluntary Assessments
. .........
roperty Address
per (fees Name
information Is requiredfor overt State R zip Code ]ate of Inspection
page. CitylTown
E, Report completOness checklist
Complete all applicable s4etions of this form inclusive
A. Inspector l fors tion- Complete all flaids in this section.
D. Certification: Sig ed&Dated and 1 2 3, or 4 checked
Cj3/C. Inspection Sumr ary:
1,2, 3, or 5 compWted as appropriate
(Failure Criteria Ord 6(Checklist)completed
E�/D. System Information:
For : Tig tll oldie Wank -Pumping contract attached
For 1 : Sketch of sewage Disposal System drawn on pg. 16 or attained
For 1 a: Explanation, of estimated depth to high groundwater included
i
t5insp.dw•tev.7125=18 TM 5 Ofrida[Ins pacdon E*Nw.Subsurface gage EXspoGW Syslam-Page 18 of 18
a
I
OFFICE HOURS Jim# , '" 1
Monday ..3 02
8:00-4: 0 110 son
1 �0 9 �2
Tues 6.00
Town North Andover
,]1 iJ''���/''�11Y�L i . �1''�}
y' ��.+;+Vt K1/ . V ""�;''?-i' Li
120 Main Street Thu : - : 0 1
Billing information: 1
( - 12 10 018-03/oa 1 5 1 019
Reading information'
{978)68&9570 115 CANDLESTICKROAD7-2
AM
OU
=AI �
' VKi_ 1
...,�,T ._�T, ---- 1
-�
-, -------
1 1 LORUM STREET PREVIOUS BALANCE 11! .1
4
ADJUST. THROUGH 01019 $ .0
5
INTEREST AS op o 1 1
BALANCE FORWARD
a
READINGS USAGE NBOF CURRENT BILL DETAIL USAGE UNIT AM UNT
Current Type Date DAYS �
36 07059 486 a 03/08/2019 4 a STATER USAGE
ADMINIsTRATIVE FEE $7.8
1
SERIAL# READINGS USAGE N8 OF
Current Type Date
DAYS
36207059 456 a 1 /10/2018 26 09
2.0*70 433 a 0911 01-8 23 93
36207059 408 a 0 /11 2018 2 96
3207059 3 a 0107/208 1'7 90
e.6.
3607059 386 a 491�.4/2at7 96 TOTAL $23.02
06106 017 3 92
33620705983 a 34
36207059 383 a 03108/2017
MESSAGES._RETAIN THIS PORTION FOR
R RECORDS} MOVING? PLEASE ALL 8- 0 I ADVANCE.
E :TOWN HAi a @ 120 C IA# STREET OR MAIL TO Ov LOCH BO @ P.O.ao 18 E Fo , 11A 02155
* OTEAlf � SILD SAE
WATER SATE= FIRST UNITS .8 OVER UNITS $5. 5
FIRST 20 UNITS $5.9 5 OVER � T .
SEWER -RATE,A� METER 1 A E RATE: AL UNITS Pay online a
www. or andover a. e
h M
i
i
E
mania
OFFICE HOUR 4" m RE-.
Monday
8:00 � .
8fTues
F
Eg.
of North Andover
Town
4:30 01/22/2019
';I
120 MM Street MA 018451 : 3170294 ,':4 l
North
!• Y PP
; .r'D'1'`r''��L( 8 - Billing in or�r� an: 0 1/2 019
'+j- 1R J_i-4'. }..;.!�si•'•:_ _Iv.'i_i. f
r
Readingail :......
y i■.I FI_r. ;Y�i
kF"":Ns._,y�,._„ I i• +' .r:ir.'• �yi'�' 5,. k •y
r
7- {, - ;
MARQUES REALTY $99.70
161 Q � p�
1 -1 1 of/ /2 1 -9 .70 11 q1
11FUTIM AI)JTJST. THROUG-,q 01/22/2019
T- T 'REST AS OF r
IBLANCIE, poR.WARIM
0/4 —B F CURRENT BILL
DETAIL
SAG l IT M T
SERIAL# READINGS Type . ........1DAY
current 26
$ 12/?o f 2018 26 69 WATEER TJSAGE7.82 M1I
ADMINISTRATIVE FEE
READINGS USAGE NB OF
k
I
Current Type Date
93
12
32070593 9+5
� 06/11/2018 25
4 90
36201059 59 391 a 03/o?/20w8 85
391. a 1 2/07/201'
3 2€}7 59 09/12/ 017 5 96
070 9 3B5 92 TOTAL . .' ,
� 0D8/2 �.7 3
362070 9 383 3
362o7059 83 a �� oe�2�1"7 55
62'07059'
E CALL
MESSAGES: REDAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEAS MA 02155
*NOTE* 120 MAIN STREET OR B MAIL TO OUR LOCKBOX @ p.0.BoX 184 MEDFORD
AYMENTS S c) j_D BE BADE. "NITS $ .55
A'�:`E RATE: � TT $ .9 OVER 0 UNIT 9.
24
SEWERRATE; `I �. L UNITS $ . pair online at
BYPASS METERWATER A`" = www.northan ov r a. o
4
1
OFFICEOURS PAYMENT
Monday 8: o-4:3 .1. � �99 . 70
wn of North Andover Tu 8:0 -6:00 �Ir
WeQ�r1 f} �1 +� ..�,I••I r f' �tr' `,rlr.'r�Pf. .-.�,I,......I,.J- -I'. i,.I�-•"`•��I
120 Main Street
Tours 5:0 - 3� � ..�.# 1 � IB r
NorthAndover, MA 1845 H : -1 :o
a
8)688-9550 ,_,,.;rF: r ,.4L'. Yd,..I. r�ry{IN 1"..aG.1. k;•"•*.w,y;;:"�i,_. 'y
Billing i or bon:
- f1 2 018 10 18
'�_I_ '•:.'i'7",`•n...,.+-.,.,•.•rJ�•a:_r _•`b.a"n"�..r..,r-�eLrr;•-u
Reading information: ",{4y..r 4I ,4-k #\If 'r 4. �.•M. �I+ ..gyp,�•'n
88- 7
7-2 ;
,.,..- .,.,u„�.,,�y._w„-.,-.r.,HJ<-•fl_,U„ -rtrrr;. _:Y'F;"I, _. y�:
.!.P
#13.q fir/ 4 7 EALT ��•#y. r�i`= -T AMOUNT,' ;y {
T WKSBU A 18 - 1 PREVIOUS BALANCEo F
PAYMENTS THROUGH 10/15/2018
1
......... i3D •
4
INTEREST AS OF 111018 $0.00
BALANCE FORWARD $0.00 ,
SERIAL# READINGS USAGE NBOF CURRENT BILL DETAIL. USAGE UNIT AMOUNT
Current Type Date DAYS
36207059 456 a 09/12/2018 23 93 WATER USAGE 2 $ 1.6
ADMINISTRATIVE FEE $7.B
3
SERIAL# READINGS USAGE NBOF
Current Type Date DAYS
36207059 406 a: 06 11/ 018 25 9 5
35207059 391 a 03/07/ 018 17 90
36207059 391 a 12 07/ 017 8
3607059 366 a 09017 5 96
3620'7059 383 a 06/08/ 017 3 9
36207059 383 a 03/08/2017 3
3.6 07059 383 f 0 0 / CI7 55
TOTAL
36207059 333 a 12/09/2016 91
t
M S A ES: R T I-N THIS.-P 0 RTI ON FOR YOU R..RECO RD S. MOVI G PLEA . AL.L.,(97 8)..688-9570 1N.-._._.._.._....
r
*N OTE*PAYM E NTS 5 HOU LD BE MADE;TOW N HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOAC 184 MEDF R ,MA 0 155
WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55
SEWED. RATE: FIRST 20 UNITS $15.95 OVER 20 'UNITS $9.24
BYPASS METER WATER RATE; ALL UNITS $5.55
Pay online at
k
z
...........................
= I
C
I
k
OFFICE HOURS PAYMENT BEFORE
Monday :0 -4; 0 2 2 $109 -65
Town f North Andover Tu _
Vied 8:0 r
�/y�+�y7 ni�l'ti„% _H..,:' '{- 5�. a,.,:i}`'�' hy+r.;-.._.", �.•'i[� 7 LI, .. A. ,i..
- . „i..i�,'w'ice? i/�i Jf i °n"L III• ., 'r J H'...'..•6 y•�•I�' f� �_a.Gi.L.:s,i:,
rt d ov r, MA 1 45 Fri :00—1 : 0 �."� t
'r:. - '2�*
YVY; ' b_ } . :"�I'•ti1sr�+'
Billing■ orma■
on:(978) - 5 03 07 2018-06 11 016 �8 's
�. vfaw — ',T��rL"+.��' �,;rl•i,:'J':'f�:l;.i��..-•'-'-,....4-.lii_f-''�,-.'Gk I
,�I'.•_.I"""��-� '.A;;' �;I I_'II'r ..I'•"%i'�,..Y,�:I��.y , �-r,l r'+'+
ADDR...
Reading i n ,� .:I,'-I;..;���.�.I_"ry.�'li'�"{�..k.•:.�i
r Uon
*
7 - 570 115 CANDLESTICK ROAD
7-2
AL
.�I_;.r;'".��:'..,.,{�.. :.I''=`I 'i;�.y _,l V�,._I'""'ir:y','`i•' �ra� l
MARQUES
+ �/y-�'.��y REALTY :..?i". :..RE ,.,x,'I',',.-:;,-F -'>' ;;�,,�,�;}f�1 __..+.?�.,.,,F...J:i: k
11 LRM STREET42
--� - PREVIOUS BALAN $72.
TEWKStSURYMA 118076�1716
[fill11 pAYMENTS THROUGH.' 07 18/ 018 -7 . 2
ADJUST. THROUGH 07/18 2 018 $C.0 C '.
I
INTEREST AS OF 08 2 2018 $0.00
00
BALANCE FORWARD .
s {�
TRIAL# READINGS f S USAGE NB OF CURRENT ILL DETAIL USAGE UNIT AMOUNT
D
Current Type Date Y �
36207059 433 a 06 11 018 25 96 WATER USA 5 $101.8
ADMINISTRATIVE FEE $ . 2
I
SERIAL# READINGS USAGE NBOF ;
Current Type Date DAYS
36207059 391 a 03 07/2018 17 90
36207059 391 a 12/0 7 017 86 1
36207059 386 a 09/12/20 7 5 96
92
3- 207059 3.8.3 a 06. 08. 2017 3
360709 383 a 0308017 4
6207059 383 02/02 2017 55
TOTAL $109.65
36207059 383 a 12/0.9/20.16 91
36207059 383 a 09 09 201 88
I PORT ION , � V I PLEASE CALL(978) -9 7 i ADVANCE.
E.
MESSAGES: RETAIN ....
* TS SHOULD BADE:TO HALL @ 12D MAI STREET R B MAIL T OUR LOCI P.O.BOAC 184 EDFORD, A 02155NOTE }
WATER RATE: FIRST 0 UNITS $3.80 OVER20 UNITS $5,55
SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24
BYPASS METER WATER RATE: ALL UNITS $5.55Pay online a
www.northandoverma.gov
I
f '
I
i
1
F ,
OFFICE HOURS
FII' load :0 - : 0 '
Andover
120 Main $72 .42
Street
- co
Jkc e Wed :00 _.-. :..
01845 Thurs 8:00-4:30
- D Fri :00--1 . D 3 +-{
02-94 O 2201 AT.'7:
Billing Information; .'f'- _.-
(978)688-gs5o
-12 C7 2017-03 07/ 018 =
32
F di i forrr�at�o : ::F a w,w
.2 ;x._,
1� Er
REALTY161 LORUM STREET ......
MLESTICK ROAD
= ` -
TWKSR MA 1 �1 1a ;. # 'may}O #V�#T F
-. �._ A� , I T
PREP } ,.
A.Y lENTS TH OTJG 0 i
.. 2 � $7.82
,7.82 '
ADJ-08T. T O H 0 10/2 18
00
L E S T AS Off' 5 2 �.
20�
.2AE �
SERIAL# READINGS
USAGE B OF
Current � p ateCURRENT ILL� T ��
3600s DAYS ]SAGE UNIT
a a2s AMOUNT
7 90 i
WATER USAGE 17
r
. o
1
AD I TRATI FEE
$ .82
READINGS ;
Current Type USAGE 8
3620705 Date SAYS
36207059 12/07/ 017
36207059
386 a 09/12/ 01'7 5 86
383 96
362070 9 06/08/ 01 3
36207059 3833 32
a 03/08/2017 34
3627059 38 55 ;
30705 383 a 1 /09/2016 91
36207059 09/0 /2016
383 a 06/13016 88
MESSAGES: RETAIN THIS TOTAL
YOUR RECORDS. MOVING?
WATER ��' FIRST CALL(978) 6;88-9S70 IN ADVANCE.
� B A��,TO OUR HOBO @€�.0.$OTC 14
- 1R 2 UNITS OVER 2{ UNITS 0 ,1 O S� : FIRST 20 UNITS �' '
Y BYPASS META? WATER $ . OVER 20
� � .� Please note���officehours
F� .� are have
effective 4130.See above. I
Pair online a '
I
OFFICE HOURS PAYMENT ON DR BEFORE
. .................
Monday :00-4:30 02/26/2018 $7 . 82
Town ofNorthAndover Tu :0 - : 0
'i/4l] ,
i �'y[ r0 : Y #} `y�,}J i .::I:,•I LLa.i,T' '.i "':;:.'.i._ _±i.-�'• ,: ..
12 Main Street I:t: � � { I,.� , � Am:;..:.,:=;
North Andover, MA 0 1 � 3170294 01 2 ....
Fri . 1 : 0
(9 - 5 Y
Billing information: ,,..,�.,. = �
{L
Reading information:7-2 -
978)688-9570 115 CANDLESTICK ROADI a
MARQUES REALTY v....... AM NT,
.._.....r..._. i
:....
1 1 LORAN STREET _.............
T WKSB U RY MA 0 1876-1716 PREVIOUSBALANCE 2 . 8 i
PAYMENTS TOUGH 01201 - :7 {
ADJUST. TEIROUGH 01/17/2018 $0.00 � R
I
INTEREST OF 02 2 2018 $0.co
BALANCE FORWARD $0.00
SERIAL# READINGS USAGE NB OFCART BILL DETAIL USAGE UNIT AMOUNT
Current Type Date DAYS
36207059 391 a 1 0 7 01'7 815 WATER USAGE $0.0 0
ADMINISTRATIVE FEE $ .8 2
I
.'y I
SERIAL# READINGS USAGE NBOF f
Current Type [date DAYS
36207059 386 a 09/1 2017 5 9 a
36207059 383 a 0 /08/ 017 3 9
36207059 383 a 0 08 017 34
360709 383 f 00 / 017 55
30709 383 a 109016 91
3607059 383 a 09/09/2016 88
36207059 383 a 06 13 2'01G 96 TOTAL $7.82
3620705.9 383 a 03 09 016 90
MESSAG ES R ETAINTHIS PO RTION FOR YOUR RECORDS. M-OVING? PLEASE CALL.( ) 688-95 70 1 N ADVANCE.
I
`N OTE PAYM ENTS SHOULD BE MADE:TOWN FALL @ 120 MAIN STREET OR 13Y MAIL TO OUR LOCKBOX @ P.E .BOA{194 l E F R ,MA 02 15
WATER RATE: FIRST 20 UNITS $3.80 OVER 20 ITS $5.55 Please note our office hays have
I
SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNI r- A9.24changed, t 1 0.See above.
BYPASS METER WATER AT : ALL UNITS $5.55
Pay online at
www.nor han ov a.gov
41
i
{
2
G
OFMCE HOURS
Monday :0 - :30
Trr t rh Andover Toes : - : .
120 Main Street Vied 8: 0- :8 .i::
-I=!1
North
Andover, MA 01845 Fri 8: —12:00 17 k'
(9 8)688-9550
Billie information: �d-1-r.
( 8)888- 50 1 06080.7#01 /27 ,;
1 2 7'7
Reading information: iT1
r
115 CANDLESTICK ROAD
MARQUES REALTY
77
- -.-
PREVIOUS BALANCE
fir
PAYMENTS THROUGH J-0/10/2017 $-62-35
e J7JS r. THROUGH 10/10/201
I
INTEREST AS of 11/17/217 $0. o
]BALANCE FORWARD
i
SERIAL## READINGS �
USAGEOF CURRENT BILL DETAIL USAGE UNIT AMOUNT
f
CurrentType Date DPI
Type
YS
362070.59 391 a 09/12 017
WATER USAGE �
$19.0
ADMINISTRATIVE EE �
7.82
i
SERIAL# READINGS USAGE NB
OF
Current Type Date DAYS
�y
362 l059 38 ;
a 0 /08/2�1'7 3 92 �
36207059 383 a 03/08/2027
3620'7059 383 '7 02/02/201 3�
320705 '
383 a 12/09/2016 91
36207059 383 a 0910 12016 68
36207059 383 a 0 /13/201 - f
36207059 383 a 0 /09/201
36207059 ------ 383 a / 90 TOTAL
/ 9 2 . 2
MESSAGES: RETAIN THIS PORTION FOR YOUR RECURDS.
MOVING PLEASE CALL.-.--- -(978) - 5 IN ADVANCE
3TE*PAYMENTS 5 HOU LD SE MADE:TOWN MALL @ 120 MAIN STR EET OR BY MAIL To OUR LOCKBOX
1 2
155
WATER RATE: FIRST 20 UNITS �3 .80 OVER 20 UNITS $5.55
SEATER RATE. R �' 2 UNIT OVER UNIm Please rote our o hourshave �
SAS METE WATER RATE: ALL UNITSBY
changed,effective 4130. above.
Pay online a
i
it 06
Town of North Andover
04AY49 Af* HEALTH DEPARTMENT
iiiWS
00
CH
Cr
DATE-
E K
LOCATION: /o
H, 0 NAMES
CONTRACTOR NAME-.
Type of'der mit or License: (Check box)
El Anihnal $
0 Body Art Est Est $
0 Body. Art Practitioner $
0 Dunipster $
0 Food Service- Type:. $
• Funeral'Directors
• Massage Establishnient $
• Massage Practice $
�O Offal(Septic)Hauler $
0 Recreational Camp
11 Sun tanning $
�D Swimming'Pool
11 Tobacco
0 TrashlSolid Waste Hauler
11 Well Cionstniction
SEPTIC Systems:
0 Septic-Soil g'Tesitin
0 Sephic,-Design Approval $
D Septic Disposal Works Construction(DWC)
Eli Septic Disposial Works Installers(DWI)
11 Title 5 Inspector $
Title 5 Report
io
0 Othen Undicate) $
.........*..........
HT41th-Agent Initials,
White-Applicant, Yellow-Health Pink-Treasurer ,�If