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HomeMy WebLinkAboutPass - Title V Inspection Report - 1749 SALEM STREET 7/19/2021 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments erty,Add tl �` �- 2 U;a — Owner 0 er's Name information is required for every page. lty/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. Inspector Information RECE1 filling out forms 11 on the computer, use only the tab CHARLES J. ROUX 1 ( ?_�TN key to move your Name of Inspector cursor-do not CHARLES J. ROUX, LLC �F NORSH Z key the return Company Name213 Y PATTEN ROAD Co � Company Address TEWKSBURY _ MA 01876 City/Town State Zip Code 978-640-9984 S1891 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. V Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1Z4 //)` _ - 7 --a1 - Ins r' lgn re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: [t� 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: A n A rJ o 4z ne e r -� V, o VV L�L,/�j 2) 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/pection o" or"not determined" (Y, , ND)for the following statements. If"not determined," plean. The septic tank is d over 20 years of or the septic tank (whether metal or not) is structurally unsound, exhibits ial infiltration or filtration or tank failure is imminent. System will pass inspection if the enk is replace ith a complying septic tank as approved by the Board of Health. *A metal septic taass i pection if it is structurally sound, not leaking and if a Certificate of Compliance indica t tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 1 Owner Owner's Name information is required for every _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level ' the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or unev 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 ❑ ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced Y ❑ N ❑ ND (Explain below): ❑ The system required mping more than 4 times a year due to broken or obstructed pipe(s). The system will pass in ection if(with approval of the Board of Health): ❑ broken ipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ ob ruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation b he Board of Health in order to determine if the system is failing to protect public health, saf or the environment. a. System will pass unless Board of H th determines in accordance with 310 CMR 15.303(1)(b) that the system is not f tioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewa a Disposal System Form -Not for Voluntary Assessments roperty Address Owner Owner's Name information is required for every _ page. City/Town State Zip Code Date of inspect- ion-C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Suppli r, if any) determines that the system is functioning in a manner that protects a public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) nd the SAS is within 100 feet of a surface water supply or tributary to a surface water pply. ❑ The system has a septic tank and SAS and the SAS is with' a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS i ithin 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the S 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 analy ' , performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the esence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no er failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ Ejj/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ d 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 1/z day flow ❑ LT Required pumping more than 4 times in the last year NOT due to clogged or � obstructed pipe(s). Number of times pumped: ❑ E Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ d Any portion of a cesspool or privy is within a Zone 1 of a public water supply 1 well. ❑ LJ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ d Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ d 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must ind/mapped yes" or"no" each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the systemfeet of a surface drinking water supply ❑ ❑ the system0 feet of a tributary to a surface drinking water supply ❑ ❑ the system a nitrogen sensitive area (Interim Wellhead Protection Area - IWped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G jf� Property Address Owner Owner's Name information is required for every ------ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No Z ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ N� 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? d ❑ 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? Rf ❑ Was the site inspected for signs of break out? Rr ❑ Were all system components, excluding the SAS, located on site? d ❑ 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? d ❑ 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: [v� ❑ Existing information. For example, a plan at the Board of Health. �/ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): — Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: / Number of current residents: / Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes Q No If yes, discharges to:Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes [Al No information in this report.) Laundry system inspected? A/X ❑ Yes ❑ No Seasonaluse? ❑ Yes 14 No Water meter readings, if available last 2 ears usage d C)� 1 �� 9 ( Y 9 (gP ))� Detail: Sump pump? Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address -- Owner Owner's Name - information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): gallons per day(gpd) _ Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 stem? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: C Source of information: J y SCkAJ A 6-Y Was system pumped as part of the inspection? ❑ Yes [2r No If yes, volume pumped: gallons How was quantity pumped determined? — Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 2 Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: / �'I' 2 C1 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): / Depth below grade: feet Material of construction: [cast iron ❑ 40 PVC — ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): /11 C> lac C.� Oh re_-e t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sew ge Disposal System Form - Not for Voluntary Assessments 5e rope rty Address -- Owner Owner's Name -- information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: �� Q — feet Material of construction: Eeconcrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: - years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes [n No Dimensions: 9 -X- X -- Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 / J How were dimensions determined? .�--�— Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ce (���-r�l� ( ►�O,X�'� 1VJ k2l,la -h"1/�Q-, AJ k4)�!�. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Dispo al System Form -Not for Voluntary Assessments ProperhyAddres.S Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass polyethylene ❑ other(explain): Dimensions: -- Scum thickness Distance from top of scum to top of outlet to or baffle Distance from bottom of scum to bottom f outlet tee or baffle Date of last pumping: Date Comments (on pumping recomm dations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet * vert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal fiberglass polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewag Disposal System Form - Not for Voluntary Assessments L 4-9' 5q L _ Property Address Owner Owner's Name information is required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: /itches, s ❑ No Alarm level: n working order: ❑ Yes ❑ No Date of last pumping: Comments (condition of alarm and fl *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert (25 — 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.): t-s Le Ve de— CZCL1�'r�� ,'�� r�)-�' � �cr�,c✓ Ire S,z�,h�� © --� -- t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form 1; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v/ Property Address --- Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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 ps and 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): --� Cc �e d — �r �� -� �.✓ �,z- 1� cry c Type: ❑ leaching pits number: -- ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: —>� .. ❑ overflow cesspool number: — ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts (p Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •�, Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)' -� — ;,✓_ - �(��cl 12. Cesspools (ces ooCl m�ust bep:eia's part 4S � t C—IJ1vc`CL o" Ins ) aoJtiep V Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, gns of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Ad res --- Owner Owner's Name - information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic ilure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 15 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments roperty Ad ress Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: [ hand-sketch in the area below [� drawing attached separately �1 I �d 3� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rope4 Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar / ❑ Shallow wells Estimated depth to high ground water: feet , Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �- P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: L� A. Inspector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or 4 checked L✓J C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed 11�J D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 �" u�i►°� >9�" � IIIIIIIIIIIIIIIIINIIIIIIIIIII OFFICE HOURS PAYMENT ON •• BEFORE Monday 8:00-4:30 05/21/2021 $23 . 02 Town of North Andover Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 ACCOUNT BILOW DATE Thurs 8:00-4:30 North Andover, MA 01845 Fri 8:00-12:00 3170138 04/21/2021 (978)688-9550 _ Billing information: SERVICE DATES DUE DATE (978)688-9550 12/07/2020-03/04/2021 05/21/2021 Reading information: SERVICE ADDRESS 34 (978)688-9570 1749 SALEM STREET DECOSTA,JOSEPH M. TRANSACTIONS THIS PERIOD ' AMOUNT 1749 SALEM STREET NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $15.39 IIII'lll"II'I'III"IIIIIIIIIIIIIII""111111111111'I"IIIIIII111 PAYMENTS THROUGH 04/21/2021 $-15.39 ADJUST. THROUGH 04/21/2021 $0.00 The Town now has a new Online Bill payment System. INTEREST AS OF 05/21/2021 $0.00 To ensure we receive your payments online please visit BALANCE FORWARD $0.00 www.-northandoverma.gov/pay to setup our new account. SERIAL# READINGS USAGE NB OF CURRENT BILL DETAIL USAGE UNIT AMOUNT Current Tye Date DAYS 36393535 465 a 03/04/2021 4 87 WATER USAGE 4 $15.20 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Type Date DAYS 36393535 459 a 12/07/2020 2 94 36393535 449 a 09/04/2020 10 93 36393535 438 a 06/03/2020 11 90 36393535 434 a 03/05/2020 4 87 36393535 431 a 12/09/2019 3 87 36393535 429 a 09/13/2019 2 98 36393535 425 a 06/07/2019 4 92 TOTAL $23.02 36393535 422 a 03/07/2019 3 90 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978) 688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 184 MEDFORD,MA 02155 WATER RATE: FIRST 20 UNITS $3 .80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.northandoverrna.gov Please return this portion with your payment to Any amount which is not paid by due date will be subject to interest charges of Town of North Andover 14%Per Annum w 120 Main Street NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978)688-9550 (978)688-9550 Tues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri 8:00-12:00 1 IN IN 11111111111111111111111101 ACCOUNT BIt0 G DATE 3170138 04/21/2021 SERVICE ADDRESS 3-2 DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYMENT ON •- NORTH ANDOVER MA 01845-3318 05 21 2021 23 . 02 IIII'III"II'I'III"Illlilllllllltl""IIIIIIIIIIIIIIIIIIII111F- AMOUNT -. �;Z'— OFF HOURS • •• BEFORE onday8:00-4:30 02/12/2021 $15 . 39 Town of North An over Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 ACCOUNT BILLING DATE Thurs 8:00-4:30 North Andover, MA01845 Frirs8: 0-4:0 -1170138 01/13/2021 (978)688-9550 -- Billing information: SERVICE DATES I DUE DATE (978)688-9550 1 09/04/2020-12/07/2020 02/12/2021 Reading information: SERVICE ADDRESS (978)688-9570 3-2 1749 SALEM STREET : DECOSTA,JOSEPH M. TRANSACTIONS THIS PERIOD AMOUNT 1749 SALEM STREET NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $45.B2 II'I'lllllllllllllll'III'II'II'I'IIII"I"I'I'lllllll'lllllllllll PAYMENTS THROUGH 01/13/2021 $-45.85 ADJUST. THROUGH 01/13/2021 $0.00 The Town now has a new Online Bill Payment System. INTEREST AS OF 02/12/2021 $0.00 To ensure we receive your payments online please visit BALANCE FORWARD $-0.03 www.northandoverma.gov/pay to setup our new account. SEP.:AL Rs.DINGS USAGE N8OF CURRENT BILL DETAIL USAGE UNIT AMOUNT Current Type Date DAYS 36393535 461 a 12/07/2020 2 94 WATER USAGE 2 $7.60 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Type Date DAYS 36393535 449 a 09/04/2020 10 93 36393535 438 a 06/03/2020 11 90 36393535 434 a 03/05/2020 4 87 36393535 431 a 12/09/2019 3 87 36393535 429 a 09/13/2019 2 98 36393535 425 a 06/07/2019 4 92 36393535 422 a 03/07/2019 3 90 TOTAL $15.42 36393535 420 a 12/07/2018 2 87 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978) 688-9570 IN ADVANCE. *NOTE"PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 194 MEDFORD,MA 02155 WATER RATE: FIRST 20 UNITS $3 .80 OVER 20 UNITS $5.S5 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.northandoverrna.gov Please return this portion with your payment to Any amount which is not paid by due date will be Town of North Andover subject to interest charges of Ail M—r!' 14%Per Annum 120 Main Street NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978)688-9550 (978)688-9550 rues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri 8:00-12:00 IN IN 11111111111 IIII 1111 ACCOUNT = BILLING DATE 3170138 1 01 13 2021 SERVICE ADDRESS 3-2 e DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYMENT ON OR BEFORE NORTH ANDOVER MA 01845-3318 0 2 12 2 0 21 1S . 39 II,Illlllllllllllll'III'll'll'I'IIII"I"I'I'lllllll'lllIIIIIIIIAMOUNT -. . IIIIIIIIIIIINIIIIIIIIIIIIIIII OFFICE HOURS i PAYMENT ON OR BEFORE Monday 8:00-4:30 11/13/2020 $45 . 82 Town of North Andover Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 ACCOUNT BILLING DATE North Andover, MA01845 rnurs a:oo-a:3o Fri 8:00-12:00 3170138 10/14/2020 (978)688-9550 to G?V� AT Q! MP/VUtJ Billing information: SERVICE DES B DUE ITE t�3 gs (978)688-9550 06/03/2020-09/04/2020 11/13/2020 ,P �r/S/�o eading information: SERVICE ADDRESS (978)588-9570 a-z 1749 SALEM STREET DECOSTA,JOSEPH M. TRANSACTIONS THIS PERIOD AMOUNT 1749 SALEM STREET NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $49.62 II111�.1111'•• '��"11,IIII11111�1 �11���'I��II"�"11�1111 PAYMENTS THROUGH 10/14/2020 $-49.62 ADJUST. THROUGH 10/14/2020 $0.00 The Town now has a new Online Bill Payment System. INTEREST AS OF 11/13/2020 $0.00 To ensure we receive your payments online please visit PAT:zLNCE FORW_ZLRD $ _0 0 www.northandoverma.gov/pay to setup our new account. SERIAL# READINGS USAGE NB OF CURRENT BILL DETAIL USAGE UNIT AMOUNT Current Type Date DAYS 36393535 459 a 09/04/2020 10 93 WATER USAGE 10 $38.00 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Tye Date DAYS 36393535 438 a 06/03/2020 11 90 36393535 434 a 03/05/2020 4 87 36393535 431 a 12/09/2019 3 87 36393535 429 a 09/13/2019 2 98 36393535 425 a 06/07/2019 4 92 36393535 422 a 03/07/2019 3 90 36393535 420 a 12/07/2018 2 87 TOTAL $45.82 36393535 414 a 09/11/2018 6 95 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978) 688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 194 MEDFORD,MA 02155 WATER RATE: FIRST 20 UNITS $3 .80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.northandoverrna.gov Please return this portion with your payment to Any amount which is not paid by due date will be Town of North Andover subject to interest charges of 14/o Per Annum 120 Main Street NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978)688-9550 (978)688-9550 Tues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri 8:00—12:00 I�III 1111111 lilt u� II III II1I'II11ACCOUNT BILLINGDATE 3170138 10/14/2020 SERVICE ADDRESS 3-2 DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYNIENI ON OR BEFORE NORTH ANDOVER MA 01845-3318 11 13 2020 45 . 82 �IIII� IIII � ��. 11111111111�1. �11���'I��II. �. II�I111AN10UNT Ilnl'lnll ['7 rn7r171 nnnnnnnnnnnnnni nni nn nl.nno nni nnnnnnnnnni. rnnnnn OFFICE HOURS PAYMENT ON OR Monday 8:00-4:30 08/14/2020 $49 . 62 Town of North Andover Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 ACCOUNT BILLING DATE Thurs 8:00-4:30 North Andover, MA 01845 Fri 8:00-12:00 3170138 07/15/2020 iB (978)688-9550 Billing information: SERVICE DATES DUE DATE �QKgD WP5'4Y (978)68&9550 03/05/2020-06/03/2020 08/14/2020 �y9 b� R ding information: SERVICE ADDRESS 4 1 P (�/3lot O (978)688-9570 1749 SALEM STREET DECOSTA,JOSEPH M. TRANSACTIONS 1749 SALEM STREET THIS PERIOD AMOUNT NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $23_02 I'I'I'1'II'IIIIIIIIIIIIIIIII"I'lllllll'lll"II11'll'llll"' PAYMENTS THROUGH 07/15/2020 $-23 .02 ADJUST. THROUGH 07/15/2020 $0.00 INTEREST AS OF 08/14/2020 $0.00 BALANCE FORWARD $0.00 - ---- - _ SERIAL# READINGS USAGE NB OF CURRENT BILL DETAIL USAGE UNIT AMOUNT Current Type Date DAYS 36393535 449 a 06/03/2020 11 90 WATER USAGE 11 $41.80 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Type Date DAYS 36393535 434 a 03/05/2020 4 87 36393535 431 a 12/09/2019 3 87 36393535 429 a 09/13/2019 2 98 36393535 425 a 06/07/2019 4 92 36393535 422 a 03/07/2019 3 90 36393535 420 a 12/07/2018 2 87 36393535 414 a 09/11/2018 6 95 TOTAL $49.62 36393535 411 a 06/08/2018 3 94 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978) 688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 184 MEDFORD,MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.northandoverma.gov Please return this portion with your payment to Any amount which is not paid by due date will be Town of North Andover subject to interest charges of 14%Per Annum 120 Main Street NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978)688-9550 (978)688-9550 Tues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri 8:00-12:00 IN IN I 111111111 oil 11 ACCOUNT BILLING DATE 3170138 07/15/2020 SERVICE ADDRESS 4-1 DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYMENT ON OR • NORTH ANDOVER MA 01845-3318 0 8 14 2 02 0 49 . 62 I'I'I'rlrlllrrllllnnll,I„I"rllllllrnl"IIII'n'llll"' AMOUNT PAID nnnni, % r-irn-in-inn nnnnnnnnnr,nn-,� OFFICE HOURS . Town of North Andover Tues s o0-6:00 o s/o 8/2 0 2 0 0 (978)688-9550 $23 . 0120 Main Street Wed 8:00-4:30ACCOUNTNorth Andover, MA 01 Thurs 8:00-4:3o BILLING DATE Fri 8:00—12:00 3170138 04/08/2020 QT.37N kHH-lT illing information: SERVICED DUE DATE +��3,Da 78)68>3-9550 12/09/2019-03/OS/2020 05/OS/2020 10 y �oZ a Re,a�'ding information: SERVICE ADDRESS 3-2 / /`(978)688-9570 DECOSTA,JOSEPH M. L 1749 SALEM STREET 1749 SALEM STREET TRANSACTIONS THIS PERIOD AMOUNT NORTH ANDOVER MA 01845-3318 '1�1�11"�II111�111�,11�11„I•II"'I�I��I�11'I'llll��'I'11111, PREVIOUS BALANCE $19.22 PAYMENTS THROUGH 04/08/2020 $-19.22 ADJUST. THROUGH 04/08/2020 $0.00 INTEREST AS OF 05/08/2020 $0.00 SERIAL# READINGS USAGE NB OF Current Type Date DAYS CURRENT BILL DETAIL USAGE UNIT AMOUNT 36393535 438 a 03/05/2020 4 87 WATER USAGE 4 $15.20 ADMINISTRATIVE FEE $7 82 SERIAL# READINGS USAGE NB OF Current Type Date DAYS 36393535 431 a 12/09/2019 3 36393535 429 87 a 09/13/2019 2 98 36393535 425 a 06/07/2019 4 36393535 422 92 a 03/07/2019 3 90 36393535 420 a 12/07/2018 2 36393535 414 97 a 09/11/2018 6 95 36393535 411 a 06/08/2018 3 36393535 408 a 03/ 94 TOTAL06/2018 3 90 $23,D2 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978)688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 184 MEDFORD,MA 02155 WATER RATE: FIRST 20 UNITS $3.80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at -- - www.northandoverma.gov Please return this portion with your payment to Any amount which is not paid by due date will be Town of North Andover subject to interest charges of 120 Main Street 14%Per Annum North Andover, MA 01845 NEW OFFICE HOURS (978)688-9550 Billing information: Monday 8:00-4:30 (978)688-9550 Tues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 lull 11111IIIII 1111111111 Fri 8N —ATE A;70 BILLING DATE 1 04 08/2020 3-2 ERVLE DRESS DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET — NORTH ANDOVER MA 01845-3318 , ' •' 'Ililll"�IIIII�IIII,IIILII,II"'I�11�1�11'I'�III��•I'LIIII, 05 08 2020 23 . 02 AMOUNT PAID py3aM z�� Illllillllllnlllllllllllllll i9,z �/,3��C O ICE HOURS • • BEFORE nday8:oo-4:30 02�14/2020 $19 . 22 Town of North An over Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 ACCOUNT 8{ NG I1AT£` North Andover, MA 01845 Thurs 8:00-4:30 Fri8:00-12:00 3170138 T .01/15/2020 (978)688-9550 Billing information: 5 DUE DATE (978)688-9550 09/13/2019-12/09/2019 02/14/2020 Reading information: SI ,iiADDRESS 3-2 (978)688-9570 FL= 1749 SALEM STREET S JOSEPH M. 1749 SALEM STREET TRANSA1-fiONSTHIS PERIOD' AMOUNT 1749 NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $15.42 'IIIIII11111„ I.II..1 .II"'illl'llll'll"IIIIIIIIII'll'I'lll'll PAYMENTS THROUGH 01/15/2020 $-15.42 ADJUST. THROUGH 01/15/2020 $0.00 i INTEREST AS OF 02/14/2020 $0.00 BALANCE FORWARD $0.00 SERIAL# READINGS USAGE NB OF _-- —T` CURREN BILL DETAIL USAGE UNIT AMOUNT Current Type Date DAYS 36393535 434 a 12/09/2019 3 87 WATER USAGE 3 $11.40 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Type Date DAYS 36393535 429 a 09/13/2019 2 98 36393535 425 a 06/07/2019 4 92 36393535 422 a 03/07/2019 3 90 36393535 420 a 12/07/2018 2 87 36393535 414 a 09/11/2018 6 95 36393535 411 a 06/08/2018 3 94 36393535 408 a 03/06/2018 3 90 TOTAL $19.22 36393535 405 a 12/06/2017 3 89 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978)688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL IS 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 184 MEDFORD,MA 02155 WATER RATE: FIRST 20 UNITS $3 .80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.northandoverrna.gov Please return this portion with your payment to Any amount which is not paid by due date will be Town of North Andover subject to interest charges of 14%Per Annum 120 Main Street NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978)688-9550 (978)688-9550 Tues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri 8:00—12:00 I loll 1111111111111111 oil I ACCOUNT BILLING DATE 3170138 01/15/2020 SE#t�/bAtSS 3-2 DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYMENT ON OR BEFORE NORTH ANDOVER MA 01845-3318 0 2 14 2 0 2 0 --$19 . 22 IIIIIIIIIII...L I L.1,.II...IIII.IIII,II..11llllllll.11.l.ln'Il AMOUNT PAID OFFICE HOURS PAYMENT ON • Monday 8:00-4:30 11/11/2019 $15 .42 Town of North Andover Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 ACCOUNT B{WNG DATE Thurs 8:00-4:30 __ North Andover, MA 01845 Fri 8:00-12:00 3170138 10/10/2019 (978) 688-9550 PMG07-IU$Z' Billing information: SERVICE DAB; QC `ATE IIr yaZ (978)688-9550 06/07/2019-09/13/2019 11/11/2019 Reading information: SERVICE ADDRESS 3-2 ! (978)688-9570 1749 SALEM STREET DECOSTA,JOSEPH M. 1749 SALEM STREET TRANSAGDONS THIS PERIOD AMOUNT NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $23.02 I'111'I'II"IIII'IIII1111,I"1'11"I'lllllll'llllllllllll'1'll'll PAYMENTS THROUGH 10/10/2019 $-23.02 ADJUST. THROUGH 10/10/2019 $0.00 INTEREST AS OF 11/11/2019 $0.00 BALANCE FORWARD $0.00 SERIAL# READINGS USAGE NB OF CURRENT BILL DETAIL USAGE UNIT AMOUNT Current Type Date DAYS 36393535 431 a 09/13/2019 2 98 WATER USAGE 2 $7.60 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Type Date DAYS 36393535 425 a 06/07/2019 4 92 36393535 422 a 03/07/2019 3 90 36393535 420 a 12/07/2018 2 87 36393535 414 a 09/11/2018 6 95 36393535 411 a 06/08/2018 3 94 36393535 408 a 03/06/2018 3 90 36393535 405 a 12/06/2017 3 89 TOTAL $15.42 36393535 402 a 09/08/2017 3 94 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978) 688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 194 MEDFORD,MA 02155 WATER RATE: FIRST 20 UNITS $3 .80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.northandoverma.gov Please return this portion with your payment to Any amount which is not paid by due date will be Town of North Andover subject to interest charges of 120 Main Street 14%Per Annum NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978)688-9550 (978)688-9550 Tues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri 8:00-12:00 ACCOUNT BALING DATE Illull pN 11 �J q 3170138 10/10/2019 SERVICE ADDRESS 3-2 DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYMENT ON •• BEFORE NORTH ANDOVER MA 01845-3318 11 11 2 019 15 .42 Lnl,l.11.,IIII,Illlllu'L.I,II..l,lllllu'lllnllllln.l,ll.11 • nnnnis'irnrn-in-innnnnnn-nn -- --- - ---------- - - - OFFICE HOURS PAYMENT ON •• •• Monday 8:00-4:30 08/26/2019 $23 . 02 Town of North Andover Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 ACCOUNT BIWNG DATE 30 North Andover, MA 01 Fri 8:00-12:Thurs 8:00-4:0 3170138 07/25/2019 (978) 688-9550 FW FI QDZYy Billing information: SERVICE AT 00E DATE (978)688-9550 03/07/2019 06/07/2019 08/26/2019 eading information: SERVICE ADDRESS 32 / (978)688-9570 1749 SALEM STREET DECOSTA,JOSEPH M. TRANSACTIONS THIS PERIOD AMOUNT 1749 SALEM STREET NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $19.22 "II'1"II'I11"I'I'I"iI.11lllll'll'lllll"IIIII'lllllllllllllll PAYMENTS THROUGH 07/25/2019 $-19.22 ADJUST. THROUGH 07/25/2019 $0.00 INTEREST AS OF 08/26/2019 $0.00 BALANCE FORWARD $0.00 SERIAL# READINGS USAGE NB OF CURRENT BILL DETAIL USAGE UNIT AMOUNT Current Tye Date DAYS 36393535 429 a 06/07/2019 4 92 WATER USAGE 4 $15.20 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Type Date DAYS 36393535 422 a 03/07/2019 3 90 36393535 420 a 12/07/2018 2 87 36393535 414 a 09/11/2018 6 95 36393535 411 a 06/08/2018 3 94 36393535 408 a 03/06/2018 3 90 36393535 405 a 12/06/2017 3 89 36393535 402 a 09/08/2017 3 94 TOTAL $23.02 36393535 398 a 06/06/2017 4 91 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978) 688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O-BOX 184 MEDFORD,MA02155 WATER RATE: FIRST 20 UNITS $3 .80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.northandoverma.gov Please return this portion with your payment to Any amount which is not paid by due date will be subject to interest charges of Town of North Andover 14%Per Annum 120 Main Street NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978) 688-9550 (978)688-9550 Tues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri 8:00—12:00 III uIu NIII'UN�II��II(UI ACCOUNT BiWNG DATE u uu uH u 3170138 07/25/2019 SERVICE ADDRESS 3-2 DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYMENT ON •• BEFORE NORTH ANDOVER MA 01845-3318 08/26/2019 2 3 . 0 2 "II'r'I1'IIr'1'I'r'I1'lllllll'IrIIIII"IIIII'IIIIIII11111n1 D too I ram• 7 61°01`y+� > ,�. q.�� Iliilllllilllllllllllllilllll OFFI URS PAYMENT ON OR • ay8 .00-4:30 /16/2019 05 $19 . 22 Town of North Andover Tues 8:00-6:00 120 Main Street Wed 8:00-4:30 A !�T Thurs 8:00-4:30 I DATE North Andover, MA 01845 Fri 8:00-12:00 3170138 04/16/2019 (978)688-9550 Billing information: SERVICE DATES DUE DATE (978)688-9550 12/07/2018-03/07/2019 05/16/2019 Reading information: SER CEADDRESS (978)688-9570 3-z 1749 SALEM STREET DECOSTA,JOSEPH M. TRANSACTIONS THIS P uj = AMOUNT 1749 SALEM STREET NORTH ANDOVER MA 01845-3318 PREVIOUS BALANCE $15.42 II'IIII'IIII'Iillllllllllllll'IIIII"IIIIIIIII'llll"11111111111' PAYMENTS THROUGH 04/16/2019 $-15.42 ADJUST. THROUGH 04/16/2019 $0.00 INTEREST AS OF 05/16/2019 $0.00 BALANCE FORWARD $0.00 SERIAL# READINGS USAGE NB OF CURRENT BILL DETAIL USAGE UNIT AMOUNT Current Type Date DAYS 36393535 425 a 03/07/2019 3 90 WATER USAGE 3 $11.40 ADMINISTRATIVE FEE $7.82 SERIAL# READINGS USAGE NB OF Current Tye Date DAYS 36393535 420 a 12/07/2018 2 87 36393535 414 a 09/11/2018 6 95 36393535 411 a 06/08/2018 3 94 36393535 408 a 03/06/2018 3 90 36393535 405 a 12/06/2017 3 89 36393535 402 a 09/08/2017 3 94 36393535 398 a 06/06/2017 4 91 TOTAL $19.22 36393535 395 a 03/07/2017 3 89 MESSAGES: RETAIN THIS PORTION FOR YOUR RECORDS. MOVING? PLEASE CALL(978) 688-9570 IN ADVANCE. *NOTE*PAYMENTS SHOULD BE MADE:TOWN HALL @ 120 MAIN STREET OR BY MAIL TO OUR LOCKBOX @ P.O.BOX 194 MEDFORD,MA 021S5 WATER RATE: FIRST 20 UNITS $3 .80 OVER 20 UNITS $5.55 SEWER RATE: FIRST 20 UNITS $5.95 OVER 20 UNITS $9.24 BYPASS METER WATER RATE: ALL UNITS $5.55 Pay online at www.no,rthandovenna.gov Please return this portion with your payment to Any amount which is not paid by due date will be Town of North Andover subject to interest charges of 14/o Per Annum 120 Main Street. NEW OFFICE HOURS North Andover, MA 01845 Billing information: Monday 8:00-4:30 (978) 688-9550 (978)688-9550 rues 8:00-6:00 Reading information: Wed 8:00-4:30 (978)688-9570 Thurs 8:00-4:30 Fri —12:00 lull 11111111111111111 oil III ACCOUNT B(I 8:00 DATE 3170138 ._04/16/2019 SERVICE ADDRESS 3-2 DECOSTA,JOSEPH M. 1749 SALEM STREET 1749 SALEM STREET PAYMENT ON • NORTH ANDOVER MA 01845-3318 0 5 16 2 019 19 . 22 II'IIII'IIII'lIIIIIIIIIIIIIII'lllll"II1111111'llll"IIIIII11111' ANIOUNT ., 2-74 12 ' A (zST 'AORTN 1 Town of North Andover `ti'•;;;o::` r HEALTH DEPARTMENT ,SSACMU+t� CHECK#: Xa,z 9 DATE: LOCATION: 7 S� 9 Jr'c✓er� S� H/O NAME: 2C� CONTRACTOR NAME: /50y Y,- Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ 15 Title 5 Report ❑ Other:(Indicate) $ 1 60 Hearth Agent Initials White-Applicant Yellow-Health Pink-Treasurer