HomeMy WebLinkAboutPass - Title V Inspection Report - 107 GRANVILLE LANE 9/19/2024 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments
P' arty Artdress
Owner 's N e C ! b l T CT
ifafclmlatfon Is _y
required for every _ �'t 4t Q.�� r _.. _,..._ �_ __.__ �.... � _. ._
Pager City/I own Sae lip G Date of Inspection
Inspection results must be submitted on this farm. Inspection forms may not be altt in any
way. please see completeness checklist at the end of the form.
Important:When
filling out forms A. Inspector Information
on the computer, �
use only the tab CHARLES J. ROUX
key to move your N;arne of Inspector
rUrsor-do not CHARLEvS J. ROUX, LL.0
use the return —
key. Company N;arne
213 PATTEN ROAD _
mti Company address
TEWKSBURY MA � � 01876 -
City/[awn State Zip Code
978 640 9984 S1891 _
Telephone Number UGonse 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 arid 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 haven determined
that the system:
1. (/Passes
2. [ Conditionally Passes
3. El Needs Further Evaluation by the I.ol;a,l Approving Authority
4. Fails
I` " /
In,~`;pectors Slgnatulrr„ 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 appropricato
regional office of the DEP. Than original form should be sent to the system owner and copies sent to
they 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.
t5in.5p,doc.•niv-712612018 Title S Official In,';Pe ct(on Form:Subsurfacre,Sewage Disposal System-Page 7 of 18
(commonwealth of Massachusetts
; � Title 5 Official Inspection Form
r"d Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments
F ropr.fty Address
Owner _.
Owner'sr"�dcar�arw
information n is
ar quiraad for(.very
city/T Own
_..
Page. star(" Duda Code
Date of da7s der*c'Uffr7
C. Inspection Summary _
Inspection Summary: Complete, 1, 2, 3, or 5 and all of 4 and 5,
1) System Passes:
I have not found any information which indicates that any of the failure criteria described
in 310 C�MR 15,303 or in 310 C;MR 15,304 exist. ,any failure criteria riot evaluated are
it
indicated below.
C Ornrnents:
AYIVAU AJTQA�Tvl-�
2) System Conditionally Passes:
[j One or more system componerits as described ir'a the "Conditional Pass" section need to be
replaced
paced or repaired, 'The
system, upon completion of the replacement or repair, as approved by
f f
the Board of Health„ will past,,
determined,"e Check
t he box
lfor
rsc es "no"car "riot determined" ("Y, N, ND' for the following staternents. If "riot
p y explain.
'f'he septic tank is metal and over 20 years old* or th septic tank (whether metal or riot) is structt.rraiiy
unsound, exhibits substantial infiltration or exfiVtrati i or tank failure is imminent. System will pass
inspection if the existim tank is replaced with <a r rrpplyinct septic tank as approved by the Board of
*A metal selptic, tank wilt pass inspection ' it is structurally sourtd, not leaking arid if a Certificate of
Compliance indicating that the tank is I ,s than 20 years old is available,
C.. 'Y [m] N
E] N (Explain below):
t`V1W,(V d(W 7126/�,,1'PnlR
r'i�u p l'kPMou^l iln„up rave n f of", sua,uurfarP,Seww;e D vt7a1 v system•page r`uzY 9k'k
£.,. Commonwealth of Massachusetts
+wkY'r nX l
Title 5 Official Inspe�aic►n Form
Subsurface Sewage Disposal System Farm - Not for VcAuratary Assessments
roperty Addross
Owner 0wearaar's Nranio
Mfurrrratnn is
required for every _
it �T'caw11 4t atr Zip r c�rir„ C J,r@e.of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
[ _ Pump Chamber pumps/alarms scat operational. System will pass with Board of Health approva�AV it
I'unripslalarrns ;area repaired.
to broken orr obstructed p(s)or due t out or
settled
or unevenautionibtox. box rr,
of sewage p s
box. `iyste�Gt'a will
pass inspection if (with approval of Board of Health):
,...) broken pipe(s) are replaced (� Yxplain below):
( � obstruction 8:;� removed [ yxplain b0ow):
Ej distribution box is leveled or re lace,,d ( Yx �p 7xplair'a below):
systemstern pass required
��pe�cmpinf(math approval the Se
e thantimes
aae�ar due to broken or obstructed pipe(s). I ho
will
Board of Health):
(�. ] broken pipe(s) rare placed [,, Y E] N Ll NCB (E;:xpl,ain below):
E.] obstruction is r knoved Y E] N E] NCB (Explain below).
3) Further Evaluation is Required by the Board of Health:
Conditions exist which require further eavalurati r by the Board of EleaaBtt'a in order to deaterra°aurae r't
the system is failing to protect public health ,.ahtty or the environment.
a. System will pass unless Board of ealth determines in accordance with 310 CMR
15.303(1)(b) that the system is not nctioning in a manner which will protect public health,
safety and the environment:
tl5 sp doc^v'erv.?h2r12018 P ido 5 offr ml a nup,4C.Iurr r o m suEemreriane seNaw,, syste-^1'wle 3 0 1di
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage disposal System Form - Not for Voluntary Assessments
o Vill
Property Address
_ .......
Owner Owner's Narne
inforrrration is
reyuiied for ovefy
page. (ity/`Town State zip code Date of Inspection
C. inspection Summary (cant.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
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 lest,
than 11w day flow
Required purnping rnore, than 4 tunes in the last year NOT duet to clogged of,
obstructed pipe(s). Number of times pumped:
[._ [ 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
C� tributary to a surface water supply.
,t Any portion of a cesspool or privy is within a Zone; 1 of a public water supply
well.
[ ] [ Any portion of a cesspool or privy is within 50 feet of a private water supply weEl
C_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
frorn 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.
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. I he
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 syste ust serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you mt.rst indicate either. "yes"" or""no" to es ,t of the following, in addition to the
questions in Section C.4.
Yes No
( [ the system is within 400 feet f a surface drinking water supply
the system is within 200 eet of a tributary to a surface drinking water supply
the system is locate In a nitrogen sensitive area (Interim Wellhead Protection
Area -- IWPA) or tipped Zone: II of a public water supply well
t5ur spAoc rev.7F'2W018 1 ide fa Offiraaf Inspection Form Subsurface,Sewage Di.«,ft.sat System-PNE,5 of 18
Commonwealth of Massachusetts
Title 5 C fficiel Inspection Form
`+ Subsurface Sewage Disposal S stem Form - Not for Voluntary Assessments
Property Address
owner Owners Narne
inforrnatuorr u
required fo> every _._..__..
p<af e. Oty(Towrf sttfte: Zip Code t)tlto(if Inspection
D. System Information
1. Residential Flow Conditions:
Ntar'rrtae;r of bedrooms (design): Number of bedrooms (ackjal): _
DESIGN flow based on 310 CMFR 15.203 (for example: 110 gpd x t#of bedroorns):
Description: �
Number of current residents:
[does residence have a garbage grinder? El Yes 140
Does residence have a water treatment unit? Yes [` o
If yes„ discharges to: .�
Is laundry on a separates sewage system? (Include laundry system inspection
information in this report.) C_..] Yes IV No
Laundry system inspected? M F1 Yes (.......] No
Seasonal use? Y os,
. N ca�,N
w g ( y e (gpd)) J C_�t .)(�_ ,
Water r'rte,te,r reartirt s, if available (last 2 earn usage
Detail 4
Sump purrip? Yes ]_....] No
Last date of occupancy:
�te
r'a.ntrb tia',ru• wv 8f;fr's7f'atkk Tte 5 Crffwqi hb��.;oat<:Uaurt ra.ai itr ,"rkak'b a rf.aae3",, w;r,d r,spo w4 4yt„ton-9,age"7 of 98
Commonwealth of Massachusetts
Title 5 01 icial Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
r'rckraorty 4drirr,ss
Owner __ _.. _...
r"s Millie
information Vs
required for every
Page CItyl°I rawru `�t<ato G�u a code _.. w
_ _ _ __ .. _ fie; C�aalar r,„at In�rrrw¢trtara
D. System Information (cent.) __... .
2. Commercial/Industrial Flow Conditions:
Type of Establishment: _.
Design flown (based on 310 (.MIR 15.203): _...GaUons per day purr)
Basis of design flow (seats/persons/sel.ft., etc.):
Grease trap present'? 0 Yes N
Water treatment unit present? Q_..l Yes ["I No
If yes, discharges to: _
Industrial waste bolding tank present? El Yes (..m.� Nco
Nora sanitary waste discharged to ffie Title ' system? C.. Yeu, ] No
Waster ureter readings, if available:
Last date of occupancy/use: _..
Date
Other (describe; below):
3. Pumping Records:
Source of information;
Was systern pumped as part of the inspection? Yes ( ) No
If Yes, volume pumped: 0- 0
�r4alBr,r�., � � _..
Flow was quantity pumped determined? t
Reason for pumping; ."- Izv,k-N C",xj-l!---42
t5"vip.doc•row If:+612016 PiCt¢:ra 4.71hua'ru lor, ¢art�rvru I'nrn.E�ukr aor6�;ra:" �o�aa�� CDo�arwtr;v"xu `y��G�:err•f'ry t P�Gst`4r,4
". Commonwealth of Massachusetts
Title 5 Off dal Inspection Form
"1 Subsurface. Sewage Disposal System Form Not for-Voluntary Assessrrtents
Property, ddre ss,
Owner
i nfG'.)rk cation is
re' jwire�ef for every
P<rgr-:t t";ityClarwrr _ .___
�t;rte Zip Code' Dato of Ir7", a�a_tjon
D. System Information (cont.)
. _ .. _ _ _
4. Type of System:
I Septic;tank, distribution box, soil absorption system
0 Single cesspool
L1 Overflow cesspool
El Privy
�..� Shared syste rn (yes or no) (if yes, attach previous inspection records, if any)
..� Vnnovative/Alternative techno0ogy. Attach as copy of the current operation and
maintenances contract (to be obtained frorn systern owner) and a (;opy of latest
inspection of the ICA system by system operator under contract
El Tight tank, Attach a copy of they Df P approval.
Other (describe):
Approximate aye of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? Yes No
b. Building Sewer (locate on site plan):
Depth below grade:
feet
Material of construction:
14 cast ir-on 1."_.1 40 PVC
EJ other(explain;):
Distance frorn private wate�r Supply well or suction line:
feet
Comments (on condition of joints, venting, evidence of leakage, et(...):
tl°psri^,g>.r4 a; rw YFdkaf apt f9 'O fffE*ay f'NfCw<rG r4 Iu M1psrroa'.Ria7rr f trrcr:SGbbsurtl3Cxw&,,w jqe tl 6itw.rbCja�iysR"nro-page of 18
Commonwealth of Massachusetts
Title 5 Offid l Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
ot
r'rc�tx«�rty a�a�T red � 4
Owner clwrpe, s Naenea
Mormattion is
t`f,g Uil4'ed for evor'y
page City(Teawn State Zip code Date of Inspection .._... _
C. Inspection Summary (cant.)
,._ Cesspool or privy is within 50 feet of as surface water
....) Cesspool or privy is within 50 feet of as bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Sup p ier, if any)
determines that the system is functioning in a manner that protect° e public health,
safety and environment:
El The system has as septic tank and soil absorption system (S arid the SAS is within
100 feet of a surfaced water supply or tributary to a surface wa r supply"
[_". 'The systern ha:is a septic tank and SAS and the SAS i ithin a Zone 1 of as public water,
supply.
[_] The system has as septic tank and SAS and the S is within 50 feet of a private water"
supply well.
[ ] The system has a septic:tank and SAS and th SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance,:
`* l his systearn passes if the well water aria sis, perfornaead at a DE_P certified laboratory, for fecaa8
ter indicates absent and th presence, rrTmonia nitrogen arid nitrate nitrogen is e�ctia<�al
ccalifcarrn bacteria a � rra, arovlcle,d that no the,r fair s of a
to or less that) Iona criteria are triggered A copy of the analysis rnrtsa
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:
Yeas No
[ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Dis ^ T l g t the surface of the ground or surfaced waters
l [. due to�an overloaded or clogged SAS or cesspool
t rrmp�r%Cat" "w Pd ei� 'S.k tE! TKO i roPfrua nsp v(^,tmii Form ls,.xb�¢r�fda;r Sapw,&d a;Dl
p o,e ed.ay.+�wrv'4-praqe 4 oP 19
Commonwealth of Massachusetts
Title 5 �ff""dal Inspection Form
Subsurface Sewage Uis oral System Farm - Not for Voluntary Assessments
'r�YA'
roperrty fi ddrw,.
Owner Owner's Naar°rraa
information is
reetaauaref for every
page, cityfr¢rwea
,taate, ZO C ode« Datea of Inspe'dO
D. System Information (cont.)
6. Septic Tank (locate on site kalan).
Depth below grade: -1 11 J ' 11 a'-.'
feet
Material of constructican:
1; concrete L metal fiberglass,fibc��rg °�ss ( � polyethyk me �..� ether(explain)
If tank is metals list age; , .
years
Is age confirmed by a Certificate of(,orn liance? attach as copy of certificate) w. Yes _� No
Dimensions;
Sludge; depth:
Distance frorn top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance frees to[) of SCUM to top of outlet tee, or baffle,
Distance frora bottom of scum to bottom of outlet tee or baffle
Flow were dimensions deterrnined?
( omrnf.,ants (on Pumping recommendations, inlet and Outlet tee or baffle condition, structural integrity„
liquid levels as related to outlet invert, evidence of leakage, etc.):
I-fe I
'S
0 8- 9,Lx
10"
�j.. -I � �) ,(
5 rrocea,dOC•rev 7l26001 r1U G,6fo-muael B ^tguwt Ms«a�ro err r kart ska IW ser^rrmwa q k,u)r08,tl�" � 'ymrzrar-6'fiega 10 of 165
Commonwealth of Massachusetts
1, Title 5 Official Inspection Form
r oE'y Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Propertyfrr9cSress
Owwner �_. � — —
C7wwnw„r"�; artar,
Otor`rrsrltion is
rrwctutred for every
pageg, CityFrowwn — Statr,.._ Zip Code Date of lnspertion
D. System Information (cant,)
7. Grease Trap (locate can site plan):
Depth below grade:
fnr:t
Material of construction:
E g poly.,, concrete El metal El fiberglass E] ofe ylene; L� other(explain):
Dimensions:
Scurn thickness - .._.
Distance from top of scurn to tap of outlet tee or baf e
Distance from bottom of sc:;urn to bottorn of outl tee or baffle
Date of last pumping: Date
C onirrrents (on purnping recorninend/,,vidence
inlet and outlet tee or baffle condition, structurai integrity,
liquid levels a related to ar.ttlet invert of leakage, otc.).
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: _
Material of constrt.tctiort.
.w..} rr c, [_. bbe rglass [.. polyethylene �_.] other (erplaar�);
.. concrete tta6
Dimensions:
Capacity.
C�altt?Gi;">
Design Row: __...
gallons pr;r duty
t5mi,pa.<acw•rev W(,F1'018 '71fi.5 Oft am 8nsrrvrretiion vrxfaa g9ijg swfaaar'Sewage Dispw%ar System-Page'C'k of 16
$'� Commonwealth of Massachusetts
„ ,
Title 5 Official Inspection Form
( Subsurface Sewage Dispersal System Form - Not for Voluntary Assessments
Property Address _.... _.
Owner _ _. _._. ....._.._ _ _. _..
C7wner',Name
information is
r
equired for every
agk:. C ftyCTown State Zip Code Date of Inspection
D. System Information (cant.)
8. Tight or Holding Tank (cant.)
Alarm present: ( Ye �] No
Alarm level; Alarm in working order: [__) Yes (� No
Date of last pumping:
Date
Comments (condition of alarm and float s itches, etc.):
Attach copy of current pumping contract (required). Is copy attached? �,.,� Yes [.._1 No
g. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
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.):
J. 6
---
� , _ F
t6lnsfr.(lr)c•reev.'112612016 6i¢ta7 5 C7fRe,:raY le t^�rrt;e,�t�cre'i&crnrr.'ubsuvi eu°.e:>c�w,;aye fl)� 6ltcr:,rrl:�y te;rrt•r';ge YP r,11'k k'{
` Commonwealth of Massachusetts
` Tide 5 Official Inspection Form
9" Subsurfaces Sewage Disposal System Form - Not for Voluntary Assessments
;'�,
Property Address
Owner Owner's Narne,
mfc;araro;'Mon is
ak gwirrrrl for ravery
page, Gty[Town State lrta Code Date of Inspection
D. System Information (cons.)
10. Pump Chamber(locate or) site plan):
Purnps in working order: 'Yes [_l No*
Alarms in working order: Yes (mIc7*
C;ornifnents (note condition of pump chamber, condition of pumps and appurtenances, etc,):
, .k''v ..>' CU4r�.P ar tf
i rU
C�v.. ... _ . -
If puMps or alarms are not in working order, system is a conditional pass,
11, Soil Absorption System (SAS) (locate on site plat)„ excavation riot required):
If SAS riot located, explain why:
f We,
El leaching pits nurrtber;
leaching chrambers number: _
] leaching galleries number; —
El leaching trenches number, length:
2leaching field, number,, dimensions: '
.
� . overflow cosspool number:
(,......,� innovative/alternative system
Type/name of technology:
V)mspr€oc•rr m T�16(2018 l ite 5 Official irlspf a moan k oril Subsurface'4+mA)v C"Yis5r s of,i'y^xitern^aIaoe a;3 of i 8
Commonwealth of Massachusetts
Title Official Inspection or
r1 �t.
r Subsurface Sewage [disposal System Form -Not for Voluntary Assessrnents
'operty Address
_...
Owner Owner's Narne
inforrrmt6rtn fy
rcr quired for every
pa q r"o Cityffrlwti State, Z P Code Date of Ertstret<.'tmrr
D. System Information (cant.)
11. Sail Absorption System (SAS) (cant.)
Comments (note condition of soii, signs of hydraulic; failure, level of ponding, darnp sail, condition of
vegetation, etc.):
12. Cesspools (cesspool rTlU,t be purnped as part of inspection) (locate can site plan):
Number and configuration
Depth -- toffs of liquid to inlet invert
[depth of solids layer
Depth of scum layer
Dimensions of cesspool _
Materials of constr/inw
_ _....._
Indication of groundwater1 Yes l No
Corn ments (note cs of hydraulic failure, level of ponding, condition of vegetation,
etc'):
t5msp.doc�rev.]IdW018 TtUe 5 Oft(,ojl inmr eteticm E orm Subswfetri)scswrda9v a spas al syester n^rage 14:r f lt
° Commonwealth of Massachusetts
Title 5 Official Inspection Form
". Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 ._ 7..._CC
Property Address
Owner
wner's Ni1fT1C;
information IS
required for every
p arc;. city/Fowit State Zip Code Date of Inspection
D. System Information (cant,)
13. Privy (locate on ;site plan):
Materials of construction:
Dimensions
Depth of solids _... _. __ _....
Comments (note condition of sail„ signs of hydra 'c failure, level of ponding, condition of vegetation,
etc.):
t5tlnSp,0M^10v 7126/201 s 'Title 5 Official Inspec on norm.SubSuffico Sewage r)itarrusai System^page is of is
Commonwealth of Massachusetts
1�'w, r Title 5 t" fficial Inspection orm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Properly Artrtr
Owner Owner Is Name
information is
rnquarod for ovary
Dtl"Towr _ _ ...._ .... Date of Inspection
a " Crt
Q. System Information (cant.)
14, Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal systern, including ties to at least two permanent reference
landmarks or benchmarks, Locate all wells within 100 feet. Locate where public water supply enter:
the building. Check one of the boxes below.
✓ TarTd sketch in the area below
drawin0 attached separately
S
P
Goa
C7 G"
u
i
r II
15,nGrro riot•ww.02612018 ➢'ite 5 ON2,3Y Insr"Wr'bo o 6'rwm�Subsurfaac fwww°wt O6¢,ars,V "YvwWern•Pnop,W reef Bh
Vf V
r V 5chedule of Tie Distances
A kC = 74.4 A E = 78.9 AG = 101.9'
114.0'
BD = J8.J' BF = 6J.5' BH = 69.Y
/ hereby cent th
at y 1' at / have inspected the cons tru-�Ition Of
this disposal system and that the construction and final
grading has been in accordance with the designer' s intent
and that the materials used conform to the plcn
specifications and -510 CUR 15.a
Lot 7 This plan has been prepared for the purpose of showing
the "As—Built" conditions of the sonitory disposal system
installed on the premlses. All work was done in substantial
conformance with the design plans as prepared. All work was
done within the construction limitations expected for a job
of this t e.
S7� MAL 2-C �f-
Design inW Date
W3M38
�hmark
gasin
IG8.871
10557'
Tbomas E Neve Associates, Inc.
5. Engineers — Surveyors — Land Use P16nners
447 Old Boston Road — US. Route I
Topsfield, Ycsscchusetts G198J 887-8586
1638—SSDAB-8
Y
E� 44
1
11t �
i
i
� f
1''y*sting StOr�
Four Bedroom
iiaad FrB�ze Dwelling
Existirxg Sep c ;�
r
sot fL ISM
��gg c s4JL7 f
l
ox
LJ i_
iI
CP
f
�,�+ `
Vel7t t
l
F
R— 1,60.00'
Edge ref i'c,
a n
1 � ,-
Publl�
Ben(
cots
4 Rim
,"f�1i
/1�'�Y / /�,�� �/, lr .r��� J J91�r rr✓ �'IYf�"'���E�iP�1�
fly frl� ,4 // ee x f f p l �i -
f
1f 6 v
� A r
l
3
T AYER'S COPY
107 LE LANE
AC ��r . �
AU7 � ..
CA2 C24 U7A22024
08/21/2 4P2�2 ��A1
ON
.W jo.
..C`.
•"�wi..Qli i(/�' is A ...,... ...
,..,.,...«.,..... �' e
sz,c CCS8 „l s.
SFYPA&S , .. two 'VA7F:E z RA .: c.I �.
Pay online at
n,,THE PORTION Bel..O W WrTH YOUR RAYMJ;N'9 www.nortliandoverma.gov
120 WN '"REET Any arnount which is not
pt,i+d by due<tatra wvaOV be,
NORTH Al" DO Eq MA 01845 subject to interest charges of 14%per annurn.
978-688-9550
a► r • : •
08/21/2024 $87.83
J HN
S LANE
w, p,
VA 01845...44:903 TOWN OF NORTH ANDOV R
DEPARTMENT 2850
PO BOX 986.500
BOSTON,MA 0 ., 6500
00004151?5 0240[300000000000317002?04031 70027QnnF1t nnf"IA'7Ainnq
�)
12/07/?�, .. � 15 A 84 wJkl' F1•tjt;i 5 1 �"bT f1r7
➢9F1 �
,TE�?AE'l\/Ew
Calm
$136.24 -$136.24 $0.00 $0.00 $0,00 $64V $64.82
M ES SA"3E',:
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
LlP:TAC H AND Rr,C'C.3RN t HE l'ION Rr:'4.OW W TH Y(XJH lrt^4'tl'
.........""'m"7.............
107 CRANVILLE LANE 3170027 03/07/2024 - 06/10:/20277E: "22`
/22/2024 08/21/2024
WArER USAGE 215 �t3C1.0
t7:3/837f2Q124 2499 C15/10/2024 252CD 21 A 9
ADMINISTRATIVE FEE$68 5Lf3
TOTAL DUE
�....__. -$68�62 62 $0.00 $0.00 $0.00 $87.83 $87.83
MESSAGE;
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
C7r'�ACH Arwn>i Trsc:nOl L1P .C>W Wl vrauIR PA-ME:ra"r
www.northaridoverma.gov
107 GRAANVIL.L_E LANE 3170027 1210712023 (J3/07/2024 04/16/2024 05/16/2024
12/07/2023 2483 01/07/2.024 2499 16 A 91 WATER USAGE E 16 $i60.f�C'1
ADMINISTRATIVE FEE $1,82
TOTAL DUE
$64.82 $64.82 $0.00 $0.00 $0.00 $68.62 $68.62
WATER RATE- FIRST 20 UNITS$3.80 OVER 20 UNITS$5.55
2 06 r^�q�22 �YA�y a /� /�y L,. ryyryry rym �y 0 q° W
0 12„A 4..m4As:'1./.w".»Y G�•�V/ L/aA0�.J47<G 4XG�� C^M I+'� 1" /y µ .P " N7r
-12
A(JMINIaTITIVE F=EE
7.
_...m .._._e ..C?C� 2$0
MESSAGE
WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNfT'S$5.55
SEWER RATE: FIRST"20 UNITS$5.95 OVER 20 UNITS$9,24
BYPASS METER WATER RATE:All UNII S$5.;i5
Pay online at
_._r"vtsaaFa =ae°r rF�ry www.northandoverma.gov
.Mi AND FiF:TC1!^'tty'tlkt8;f C�W�iI'iCNkB fkE':l t7W VNf ....�....,�..„�, ..,� ....,.. ....... ....._.
7 GRANVIL LE: LANE
10 _ 3 O6/C)7/2023
31700;�7 OS/OE.i/202 I/14/202t3 08A14A2fl23
I I
�03106/2023 2419 06f0�
7/2123 2438 19 A 93 WATER USAGE 19 $12,20
ADMINISTRATIVE FEE $l,dir
��r 7 r a "F"�,rn9r i,;:✓4 x'N�utrJlrc""T"'",'"""","„,�,�," j/per;e,„ t, ;'` ,.,.. .-,,.�,.-�. ...,„,„�„,„„
Ir 8 r H it l GQ
�I Ili Ei
Mi
,�,,,,,,�;�:,� kNry,/r, r idl ✓, ,,rFr/ r,G,E, „ ,h a
$ 3.42 $53 42 $0 00 00 MOO $BU.02
MESSAGE
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:At..L UNITS$5.55
Pay online at
Fz�iACH AND FrF UIN THE POF ION BELOW W[III v(.)(JR PAYNIfpa www.northandovern"ia.gov
07 (MANVII L E LANE 3170027 06/07/� 0 /14/2023 1 1 3f2C723 � 1 023
Eli
/U?2Ck2:S 2438 09/14/2023 2468 30 A a¢�
39 WATER R USAGE 30 $P 28 42
ADMINISTRAIIVE FEE $/ �y
I
i
TOTAL
L �U���
$80. $80.02 $0 00 v
_. _.._.._02.... $0.00 $0 00 $1`T8 24 $1 S&.24
MESSAGE
m
Fp�
,'„r$.
.110412022 2322 06/01/2022 2344 22 A 95 WATER USAGE. 22 $811>.56
ADMINISTRATIVE FEE $l.832
TOTAL DUE
I'
$S4.E§2 4
-$64,32 $(T.00 =$O M$000,
$ 3.38 �'� $33.3E3
VI F,SSAGF::
WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNITS$5,55 �
SEWER RATE` FIRST 20 UNITS$5.95 OVER 20 UNITS$9.24
HYPASS METER WATER RATE: ALL UNPS$,55
Pay online at
_ un@ w.northwondovarrna..cgov
4 NIA ANO Rf TURN ahfir r"i'f6ON BELOW 9oVOM MfDUH Pd YMEN'S .-..... ..
( l f1 '
0 OAANVILLFC CARE" � �. t�� crer r�r�u�.�
/�/zv-zz c�I
Hr+ 1
9/08/2022 2,39 4 12/06/2022 240'T 13g 7AD!MN,,TFUSAGE
W"IVE FEE � /t<
Mr S,CAM:
WATER RATE: FIRST 20 UNITS$3, U OVER 20 UNITS$5.55
SEWER RATE: FIRST 20 UNIT"S$5.95 OVER 20 UNITS$ .24
BYPASS METER WATER RATE:ALL UNITS$5.55 pay online at
wvww.northandoverma.gov
DETACH AW)R 11,NM THE r;�ORTV&:N BROWNTH YOURPAYMENT
...,._._ ..... .,.,.w ..�,._..
P4VMFNT COPY
r
Mon.Wod. TThu�r,E3 00 AM 4 30 f
' TOWN OF N H'T'H ANDOVER �1 f � 83 00 AM � ti:
120 {FAIN TTTE-FT � /� E �/° rues � . t0 �M
N RTI-i ANDOVER MA Q 1845 F�rr. :ran AM� 1�.o�r�rw
PA. QT-Mft-QA H
k _ tr ' II . nsi Mt"fox
Town of North Andover
ROd Box 184
MOVING? PLEASE CALL 978- W957C11N ADVANCE. Medford,MA 02155
rax Office,(978) £3£3 9 5h0
°Ir (I�IE�IEr1rEE�a�1lal�lalEElllrrr�N« Ii1��ll�r lfllrElErllllt' Water Oept.:(978)50E3,.9570
N �
907 .... *'AU'T(,)"`5-DIGIT 01840 Rol Qnlip e,
ANDERSON,JC:HN T'he"l'own now has a new Online EMI Paymo,ra
107 GRANVILLE LANE System. le)enSure w4,receive your payrY e w s I
N.ANDOVER MA 01845-4003 onllne please visit
www.northandoverma,gov/pay
_......to Setufa your account,
,.— TAXPAYER'S COPY
► a� Im s a a
07" GRANVIL.L E LANE 3170027 12 3/2022 05/13/2022
14
'10712021 2307 03/04/2022 2322 15 A 87 WATER USAGE 15 $57,00 1
ADMINISTRAT'BVE FEE $l 82
54 w Y I "flayI:} �, :,� TOTALII
$100.4 T -$100.47 $0,0o 0.0(} s0,00 $64.82 $64.82
7lF?SAt.�E:: �^ry
WATER RATE: FIRST 20 UNITS$3.80 OVER 20 UNITS$5.55
SEWER RA'fE:: FIFIST 20 UNLT'S$5,95 OVER 20 UNITS$9.24
BYPASS METER WATER EW'E: AL.L, I INIT'S$5.55
Pay online at
ua:' rr a_K�onr rrrtjcna4 wvw.nort andoverma.gov
v � >r
TOWN OF NOFTTFE ANDOVER
PAYMENT COPY
Any arnount which is not paid by due(kite:will be;
120 MAIN TT"3EET 'Alt�jmt to interest charge of 14%per annum
NORTH ANDOVER MA 01845
9 78-688-9550
DUE DATE TOTAL �
a
05/13/2022 .82
,...,.,'e "-- � u"° ^..✓ v "inJr�J lu�'hfi i�ru a »a qq,;(rro "$ ir"W ud w^""^" "7+^^rv�^'i�6�1 AMOUNTY
107 GRANVILlE LANE 31 70027
ANDFRSON,.IOHN h4 kt tt k F y f E t1 d.Ma EI 1 ;
107 GItANVILLE LANE` TOWN OF NORTH ANDOVER
N.ANDOVER MA 01E345-490:3 PO BOX 184
MEDFORD MA 02155
nnrinrF'w r'i -rr'ici-i-iririnrinnrrnnnnrin- i ,nn , er, .m— ,n.,•, r w, ,. ,r, -. -.-^..