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HomeMy WebLinkAboutTitle V Inspection Report - 136 CARLTON LANE 9/22/2015 Commonwealth of Massachusetts cf� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 13GCARLTONLANE Property Address R|CKP|ECEVV|CZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date ofInspection Inspection nomm|bs must besubmitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist mt the end pf the form. Important:When A. o������U U�������~�� �|Ungo��nno ~ ~~ ~- ~ ~Information ---- - on the ' �, 0PT G � �O1� ueep»y hetu 1 Inspector ]��/� ' �v. ° " �" '" ky o mmeyour � �= cursor-d»not John J G R[|!ANDOVER use the return Name key. --- ---- `-' 8o Sewer Service Inc. Company Name �---� 7G North Bmad Company Address NH 03078 �—~--� Cityrrown State Zip Code 803-898-9339 13397 � Telephone Number License Number B. Certification � I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. lmmumDEPapproved system inspector pursuant to Section 15.340mf Title 5(310CN1R 15.0U0)' The system: paoeee Fl Conditionally Passes El Fails E] Nped'surther Evaluation by the Local Approving Authority 41CL-Ac—,"1)/_)A J� ��A 9/22/15 Z'-1_ns 0 bri-sigin—ature Date 7esystem ..-,---- shall submit- _copy _f this inspection '.' to the '.' -~ Authority (Board� of Health orDEP>within 30 days of completing this inspection. If the system is a shared uysharn or � has e design flow of1O.OUOgpdor greater, the inspector and the evetenno�n�rahaUoubmittha � ' | report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent bo the buyer, if applicable, and the approving authority. | ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions wfuse. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): • broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): • obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): • distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is N. ANDOVER MA 01845 9/22/15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title f i i l Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? • ❑ 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: • ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title Official n ti r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N.ANDOVER MA 01845 9/22/15 page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail SEE ATTACHED Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: CURRENT Date Other(describe below): General Information Pumping Records: Source of information: Soucy's Sewer Service Inc Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Gauge on truck Reason for pumping: Maintenance and Inspection 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. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page S of 17 Commonwealth of Massachusetts Title Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): NO SAGGING. PIPE APPEARS TO BE WATERTIGHT. Septic Tank(locate on site plan): 4.. Depth below grade: feet Material of construction: ® concrete ❑ 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 ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 39" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? TAPE & SLUDGE TOOL Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK IS STRCTURALY SOUND. NO APPARENT LEAKAGE. TEES ARE GOOD. 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 tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): PUMP TANK ANNUALLY 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 Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title fi i l Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert oil Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): "D" BOX REPLACED PRIOR TO INSPECTION. SEE PERMIT. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (2)4'X 8' SHALLOW PITS ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): PIT"E" 3"STATIC LEVEL ON BOTTOM. PIT"F" COMPLETELY DRY YET ACCEPTING FLOW. NO SIGNS OF HYDRAULIC FAILURE. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °H 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is N. ANDOVER MA 01845 9/22/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately � a yf6 i•• at l� t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 6 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: DUG HOLE WITH AUGER IN FRONT LOW DROP OFF AREA, APPROXIMATELY 30' FROM ROAD, 4' NO WATER ( 3' ELEVATION DIFFERENCE TO S.A.S. LOCATION ) Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 136 CARLTON LANE Property Address RICK PIECEWICZ Owner Owner's Name information is required for every N. ANDOVER MA 01845 9/22/15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Summary Record Card generaled on 91312015 3 30 11 PM by Maureon McAuley Page 1 . Town of North Andover Tax Map # 210w106.C-0098-0000 Parcel Id 17733 136 CARLTON LANE PIECEWICZ, RICHARD & LINDA / 136 CARLTON LANE N. ANDOVER, MA 01845 Class 101 Single Family Property 1 Zoning2 1 Residential Z-oning3 Size Total 1,16 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Ac PIECEWICZ,RICHARD K LINDA Payer 136 CARLTON LANE N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Activellnactive Bldg Id. 14197.0-136 CARLTON LANE Last Billing Date 6/4/2015 2100189 02 Cycle 02 Active UB Services Maint. Account No.2100189 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 175.52 /1 UB Meter Maintenance Account No.2100189 Serial No Status Location Brand Type Size YTD Cons 13242331 a Active ERT HH METE METE w Water 0.63063 685 Variance Date Reading Code Consumption Posted Date 8/4/2015 1174 a Actual 38 166% 5/4/2015 1136 aActual 14 6/22/2015 11% 2/3/2015 1122 a Actual 16 3/20/2015 r° 11/3/2014 1106 a Actual -35 /o 25 12/•15/2014 -35% 811/2014 1081 a Actual 36 9/11/2014 163% 5/512014 1045 a Actual 14 6/12/2014 -7% 2/4/2014 1031 a Actual 16 3/17/2014 -55% 10/31/2013 1015 aActual 34 12/20/2013 -22% 8/1/2013 981 a Actual 44 9/18/2013 205% 5/1/2013 937 a Actual 13 6/18/2013 -13% 2/7/2013 924 aActual 18 3/13/2013 -51% 10/30/2012 906 aActual 33 12/13/2012 14% 8/2/2012 873 aActual 30 9/26/2012 167% 5/2/2012 843 aActual 11 6!2012012 24% 212!2012 832 aActual 15 3/14/2012 -36% 11/1/2011 817 a Actual 23 12/15/2011 -40% 8/2/2011 794 a Actual 39 9/14/2011 0 5/2/2011 755 a Actual 184/o 13 6/13/2011 -11 2/4/2011 742 a Actual 16 3/15/2011 -60% 11/1/2010 726 a Actual 38 12/13/2010 -14% 8/3/2010 688 a Actual 45 9/1312010 218% 5/3/2010 643 a Actual 14 6/9/2010 -12% 2/1/2010 629 aActual 16 3/11/2010 ° 11/2/2009 613 a Actual -53/o 34 12/11/2009 22o/u 8/3/2009 579 aActual 27 9/11/2009 68% 5/7/2009 552 a Actual 17 6116/2009 5% 2/3/2009 535 a Actual 16 3/16/2009 -44% 11/3/2008 519 aActual 29 12/10/2008 -27% Xtta� Commonwealth of Massachusetts Map-snick-Lot ;,_•a 106,C0098 BOARD OF HEALTH -------- ---- ------ Pemiit No North Andover BHP-2015-0384 FEE $125.00 ----------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John Soucy ----------------------------------------------- ----------------------- to(Construct)an Individual Sewage Disposal System. at No 136 CARLTON LANE as shown on the application for Disposal Works Construction Permit No. BHP Dated September I6,2015 co Issued On; Sep-16-2015 BOARD OF HEALTH