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HomeMy WebLinkAboutTitle V Inspection Report - 230 GRAY STREET 1/11/2016 ..........:........_. l Commonwealth of Massachusetts Tifte 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r t 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/11/2016 page. CitylTown State Zip Code Date of Inspection 4 Inspection results must be submitted can this form. Inspection forms may not be altered in ar way. Please see completeness checklist at the end of the form. Important:When A. General Information tilling out forms on the computer, use only the tab 1. Inspector: key to move your i r' r 11.11 cursor-do not Neil J. Bateson use the return Name of Inspector ' ' t`�' key. Bateson Enterprises Inc. �y Company Name 111 Argiila Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 S115 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 an 6i as of the time of the inspection. The insp( was performed based on my training and experience in the proper function and maintenance of on sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 c Title 5(310 CMR 15.000).The system: ❑ Passes Conditicnally Passes ❑ .Fails ❑ Needs Further Evaluation by the Local Approving Authority 1/11/2016 Ins c r Signatu Date t The system inspector shall submit a copy of this inspection report to the Approving Authority(Bc tt of Health or DEP)within 30 days of completing this inspection. If the system is a shared 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 should be sent to the system ov+ and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time'of inspection and under the conditions o , at that time. This inspection does not address how the system will perform in the future u the same or different conditions of use. ;f t5ins 3/13 Title,SOfficial Inspection Form:Subsurface Sewage Disposal System•Page `! I Commonwealth of Massachusetts Title 5 Official Inspection r Subsurface Sewage Disposal System Form Not fc, '.oluntary Assessments " 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every page. Cityrrown 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 b' replaced or repaired. The system, upon completion of the replacement or repair, as approV 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 stru.'=F,. ' unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pE inspection if the existing tank is replaced with a complying septic tank as approved by the Boar Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificat Compliance indicating that the tank is less than 20 years old is available. ❑ Y Z. N ❑ ND (Explain below): t5ins•3113 Title 5 uSicial Inspection Form:Subsurface Sewage Disposal system-Page Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.F arm - Not for Voluntary Assessments F " 230 Gray Street Property Address Sandra Han _ Owner Owners Name information is required for every North Andover MA 01845 1/11/2016 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health apl, ! pumps/alarms are repaired. f B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution bo_,', to broken or obstructed pipe(c;�or due to a broken, settled or uneven distribution box. Sys` " 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 p p i e ' i i system will pass inspection if(tarith approval of the Board of Health): ❑ broken pipe(s)are rer;aced ❑ Y ON ❑ 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 determ 1 ' 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 safety and the environment: ❑ Cesspool or privy is wit'rlin 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsf t5ins•3113 Title 5 C fficial Inspection Form:Subsurface Sewage Disposal System•Pa, , f Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments z " 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/11/2016 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 1 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 hea";` safety and environment: i ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is withi.'- 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within a Zone 1 of a.public wE` supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private wat 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 supp, well". Method used to determine distance: r,f *`This system passes if the well water analysis, pen°ormed at a DEP certified laboratory, for coliform bacteria indicates absent and the presenwv of ammonia nitrogen and nitrate nitrogen �' ;,`,c to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analy be attached to this form. ; 3. Other: Fill holes over leach trench# 1 with clean sand & remove tree on d-box&pipe for leach tren;,i t 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 tf, clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface due to an overloaded or clogged SAS or cesspool ;. ® Static liquid level in the distribution box above outlet invert due to an ove 't )r or clogged SAS or cesspool ® Liquid depth in,-cesspool is less fhan 6" below invert or available volume than 1/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•P. ill I :�1 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1111/2016 required for every - page, City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more the times in the last year NOT due to clog Rl ❑ ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water I, Any portion of cesspool or privyis within 100 feet of a surface water idl ❑ ® tributary to a surface water supply. I ❑ ® 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 ❑ E Any portion of a cesspool or pri'v'y is less than 100 feet but greater tha,,WMt''f', from a private water supply well with no acceptable water quality anal, } � system passes if the well water analysis, performed at a DEP ceh "^ laboratory, for fecal coliform bacteria indicates absent and the pry, rj of ammonia nitrogen and nitrate nitrogen is equal to or less than provided that no other failure criteria are triggered. A copy of the and chain of custody must be attached to this form.] , , t El The system is a cesspool sc;king a facility with a design flow of 2000gV; , , 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above fa'' criteria exist as described in 310 CMR 15.303, therefore the system fa . system owner should contact the Board of Health to determine what necessary to correct the failure, J E) Large Systems: To be considered a large system the system must serve a facility witl design flow of 10,000 gpd to 15,000 gpd. , For large systems, you must indicate either"yes"or"rlo"to each of the following, in addition 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 s *1,. I` ❑ E] the system is located in a nitrogen sensitive area (Interim Wellhead Pr(((, t 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 significa'i or answered"yes" in Section D above the large system has failed. The owner or operator of;T ' system considered'a significant threat under Section E or failed under Section D shall upgrac system in accordance with 310 CMR 15.304. The system owner should contact the approprit' regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface sewage Disposal system ilfi r i, I�l 11� Commonwealth of Massachusetts Title 5 Official Inspect" Xi Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every 1'.North Andover A 01845 1/11/2016 page. City/Town ' State Zip Code Date of Inspection C. Checklist Check if the following have beer,done. You must indicate "yes" or"no" as to each of the fc ' Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board ❑ Were any of the system corniF)onents pumped out in the previous two ❑ ® Has the system received normnal flows in the previous two week period,:; Have large volumes of water bee,i introduced to the system recently El ® or£_.,`, this inspection? :-i ® 1:1 available as built plans of the.system obtained and examined?.(If they wer available note as N/A) w ® ❑ Was the facility or dwel!ng 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? V ® ❑ Were the septic tank manholes uncovered, opened, and the interior of inspected for the condition of the baffles or tees, material of con structlo} dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and o' ;�Apaants if different from owner) provided information on the proper maintenance of subsurface sewage disposal ; t The size and location of the Soil Absorption System(SAS)on the s' been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if arnv of the.failure criteria.related to Part C is ai approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• I i i Commonwealth of Massachsjsetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F " 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yi. r. Is laundry on a separate sewage system?(Include laundry system inspection ❑ Y information in this report.) 1.., Laundry system inspected? ❑ y x Seasonal use? ❑ Y Water meter readings, if available(last 2 years usage (gpd)): Yes Detail: t r C Sump pump? ❑ Y Last date of occupancy: Two v Date Commercial/Industrial Flow Conditions: Type of Establishment: - i Design flow(based on 310 CMR 15,203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): d} i F Grease trap present? ❑ YErft t Industrial waste holding tank presant? ❑ Ye Non-sanitary waste discharged to the Title 5 system's ❑ YE Water meter readings, if available: t5lns-3/13 { Title 5 Official Inspection Form:Subsurface Sewage Disposal Syster, { `: Commonwealth of Massachusetts - Title 5 Official [Inspection For a Subsurface Sewage Disposal Sy,,item Form - Not for Voluntary Assessments F " 230 Gray Street Property Address Sandra Han Owner Owner's Name info7ation is North Andover MA 01845 1/11/2016 required for every — - page. Cityftown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date n Other(describe below): General Information Pumping Records: Source of information: P L:, ed two years ago, owner Was system pumped as part of the inspection? ® Yes [ ` If yes, volume pumped: 1500 gallons _.__........._- How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distt ution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy I�, ❑ Shared system (yes or no) (if yes, attach previous inspection records, If ar '" i ❑ Innovative/Alternative technology. Attach a copy of the current operation 6 i maintenance contract (to be obtained from system owner) and a copy of h: inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. I ❑ Other(describ,_.;, fSins 3173 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syste, Commonwealth of Massachusetts Title 5 Official Ins ect' n Form a Subsurface Sewage Disposal System Form - Nct for Voluntary Assessments 230 Gray Street Property Address Sandra Han _ Owner Owner's Name ' information is required for every North Andover MA 01845 1/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installaa (if known) and source of information 10 years old, 11/16/2005, as built plan Were sewage odors detected when arriving at the si"a'? ❑ Yes Building Sewer(locate on site plan): Depth below grade: 1.3 feet Material of construction: ❑ cast iron ® 40 PVG ❑ other(e;;<plain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4".PVC through wall, .3" PVC in house, no le°4s visible. Septic.Tank(locate on site plan): Depth below grade: 0.3 feet Material of construction; concrete ❑ metal ❑fiber lase g El polyethylene ❑ othe , If tank is metal, list age: ; years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes Dimensions: 10' x 5'x 4' Sludge depth: 4" t5ins•3/13 T o Official Inspection Form:Subsurface Sewage Disposal Syste, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F ' 230 Gray Street Property Address Sandra Han Owner Ownel's Name information is North Andover MA 01845 1/11/2016 required for every _ page. City/Town State; Zip Code Date of Inspection D. System Information jwnt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 411 Scum thickness 811 Distance from top of scum to top of outlet tee or baffle y ' 11" Distance from bottom of scum to bottom of outlet t ' or baffle How were dimensions determined? Tape measure Comments (on pumping recommendations, iniet.and outlet tee or baffle condition, struct liquid levels as related to outlet invert, evidence of I -akage, etc.): Pumped septic tank. Inlef tee ok. Outlet tee h. Depth of liquid at outlet invert. No leakage, Inlet cover&outie:cover has metal cow4-'2"deep. Grease Trap(locate on site plan): Depth below grade: feet i Material of construction: ❑concrete ❑ m�tG:: ❑fiberglass ❑ polyethylene ❑ otl- Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baff]® — Distance from bottom of scum to bottom of outlet tee or baffle I , f Date of last pumping: Date Y t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systc Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official ln i on Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/1112016 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 0 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 level &distribution equal. No evidence of leakage. No evidence of carryover. D-box had root invasion from tree right up against box. Remove roots from D-box. Tree should be removed. 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.): Chamber ok. Pump ok. Floats ok. Alarm has both audible&visual. *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 Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "Y 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/11/2016 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 18 ❑ Teaching 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.): Soil ok. Vegetation ok. No sign of ponding to surface. Three trenches of infiltator chambers, six chambers per trench. Some one dug holes over trench# 1. Holes needs to be filled in with clean sand. 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 a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 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 r WG� F 6 .� X500 a 7�` T ' 151ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every 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: 4 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: 8/16/2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design Plan ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments «, r 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts City/Town of . System Pumping Record Form 4 DEP has provided this form for use-by local Boards of Health. Other forms may be'used, but the information,must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of hou Ig rea o house Left/right side of house, Left/ Right side of building, Left/Right front of eft I Pit rear of building, Under deck 9 Address City/rown `�— State Zip Code 2. System Owner.` ' Name Address(if different from location) Citylrown • '. StateCode Telephone Number .B. Pumping Rgcord �. 1. Date of Pumping Date ;;eptic Qua Pumped: Gallons 3. Type-of system: ❑ Cesspool(s) Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No if yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System: LA � 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. Locati contents were disposed: L Lowell Waste Water SignAtube I Haule Date t5form4.doC 06/03 System Pumping Record•Page 1 of 1 Summary Record Card generated on 1/13/2016 2:26:47 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-107.01-0128-0000.0 Parcel Id 22684 230 GRAY STREET SANDRA HAN 34 HARWICH ROAD CHESTNUT HILL MA 02467 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.31 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until SANDRA HAN Owner 34 HARWICH ROAD CHESTNUT HILL MA 02467 STELLA, MARY Previous Customer Inactive 10/1/2005 C/O JANET M. KLISKA,TR 180 GRAY STREET NORTH ANDOVER, MA 01845 LITCHFIELD CO. Previous Customer Inactive 12/7/2005 26 RAY AVENUE BURLINGTON, MA 01803 TONG HAN Previous Customer Inactive 7/29/2011 34 HARWICH ROAD CHESTNUT HILL,MA 02467 CYNTHIA LIU Previous Customer Inactive 8/17/2012 34 HARWICH ROAD CHESTNUT HILL, MA 02467 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17708.0-230 GRAY STREET Last Billing Date 11/13/2015 1090515 01 Cycle 01 Active UB Services Maint. Account No. 1090515 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/1 WTR WATER 01 ALL METER SIZE 41.80 1/1 UB Meter Maintenance Account No. 1090515 Serial No Status Location Brand Type Size YTD Cons 32421970 a Active 00 b Badger w Water 0.63 0.63 1740 Date Reading Code Consumption Posted Date Variance 10/22/2015 2086 a Actual 11 11/20/2015 -17% 7/24/2015 2075 a Actual 13 8/14/2015 -1% 4/27/2015 2062 a Actual 13 5/19/2015 -8% 1/30/2015 2049 aActual 16 2/20/2015 -87% 10/24/2014 2033 aActual 117 11/14/2014 -19% 7/25/2014 1916 a Actual 146 8/13/2014 590% 4/24/2014 1770 a Actual 20 5/15/2014 5% 1/27/2014 1750 aActual 21 2/14/2014 -92% 10/23/2013 1729 aActual 252 11/18/2013 972% 7/23/2013 1477 a Actual 23 8/15/2013 14% 4/24/2013 1454 a Actual 20 5/20/2013 17% 1/25/2013 1434 aActual 18 2/13/2013 -92% 10/23/2012 1416 aActual 222 11/9/2012 285%