HomeMy WebLinkAboutMiscellaneous - 114 SOUTH BRADFORD STREET 4/30/2018 (2) 114 SO BRADFORD STREET -1, Street
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toy Fomsrs�. bOaP`� FORM 4-SYSTEM PUINVIING RECORD.
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.co onwealth of Massachusetts
Massachusetts
5,Y1 Pum,�inQ Record
ystem H'nerSystem Location
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Date of Pumping: Quantity Pumped:r c1 gallons
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Cesspool: No Lam" Yes ❑ Septic Tank: No ❑ Yes ❑'�
System Pumped by: License #:
Contents transferred to:
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Date Inspector
N0- 1156
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.
C 19L
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Application by the undersigned is hereby made to connect with the town sew main in . 1_1' �� Street,
subject to the rules and regulations of the Division of Public Works. /
The premises are known as No. /J �� Street
or subdivition lot no. I
Owner '> Address
LL/
Contractor Address
Applicant's Signature
O G_
PERMIT TO CONNECT WIT� hAAIN
The Division of Public Works hereby grants permission to
1
to make a connection with the sewer main at ✓G Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Works
By
Inspected by
Date
See back for rules and regulations
STATEMENT j
DANIEL A. GIARD
130A Appleton Street
NORTH ANDOVER, MA 01845 DATE _��
Phone 686-7653
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TERMS:
• PLEASE DETACH AND RETURN WITH YOUR REMITTANCE
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'DATE 1 INVOICE NUMBER/DESCRIPTION CHARGES I CREDITS ( °BALANCE
•• �-�.:..z ��-__ �,_� -- - .�..w, 111 ..�,.y[
BALANCE FORWARD
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64
PAY LAST AMOUNT
DANIEL A. GIARD IN THIS COLUMN
PNODUCT I*?CA!i!n7 IM.Wm Wm OuFI.To OrL*PIONS TOIL FREE 14nm-leo
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS 114 so
DATE INSPECTED `
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
WA i EP a V A L I T`i' TE5 1 C� ' hEsoTS?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name JO n L C. `'1/
2. Street Address _ // V .Dv 131-aG/ 14j'aJ �'
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
aseptic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no CKdo not know-
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years Z Y11-20 years-:zz
❑ over 20 years ❑ do not know
7. Has your sewage—disposal system been rebuilt or repaired?
❑ yes f no ❑ do not know
If yes, approximately how long ago? years. What was done?
Y 8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years e' every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes 0---no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground .
10. How many of each appliance are connected to your sewage disposal system?
washing machine �' dishwasher 1!!f� garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains showerlbathtub
11. Please state the brand and pe (liquid or powder) of detergent you use for:
dishwasherz-
clotheswasher
12. Does your property have a lawn? U---yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre E� '/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
r,• . Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use.
❑ Check here if your lawn is maintained by a professional landscape contractor.