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HomeMy WebLinkAboutMiscellaneous - 120 WINTER STREET 4/30/2018 (2),ii 14— 1157 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. IrIf 19 Application by the undersigned is hereby made to connect with the town sewer main inStreet, subject to the rules and regulations of the -Division of Public %Woks�.� n The premises are known as No. C C_- D v'i i✓' / ` Street or subdivision lot no Owner Address Contractor Address �i Applicant's Signature �O �k,��� } } PERMIT. TO CONNECT WITH ISEWER The Division of Public Works hereby grants permission to to make a connection with the sewer main at�d subject to the rules and regulations of the Division of Public Works.. Inspected by Date By See back for -rules and regulations Street Division of Public Works °i DATE DESCRIPTION AMOUNT 4/15/93 V Pumped Septic Tank - $120.00 34 Bateson Enterprises, Inc. - Andover, MA 01810 1'-�d 0JAw— �Q ,f 40 16, SEPTIC SYSTEM INSPECTION FORM ADDRESS 126 Lo L DATE INSPECTED �-S(o PROPERLY FUNCTIONING? i') N WEATHER CONDITIONS COMMENTS: WATER 4i)ALt i Y TES T Eb ? JZESULTS? DYE TEST PERFORMED? Y N SKETCH: q DATE? WATERSHED RESIDENTS QUESTIONNAIRE ,. _ _ . k 1 1. Name 2. Street Address u 7v �" E 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool ❑ septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) 5�-�do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no Z�-do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years �_4�1-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? yes ❑ no ❑ do not know If yes, approximately how long ago? years. '`'What was done? TA,�Trd 8. How frequently is your sewage disposal system pumped out? ❑ annually ❑ every 2-4 years ❑ every 5-10 years fiver 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes C� o 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 garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher r C' clotheswasher - t_:41 12. Does your property have a lawn? If yes, approximately whatssizi 7 ❑ less than 1/4 acre I� 1/4 acre ❑ more than 1 acre (Specify) yes ❑ no ❑ 1/i acre ❑ 3/4 acre ❑ 1 acre acres 13. How often do you fertilize your lawn? No. of applications per year OSeason(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ElCheck here if'your lawn is maintained by a professional landscape contractor. 2. Street Address ( 3. How many members are in your household? 4. VTha# type of sewage disposal system do you have? <_esslzoo. ❑ sc-PEic tank and leaching area LJ con.ncction to municipal sewer ❑ oler (describe) r- nc.t know 5, Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ y -S ❑ no C -'do not know fIov,-oldisyoursewagedisposal system? ❑ 0-5years ❑ 6-10 years . 1-20 years ❑ over 20 years ❑ do not know as yctEjr sewage disposal system been rebuilt or repaired? �re1„ ❑ no ❑ do not know e. -pp.roximately how long ago? � years. What was done? v Q ow freE,�uentiy is your sewage disposal system pumped out? Elannually every 2-4 years ❑ every 5-10 years Z5 over 10 years ❑ never :ve you had any problems with your sewage disposal system? ❑ yes Rr—no es, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors El sewage surfaces through ground -- many of each. appliance are connected to your sewage disposal system? '. ng minachine /' dishwasher garbage .disposal 7a tidifier drain sump pump toilet paverment drains showeribathtub 'e state the'brand and type (liquid or powder) of detergent you use for: vasher �'�t i c >.c�< swGsher , � .7011, property have a lawn? [eyes ❑ no approximately what�sfl/Z��? srr�s than 1/4 acre F "/4 acre Elh ' acre EJ3/9 acre O 1 acre ore than 1 acre (Specify) acres ,ften do you fertilize your lawn? applications per year -(s) cf the year Tate the brand and type (liquid or granular) of lawn fertilizer you use: Check here if your lawn is maintained by a professional landscape contractor. 107 ForesrSt. Miftet k% AAA 01949 G %q t'09011 FORINT 4 SYSTEM PUINIPING RECORD .:_Commonwealth of Massachusetts n_ . �P/) _ , Massachusetts ystem vmer �Zto G�t� 0 ff"101i' • i� Date of Pumping:..., Quantity Pumped: /j ." gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes System Pumped by:LLicense #: Contents transferred to: Date Inspector ,( �,