HomeMy WebLinkAboutMiscellaneous - 135 SOUTH BRADFORD STREET 4/30/2018 135 SO BRADFORD STREET Street
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BOARD OF HEALTH �,,
MAIN ,,,,.,....
146 AIN STREET �
TOWN OF NORTH..................
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,TELEPHONE# (508) 688-9540 soA�of= -
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APPLICA TION FOR ABANDOAMENT SEP X996
OF SUBSURFACE DISPOSAL SYSTEW
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
Name t VC, V1 b Phone
Address j3r7F
Contractor hired for work:
Name cu(/'o cer�z4k Phone (�U�1- ZZ
Address '54 Z2
Date for scheduled abandonment
The septic system at the abov7address;has e oned according to
Title V specifications.
gns tre of&ntractor
Method of septic tank abandonment (check one). ( ) removal ( ) sandfill
( crush ( ) other
Name of Offal Hauler � `� .
This form must be returned to the North Andover Board of Health.
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR-`HEALTH
REPRESENTATIVE'S USE ONLY.
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Inspecting Agent Date
Fes"
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STATEMENT
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
DATE INVOICE NUMBER:DESCRIPTION I CHARGES I CREDITS BALANCE
BALANCE FORWARD
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DANIEL A. GIARD PAYLAST AMOUNT
I.THIS CCLUMtl:
COMPLAINT NUMBER DATE:
12 4- NOVEMBER 18, 1992
COMPLAINTANT:ROBERT MCKINNON CLOSE DATE:
ADDRESS: 135 S. BRADFORD STTREET PHONE: 794- %M
OWNER:UNKNOWN 0,97.1'y -D,*w6 o 4l PHONE #: Lz)c9 Ri;
ADDRESS: 134 S. BRADFORD STREET �8�' 49 Z 7 1 895 ,36-xll
INSPECTION DATE: ORDER L DATE:
COMPLAINT:NEIGHBOR HAS 9 WILD CATS. DAUGHTER ALMOST GOT ATTACKED BY ONE OF
THEM. MR. MCKINNON BOUGHT THE HOME JUST TWO WEEKS AGO. ONE CAT
URINATED INSIDE THEIR HOUSE WHILE WIFE WAS BRINGING IN THE
ACTION: GROCERIES. HE IS WORRIED ABOUT HIS CHILDREN.
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subject
FORM 29810 AMSTERDAM PRiRnxo RRR LITHO CURD.♦MSTERUAM.R.I.
& I a.31
Please forward us as much of the following information that: is possible ;
1.. Type Of system
2 . Age
3. Loc at ion,
4 • Maintenance records and date of last pumping out
I
Pocumentati on of repairs and reconstruction
6. Site conditions
7. Builder of system
8. Engineer who approved'
— Site
-- System
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9 . Installation Procedure
10. Problems
I
SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED �C
PROPERLY FUNCTIONING? OYI N
WEATHER CONDITIONS
COMMENTS :
WATER avALI- Y °TTES I E't� 2 Ros uLTS?
DYE TEST PERFORMED? Y N
DATE'?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
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)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
® yes ❑ no ❑ do not know-•-.
6. How old is your sewage disposal system? ❑ . 0-5 years ❑ 6-10 years ❑ 11-20 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?
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years Pa' never
9. Have you had any problems with your sewage disposal system? ❑ yes ®" 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 garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub Qjf2,
11. Please state the rand and type (li uid or powder) of detergent you use for:
dishwasher i ' 'z —
clotheswasher
12. Does your property have a lawn? CK yes ❑ no
If yes, approximately what size?
❑ less than % acre ❑ % acre ❑ 1/z acre ❑ % acre [Y/ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn.
No. of applications per year ZV-;1-&--
Season(s) of the year
14. Please state the brand and type ( squid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.